• Clinics in Shoulder and Elbow
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• v.3 no.1
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• pp.26-32
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• 2000

Purpose : The aim of this study is the assessment of the clinical outcomes after percutanous pinning of unstable two-parts fracture of surgical neck in humerus. Materials and Methods: This study was based on thirteen cases of non-comminuted unstable surgical neck fracture of humerus among 19 cases, which followed-up more than one year. Follow-up averaged 29 months. We treated with percutaneous pinning techniques and assessed clinical outcomes. Functional evaluation was performed using the standard method of research committee of American Shoulder and Elbow Surgeons(ASES). Results: Last follow-up ROM of shoulder joint were 142 degrees of forward elevation, 57 degrees of external rotation, 72 degrees of external rotation in 90 degrees abduction, and T8 of internal rotation. Pain scale was l(range : 0∼3). ASES scores was 86.2(range : 63.3~98.3). Patient satisfaction based on ASES were excellent in 6 cases, good in 5 cases, fair in 1 case, poor in 1 case. A case of fair result was caused by limitation of motion in shoulder joint and poor case was paraplegia patient after traffic accident. Conclusion : Percutaneous pinning is recommended for non-comminuted unstable fracture of surgical neck in humerus.

• Clinics in Shoulder and Elbow
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• v.20 no.2
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• pp.90-94
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• 2017

Background: Proximal humerus fracture is considered to be the third most common fracture for patients aged 65 years or older. Conservative treatment has been known to treat most of humerus fracture. However, fractures with severe displacement or dislocation may require surgical treatment. Intramedullary fibular allograft with a locking plate is frequently used in patients accompanying medial metaphyseal disruption. In this study, author intends to evaluate clinical and imaging results based on patients who underwent surgical treatment using fibular allograft with a locking plate. Methods: This study is conducted prospectively at Wonju Severance Christian Hospital, targeting patients who previously underwent surgical treatment using open reduction and intramedullary fibular allograft with a locking plate between 2011 and 2015. A total of 26 patients were evaluated on the following: postoperational clinical assessment measuring Constant score, American Shoulder and Elbow Society (ASES) score, and the Disabilities of the Arm, Shoulder and Hand (DASH) score. Postoperational imaging assessments are evaluated via measuring the neck-shaft angle. The study subject were Neer classification type 3, 4 proximal humerus fracture cases with disrupted medial hinge and having cortical comminution in the region of the surgical neck. Results: The average period of progression was 22.5 months, and the average age of patients was 72.6 years. At the final follow-up, the average Constant, average ASES, and average DASH scores were 80.1, 78.5, and 20.6 respectively. The average neck-shaft angle was $127.5^{\circ}$. Conclusions: In conclusion, fibular allograft augmentation with a locking plate showed satisfying results in both clinical and imaging studies.

• Clinics in Shoulder and Elbow
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• v.6 no.2
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• pp.149-160
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• 2003

Purpose: to determine the results after open intramedullary nailing and tension band suture technique in proximal humerus fracture for improving the stability and decreasing the complications. Materials and Method: Authors reviewed 27 patients treated by open intramedullary nailing and tension band suture technique. Mean follow-up period was 39 months (24-59months). Surgical neck fracture were 6 cases, surgical neck fracture with shaft fracture were 3 cases, three part fracture with greater tuberosity fracture were 17 cases, four part fracture was 1 case and fracture and dislocation were 2 cases Results: We got the bony union in 26 cases. Average pain scale was 1 point (0-6), Neer score was 86 point(45-99) and ASES score was 85 point(40-100). We separate all cases in two groups based on age (65 years), L-spine t-score (-2.5) and Neer classification (2 and 3 part). There is no significance in pain scale, Neer score and ASES score between each group. Conclusion: As a method of surgical treatment on severe proximal humeral fractures, we recommend intramedullary nailing and tension band suture technique and it may have particular advantages in early exercise and satisfactory functional outcome.

• Clinics in Shoulder and Elbow
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• v.25 no.4
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• pp.304-310
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• 2022

Background: The Boileau classification distinguishes three surgical neck fracture patterns: types A, B, and C. However, the reproducibility of this classification on plain radiographs is unclear. Therefore, we questioned what the interobserver agreement and accuracy of displaced surgical neck fracture patterns is categorized according to the modified Boileau classification. Does the reliability to recognize these fracture patterns differ between orthopedic residents and attending surgeons? Methods: This interobserver study consisted of a randomly retrieved series of 30 plain radiographs representing clinical practice in a level 1 and a level 2 trauma center. Radiographs were included from patients (≥18 years) who sustained an isolated displaced surgical neck fracture if they were taken ≤1 week after initial injury. A ground truth was established by consensus among three senior orthopedic surgeons. All images were assessed by 17 orthopedic residents and 17 attending orthopedic trauma surgeons. Results: Agreement for the modified Boileau classification was fair (κ=0.37; 95% confidence interval [CI], 0.36-0.38) with an accuracy of 62% (95% CI, 57%-66%). Comparison of interobserver variability between residents and attending surgeons revealed a significant but clinically irrelevant difference in favor of attending surgeons (0.34 vs. 0.39, respectively, Δκ=0.05, 95% CI, 0.02-0.07). Conclusions: The modified Boileau classification yields a low interobserver agreement with an unsatisfactory accuracy in a panel of orthopedic residents and attending surgeons. This supports the hypothesis that surgical neck fractures are challenging to categorize and that this classification should not be used to determine prognosis if only plain radiographs are available.

• 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.9 no.1
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• pp.34-41
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• 2006

Purpose: This study is to analyze the result and complications of internal fixation with T-plate for two-part fracture of the neck of the humerus. Materials and Methods: The clinical results of fourteen patients who had been performed with this method mentioned above were reviewed. Their average age was 49.6. Postoperative mean follow up period was 24.1 months. Radiological evaluation was done by Kronberg's and shoulder function by Neer's. Results: By Kronberg evaluation, nine cases were good, two cases acceptable and three cases poor. By Neer's, mean score of shoulder function was 77.6 and 4 cases were excellent, one satisfactory, five unsatisfactory and four failure. The complications were the sfiff shoulder, loss of reduction and avascular necrosis of humeral head. Conclusion: In this study, there were differences according to the age. And we obtained an unsatisfactory result in patients over 50 years old. We consider that in patients over 50 years old, the differences were due to the muscle weakness through wide surgical approaches, postoperative implant loosening or the stiffness caused by poor rehabilitation.

• Clinics in Shoulder and Elbow
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• v.10 no.1
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• pp.112-123
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• 2007

Purpose: Evaluate the clinical results of humerus neck nonunion treated with Polarus intramedullary nail. Materials and Methods: 8 patients who underwent surgery for nonunion of humerus surgical neck fracture were included. All patients were female, the average age was 65 years. 5 out the total 8 cases initially received surgery, open reduction and internal fixation with metal plate in 1 case, Ender nail insertion in 2 cases, external fixator in 1 case and closed reduction and percutaneous pinning in 1 case. The other 3 non union cases initial received conservative managemnent. The average period of nonunion was 9 months in the operated group and 6.2 months in the conservative group. All 8 cases received closed reduction with intrameedullary Polarus nail and auto iliac bone graft. Union was confirmed radiologically, and functional evaluation was done with the UCLA functional criteria. Results: All 8 cases showed union on radiologic evaluation. Average time to union was 3.5 months, average follow up period was 27 months. Average UCLA shoulder evaluation score was 7.6 points preoperatively which improved to 26.3 points after surgery. Active shoulder flexion was 40.7 degrees preoperatiely which increased to 104 degrees after surgery. Shoulder abduction improved from 32.9 degrees preoperatively to 96.3 degrees after surgery. UCLA functional criteria was good in 5 cases and fair in 3 cases, which no poor cases. Conclusion: Polarus IM nailing and AIBG is a useful method for treating nonunion of humerus neck fracture with improvement in union and function.

• Journal of the Korea Convergence Society
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• v.8 no.11
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• pp.115-121
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• 2017

The present study aimed to obtain basic knowledge of a customized artificial joint based on the convergence research of Digital Imaging and Communications in Medicine(DICOM) and 5-axis machining technology. In the case of the research method, three-dimensional modeling was generated based on the medical image of the humerus bone, and the shape was machined using a chemical wood material. Then, the anatomical characteristics and the modeling machining computation times were compared. The results showed that the Stereolithography (STL) modeling required twice more time for semi-finishing and 10 times more time for finishing compared to the Initial Graphics Exchange Specification(IGES) modeling. For the 5-axis machining humerus bone, the anatomical structures of the anatomic neck, greater tubercle, lesser tubercle, and intertubercular groove were similar to those in the three-dimensional medical image. In the future, the convergence machining technology, where 5-axis machining of various structures(e.g., the surgical neck undercut of the humerus bone) is performed as described above, can be efficiently applied to the manufacture of a customized joint that pursues the precise model of a human body.

• Clinics in Shoulder and Elbow
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• v.22 no.1
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• pp.29-36
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• 2019

Background: The execution of fibular allograft augmentation in unstable proximal humerus fractures (PHFs) was technically demanding. In this study, the authors evaluated the clinical and radiographic outcomes after tricortical iliac allograft (TIA) augmentation in PHFs. Methods: We retrospectively assessed 38 PHF patients treated with locking-plate fixation and TIA augmentation. Insertion of a TIA was indicated when an unstable PHF showed a large cavitary defect and poor medial column support after open reduction, regardless of the presence of medial cortical comminution in preoperative images. Radiographic imaging parameters (humeral head height, HHH; humeral neck-shaft angle, HNSA; head mediolateral offset, HMLO; and status of the union), Constant score, and range of motion were evaluated. Patients were grouped according to whether the medial column support after open reduction was poor or not (groups A and B, respectively); clinical outcomes were compared for all parameters. Results: All fractures healed radiologically (average duration to complete union, 5.8 months). At final evaluation, the average Constant score was 73 points and the mean active forward flexion was $148^{\circ}$. Based on the Paavolainen assessment method, 33 patients had good results and 5 patients showed fair results. The mean loss of reduction was 1.32 mm in HHH and 5.02% in HMLO. None of the parameters evaluated showed a statistically significant difference between the two groups (poor and not poor medial column support). Conclusions: In unstable PHFs, TIA augmentation can provide good clinical and radiological results when there are poor medial column support and a large cavitary defect after open reduction.

• Journal of the Korean Orthopaedic Association
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• v.54 no.2
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• pp.110-119
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• 2019

Proximal humerus fracture can be defined as a fracture that occurs in the surgical neck or proximal part of the humerus. Despite the appropriate treatment, however, various complications and sequelae can occur, and the treatment is quite difficult often requiring surgical treatment, such as a shoulder replacement. The classification of sequelae after a proximal humerus fracture is most commonly used by Boileau and can be divided into two categories and four types. Category I is an intracapsular impacted fracture that is not accompanied by important distortions between the tuberosities and humeral head. An anatomic prosthesis can be used without greater tuberosity osteotomy. In category I, there are type 1 with cephalic collapse or necrosis with minimal tuberosity malunion and type 2 related to locked dislocation or fracture-dislocation. Category II is an extracapsular dis-impacted fracture with gross distortion between the tuberosities and the humeral head. To perform an anatomic prosthesis, a tuberosity osteotomy should be performed. In category II, there are type 3 with nonunion of the surgical neck and type 4 with severe tuberosity malunion. In type 1, non-constrained arthroplasty (NCA) without a tuberosity osteotomy should be considered as a treatment. On the other hand, reverse shoulder arthroplasty (RSA) should be considered if types 1C or 1D accompanied by valgus or varus deformity or severe fatty degeneration of the rotator cuff. In general, the results are satisfactory when NCA is performed in type 2 sequelae. On the other hand, RSA can be considered as an option when there is no bony defect of the glenoid and a defect of the rotator cuff is accompanied. In type 3, it would be effective to perform internal fixation with a bone wedge graft rather than shoulder replacement arthroplasty. Recent reports on the results of RSA are also increasing. On the other hand, recent reports suggest that good results are obtained with RSA in type 3. In type 4, RSA should be considered as a first option.