BACKGROUND: The purpose of this study is to assess the range of shoulder motion using an indirect evaluation method without physical examinations of patients based on questionnaires regarding several specific arm postures referenced by patient's own body parts. METHODS: Nine criteria of specific shoulder motion including 4 forward flexion, 2 external rotation, and 3 internal rotation were decided as reference position which can represent a certain shoulder motion. Flexion contains postures such as lifting arm to waist-height, shoulder-height, eye-height, and raising arm above head with arm touching ears. External rotation comprises grasping ears and placing hands on back of the head. Vertebral height in internal rotation is determined by calculating the samples' motions, which are holding on to trouser belts, opposite-elbow, and scapula. These postures are included in questionnaires for patients to evaluate the validity and effectiveness of this indirect method. RESULTS: The range of flexion was 77degrees (60degrees to 100degrees), 96degrees (87degrees to 115degrees), 135degrees (115degrees to 150degrees), and 167degrees (150degrees to 175degrees) when arms go up to waist, shoulder, eye, and high vertically. Range of external rotation was 39.6degrees (30degrees to 50degrees) when grasping ears and 69.2degrees (60degrees to 80degrees) with the hands on the back of the head. Range of internal rotation was L4 when placing trouser belts, T12 for holding opposite elbow, and T9 for reaching scapula. The mismatch rates of flexion, external rotation, and internal rotation were 11.6%, 9.6%, and 7.8%. CONCLUSIONS: The range of shoulder motion using this method is expected to be applied to an established shoulder scoring system which included shoulder motion evaluation item.
Arm ; Ear ; Elbow ; Hand ; Hand Strength ; Head ; Human Body* ; Humans ; Lifting ; Physical Examination ; Posture ; Range of Motion, Articular ; Scapula ; Self-Assessment ; Shoulder Joint ; Shoulder* ; Telephone ; Surveys and Questionnaires

BACKGROUND: The purpose of this study is to assess the range of shoulder motion using an indirect evaluation method without physical examinations of patients based on questionnaires regarding several specific arm postures referenced by patient's own body parts. METHODS: Nine criteria of specific shoulder motion including 4 forward flexion, 2 external rotation, and 3 internal rotation were decided as reference position which can represent a certain shoulder motion. Flexion contains postures such as lifting arm to waist-height, shoulder-height, eye-height, and raising arm above head with arm touching ears. External rotation comprises grasping ears and placing hands on back of the head. Vertebral height in internal rotation is determined by calculating the samples' motions, which are holding on to trouser belts, opposite-elbow, and scapula. These postures are included in questionnaires for patients to evaluate the validity and effectiveness of this indirect method. RESULTS: The range of flexion was 77degrees (60degrees to 100degrees), 96degrees (87degrees to 115degrees), 135degrees (115degrees to 150degrees), and 167degrees (150degrees to 175degrees) when arms go up to waist, shoulder, eye, and high vertically. Range of external rotation was 39.6degrees (30degrees to 50degrees) when grasping ears and 69.2degrees (60degrees to 80degrees) with the hands on the back of the head. Range of internal rotation was L4 when placing trouser belts, T12 for holding opposite elbow, and T9 for reaching scapula. The mismatch rates of flexion, external rotation, and internal rotation were 11.6%, 9.6%, and 7.8%. CONCLUSIONS: The range of shoulder motion using this method is expected to be applied to an established shoulder scoring system which included shoulder motion evaluation item.
Arm ; Ear ; Elbow ; Hand ; Hand Strength ; Head ; Human Body ; Humans ; Lifting ; Physical Examination ; Posture ; Range of Motion, Articular ; Scapula ; Self-Assessment ; Shoulder Joint ; Shoulder ; Telephone ; Surveys and Questionnaires

Approximately 5-6% of distal radius fractures have a concomitant distal ulnar fracture, this incidence is more frequent in osteoporotic elderly patients. When the distal ulnar fracture is stable after fixation of the distal radius fracture, the distal ulnar fracture can be managed with cast immobilization. However, when the distal ulnar fracture shows malalignment or instability, an operative method should be used. The operative method for distal ulnar fracture includes internal fixation using a K-wire, intramedullary nail, or plates and salvage procedures including ulnar head resection or Sauve-Kapandji procedure. Approximately 50% of distal radius fractures are combined with ulnar styloid process fracture. Although approximately 50-70% of ulnar styloid process fractures result in nonunion if they are not treated by an operative method, they tend to be asymptomatic. Recent studies of distal radius fracture treated using a volar locking plate have generally reported that neither the presence nor the size of concomitant ulnar styloid fracture has an effect on clinical outcome.
Aged ; Head ; Humans ; Immobilization ; Incidence ; Nails ; Radius ; Radius Fractures

STUDY DESIGN: Retrospective study. OBJECTIVES: To demonstrate the fusion rate, degree of subsidence and donor site morbidity of anterior cervical interbody fusion with autogenous bicortical iliac bone graft and anterior cervical locking plate. SUMMARY OF THE LITERATURE REVIEW: In anterior cervical discectomy and fusion with autogenous tricortical iliac bone graft, a large percentage of patients report chronic donor site pain. MATERIALS AND METHODS: Retrospective research was done for 39 patients who underwent anterior cervical interbody fusion with autogenous bicortical iliac bone graft, from January 2006 to July 2011, with a follow up period of longer than 1 year. Fusion rates and subsidece of the graft is estimated with radiographs. Neck pain and donor site pain was estimated with visual analogue scale (VAS) and dysfunction was estimated with the neck disability index (NDI). RESULTS: A 95% of patients who underwent anterior cervical interbody fusion with autogenous bicortical iliac bone graft revealed definitive fusion with little amount of subsidence. The mean VAS score was 0.7 on the donor site and the mean NDI score was 3.8 at the final visit. There was excellent clinical outcome without complication at the donor site or the recipient site. CONCLUSIONS: Anterior cervical interbody fusion with autogenous bicortical iliac bone graft showed high fusion rates and minimal subsidence with excellent clinical outcomes. Therefore, bicortical iliac bone graft is an effective operational procedure in anterior cervical interbody fusion.
Diskectomy ; Follow-Up Studies ; Humans ; Neck ; Neck Pain ; Retrospective Studies ; Tissue Donors ; Transplants

PURPOSE: In the present study, the usefulness of single bone flexible intramedullary nail fixation in pediatric displaced both forearm bone shaft fractures was evaluated. MATERIALS AND METHODS: From 2006, we treated 14 consecutive pediatric both forearm bone shaft fractures using a single bone flexible intramedullary fixation. The average age of patients was 8.6 years (range, 3-12 years). We nailed the one bone of the two that showed either greater deformity in the initial radiographs, or difficulty in maintaining reduction, which in our cases was usually the radius. The operation time, duration of cast removal, functional recovery and complications were evaluated. The bony alignment, maintained until bony union, was analyzed by radiographic assessment. These data were compared with 27 cases of both bone nailing, which was the standard treatment in our institution prior to 2006. RESULTS: All cases in both groups healed without secondary intervention. All cases recovered to a normal functional status after postoperative average 12 weeks. In regards to their clinical and radiographic results, there was no significant difference between the single bone fixation group and the both bone fixation group, except that there was a shorter operation time, and longer period of cast immobilization, for the single bone fixation group. CONCLUSION: Single bone flexible intramedullary fixation is a useful method for the treatment of displaced forearm bone shaft fractures in children. The strategy of fixating the bone that exhibits greater deformity or difficulty in maintaining reduction, which was usually the radius, was found to be effective in our cases.
Bone Nails ; Child ; Congenital Abnormalities ; Forearm ; Humans ; Immobilization ; Nails ; Radius

PURPOSE: The present study aims at evaluating our results of intramedullary decompression of the unicameral bone cysts in children with using flexible nail(s) or titanium cannulated screws. MATERIALS AND METHODS: We treated fourteen children with unicameral bone cysts by intramedullary decompression. Eleven cases were in the metaphysis of long bones (seven in the proximal humerus amd four were in the proximal femur), which were all treated by flexible intramedullary nailing; while a cancellous screw was axially placed in three cysts of the short bones (all in the calcaneus). The mean age of the patients at the time of surgery was 11.8 years, and the mean duration of follow-up was 16.7 months. The final outcome was radiographically classified into the four categories of Capanna et al.,; completely healed, healed with residual radiolucency, recurred or having no response. RESULTS: All of the cysts In the long bones responded to treatment. Seven cysts healed completely, and three healed with residual radiolucent areas visible on radiographs. One cyst, which initially appeared completely healed, recurred after the removal of nails. The healing period varied from three to 36 months. For the calcaneal cysts, there was no definite sign of effective consolidation in all three cases. CONCLUSION: Intramedullary decompression by flexible nailing for the treatment of unicameral bone cyst of a long bone was effective in providing early stability and for accelerating consolidation of the cyst. Its surgical intervention is minimal, and the result is predictable. Our trial of placing a screw in the calcaneal cysts was unsuccessful according to the short term follow-up.
Bone Cysts ; Child ; Decompression ; Follow-Up Studies ; Humans ; Humerus ; Nails ; Titanium

Cubitus varus deformity of the elbow may not only cause cosmetic problems, but delayed functional deficiencies also. This case report demonstrated delayed posterolateral rotatory instability due to lateral collateral ligament complex avulsion long after posttraumatic cubitus varus. Satisfactory results were obtained using cubitus varus correction and reattachment of the lateral collateral ligament complex to the lateral epicondyle of the humerus.
Congenital Abnormalities ; Elbow* ; Humerus ; Lateral Ligament, Ankle

PURPOSE: evaluate the radiologic and clinical results of modified step-cut osteotomy for correction of cubitus varus deformity in children. MATERIALS AND METHODS: We analysed 16 children who had varus deformity preoperatively and received modified step-cut osteotomy. The results were evaluated by final follow-up radiographs and clinical results, which were humeral-elbow-wrist angle, lateral prominence, range of motion and complications. RESULTS: The average preoperative humeral-elbow-wrist (HEW) angle was -15.8degrees and average last follow-up HEW angle was +6.7degrees Lateral prominence under 5 mm occurred in 3 cases and one children showed limited motion and transient ulna neuropathy. CONCLUSION: The results demonstrate that modified step-cut osteotomy achieve good correction of cubitus varus without lateral bony prominence or complications.
Child* ; Congenital Abnormalities* ; Follow-Up Studies ; Humans ; Humerus* ; Osteotomy* ; Range of Motion, Articular ; Ulna

Metaphyseal chondrodysplasia (MCD) is a relatively rare hereditary disease of the skeletal system, in which disproportionate dwarfism sparing the trunk is noted. Among the four subtypes of MCD, the Schmid type is relatively common and shows minimal clinical abnormalities. We report a boy, diagnosed to have MCD, Schmid type, and who was followed-up for 17 years until skeletal maturity, during this period he underwent proximal femoral valgus osteotomies as well as tibial deformity correction with lengthening and femoral lengthening procedures.
Congenital Abnormalities ; Dwarfism ; Follow-Up Studies* ; Genetic Diseases, Inborn ; Humans ; Male ; Osteotomy

BACKGROUND: Matrix metalloproteinase (MMP)-1 and 3 are the most important degradating enzymes of the chondroid matrix. Chondrocytes may undergo apoptosis under various stimuli including nitric oxide (NO). We studied the expression rate and zone of MMP-1, MMP-3, nitrotyrosine, a marker of NO release, and apoptosis in the articular cartilage of human osteoarthritis. METHODS: To investigate the role of nitrotyrosine and apoptosis in the degradation of the chondroid matrix in human osteoarthritis, immunohistochemistry was done for MMP-1, MMP-3, and nitrotyrosine; and the terminal deoxynucleotidyl transferase mediated nick end labeling (TUNEL) method was performed for apoptosis using a total of 93 articular cartilages from 12 femoral heads and 17 knees obtained from total joint arthroplasty and 7 normal articular cartilages. RESULTS: In the normal control group, the expression rates for MMP-1, MMP-3, nitrotyrosine, and apoptosis were very low; and their expression zones were confined to the superficial layer of the articular cartilage. Their expression rates were low in the early stage of osteoarthritis and were moderate to high in the late stage (P<0.05). Their expression zones were confined to the superficial layer of the articular cartilage in the early stage of osteoarthritis and were expressed throughout the whole layer in the late stage and those of MMP-3 and nitrotyrosine were statistically significant (P<0.05). Their expression rates and zones were significantly correlated with the grade of osteoarthritis (P<0.05). Conclusion : The expression rate and zone of apoptosis and nitrotyrosine correlated well with those of MMP-1 and MMP-3. Therefore, NO and apoptosis may be related to the progression of human osteoarthritis.
Apoptosis* ; Arthroplasty ; Cartilage, Articular* ; Chondrocytes ; DNA Nucleotidylexotransferase ; Head ; Humans* ; Immunohistochemistry ; Joints ; Knee ; Matrix Metalloproteinase 1 ; Nitric Oxide ; Osteoarthritis*