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REFERENCE LINKING PLATFORM OF KOREA S&T JOURNALS
> Journal Vol & Issue
Clinics in Shoulder and Elbow
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Journal DOI :
Korean Shoulder and Elbow Society
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Volume & Issues
Volume 14, Issue 2 - Dec 2011
Volume 14, Issue 1 - Jun 2011
Selecting the target year
Coracoclavicular Ligament Augmentation Using Endobutton for Unstable Distal Clavicle Fractures - Preliminary Report -
Cho, Chul-Hyun ; Jung, Gu-Hee ; Sin, Hong-Kwan ; Lee, Young-Kuk ; Park, Jin-Hyun ;
Clinics in Shoulder and Elbow, volume 14, issue 1, 2011, Pages 1~5
DOI : 10.5397/CiSE.2011.14.1.001
Purpose: The purpose of this study was to evaluate the radiologic and clinical outcomes after operative treatment using endobuttons for unstable distal clavicle fractures. Materials and Methods: Between October 2007 and September 2009, 9 consecutive patients who were followed up for at least more than 12 months after operative treatment using a TightRope
were studied. The radiologic results on the serial plain radiographs and the clinical results according to the American Shoulder Elbow Surgeons (ASES) score were analyzed. Result: Bony union was shown in 8 cases (88.9%) and the average time to union was 12.9 (range: 9~16) weeks. The average coracoclavicular distances at the postoperative and final follow-up were 5.6 mm and 6.2 mm, respectively, with no statistically significant difference (p>0.05). The average ASES score was 90.3 (range: 78~96) and the clinical outcomes were 6 excellent, 2 good and one fair. There were no complications such as implant failure or infection except for one case of nonunion due to loss of the initial reduction. Conclusion: A major advantage of TightRope
fixation for unstable distal clavicle fractures is that no further surgery is needed to remove the implant. We suggest that this technique provides an alternative for fracture with a distal fragment, which is difficult to fix.
Hook Plate Fixation for Unstable Distal Clavicle Fractures: A Prospective Study
Kim, Kyung-Cheon ; Shin, Hyun-Dae ; Cha, Soo-Min ; Jeon, Yoo-Sun ;
Clinics in Shoulder and Elbow, volume 14, issue 1, 2011, Pages 6~12
DOI : 10.5397/CiSE.2011.14.1.006
Purpose: We wanted to analyze and report on the radiologic and clinical results of prospective Hook plate fixation for unstable distal clavicle fractures after a minimum of 2 years follow up. Materials and Methods: We followed up 17 out of 20 cases that underwent prospective Hook plate fixation from 2008 to 2009. We performed radiologic follow up at 2 weeks, 6 weeks, 3 months, 6 months, 18 months and 24 months postoperatively. The clinical results were evaluated at 12 months and 24 months postoperatively. Results: The mean period for bony fusion was 14.5 weeks and the plate was removed after an average of 20.2 weeks. The VAS pain scores were 0.7 and 0.8, the UCLA scores were 33.5 and 33.3, the ASES scores were 92.8 and 92.5, the Constant-Murley scores were 81.5 and 77.0, the KSS scores were 92.5 and 94.3 and the ranges of motion were
of external rotation,
of the internal rotation,
of abduction and
of extension at 1 and 2 years follow-up, respectively. There was no statistically significant difference of clinical outcomes and the range of motion at 1 year and 2 year postoperatively (p>0.05). There was no other complication except 1 case of delayed union. Conclusion: For Hook plate fixation at 2 years postoperatively, the complications will be decreased and excellent clinical results should occur.
A Retrospective Analysis of the Relationship Between Rotator Cuff Tear and Biceps Lesion
Seo, Seung-Suk ; Kim, Jung-Han ; Choi, Jang-Seok ; Kim, Jeon-Gyo ;
Clinics in Shoulder and Elbow, volume 14, issue 1, 2011, Pages 13~19
DOI : 10.5397/CiSE.2011.14.1.013
Purpose: Not much is known about the obvious relationship between posteroinferior rotator cuff tear and biceps lesion. The purpose of this study is to analyze the effect of posteroinferior rotator cuff tear on a biceps lesions by comparing the rotator cuff tear and biceps lesions with the number of cuff tears and the degree of degeneration of the rotator cuff. Materials and Methods: 65 patients who underwent surgery for a posteroinferior rotator cuff tear from 2002 to 2009 were included as subjects. The study determined the factors (the number of cuff tears and the degree of degeneration as assessed by MRI) that affected biceps lesions and the kinematic stability of the rotator cuff. Results: Biceps lesion was noted 11 patients among the 51 patients with supraspinatus tendon tears and in 8 patients among the 14 patients with supraspinatus, infraspinatus or teres minor tendon tears, and there was a statistically significant difference between those two groups (p=0.0095). The number of cuff tears was proportional to biceps lesion with statistical significance (p=0.0095). Among the biceps lesions, SLAP II lesion showed a statistically different distribution according to the number of cuff tears (p=0.0073). The degeneration factors (Goutallier's classification and the tangent sign) had no correlations with biceps lesion. Conclusion: Posterosuperior cuff tear may affect biceps lesion. Especially, the number of cuff tears has a close relationship, but the degenerative indicators have no relationship with biceps lesion.
Accompanying Lesions and Clinical Results in the Greater Tuberosity Fracture of the Humerus with Anterior Shoulder Dislocation Under the Age of Forty
Kim, Doo-Sup ; Yoon, Yeo-Seung ; Lee, Dong-Kyu ; Park, Hyeun-Kook ; Park, Jang-Hee ; Shin, John ;
Clinics in Shoulder and Elbow, volume 14, issue 1, 2011, Pages 20~26
DOI : 10.5397/CiSE.2011.14.1.020
Purpose: The purpose of this study is to investigate the accompanying lesions of humerus greater tuberosity fracture with anterior shoulder dislocation and to analyze its clinical results. Materials and Methods: From May 2005 to November 2008, arthroscopy was performed on a total of 30 selected patients who were diagnosed with humerus greater tuberosity fracture with anterior shoulder dislocation and who were also under the age of 40. The preoperative and postoperative Constant and Rowe scores were compared. Results: There was a total of 21 cases of anteroinferior labral lesions: 2 Bankart lesions, 4 bony Bankart lesions, 4 Perthes lesions, 2 free ALPSA lesions, 3 GLAD lesions and 6 capsular tears. For other lesions, 5 rotator cuff partial tears, 3 SLAP lesions and 1 biceps tendon rupture were found. The constant scores were increased from 56.3 to 94.43 points (p=0.034), and the Rowe scores were increased from 52.56 to 91.76 points (p=0.026). Conclusion: For humerus greater tuberosity fracture with anterior shoulder dislocation, the accompanying lesion was identified and the fracture was treated using arthroscopy. Good clinical results and bone union were achieved. According to the secondary arthroscopic findings, all of the Perthes lesion, the free ALPSA lesion, the GLAD lesion and the capsular tear spontaneously healed or they did not progress to extended rupture although arthroscopic suture was not performed. Any postoperative secondary instability was not observed.
Operative Treatment of Displaced Proximal Humerus Fractures with the Angular Stable Locking Compression Plate
Kim, Dong-Wook ; Kim, Chong-Kwan ; Jung, Sung-Won ; Kim, Hyeon-Soo ;
Clinics in Shoulder and Elbow, volume 14, issue 1, 2011, Pages 27~34
DOI : 10.5397/CiSE.2011.14.1.027
Purpose: We examined the clinical and radiological outcomes for displaced proximal humerus fractures that were treated with a PHILOS angular stable plate. Materials and Method: Forty four patients who underwent surgery between March 2007 and February 2010 were included in this study. All the cases were followed up for an average of 12 months. All the patients were examined and interviewed using the Visual Analog Scale (VAS) score, the Constant score and standardized X-rays to check the neck-shaft angle (NSA) and the presence of medial support. Results: The average Visual Analog Scale score was 2.8 points and the average Constant score was 70.5 points. The average neck shaft angle was
and this was statistically significant between the good result group and the poor result group. There were 36 cases of the presence of medial support and 8 cases of the absence of medial support and the difference was statistically significant. Complications such as fixation failure happened in 12 cases. Conclusion: PHILOS angular stable plate fixation as an operative treatment for displaced proximal humerus fractures is a good and reliable treatment option.
MR Evaluation of Tendinous Portions in the Subscapularis Muscle
Shon, Min-Soo ; Koh, Kyoung-Hwan ; Lee, Sung-Sahn ; Yoo, Jae-Chul ;
Clinics in Shoulder and Elbow, volume 14, issue 1, 2011, Pages 35~45
DOI : 10.5397/CiSE.2011.14.1.035
Purpose: The purpose of this study was to document the structural features of the tendinous portions within the non-pathologic subscapularis muscle by performing high resolution MR imaging of the shoulder. Materials and Methods: Between April 2007 and May 2010, we retrospectively obtained the MR scans of 88 consecutive young patients (88 shoulders) who were in their twenties. MRI and MR arthrography were performed using a 3.0-T system for the evaluation of glenohumeral instability and nonspecific shoulder pain. None of the patient in this study had any evidence of injury to the tendon or muscle belly of the subscapularis. On MR images, we recorded the transverse length of a stout tendinous band and the total tendinous portion of the subscapularis. In addition, we recorded the number of intramuscular tendinous slips of the susbscapularis. Results: The mean transverse length of the tendinous band was 15.0 mm (range: 8 to 20 mm). The mean transverse length of the total tendinous portion was 48.9 mm (range: 40 to 60 mm). The number of intramuscular tendinous slips on the base of the glenoid fossa was 3 in 20 (22.72%), 4 in 45 (51.14%) and 5 in 23 shoulders (26.14%). On the lateral portion, the intramuscular tendinous slips became gradually rounder and thicker and they gave converge in the superior direction. Conclusion: In this study, the structural features of the tendinous portions of the subscapularis on the MR scans were identified. This will in return give good justification for the lines to be pulled during biomechanical stimulation and also for the surgical approach to restore the biomechanical function.
The Result of Rotator Cuff Repair Using Arthroscopic Margin Convergence Technique in Irreparable Large and Massive Rotator Cuff Tears
Choi, Eui-Sung ; Park, Kyoung-Jin ; Kim, Yong-Min ; Kim, Dong-Soo ; Shon, Hyun-Chul ; Cho, Byung-Ki ; Park, Ji-Kang ; Lee, Hyung-Joon ;
Clinics in Shoulder and Elbow, volume 14, issue 1, 2011, Pages 46~52
DOI : 10.5397/CiSE.2011.14.1.046
Purpose: This study was performed to assess the usefulness of non-anatomical repair for irreparable large and massive rotator cuff tears by the arthroscopic margin convergence technique. Materials and Methods: Twenty-two patients were followed up more than 1 year after non-anatomical repair for irreparable large and massive rotator cuff tears using the arthroscopic margin convergence technique. The clinical evaluation was performed according to the KSS score, the UCLA score and the Visual analogue scale (VAS). The measurement of the acromio-humeral distance was performed using the shoulder anterior-posterior radiographs. The measurement of fatty degeneration and the healing status was performed using the shoulder MRI after 6 months. Results: Among twenty-two patients, follow up MRI was performed in eleven cases. Three cases were well healed, four cases were partial healed and another four cases were re-torn. The KSS and UCLA scores had significantly improved from a preoperative average of 45.0
8.014 and 10.8
2.302 points to 77.1
10.151 and 30.0
1.521 points, respectively, and the pain VAS had decreased from a preoperative average of 7.7
0.616 points to 3.0
1.021 points at the last follow up. Less favorable results were obtained when the patient had a grade of fatty degeneration higher than grade 3 on the preoperative MRI. Conclusion: Non-anatomical repair for irreparable large and massive rotator cuff tears by the arthroscopic margin convergence technique showed good functional results. It seems to be one of the effective treatment methods for irreparable large and massive rotator cuff tears.
Using the Arthroscopic Remplissage of Anterior Shoulder Instability with Hill-Sachs Lesion
Ko, Sang-Hun ; Jung, Kwang-Hwan ; Shin, Seung-Myeong ; Park, Han-Chang ;
Clinics in Shoulder and Elbow, volume 14, issue 1, 2011, Pages 53~58
DOI : 10.5397/CiSE.2011.14.1.053
Purpose: We evaluated the minimal 1 year follow-up results (shoulder stability and the clinical and functional results) for the Remplissage technique to fill a Hill-Sachs lesion. Materials and Methods: The subjects were 12 patients who could be followed up for more than 12 months after the "Remplissage" procedures in our hospital from December 2008 to November 2009. Their mean age was 27.9 years old and the mean follow-up was 19 months. The evaluations included the ROM, the ASES score, the KSSI score, the ROWE score and postoperative MRI. Results: On the postoperative functional evaluation after an average of 16 months, the ASES score improved from 50.8 preoperatively to 78.3 postoperatively, the KSSI score improved form 44.5 preoperatively to 81.0 postoperatively and the ROWE score improved from 40.2 preoperatively to 84.3 postoperatively. After an average 14 months for all the cases, the range of movement was nearly in the normal range, which is 178.6
18.6 (165~180) degrees for forward flexion and 49.3
10 (43~60) degrees for external rotation. Conclusion: For recurrent shoulder instability with a large Hill-Sachs lesion, the Remplissage technique has a good outcome after more than 1 year follow-up in terms of the shoulder stability and the clinical and functional results.
Operative Treatment of Distal Clavicle Fracture with Acromioclavicular Joint Injury
Kang, Ho-Jung ; Koh, Il-Hyun ; Joo, Jong-Hwan ; Chun, Yong-Min ; Kim, Hyung-Sik ;
Clinics in Shoulder and Elbow, volume 14, issue 1, 2011, Pages 59~66
DOI : 10.5397/CiSE.2011.14.1.059
Purpose: We wanted to evaluate the clinical and radiological outcomes and the prognosis of various surgical treatments for the distal clavicle fracture with an acromioclavicular joint injury. Materials and Methods: A retrospective study of 21 patients with a minimum of 12 months follow up was done. We classified acromioclavicular (AC) injury into type I (only intra-articular fracture (IAF), 5 cases), type II (IAF with widening of the AC joint > 7 mm, 9 cases) and type III (IAF with AC joint superior subluxation > 50%, 7 cases). The distal clavicle fractures were fixed using plate (9 cases), mini screws (1 case), K wire and tension band wiring (10 cases) and transarticular pinning (1 case). Acromioclavicular or coracoacromial ligament reconstruction was not done in all the cases. Results: In 20 of 21 cases, bone union was achieved at an average of 8.4 weeks. Traumatic arthritis (5 cases), AC joint widening (4 cases) and AC joint subluxation (2 cases) were noted at the last follow up. The average UCLA score was 32.6 in the type I AC joint injuries, 34 in type II and 34.1 in type III. There was no relationship between the clinical outcomes and the preoperative AC joint injury pattern, postoperative traumatic arthritis, AC joint widening or AC joint subluxation (p>0.05). Conclusion: Satisfactory results were achieved by acute reduction and firm fixation of the distal clavicle fracture with AC joint injury. There was no relationship between the pattern of AC joint injury, the residual radiologic findings and the functional outcome.
The Use of Arthroscopic UU Stich for Rotator Cuff Tear and Clinical Results
Ko, Sang-Hun ; Shin, Seung-Myeong ; Choi, Young-Jin ; Cha, Jae-Ryong ; Park, Han-Chang ;
Clinics in Shoulder and Elbow, volume 14, issue 1, 2011, Pages 67~72
DOI : 10.5397/CiSE.2011.14.1.067
Purpose: There are various known methods for arthroscopic rotator cuff repair. The purpose of this retrospective study is to report on the clinical results and anatomical results of UU repair surgery, which is a new repair method. Materials and Methods: We enrolled 156 patients (88 men and 68 women) who underwent UU repair for rotator cuff tears from January 2009 to May 2010 in our hospital. Their average age was 55 years old (range: 38~75 years old) and the average follow-up period was 12 months (range: 6~23 months). For determining the results, we evaluated the VAS for pain, the daily living index (ADL) in the ASES scores, the UCLA and KSS scores, and all these tests were conducted at the first hospital visit and 6 months and 1 year after surgery and at the final follow-up. During the follow-up period, MRI was performed 3 and 6 months after surgery only in the patients who consented to MRI scans to confirm the presence of re-rupture. Results: The average scores of the VAS as a pain indicator decreased from 7.0 before surgery to 2.7 after surgery (p<0.05). The UCLA and KSS scores increased from 22.2 to 32.5 and from 83.7 to 91.5, and the changes was significant (p<0.05). For the active joint range of motion, the average forward flexion was improved from 125 to 175 degrees, the average lateral external rotation was improved from 38 to 58 degrees, and the average abduction was improved from 104 to 169 degrees. Out of a total of 156 patients, re-rupture was observed in 4 cases (3%) of 117 cases (75%) for which MRI was performed (with consent) between 3 and 6 months after surgery. Conclusion: UU repair surgery as arthroscopic repair of rotator cuff tear is a good repair method that shows excellent clinical results and a low re-rupture rate.
The Clinical Usefulness of the Minimal Invasive Ulno-humeral Arthroplasty in the Patients with Mild to Moderate Elbow Arthritis
Kim, Bo-Kun ; Shin, Hyun-Dae ; Kim, Kyung-Cheon ; Cha, Soo-Min ;
Clinics in Shoulder and Elbow, volume 14, issue 1, 2011, Pages 73~79
DOI : 10.5397/CiSE.2011.14.1.073
Purpose: To evaluate of the clinical usefulness of minimal invasive ulnohumeral arthroplasty in patients with mild to moderate elbow arthritis. Materials and Methods: From January 2000 to December 2008, twenty-nine patients with mild to moderate elbow arthritis underwent minimal invasive ulnohumeral arthroplasty. Among these patients, we reviewed the cases of 24 patients for whom we had follow-up data for at least 1 year. There were 20 males and 4 females with a mean age of 53 years (range: 31~69). We excluded patients with preoperative ulnar neuropathy symptoms and investigated the mean operation time, the joint range of motion, the time required until the start of joint exercise, and the Mayo elbow performance score (MEPS). Results: Passive and active joint exercises were started in an average of 1.8 days (range: 1~4) after surgery; the mean operation time was 38 minutes (range: 25~55). The elbow joint range of motion was 25-104 degrees (extension 0~70, flexion 80~130) preoperatively and was improved 40 degrees on average to 14-133 degrees (extension 0~45, flexion 90~150) after a year of follow up. The average time required until the start of joint exercise was 1.6 days (range: 1~5). MEPS were excellent in 9 cases and good in 5 cases after a year of follow up. Although there was 1 case of delayed wound healing and 7 cases of postoperative edema, they improved spontaneously. Conclusion: For patients with mild to moderate elbow arthritis, minimal invasive ulnohumeral arthroplasty is a clinically useful surgery since its operation time is short, early joint exercise is possible, and pain is mild.
Traumatic Posterior Dislocation of the Shoulder with Ipsilateral Humeral Surgical Neck Fracture in a Child - A Case Report -
Kang, Suk ; Chung, Phil-Hyun ; Kim, Jong-Pil ; Kim, Young-Sung ; Lee, Ho-Min ; Kim, Jong-Hyun ;
Clinics in Shoulder and Elbow, volume 14, issue 1, 2011, Pages 80~83
DOI : 10.5397/CiSE.2011.14.1.080
Purpose: Traumatic posterior dislocation of the shoulder in a child is extremely rare, and posterior dislocation of the shoulder concomitant with ipsilateral humeral surgical neck fracture has not been reported in a child previously in Korea. Materials and Methods: The authors treated a 10-year-old with posterior dislocation of left shoulder and an ipsilateral humeral surgical neck fracture, that occurred during Taekwondo practice, by open reduction of the shoulder and pin fixation under general anesthesia. Results: A normal range of motion with complete union and good remodeling was achieved without redislocation or avascular necrosis of humeral head at 1 year after surgery. Conclusion: The authors report a successfully treated case of traumatic posterior dislocation of the shoulder with an ipsilateral humeral surgical neck fracture in child.
Calcific Tendinits at the Origin of Common Extensor Tendons of the Forearm - A Report of Two Cases -
Kim, Young-Kyu ; Cho, Seung-Hyun ; Moon, Sung-Hoon ; Kim, Nam-Ki ;
Clinics in Shoulder and Elbow, volume 14, issue 1, 2011, Pages 84~88
DOI : 10.5397/CiSE.2011.14.1.084
Purpose: We report here on two cases of calcific tendinitis at the origin of the common extensor tendons of the forearm. Materials and Methods: A 42 year-old female complained of left elbow pain and flexion contracture. After obtaining the simple radiographs and MRI, surgical excision of the calcific deposits was done under the diagnosis of calcific tendinitis. A 25 year-old female complained of right elbow pain and a limited range of motion. Simple radiographs showed a calcific deposit just distal to the lateral epicondyle, and then she was managed with extracorporeal shock wave therapy. Results: The pain disappeared completely and both patients regained a full range of motion after treatments. Conclusion: Calcific tendinitis at the origin of the common extensor tendons of the forearm should be included in the differential diagnosis of the lateral elbow diseases that cause pain and a limited range of motion.
Treatment of Lateral Antebrachial Cutaneous Neuropathy by Biceps Tenoplasty
Rhyou, In-Hyeok ; Suh, Bo-Gun ; Chung, Chae-Ik ; Park, Kyung-Jun ; Kang, Hyun-Suk ;
Clinics in Shoulder and Elbow, volume 14, issue 1, 2011, Pages 89~93
DOI : 10.5397/CiSE.2011.14.1.089
Purpose: We want to report on one patient who presented with lateral forearm pain caused by compression neuropathy of the lateral antebrachial cutaneous nerve. Materials and Methods: A female patient was managed by operative treatment (biceps tenoplasty) after failure with conservative treatment for 6 weeks. One year later, we evaluated the clinical symptoms and biceps tendon problems such as supination weakness or rupture after the tenoplasty. Results: Her symptom completely subsided immediately at the first postoperative day and her recovery was uneventful. Supination weakness and rupture of the distal biceps tendon were not found after the operation. Conclusion: We have reported here on a case of successful management of lateral antebrachial cutaneous neuropathy by performing biceps tenoplasty, along with a review of the previously published articles.
Treatment of Anterior Glenoid Rim Fracture with Comminuted Fragment Using Arthroscopic Reduction and AO Headless Compression Screw Fixation - A Case Report -
Kim, Hyung-Sik ; Koh, Il-Hyun ; Kim, Sung-Guk ; Chun, Yong-Min ; Kim, Sung-Jae ; Kang, Ho-Jung ;
Clinics in Shoulder and Elbow, volume 14, issue 1, 2011, Pages 94~98
DOI : 10.5397/CiSE.2011.14.1.094
Purpose: We present a case of anterior glenoid rim comminuted fracture that was treated with arthroscopic reduction and an AO headless compression screw (HCS) fixation. Materials and Methods: A 31-year old man complained of left shoulder pain after falling down on stairs. The anterior glenoid comminuted fragments were arthroscopically reduced. Fixation with an AO HCS was done after placement of 1.1 mm Kirschner wire as a guide pin through a standard cannulated anterosuperior portal. Results: Twelve months after the operation, union of the fracture was achieved and the range of motion was fully recovered. He did not complain of any discomfort during his activities of daily living. Conclusion: An AO HCS had various screw sizes and this was good for fixation of a small glenoid fracture and a long drill bit and screw driver were useful for fixation of deep seated glenoid fracture. A short guide wire could be replaced by a 1.1 mm K-wire. An AO HCS was useful for fixation of an anterior glenoid rim comminuted fracture.
Linked Semi-constrained or Unlinked TER: What We Should Know Before We Use?
Jung, Hong-Jun ; Jeon, In-Ho ; Chun, Jae-Myeung ;
Clinics in Shoulder and Elbow, volume 14, issue 1, 2011, Pages 99~104
DOI : 10.5397/CiSE.2011.14.1.099
Purpose: Total elbow arthroplasty (TEA) is still in its infancy as compared with other forms of arthroplasty. TEA designs have evolved with experience, but comparatively little long-term outcome data is available. This article provides an overview of the current states of linked, unlinked, and convertible total elbow arthroplasty. Material and Method: The designs of total elbow prostheses can be subdivided into three categories: unlinked, linked, and convertible. This article provides an overview of the current states of linked, unlinked, and convertible total elbow arthroplasty. Results and Conclusion: By proper patient selection and by utilizing implant design advances, improvements in cementation techniques, a meticulous surgical technique, and appropriate postoperative rehabilitation, total elbow arthroplasty can provide a high level of patient satisfaction and pain relief.
Reverse Total Shoulder Arthroplasty: Where we are? "Principles"
Noh, Kyu-Cheol ; Suh, Il-Woo ;
Clinics in Shoulder and Elbow, volume 14, issue 1, 2011, Pages 105~110
DOI : 10.5397/CiSE.2011.14.1.105
Purpose: The purpose of this article is to identify and understand the complications of RTSA and to review the current methods of preventing and treating this malady. Materials and Methods: Previous constrained prostheses (ball-and-socket or reverse ball-and-socket designs) have failed because their center of rotation remained lateral to the scapula, which has limited of the motion of the prostheses and produced excessive torque on the glenoid component, and this leads to early loosening. The Grammont reverse prosthesis imposes a new biomechanical environment for the deltoid muscle to act, thus allowing it to compensate for the deficient rotator cuff muscles. Results: The clinical experience does live up to the lofty biomechanical concept and expectations: the reverse prosthesis restores active elevation above
in patients with a cuff-deficient shoulder. However, external rotation often remains limited and particularly in patients with an absent or fat-infiltrated teres minor. Internal rotation is also rarely restored after a reverse prosthesis. Failure to restore sufficient tension in the deltoid may result in prosthetic instability. Conclusion: Finally, surgeons must be aware that the results are less predictable and the complication/revision rates are higher in revision surgery than that in the first surgery. A standardized monitoring tool that has clear definitions and assessment instructions is surely needed to document and then prevent complications after revision surgery.
Reverse Total Shoulder Arthroplasty: Complications
Kim, Young-Kyu ;
Clinics in Shoulder and Elbow, volume 14, issue 1, 2011, Pages 111~116
DOI : 10.5397/CiSE.2011.14.1.111
Purpose: The purposes of this article are to review the mid-term results and the complications after reverse total shoulder arthroplasty and to analyze the influence of the etiology on the result. Materials and Methods: We conducted a systemic review of the published literature with the mid-term follow-up after reverse total shoulder arthroplasty was performed. The overall rates of problems, complications, reoperations and revisions were determined. Results: The reported complication rates varied from 0% to 68%. The first series of reverse prosthesis with at least 2 yrs of follow-up confirmed the preliminary results, with excellent functional outcomes. However, a systemic review of the published literature with a mid-term follow-up showed problems in 44% of the cases, complications in 24% of the cases, reoperations in 3.5% of the cases and revision in 10% of the cases. Conclusion: Reverse total shoulder arthroplasty has relatively high complication and revision rates. So, a reverse prosthesis should be used in patients with very disabling arthropathy and a massive cuff tear and who are over seventy (at least sixty-five) years old.
Arthroscopic Reconstruction of Bony Defect in Shoulder Instability
Kim, Yang-Soo ; Ok, Ji-Hoon ;
Clinics in Shoulder and Elbow, volume 14, issue 1, 2011, Pages 117~124
DOI : 10.5397/CiSE.2011.14.1.117
Purpose: We reviewed arthroscopic reconstruction among the several treatment options for anterior shoulder instability with a bony Bankart lesion. Materials and Methods: Although open Bankart repair has long been considered the optimal surgical management of anterior shoulder instability, advancements in arthroscopic techniques have led to a recent shift to arthroscopic Bankart repair. However, for cases of a glenoid bony defect, several authors have reported various methods to accurately measure the amount of bony defect. Results: The arthroscopic technique of bony Bankart reconstruction continues to evolve and various methods have followed. To overcome the limitations of single fixation of a Bankart lesion, arthroscopic dual fixation (2 point fixation) has recently been tried to anatomically repair and restore the rigid fixation of a bony fragment. The concept of performing the Bristow-Latarjet transfer procedure under arthroscopy has also recently emerged. However, a large series of cases and long term follow up are required to prove the better results. Conclusion: To obtain a successful outcome for patients with anterior instability with a glenoid bony defect, it is imperative that the surgeon be aware of the accurate status of the bony defect and the intraoperative, postoperative factors associated with the proper treatment of this unstable pathology.
Reverse Total Shoulder Arthroplasty - Techniques and Pitfalls -
Chung, Seok-Won ; Kim, Joon-Yub ; Oh, Joo-Han ;
Clinics in Shoulder and Elbow, volume 14, issue 1, 2011, Pages 125~133
DOI : 10.5397/CiSE.2011.14.1.125
Purpose: The purpose of the present article is to help orthopedic surgeons better understand the function and performance of reverse total shoulder arthroplasty, and also to help them perform the most proper surgical technique for reconstruction. Materials and methods: In this article, the specific technical aspects and pitfalls of reverse total shoulder arthroplasty were reviewed in depth. Additionally, the current issues relevant to the reverse total shoulder arthroplasty such as scapular notching and restoration of active external rotation were discussed. Results and conclusion: An understanding of the biomechanics of reverse total shoulder arthroplasty and the technical details and pitfalls of its implantation are critical in order to provide the best functional outcome without increasing the risk of complications.
Review in Remplissage on Anterior Shoulder Instability with Huge Hill-Sachs Lesion
Ko, Sang-Hun ; Lee, Chae-Chil ; Park, Han-Chang ;
Clinics in Shoulder and Elbow, volume 14, issue 1, 2011, Pages 134~139
DOI : 10.5397/CiSE.2011.14.1.134
Purpose: We wanted to review the arthroscopic Remplissage technique and introduce our experiences with it for treating recurrent shoulder instability with a large Hill-Sachs lesion. Materials and Methods: The arthroscopic Remplissage technique with Bankart repair is performed in patients with no osteoarthritis, no fracture around the shoulder, a history of recurrence more than 10 times, a large Hill-Sachs lesion more than 30 to 40% of the humeral articular surface and glenoid bone loss less than 20%. Results and Conclusion: For recurrent shoulder instability with a large Hill-Sachs lesion, the Remplissage technique resulted in a good outcome for the shoulder stability, and good clinical and functional results.
Clinical Application of Radial Head Prosthesis
Moon, Jun-Gyu ;
Clinics in Shoulder and Elbow, volume 14, issue 1, 2011, Pages 140~145
DOI : 10.5397/CiSE.2011.14.1.140
Purpose: Installing a radial head prosthesis has developed into a reliable procedure to replace the native radial head for treating unreconstructible radial head fracture when this is associated with an unstable elbow or forearm. A variety of implants have been developed and these are now commercially available. This article reviews the literature related to the indications, the available implants and the surgical techniques of radial head replacement arthroplasty. Materials and Methods: The main indication for a metallic radial head prosthesis is a comminuted fracture that is not amenable to reconstruction, and particularly if it is associated with complex elbow injuries. Excision of the radial head should be avoided in the presence of combined injured ligaments or interosseous membrane injury. Three different implants are available in Korea, including the bipolar, press fit monopolar and loose fit monopolar radial head prostheses. A primary technical goal of radial head arthroplasty is the insertion of an implant that closely replicates the native radial head. The major pitfall when using a metallic radial head prosthesis is the insertion of a longer implant, which results in overstuffing of the radiocapitellar joint. Results and Conclusion: Satisfactory clinical results can be anticipated when a radial head prosthesis is used for the correct indications and when a systemic approach is undertaken to ensure proper sizing. For the future studies, we need data regarding the long term outcomes and comparison of the various types of prostheses.
Outcomes and Complications of Total Elbow Arthroplasty
Park, Min-Jong ;
Clinics in Shoulder and Elbow, volume 14, issue 1, 2011, Pages 146~152
DOI : 10.5397/CiSE.2011.14.1.146
Purpose: To describe the recent clinical results and complications of total elbow arthroplasty based on the literature review. Materials and Methods: The indications of total elbow arthroplasty include rheumatoid or inflammatory arthritis, posttraumatic arthritis, anklylosed elbow, tumor resection which cannot recover elbow function by other reconstructive procedures, and comminuted distal humerus fracture in elderly patients. Complications are aspetic loosening, infection, prosthesis fracture, periprosthetic fracture, ulnar neuropathy, ectopic ossification, triceps insufficiency, dislocation, and bushing wear. Results and Conclusion: Mean 10 year survival rate following total elbow arthroplasty has been reported 85% on the basis of revision. The prognosis in patients with an inflammatory arthritis is reported to be best, and loosening rate in patients with a posttraumatic arthritis tends to be high. Complication rate is known to be higher than that of other joint arthroplasty. In particular, deep infection occurs in 3~5% of the patients. Total elbow arthroplasty provide satisfactory results when it is performed properly in selected patients who have an elbow joint with irreversible dysfunction and low level activities.