PURPOSE: The purpose of this study was to analyze the effectiveness of coracoclavicular screw fixation with tension band wiring in the treatment of displaced distal clavicle fractures. MATERIALS AND METHODS: From October 2006 to December 2010, 18 patients with Neer type 2 displaced distal clavicle fracture were surgically treated. Fixation was performed, using coracoclavicular screw with tension band wiring. Radiographic and clinical evaluation was performed and the University of California at Los Angeles (UCLA) shoulder rating scale was employed for the assessment of shoulder joint function. RESULTS: Osseous union was achieved approximately 9.5 weeks (8-11 weeks) in all patients. After the union, the screw and wire were removed under local anesthesia. All patients returned to the normal shoulder range of motion. Loosening of the screw was seen in two patients and breakage was seen in one patient. However, we could not observe the delayed union and complications, such as infection and refracture. All but one patient showed excellent results according to the UCLA shoulder score at one year after the operation. CONCLUSION: Coracoclavicular screw fixation with tension band wiring in the treatment of displaced distal clavicle fractures is a clinically useful technique with good result and less complication.
Anesthesia, Local ; California ; Clavicle ; Humans ; Los Angeles ; Range of Motion, Articular ; Shoulder ; Shoulder Joint

PURPOSE: We evaluated the integrity after repairing the arthroscopic rotator cuff tendon using the suture-bridge technique in patients with full thickness rotator cuff tendon tears. MATERIALS AND METHODS: Forty two (males: 14, females: 28) consecutive shoulders that were treated with this index procedure and that had magnetic resonance imaging (MRI) taken at a mean of 9 months postoperatively were enrolled to estimate the postoperative intregrity of the repair. The mean age was 57 years (range: 44-75 years) and the mean follow-up period was 14 months (range: 12-16 months). The follow up MRI was evaluated using the Sugaya classification for postoperative cuff integrity. The clinical outcomes were evaluated by using the University of California Los Angeles (UCLA) score, the Korean Shoulder Scoring System (KSS) and Visual Analogue Scale (VAS). Significance was set at p values < 0.05 RESULTS: In the 42 cases with follow up MRI, the cuff integrity was graded as type I in 10 cases, type II in 28, type III in 2, type IV in 1 and type V in 1 case. Out of the 39 cases having a medium to large tear, the type I and II cuff integrity was 92.3% and two patients had type III cuff integrity postoperatively, while the rate of retear was 33.3% (1 of 3) in the cases with massive tear. The overall rate of retear was 4.8%. For the intact postoperative repair rate, the precent of cases with fatty degeneration of grade 3 or less seen on preoperative MRI was 92.7%. For 41 patients, except for 1 case of type V retear, the UCLA score and the KSS score were significantly improved (p < 0.05) from 17.2 to 31.4 and from 58.2 to 90.8 on average, respectively, which showed satisfactory clinical outcomes regardless of the type of repair integrity. CONCLUSION: The arthroscopic suture-bridge technique resulted in intact repair integrity in 90.4% of the cases and improved clinical outcomes, so we think this technique is one of the reliable procedures for treating full-thickness rotator cuff tear.
California ; Follow-Up Studies ; Humans ; Los Angeles ; Magnetic Resonance Imaging ; Rotator Cuff ; Shoulder ; Sutures ; Tendons

PURPOSE: Subscapularis tendon tears associated with supraspinatus tendon tears are often found during rotator cuff repair. However, there have been only a few reports about both subscapularis and rotator cuff repair. The authors conducted arthroscopic repair for cuff tear associated with subscapularis tendon tear and assessed its outcomes. MATERIALS AND METHODS: We evaluated 320 cases of arthroscopic repair following rotator cuff tear between June 2006 and January 2009 at Gil Medical Center. Out of 66 cases (21%) associated with subscapularis tear, forty cases of bone to tendon repair using suture anchor were selected except for 26 cases of tendon to tendon repair. Clinical outcomes of 25 cases followed up for over a year were finally assessed. Clinical outcomes were evaluated using the following measures: range of shoulder motion, muscle strength, belly press test, Visual Analogue Scale (VAS) on pain, and University of California Los Angeles (UCLA) score. RESULTS: The average VAS pain scale improved from 5.3 preoperatively to 1.4 postoperatively. Internal rotation strength increased from its preoperative level, 4.1 to 4.2 in postoperative 6 months and to 4.6 at last follow-up. Range of internal rotation increased from the second lumbar level at postoperative 6 months to the 11th thoracic level at last follow-up. UCLA score had significantly improved from 17.4 to 30.8 (p<0.05). CONCLUSION: It is recommended that concurrent repair of the subscapularis tendon during rotator cuff repair for a satisfactory treatment result.
California ; Follow-Up Studies ; Los Angeles ; Muscle Strength ; Rotator Cuff ; Shoulder ; Suture Anchors ; Tendons

PURPOSE: The purpose of this study was to investigate when the quality of life improve after rotator cuff repair. MATERIALS AND METHODS: Eighty-five consecutive cases with rotator cuff repair were studied. Patients completed the visual analogue scale (VAS), University of California Los Angeles scale (UCLA), American Shoulder and Elbow Surgeon's scale (ASES), Korean Shoulder scale (KSS), and the World Health Organization Quality of Life Scale abbreviated version (WHOQOL-BREF) preoperatively and at postoperative 3, 6, and 12 months. For evaluation of serial recovery pattern, section I (preoperatively-postoperative 3 months), section II (postoperative 3 months-postoperative 6 months), and section III (postoperative 6 months-postoperative 12 months) were divided. RESULTS: The mean WHOQOL-BREF score was significantly improved from 58.8 preoperatively to 66.4 at postoperative 12 months, with improvement of VAS, ULCA, ASES, and KSS scores. On serial recovery pattern, all measurements in section I, VAS, UCLA, and KSS scores in section II, and UCLA score in section III, were significantly improved. Female sex had a negative effect on all outcome measurements at postoperative 12 months. CONCLUSION: Our results showed improvement of quality of life as well as reduced pain and increased function at 3 months after rotator cuff repair. Further recovery of clinical outcomes showed gradual progress until postoperative 12 months.
California ; Elbow ; Female ; Humans ; Los Angeles ; Quality of Life ; Rotator Cuff ; Shoulder ; World Health Organization

PURPOSE: We evaluate the short-term clinical outcome of arthroscopic rotator cuff tendon repair with suture-bridge technique in patients with full thickness rotator cuff tear. MATERIALS AND METHODS: 29 (male:17, female:12) consecutive shoulders treated with this index procedure and early rehabilitation were enrolled. Mean age was 56.4 years (range, 34~73 years) and mean follow-up period was 13 months (range, 12-15 months). Clinical outcomes were evaluated by using the University of California Los Angeles (UCLA) score, the Korean Shoulder Scoring System (KSS) and Visual Analogue Scale (VAS). Postoperative cuff integrity was evaluated through magnetic resonance imaging (MRI) and categorized by Sugaya classification. RESULTS: Postoperative UCLA scores improved from16.4 to 31.6 (p< 0.05) and KSS scores showed 88 at 6 months and 92 at last follow up. Preoperative VAS score was 8.6, which was decreased to 2.1 at 3 months and 1.4 at 6 months postoperatively. 28 patients (96.5%) had increase in range of motion. The follow up MRI was taken in 15 shoulders and the cuff integrity was type I in 6 cases, type II in 7, type III in 1 and type V in 1 by Sugaya classification. CONCLUSION: Arthroscopic suture-bridge technique resulted in good or excellent clinical outcome in 96.5% of the cases, so we think this technique is one of the reliable procedure for full-thicknes rotator cuff tear.
California ; Follow-Up Studies ; Humans ; Los Angeles ; Magnetic Resonance Imaging ; Range of Motion, Articular ; Rotator Cuff ; Shoulder ; Sutures ; Tendons

PURPOSE: The aim of this study is to analyze the clinical results of using the technique of rotator cuff repair without parting the biceps long head from the glenoid for large or massive tear of the rotator cuff. MATERIAL AND METHODS: Form January 2005 to January 2007, we performed the arthroscopic biceps repair with incorporating suture to the rotator cuff for 21 patients with large or massive rotator cuff tear. The mean follow up period was 23 months (range: 6-48months). The number of males and females was 9 and 13, respectively. The age distribution ranged from 47 to 73 years with a mean age of 60.3 years. We compared the preoperative score with the postoperative scores using the University of California Los Angeles (UCLA) score, the shoulder index of the American Shoulder and Elbow Surgeons (ASES) and a simple shoulder test (SST). RESULTS: The improvement in the VAS, ASES and the UCLA and SST scores was statistically significant at the final follow up (average follow-up 23 months) (p>0.05). Two of nine cases were found to have partial tear with continuity but seven cases were found to have complete tear according to the ultrasonography and MRI. CONCLUSION: The technique of rotator cuff repair without parting the biceps long head from the glenoid for large or massive tear of the rotator cuff is considered to be recommendable.
Age Distribution ; California ; Elbow ; Female ; Follow-Up Studies ; Head ; Humans ; Los Angeles ; Male ; Rotator Cuff ; Shoulder ; Sutures ; Tendons

PURPOSE: To evaluate the in vivo corneal endothelial changes after intravitreal bevacizumab (Avastin(R); Genentech Inc., San Francisco, California, USA) injection. METHODS: A total of 30 eyes of 28 patients who received intravitreal bevacizumab injections were included in the present study. Before injection and one and three months after injection, specular microscopy was performed to analyze the corneal endothelial cell changes. In order to compare the differences in the changes of corneal endothelial cells, the eyes were divided into two groups, a single injection group and a multiple injection group. RESULTS: The mean endothelial cell count decreased from 2,497.4 +/- 427.8 at baseline to 2,421.2 +/- 430.5 at one month and to 2,362.7 +/- 366.2 at three months after the injection in all patients. However, the change in endothelial cell count was not statistically significant. In addition, the postoperative change in endothelial cell count was more prominent in the multiple injection group than in the single injection group, although the difference was again not significant. No significant changes in preoperative or postoperative coefficients of variation for cell area or hexagonalities were observed in either patient group or within each group. CONCLUSIONS: There was no significant change in corneal endothelial cells after intravitreal bevacizumab injection. In addition, there was no significant difference in the changes in corneal endothelial cells according to the number of bevacizumab injections.
Antibodies, Monoclonal, Humanized ; California ; Cornea ; Endothelial Cells ; Endothelium ; Eye ; Humans ; Microscopy ; San Francisco ; Bevacizumab

PURPOSE: Loneliness may be a typical psychological consideration in chronically ill patients, linking with low life satisfaction. We aimed to determine if loneliness would be independently associated with life satisfaction in pneumoconiosis patients hospitalized in long-term care facilities. METHODS: We recruited 164 patients from 3 pneumoconiosis-specialized hospitals in M and S cities, South Korea, and measured loneliness and life satisfaction by using the University of California Los Angeles loneliness and life satisfaction index-Z scales. The Multiple regression analysis was performed to examine an independent association between loneliness and life satisfaction after adjustment for age, the levels of dyspnea and bronchitisemphysema symptom, length of institutionalization, marital status, previous coal work experience, perceived socioeconomic status, and presence of caregivers. RESULTS: The mean of loneliness was 46.4. We found a significant association between loneliness and life satisfaction (standardized beta=-0.16, p=0.049), independent of all the covariates. Conclusions: Loneliness was an independent associate of life satisfaction in patients with pneumoconiosis who were institutionalized in long-term care facilities. Thus, a nursing intervention strategy for relieving loneliness is needed to increase life satisfaction in these patients.
California ; Caregivers ; Chronic Disease ; Coal ; Dyspnea ; Humans ; Institutionalization ; Loneliness ; Long-Term Care ; Los Angeles ; Marital Status ; Pneumoconiosis ; Republic of Korea ; Social Class ; Weights and Measures

PURPOSE: The descriptive-correlational study was undertaken in order to investigate the relationships between critical thinking disposition and critical thinking skill in clinical nurses. METHODS: A convenience sample of 50 registered nurses was obtained from E University Hospital. The instruments used in this study were general characteristics, California Critical Thinking Disposition Inventory (CCTDI) and California Critical Thinking Skill Test(CCTST) developed by Facione & Facione (1994). The data were analyzed by descriptive statistics, t-test, ANOVA, Duncan test and Pearson's Correlation Coefficient with SPSS 12.0 Program. RESULTS: 1) There was a statistically significant difference in critical thinking disposition according to age (F=3.23, p=.03) and educational background (F=39.07, p=.00). 2) There was a statistically significant difference in critical thinking skill according to age (F=3.40, p=.02), educational background(F=32.51, p=.00), and period of professional nursing experience(F=3.56, p=.02). CONCLUSION: A significant positive correlation between critical thinking disposition and critical thinking skill was found(r=.68, p=.00). Critical thinking disposition and critical thinking skill according to age and educational background had statistically significant differences. Therefore, it is needed to emphasize the necessity of continuous education and training of nurses which prepare their critical thinking ability.
California ; Education ; Nursing ; Thinking*

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.
California ; Clavicle* ; Joints ; Skin