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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 15, Issue 2 - Dec 2012
Volume 15, Issue 1 - Jun 2012
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Effectiveness of Multimodal Pain Control in Early Phase After Arthroscopic Rotator Cuff Repair
Park, Chang-Min ; Kim, Jong-Hae ; Kim, Suk-Jun ; Choi, Chang-Hyuk ;
Clinics in Shoulder and Elbow, volume 15, issue 1, 2012, Pages 1~7
DOI : 10.5397/CiSE.2012.15.1.1
Purpose: The purpose of this study was to identify the effectiveness of multimodal pain control method in an early phase after arthroscopic rotator cuff repair, under interscalene brachial plexus block, this study was performed. Materials and Methods: The study was progressed with the 80 cases of arthroscopic rotator cuff repair. Interscalene brachial plexus block was used to all of the 80 cases and patients were divided into 2 groups. Group A consisted of patients injected with bupivacaine, through subacromial space catheter after surgery, and group B consisted of patients with additional method of multimodal pain control using oral opioids, acetaminophen-tramadol complex and selective COX2 inhibitor. Subacromial cathter was removed after injection in both groups. The pain during the day time and night time was compared on the operation day, postoperative 1st, 2nd, 3rd day and 2nd weeks, and it was measured with VAS (visual analogue scale) score. Additionally, the number of ketolorac injection and side-effect related to analgesics was compared between the 2 groups. Results : The mean VAS score of night time on the operation day and day/night time pain of the 1st, 2nd, 3rd day and 2nd weeks was 7.4, 7.0/6.8, 4.5/5.2, 4.8/5.0, 2.2/2.7 on group A and 6.5, 4.3/5.4, 3.2/4.3, 3.0/4.1, 2.4/2.5 on group B, respectively. Significant difference was observed in the night pain on the operation day, 1st, 2nd, 3rd day time and 1st night time pain (p<.05). The average number of ketololac injection was 1.1 and 0.5 in each group, and there was no difference in the frequency of side effects. Conclusion: Multimodal pain control method, after arthroscopic rotator cuff repair, showed an effective early pain control and improved patients` satisfaction.
Relationship Between Insertion Torque, and Pullout Strength Depending on the Size of the Pilot Hole and Biodegradable Suture Anchor in Osteoporotic Humeral Head
Chun, Yong-Min ; Lee, Young-Han ; Kim, Sung-Hwan ; Park, Yoo-Jung ; Kim, Sung-Jae ;
Clinics in Shoulder and Elbow, volume 15, issue 1, 2012, Pages 8~15
DOI : 10.5397/CiSE.2012.15.1.8
Purpose: The object of this study was to investigate the difference in torque and pullout strength between the standard anchor insertion (5.0 mm) with a small awl (3.7 mm) and larger anchor insertion (6.5 mm), with a standard awl (5.0 mm) in osteoporotic humeral head. Materials and Methods: The embalmed 24 paired cadaveric shoulders were assigned to either Group A or B. After measuring the bone mineral density (BMD) of the ROI (region of interest) in the humeral head, 5.0 mm suture anchors were inserted using a 3.7 mm awl in Group A1, and the same 5.0 mm anchors were inserted using a 5.0 mm awl in Group A2. The 5.0 mm anchors were inserted using a 5.0 mm awl in Group B1, and 6.5 mm anchors were inserted using a 5.0 mm awl in Group B2. We measured the torques at the time of the anchor insertion and pullout strengths. Results: There was no significant difference in the BMD between the groups. The torque of A1 (20.6
) was significantly higher than that of A2 (13.2
), and the torque of B2 (20.8
) was significantly higher than that of B1(12.1
). However, the difference in the increased torque between group A and B was not significant. The pullout strength of A1 (204.2 N) was significantly higher than that of A2 (152.9 N), and the pullout strength of B2 (210.9 N) was significantly higher than that of B1 (149.5 N). However, the difference in the increased pullout strength between Group A and B was not significant. Conclusion: In severe osteoporosis, the use of a larger suture anchor with a standard awl increased the torque and pullout strength significantly, in comparison to the use of the same sized suture anchor and awl. If there is an inadequate interval between the anchors on the greater tuberosity, the use of a 3.7 mm awl and 5.0 mm anchor will be beneficial compared to that of a 5.0 mm awl and 6.5 mm anchor, considering that an increase in the pullout strength does not depend on the awl size.
Patterns of Retear After Repair of the Rotator Cuff - MRI Analysis of 109Cases -
Tae, Suk-Kee ; Kim, Young-Sung ; Lee, Ho-Min ; Park, Pan-Kun ;
Clinics in Shoulder and Elbow, volume 15, issue 1, 2012, Pages 16~24
DOI : 10.5397/CiSE.2012.15.1.24
Purpose: This study was designed to investigate the rate of incidence, location and the clinical value of the rotator cuff retear by analyzing MRI scans, which was taken after an arthroscopic rotator cuff repair. Materials and Methods: This study included a total of 109 patients, who underwent a shoulder MRI scan after an average of 10.6 months later from the arthroscopic rotator cuff repair. We only defined the `retear` when the Sugaya type IV and V was observed in the sagittal section of the MRI. The location of the retear was divided into the medial and lateral areas by the site, which was 1 cm medial to the anchor insertion. We investigated the incidence rate and the location of the retear, in terms of the age, sex, initial tear size and the suture method. Also, we compared the functional score of the retear group and the non-retear group, after an average of 13.9 months follow-up. Results: There were 38 of the 109 patients that showed the rotator cuff retear. Of these patients, 25 were male patients, and 13 were female patients. Of the 38 patients with the rotator cuff retear, 21 patients were included in the <3 cm retear group, and 17 were included in the
cm retear group. At the end of the follow up period, all 109 patients showed a statistical significant improvement in the shoulder functional score. Conclusion: According to the follow up of the MRI scan, which was taken after the rotator cuff repair, the retear rate reached 34.9 %, and there were no significant differences on the age and the suture method. More rotator cuff retear occurred in male patients, and the initial tear size was positively correlated with the incidence rate of the rotator cuff retear. Also, the retear was more frequently observed at the medial side. That is because when the suture was performed, excessive tension was loaded on the medial side of the suture site.
Internal Fixation of Proximal Humerus Fracture with Polyaxial Angular Stable Locking Compression Plate in Patients Older Than 65 Years
Lee, Ki-Won ; Choi, Young-Joon ; Ahn, Hyung-Sun ; Kim, Chung-Hwan ; Hwang, Jae-Kwang ; Kang, Jeong-Ho ; Choo, Han-Ho ; Park, Jun-Seok ; Kim, Tae-Kyung ;
Clinics in Shoulder and Elbow, volume 15, issue 1, 2012, Pages 25~31
DOI : 10.5397/CiSE.2012.15.1.25
Purpose: The clinical and radiographic outcomes of the internal fixation, which were executed on patients over the age of 65 with proximal humerus fracture by using a polyaxial angular stable locking compression plate (Non-Contact-Bridging proximal humerus plate, Zimmer, Switzerland, NCB), were evaluated. Materials and Methods: Thirty two patients over the age of 65 among the proximal humerus fracture treated with NCB plate, between August 2007 and January 2011, were chosen as the subjects. The average age of patients was 71 years, and the average postoperative follow-up period was 11.5 months. The fractures included 14 two-part and 18 three-part fractures. The clinical results were evaluated, using the visual analog scale (VAS) score and the Constant score. The radiological results were evaluated by time to union and Paavolainen method, which measures the neck shaft angle. Results: At the last follow-up examination, the mean VAS score was 3 points and the mean Constant score was 64.5 points, with bone union achieved after the average of 16.2 weeks following the surgery in all the cases. The mean neck shaft angle was 125.9 and 24 cases had good results, while 8 cases had fair results by Paavolainen method, at the last follow-up. There were 1 case of delayed union and cerclage wire failure, and 3 cases of subacromial impingement. There were no complications, such as loss of reduction, nonunion, screw loosening, or avascular necrosis of the humeral head. Conclusion: Internal fixation, using a NCB plate, was considered to be an effective surgical method in treating proximal humerus fracture in the elderly patients, on whom the fixation of the fracture and maintenance of reduction are difficult.
Intercalary Tricortical Iliac Bone Graft in the Surgical Treatment of Nonunion of Midshaft Clavicular Fractures
Cho, Chul-Hyun ; Jang, Hyung-Gyu ;
Clinics in Shoulder and Elbow, volume 15, issue 1, 2012, Pages 32~36
DOI : 10.5397/CiSE.2012.15.1.32
Purpose: The purpose of this study was to evaluate the radiologic and clinical outcomes after intercalary tricortical iliac bone graft with plate fixation for the nonunion of midshaft clavicular fractures. Material and Methods: Between September 2007 and May 2011, 10 patients who were treated by the intercalary tricortical iliac bone graft, with plate fixation for clavicle nonunion, were studied. The mean follow-up period was 30.7 (12~57) months. After the sclerotic bone was excised to the bleeding cortical bone, we interposed the tricortical iliac bone to provide structural support and restore clavicle length, and then fixed the plate and screws. The radiologic outcomes on the serial plain radiographs and clinical outcomes, according to UCLA, ASES and Quick DASH scores, were analyzed. Results: Bony union was obtained in all cases (100%) and the average union time was 18.4 (14~24) weeks. The average respective UCLA and ASES scores improved from 16.7 and 52.1 preoperatively to 27.4 and 83.6 postoperatively (p<0.05). The average Quick DASH score was 40.5, at the final follow-up. Complications were 2 shoulder stiffness, and one case had removal of device and arthroscopic surgery at 11 months, postoperatively. There were no implant failure or infection. Conclusion: Intercalary tricortical iliac bone graft, with plate fixation for the nonunion of midshaft clavicular fractures, is a good option that can provide structural support and restore clavicle length, as well as high union rate.
Treatment of Open Proximal Humerus Fracture by Gunshot
Kim, Sung-Jae ; Lee, Jae-Hoo ; Chun, Yong-Min ;
Clinics in Shoulder and Elbow, volume 15, issue 1, 2012, Pages 37~42
DOI : 10.5397/CiSE.2012.15.1.37
Purpose: To consider the proper management of proximal humerus fracture on gunshot wounds. Materials and Methods: A 28-year-old male patient, who sustained a gunshot injury on the left arm 5 days ago, was admitted through the emergency department. Although he underwent an emergency surgery (bullet fragment removal and debridement), there remained bullet fragments around the proximal humerus fracture site. The wound seemed to be infected and a partial dehiscence occurred. No neurologic deficit was noted. Immediate exploration and debridement were performed, and an external fixator was applied to restore the anatomical alignment and manage the wounds. Intravenous antibiotics were administered. On the 9th postoperative day, wound debridement was done again, and cement beads mixed with antibiotics were inserted. After two weeks, the external fixator was removed, and the pin sites were closed after debridement. One week later, the open reduction and internal fixation with locking compression plate and screws were done. Result: At 3 months after the internal fixation, the bone union was obtained with satisfactory alignment of the humerus. Conclusion: The severity of the soft tissue injury influences the fracture management plan. Further, the risk on lead toxicity should be considered.
Recent Treatment Options for the Clavicle Fracture
Oh, Joo-Han ; Choi, Hye-Yeun ;
Clinics in Shoulder and Elbow, volume 15, issue 1, 2012, Pages 43~51
DOI : 10.5397/CiSE.2012.15.1.43
Purpose: We sought to determine the appropriate management modality for clavicle fracture through the review of current literature. Materials and Method: This article provides an overview of the knowledge regarding clavicular fracture in adults, including epidemiology, classification, surgical indication, current technique, and results. We also addressed recent debates: the range of the surgical indication for mid-clavicular fracture and the introduction of anatomically precontoured plate as a new treatment modality. Result and Conclusion: Nonsurgical treatment has been regarded as the first choice in the management of clavicle fractures. Quite recently, mounting evidence has shown that adverse outcomes, after a nonsurgical treatment, such as nonunion and malunion, were more prevalent than previously assumed. Accordingly, the indications for surgical fixation appear to be broadening. However, given that the ideal treatment option remains to be determined, the appropriate treatment of clavicle fractures should be tailored based on careful assessment of individual patient`s data and preference.
Diagnosis for Acute Traumatic Shoulder Injuries
Clinics in Shoulder and Elbow, volume 15, issue 1, 2012, Pages 52~64
DOI : 10.5397/CiSE.2012.15.1.52
Acute traumatic shoulder injuries related to motor vehicle accidents and industrial accident has shown a steep increase recently. In regard to the causal relationship and the previous illness, the rotator cuff tear and SLAP lesion are the mostly debated among shoulder injuries related to trauma. Both the possibility of spontaneous occurrence related to their degenerative etiology and the discordance between the extent of injury and the symptom of the rotator cuff tear and SLAP lesion, make it difficult and obscure to estimate the extent of involvement of accident. Therefore, the Insurance Committee of Korean Shoulder and Elbow Society performed a questionnaire for the shoulder specialists to investigate their criteria about deciding the treatment modalities and SLAP lesion and reviewed literatures regarding the causal relationship between the accident and the rotator cuff tear and SLAP lesion. The committee recommended the diagnostic criteria to judge contribution of the accident on traumatic shoulder injuries, and to offer a guideline for disabilities.