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Orthogonal versus Parallel Plating for Distal Humeral Fractures.

Clinics in Shoulder and Elbow.2015;18(2):105-112. doi:10.5397/cise.2015.18.2.105

In orthopedic trauma surgery, treatment of intraarticular distal humerus fractures is a challenge. With development of implants and biomechanical studies, surgical strategies with recommendations including preoperative computed tomography images, proper approaches and open reduction and internal fixation with dual plates have emerged. In addition, as an effort to provide stable fixation to permit early elbow motion, different methods of internal fixation, particularly plate configuration, have evolved. Using dual plates, either oriented parallel to each other or orthogonal, stable fixation has been achieved and satisfactory clinical outcomes have been reported. With rationales and advantages/disadvantages of each plate configuration, both techniques are selected according to surgeons' preference, and, in specific cases, one could be preferred over another. The key to successful fixation by either technique is obtaining anatomical reduction with restoration of two stable columns of the distal humerus.
Elbow ; Fracture Fixation ; Humeral Fractures* ; Humerus ; Orthopedics

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A Ganglion Cyst Formed after Anterior Transposition of the Ulnar Nerve: A Case Report.

Young Bae KIM ; Jung Ro YOON ; Woo Seung LEE ; Jae Hyuk YANG ; Hoonnyun LEE

Clinics in Shoulder and Elbow.2015;18(2):102-104. doi:10.5397/cise.2015.18.2.102

In this report, a case of a 70-year-old man with a large ganglion cyst formed after anterior transposition of the left ulnar nerve is presented. Three months after the index surgery, the patient presented with a painless superficial ovoid, soft mass measuring 5x4x2 cm in size located at the posteromedial aspect of the left elbow, the previously operated site. Magnetic resonance imaging showed a well demarcated cystic mass with a stalk connecting to the elbow joint. Excisional biopsy was performed and pathologic findings showed that the cystic wall had no definite lining cells with myxoid degeneration compatible with findings of ganglion cyst.
Aged ; Biopsy ; Cubital Tunnel Syndrome ; Elbow ; Elbow Joint ; Ganglion Cysts* ; Humans ; Magnetic Resonance Imaging ; Ulnar Nerve*

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Three Cases of Rare Anatomic Variations of the Long Head of Biceps Brachii.

Sang Ho KWAK ; Seung Jun LEE ; Byung Wook SONG ; Min Soo LEE ; Kuen Tak SUH

Clinics in Shoulder and Elbow.2015;18(2):96-101. doi:10.5397/cise.2015.18.2.96

In general, the long head of the biceps brachii originates from the superior glenoid labrum and the supraglenoid tubercle, crosses the rotator cuff interval, and extends into the bicipital groove. However, rare anatomic variations of the origins of the long head have been reported in the past. In this report, we review the clinical history, radiologic findings, and arthroscopic identifications of 3 anatomic variants of the biceps tendon long head. As the detection of long head of biceps tendon pathology during preoperative radiologic assessment can be difficult without prior knowledge, surgeons should be aware of such possible anatomic variations.
Anatomic Variation ; Head* ; Pathology ; Rotator Cuff ; Shoulder ; Tendons

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Comparing the Use of Single and Double Interlocking Distal Screws on a Polarus Intramedullary Nail for Humeral Shaft Fractures.

Hee Seok YANG ; Jeong Woo KIM ; Hong Je KANG ; Jung Hyun PARK ; Yong Chan LEE ; Kwang Mee KIM

Clinics in Shoulder and Elbow.2015;18(2):91-95. doi:10.5397/cise.2015.18.2.91

BACKGROUND: Our aim was to make a comparative analysis of radiological and clinical outcomes of using either one or two interlocking distal screws on a Polarus intramedullary nail for the internal fixation of humeral shaft fractures. METHODS: From January 2008 to March 2014, we enrolled 26 patients with humeral shaft fractures who were operated on using intramedullary nails. The patients were divided into 2 groups according to how many interlocking distal screws were used to lock the Polarus nail: in group 1, a single interlocking distal screw was used in 12 patients; and in group 2, double interlocking distal screws, in 14 patients. We compared the degree of recovery of the displaced fracture fragments between the two groups. To compare the nonunion and shoulder function, we assessed each patient's modified American Shoulder and Elbow Surgerns (ASES) score. RESULTS: We found that 10 of 12 fractures achieved union in group 1, and 13 of 14 fractures, in group 2. We did not find a meaningful difference in the time to bone union between the two groups. The percentage of recovery of displaced fracture fragments until union was 66.9% for group 1 and 59.41% for group 2. At the final follow-up, we found that the scores for shoulder joint modified ASES was 78.7 for group 1 and 80.7 for group 2. CONCLUSIONS: Our results show that if locked appropriately, even a single screw on a Polarus nail can provide satisfactory radiological union and improved clinical outcome after intramedullary nailing of humeral shaft fractures.
Bone Screws ; Elbow ; Follow-Up Studies ; Fracture Fixation, Intramedullary ; Humans ; Humeral Fractures ; Shoulder ; Shoulder Joint

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Evaluation of Focal Bone Mineral Density Using Three-dimensional Measurement of Hounsfield Units in the Proximal Humerus.

Young Lae MOON ; Sung JUNG ; Sang Ha PARK ; Gwi Youn CHOI

Clinics in Shoulder and Elbow.2015;18(2):86-90. doi:10.5397/cise.2015.18.2.86

BACKGROUND: Although there are several methods for evaluating bone quality, Hounsfield units (HU), a standardized computed tomography (CT) attenuation coefficient, provide a useful tool for estimating focal bone mineral density (BMD). The aim of this study is to investigate the HU for evaluating the degree of osteoporosis in greater tuberosity with regard to anchor positioning. METHODS: Forty patients diagnosed as normal on shoulder CT were included and categorized according to age and gender. Axially sectioned CT images were processed to 3-dimensional models containing information about bone quality using Mimics (14.11 platform v14.1.1.1 Materialise). Three-dimensional anchors were simulated and positioned according to 6 regions of interest (ROI) in the greater tuberosity classified using Tingart's system. Mean HU of intra-anchor volumes in the 6 regions was measured. RESULTS: A significant decrease in HU was observed with increasing age (p=0.0001) and menopause (p<0.001). A significant difference in HU was found between male and female groups with males showing the higher values (p=0.0001). HU of proximal areas of ROI was higher than those of distal areas (p<0.005). However, although mean HU of distal posterior ROI showed the lowest values, no statistically significant difference was found between anterior, middle, and posterior regions (p=0.087). CONCLUSION: Mean HU of ROIs provides a tool for preoperative assessment of focal BMD, which is a factor of suture anchor stability and can be used to aid decision-making regarding secure anchor positioning for rotator cuff repair. Our data support that the most secure point is the proximal regions of ROI.
Bone Density* ; Female ; Humans ; Humerus* ; Male ; Menopause ; Osteoporosis ; Rotator Cuff ; Shoulder ; Suture Anchors

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Adrenal Insufficiency in Patients with Rotator Cuff Tear: Prevalence, Risk Factors and Influence on Outcome.

Jung Han KIM ; Heui Chul GWAK

Clinics in Shoulder and Elbow.2015;18(2):80-85. doi:10.5397/cise.2015.18.2.80

BACKGROUND: This study measured the rate of adrenal insufficiency among rotator cuff tear patients, and determined the roles of steroid treatment and herbal medicine as specific risk factors of adrenal insufficiency. METHODS: We prospectively evaluated the 53 patients who agreed to participate in the study and underwent arthroscopic rotator cuff repair due to a chronic full-thickness tear from March 2012 to September 2013. The diagnosis of adrenal insufficieny was made by rapid adrenocortical hormone test before the operation. We collected information regarding their history of steroid and herbal medicine treatment within the last 12 months. RESULTS: The rate of adrenal insufficiency among the rotator cuff tear patients in our study was 18.9% (10 of 53 patients). Steroid treatment (p=0.034), frequency of local steroid injection (p=0.008), and herbal medicine treatment (p=0.02) showed significant association with the risk of adrenal insufficiency. CONCLUSIONS: In this study, careful taking of a patient's medical history, such as the use of steroids and herbal medicine, is important when investigating adrenal function before surgery.
Adrenal Insufficiency* ; Diagnosis ; Herbal Medicine ; Humans ; Prevalence* ; Prospective Studies ; Risk Factors* ; Rotator Cuff* ; Steroids

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Comparative Analysis of the Result of Minimally Invasive Anterior Plating and Open Reduction and Internal Fixation in Humerus Shaft Simple Fracture.

Sang Hun KO ; Chang Gyu CHOE ; Ju Hyung LEE

Clinics in Shoulder and Elbow.2015;18(2):75-79. doi:10.5397/cise.2015.18.2.75

BACKGROUND: This retrospective comparative study aims to evaluate the surgical outcomes and complications of two surgical methods for simple fractures of the humeral shaft; minimally invasive anterior plating and open reduction combined with internal fixation. METHODS: A total of 26 patients with humeral shaft simple fractures, who had surgery between June 2009 and September 2013 and were followed-up at least 12 months, were included in our analysis. They were divided into two groups; group 1 comprised of 12 patients who underwent minimally invasive anterior plating and group 2 comprised of 14 patients who underwent an open reduction and internal fixation. The clinical outcomes, radiological results, and complications were compared and analyzed. RESULTS: We found that bone union was achieved in all patients, and the mean union periods were 20.7 +/- 3.34 and 20.3 +/- 3.91 weeks for groups 1 and 2, respectively. In most patients, we found that shoulder and elbow functions were recovered. At 12 months post-operation, we found that the Korean Shoulder Scoring system, the University of California at Los Angeles score and Mayo elbow performance score were 91.4 +/- 7.97, 33.4 +/- 1.15, and 90.8 +/- 2.23 for group 1, and 95.2 +/- 1.53, 33.3 +/- 1.43, and 90.17 +/- 1.85 for group 2. In terms of complications, we found that 2 patients had radial nerve palsy after open reduction and internal fixation, but all cases spontaneously resolved within 6 months. Complications such as infection and loss of fixation were not reported. CONCLUSIONS: Both minimally invasive anterior plating and open reduction with internal fixation produced satisfactory outcomes in the treatment of simple fractures of the humeral shaft.
California ; Elbow ; Fracture Fixation, Internal ; Humans ; Humeral Fractures ; Humerus* ; Paralysis ; Radial Nerve ; Retrospective Studies ; Shoulder

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Efficacy of Additive Trans-cuff Augmentation Sutures for Proximal Humeral Fractures Stabilized by Locking Plates in Elderly Patients.

Nam Su CHO ; Hee Seok SHIM ; Sang Hyeon LEE ; Jong Wook JEON ; Yong Girl RHEE

Clinics in Shoulder and Elbow.2015;18(2):68-74. doi:10.5397/cise.2015.18.2.68

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*

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Degeneration Exists along the Entire Length of the Supraspinatus Tendon in Patients with a Rotator Cuff Tear.

Chris Hyunchul JO ; Mee Soo CHANG

Clinics in Shoulder and Elbow.2015;18(2):61-67. doi:10.5397/cise.2015.18.2.61

BACKGROUND: The purposes of the study were to examine rotator cuff tendon degeneration with respect to harvesting location, to determine a rationale for debridement of the torn end, and thus, to determine adequate debridement extent. METHODS: Twenty-four patients with a full-thickness rotator cuff tear were included in the study. Tendon specimens were harvested during arthroscopic rotator cuff repair from three locations; from torn ends after minimal regularization of fraying (native end group, NE group), from torn ends after complete freshening of the frayed end (freshened end group, FE group), and from the macroscopically intact portion just distal to the musculotendinous junction (musculotendinous junction group, MTJ group). Control samples were harvested from patients admitted for surgery for proximal humerus fracture. Harvested samples were evaluated using a semi-quantitative grading scale. RESULTS: Mean total degeneration scores in the NE group (13.3 +/- 3.21), the FE group (12.5 +/- 2.30), and in the MTJ group (10.8 +/- 3.10) were significantly higher than those in the normal control group (5.0 +/- 2.87; all P>0.001). Mean total degeneration score in the NE group was significantly higher than that in the MTJ group (p=0.012), but was not from that of the FE group. Mean total degeneration score in the FE group was not significantly different from that of the MTJ group. CONCLUSIONS: Tendon degeneration exists throughout the entire tendon to the macroscopically intact portion of full-thickness rotator cuff tear. Therefore, aggressive debridement to grossly normal appearing, bleeding tendon is unnecessary for enhancing healing after repair.
Debridement ; Hemorrhage ; Humans ; Humerus ; Rotator Cuff* ; Tendons*

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Eulogy: In Memory of Stephen A. Copeland, the Father and Friend in Shoulder Surgery and Orthopedics.

Young Kyu KIM

Clinics in Shoulder and Elbow.2015;18(2):59-60. doi:10.5397/cise.2015.18.2.59

No abstract available.
Fathers* ; Friends* ; Humans ; Memory* ; Orthopedics* ; Shoulder*

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