• Clinics in Shoulder and Elbow
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• 제19권1호
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• pp.33-38
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• 2016

Background: This study was conducted to evaluate the surgical outcomes of plate fixation using autologous iliac bone graft shaped in the form of a matchstick in clavicle nonunion resulting from prior surgical or non-surgical management. Methods: From May 2005 to February 2013, 17 patients underwent surgery for clavicle nonunion. The mean age at the time of surgery was 48.8 years. The iliac bone was harvested and shaped into slivers approximately 3 cm long, which resembled matchsticks. After opening of the medullary canal, the plate and screws were applied and cancellous bone was placed at the nonunion site. Matchstick bone grafts which were longitudinally placed and encircled on the nonunion site were tied with periosteum using 3-4 stitches. Union was determined via postoperative plane X-ray. Clinical status was evaluated using the visual analogue scale score for pain, and Constant and American Shoulder Elbow Surgeon score. Results: All patients had a stable radiological union at the follow-up. The mean duration from index operation to nonunion operation was 13.2 months (7-32 months). The mean follow-up period was 20.1 months (8-56 months), and the mean duration until union was 11.2 weeks (8-16 weeks). All clinical scores were improved at the final follow-up (p<0.001). The mean segmental defect was $3.3{\pm}2.6mm$ (1-18 mm); and the difference in clavicular length between operative and non-operative site was $5.9{\pm}6.9mm$. Conclusions: Matchstick shaped autologous iliac bone grafting technique in clavicle nonunion is acceptable with a high union rate.

• Clinics in Shoulder and Elbow
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• 제19권1호
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• pp.2-7
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• 2016

Background: The purpose of this study is to compare the radiological and clinical outcomes after open reduction and plate fixation of midshaft clavicle fractures between patients who achieved successful anatomical reduction and those who had a remaining fracture gap even after open reduction and plate fixation, and were thus treated with additional demineralized bone matrix (DBM). Methods: This retrospective analysis was conducted on 56 consecutive patients who underwent open reduction and internal fixation using a locking compression plate for acute displaced midshaft clavicle fractures, and who underwent radiographic and clinical outcome evaluations at least 6 months postoperatively. The outcomes between those who achieved perfect anatomical reduction without remnant gap (n=32) and those who had a remaining fracture gap even after open reduction and plate fixation treated with additional DBM (n=24) were evaluated. Results: There were no differences in the use of lag screws or wiring and operation time (all p>0.05) between those with and without remnant gap. No difference in the average radiological union time and clinical outcomes (satisfaction and Constant score) was observed between the two groups (all p>0.05). However, significantly faster union time was observed for AO type A fracture compared with other types (p=0.012), and traffic accident showed association with worse clinical outcomes compared with other causes of injury. Conclusions: Surgical outcome of midshaft clavicle fracture was more affected by initial fracture type and event, and re-reduction and re-fixation of the fracture to obtain a perfect anatomical reduction spending time appears to be unnecessary if rigid fixation is achieved.

• Clinics in Shoulder and Elbow
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• 제24권2호
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• pp.72-79
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• 2021

Background: A midshaft clavicle fracture is a common fracture that typically responds well to open reduction and internal fixation (ORIF). However, refracture can occur after implant removal (IR). This study aimed to analyze the rate of refracture and related factors after removal of the locking compression plate (LCP) for displaced midshaft clavicle fractures. Methods: We retrospectively reviewed the medical records of 201 patients who had undergone ORIF with LCP for midshaft clavicle fractures after IR after bony union from January 2011 to May 2018 at our institute. We evaluated basic demographic characteristics and radiographic parameters. All patients were treated with an LCP for primary fracture. The patients were divided into two groups: a refracture group that experienced a second fracture within 1 year after IR and a no-fracture group. Results: There were four cases (1.99%) of refracture; three were treated conservatively, while one was treated surgically. All patients achieved bony union. The average interval between refracture and IR was 64 days (range, 6-210 days). There was a significant difference in classification of fractures (AO Foundation/Orthopaedic Trauma Association [AO/OTA] classification) between the two groups. However, other patient demographics and radiographic measurements between refracture and IR, such as bone diameter, showed no significant difference between the two groups. Conclusions: This study showed that one in 50 patients suffered from refracture after removal of the LCP. Thus, if patients desire IR, the surgeon should explain that there is a relatively higher possibility of refracture for cases with simple or segmental fractures than for other types of fracture.

• 대한영상의학회지
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• 제83권2호
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• pp.414-419
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• 2022

개화성 반응성 골막염은 드문 양성 섬유골성 증식으로 대부분 손의 짧은 관상골을 침범하고, 긴 관상골의 침범은 드물다. 저자들은 26세 남자에서 수술로 확진되었던 쇄골의 개화성 반응성 골막염 1예를 보고한다. 자기공명영상에서 병변은 높은 T2 신호강도를 보이는 연조직 종괴로 쇄골의 골막에서 기인하는 것으로 보였고, 주변의 골막거상과 종괴 주변의 연조직 부종이 관찰되었다. 조영증강 시 종괴의 내부는 강한 조영증강을 보였고, 쇄골의 골막을 따라서도 쇄골 둘레의 절반 이상을 둘러싸며 조영증강이 확인되었다. 연속된 단순촬영에서는 무기질 침착이 없는 연조직 종괴로 보이다가 한 달 이내에 빠른 속도로 연조직 종괴의 골화가 확인되었고, 고체형 골막반응이 동반되었다.

• 대한핵의학회지
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• 제26권1호
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• pp.155-159
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• 1992

Sternocostoclavicular hyperostosis (SCCH) is a chronic, nonsuppurative inflammatory disease involving sternum, clavicle, upper ribs and its adjacent soft tissue. It is a relatively newly described syndrome, characterized by ossification in the region between the clavicle and the first rib, and hyperostosis of the medial end of the clavicle with simultaneous involvement of the sternum and juxtasternal ribs. We experienced one case of sternocostoclavicular hyperostosis, diagnosed by pinhole bone scintigraphy. This paper describes characteristic pinhole scintigraphic findings of SCCH, with comparative study with radiographic and pathologic findings.

• Clinics in Shoulder and Elbow
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• 제21권3호
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• pp.158-161
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• 2018

Hereditary multiple exostosis (HME) is an autosomal dominant disorder manifested by the presence of multiple osteochondromas. Although the lesions are benign in nature, exostoses are often associated with characteristic progressive skeletal deformity and displaying clinical symptoms such as mechanical irritation or impingement. We present the successful arthroscopic resection in a 24-year-old HME male with impingement syndrome and long head tendon tear of the biceps caused by osteochondroma arising from the distal clavicle.

• Clinics in Shoulder and Elbow
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• 제17권2호
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• pp.77-79
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• 2014

The migration of metallic devices such as Kirschner's wire (K-wire) from the shoulder is a well-recognized and significant complication of operation, the wire ending up in the lungs, the heart, the esophagus, the aorta or the subclavian artery. However, spinal migration is very rare. We report the case of a 72-year-old female patient with K-wire migration into the C7-T1 intervertebral foramen, 2 months after surgery for a lateral end fracture of left clavicle.

• 대한기관식도과학회:학술대회논문집
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• 대한기관식도과학회 1997년도 대한이비인후과학회 종합학술대회 초록집
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• pp.117-117
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• 1997

성문하 협착과 기관 협착이 동반된 경우 이를 치유할 몇가지 방법이 시도되고 있으나 만족할만한 효과를 얻지는 못하고 있다. 저자들은 성문하와 기관협착이 동반된 27세 남자환자에서 기관 및 성문하 협착부 전면을 제거후 쇄골에 흉쇄유돌근(Sternocleidomastoid muscle: SCM)이 붙은채로 쇄골의 절반을 절제하여 수질부위를 제거후 협부점막을 부착하였다. 이렇게 얻어진 Vascularized clavicle을 성문하와 기관의 전면부 재건에 이용하여 좋은 결과를 얻었기에 문헌고찰과 함께 이를 보고하고자 한다.

• Clinics in Shoulder and Elbow
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• 제1권1호
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• pp.66-71
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• 1998

The fractures of lateral end of clavicle can be treated by conservative or operative treatment, but many authors report the higher rate of non-union with conservative treatment and that the operative treatment is more effective for the type II fractures. The authors reviewed and analysed 15 cases of lateral end fracture of clavicle which had been treated at Department of Orthopedic Surgery, Kyungpook National University Hospital from 1991 to 1996. The results were as follows; 1. Among the 15 patients, male was 6,female 9 and the average age was 46.2 years ranged from 21 to 72 years. 2. According to the classification by Rockwood, type II a was 8 cases and II b was 7 cases. 3. We treated operatively 12 cases, 9 cases with tension band wiring and 3 cases with intramedul-Iary K-wire fixation. And we treated conservatively 3 cases with Velpeau cast, but I case of nonunion was treated with tension band wiring. 4. The average follow-up was 3.2 years ranged from 2.1 to 4.7 years. 5. The functional results were evaluated with Weitzman's classification. 6. In the operatively treated cases, there were 4 cases(30.7%) in excellent, 7 cases(53.8%) in good and 2 cases(15.3%) in fair result. But, in the conservatively treated cases, there were 2 cases in good and I case in poor result, and the poor case did not united and had open reduction and internal fixation. 7. In conclusion, the operative treatment revealed good functional results in most cases (10/12) and early open reduction and internal fixation was better method than conservative treatment.

• Clinics in Shoulder and Elbow
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• 제1권1호
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• pp.83-92
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• 1998

Fractures of the clavicles are extremely common, accounting for 5 to 10% of all injuries in the adult skeletal trauma. Despite this, nonunions and symptomatic malunions after clavicular fracture are uncommon. When these complications occur, however, they may be associated with 11 pattern of disability that includes not only pain but also impairment of upper extremity function. The purpose of this study was to clarify the outcome of clavicular fractures treated by conservatively, and emphasize treatment and factors that possibly predispose a clavicular fracture to poor function or nonunion. We evaluated 9] consecutive fractures of the middle-third of the clavicle in adults which had been treated conservatively. There were 59 males and 33 females ranging in age from 17 to 80 years (average 36.8 years). Nine of the 91 fractures (10%) had developed nonunion, and 4 fractures (4.4%) reported unsatisfactory results. No patients had significant impairment of range of motion or strength as a result of the injury. We found that initial shortening at the fracture of≥20mm(6 cases) had a highly significantly association with nonunion(P<0.0001). Final shortening of 20mm or more (4 cases) was associated with an unsatisfactory result, but not with nonunion(P<0.0001). Our results have led us to recommend the open reduction and internal fixation of severely displaced fractures of the middle third of the clavicle in adults patients.