• Clinics in Shoulder and Elbow
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• v.9 no.1
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• pp.42-49
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• 2006

Purpose: This study evaluated clinical results, and recommended treatment protocol of traumatic anterior shoulder dislocation in the patients older than 60 years of age. Materials and Methods: Thirty-eight patients with first traumatic anterior shoulder dislocation aged over 60 years were included. The average age was 69.4 (range, 60 to 87 years). There were 8 men (average age of 71.6) and 30 women (average age of 69). Most common cause of injuries was a fall on the outstretched hand. The additional injuries were evaluated using MRI or CT arthrogram in the patients with significant pain and weakness while movements after 2 weeks sling immobilization. Results: Fifteen patients (39%) had rotator cuff tears and 5 patients (14%) had greater tuberosity fractures. The sizes of rotator cuff tears were diverse; 2 partial tears, 1 small tear, 4 medium tears, 3 large tears and 5 massive tears. Among 5 massive cuff tears, 3 patients revealed cuff arthropathy after reduction. 4 patients (11%) had recurrent dislocation more than one time during 1 month after the first dislocation. Bankart lesions revealed in 5 patients and three of them had associated rotator cuff tears. 3 out of 5 patients with Bankart lesions, 13 out of 15 patients with rotator cuff tears and 3 patients with displaced greater tuberosity fracture had operations. Conclusion: The injury mechanism of shoulder dislocation in patients older than 60 years of age seems to have either anterior or posterior mechanism. The diagnosis and treatment should be approached 2 weeks after dislocation.

• Clinics in Shoulder and Elbow
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• v.17 no.1
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• pp.18-24
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• 2014

Background: To evaluate the efficacy of the subclavian portal approach for the arthroscopic repair of isolated subscapularis tendon tear. Methods: We used the subclavian portal to carry out arthroscopic repair of the isolated subscapularis tendon tear. The surgery was carried out in 18 cases (average age of 53) from May 2006 to December 2009 with a mean follow-up period of 35 months. Of these cases, 13 patients had the tear in their dominant arms, 16 were male, and 12 were from traumatic ruptures with on average 7.6 months of symptom period to operation. Additional surgery, acromioplasty and subacromial debridement, were carried out on 4 cases each during the subscapularis repair. The integrity of cuff status was assessed by ultrasonographic examination at 6 months and at 1 year after operation. Results: The initial average range of motion in forward flexion, external rotation, and internal rotation were $160^{\circ}$, $50^{\circ}$ and L4, respectively. At the 1 year follow-up period, these improved to $160^{\circ}$, $52^{\circ}$ and T12, respectively. The initial average functional scores were assessed by KSS, ASES, UCLA, and Constant scoring systems, which were 67, 60, 26, and 65, respectively. These scores improved progressively with time. At 3 months after operation, the scores were 74, 67, 27, and 74; at 6 months, 83, 77, 31, and 75; at 1 year, 88, 86, 32, and 79; and at the final follow-up of 35 months, 84, 92, 34, and 84. Conclusions: In the repair of isolated subscapularis tendon tear, the subclavian portal approach provided a good angle for anchor insertion and sufficient space to manage the upper portion of the tendon tear. In turn, these provisions resulted in satisfactory clinical results.

• Clinics in Shoulder and Elbow
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• v.20 no.3
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• pp.162-166
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• 2017

Traumatic anterior shoulder dislocation combined with scapular fracture in elderly patients is relatively rare. In this case, a patient visited Emergency Room of Dong-A University Hospital for shoulder pain after falling off a ladder. Radiographs demonstrated anterior shoulder dislocation with displaced Ideberg type IIb scapula (glenoid fossa) fracture combined with a large rotator cuff tear on magnetic resonance imaging. We performed arthroscopic rotator cuff repair, but a large fragment in the inferior glenoid was left untreated. At the 1 year follow-up visit, the pain visual analogue scale of the patient was 2, the American Shoulder and Elbow Society score was 88 and the patient had gained nearly full range of motion without any apprehension.

• Journal of Trauma and Injury
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• v.28 no.1
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• pp.21-26
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• 2015

Complete radial tears of the lateral meniscus are relatively rare. Once torn, the injury can be debilitating due to disruption of the circumferential fibers of the meniscus. We experienced a case of a lateral meniscus with a complete radial tear at the midbody, where the two torn ends were displaced more than 1 cm and could not be approximated during arthroscopy. Thirteen months after surgery, follow-up MRI and second-look arthroscopic findings showed that the complete radial tear has healed spontaneously. However, twenty nine months after the second-look arthroscopy, the patient complained of severe knee pain during exercise. On follow-up MRI, increased sclerosis and newly developed bone marrow edema were observed in the lateral femoral condyle, compared with previous MR images. Finally, we performed meniscal allograft transplantation due to the defective properties of the completely healed lateral meniscus.

• Clinics in Shoulder and Elbow
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• v.2 no.2
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• pp.93-98
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• 1999

Purpose: The purpose of this study was to analyze the prognostic factors for arthroscopic subacromial decompres­sion and rotator cuff debridement in impingement syndrome. Materials and Methods : Arthroscopic subacromial decompression with or without rotator cuff debridement was performed in 46 cases of 44 consecutive patients with either stage n or stage ill impingement syndrome. The patients were classified by Neer's stage and size of tear according to the criteria of Cofield. The results were assessed with UCLA rating scale. We used repeated measures ANOVA and Chi-square test to assess correlation between the results and six variables including stage, rotator cuff tear size, age at the operation, duration of symptom, throwing sports activity, and trauma history. The follow-up period averaged 53 months(range, 27 to 92 months). Results: Lower stage by Neer's stage was correlated with higher postoperative scores and with significant difference between preoperative and postoperative scores of UCLA rating scale. However, other factors did not show significant influence upon the results. The patients with complete rotator cuff who showed satisfactory results after procedures were older and had shorter symptom duration, small cuff size. Conclusions : In patients with impingement syndrome treated by arthroscopic debridement and subacromial decompression, superior results were obtained when belonged to a lower Neer stage and when the rotator cuff was only partially tom. In cases with complete rotator cuff tear, higher success rates were obtained with smaller tear sizes. Age at operation, duration of symptoms, throwing athlete, traumatic tear did not affect the results.

• Korean Journal of Bronchoesophagology
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• v.3 no.1
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• pp.169-173
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• 1997

Cerebrospinal fluid (CSF) rhinorrhea usually occurs as a result of trauma including operation. Unheated CSF rhinorrhea may induce major morbidity such as meningitis and brain abscess, etc. This paper presents a review of four cases of traumatic CSF rhinorrhea Sites of CSF leakage were easily found out by intrathecal fluorescent dye injection. Surgery was performed by external ethmoidectomy approach and dural tear and bone defect was repaired with abdominal fat and free mucosal graft taken from amputated middle turbinates. We conclude that repair using free fat and mucosal graft via external ethmoidectomy approach could be accepted as the intial method of CSF rhinorrhea management.

• Journal of Chest Surgery
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• v.23 no.4
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• pp.782-784
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• 1990

We present a case of ruptured abdominal aortic aneurysm caused by blunt injury. The patient was 23-year-old soldier injured by a motor vehicle accident. Injuries sustained a contused abdominal aorta. At the time of aortic repair, the involved segment formed huge pseudoaneurysm, and which had intimal tear. Aorto-iliac graft replacement was carried out with a woven-dacron Y-graft prosthesis, which restored satisfactory circulation to both lower limbs. The postoperative course was uneventful.

• Clinics in Shoulder and Elbow
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• v.1 no.2
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• pp.266-277
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• 1998

Forty-nine partial thickness rotator cuff tears underwent arthroscopic debridement or repair, and were followed up for a minimum of two years. Follow-up evaluations of the results were completed using a detailed functional questionnaire which was comprised of a rating of the UCLA shoulder scale and return to the previous sports activity and job. The average age of the 49 study patients was 46.5 years(range, 14 to 67 years). The patients were divided into four groups on the basis of the onset of the patient's symptoms. Thirty-five patients(72%) had partial tearing only on the articular surface, six(12%) on the bursal surface, and eight(16%) on both surfaces. Group I consisted of 21 patients with an average age of 56.7. Partial tearing in group I was attributed to the impingement syndrome. In group II, partial tearing of the rotator cuff was related to the anterior instability of the shoulder. This group included 9 patients with an average age of 27.9. In group III, all of the 8 patients were overhead athletes with an average age of 21.8. In this group, no isolated instances of significant trauma were related to the development of the shoulder pain. In group IV, 11 patients noted that a significant traumatic event preceded the onset of their pain. The average age of the patients was 34.9. Overall, 82% of the patients demonstrated satisfactory results and 18% revealed unsatisfactory results. The worst UCLA score and rate of return to the prior activity was noted in group III. In conclusion, partial thickness rotator cuff tear can be caused by subacromial impingement, instability, repetitive microtrauma, and macrotrauma. Arthroscopic debridement of partial tear of the rotator cuff provides a favorable outcome except in overhead athletes.

• Journal of Chest Surgery
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• v.21 no.1
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• pp.169-174
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• 1988

Thoracic esophageal rupture caused by blunt trauma is often not recognized until late because of the vague symptoms in the initial state as well as its rare incidence, which can easily lead to fulminant mediastinitis with frequent fatal outcome. Once extensive mediastinitis occurs, the primary surgical repair of the esophageal tear is considered to be practically impossible. Various methods have been proposed for the management of these desperately ill patients, but no one provides an acceptable good result yet. The purpose of this article is to report the successful result obtained in the treatment of a patient with fulminant mediastinitis from traumatic esophageal rupture by continuous transesophageal irrigation. A 27 year-old male patient was brought to the emergency room of our hospital complaining of dyspnea and chest pain after blunt trauma. The diagnosis of esophageal rupture in the thorax was made late, about 46 hours after the initial injury, when mediastinitis had already progressed. The transesophageal irrigation method was immediately instituted which consisted of profuse transesophageal irrigation of the mediastinum with orally ingested fluid and/or by Levin tube, positioned proximal to the site of the rupture, and drainage of the irrigation fluid by thoracoscopically accurately positioned chest tubes connected to a well suctioning system. With subsiding inflammatory signs and symptoms, the esophagogram, obtained 54 days after the treatment, showed no evidence of the mediastinal leakage of contrast material which contrasted previous esophagograms with definitive dye collections in the mediastinum. Additional endoscopic finding confirmed complete healing of the esophageal mucosa, previously ruptured. He has been followed up without any problem until recently, 6 months after discharge.

• Clinics in Shoulder and Elbow
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• v.7 no.2
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• pp.98-102
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• 2004

The terrible triad of the shoulder, a combination of anterior shoulder dislocation, massive rotator cuff tear and neurologic injury, is rare. We experienced 4 patients with this condition who were treated with a rotator cuff repair. The mean age was 65 years. Follow-up averaged 27 months. All patients had a history of redislocation after initial traumatic shoulder dislocation and were evaluated with electromyography and magnetic resonance imaging. At the operation, massive rotator cuff tear and hypertrophy of the long head of the biceps were found in all patients. Clinically, 3 patients achieved recovery of their nerve injury by 3 months postoperatively and the final results were fair. In one patient, there was no recovery of deltoid function and this case was rated as a failure. For this injury pattern, the prognosis appears to be dependent on eventual nerve recovery when the rotator cuff has been repaired early.