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REFERENCE LINKING PLATFORM OF KOREA S&T JOURNALS
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Clinics in Shoulder and Elbow
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Korean Shoulder and Elbow Society
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Volume & Issues
Volume 19, Issue 2 - Jun 2016
Volume 19, Issue 1 - Mar 2016
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EDITORIAL : Clavicle Fracture: Your Best Day or Your Worst Nightmare?
Yoo, Jae Chul ;
Clinics in Shoulder and Elbow, volume 19, issue 1, 2016, Pages 1~1
DOI : 10.5397/cise.2016.19.1.1
Comparison between Accurate Anatomical Reduction and Unsuccessful Reduction with a Remaining Gap after Open Reduction and Plate Fixation of Midshaft Clavicle Fracture
Kim, Joon Yub ; Choe, Jung Soo ; Chung, Seok Won ;
Clinics in Shoulder and Elbow, volume 19, issue 1, 2016, Pages 2~7
DOI : 10.5397/cise.2016.19.1.2
Background: The purpose of this study is to compare the radiological and clinical outcomes after open reduction and plate fixation of midshaft clavicle fractures between patients who achieved successful anatomical reduction and those who had a remaining fracture gap even after open reduction and plate fixation, and were thus treated with additional demineralized bone matrix (DBM). Methods: This retrospective analysis was conducted on 56 consecutive patients who underwent open reduction and internal fixation using a locking compression plate for acute displaced midshaft clavicle fractures, and who underwent radiographic and clinical outcome evaluations at least 6 months postoperatively. The outcomes between those who achieved perfect anatomical reduction without remnant gap (n=32) and those who had a remaining fracture gap even after open reduction and plate fixation treated with additional DBM (n=24) were evaluated. Results: There were no differences in the use of lag screws or wiring and operation time (all p>0.05) between those with and without remnant gap. No difference in the average radiological union time and clinical outcomes (satisfaction and Constant score) was observed between the two groups (all p>0.05). However, significantly faster union time was observed for AO type A fracture compared with other types (p=0.012), and traffic accident showed association with worse clinical outcomes compared with other causes of injury. Conclusions: Surgical outcome of midshaft clavicle fracture was more affected by initial fracture type and event, and re-reduction and re-fixation of the fracture to obtain a perfect anatomical reduction spending time appears to be unnecessary if rigid fixation is achieved.
Intramedullary Screw Fixation for Clavicle Shaft Fractures: Comparison of the Anterograde versus the Retrograde Technique
Rhee, Yong Girl ; Cho, Nam Su ; Cho, Sung Whan ; Song, Jong Hoon ;
Clinics in Shoulder and Elbow, volume 19, issue 1, 2016, Pages 8~14
DOI : 10.5397/cise.2016.19.1.8
Background: The purpose of this study was to investigate the difference between two nailing approaches of intramedullary screw fixation, the retrograde nailing versus the anterograde nailing, on the radiological and clinical outcomes in patients with clavicle shaft fractures. Methods: From April 2002 to August 2014, we enrolled a total of 22 patients with clavicle shaft fractures to participate in this study. Twelve patients received retrograde intramedullary nailing and 10 received anterograde nailing. The average duration of follow-up was 12 months. In all the patients, we took follow-up radiographs of the anteroposterior and the axial views to assess the postoperative radiological outcomes. We measured the visual analogue scale (VAS) score, American Shoulder and Elbow Surgeons (ASES) score, and the range of motion (ROM). Results: Clinically, we did not find a statistically significant difference in the retrograde group and the anterograde group in terms of the duration to bone union, the VAS score the ASES score and the ROMs. Radiologically, we found that the difference in the clavicle shortening of the affected arm and the unaffected arm did not show a statistically significant difference at the immediate postoperative assessment. we found that the difference in the clavicle shortening of the affected arm between the immediate postoperative and the final follow-up value did not show a statistically significant difference. Conclusions: We found that both the retrograde nailing and the anterograde nailing gave a favorable outcome for clavicle shaft fractures. Although we saw evidence of clavicle shortening after intramedullary screw fixation, this was not a factor that influenced clinical outcome.
Shoulder and Elbow Injury Rates and Patterns in Korean Rookie Professional Baseball Pitchers
Park, Jin-Young ; Lee, Seung-Jun ; Kim, Yong-Il ; Heo, Gu-Yeon ;
Clinics in Shoulder and Elbow, volume 19, issue 1, 2016, Pages 15~19
DOI : 10.5397/cise.2016.19.1.15
Background: To investigate how many rookie pitchers suffered from injuries while playing in the amateur league without guidelines for prevention of excessive pitching, we analyzed their amateur pitching patterns based on the pitch count, use of breaking balls, and pitches during winter camp. Methods: Forty-one rookie pitchers who graduated from high school or university in 2013 and joined professional baseball teams. Participants were interviewed by a trainer using our questionnaire. Injury inclusion criteria were 1) history of shoulder surgery, 2) history of elbow surgery, 3) shoulder pain requiring treatment, and 4) elbow pain requiring treatment. Results: Mean number of pitches per game and warm-up pitches for practice was 84.5 pitches (range, 15 to 130 pitches) and 16.4 pitches (range, 2 to 210 pitches), respectively. Mean number of pitches during the last year was 906.9 (range, 80 to 2,000). Mean number of maximal pitches was 127 pitches (range, 50 to 210 pitches). Fourteen pitchers had pitched over 150 pitches. Twenty-seven pitchers (65.9%) had pitched in spite of enduring pain. During winter training (mean 1.8 months), mean number of pitches per day was 162.5 pitches, and 20 pitchers (48.8%) had practiced pitching excessively despite the cold weather. Twenty-six rookies (63.4%) had shoulder pain or history of shoulder surgery, and 31 pitchers (75.6%) had elbow pain or history of elbow surgery. Only four participants (9.8%) did not have pain and history of surgery. Conclusions: For young baseball pitchers, guidelines for prevention of excessive pitching and for regulating the winter training program may be needed.
Is Extracorporeal Shock Wave Therapy Effective in the Treatment of Myofascial Pain Syndrome?
Kim, Jong-Ick ; Lee, Hyo-Jin ; Park, Hyung-Youl ; Lee, Won-Hee ; Kim, Yang-Soo ;
Clinics in Shoulder and Elbow, volume 19, issue 1, 2016, Pages 20~24
DOI : 10.5397/cise.2016.19.1.20
Background: Extracorporeal shock wave therapy (ESWT) is one of the treatment options used for patients with myofascial pain syndrome (MPS), although its effectiveness is controversial. The purpose of this study was to evaluate the effectiveness of ESWT in the treatment of MPS in terms of pain relief and functional improvements. Methods: We assessed 93 patients with MPS who underwent ESWT from March 2009 to July 2014. After exclusion of 25 patients with shoulder diseases, 68 patients were enrolled in the study. The mean follow-up period was 7.5 months (
), and the average duration of symptoms was 5 months (range, 2-16 months). ESWT was applied to intramuscular taut bands and referred pain areas once a week for 3 weeks. Visual analog scale (VAS) pain scores and American Shoulder and Elbow Surgeons (ASES) scores were obtained at an initial assessment and at the 6-week, 3-month, and 6-month follow-up assessments. Results: VAS pain scores and ASES scores improved significantly after 3 sessions of ESWT (p<0.05). Both scores were improved, although not significantly, after 6 weeks (p>0.05). Conclusions: ESWT is an effective treatment option for patients with MPS.
A Novel Fluoroscopic View for Positioning the AO Clavicle Hook Plate Decreases Its Associated in situ Complications
Hyun, Yoon-Suk ; Kim, Gab-Lae ; Choi, Sang-Min ; Shin, Woo-Jin ; Seo, Dong-Yeon ;
Clinics in Shoulder and Elbow, volume 19, issue 1, 2016, Pages 25~32
DOI : 10.5397/cise.2016.19.1.25
Background: The goal of this study was to evaluate whether a modified fluoroscopic technique for positioning a hook plate affected the clinical results of treating Neer type II distal clavicle fractures and Rockwood type V acromioclavicular (AC) joint separations with this device. Methods: The study was a retrospective consecutive case series with data analysis. Sixty-four patients with a Neer type II distal clavicle fracture or a Rockwood type V AC joint injury treated between March 2009 and June 2013 were divided into 2 groups: traditional fluoroscopic technique (traditional view, 31 patients) or modified fluoroscopic technique ('hook' view, 33 patients). A visual analogue scale (VAS) score, the modified University of California-Los Angeles (UCLA) shoulder scale score, and radiographic osteolysis were the main outcome measures. Results: The traditional group included a significantly larger number of patients with acromial osteolysis than the hook view group: 23 patients (74.2%) vs. 11 patients (33.3%), respectively (p=0.01). Before plate removal, the hook group reported less pain and higher UCLA shoulder scale scores than the traditional group: average VAS score, 1.55 vs. 2.26, respectively; average UCLA score, 30.88 vs. 27.06, respectively. However, there was no significant difference after plate removal. Conclusions: The hook view allows more accurate bending of the hook plate around the contour of the acromion, resulting in decreased osteolysis, decreased pain, and better function with the plate in situ.
Clavicle Nonunion: Matchstick Bone-grafting and Osteosynthesis
Park, Yong Bok ; Yoo, Jae Chul ; Park, Geun Min ; Kum, Dong Ho ; Tauheed, Mohammed ; Jeong, Jeung Yeol ;
Clinics in Shoulder and Elbow, volume 19, issue 1, 2016, Pages 33~38
DOI : 10.5397/cise.2016.19.1.33
Background: This study was conducted to evaluate the surgical outcomes of plate fixation using autologous iliac bone graft shaped in the form of a matchstick in clavicle nonunion resulting from prior surgical or non-surgical management. Methods: From May 2005 to February 2013, 17 patients underwent surgery for clavicle nonunion. The mean age at the time of surgery was 48.8 years. The iliac bone was harvested and shaped into slivers approximately 3 cm long, which resembled matchsticks. After opening of the medullary canal, the plate and screws were applied and cancellous bone was placed at the nonunion site. Matchstick bone grafts which were longitudinally placed and encircled on the nonunion site were tied with periosteum using 3-4 stitches. Union was determined via postoperative plane X-ray. Clinical status was evaluated using the visual analogue scale score for pain, and Constant and American Shoulder Elbow Surgeon score. Results: All patients had a stable radiological union at the follow-up. The mean duration from index operation to nonunion operation was 13.2 months (7-32 months). The mean follow-up period was 20.1 months (8-56 months), and the mean duration until union was 11.2 weeks (8-16 weeks). All clinical scores were improved at the final follow-up (p<0.001). The mean segmental defect was
(1-18 mm); and the difference in clavicular length between operative and non-operative site was
. Conclusions: Matchstick shaped autologous iliac bone grafting technique in clavicle nonunion is acceptable with a high union rate.
Spontaneous Rupture of the Extensor Carpi Radialis Brevis and Radial Collateral Ligament of the Elbow in a Recreational Golfer: Surgical Experience of Repair of a Chronic Retracted Tendon and Ligament
Park, Jin-Young ; Bang, Jin-Young ;
Clinics in Shoulder and Elbow, volume 19, issue 1, 2016, Pages 39~42
DOI : 10.5397/cise.2016.19.1.39
Lateral epicondylitis with rupture of the radial collateral ligament of the elbow has not been reported in the literature. We report on a case of a recreational golfer who had not received steroid injection and had no trauma history. The patient was treated with open surgical repair. At 2 years follow-up, satisfactory clinical and radiological outcomes were observed with return to pre-injury level. The authors report this case and review the literature.
New Fixation Method Using Two Crossing Screws and Locking Plate for Cubitus Varus Deformity in Young Adult Elbow: Case Report
Kim, Byoung Jin ; Seol, Jong Hwan ; Kim, Myung Sun ;
Clinics in Shoulder and Elbow, volume 19, issue 1, 2016, Pages 43~47
DOI : 10.5397/cise.2016.19.1.43
Many types of osteotomy have been proposed for the treatment of cubitus varus deformity of the elbow, and various methods for fixation of the osteotomy site have also been described. However, no method has been perfect. We treated two cases of cubitus varus elbow deformity with step-cut osteotomy using a new fixation method with two crossing screws and an anatomically designed locking plate. Active assisted elbow range of motion (ROM) exercise was permitted at postoperative 3 days, after removal of the drainage. Preoperative and postoperative humerus-elbow-wrist angles and ranges of motion of the two patients were compared. At 3 months followup, each patient had recovered the preoperative elbow ROM, and achieved the complete bony union of the osteotomy site and proper correction of the cubitus varus deformity. In addition, the appropriate remodeling of the lateral bony protrusion was observed. Therefore, we introduce a new fixation method for achievement of stable fixation allowing immediate postoperative elbow motion after corrective osteotomy for cubitus varus deformity in young adults.
Increased Biceps Translation: A Clinical Sign of Complete Distal Biceps Tendon Rupture
Malhotra, Karan ; Waheed, Abdul ;
Clinics in Shoulder and Elbow, volume 19, issue 1, 2016, Pages 48~50
DOI : 10.5397/cise.2016.19.1.48
Various tests to help in the clinical diagnosis of distal biceps tendon ruptures have been described. In our experience these tests are painful in the acute setting. We suggest a simple alternative test wherein the biceps muscle belly is held by the examiner and translated medially and laterally. This is done with the forearm flexed to 90 degrees. It is first performed with the biceps relaxed and subsequently performed with the forearm flexed against resistance. In the relaxed forearm the biceps easily translates over 50% of its width. When placed under tension (by flexing against resistance) this translation is significantly reduced. In cases of complete distal biceps tendon rupture, the biceps still translates, even under resisted flexion of the forearm. This simple test is less painful than other described tests, is easy to perform, and aids in clinical diagnosis of distal biceps tendon ruptures.
Biomechanical Test for Repair Technique of Full-thickness Rotator Cuff Tear
Lim, Chae-Ouk ; Park, Kyoung-Jin ;
Clinics in Shoulder and Elbow, volume 19, issue 1, 2016, Pages 51~58
DOI : 10.5397/cise.2016.19.1.51
The arthroscopic rotator cuff repair is now considered a mainstream technique with highly satisfactory clinical results. However, concerns remain regarding healing failures for large and massive tears and high revision rate. In recent decades, various repair strategies and construct configurations have been developed for rotator cuff repair with the understanding that many factors contribute to the structural integrity of the repaired construct. The focus of biomechanical test in arthroscopic repair has been on increasing fixation strength and restoration of the footprint contact characteristics to provide early rehabilitation and improve healing. These include repaired rotator cuff tendon-footprint motion, increased tendon-footprint contact area and pressure, and tissue quality of tendon and bone. Recent studies have shown that a transosseous tunnel technique provides improved contact area and pressure between rotator cuff tendon and insertion footprint, and the technique of using double rows of suture anchors to recreate the native footprint attachment has been recently described. The transosseous equivalent suture bridge technique has the highest contact pressure and fixation force. In this review, the biomechanical tests about repair techniques of rotator cuff tear will be reviewed and discussed.