Intra-articular Lesions and Clinical Outcomes in Traumatic Anterior Shoulder Dislocation Associated with Greater Tuberosity Fracture of the Humerus

Kuk Pil Lim,In Seung Lee,In-Bo Kim 대한견주관절의학회 2017 대한견주관절의학회지 Vol.20 No.4

Background: This study investigated and evaluated the clinical outcomes of intra-articular lesions of traumatic anterior shoulder dislocation (TASD) associated with greater tuberosity (GT) fracture of the humerus. Methods: Subjects included 20 patients who were surgically or non-surgically treated for GT fracture of the humeurs with TASD, and followed-up for at least 2 years. The mean follow-up period was 54.1 months (range, 24–105 months). Of the 20 patients, 12 were treated surgically. Intra-articular lesions were identified randomly on magnetic resonance imaging scans (repeated thrice) by experienced radiologists and orthopedic surgeons. The accompanying intra-articular lesions were left untreated. Clinical outcomes were evaluated by Simple Shoulder Test (SST) and Western Ontario Shoulder Instability index (WOSI) at the last follow-up. Results: Intra-articular lesions were identified in 19 patients: 7 Bankart lesions, 15 humeral avulsion of the glenohumeral ligament lesions, 3 glenoid avulsion of the glenohumeral ligament lesion, and 6 inferior capsular tears. Two or more intra-articular lesions were identified in 6 patients. The mean SST score was 10.9 and the mean WOSI score was 449.3 at the last follow-up. Conclusions: For GT fracture of the humerus with TASD, a high frequency of diverse intra-articular lesions was identified. There were no incidence of recurrent shoulder dislocations, and good clinical outcomes were obtained without treatment of the intra-articular lesions. We thereby comprehend that although intra-articular lesions may occur in TASD associated with GT fracture of the humeurs, merely treating the GT fracture of the humerus is sufficient.

나선상 경골 간부 골절에 동반된 원위 경골 관절내 골절에서 컴퓨터 단층촬영의 유용성

변성은 ( Seong Eun Byun ),이상준 ( Sang June Lee ),김욱 ( Uk Kim ),최영락 ( Young Rak Choi ),한수홍 ( Soo Hong Han ),김병국 ( Byong Guk Kim ) 대한골절학회 2016 대한골절학회지 Vol.29 No.2

목 적: 경골 간부 골절 중 나선상 골절은 경골 원위 관절내 골절이 동반되는 빈도가 높으나 단순방사선 검사만으로 발견되지않아 적절히 치료하지 못하는 경우가 보고되고 있다. 본 연구에서는 computed tomography (CT)에서만 확인 가능하였던원위 경골 관절내 동반 골절의 양상 및 수술적 고정의 적응에 해당하였거나 시행했던 경우를 분석하여, 경골 간부 나선형 골절에서 발목관절 CT 촬영의 필요성을 검증하고자 하였다. 대상 및 방법: 수술 전 족관절 단순방사선 검사 및 CT를 시행한 95예의 나선상 경골 간부 골절을 대상으로 CT에서만 진단된동반 원위 경골 관절내 골절의 양상을 파악하고, 이 중 수술적 고정의 적응에 해당하였거나 수술적 고정을 시행한 증례를 후향적으로 분석하였다. 결 과: 원위 경골의 관절내 골절이 62예에서 확인되었다. 복합골절을 포함한 52예의 후과 골절 중 20예는 단순방사선 검사로 진단되었고, 이 중 16예가 수술적 고정의 적응증이 되었으며, 14예에서 시행되었다. CT로 진단된 32예의 후과 골절 중 26예에서 수술적 고정의 적응증이 되었고, 이 중 18예에서 시행되었다. 결 론: CT는 나선상 경골 간부 골절에서 동반골절의 진단율을 높이며, 진단된 후과 골절의 경우 수술적 고정이 시행된 빈도가 높아 나선상 경골 간부 골절에서 CT의 시행이 필요할 것으로 보인다. Purpose: The purpose of this study is to evaluate the usefulness of computed tomography (CT) for spiral tibia shaft fracture by analyzing associated distal tibia intra-articular fractures diagnosed by CT only which met the indication of surgical fixation and were fixed. Materials and Methods: Ninety-five spiral tibia shaft fractures with preoperative ankle plain radiographs and CT were analyzed retrospectively. The incidence and type of associated distal tibia articular fractures were evaluated by reviewing ankle plain radiography and CT. The number of fractures diagnosed by CT that correspond with the indication of fixation and that were actually fixed were analyzed. Results: Among 95 spiral tibia shaft fractures, 62 cases (65.3%) were associated with distal tibia intra-articular fracture. There were 37 cases of posterior malleolar fracture, 5 cases of avulsion fracture of the distal anterior tibiofibular ligament, 5 cases of medial malleolar fracture, and 15 cases of complex fracture. Among 52 posterior malleolar fractures including complex fracture, 20 cases were diagnosed by ankle plain radiograph. Of these 20 cases, 16 posterior malleolar fractures (80.0%) met the indication of surgical fixation, and 14 cases were actually fixed with a screw. Among 32 posterior malleolar fractures diagnosed by CT only, 26 cases (81.3%) met the indication of surgical fixation and 18 cases (56.3%) were fixed by screw. Conclusion: Approximately 50% of associated fractures were diagnosed by CT only and more than 80% of associated posterior malleolar fractures met the indication of surgical fixation and among these fractures, 18 cases (56.3%) were actually fixed by screw. This result suggests that CT is useful in diagnosis and treatment of distal tibia intra-articular fracture associated with spiral tibia shaft fracture.

Juxta-articular Plate Fixation in Distal Radius Intra-articular Fractures with Accompanying Volar Free Fragments beyond the Watershed Line

이준구,이수현,심영석,김태호,백유진,한수홍 대한정형외과학회 2018 Clinics in Orthopedic Surgery Vol.10 No.2

Background: Although distal radius fractures (DRF) are common fractures, intra-articular comminuted DRF with volar free fragments are uncommon. There is considerable difficulty in the fixation of free fragments beyond the watershed line using the existing volar locking plate. We aimed to examine the efficacy and potential complications associated with the use of juxta-articular volar plates in intra-articular DRF accompanied by free fragments beyond the watershed line. Methods: The patients were enrolled in a consecutive manner between 2007 and 2016. In cases of DRF with free fragments beyond the watershed line, we employed a 2.4-mm small fragment juxta-articular volar locking compression plate using a volar Henry approach. A total of 32 patients were included in this study. There were 15 males and 17 females with a mean age of 52.3 years (range, 33 to 69 years). The mean follow-up period was 14.5 months (range, 10 to 24 months). Preoperative radiographs and three-dimensional computed tomography images were used to analyze fracture patterns and assess the free fragments beyond the watershed line. The mean number of free fracture fragments beyond the watershed line was 2.33. Plain radiographs of immediate postoperative and last follow-up were used to confirm fracture union, incongruence, radial height, volar tilt, radial inclination, and arthritic changes. For functional assessment, we measured grip strength, range of motion (ROM), modified Mayo wrist score (MMWS) and determined Disabilities of Arm, Shoulder and Hand (DASH) scores at the last follow-up. Postoperative complications were monitored during the follow-up period. Results: All patients obtained sound union without significant complications. At the last follow-up, 16 cases presented with an articular step-off of more than 1 mm (mean, 1.10 mm). The mean MMWS was 76.3 (range, 55 to 90), mean DASH score was 15.38 (range, 9 to 22), mean visual analogue scale score for pain was 1.2 and mean grip strength was 75.5% of the opposite side. The mean ROM was 74.3° for volar flexion and 71.5° for dorsiflexion. Conclusions: In cases of intra-articular DRF with free fragments beyond the watershed line, a volar approach with use of a juxtaarticular plate provided favorable outcomes without significant complications.

종골의 관절내 골절 후 발생한 불유합의 수술적 치료

은일수,정철용,김진완,고영철,허정욱,Eun, Il-Soo,Jung, Chul-Young,Kim, Jin-Wan,Ko, Young-Chul,Huh, Jung-Wook 대한족부족관절학회 2009 대한족부족관절학회지 Vol.13 No.1

Purpose: Nonunion of intra-articular fractures of calcaneus is rarely reported complication. We present our experiences with 4 patients (5 cases) treated operatively for nonunion after intra-articular fracture of calcaneus. Materials and Methods: 4 patients (5 cases) with nonunion of intra-articular fracture of calcaneus after operative treatment were followed for 4 years (from 2002 to 2006). For assessment, the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and Visual Analogue Scale (VAS) were assessed for clinical outcome and the union of fracture site, the talocalcaneal height and the angle of talar declination were determined for radiologic outcome. Results: The mean talocalcaneal height was 6.94 cm (range, 5.9${\sim}$7.6 cm) preoperatively and 7.34 cm (range, 6.0${\sim}$8.3 cm) at last follow-up. The mean angle of talar declination was 5.68 degrees (range, 4.6${\sim}$8 degrees) preoperatively and 13.1 degrees (range, 5.7${\sim}$21 degrees) at last follow-up. The mean preoperative AOFAS score and VAS were 20.4 (range, 14${\sim}$36) and 4 (range, 3${\sim}$6), respectively. At last follow-up, these scores improved to a mean of 59.6 (range, 54${\sim}$68) and 3 (range, 2${\sim}$4), respectively. Unions of previous nonunion site of intra-articular fracture of calcaneus were achieved in all 4 patients (5 cases). Conclusion: The reconstructive procedure for nonunion of intra-articular fracture of calcaneus showed good results in terms of bone union, radiologic results and functional improvement than preoperative state. Because the plantar pain for the inferior angular formation in nonunion site may happen, we will pay attention to reduction of fragment.

슬개주위 도달법을 이용한 AO/OTA 분류 33-C형 원위 대퇴골 관절내 골절의 수술적 치료

주석규 ( Suk Kyu Choo ),조성탄 ( Sung Tan Cho ),오형근 ( Hyoung Keun Oh ) 대한골절학회 2022 대한골절학회지 Vol.35 No.1

목적: AO/OTA 분류 33-C형 원위 대퇴골 관절내 골절에 대한 슬개주위 도달법의 수술적 치료 결과를 보고하고자 한다. 대상 및 방법: AO/OTA 분류 33-C형 원위 대퇴골 관절내 골절로 치료한 21명의 환자를 대상으로 하였으며, C2형 11예, C3형 10예였다. 방사선적으로 골유합 시기, 관상면상의 하지정렬 등을 조사하였고, Oxford knee score 등으로 기능적 평가를 시행하여 골절 분류에 따른 치료 결과를 비교하였다. 결과: 전 예에서 관절면의 충분한 노출 및 해부학적 정복을 얻을 수 있었으나, 4예(19.0%)에서 골간단부 골절의 지연 유합으로 자가골 이식술이 필요하였다. 지연 유합군에서 정상 골유합군에 비하여 슬관절의 통증 및 Oxford knee score가 불량하였다. C2형과 C3형 골절의 방사선적 및 임상적 치료결과의 차이는 없었다. 결론: 원위 대퇴골 관절내 골절에서 슬개주위 도달법은 관절면의 해부학적 정복과 최소 침습적 금속판 내고정술에 유용하다. 관절면 분쇄 정도와 상관없이 양호한 치료 결과를 얻을 수 있었으나 골간단부 지연 유합의 위험 요소에 대한 연구가 필요하다. Purpose: To report the surgical results of the parapatellar approach for AO/OTA 33-C distal femoral intra-articular fractures. Materials and Methods: Twenty-one patients with AO/OTA 33-C distal femoral intra-articular fracture were included. There were 11 cases of C2 and 10 cases of C3 fractures. The time of union and the coronal alignment were radiographically investigated. The complications related to surgery were clinically investigated, and a functional evaluation using the range of motion and Oxford knee score was performed to compare the surgical results according to fracture classification. Results: In all cases, sufficient articular exposure and anatomical reduction were achieved with the parapatellar approach. No cases of coronal malalignment, loss of reduction, and plate failure were noted. On the other hand, in four cases (19.0%), an autogenous bone graft was performed due to delayed union on the meta-diaphyseal fracture site. There were no differences in the radiological and clinical outcomes of the C2 and C3 fractures. The knee joint pain and Oxford knee score were poorer in the delayed union group than the normal union group. Conclusion: The parapatellar approach is useful for achieving an anatomical reduction of the articular surface of the distal femur and minimally invasive plating technique. Although satisfactory surgical results could be obtained regardless of the degree of articular comminution, a study of the risk factors of delayed metaphyseal fusion may be necessary.

관절 내 종골 골절에서 Ollier 접근법을 이용한 나사못 고정술 시 삼면 피질골 이식

방태정,배서영,우승훈,정형진,Bang, Taejung,Bae, Su-Young,Woo, Seung Hun,Chung, Hyung-Jin 대한족부족관절학회 2017 대한족부족관절학회지 Vol.21 No.1

Purpose: Bone grafting is often necessary to maintain a reduction and prevent delayed collapse of reduced fracture in a treatment of severely displaced comminuted intra-articular calcaneal fractures. Herein, we analyzed the usefulness and necessary conditions to perform tricortical-allobone grafting in open reduction of calcaneal fracture via the Ollier approach. Materials and Methods: We performed a retrospective review of 57 intra-articular calcaneal fractures that underwent an operation via the Ollier approach between April 2009 and April 2015. They were divided into two groups: Group 1 (n=17) included those with tricortical-allobone grafts underneath the posterior facet fragment, and group 2 (n=40) included cases without a bone graft. We measured the $B{\ddot{o}}hler$ angle, Gissane angle, height, and width of the calcaneus at preoperative, postoperative, and final follow-up radiograph. We measured the sagittal rotational angle of the posterior facet fragment of preoperative computed tomography to analyze the effect and necessary conditions for bone grafting. We also reviewed the clinical results by the American Orthopaedic Foot and Ankle Society (AOFAS) scale, visual analogue scale (VAS), and any complications. Results: According to the Sanders classification, there were 3 type-II fractures, 12 type-III fractures, and 2 type-IV fractures in Group 1; whereas in Group 2, there were 26 type-II fractures, 13 type-III fractures, and 1 type-IV fracture (p=0.002). Regarding the preoperative radiologic parameters, there were significant differences in the $B{\ddot{o}}hler$ angle (p=0.006), Gissane angle (p=0.043), and rotational angle of the posterior facet fragment (p=0.001). No significant difference was observed in the preoperative calcaneal height and width, as well as postoperative radiologic parameters. There was no significant clinical difference between the two groups (p=0.546). Conclusion: We suggest that a tricortical-allobone graft may be useful in open reduction and screw fixation via the Ollier approach for displaced intra-articular calcaneal fracture with a bony defect after reduction of collapsed posterior facet fragment. This graft can contribute to the stable reduction via a small approach, even without a plate.

Comparative study on Kirschner-wire and screw fixation for intra-articular fractures of the proximal phalanx head

Jin Soo Kim,Jae Yong Lee,Dong Chul Lee,Si Young Roh,Kyung Jin Lee,Sung Hoon Koh 대한수부외과학회 2022 대한수부외과학회지 Vol.27 No.3

Purpose: This study compared screw and Kirschner-wire (K-wire) fixation for intra-articular fractures of the proximal phalanx head regarding the success of union and functional outcomes. Methods: In this retrospective study, we enrolled patients with closed intra-articular fractures of the proximal phalangeal head treated between January 2011 and December 2021. Patients with open wounds, tendon or neurovascular injuries, comminuted fractures, or middle phalangeal fractures were excluded. Patients’ demographics, bone union, proximal interphalangeal (PIP) joint range of motion (ROM), grip power, and complications were collected and analyzed. The percentage of intra-articular surface involvement and the number of bone fragments were also analyzed in relation to the functional results. Results: Among 41 patients, 21 were managed with screw fixation, and the remaining 20 with K-wire fixation. The mean union rate was 100% in the screw fixation group and 95.0% in the K-wire fixation group, with no statistically significant difference (p=0.488). Other functional parameters (PIP joint ROM, time to bone union, and grip power) were not significantly different between the two groups. Regardless of the treatment modality, the PIP joint ROM showed significant negative associations with the involvement of more intra-articular surfaces (p<0.001) and the presence of a greater number of bone fragments (p=0.040). Conclusion: In intra-articular fractures of the proximal phalanx head, the treatment modality (screw or K-wire) did not affect the treatment outcome. Instead, the percentage of intra-articular surface involvement and the number of bone fragments showed significant negative associations with the PIP joint ROM after treatment.

관절내 종골 골절에 대해 AO 종골 금속판을 이용한 수술적 치료 결과

김성택,윤태현,박진범,이준영,Kim, Seong-Tek,Youn, Te-Hyun,Park, Jin-Bum,Lee, Jun-Young 대한족부족관절학회 2009 대한족부족관절학회지 Vol.13 No.1

Purpose: To evaluate the outcomes of intra-articular calcaneal fractures treated using AO calcaneal plate surgically. Materails and Methods: Total 15 cases of intra-articular calcaneal fracture that treated with open reduction and internal fixation using AO calcaneal plate were evaluated. The patients were followed over a mean period of 19.8 months. The mean age was 41.6 years. By Sanders classification, there were 2 cases of type II, 10 cases of type III, and 3 cases of type IV. We evaluated radiological outcomes by Bohler angle, Gissane angle, calcaneal hight, calcaneal width and clinical outcomes by Creighton-Nebraska health foundation score. Results: All fractures united at a mean duration of 13.3 weeks. Radiologically, the mean preoperative Bohler angle was $8.5^{\circ}$ and restored to $23.3^{\circ}$. The mean preoperative Gissane angle was $118.7^{\circ}$ and restored to $124.2^{\circ}$. The mean preoperative calcaneal hight was 30.8 mm and restored to 38.9 mm. The mean preoperative calcaneal width was 41.3 mm and restored to 35.3 mm. 10 cases had excellent and good clinical outcomes and 5 cases having fair outcome. Conculsion: In our study, open reduction and internal fixation using AO calcaneal plate showed good results with anatomical restoration of articular surface and stable fixation without late collapse.

관혈적 정복 및 내고정을 이용한 관절 내 종골 골절의 치료 시 골이식 유무에 대한 비교 연구

손홍문 ( Hong Moon Sohn ),하상호 ( Sang Ho Ha ),이준영 ( Jun Young Lee ),조승환 ( Sung Hwan Jo ),양훈 ( Hoon Yang ) 대한골절학회 2010 대한골절학회지 Vol.23 No.2

목적: 종골의 관절 내 분쇄 골절에 대하여 관혈적 정복 및 금속판을 이용한 내고정을 시행한 환자에서 골이식의 시행여부에 따른 임상적 결과 차이를 비교하고자 하였다. 대상 및 방법: 관혈적 정복술 및 금속판을 이용하여 내고정술을 시행한 종골의 관절 내 골절 환자 중 최소 1년 이상 추시가 가능한 25예를 대상으로 하였으며 이중 골이식을 시행한 경우가 15예였다. 골이식 여부에 따른 골유합 기간 및 기능적 평가를 분석하였으며 합병증을 조사하였다. 결과: 전례에서 골유합을 얻었으며, 평균 골유합 기간은 골이식 군에서 11.6주, 골이식하지 않은 군에서 12.8주였고, Creighton-Nebraska Health Foundation (CNHF) 종골 골절 평가 점수는 골이식 군에서 평균 86.5점, 골이식 하지 않은 군에서는 평균 80.3점이었다. 골이식 여부에 따른 골유합 기간과 CNHF 점수의 통계학적 의의는 없었다. 골이식을 하지 않은 군에서는 4예, 골이식 군에서는 5에에서 합병증이 관찰되었다. 결론: 종골의 관절 내 분쇄 골절 치료에 있어 관혈적 정복술 및 금속판을 이용한 내고정을 시행하는 경우, 골이식 여부는 골유합기간 및 기능적 평가에서 큰 차이를 보이지 않는 것으로 생각된다. Purpose: This study compares the clinical results of open reduction and internal fixation with and without bone graft for the treatment of intra-articular calcaneal fractures. Materials and Methods: Twenty-five patients who had open reduction and internal fixation for intra-articular calcaneal fractures and available for at least 1 year of follow-up were included in this study. Fifteen cases were operated with bone graft. Period to bone union and functional evaluation score were compared between both groups with analysis of complications. Results: Bone union was achieved in all cases with average bone union time of 11.6 weeks and 12.8 weeks in group with and without bone graft respectively. Creighton-Nebraska Health Foundation (CNHF) functional score was 86.5 points and 80.3 points respectively. The period to bone union and the CNHF score in the comparison of two groups were statistically insignificant. Complications were observed in four cases of group without bone graft and 5 cases of group with bone graft. Conclusion: This study indicates that bone graft does not play a significant role in bone union and functional outcome when intra-articular calcaneal fractures are treated with open reduction and internal fixation.

Triangular Fixation Technique for Bicolumn Restoration in Treatment of Distal Humerus Intercondylar Fracture

정성원,Seung-Hoon Kang,Min Jeong,Hae-Seong Lim 대한정형외과학회 2016 Clinics in Orthopedic Surgery Vol.8 No.1

Background: Distal humerus intercondylar fractures are intra-articular and comminuted fractures involving soft tissue injury. As distal humerus is triangle-shaped, parallel plating coupled with articular fixation would be suitable for bicolumn restoration in treatment of distal humerus intercondylar fracture. Methods: This study included 38 patients (15 males and 23 females) who underwent olecranon osteotomy, open reduction and internal fixation with the triangle-shaped cannulated screw and parallel locking plates (triangular fixation technique). Functional results were assessed with the visual analog scale (VAS) scores, Mayo elbow performance (MEP) scores and Disabilities of the Arm, Shoulder and Hand (DASH) questionnaires. Anteroposterior and lateral elbow radiographs were assessed for reduction, alignment, fracture union, posttraumatic arthrosis, and heterotopic ossification, and computed tomography (CT) scans were used to obtain more accurate measurements of articular discrepancy. Results: All fractures healed primarily with no loss of reduction. The mean VAS, MEP, and DASH scores of the affected elbow were not significantly different from those of the unaffected elbow (p = 0.140, p = 0.090, and p = 0.262, respectively). The mean degree of flexion was significantly lower in the affected elbow than in the unaffected elbow, but was still considered as functional (p = 0.001, > 100° in 33 of 38 patients). Two cases of articular step-offs (> 2 mm) were seen on follow-up CT scans, but not significantly higher in the affected elbow than in the unaffected elbow (p = 0.657). Binary logistic regression analysis revealed that only Association for Osteosynthesis (AO) type C3 fractures correlated with good/excellent functional outcome (p = 0.012). Complications occurred in 12 of the 38 patients, and the overall reoperation rate for complications was 10.5% (4 of 38 patients). Conclusions: Triangular fixation technique for bicolumn restoration was an effective and reliable method in treatment of distal humerus intercondylar fracture. This technique maintained articular congruency and restored both medial and lateral columns, resulting in good elbow function.