• Clinics in Shoulder and Elbow
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• v.16 no.1
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• pp.27-32
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• 2013

Purpose: The purpose of this study is to evaluate the clinical and radiological outcomes of treatment of humerus shaft simple fracture by minimally invasive percutaneous osteosynthesis (MIPO) technique using locking compression plate (LCP). Materials and Methods: Six patients who were operated for humerus shaft simple fracture from August 2010 to May 2011 were enrolled for this study. We checked the cause of injury and the accompanying injuries and evaluated the operation time, the clinical and radiological period of union, postoperative range of motion of the shoulder and elbow joint, pain, activities in daily living, radiologic alignment, and other complications. Results: The clinical period of bone union was 7.2 weeks on average, and the radiologic period of bone union was 8 weeks on average. Follow-up period was more than 12 months in all cases. The angulation through postoperative alignment was 2.8 degrees in AP view and 2 degrees in lateral view. The postoperative range of motion was 167 degrees in forward flexion, 50 degrees in external rotation, and thoracic vertebra 12 level in internal rotation. The average value of visual analogue scale (VAS) was 1.2 and that of KSS was 91.3. The American Shoulder and Elbow Surgeons' score (ASES) was 26.5 and the UCLA score was 31.5. Conclusion: MIPO technique for the humerus shaft simple fracture showed good functional and radiological outcomes and may be considered as one of the treatment options for humerus shaft simple fracture.

• Clinics in Shoulder and Elbow
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• v.13 no.1
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• pp.1-6
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• 2010

Purpose: To evaluate the results and complications of antegrade intramedullary interlocking nailing in humerus shaft fractures. Materials and Methods: We evaluated the clinical outcomes, radiologic results and complications in 47 patients with humerus shaft fracture treated with antegrade intramedullary interlocking nailing, and followed up until bony union. Bony union was confirmed by serial plain radiographs and the clinical outcomes were assessed according to the ASES scoring system. Results: Bony union was confirmed in 41 (87.2%) out of a total 47 patients, and the mean union period was 14.5 weeks. Major complications were as follows: 6 non-union, 3 delayed union, 2 intraoperative posterior cortex fracture in the distal humerus and 2 permanent shoulder pain, including 1 case of adhesive capsulitis. The clinical outcomes were as follows: 29 excellent, 11 good, 4 fair and 3 poor. Satisfactory outcomes were demonstrated in 40 patients (85.1%). Conclusion: Anterograde intramedullary interlocking nailing as treatment for humerus shaft fracture showed satisfactory bony union and clinical outcomes. It is considered an efficacious treatment, especially in patients with associated injury, such as multiple fractures and segmental fracture.

• Clinics in Shoulder and Elbow
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• v.16 no.2
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• pp.107-114
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• 2013

Purpose: This study is designed to evaluate the clinical and radiographical results for the displacement of fracture fragments after interlocking intramedullary nailing in humeral shaft fractures. Materials and Methods: We retrospectively reviewed the results of 8 cases of humeral shaft fractures that have displacements of over 10 mm and under 20 mm after interlocking intramedullary nailing between July 2004 and August 2011. The mean age was 54.1 years (range, 43 to 70 years) and there were 3 male and 5 female patients. Radiographically, the time to bony union, change of displacement and angulation of the fracture site, and degree of improvement of these two factors were measured. Clinically, the range of motion of shoulder and elbow joints, postoperative pain and complications were evaluated. Results: All cases showed complete bony union in last follow-up. The mean time to bony union was 16.1 weeks. At the last follow-up, almost all cases had normal range of motion of shoulder and elbow joints. But, one case had stiffness of shoulder joint. Therefore, arthroscopic capsular release and manipulation was performed. One case had transient shoulder pain and the other case had transient elbow pain. In the two cases, pull-out of proximal interlocking screw were noted, but they finally had bony union. Conclusion: Although considerable displacement of fracture fragments after interlocking intramedullary nailing in humeral shaft fractures was present, we had excellent radiographical and clinical outcomes. Therefore, an additional procedure, such as open reduction or another fixation for the fracture site, was not necessary.

• The Journal of the Korean bone and joint tumor society
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• v.17 no.2
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• pp.58-64
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• 2011

Purpose: The purpose of this study is to observe unicameral bone cyst (UBC) outcome after the fracture has healed and if there is any identifiable prognostic factors. Materials and Methods: 13 UBC patients with pathologic fracture from 2001 to 2010 were reviewed. The mean follow up were 26 months (3-90 months). There were 11 male and 2 female patients and the mean age of the patients were 10.2 years old (6-16 years). 9 involved proximal humerusand 2 involved humerus shaft and 1 involved proximal femur and 1 involved proximal tibia. The treatment of UBC fracture was conservative cast application to heal the fracture initially, and 1 patient was treated with primary auto bone graft and open reduction with internal fixation. 5 patients were treated with steroid injection during follow up period and 2 patients with auto bone graft. We analyzed the change of UBC during pathologic fracture healing period and prognostic factor about age, the size of UBC, the involvement of physis. Results: The mean duration of the fracture healing was 8.2 months. Complete healing were occurred at 4 patients (31%). No statiscal difference was checked with age about UBC healing (p=0.42). But, more larger size about UBC and more closer to physis, the healing was difficult (p=0.05, p=0.03). Conclusion: While pathologic fracture of UBC was possibly healed, active treatment should be applied especially those cysts that involvescloser area of the physis or large size.

• Clinics in Shoulder and Elbow
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• v.12 no.1
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• pp.33-37
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• 2009

Purpose: To evaluate the results of the compression plate fixation and autogenous bone graft in the management of humerus shaft nonunion. Materials and Methods: Eighteen cases were treated for humerus shaft nonunion using compression plate fixation and an autogenous iliac bone graft. The mean follow-up period was 28 months. Bony union was confirmed from the serial radiographs and the clinical outcomes were assessed according to ASES scoring system. Results: In 12 cases of initial plate fixation, the causes of nonunion were 6 cases of inadequate plate length, 2 with a broken plate, 2 with screw loosening, 1 infection and 1 noncompliance of a psychiatric patient. In 3 cases of initial intramedullary fixation, the cause of nonunion was a distraction of the fracture site. In 3 cases of external fixation, the cause of nonunion was inadequate fixation. All cases showed bony union after an average of 24 weeks. The clinical outcomes were 11 excellent, 6 good and 1 fair. Conclusion: In the treatment for nonunion, compression plate fixation with autogeneous bone graft after complete removal of the fibrous and necrotic tissue is believed to give satisfactory results.

• Journal of Korean Orthopaedic Sports Medicine
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• v.2 no.2
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• pp.168-175
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• 2003

Fracture about proximal humerus may be classified as the articular segment or the anatomical neck, the greater tuberosity, the lesser tuberosity, and the shaft or surgical neck. Now, usually used, Neer's classification is based on the number of segments displaced, over 1cm of displaced or more than 45 degrees of angulation , rather than the number of fracture line . Absolute indication of a operative treatment a open fracture, the fracture with vascular injury or nerve injury , and unreductable fracture-dislocation . Inversely, the case that are severe osteoporosis, and eldly patient who can't be operated by strong internal fixation is better than arthroplasty used by primary prosthetic replacement and early rehabilitation program than open reduction and internal fixation. The operator make a decision for the patient who should be taken the open reduction and internal fixation, because it's different that anatomical morphology, bone density, condition of patient. The operator decide operation procedure. For example, percutaneous pinning, open reduction, plate & screws, wire tension bands combined with some intramedullary device are operation procedure that operator can decide . The poor health condition for other health problem, fracture with unstable vital sign and severe osteoporosis , are the relative contraindication. The stable fracture without dislocation is not the operative indication . The radiologic film of the prokimal humerus before the operation can not predict for fracture evaluation. It's necessary to good radiologic film for evaluation of fracture form. The trauma serise is better than the other radiologic film for evaluation. The accessary radiologic exam is able to help for evaluation of bone fragment and anatomy. The CT can be helpful in evaluating these injury, especially if the extract fracture type cannot be determined from plain roenterogram of the proximal humerus, bone of humerus head. If the dislocation is severe anatomically , we could consider to do three dimentional remodelling. The MRI doing for observing of bony morphology before the operation is not better than CT If we were suspicious of vascular injury, we could consider the angiography.