• Clinics in Shoulder and Elbow
• /
• 제14권1호
• /
• pp.140-145
• /
• 2011

목적: 금속 요골두 치환술은 주관절 불안정성을 동반한 고정할 수 없는 분쇄된 요골두 골절의 치료로 최근 다양한 임플란트의 개발로 널리 사용되고 있다. 저자는 금속성 요골두 치환술의 적응증과 국내에 사용중인 임플란트의 종류와 수술 술기를 문헌 고찰과 함께 기술하고자 한다. 대상 및 방법: 요골두 치환술의 주 적응증은 동반된 연부조직 손상으로 인한 주관절의 불안정성이 있고, 요골두의 분쇄 골절로 안정적인 내고정이 불가능한 골절이다. 이러한 경우 과거 시행되었던 요골두 절제술은 많은 합병증의 발생으로 금기시되고 있다. 현재 국내에서는 양극성, 압박 고정 단극성 및 이완 고정 단극성 임플란트의 3종류가 수입되어 사용되고 있다. 요골두 치환술은 궁극적으로 원래의 요골두의 크기와 길이로 복원하는 것이 중요하다. 과도하게 긴 요골두의 삽입은 흔한 합병증으로 수술 시 주의가 필요하다. 결과 및 결론: 요골두 치환술은 적절한 적응증과 정확한 수술 술기로 만족할 만한 임상적 결과를 얻을 수 있다. 향후 장기추시 연구와 다양한 치환물들의 임상적인 비교 연구가 필요하다.

• Clinics in Shoulder and Elbow
• /
• 제21권4호
• /
• pp.234-239
• /
• 2018

Background: In elbow fracture-dislocation, partial excision of the comminuted radial head fracture that is not amenable to fixation remains controversial considering the accompanying symptoms. This study was undertaken to evaluate the results of radial head partial excision when the comminuted radial head fracture involved <50% of the articular surface in all-arthroscopic repair of elbow fracture-dislocation. Methods: Patients were divided into two groups based on the condition of the radial head fracture. In Group A, the patients had a radial head comminuted fracture involving <50% of the articular surface, and underwent arthroscopic partial excision. Group B was the non-excision group comprising patients with stable and non-displacement fractures. Follow-up consultations were conducted at 6 weeks and at 3, 6, 12, and 24 months after surgery. Results: In all, 19 patients (Group A: 11; Group B: 8) met the inclusion criteria and were enrolled in the study. At the final follow-up, all 19 patients showed complete resolution of elbow instability. No significant differences were observed in the range of motion, visual analogue scale score, and Mayo elbow performance score between groups. Radiological findings did not show any complications of the radiocapitellar joint. However, nonunion of the coracoid fracture was observed in 3 patients (Group A: 1; Group B: 2), without any accompanying instability and clinical symptoms. Conclusions: Considering that the final outcome is coronoid fracture fixation and lateral collateral ligament complex repair for restoring elbow stability, arthroscopic partial excision for radial head comminuted fractures involving <50% of articular surface is an effective and acceptable treatment for elbow fracture-dislocation.

• Clinics in Shoulder and Elbow
• /
• 제23권3호
• /
• pp.131-135
• /
• 2020

Background: Resection of the radial head is a surgical indication for comminuted radial head fracture in which internal fixation is inaccessible. Some complications from the surgery can alter the function of the patient's elbow. The objective of this study was to assess functional outcome of the elbow after resection of the radial head. Methods: A retrospective longitudinal study was performed with patients who underwent radial head resection between 2008 and 2018. Elbow function was assessed by the Mayo Elbow Performance Index (MEPI) for 11 patients comprising three women and eight men. The mean follow-up was 47.6 months. The mean age was 41±10.3 years. Results: Nine patients had a stable and painless elbow. The mean extension-flexion arc was 97.73°±16.03°. The mean values of pronation and supination were 76.8° and 74.5°, respectively. The mean MEPI score was 83.2 points, and restoration of overall function was achieved in 81% of the cases. Poor function was noted in one in 10 that presented with a terrible triad. Conclusions: Resection of the radial head restored elbow functionality at a rate of 81%, which was a good outcome for patients.

• Clinics in Shoulder and Elbow
• /
• 제5권1호
• /
• pp.37-41
• /
• 2002

Purpose : To evaluate the effect of radial head resection on longevity in nonconstrained total elbow arthroplasty, Materials and Methods : The results of 20 cases of radial head replaced Pritchard ERS and 18 cases of radial head excised Kudo elbow was followed for 6 to 16 years, 10.6 years in average. The rate of loosening, osteolysis, radial head subluxation, joint dislocation and valgus deformity were compared between the two groups. Results'There was no exaggerated cubitus valgus in Pritchard ERS group. However there developed one case of delayed subluxation of radial head occurred in 6 years postoperatively, one case of loosening, and one case of sponta- neous fracture of humeral shaft due to osteolysis. In Kudo elbow group,5 cases (27.8%) showed exaggerated valgus deformity with instability. There were one case of loosening and one case of delayed dislocation occurred in a year postoperatively. Conclusion : The most clear feature of Kudo elbow was exaggerated cubitus valgus. However, the ostolysis was developed in both groups and there was no difference in rate of the other complications between the two groups.

• 대한두경부종양학회지
• /
• 제18권1호
• /
• pp.46-49
• /
• 2002

Background: Free flaps have become a very important role in the ablative head and neck surgery with functional preservation of defect sites. The forearm free flap has many advantage of lack of bulk, ease of dissection, vascularity, and malleability. Patients and Methods: A review of 51 radial forearm free flaps performed between may 1990 and feburary 2001 at the Korea University was undertaken to determine outcome. Patient age ranged 27 to 72 years (mean 56). There were 44 men and 7 women. The most prevalent neoplasm was squamous cell carcinoma. Results: The tans verse cervical artery and the external jugular vein were the most frequent receipient sites for microvascular anastomosis. Total flap loss occurred in 2 cases (4%) and other complications were seen in 42%. Fifteen patients received preoperative irradiation and the complication was higher than non-irradiation patients, but statistically not significant. Conclusion: The radial forearm free flap offers a variety of reconstructive options for head and neck. Its low flap loss and complication rates offer the best choice for reconstruction of defect of head and neck malignancy.

• Clinics in Shoulder and Elbow
• /
• 제23권3호
• /
• pp.117-118
• /
• 2020

• Clinics in Shoulder and Elbow
• /
• 제10권1호
• /
• pp.131-135
• /
• 2007

23세 남환에서 발생한 요골 두 급성 전방 탈구를 경험하였기에 이를 보고하고자 한다. 수상 당시 전완부는 회내전, 주관절은 약간 굴곡되어 있었고, 손이 지면에 닿아 체중이 실리면서 주관절의 갑작스런 과도한 회내전이 발생하였다. 요골 두는 상완근의 외측 근육 다발에 의해 감돈 되었고, 윤상인대가 척골의 후방 부착부에서 견열되어 요골 두와 소두 사이에 끼어 정복을 방해하였다. 관혈적 정복을 시행하였다. 12개월간 추시 관찰을 하였으며 요골 두의 정복은 잘 유지되고 있었고 주관절의 운동제한은 없었다.

• Clinics in Shoulder and Elbow
• /
• 제23권4호
• /
• pp.183-189
• /
• 2020

Background: The purpose of the current study was to investigate short- to mid-term outcomes and complications following radial head replacement (RHR) for complex radial head fractures and to identify factors associated with clinical outcomes. Methods: Twenty-four patients with complex radial head fractures were treated by RHR. The mean age of the patients was 49.8 years (range, 19-73 years). Clinical and radiographic outcomes were evaluated for a mean follow-up period of 58.9 months (range, 27-163 months) using the visual analog scale (VAS) score for pain, the Mayo elbow performance score (MEPS), the quick disabilities of the arm, shoulder and hand (Quick-DASH) score, and serial plain radiographs. Complications were also evaluated. Results: At the final follow-up, the mean VAS score, MEPS, and Quick-DASH score were 0.6±1.1, 88.7±11.5, and 19.4±7.8, respectively. The mean range of motion was 132.7° of flexion, 4.7° of extension, 76.2° of pronation, and 77.5° of supination. Periprosthetic lucency was observed in six patients (25%). Heterotopic ossification was observed in four patients (16.7%). Arthritic change of the elbow joint developed in seven patients (29.2%). Capitellar wear was found in five patients (20.8%). Arthritic change of the elbow joint was significantly correlated with MEPS (P=0.047). Four cases of complications (16.6%) were observed, including two cases of major complications (one stiffness with heterotopic ossification and progressive ulnar neuropathy and one stiffness) and two cases of minor complications (two transient ulnar neuropathy). Conclusions: RHR for the treatment of complex radial head fractures yielded satisfactory short- to mid-term clinical outcomes, though radiographic complications were relatively high.

• Anatomy and Cell Biology
• /
• 제56권1호
• /
• pp.39-45
• /
• 2023

Fixation of radial head fracture with minimally invasive posterior approach remains a significant challenge. The aim of this study was to determine the feasibility of trans-anconeus posterior elbow approach and to observe lateral ulnar collateral ligament (LUCL) in extended elbows. This cadaveric study was performed in twenty upper limbs of fresh fixed adult male cadavers. An oblique incision was made in the middle segment of anconeus until the lateral ligament complex and the joint capsule had been revealed. A deep dissection was explored to observe the anatomical relationship of the LUCL to the anconeus. Measurements of the LUCL were recorded while the elbow was fully extended. The mean distance between the edge of the radial head and the proximal insertion of the LUCL was 13.3 mm (11.5-16.2 mm); the mean distance between the edge of the radial head and the distal insertion of the LUCL was 20.9 mm (19.2-23.4 mm); the distance between the edge of the radial head and the distal edge of the annular ligament was 11.2 mm (8.22-11.7 mm). By estimate correlation of the previous measurements, the direct and accessible way to expose the posterolateral articular capsule of the elbow joint was through a window in medial 2/3 of the middle segment of anconeus muscle. These trans-anconeus approach is useful. It provides good visualization, facilitates applying the implants, and lessens the risk of radial nerve injury. Awareness of the anatomy is mandatory to avoid injury of LUCL.

• Clinics in Shoulder and Elbow
• /
• 제10권1호
• /
• pp.84-91
• /
• 2007

목적: 총 7예의 금속형 요골 골두 치환술을 경험하여 적응증을 바탕으로 국내 요골두 치환술의 실태와 필요성을 소개하고자 하였다. 대상 및 방법: 2006년 4월부터 고려대학교 정형외과 교실에서 경험하였던 총 7예의 환자를 대상으로 수술 적응증, 수술 소견 및 수술 후 상태를 조사하였다. 그리고 치환물의 술 전 준비상태와 보험 적용 여부를 조사하였다. 금속형 치환물은 양극성 유형의 요골두 치환물(Tornier SA. Saint-Ismier, France)을 사용하였다. 결과: 전 예에서 요골두 분쇄 골절 이외에 $1{\sim}2$ 곳의 다른 골절 및 연부조직 손상을 동반한 복합 손상으로 요골두 치환술의 적응증에 해당되었다. 요골두 골절은 Mason 분류상 III형이 3예, IV형이 4예였고 분쇄골절로 인해 만족할만한 내고정을 얻지 못해 치환술을 시행하였다. 술 후 평가에서는 우수 2예, 양호 4예, 불량 1예였고 추시 시 치환물의 문제로 인한 합병증은 보이지 않았다. 술 전 수술 기구의 공급 부족으로 2예에서 수술 날짜를 변경하였고 치환물에 대한 비용은 산재 환자 2예를 제외한 5예에서 환자 개인이 부담하였다. 결론: 요골 골두의 분쇄를 포함한 주관절의 복합 손상에서 금속형 치환물은 술 전 계획 하에 준비되어야 하며, 의료보험의 적용으로 의사 및 환자들의 치료 선택에 도움을 주어야 할 것으로 생각되었다.