• Archives of Reconstructive Microsurgery
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• v.7 no.1
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• pp.35-40
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• 1998

The incidence of brachial plexus injury is increasing because of the development of motor vehicle but the the results of treatment was reported poor due to its complex anatomical structure and changes of function and sensory during the recovery after trauma. But the results of treatment has been improved by the recently introduced high sensitive diagnostic method that can evaluate accurately the site and extent of the injury and treatment method. Restoration of the elbow flexion is the most important goal of treatment after brachial plexus injury and nerve graft, neurotization and muscle transfer were used for methods of treatment. From December 1992 to May 1994, the author performed 6 cases of latissimus dorsi transfer at the same side for the improvement of elbow flexion in the patients of brachial plexus injury. There were 5 cases of male, one case of female and average age was 22 years old. The causes of injury were traffic accident in 3 cases, gun shot injury, falldown and birth injury in each one case and in all cases, the type of injury were upper arm type. The average follow up period were 1 year 5 months ranging from 12 months to 4 years 5 months. In all cases, active elbow flexion was impossible before operation and average muscle power was grade I. We analysed the active range of motion, muscle power and the functional results. At the last follow up, range of active elbow flexion was average $124^{\circ}$ and flexion contracture was average 11 degrees and the average of muscle power was grade IV. In the functional analysis, there were two cases of excellent, three cases of good and 1 case of fair. There was no complications including wound infection, vascular compromise and donor site problem. The results of latissimus dorsi transfer for improvement elbow flexion in the patients of brachial plexus injury is one of the useful mettled for the restoration of elbow flexion.

• Clinics in Shoulder and Elbow
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• v.25 no.3
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• pp.188-194
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• 2022

Background: Medial elbow laxity develops in throwing athletes due to valgus forces. Medial elbow instability in professional, collegiate, and high school athletes is well documented; however, the medial elbow of young throwing athletes has received less attention. This study investigated the medial elbow and common flexor tendon during applied elbow valgus stress of youth baseball players. Methods: The study included 15 participants. The medial elbow width and thickness of the common flexor tendon were measured on ultrasound images. Results: No significant side differences in medial elbow width or common flexor tendon were found at rest or under applied valgus stress. At rest, the medial elbow joint width was 3.34±0.94 mm on the dominant side and 3.42±0.86 mm on the non-dominant side. The dominant side increased to 3.83±1.02 mm with applied valgus stress, and the non-dominant side increased to 3.96±1.04 mm. The mean flexor tendon thickness was 3.89±0.63 mm on the dominant side and 4.02±0.70 mm on the non-dominant side. Conclusions: These findings differ from similar studies in older throwing athletes, likely because of the lack of accumulated stress on the medial elbow of youth throwing athletes. Maintaining elbow stability in young throwing athletes is a vital step to preventing injury later in their careers.

• Archives of Reconstructive Microsurgery
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• v.7 no.2
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• pp.102-107
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• 1998

We have performed the operations for the restoration of shoulder abduction and elbow flexion in 17 patients(20 cases of neurotization) of brachial plexus injury at the Department of Orthopaedic Surgery, Korea University Hospital from October 1991 to May 1997. The mean follow-up period was 42 months. After neurotization for brachial plexus injury, functional recovery of shoulder abduction and elbow flexion were good and fair in 65%. In the functional evaluation, the clinical results of whole arm type were poorer than those of upper arm type, and the operations performed within 6 months since the injury were better than those of other cases.

• Clinics in Shoulder and Elbow
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• v.18 no.1
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• pp.8-12
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• 2015

Background: The aim of this study was to assess demographics, clinical outcomes, and complications of classic floating elbow in adults. Methods: Six patients with ipsilateral diaphyseal fractures of the humerus, radius, and ulna were reviewed retrospectively. All patients were treated operatively and available for follow-up at a minimum of 1 year after surgery. The average age of the patients was 45.2 years (22-64 years) and the average follow-up period was 37.0 months (14-103 months). They were evaluated with postoperative outcome measures, including a visual analog scale (VAS) for pain, Mayo elbow performance score (MEPS), and American Shoulder and Elbow Surgeons (ASES) shoulder score. Residual complications were also evaluated. Results: Five patients (83.3%) had open fracture, and 4 patients (66.7%) presented with associated nerve injury. All fractures were united within postoperative 4 months, except 1 delayed union. The average VAS pain score, MEPS, and ASES shoulder score at the final follow-up examination was 2.5, 79.8, and 67.5 respectively. Three patients including 2 cases of joint stiffness with incomplete recovery from nerve injury and 1 case of complex regional pain syndrome had poor clinical outcome. Conclusions: Although the classic floating elbow is rare, these injuries potentially have associated problems such as open fracture or nerve injury. The presence of residual neurological symptoms predispose to poorer clinical outcomes.

• Journal of Korean Orthopaedic Sports Medicine
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• v.7 no.1
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• pp.8-14
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• 2008

Elbow joint injuries during exercise mostly occur by repeated stress to the joint than direct trauma. A pitcher who uses his arm above his head is most likely to be injured. So learning the right way to exercise and gaining the strength by maturating the body are essential for diminishing the chance of injury. On lateral ulnar tendon injury, which is most commonly injured area on elbow joint, pitchers generally complain of pain in arm movement above head and reduction of velocity, accuracy, and number of pitching. When there is pain on upper arm in harsh using, the stress fracture must be thought and epicondylar physis fracture of medial arm can occur by repeated abduction stress and contraction of flexors on forearm on children with immature skeleton. Osteochondritis dissecans of capitullum occur in young athletes who use there upper limb continuously lifting weights and gym work. And stress of abduction-extension includes damage of soft tissue and bone components, post medial crush syndrome, lateral ulnar ligament injury, extensor-abductor injury, stress of radius- capitullum are in this category.

• Clinics in Shoulder and Elbow
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• v.1 no.2
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• pp.236-241
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• 1998

Recurrent dislocation of elbow joint occurs relatively rarely by the injury of the collateral ligament which contributes elbow joint stability. Among them, posterolateral rotatory instability occurs by the injury to the lateral ulnar collateral ligament. We experienced a case of recurrent dislocation of elbow joint due to posterolateral rotatory instability. We treated operatively with lateral ulnar collateral ligament reconstruction using the palmaris longus tendon by technique of Nestor et al. We report it with literature analysis.

• Clinics in Shoulder and Elbow
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• v.23 no.1
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• pp.27-30
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• 2020

Osborne-Cotterill lesion is an osteochondral fracture located in the posterolateral margin of the humeral capitellum, which may be associated with a defect of the radial head after an elbow dislocation. This lesion causes instability by affecting the lateral ulnar collateral ligament over its capitellar insertion, which is associated with a residual capsular laxity, thereby leading to poor coverage of the radial head, and hence resulting in frequent dislocations. We present a 54-year-old patient, a physician who underwent trauma of the left elbow after falling from a bike and suffered a posterior dislocation fracture of the elbow. The patient subsequently presented episodes of instability, and additional work-up studies diagnosed the occurrence of Osborne-Cotterill lesion. An open reduction and internal fixation of the bony lesion was performed, with reinsertion of the lateral ligamentous complex. Three months after surgery, the patient was asymptomatic, having a flexion of 130° and extension of 0°, and resumed his daily activities without any limitation. Currently, the patient remains asymptomatic 2 years after the procedure. Elbow instability includes a large spectrum of pathological conditions that affect the biomechanics of the joint. The Osborne-Cotterill lesion is one among these conditions. It is a pathology that is often forgotten and easily overlooked. Undoubtedly, this lesion requires surgical intervention.

• Journal of Korean Orthopaedic Sports Medicine
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• v.7 no.2
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• pp.67-74
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• 2008

Repetitive overhead throwing exerts significant mechanical stress on the elbow joint. Pitching in baseball, serving in tennis, spiking in volleyball, passing in American football and launching in javelin-throwing can all produce elbow pathology by forceful valgus stress, with medial stretching, lateral compression and posterior impingement. This stress can lead to developmental anatomic changes in the young thrower. Asymptomatic pathology in the shoulder and elbow joint is prevalent and, with overuse, can progress to disabling injury. Joint injury occurs as a result of the body's inability to properly coordinate motion segments during the pitching delivery, leading to further structural damage. The implications of acute and overuse injuries and the possibility of permanent damage should be understood by parents, coaches and the athletes. Proper understanding of the intrinsic and extrinsic risk factors that could lead to elbow injuries is thus required. Measures to prevent elbow injuries should include proper coaching, warm-up, medical expertise and protective gear. Injury prevention and rehabilitation should center on optimizing pitching mechanics, core strength, scapular control, and joint range of motion.

• Archives of Reconstructive Microsurgery
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• v.14 no.1
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• pp.63-69
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• 2005

Purpose: The purpose of this study was to analyze the clinical results after Steindler flexoplasty. Materials and Methods: We analyzed 6 cases who had nearly normal finger and wrist joint flexion function, but could not flex elbow joint actively because of upper arm type brachial plexus injury. We performed operation during the period from February 1997 to July 2003. There were 5 males and 1 female with mean age of 28 years (range: $19{\sim}51$ years) when Steindler flexoplasty was done. The average follow-up period was 3 years 11 months (range: 12 months${\sim}$7 years 4 months). We assessed active range of motion of elbow joint, muscle power and elbow function by Mayer & Green grade scale at last follow-up. We assessed how much they were favorable for Steindler flexoplasty and had improvement of upper extremity function and correction of deformity. Results: Postoperative, flexion range of elbow joint improved to average $111.7^{\circ}$ (range: $90{\sim}130^{\circ}$). $25.8^{\circ}$ (range: $15{\sim}45^{\circ}$) in flexion contracture and $16.6^{\circ}$ (range: $10{\sim}35^{\circ}$) in pronation contracture were remained. Range of motion of elbow joint improved to average $85.3^{\circ}$ (range: $45{\sim}105^{\circ}$). Flexion power of elbow joint improved to Grade 5 in all cases. Postoperatively on Mayer & Green grade scale, there were excellent in 3 cases(50%), good in 2 cases(33.3%), fair in 1 case(16.7%). On patient's own assessment of functional improvement, there were excellent in 4 cases(66.6%), good in 1 case(16.7%) and fair in 1 case(l6.7%). Conclusion: Steindler flexoplasty can reserve good clinical results with being improved to active flexion of elbow joint in cases who have functional hand and wrist, but paralysis upper arm muscle in brachial plexus injury.

• The Academic Congress of Korean Shoulder and Elbow Society
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• 2004.11a
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• pp.176-179
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• 2004

Arthroscopy of the stiff elbow joint is a technically difficult procedure because of the decreased joint space of the elbow joint. even to experienced surgeons. Problems encountered include limited access of instrument to the intra-articular ,pace and an increased risk of cartilage injury in the contracted elbow joint. This study describes a novel transarticular approach for elbow arthroscopy that allow, the safe and effective creation of the proximal medial and lateral portals.