• Clinics in Shoulder and Elbow
• /
• 제19권2호
• /
• pp.105-109
• /
• 2016

Arthroscopy is recognized as an important adjunct in treatment of intra-articular fractures. The author reports on successful treatment of a displaced transverse glenoid cavity fracture, reduced and fixed with arthroscopic assist, using two cannulated screws perpendicular to the fracture surface, in a patient with frail chest. One screw passed through the Neviaser portal, and the other screw passed through the base of the coracoid process. Arthroscopy assisted reduction and 2 cannulated screw fixation through the Neviaser portal and coracoid base appears to be a good method for treatment of transverse glenoid fractures.

• Clinics in Shoulder and Elbow
• /
• 제17권4호
• /
• pp.190-193
• /
• 2014

Recurrent posterior shoulder instability is a debilitating condition that is relatively uncommon, but its diagnosis in young adults is increasing in frequency. Several predisposing factors for this condition have been identified, such as the presence of an abnormal joint surface orientation, an osteochondral fracture of the humeral head or glenoid cavity, and a postero-inferior capsuloligamentary deficit, but their relative importance remains poorly understood. Whilst, conservative treatment is effective in cases of hyperlaxity or in the absence of bone abnormality, failure of conservative treatment means that open or arthroscopic surgery is required. In general, soft-tissue reconstructions are carried out in cases of capsulolabral lesions in which bone anatomy is normal, whereas bone grafts have been required in cases where posterior bony Bankart lesions, glenoid defects, or posterior glenoid dysplasia are present. However, a consensus on the exact management of posterior shoulder instability is yet to be reached, and published studies are few with weak evidence. In our study, we report the reconstruction of the glenoid using iliac bone graft in a patient suffering recurrent posterior shoulder instability with severe glenoid bone defect.

• Clinics in Shoulder and Elbow
• /
• 제26권3호
• /
• pp.306-311
• /
• 2023

A 13-year-old male was diagnosed with a glenoid fracture following direct shoulder trauma, for which surgical treatment was considered. After referral to a center for pediatric orthopedic care, physical examination, contralateral shoulder X-ray, and detailed computed tomography examination ruled out the presence of fracture; these findings were later confirmed by magnetic resonance imaging. Normal ossification patterns in the adolescent shoulder may simulate a fracture in traumatic settings. To accurately diagnose and manage pediatric shoulder pathology, orthopedic surgeons must be aware of the normal anatomy of the growing shoulder, its secondary ossification centers, and growth plates.

• Clinics in Shoulder and Elbow
• /
• 제20권3호
• /
• pp.147-152
• /
• 2017

Background: To evaluate the clinical and functional outcomes of arthroscopic-assisted reduction and percutaneous screw fixation for glenoid fractures with scapular extension, and investigate the radiologic and clinical benefits from the results. Methods: We evaluated patients treated with arthroscopic-assisted reduction and percutaneous screw fixation for glenoid fractures with scapular extension from November 2008 to September 2015. Fractures with displacement exceeding one-fourth of the anterior-articular surface or more than one-third of the posterior-articular surface in radiographic images were treated by surgery. Clinical assessment was conducted based on range of motion, Rowe score, and Constant score of injured arm and uninjured arm at last follow-up. Results: Fifteen patients with Ideberg classification grade III, IV, and V glenoid fracture who underwent arthroscopic-assisted reduction using percutaneous screw fixation were retrospectively enrolled. There were no differences in clinical outcomes at final follow-up compared to uninjured arm. Bone union was seen in all cases within five months, and the average time to bone union was 15.2 weeks. Ankylosis in one case was observed as a postoperative complication, but the symptoms improved in response to physical therapy for six months. There was no failure of fixation and neurovascular complication. Conclusions: We identified acceptable results upon radiological and clinical assessment for the arthroscopic-assisted reduction and percutaneous fixation. For this reason, we believe the method is favorable for the treatment of Ideberg type III, IV, and V glenoid fractures. Restoration of the articular surface is considered to be more important than reduction of fractures reduction of the scapula body.

• 대한정형외과스포츠의학회지
• /
• 제2권2호
• /
• pp.176-180
• /
• 2003

저 자들은 관절와의 전위 된 횡골절에 대해 관절경 을 이 용하여 골절된 관절면을 확인하면서 골절의 정복을 유지 하고, 견관절경술식에 일 반적으로 사용되는 견봉 바로 외측에 위 치 한 외 측 삽입 구나 또는 견갑상와의 상부 삽입구 (Nevlaser porial)에서 피부를 통해 직경4 mm 타이타늄 유관 해면골 나사를 이 용하여 고정하였다. 관절경을 이 용한 골절 내고정술은 좋은 시 야를 확보할 수 있었고, 최소 침습 수술이므로 작은 연부조직 절개 , 적은 출혈량, 수술후 재활 기간의 단축 및 조기 관절 운동 힌용 등의 여러 장점 을 가지므로 이에 수술 방법과 증례를 보고하는 바이다

• Clinics in Shoulder and Elbow
• /
• 제27권1호
• /
• pp.88-107
• /
• 2024

The aim of this systematic review was to collect evidence on the following 10 technical aspects of glenoid baseplate fixation in reverse total shoulder arthroplasty (rTSA): screw insertion angles; screw orientation; screw quantity; screw length; screw type; baseplate tilt; baseplate position; baseplate version and rotation; baseplate design; and anatomical safe zones. Five literature libraries were searched for eligible clinical, cadaver, biomechanical, virtual planning, and finite element analysis studies. Studies including patients >16 years old in which at least one of the ten abovementioned technical aspects was assessed were suitable for analysis. We excluded studies of patients with: glenoid bone loss; bony increased offset-reversed shoulder arthroplasty; rTSA with bone grafts; and augmented baseplates. Quality assessment was performed for each included study. Sixty-two studies were included, of which 41 were experimental studies (13 cadaver, 10 virtual planning, 11 biomechanical, and 7 finite element studies) and 21 were clinical studies (12 retrospective cohorts and 9 case-control studies). Overall, the quality of included studies was moderate or high. The majority of studies agreed upon the use of a divergent screw fixation pattern, fixation with four screws (to reduce micromotions), and inferior positioning in neutral or anteversion. A general consensus was not reached on the other technical aspects. Most surgical aspects of baseplate fixation can be decided without affecting fixation strength. There is not a single strategy that provides the best outcome. Therefore, guidelines should cover multiple surgical options that can achieve adequate baseplate fixation.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제41권
• /
• pp.57.1-57.8
• /
• 2019

Background: The relationship between the lateral deviation of chin and the upper and middle facial third asymmetry is still controversial. The purpose of this study is to evaluate the correlation of upper and middle facial third asymmetry with lateral deviation of chin using 3-dimensional computed tomography. The study was conducted on patients who underwent orthognathic surgery from January 2016 to August 2017. A total of 40 patients were included in this retrospective study. A spiral scanner was used to obtain the 3-dimensional computed tomography scans. The landmarks were assigned on the reconstructed 3-dimensional images, and their locations were verified on the axial, midsagittal, and coronal slices. The Pearson correlation analysis was performed to evaluate the correlation between chin deviation and difference between the measurements of distances in paired craniofacial structures. Statistical analysis was performed at a significance level of 5%. Results: In mandible, the degree of chin deviation was correlated with the mandibular length and mandibular body length. Mandibular length and mandibular body length are shorter on the deviated-chin side compared to that on the non-deviated side (mandibular length, r = -0.897, p value < 0.001; mandibular body length, r = -0.318, p value = 0.045). In the upper and middle facial thirds, the degree of chin deviation was correlated with the vertical asymmetry of the glenoid fossa and zygonion. Glenoid fossa and zygonion are superior on the deviated-chin side than on the non-deviated side (glenoid fossa, r = 0.317, p value = 0.046; zygonion, r = 0.357, p value = 0.024). Conclusion: Lateral deviation of chin is correlated with upper and middle facial third asymmetry as well as lower facial third asymmetry. As a result, treatment planning in patients with chin deviation should involve a careful evaluation of the asymmetry of the upper and middle facial thirds to ensure complete patient satisfaction.

• 한국방사선학회논문지
• /
• 제9권6호
• /
• pp.331-335
• /
• 2015

Glenohumeral joint's를 나타내는 단순방사선 촬영법으로 전후사방향 자세에서 촬영하는 Grashey법이 있다. 이 촬영법 자세는 선 자세에서 검사 측을 들어 올리고 촬영한다. 하지만 촬영 시 환자를 몸통을 들어 올리고 회전하는 정도에 따라 관찰범위가 변화한다. Glenohumeral joint's를 가장 잘 나타내기 위한 몸통 회전 각도를 알아보기 위하여 총 20명(남:13명, 여:7명)을 대상으로 촬영을 실시하였으며, 정확한 영상의 판단을 위하여 정형외과 전문의 2명, 방사선사 2명(경력 15년 이상자)이 관찰 평가하였다. 평가의 척도는 Glenohumeral joint's 분리 정도의 점수를 0점은 '분리 안 됨', 1점은 '불량', 2점은 '보통', 3점은 '양호'로 점수를 부여하였다. 몸통 회전 각도를 $30^{\circ}$ 인 영상은 Humerus head와 Glenoid fossa가 겹쳐서 나타났고, $35^{\circ}$ 인 영상에서는 Humerus head와 Glenoid fossa가 약간 겹쳐서 나타났고, $40^{\circ}$ 인 영상에서는 Humerus head와 Glenoid fossa의 관절강이 가장 겹침이 적게 나타났고, $45^{\circ}$ 인 영상에서도 겹침 정도가 많았다. 각 영상의 평가 점수는 $30^{\circ}$는 $0.40{\pm}0.499$, $35^{\circ}$는 $1.34{\pm}0.657$, $40^{\circ}$는 $1.84{\pm}0.573$, $45^{\circ}$는 $0.76{\pm}0.649$로 나타났고 통계적으로 유의한 차이를 나타냈다.(p < .05). 선 자세에서 Glenohumeral joint's를 나타내기 위한 자세에서 환자 몸통을 $40^{\circ}$ 검사 반대 측을 들어 올리고 촬영하였을 경우 우리는 가장 양호한 접시오목(Glenoid fossa)를 나타낼 수 있었다.

• Clinics in Shoulder and Elbow
• /
• 제11권2호
• /
• pp.150-157
• /
• 2008

목적: 견갑골 체부 골절의 수술적 치료 결과를 분석하고자 하고자 한다. 대상 및 방법: 7명의 환자를 대상으로 수술적 치료를 시행하였다. 견갑골 외측 경계가 100% 전위된 경우, 관절와가 $25^{\circ}$ 각변형 되거나 1 cm 이상 내측 전위된 경우, 견갑골 체부와 쇄골 골절이 동반된 경우를 수술적 치료의 대상으로 삼았다. 남자가 5명 여자가 2명, 평균 나이는 49(40~58)세, 평균 추시는 11(6~24)개월 이였다. 두 명은 다발성 늑골 골절과 척추 골절을 동반하였다. 기능적 평가를 위해 UCLA score 와 Korean shoulder score, 술 후 주관적인 만족도를 이용하였다. 결과: UCLA score는 평균29(17~33)점 이었고 평균 Korean shoulder score는 86(63~94)점이었다. 환자의 주관적인 만족도는 10점 만점에 7.7(4~9)이었다. 합병증으로 정복된 골절의 소실 없는 나사못 이완이 1예에서 관찰되었으며 관절와로 돌출된 나사못으로 1예에서는 교환하여야 하였다. 결론: 심하게 전위된 견갑골 체부골절에서는 견관절 및 견갑흉곽관절의 생역학적 이상으로 인한 견관절의 운동 장애를 예방하기 위해 수술적 치료가 도움이 될 것으로 판단된다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• 제43권5호
• /
• pp.336-342
• /
• 2017

Synovial chondromatosis is a rare benign lesion originating from the synovial membrane. It presents as adhesive or non-adhesive intra-articular cartilaginous loose bodies. Although the causes of synovial chondromatosis have not been fully elucidated, inflammation, external injury, or excessive use of joints have been suggested as possible causes. Synovial chondromatosis has been reported to occur most frequently at large joints that bear weights, with a rare occurrence at the temporomandibular joint (TMJ). When synovial chondromatosis develops at TMJ, clinical symptoms, including pain, joint sounds, and mouth opening may common. Moreover, synovial chondromatosis rarely spreads to the mandibular condyle, glenoid cavity, or articular eminence of TMJ. The goal of this study was to discuss the methods of surgery and other possible considerations by reviewing cases of patients who underwent surgery for synovial chondromatosis that extended to the temporal bone.