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REFERENCE LINKING PLATFORM OF KOREA S&T JOURNALS
> Journal Vol & Issue
Clinics in Shoulder and Elbow
Journal Basic Information
Journal DOI :
Korean Shoulder and Elbow Society
Editor in Chief :
Volume & Issues
Volume 18, Issue 4 - Dec 2015
Volume 18, Issue 3 - Sep 2015
Volume 18, Issue 2 - Jun 2015
Volume 18, Issue 1 - Mar 2015
Selecting the target year
Eulogy: In Memory of Stephen A. Copeland, the Father and Friend in Shoulder Surgery and Orthopedics
Kim, Young-Kyu ;
Clinics in Shoulder and Elbow, volume 18, issue 2, 2015, Pages 59~60
DOI : 10.5397/cise.2015.18.2.59
Degeneration Exists along the Entire Length of the Supraspinatus Tendon in Patients with a Rotator Cuff Tear
Jo, Chris Hyunchul ; Chang, Mee Soo ;
Clinics in Shoulder and Elbow, volume 18, issue 2, 2015, Pages 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 (
), the FE group (
), and in the MTJ group (
) were significantly higher than those in the normal control group (
; 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.
Efficacy of Additive Trans-cuff Augmentation Sutures for Proximal Humeral Fractures Stabilized by Locking Plates in Elderly Patients
Cho, Nam Su ; Shim, Hee Seok ; Lee, Sang Hyeon ; Jeon, Jong Wook ; Rhee, Yong Girl ;
Clinics in Shoulder and Elbow, volume 18, issue 2, 2015, Pages 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
, respectively, in group A and
, 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
in group A and
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.
Comparative Analysis of the Result of Minimally Invasive Anterior Plating and Open Reduction and Internal Fixation in Humerus Shaft Simple Fracture
Ko, Sang-Hun ; Choe, Chang-Gyu ; Lee, Ju-Hyung ;
Clinics in Shoulder and Elbow, volume 18, issue 2, 2015, Pages 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
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
for group 1, and
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.
Adrenal Insufficiency in Patients with Rotator Cuff Tear: Prevalence, Risk Factors and Influence on Outcome
Kim, Jung-Han ; Gwak, Heui-Chul ;
Clinics in Shoulder and Elbow, volume 18, issue 2, 2015, Pages 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.
Evaluation of Focal Bone Mineral Density Using Three-dimensional Measurement of Hounsfield Units in the Proximal Humerus
Moon, Young Lae ; Jung, Sung ; Park, Sang Ha ; Choi, Gwi Youn ;
Clinics in Shoulder and Elbow, volume 18, issue 2, 2015, Pages 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 v22.214.171.124 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). Conclusions: 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.
Comparing the Use of Single and Double Interlocking Distal Screws on a Polarus Intramedullary Nail for Humeral Shaft Fractures
Yang, Hee Seok ; Kim, Jeong Woo ; Kang, Hong Je ; Park, Jung Hyun ; Lee, Yong Chan ; Kim, Kwang Mee ;
Clinics in Shoulder and Elbow, volume 18, issue 2, 2015, Pages 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.
Three Cases of Rare Anatomic Variations of the Long Head of Biceps Brachii
Kwak, Sang-Ho ; Lee, Seung-Jun ; Song, Byung Wook ; Lee, Min-Soo ; Suh, Kuen Tak ;
Clinics in Shoulder and Elbow, volume 18, issue 2, 2015, Pages 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.
A Ganglion Cyst Formed after Anterior Transposition of the Ulnar Nerve: A Case Report
Kim, Young-Bae ; Yoon, Jung Ro ; Lee, Woo Seung ; Yang, Jae-Hyuk ; Lee, Hoonnyun ;
Clinics in Shoulder and Elbow, volume 18, issue 2, 2015, Pages 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
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.
Orthogonal versus Parallel Plating for Distal Humeral Fractures
Moon, Jun-Gyu ; Lee, Ji-Ho ;
Clinics in Shoulder and Elbow, volume 18, issue 2, 2015, Pages 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.
Platelet-rich Plasma in Arthroscopic Rotator Cuff Repair
Kim, Do Hoon ; Kim, Sae Hoon ;
Clinics in Shoulder and Elbow, volume 18, issue 2, 2015, Pages 113~118
DOI : 10.5397/cise.2015.18.2.113
Rotator cuff tear is a common reason for shoulder pain. Although the surgical technique of rotator cuff repair is developing, high retear rate requires additional supplementary methods. Among these supplementary methods, as a kind of biologic augmentation, platelet-rich plasma (PRP) has been spotlighted and has recently been studied by many researchers. PRP, a concentrate of platelet extract obtained from whole blood, contains numerous growth factors. As this is known to play an important role in the tissue recovery process, it had been used for research in a variety of fields including orthopedics. Use of PRP has been attempted in surgical treatments of rotator cuff tear for better results; however, only a few large-scale research studies on the effect of PRP have been reported. Clinical results of each study are also variable. Therefore research using large-scale randomized, double-blind trials should be conducted in order to prove the application range, safety, and clinical effects of PRP.