• Clinics in Shoulder and Elbow
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• v.23 no.3
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• pp.156-158
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• 2020

PHILOS plate fixation in osteoporotic proximal humerus fracture of old age is well-known for high complication rate, especially metal failure, providing various augmentation techniques, such as calcium phosphate cement, allogenous or autologous bone graft. We report a case of polymethyl methacrylate augmentation to provide appropriate reduction with a significant mechanical support. This can be a treatment option for displaced unstable osteoporotic proximal humerus fracture with marked bony defect.

• Clinics in Shoulder and Elbow
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• v.19 no.4
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• pp.223-228
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• 2016

Background: The aim of study was to confirm the clinical effectiveness and results of wide and single anterior approach for fractures occurring along length of humerus. Methods: A total of 23 patients with humeral fracture were enrolled into our study who were able to participate in at least one year of follow-up. Seven patients had segmental comminuted humeral fractures and 16 patients had distal humeral fractures. We made various tractions of the muscles to expose the proximal and the middle third humerus between the biceps and brachialis and the distal humerus by partial splitting of lateral side of biceps through a single incision. Postoperatively, we measured the Mayo elbow performance index (MEPI). Results: we achieved bone union in all 23 patients. Solid union of the bone was achieved at an average 13.9 weeks. Postoperatively, two complications were observed screw loosening and nonunion. Revision surgery was performed in both patients. The patient with bone nonunion was treated using bone grafts. No postoperative infections or peripheral neuropathies were observed. At the final follow-up (average 20 months), we found that the average MEPI functional score of the patients was 91.7 points regardless of the fracture site. Conclusions: Our whole humerus with a single incision was effective for the treatment of segmental comminuted and distal fractures. we believe it is a useful alternative to preexisting methods of fracture fixation.

• Journal of Korean Orthopaedic Sports Medicine
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• v.2 no.1
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• pp.62-70
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• 2003

Purpose: We examined the kinematics and kinetics of the shoulder in youth baseball pitchers in light of the mechanisms of development of little league shoulder and humeral retrotorsion. Materials and Methods: The joint kinematics and the net force and torque acting on the humerus were calculated in fourteen youth pitchers throwing in a simulated game. Results: The major force component acting on the humerus was a tensile force of 378$\pm$81 N that peaked just after ball release. The predominant torque on the humerus was an external rotation torque about the long axis of the humerus. This torque reached a peak value of 35.3$\pm$6.7 Nm about 73$\%$through the pitching motion. This torque is approximately 66$\%$ of the torque required to fracture of the adult humerus. Conclusions: The direction of the humeral torque was consistent with the development of increased humeral retrotorsion in the throwing arm. Shear stress arising from the high torque during the late cocking phase likely leads to deformation the relatively weak proximal humeral epiphysis. The external rotation torque applied to the humerus during the pitch also agrees with the proposed mechanism for development little league shoulder, which has been hypothesized to be due to rotational stresses acting on the epiphysis during the throwing motion.

• Clinics in Shoulder and Elbow
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• v.1 no.2
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• pp.205-211
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• 1998

The comminuted fracture and dislocation of the proximal humerus occur more frequently in older patient group and operative treatment is difficult due to poor bone quality. Based on Neer's work, hemiarthroplasty has now become widly accepted for the management of the three-part fracture and four-part fracture-dislocation of the proximal humerus in old age group. The purpose of this study is to evaluate function, pain relief, and patient satisfaction after hemiarthroplasty for proximal humerus fractures and dislocations. Authors reviewed and analyzed 14 prosthetic replacement in comminuted proximal humeral fracture and dislocation at the Department of Orthopaedic Surgery, Yonsei University Wonju College of Medicine from March, 1988 to May, 1997. The results were as follows the average age was 58.9years and the ratio of males and females was 5:9. The most common cause of injury was traffic accident(43%). According to the classification of Neer, three part fracture were three(21%), four-part fracture and four-part fracture-dislocation were eleven(79%). The prosthetic replacement was performed within two weeks in eight patient and six were performed after two weeks. The results were analysed according to Neer's criteria and five cases showed satisfactory results. We concluded that hemiarthroplasty for fracture and dislocation of the proximal humerus facilitated the restoration of humerus length and pain relief, thereby allowing earlier motion to prevent the development of painful shoulder: stiffness.

• Clinics in Shoulder and Elbow
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• v.10 no.2
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• pp.204-211
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• 2007

Purpose: To evaluate the result and complication of treatment using Locking Compression Plate (LCP) for fracture of proximal humerus. Materials and Methods: Between 2004 and 2006, 21 patients with two-part and three-part fractures of the proximal humerus were treated by LCP fixation. Their average age was 54.9 years. Postoperative mean follow-up period was 22.9 months. The reduction was qualified and complication were assessed with final radiographs. The functional outcome was evaluated by Neer's rating system. Results: By Neer's functional evaluation, mean score of shoulder function was 86.3 and 18 case (86%) had excellent or satisfactory results. There was one case of nonunion but no infection or avascular necrosis of the humeral head. No correlation was found between the final result and the type of fracture, age, gender or quality of reduction. Conclusion: We obtained satisfactory result of LCP fixation for fracture of proximal humerus in this study. LCP fixation for proximal humerus fracture is a reliable method to obtain satisfactory reduction, rigid fixation and early exercise.

• Clinics in Shoulder and Elbow
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• v.21 no.4
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• pp.192-199
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• 2018

Background: The currently available reverse shoulder arthroplasty (RSA) designs can be classified into medial glenoid/medial humerus (MGMH), lateral glenoid/medial humerus (LGMH), and medial glenoid/lateral humerus (MGLH) prosthesis designs. The purpose of this study was to radiologically analyze the effect of different RSA designs on humeral position following RSA. Methods: A total of 50 patients who underwent primary RSA were retrospectively analyzed. Among 50 patients, 33 patients (group A: MGMH) underwent RSA with Aequalis system (Wright, Inc, Bloomington, MN, USA), 6 (group B: LGMH) with Aequalis system using bony increased offset, and 11 (group C: MGLH) with Aequalis Ascend Flex system. The acromiohumeral distance, acromioepiphyseal distance (AED), lateral humeral offset (LHO), LHO from the center of rotation ($LHO^{COR}$), and deltoid length were radiologically measured to quantify the distalization and lateralization of the humerus. Results: The increment in postoperative AED was $19.92{\pm}3.93mm$ in group A, $24.52{\pm}5.25mm$ in group B, and $25.97{\pm}5.29mm$ in group C, respectively (p=0.001). The increment in postoperative LHO was $0.13{\pm}6.30mm$, $8.00{\pm}12.14mm$, and $7.42{\pm}6.88mm$, respectively (p=0.005). The increment in postoperative $LHO^{COR}$ was $20.76{\pm}6.06mm$, $22.04{\pm}5.15mm$, and $28.11{\pm}4.14mm$, respectively (p=0.002). Conclusions: The radiologic analysis of the effect of different RSA designs on humeral position following RSA showed significant differences in the increment in postoperative AED, LHO, and $LHO^{COR}$ between the 3 groups. Therefore, MGLH design seems to be more effective for humeral distalization and lateralization compared to original Grammont design.

• Clinics in Shoulder and Elbow
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• v.17 no.3
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• pp.134-137
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• 2014

To report the fracture of proximal humerus in the lateral anchor site after suture bridge repair. A 57-year-old female patient with shoulder pain on the right-side was admitted through the emergency room following a car accident. Seven weeks before the accident, the patient had undergone surgery at a different hospital for the repair of supraspinatus tendon rupture on the right-side via suture bridge technique. Humerus surgical neck fracture was confirmed by X-ray, and proximal humerus fracture at the anchor site was confirmed by magnetic resonance imaging. Following 7 months of conservative treatment resulted in satisfactory bone union and motion of the shoulder joint. We report the need of close observation during and after the arthroscopic repair of the rotator cuff in patients with osteoporosis.

• Clinics in Shoulder and Elbow
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• v.20 no.4
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• pp.236-239
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• 2017

After dual plating with a locking compression plate for comminuted intraarticular fractures of the distal humerus, the incidence of ulnar nerve injury after surgery has been reported to be up to 38%. This can be reduced by an anterior transposition of the ulnar nerve but some surgeons believe that extensive handling of the nerve with transposition can increase the risk of an ulnar nerve dysfunction. This paper reports ulnar nerve injuries caused by the incomplete insertion of a screw head in dual plating without an anterior ulnar nerve transposition for AO/OTA type C2 distal humerus fractures. When an anatomical locking plate is applied to a distal humeral fracture, locking screws around the ulnar nerve should be inserted fully without protrusion of the screw because an incompletely inserted screw can cause irritation or injury to the ulnar nerve because the screw head in the locking system usually has a slightly sharp edge because screw head has threads. If the change in insertion angle and resulting protruded head of the screw are unavoidable for firm fixation of fracture, the anterior transposition of the ulnar nerve is recommended over a soft tissue shield.

• The Journal of Korean Orthopaedic Ultrasound Society
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• v.5 no.2
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• pp.106-112
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• 2012

Radial nerve palsy after surgery of humerus fracture is uncommon complication. Occasionally it needs operative treatment because of difficulty to accurate evaluation. We report this case of radial nerve palsy after surgery of humerus shaft fracture with ultrasound examination. We checked the continuity of radial nerve and radial nerve palsy was complete recovered with conservative treatment.

• Clinics in Shoulder and Elbow
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• v.8 no.2
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• pp.166-169
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• 2005

Periosteal chondroma is a slow growing benign chondroid tumor. It erode the surface of cortex and induce a saucer shape defect. Histologically, it occasionally show hypercellularity, mitosis which can lead to the erroneous diagnosis of malignant tumor. Clinical, radiographic and pathological investigations are necessary to establish the diagnosis. Marginal excision proved an effective treatment. To our knowledge, this benign chondroid tumor of humerus has never been previously reported in Korea. We report a case of periosteal chondroma of proximal humerus mimicking periosteal chondrosarcoma.