Many patients who have facioscapulohumeral muscular dystrophy eventually have instability of the scapula due to weakness of the muscles which stabilize the scapula. However, a subset of these patients have sufficient strength in the supraspinatus and deltoid muscle to abduct the arm if the scapula has been stabilized. In four patients who had facioscapulohumeral type of progressive muscular dystrophy, scapulothoracic arthrodesis was done for the treatment of limited unstable shoulder motion, especially flexion and abduction and symptomatic winging of the scapula caused by the loss of scapular stability from July 1994 to Feb.1995. The purpose of this study was to report 5 cases who obtained permanent stability after the scapulothoracic arthrodesis and compare the pre- and postoperative glenohumeral motion. The average preoperative active abduction was 74 degrees, which was improved to l35 degrees at the last follow up in 4 cases except unsatisfied 1 case. The average preoperative active flexion was 66 degrees, which improved to 140 degrees at last follow up. The average preoperative UCLA shoulder score was 18.4 points, which improved to 29.6 points at the last follow up. They were doing well in activity of daily living except unsatisfied one case. The scapulothoracic arthrodesis in the facioscapulohumeral type of the progressive muscular dystrophy is successful in achieving scapular stability so it is valuable for selected patients, as it improves appearance, enhances function, and increases tolerance to exercise.
Arm ; Arthrodesis* ; Deltoid Muscle ; Follow-Up Studies ; Humans ; Muscles ; Muscular Dystrophies* ; Muscular Dystrophy, Facioscapulohumeral ; Scapula ; Shoulder*

With the advancement of modern medicine, diabatic foot gangrene rather than acute metabolic complications are eneountered as serious problem. The diabetic gangrene, one of the angiopathic and neuropathic complications, is difficult in treatment because of wound infection and delayed healing. The authors reviewed a series of 47 cases in 40 patient of diabetic gangrene that treated in orthopedic department of Eulji General Hospitsl, Seoul, from January 1982 to December 1987. We summarized the obtained results as following. 1. The overall incidence of diabetic gangrene was 0.42%, and 77.5% of patients with gangrene were in over 50 year age group. 2. 72.5% of patients with gangrene were 5–14 years in duration of diabetes. 3. The most common predisposing factor was local pressure(45%), and the most common site of lesions was big toe(34%). 4. Bacterial infections were shown in 90% of cases, and the most common organism wasstaphylococcus(56%).5. Diabetic retinopathy was the most common associated complication and neuropathy, nephropsthy in order. 6. According to the Wagner's classification, grade 4 lesion was most common(47%). 7. There was no correlation between primary healing and the lowest palpable pulse. 8. The overall rate of primary healing was 57%.
Bacterial Infections ; Causality ; Classification ; Clinical Study ; Diabetic Foot ; Diabetic Retinopathy ; Foot ; Gangrene ; History, Modern 1601- ; Humans ; Incidence ; Orthopedics ; Seoul ; Wound Infection

The PCL is the strongest ligament in the knee joint. And it gives the posterior stability to the knee joint and act on rotation of knee joint. The many authors reported the surgical approaches for PCL. But none of them was satisfactory for exposure for PCL. Authors report the approach for repair and reconstruction on PCL injury The purpose of this report is to get the more satisfactory exposure of operation field for anatomical repair of injuried PCL. 1. PCL injury combined with MCL injury. a) MCL injury at its femoral attachment area. Detach the injuried MCL from femoral attachment completely, continue with anteromedial incision, and can observe both femoral and tibial attachment of PCL and ACL. b) MCL injury at its tibial attachment area. Retract the injuried MCL, medial meniscus, joint capsule superiorly, and through between medial meniscus and tibial proximal protion, also can observe the tivial attachment of PCL. 2. Isolated PCL injury. a) at tibial attachment(avulsion fracture) Through posterior approach or straight anteromedial approach, incised the posteromedial joint capsule, and can observed the tibial attachment of PCL. b) at substance level. Detach the MCL from its femoral attachment with bone-block and apply the knee valgus force. And can observe the entire length of PCL. Also reinforce the repaired site of PCL by reconstruction using a semitendinosus tendon.
Joint Capsule ; Knee Joint ; Knee ; Ligaments ; Menisci, Tibial ; Posterior Cruciate Ligament ; Tendons

We measured several relationships of humeral and glenoid articular surfaces with radiologic analysis in the 60 shoulders of normal adults(the 30 males and 30 females) who were without pain and limitation of motion. The average age was 29.1 year-old in the males(from 26 to 39), 27.7 year-old in the females(from 20 to 34). The results of measurement were as follows. The average radius of curvature of humeral head was 28.8±1.9mm in the males, 25.3±2,3mm in the females. The average radius of curvature of glenoid was 34.5±3.5mm in the males, 29.3±2.8mm in the females and there was difference between the radius of curvature of humeral head and glenoid about 4-Smm. Average surface area ratio of humeral head versus glenoid was 1.8±0.2 in male, 2.0±0.2 in female. The average thickness of humeral head from anatomical neck was 23.1±1.5mm in the males, 20.5±2.lmm in the females and there was distance between the radius of curvature of humeral head and the thickness of humeral head about 5 me and it was suggested that humeral head was not hemisphere. The average neck shaft angle of humerus was 51.6±4.8 degree in the males, 52.7±3.8 degree in the females. The average flare index was 3.6±0.6 in the males, 3.9±0.7 in the females, so that metaphysis of female was broader than that of male. The lateral humeral offset was 68.5±3.8mm in the males, 63.6±4.3mm in the females. The average distance from the greater tuberosity of humerus to the lateral acromion process was 20.1±3.9mm in the males, 17.6±5.1mm in the females. The average distance of upper surface from the humeral head to the greater tuberosity of humerus was 6.5±1.4mm in males, 5.9±2.0mm in females. The distance from the humeral head to the undersurface of acromion was 9.5±3.1mm in the males, 7.7±3.5mm in females. Our measurement of normal glenohumeral relationship would be useful in the diagnosis of shoulder disorders and in the design of prosthestic reconstruction in Korean. Further study would be required for the analysis of the three dimensional relationship because of the limitation of our two dimensional analysis.
Acromion ; Diagnosis ; Female ; Humans ; Humeral Head ; Humerus ; Male ; Neck ; Radius ; Shoulder ; Shoulder Joint

No abstract available.

The authors reviewed the clinical results of treatment for the impingement syndrome in 33 patients, 36 cases at the Department of Orthopaedic Surgery, Medical College, Kyung Hee University from November 1989 to March 1992. Follow-up evaluations averaged 23 months. The average age was 49 years old and there were 16 men and 17 women. The right shoulder was involved in 25 cases and the left in 11. The prominent complaint was pain with impaired shoulder function, especially in abduction, external rotation and flexion. The average duration of symptoms was 11 months ranged from 1 month to 7 years. Twenty one cases were managed with conservative therapy only, consisting of rest, physical therapy, analgesic and antiinflammatory drugs. Operation was performed in 15 of 36 cases. Anterior acromioplasty was done in 11 cases and arthroscopic decompression in 4 cases. In all patients with operative management, relief of pain and improvement of shoulder function were obtained and complications were not observed. Average preopperative shoulder rating score was 38.2 and postoperative score was 87. In 14 cases(71%) of conservative management, the symptoms were improved but still persistent in 6 cases(29%). Average initial shoulder rating score was 47 and follow up score was 68.4. In the analysis of above results, operative treatment was effective when symptoms are persistent and fail to respond to conservative management.
Decompression ; Female ; Follow-Up Studies ; Humans ; Male ; Shoulder

Fifteen shoulders in 15 patients with traumatic recurrent anterior dislocation were performed from Sept. 1993 to April 1994. The position in which the dislocation occurred were abduction and external rotation in 10 cases, but most likely direct injuries in the 13 cases. The average interval between the initial and second dislocation was 5.4 months, and the average frequency of dislocation was 15 times per year. Physically, crank test in 13, fulcrum test in 12, sulcus test in 4, and jerk test in 3 cases were positive. The classic Bankart lesions were 4 cases, the bony Bankart lesions in 11 cases, so all of them had an abnormal tension on the inferior glenohumeral ligament. The Hill-Sachs lesions were associated in 14 cases, the Superior Labrum Anterior Posterior lesion in 1 case. Traditional Bankart procedure in 12 cases, traditional method and shift surgery simultaneously for inferior laxity in 3 cases were performed. In 4 cases of bony Bankart lesion with large bone fragment, anterior capsule and subscapularis muslce was splitted during exposure. Velpeau sling was applied in a daytime for postoperative immobilization, exercise with 90° of flexion but no external rotation was permitted during 3 weeks after operation. After than 140° of flexion and 40° of flexion and averag 57° of external rotation. There was no recurrence in our series. The result at follow up were exellent in 9 cases, good in 6 cases.
Dislocations ; Follow-Up Studies ; Humans ; Immobilization ; Ligaments ; Methods ; Recurrence ; Shoulder

Indications for bone lengthening in the hand are less common than for the lower extremity. From 1991 to 1993 authors had performed nine hand bone lengthenings in the eight patients, based on callotasis and chondrodiastasis, Average age at the time of surgery was 18 years old(from 4 to 31 years old). Diagnoses included traumatic amputations in 7 cases and congenital syndactyly of both hand with hypoplastic digits in 2 cases. Sites of lengthening were metacarpal bone in 7 cases, phalangeal bone in 2 cases. Eight of 9 lengthening procedures resulted in complete consolidation of the bone gap after the single stage procedure. In one case secondary bone graft was required for the bone defect. Average consolidation period was 16 weeks(from 10 weeks to 22 weeks). Average gained length was 14.6mm (from 6 to 30mm) and average percent of gained digital bone length was 48%. There were minimal complications including marginal necrosis of skin, numbness and bone tip exposure and were responsed to conservative manage, but stump revision for bone tip exposure was performed in one case. In all cases followed to completion and for 1 to 3 years postoperatively, there was improvement of function with key pinch. The callotasis lengthening is one of the useful method of short hand bone lengthening to improve function of hand and cosmetic demand.
Amputation, Traumatic ; Bone Lengthening ; Diagnosis ; Fingers ; Hand ; Humans ; Hypesthesia ; Lower Extremity ; Methods ; Necrosis ; Osteogenesis, Distraction ; Skin ; Syndactyly ; Transplants

BACKGROUND: The purpose of our study was to evaluate the functional and radiologic outcomes of additive augmentation sutures through rotator cuff for proximal humeral fractures stabilized locking plate in elderly patients. METHODS: We enrolled 74 patients over the age of 60 years who received internal fixation using locking plates for proximal humeral fractures. Of these, 50 patients had additive augmentation sutures through rotator cuff. The mean age at the time of surgery was 72.1 years (range, 60-89 years), and the mean follow-up period was 17.5 months (range, 12-62 months). The humeral neck-shaft angle and humeral head height were used as radiological markers to assess the effect of additive augmentation sutures through rotator cuff. We allocated the patients who received additive augmentation sutures into group A and those who did not into group B. RESULTS: At the final follow-up, the mean Korean Showlder Society score and Constant scores were 88.96 +/- 12.1 and 86.6 +/- 11.9, respectively, in group A and 86.21 +/- 11.8 and 85.3 +/- 11.7, respectively, in group B (p=0.368, 0.271). At the final follow-up, the mean loss in humeral neck-shaft angle from the time of immediate postoperative measurement was 1.6degrees in group A and 4.8degrees in group B, whereas the mean loss in humeral head height was 0.82 mm in group A and 0.52 mm in group B (p=0.029, 0.178). CONCLUSIONS: The surgical outcomes of internal fixation using locking plates for proximal humeral fractures were clinically and radiologically good in elderly patients over the age of 60 years without any observable complications. Further, the loss of humeral head shaft angle at the final follow-up from its initial postoperative measurement was significantly smaller in patients who received an additive augmentation suture than in those who did not. Thus, we conclude that augmentation sutures are a beneficial option for elderly patients that clinicians can consider at the time of surgical decision making.
Aged* ; Decision Making ; Follow-Up Studies ; Humans ; Humeral Head ; Rotator Cuff ; Shoulder Fractures* ; Sutures*

The purpose of this study is to evaluate the morphologic findings of the labrum and capsuloligamentous structures in the normal and unstable shoulders and to compare the effectiveness of double contrast arthrographic findings which were taken with supine and prone position. We reviewed the computerized tomographic arthrogram in 9 cases of normal shoulder and l3 cases of shoulder instability. We evaluated the shape of the labrum, the attachment of anterior capsule and the amount of capsular laxity. Capsular laxity was compared each others in normal, the unidirectional instability and the multidirectional instability. Among these materials, we simultaneously performed CT arthrogram with supine and prone position and evaluated which is more reliable and accurate. Scapular inclination was ahout 25 degrees in the supine position and ahout 60 degrees in the prone position. Normal glenoid labrum varied in size and shape, so its lack of a classic appearance might not indicate a labral tear. Variations existed in the anterior capsular attachment onto the glenoid. The anterior capsule was used to attach far away from the glenoid rim. but it might not indicate an anterior instability. With the prone position, the labral lesion took more excellent visualization due to the contrast coating on the glenoid labrum in both anterior and posterior. Anterior capsular expansion was seen well with prone position in anterior instability. In summary, for proper interpretation of the instability, awareness of the morphologic variations of the labrum and capsuloligamentous structure is important. CT double contrast arthrography with prone position has made a significant contribution to improving and easing the documentation of variety of anatomic abnormalities. Now we recommend the prone position in CT arthrogram for imaging glenoid labrum pathology in shoulder instability.
Arthrography ; Pathology ; Prone Position ; Shoulder* ; Supine Position