• Clinics in Shoulder and Elbow
• /
• v.14 no.1
• /
• pp.146-152
• /
• 2011

Purpose: To describe the recent clinical results and complications of total elbow arthroplasty based on the literature review. Materials and Methods: The indications of total elbow arthroplasty include rheumatoid or inflammatory arthritis, posttraumatic arthritis, anklylosed elbow, tumor resection which cannot recover elbow function by other reconstructive procedures, and comminuted distal humerus fracture in elderly patients. Complications are aspetic loosening, infection, prosthesis fracture, periprosthetic fracture, ulnar neuropathy, ectopic ossification, triceps insufficiency, dislocation, and bushing wear. Results and Conclusion: Mean 10 year survival rate following total elbow arthroplasty has been reported 85% on the basis of revision. The prognosis in patients with an inflammatory arthritis is reported to be best, and loosening rate in patients with a posttraumatic arthritis tends to be high. Complication rate is known to be higher than that of other joint arthroplasty. In particular, deep infection occurs in 3~5% of the patients. Total elbow arthroplasty provide satisfactory results when it is performed properly in selected patients who have an elbow joint with irreversible dysfunction and low level activities.

• Journal of Trauma and Injury
• /
• v.22 no.1
• /
• pp.29-36
• /
• 2009

Purpose: The purpose of this study was to analyze the characteristics and severity of wrist injuries in snowboarding. Methods: December 2005 to February 2008, Snowboarders who experienced wrist injures were included in this study. On the basis of the medical records and radiographic evaluation, the severity of distal radius fracture was classified according to the Arbeitsgemeinschaft fur Osteosynthesefragen/Association for the Study of Internal Fixation (AO/ASIF) classification. Results: Most of the injured snowboarders were a either of the beginner (35 cases, 46.1%) or the intermediate (27 cases, 35.5%) level. The most common cause of injury in snowboarding was a slip down (60 cases, 78.9%). Comminuted and articular fractures classified as AO types A3, B, and C, which required surgical reduction, made up 42.3% of the distal radial fractures in snowboarders. When we analyzed the differences in severity between the educated and the non-educated groups, an A2 type injury in the AO classification was the most common type of injury in the educated group (20 cases, 38.5%), it means less severe fractures ocurred in the educated group (p=0.045). The most frequent injury mechanism of fractures was slip down (48 cases, 63.2%), and a slip down backwards was the dominant type of slip down (36 cases, 75.0%) (p=0.031). Conclusion: Among the snowboarders in this study who suffered self-down injury to the wrist, more fractures were associated with a backwards slip down than with a forward slip down due to over extension. For educated snowboarders the severity of fracture was lower than it was for uneducated snowboarders.

• Clinics in Shoulder and Elbow
• /
• v.20 no.1
• /
• pp.37-41
• /
• 2017

Background: Increased frequency of comminuted clavicle mid-shaft fractures and importance of functional satisfaction through early joint exercise has resulted in higher emphasis on surgical treatments. This study aimed to evaluate the clinical radiological results of treatment of clavicle mid-shaft fractures by open reduction and internal fixation using a plate with a small incision. Methods: The subjects of this study were 80 clavicle mid-shaft fracture cases treated with internal fixation using a plate from October 2010 to July 2014. Clavicle mid-shaft fractures were internally fixated using anatomical plates or locking compression plates. Achievement of bone union, union period, and clavicle length shortening were evaluated radiologically, and clinical assessment was done by using Constant and University of California at Los Angeles (UCLA) scores. Results: All 80 cases were confirmed to have achieved bone union through radiographs with an average union period of 10.9 weeks (range: 7-18 weeks). The average clavicle length of shortening in the affected side was 1.8 mm (range: 0-17 mm). The average UCLA score and Constant score were 33.6 (range: 25-35) and 92.5 (range: 65-100), respectively. Regarding complications, four cases reported skin irritation by metal plates, and one case reported a screw insertion site fracture due to minor trauma history. Conclusions: We were able to induce successful bone union and obtain clinically satisfactory results in displaced mid-shaft fractures of the clavicle without major complications such as nonunion through treatment of internal fixation using a plate.

• Clinics in Shoulder and Elbow
• /
• v.10 no.2
• /
• pp.212-219
• /
• 2007

Purpose: To determine the causes of the surgical treatment results in glenoid fracture by a retrospective analysis. Materials and methods: From March 1999 to February 2004, 9 patients who underwent an open reduction due to a glenoid fracture were reviewed. The modified Ideberg classification was used. There were 1, 3, 2, 1 and 2 cases of modified Ideberg type I, II, III, V, and VI, respectively. The internal fixators were a reconstruction plate, a small plate, a one-third tubular plate, a small screw, and a cannulated screw in 6, 1, 3, 3 and 1 case, respectively. The constant score and Adam's functional assessment method were used to evaluate the postoperative shoulder function. Results: The average time for fracture union was 7 weeks. The functional assessment was excellent in 4 cases, good in 3 cases, and fair in 2 cases. There were two complications related to surgery; articular screw encroachment, and inferior glenoid bone resorption without instability. Conclusion: A glenoid fracture with glenohumeral instability or displaced that was treated by open surgery showed good clinical results. Moreover, the more comminuted fracture had a lower functional score.

• Journal of Korean Foot and Ankle Society
• /
• v.21 no.1
• /
• pp.27-32
• /
• 2017

Purpose: Bone grafting is often necessary to maintain a reduction and prevent delayed collapse of reduced fracture in a treatment of severely displaced comminuted intra-articular calcaneal fractures. Herein, we analyzed the usefulness and necessary conditions to perform tricortical-allobone grafting in open reduction of calcaneal fracture via the Ollier approach. Materials and Methods: We performed a retrospective review of 57 intra-articular calcaneal fractures that underwent an operation via the Ollier approach between April 2009 and April 2015. They were divided into two groups: Group 1 (n=17) included those with tricortical-allobone grafts underneath the posterior facet fragment, and group 2 (n=40) included cases without a bone graft. We measured the $B{\ddot{o}}hler$ angle, Gissane angle, height, and width of the calcaneus at preoperative, postoperative, and final follow-up radiograph. We measured the sagittal rotational angle of the posterior facet fragment of preoperative computed tomography to analyze the effect and necessary conditions for bone grafting. We also reviewed the clinical results by the American Orthopaedic Foot and Ankle Society (AOFAS) scale, visual analogue scale (VAS), and any complications. Results: According to the Sanders classification, there were 3 type-II fractures, 12 type-III fractures, and 2 type-IV fractures in Group 1; whereas in Group 2, there were 26 type-II fractures, 13 type-III fractures, and 1 type-IV fracture (p=0.002). Regarding the preoperative radiologic parameters, there were significant differences in the $B{\ddot{o}}hler$ angle (p=0.006), Gissane angle (p=0.043), and rotational angle of the posterior facet fragment (p=0.001). No significant difference was observed in the preoperative calcaneal height and width, as well as postoperative radiologic parameters. There was no significant clinical difference between the two groups (p=0.546). Conclusion: We suggest that a tricortical-allobone graft may be useful in open reduction and screw fixation via the Ollier approach for displaced intra-articular calcaneal fracture with a bony defect after reduction of collapsed posterior facet fragment. This graft can contribute to the stable reduction via a small approach, even without a plate.

• Clinics in Shoulder and Elbow
• /
• v.10 no.1
• /
• pp.92-98
• /
• 2007

Introduction: The treatment of proximal humeral fracture is traditionally determined by Neer's classification system. The severely displaced three-part or four-part fracture is an indication for primary hemiarthroplasty. The current authors report the clinical results of 10 patients who received hemiarthroplasty for proximal comminuted fractures. The minimum follow-up period was 12 months. Materials and Methods: The current authors studied 10 patients who, between July 1999 and March 2005, each received hemiarthroplasty for a proximal humeral fracture of one shoulder. According to Neer's classification system, 5 of the patients had three-part fractures, and 5 of the patients had 4-part fractures. The mean interval between trauma and hemiarthroplasty was 6.1 days. The mean age of the 6 female and 4 male patients was 67.4 years(range: 56 to 76). Shoulder function was evaluated using the Constant score, the Simple Shoulder Test, and the modified UCLA score. Results: The mean Constant score was 51.4(range: 34 to 60). The mean modified SST score was 7.8 out of 12 tasks. Excluding the one patient who had also sustained an axillary artery rupture and a brachial plexus injury after the initial trauma, the mean Constant score for the remaining 9 patients was 53.5(range: 44 to 60), and the mean SST score was 7.2 tasks. The modified UCLA score averages for pain, function, and active forward flexion and strength were, respectively, 8.2($6{\sim}10$), 6.6($2{\sim}8$), and 6.9($4{\sim}8$). The total UCLA score was an average of 21.7($12{\sim}26$). Patients' the modified UCLA ratings were as follows: Excellent: 3, Good: 6, and Poor: 1. The patient with the poor outcome was the one who had also sustained the neurovascular injury. Patient's subjective satisfaction rating were as follows: Excellent: 2, Good: 7, and Poor: 1. Conclusion: Based on short term follow-up results, this study indicates that hemiarthroplasty is the treatment of choice for proximal humeral fractures on which it would be difficult to perform open reduction and internal fixation. Hemiarthroplasty is a useful treatment modality to prevent shoulder stiffness and to allow daily living tasks in elderly patients. However, restoration of muscle power and range of joint motion were not recovered satisfactorily.

• Journal of Yeungnam Medical Science
• /
• v.10 no.1
• /
• pp.197-211
• /
• 1993

Recently, the Supracondyle fracture of the femur is so severe and comminuted that it is difficult to treat open reduction and rigid fixation sufficiently due to violent traffic accident and external forces. The associated injuries are accompanied variously. So complications of the supracondyle fractures including joint stiffness, delayed union, infection are serious. However development of internal implant and operation skill result in relatively satisfactory function than conservative management. The authors reviewed 20 cases of the supracondyle fracture of the femur treated at Yeungnam University Hospital from 1989, Dec. To 1992, Jan. The results were as follows : 1. The male was common(70%). The 2nd-4th decade was most(87%). 2. The most common cause of injuries was traffic accident. The rate of open fracture was 35%, most of it was traffic accident. 3. According to the ASIF group classification. 4 cases were type A, 4 in type B, 12 in type C (10 in type $C_2$&$C_3$). 4. Accompanied injuries included multiple fractures in 9 cases and femoral artery injury in 1 case. 5. Among the 20 cases, conservative treatment was done in 5 cases and operative treatment was done in 15 cases. 6. Functional results (by Schatzker criteria) were as follows. The satisfactory results were achieved in 40% of cases in conservative treatment and 67% in operative treatment. 7. The average time of partial weight bearing was 15 weeks. 8. Complications were knee stiffness in 6 cases and 4 in delayed union.

• The Journal of Korean Orthopaedic Ultrasound Society
• /
• v.3 no.1
• /
• pp.26-31
• /
• 2010

Purpose: The purpose of this study is to evaluate the clinical usefulness of ultrasound in treatment of patella fracture. Material and Methods: Twenty cases of twenty patients with patella fracture radiographically from March, 2006 to September, 2009 were involved in this study, there were 8 males and 12 females, there were 13 right knees, 7 left knees, the average age was 43 years (range, 14~72 years). We decided the methods of treatment by using the ultrasound in conjunction with Drayer's test that examining the intactness of patella retinaculum. There were 10 transverse, 8 vertical and 2 comminuted fractures, we examined the patella retinaculum by using the ultrasound and performed Drayer's test. Results: In 12 cases of intact retinaculum, Drayer's test was negative and we allowed patients ambulation without surgical fixation especially. In 4 cases of completely ruptured retinaculum, Drayer's test was positive and we treated the patella fractures by the use of ORIF (open reduction and internal fixation) method, in 2 cases of partially ruptured retinaculum, Drayer's test was negative but displacement of fractures were more than 2 mm, we treated the patella fractures by the use of CRIF (closed reduction and internal fixation) method and obtained clinically satisfactory results. Conclusion: In conjunction with radiographs and Drayer's test, an ultrasound would be one of the useful diagnostic modality for determining treatment method of the patella fracture.

• Journal of the Korean Society of Radiology
• /
• v.7 no.2
• /
• pp.107-112
• /
• 2013

There is an Ankle Oblique(Broden' low) as an examination for the patient whose ankle was encased in orthopedic plaster. Some types of Ankle Joint coalition - Calcaneonavicular coalition, Talocalcaneal coalition and Naviculocuneiform coalition. This study is focused on the relation between Ankle Joints and the structural change of soft tissues, also finding the most proper angle to obtain good images of Ankle Joint from the patient who wore a plaster on his ankle, when we x-ray with Harris-Beath View($30^{\circ}{\sim}55^{\circ}$) - for observing Subtalar joint, Calcaneus Fracture, Subtentaculum, Tali Fracture and Talocalcaneal coalition. We intend to get the angle which makes us achieve the good image that shows Calcaneus Fracture, Subtentaculum, and Tali Fracture by changing internal angles of the patient's ankle. We evaluated the images obtained from 51 patients with PACS monitor. The result of the evaluation, subtalar joint was not seperated but opened, and Subtentaculum Tali Fracture was seen overlaid. at the angle 30, we could observe Calcaneus Fracture, Subtentaculum Tali Frature and the front part of behind side of subtalar joint well. And Calcaneo Navicularcoalition, Talocal Canealcoalition, Naviculo Cuneiform coalition condition were clearly seen at that angle. At the angle 35, we could achieve the clear images of subtalar comminuted fracture, talus, the behind joint of heel bone and get the high definition image on the degree of talocalcaneal joint separation. In addition to, We could obtain the good wide image of Sinus Tarsi. At the area of 45, We can distinguish the soft tissues from gyps separation. The outer-talus and density of the bone were definitely seen and Calcaneus is more separated than that of at the angle of 35, but this image is distorted. Calcaneus, Subtentaculum Tali show $1.20{\pm}0.414$ at the angle 25, $2.47{\pm}0.516$ at the angle 30, $2.27{\pm}0.458$ at the angle 45. This difference is statistically meaningful. (p<0.05). Including the degree of distortion, The distortion appears less at the area of $30^{\circ}$ but at the area of 40, there is heavy distortion. So, We could get the best image for making a diagnosis. At the $30{\sim}35^{\circ}$ degree for X-raying ankle. and at the $30{\sim}40^{\circ}$ for Calcaneus Fracture, Subtentaculum Tali Fracture.

• Journal of Korean Foot and Ankle Society
• /
• v.10 no.1
• /
• pp.42-47
• /
• 2006

Purpose: This study was performed to analyze the characteristics of calcaneocuboid joint involvement in intraarticular calcaneal fractures. Materials and Methods: Total number of 92 patients (111 cases) who underwent operation for intraarticular calcaneal fractures between Jan. 2000 and Oct. 2005 were included in this study. The preoperative computed tomographs of the subjects were retrospectively reviewed to analyze calcaneocuboid joint involvement. Results: It was revealed that 63 cases (56.8%) involved calcaneocuboid joint; 29cases (46.0%) showed type 1 (undisplaced or minimally displaced type, articular gap ${\le}1\;mm$), 16 cases (25.4%) exhibited type 2 (moderately displaced type, articular gap ${\ge}2\;mm$), 7 cases (11.1%) were included in type 3 (comminuted type) and 11 cases (17.5%) belonged to type 4 (fracture and dislocation). 48 out of 63 cases belonged to Sanders classification II and III that involved calcaneocuboid joint and included 25 cases (52.1%) of type 1 and 14 cases (29.2%) of type 2. Among 15 out of 63 cases included in Sanders classification IV, 4 (26.7%) showed type 1 and 6 (40.0%) belonged to type 4. According to our results, Sanders classification allowed to predict pattern of the involvement of calcaneocuboid joint (P<0.05). However, there was no statistically significant relationship between degree of posterior facet joint injuries and calcaneocuboid joint involvement (P>0.05). Conclusion: Calcaneocuboid joint involvement in intraarticular calcaneal fractures was common and more than half showed severe injuries. We concluded that further studies on the involvement of calcaneocuboid joint should be performed prior to surgical treatment of intraarticular calcaneal fractures.