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백구현,Hyuk Jin Lee,Hyun Sik Gong,Seung Hwan Rhee,Jihyeung Kim,Kang Wook Kim,Bong Young Kong,Won Seok Oh 대한정형외과학회 2011 Clinics in Orthopedic Surgery Vol.3 No.4
Background: There have been few outcomes studies with follow-up after performing ulnar shortening osteotomy for ulnar impactionsyndrome. We investigated the long-term clinical and radiological outcomes of ulnar shortening osteotomy for the treatmentof idiopathic ulnar impaction syndrome. Methods: We retrospectively reviewed 36 patients who had undergone ulnar shortening osteotomy for idiopathic ulnar impactionsyndrome for a mean follow-up of 79.1 months (range, 62 to 132 months). The modifi ed Gartland and Werley scores were measuredpre- and postoperatively. The radiographic parameters for the assessment of the distal radioulnar joint (DRUJ) as well as therelationship between these radiographic parameters and the clinical and radiological outcomes were determined. Results: The average modifi ed Gartland and Werley wrist score improved from 65.5 ± 8.1 preoperatively to 93.4 ± 5.8 at the lastfollow-up visit. The average preoperative ulnar variance of 4.7 ± 2.0 mm was reduced to an average of −0.6 ± 1.4 mm postoperatively. Osteoarthritic changes of the DRUJ were fi rst seen at 34.8 ± 11.1 months follow-up in 6 of 36 wrists (16.7%). Those whohad osteoarthritic changes in the DRUJ had signifi cantly wider preoperative ulnar variance, a longer distal radioulnar distance anda greater length of ulnar shortening, but the wrist scores of the patients who had osteoarthritic changes in the DRUJ were comparableto those who did not have osteoarthritic changes in the DRUJ. Conclusions: The clinical outcomes are satisfactory for even more than 5 years after ulnar shortening osteotomy for treating idiopathiculnar impaction syndrome despite the osteoarthritic changes of the DRUJ. The patients who need a larger degree of ulnarshortening may develop DRUJ arthritis.
Classifi cation and Surgical Treatment of Symphalangism in Interphalangeal Joints of the Hand
백구현,Hyuk Jin Lee 대한정형외과학회 2012 Clinics in Orthopedic Surgery Vol.4 No.1
Background: Symphalangism is a rare congenital difference characterized by ankylosis of interphalangeal (IP) joints of the fi ngersand toes. In adults, there were several attempts to restore the stiff joints into mobile ones, but these treatment options resultedin poor outcomes and could not be applied to growing children. Here, we report our experiences on surgical treatment for childrenwho had symphalangism of the hand. Methods: We treated 36 joints in 17 children with symphalangism of the hand using dorsal capsulotomy and collateral ligamentrelease. The diagnoses were based on history, physical examination, and simple radiographs. Affected fi ngers were classifi ed accordingto our grading system. Simple compressive dressing was applied using Coban after surgery. Passive range of motion (ROM)exercise was started on day one or 2 postoperative, with the help of a hand therapist and patients’ parents. The patients wereprescribed passive ROM exercises for at least 2 hours a day over a period of 6 months. Results: A single surgeon operated on 30 proximal IP joints, 3 distal IP joints, and 3 IP joints of the thumb. Twenty six joints wereclassifi ed as grade I, and 10 as grade II. The ROM of affected joints, which was 7.8 ± 8.1 (mean ± SD) degrees preoperatively,increased to 46.8 ± 18.6 degrees at fi nal follow-up. The fi nal ROM was signifi cantly better in grade I joints, especially when thechildren had operations at ages 24 months or younger. Conclusions: Symphalangism of the hand in children, can be restored into a mobile joint by release of the collateral ligament, adorsal capsulotomy, and postoperative physical therapy.