Although the concept of a single elbow dislocation mechanism, in which all dislocations start from the lateral side of the elbow joint and progress to the medial side, has never been able to explain the various conflicting experimental and clinical observations thus far, new studies and proposals for a valid mechanism have not been reported. The new proposal for posteromedial and posterolateral dislocation of the elbow joint according to the authors' study and the new treatment algorithm based on this new study can explain the various clinical and experimental results that have been difficult to explain, and provide a reasonable approach to the treatment of elbow dislocations.
Dislocations ; Elbow Joint ; Elbow

BACKGROUND: The study of conservative and surgical treatment of distal biceps tendinopathy and associated biceps tendon partial rupture. METHODS: Twenty-one cases with distal biceps tendonitis and partial ruptures were studied who visited Pohang Semyeong Christianity Hospital from June 2010 to August 2017. The mean age was 57.1 years (39–69 years), 14 males and 7 females. The mean duration of symptom at the time of first visit was 4.9 months (0.2–14 months). Ultrasonography and magnetic resonance imaging were performed for patients with severe symptoms. According to the severity of the symptoms, splint immobilization, oral nonsteroidal anti-inflammatory drugs, and ultrasound-guided steroid injection were performed. Surgical treatment was performed if the patient did not respond to conservative treatment for 3 to 6 months or longer. RESULTS: There were 9 cases of partial rupture of the distal biceps tendon associated with distal biceps tendinopathy on imaging studies. Conservative treatment showed symptomatic improvement in 16 of 21 cases. In 4 cases with a relatively mild symptom, anti-inflammatory analgesics and intermittent splinting showed good result. In 12 cases, symptoms improved after ultrasonography-guided steroid injection. Surgical treatment was performed on 5 cases that did not respond to conservative treatment. CONCLUSIONS: Conservative treatment of distal biceps tendinopathy may promise good results. However, in case of partial tear of the distal biceps tendon and refractory to conservative treatment, surgical treatment may be needed.
Anti-Inflammatory Agents, Non-Steroidal ; Christianity ; Female ; Gyeongsangbuk-do ; Humans ; Immobilization ; Magnetic Resonance Imaging ; Male ; Rupture ; Splints ; Tears ; Tendinopathy ; Tendons ; Ultrasonography

Extraskeletal chondromas are benign soft tissue tumor of hyaline cartilage. These tumors are rare and the pathogenesis is unclear. They are usually involves the hand or feet. We report the case of extraskeletal chondroma arising from subungual region of the finger with nail deformity and review of the literature.
Chondroma* ; Congenital Abnormalities* ; Fingers ; Foot ; Hand ; Hyaline Cartilage

PURPOSE: To investigate mid-term clinical outcomes of various methods of scapholunate reconstruction for chronic scapholunate instability. METHODS: We retrospectively reviewed 11 patients diagnosed as chronic scapholunate instability, from 2005 to 2013 and followed up for more than one year after surgery. 7 patients were treated with Garcia technique of triple ligament reconstruction, 2, bone-ligamemt-bone repair, and 2, dorsal capsulodesis. Mean age was 42 years (range, 23-61 years). The right side was involved in 6 patients, and the left in 5. The follow-up period averaged 42 months (range, 13-125 months). The postoperative functional outcomes were assessed with Modified Mayo wrist score (MMWS), disability of the arm, shoulder and hand (DASH) score and range of motion. The postoperative radiologic results were analyzed with the change of scapholunate angle and distance. RESULTS: The mean MMWS score improved from 65 preoperatively to 77 postoperatively (p=0.072). The mean DASH score improved from 29.4 (range, 18.3-43.3) preoperatively to 12.7 (range, 0-38.3) postoperatively (p=0.003). The dorsiflexion increased from 67° to 78°, the volar flexion decreased from 51° to 45°, the supination increased from 69° to 88°, and the pronation increased from 62° to 66°. The SL angle changed from 55° preoperatively to 51° postoperatively, the mean SL distance changed from 3.4 mm preoperatively to 1.7 mm postoperatively. CONCLUSION: The chronic scapholunate instability is amenable to various techniques and postoperative functional outcomes improved satisfactory.
Arm ; Follow-Up Studies ; Hand ; Humans ; Ligaments* ; Pronation ; Range of Motion, Articular ; Retrospective Studies ; Shoulder ; Supination ; Wrist

PURPOSE: To introduce the technique of reducing displaced or comminuted clavicle shaft fracture using composite wiring and report the clinical results. MATERIALS AND METHODS: Between March 2006 and December 2013, 31 consecutive displaced clavicle fractures (Edinburgh classification 2B) treated by anatomic reduction and internal fixation using composite wiring and plates were retrospectively evaluated. The fracture fragments were anatomically reduced and fixed with composite-wiring. An additional plate was applied. Radiographic assessments for the numbers of fragments, size of each fragment and amount of shortening and displacement were performed. The duration for fracture union and complications were investigated retrospectively. The mean fallow-up duration was 15.9 months. RESULTS: The mean number of fragments was 1.7 (1-3) and the mean width of fracture fragment was 7.1 mm (4.5-10.6 mm). The mean shortening of the clavicle was 20.5 mm (10.3-36.2 mm). The mean number of composite wires used in fixation was 1.9 (1-3). Radiographic union was achieved in all patients with a mean time to union of 11.6 weeks. There were no complications including metal failure, pin migration, nonunion, or infection. CONCLUSION: The composite wiring was suitable for fixation of small fracture fragment and did not interfere with the union, indicating that it is useful for treatment of clavicle shaft fracture.
Classification ; Clavicle* ; Fractures, Comminuted ; Humans ; Retrospective Studies

PURPOSE: To investigate short term clinical outcomes of the open surgical repair for triangular fibrocartilage complex (TFCC) foveal detachment. METHODS: We retrospectively reviewed 8 patients (5 men, 3 women) who had been treated with open surgical repair of the TFCC type 1B injury, from 2005 to 2013 and who were followed up for more than one year after surgery. Mean age at time of surgery was 34 years. The right side was involved in 3 patients, and the left in 5. The clinical results of surgery were assessed with modified Mayo wrist score (MMWS), disabilities of the arm, shoulder and hand (DASH) score and pain-visual analogue scale (VAS). Physical examination was performed to evaluate the prescence of distal radioulnar instability, preoperatively and at the latest follow-up. RESULTS: The mean follow up period were 36.5 months (range, 12-64 months). The mean MMWS improved from 52.5 (range, 25-85) preoperatively to 82.5 (range, 75-100) postoperatively (p=0.02). The mean DASH score improved from 39.6 (range, 65-13.5) preoperatively to 13.4 (range, 2.5-33.3) postoperatively (p=0.012). The preoperative mean pain-VAS was 4.6 (range, 6-3); these value was reduced to mean 2 (range, 0-3) at the latest follow-up (p=0.016). There were no patients remaining instability after the surgery, although four patients showed distal radioulnar joint (DRUJ) instability before surgery. CONCLUSION: The surgical outcomes of open repair for TFCC foveal detachment (type 1B) was contentable. Also, in cases of type 1B injury associated with DRUJ instability were managed sucessfully without additional procedure.
Arm ; Follow-Up Studies ; Hand ; Humans ; Joints ; Male ; Physical Examination ; Retrospective Studies ; Shoulder ; Triangular Fibrocartilage* ; Wrist

Most common traumatic type 1B tear of triangular fibrocartilage complex (TFCC), according to the Palmer's classification, may lead to the loss of the stability of distal radioulnar joint and is known to be one cause of the persisted ular side wrist pain. Recently as the knowledge of the anatomical structures of the TFCC accumulates and the deep fiber of the distal radioulnar ligament is recognized to play a central role, an attempt to repair it to the original ulnar fovea insertion site has been done and reported successful results. Since the introduction of open technique, numerous arthroscopic technique has been developing. Here careful considerations ought to be given during open repair will be taken with review of the related articles.
Classification ; Joints ; Ligaments ; Triangular Fibrocartilage* ; Wrist

PURPOSE: To evaluate the surgical results of distal radioulnar fractures managed by open reduction and internal fixation for the fractures of the distal radius and excision of the fractured fragments and ECU tenodesis for the comminuted fractures of ulnar head and neck. METHODS: Six cases of combined fractures of the distal radius and ulna were enrolled. Distal radius fractures were fixed by ORIF with AO locking plate without bone graft. The comminuted fragments of distal ulnar head and neck were excised and the tenodesis using half strip of ECU was added to stabilize the proximal ulnar stumps. After immobilization for 6 weeks, active ROM exercise started. The change of radial inclination and volar tilt, the ulnar shift and collapse of carpal bone and ulnar impingement were investigated with simple X-ray. Patients were assessed with residual subjective symptoms and modified Mayo wrist score (MMWS). All were female and average age was 68(58~75) years. Average follow up was 23(10~50) months. RESULTS: Resting pain was absent in all patients but heavy lift made them feel weakness and discomfort intermittently. All patients returned to the normal daily activities except one patient handicapped by hemiplegia. The average range of motion and grip power was 89% and 85% compared to the contralateral side respectively. The average MMWS was 87(75~95). The postoperative loss of the reduction of the distal radius was not observed in follow up X-ray. CONCLUSION: ORIF of distal radius fractures associated with the excision of the distal ulnar fragments and stabilization procedure using half strip of ECU may be one good method for the treatment of the fractures of the distal radius combined with the comminuted distal ulnar fractures difficult to be managed by ORIF. The intermittent weakness felt in this method made it not suitable in young active patient doing heavy work. AO locking plate was strong enough to maintain reduction until bone union.
Carpal Bones ; Disabled Persons ; Female ; Follow-Up Studies ; Fractures, Comminuted ; Hand Strength ; Head ; Hemiplegia ; Humans ; Immobilization ; Neck ; Radius ; Radius Fractures ; Range of Motion, Articular ; Tenodesis ; Transplants ; Ulna ; Wrist

PURPOSE: We wanted to evaluate the surgical results of early mobilization after rigid fixation of small coronoid fracture using the tension band technique MATERIALS AND METHODS: Eight cases of coronoid fracture were fixed with the tension band technique and using K-wire and wire through the medial approach. All the cases were Regan-Morrey type 2. According to O'Driscoll, they were classified as 5 cases of the tip type (subtype 2) and 3 cases of the anteromedial type (1 case of subtype 2, and 2 case of subtype 3). The associated collateral ligament injuries (6 cases) and radial head/neck fractures (4 cases) were managed simultaneously. After immobilization for 5~7 days, active ROM exercise with a fitted hinge brace started and continued till postoperative 6 weeks. The patients were assessed for pain, ROM and functional disability using the Mayo elbow performance score (MEPS) at an average of 11 months (range: 6~28 months). The ulnar nerve symptoms were also investigated. RESULTS: We observed solid union in all the coronoid fractures without hardware failure. An average of 2.2 wires (range: 2~4) were used. The mean extension was 3degrees (range: 0degrees~25degrees), the mean flexion was 137degrees (range: 130degrees~140degrees), the mean pronation was 69degrees (range: 45degrees~90degrees) and the mean supination was 78degrees (range: 45degrees~90degrees). The mean MEPS was 96 (range: 65~100). Ulnar nerve symptoms occurred at postoperative one day and persisted in one patient with the terrible triad of taking radial head excision and residual medial instability. CONCLUSION: The tension band technique uses easily obtained, economic K-wires and the wire was strong enough to permit early elbow ROM exercise and the technique might improve the elbow function. It was especially useful for fixation of multiple small fragments.
Braces ; Collateral Ligaments ; Early Ambulation ; Elbow ; Elbow Joint ; Head ; Humans ; Immobilization ; Pronation ; Supination ; Ulnar Nerve

PURPOSE: To evaluate the results of the external neurolysis of the scarred peripheral nerves present with the posttraumatic neuralgia refractory to the conservative treatment for at least 6 months with or without vein wrapping and/or free fat graft to prevent scar reformation. MATERIALS AND METHODS: In 8 patients with posttraumatic neuralgia of the peripheral nerve unresponsive to conservative treatment for at least 6 months, only neurolysis was done in 6 cases. Vein wrapping with free fat graft was concomitantly added after neurolysis in one case and free fat graft was added in the other case. The inclusion criteria were neuralgia felt anatomically along the affected nerve, positive Tinel sign at the scarred site and aggravation of pain with passive motion of the adjacent joint. Affected were digital nerves (two cases), ulnar nerve at the wrist (one case), median nerve (one case), peroneal nerve around knee (one case), posterior tibial nerves (two cases) and plantar nerve (one case). Patients were assessed for the disappearance of neuralgia and Tinel sign and subjective satisfaction with VAS (no pain, 0 and no change or aggravated, 10 compared to contra-lateral side) RESULT: Neuralgia was absent in four cases and persisted in four cases. Average VAS was 5.8 (0~10). According to the degree of the scarred surroungings, neuralgia was persisted after only neurolysis in four cases of the severely scarred 5 cases, but in one case having free fat graft added, neuralgia was absent. In partially scarred two cases, neurolysis with or without additional procedures (free fat graft and vein wrapping) brought the same result of VAS. In one case of good surroundings, neuralgia was absent after neurolysis. Tinel sign was absent in 4 cases where neuralgia had disappeared. CONCLUSION: Prevention of re-adhesion after neurolysis seems to be very important to yield good results. Vein wrapping and/or free fat grafting may be effective methods to be applicable if the adjacent tissue looks scarred
Cicatrix ; Humans ; Joints ; Knee ; Median Nerve ; Neuralgia ; Peripheral Nerves ; Peroneal Nerve ; Tibial Nerve ; Transplants ; Ulnar Nerve ; Veins ; Wrist