BACKGROUND: The purpose of this study was to investigate the outcomes after fixation using a 3.5-mm locking compression plate (LCP) hook plate for isolated greater tuberosity (GT) fractures of the proximal humerus. METHODS: We evaluated the postoperative radiological and clinical outcomes in nine patients who were followed up at least 1 year with isolated GT fractures. Using the deltopectoral approach, we fixed the displaced GT fragments with a 3.5-mm LCP hook plate (Synthes, West Chester, PA, USA). Depending on the fracture patterns, the hook plate was fixed with or without augmentation using either tension suture or suture anchor fixation. RESULTS: All the patient showed successful bone union. The mean time-to-union was 11 weeks. The radiological and clinical outcomes at the final follow-up were generally satisfactory. The mean visual analogue scale for pain, the University of California at Los Angeles score, the American Shoulder and Elbow Surgeons score, and the subjective shoulder value were 1.4, 30.3, 84.3, and 82.2%, respectively. The mean active forward flexion, abduction, external rotation, and internal rotation of the shoulder were 156.7°, 152.2°, 61.1°, and the 10th thoracic vertebral level, respectively. Only one patient presented with a postoperative complication of shoulder stiffness. The patient was treated through arthroscopic capsular release on the 5th postoperative month. CONCLUSIONS: We conclude that fixation using 3.5-mm LCP hook plates for isolated GT fractures of the proximal humerus is a useful treatment method that provides satisfactory clinical and radiological outcomes.
California ; Elbow ; Follow-Up Studies ; Humans ; Humerus* ; Joint Capsule Release ; Methods ; Postoperative Complications ; Shoulder ; Surgeons ; Suture Anchors ; Sutures

Intramedullary nailing is the treatment of choice for most diaphyseal fractures of the tibia. The purpose of this study is to evaluate the result of tibia fractures treated with interlocking intramedullary nail, according to different sites of fractures. From september 2004 to august 2012, 106 cases of tibia fracture with a minimum follow up until bony union were selected and analyzed retrospectively. The mean follow-up period of the patients was 24.5 months. The location of fractures were divided into three groups, proximal (n = 18), mid (n = 42), distal (n = 46). Delayed union, mal-alignment and additional operation were investigated. The number of angle change over 5 degrees in the coronal plane and 10 degrees in the sagittal plane were 7 cases in proximal, 7 cases in mid, and 12 cases in distal with statistic significance. And an additional operation was required in 6 patients in proximal fracture, 2 patients in mid fracture, and 7 patients in distal fracture during bony union. Conclusively, intramedullary nailing in proximal and distal tibia fracture showed higher delayed union rate and could result in excessive angle change due to mal-alignment. Therefore, proximal level or distal level tibia fractures need more accurate reduction of fracture than midshaft level would need more accurate reduction of fracture and observe bony union through regularly radiography examination.
Follow-Up Studies ; Fracture Fixation, Intramedullary ; Humans ; Radiography ; Retrospective Studies ; Tibia*

Medial subluxation or dislocation of the long head of the biceps is often linked to rotator cuff tear, especially a tear of the subscapularis tendon. Isolated medial dislocation of the long head of the biceps without rotator cuff tear is extremely rare. There has been only one published report of an isolated dislocation of the long head of the biceps with intact subscapularis and supraspinatus tendons after traumatic posterior dislocation, by tear of the rotator interval. We report a case of isolated medial dislocation of the long head of the biceps without rotator cuff tear and include a review of the literature.
Dislocations ; Head ; Rotator Cuff ; Tendons

PURPOSE: Given the increasing common use of rotator cuff repair (RCR), return to sport (RTS) remains an important challenge and measure of success for athletes undergoing RCR. To determine the rate of return to the same level of sports after repair of rotator cuff tears.METHODS: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed to perform this systematic review and meta-analysis of the results in the literature. The electronic databases of PubMed, Embase, Cochrane Library, and Scopus were used for the literature search. Study quality was evaluated according to the MINORS (Methodological Index for Nonrandomized Studies) checklist. Studies evaluating the rate of return to the same level of sports after repair of partial- or full-thickness rotator cuff tears were included.RESULTS: Ten studies were reviewed, including 357 patients who were treated with RCR and who had a mean follow-up of 48.1 months (range, 16–74 months). The overall rate of RTS was 88.6%. Among them, 77.9% (95% confidence interval [CI], 67.1%–86.0%) of patients were able to return to the same level of sports according to the meta-analysis. Subgroup meta-analysis revealed that partial-thickness rotator cuff tear was 77.9% (95% CI, 70.0%–84.1%), and full-thickness was 69.6% (95% CI, 46.3%–85.9%), but there was no statistical significance (p>0.05).CONCLUSION: Most patients (88.6%) were able to return to sports after RCR and 78% of patients return to sports at the same level of play as before their injury.
Arthroscopy ; Athletes ; Checklist ; Follow-Up Studies ; Humans ; Return to Sport ; Rotator Cuff ; Sports ; Tears

Anterior cruciate ligament (ACL) reconstruction is a successful procedure independently by patient selection, timing of surgery, surgicaltechnique, choice of graft, and fixation methods. Among these factors, graft selection and fixation methods might be the most criticalyet controversial questions for surgeons. Although recent studies showed that grafts have advantages and drawbacks, there is still noideal graft. Similarly, many fixation methods of femoral and tibial tunnels have been proposed over the last few decades, with no clearsuperiority of one technique over another. Surgeons should be familiar with a variety of grafts, fixation techniques, and their specificassociated surgical procedures as well as the advantages and disadvantages of each. Therefore, this article summarizes the currentliterature and discusses the current state of graft selection and fixation methods in the treatment of an ACL injury.

PURPOSE: This study was conducted to evaluate the results of intramedullary nail fixation with autogenous iliac bone graft for defects of bone after tibial fractures. MATERIALS AND METHODS: Ten patients with bone defects in tibial fractures who had been treated with intramedullary nail fixation with autogenous iliac bone graft between May 2005 and September 2008 with more than 12 month follow-up were subject to study. Of the 10 patients, 8 were male and 2 were female, and the mean age was 50.2 years (29~76 years). By cause of accident, motor vehicle accidents caused 9 cases, a crush caused 1 case, and the average follow-up period was 21.9 months (12~42 months). Radiologically, we analyzed the union of the bone defect on simple x-ray and clinical evaluation was performed using the estimate method of Mekhali. RESULTS: This study reveals that there was radiological union in all 10 cases and the mean time to union was 8.4 months (5~18 months). By clinical evaluation according to Mekhali's estimate method, 9 patients had excellent outcomes and 1 patient had limitation of motion in the ankle joint rated as a fair clinical result. None of patients developed complications post-operatively. CONCLUSION: Our study demonstrated that the intramedullary nail fixation with autogenous iliac bone graft can be a useful operative method because it can remove external fixators early and reduce complications, and autogenous bones have exceptional osteoconduction, osteoinduction, and bone-forming ability resulting in excellent union of bones.
Ankle Joint ; Bone Regeneration ; External Fixators ; Female ; Follow-Up Studies ; Fracture Fixation, Intramedullary ; Humans ; Male ; Motor Vehicles ; Nails ; Tibial Fractures ; Transplants

PURPOSE: The purpose of this study was to evaluate the clinical and radiographic results of cementless total hip arthroplasty (THA) with subtrochanteric transverse shortening osteotomy in patients with high hip dislocation. MATERIALS AND METHODS: Eighteen patients with high hip dislocation who underwent cementless THA combined with a subtrochanteric transverse shortening osteotomy, plate or cable fixation and bone graft on the osteotomy site between 2001 and 2012 were evaluated in this study. The mean duration of follow-up was 5.2 (2-8.3) years. We evaluated Harris hip score, limping, limb length discrepancy as a clinical parameter and osteolysis, loosening and union of the osteotomy site as a radiographic parameter. RESULTS: Harris hip scores at the final follow-up showed improvement of limping and limb length discrepancy in all cases. And, with the exception of two cases of infection, there were no loosening and osteolysis. All cases showed union of the osteotomy site. There were two cases of infection and one case of dislocation as a complication. Infection occurred in two patients who underwent reoperation and one patient developed sciatic nerve palsy. CONCLUSION: Cementless THA with subtrochanteric transverse shortening osteotomy showed relatively satisfactory clinical and radiologic results. However, the incidence of complications, such as infection, is relatively high, therefore, careful attention is needed.
Arthroplasty, Replacement, Hip* ; Dislocations ; Extremities ; Follow-Up Studies ; Hip ; Hip Dislocation* ; Hip Dislocation, Congenital ; Humans ; Incidence ; Osteolysis ; Osteotomy* ; Reoperation ; Sciatic Neuropathy ; Transplants

BACKGROUND: This study evaluated the benefits and safety of a multimodal pain control protocol, which included a periarticular injection of local anesthetics, in patients undergoing total hip arthroplasty. METHODS: Between March 2006 and March 2007, 60 patients undergoing unilateral total hip arthroplasty were randomized to undergo either a multimodal pain control protocol or a conventional pain control protocol. The following parameters were compared: the preoperative and postoperative visual analogue scales (VAS), hospital stay, operative time, postoperative rehabilitation, additional painkiller consumption, and complication rates. RESULTS: There was no difference between the groups in terms of diagnosis, age, gender, and BMI. Although both groups had similar VAS scores in the preoperative period and on the fifth postoperative day, there was a significant difference between the groups over the four-day period after surgery. There were no differences in the hospital stay, operative time, additional painkiller consumption, or complication rate between the groups. The average time for comfortable crutch ambulation was 2.8 days in the multimodal pain control protocol group and 5.3 days in the control group. CONCLUSIONS: The multimodal pain control protocol can significantly reduce the level of postoperative pain and improve patients' satisfaction, with no apparent risks, after total hip arthroplasty.
Adult ; Aged ; Amides/administration & dosage ; Analgesia/*methods ; *Arthroplasty, Replacement, Hip ; Clinical Protocols ; Female ; Humans ; Injections, Intra-Articular ; Length of Stay ; Male ; Methylprednisolone/administration & dosage ; Middle Aged ; Morphine/administration & dosage ; Narcotics/administration & dosage ; Pain/prevention & control ; Pain Measurement ; Pain, Postoperative/prevention & control

PURPOSE: To evaluate the results of the compression plate fixation and autogenous bone graft in the management of humerus shaft nonunion. MATERIALS AND METHODS: Eighteen cases were treated for humerus shaft nonunion using compression plate fixation and an autogenous iliac bone graft. The mean follow-up period was 28 months. Bony union was confirmed from the serial radiographs and the clinical outcomes were assessed according to ASES scoring system. RESULTS: In 12 cases of initial plate fixation, the causes of nonunion were 6 cases of inadequate plate length, 2 with a broken plate, 2 with screw loosening, 1 infection and 1 noncompliance of a psychiatric patient. In 3 cases of initial intramedullary fixation, the cause of nonunion was a distraction of the fracture site. In 3 cases of external fixation, the cause of nonunion was inadequate fixation. All cases showed bony union after an average of 24 weeks. The clinical outcomes were 11 excellent, 6 good and 1 fair. CONCLUSION: In the treatment for nonunion, compression plate fixation with autogeneous bone graft after complete removal of the fibrous and necrotic tissue is believed to give satisfactory results
Follow-Up Studies ; Humans ; Humerus ; Transplants

Although extensor tendon rupture often occurs after volar plating for a distal radius fracture, a flexor tendon rupture is extremely rare. Most reported instances of flexor tendon ruptures after volar plating have involved improper placement of the plate, increased prominence of the distal edge of the plate because of collapse of the fracture site, use of custom-made plates, current steroid use by the patient, or a history of tendon injury. We report a case of delayed rupture of the flexor pollicis longus tendon 40 months after volar plating with a 3.5-mm T-locking compression plate for which the distal edge was located at the transverse ridge level of the distal radius. If symptoms such as tendon irritation occur in this situation, surgeons should consider removing the plate as soon as possible after bony union is achieved.
*Bone Plates ; Female ; Fracture Fixation, Internal/*methods ; Humans ; Middle Aged ; Radius Fractures/*complications/pathology/*surgery ; Rupture ; Tendon Injuries/*etiology/*surgery ; Thumb/physiopathology