Repair integrity and functional outcomes of arthroscopic repair in chronic anterior shoulder instability: single-loaded versus double-loaded single-row repair.

INTRODUCTION: This study compared the clinical outcome and repair integrity of single-loaded and double-loaded single-row arthroscopic repair of chronic anterior shoulder instability. MATERIALS AND METHODS: Fifty consecutive chronic anterior shoulder instability cases treated by arthroscopic labral repair were included. A single-loaded single-row technique was used in the first 25 consecutive shoulders, and a double-loaded single-row technique was used in the next 25 consecutive shoulders. The number of suture anchors was 4 in the shoulders that underwent single-loaded repair and 3 in the shoulders that underwent double-loaded repair. 42 shoulders (84.0%) followed up clinical outcomes were evaluated a minimum 2 years (mean 28.5 months; range 24-46) postoperatively. The postoperative labral repair integrity was evaluated by MDCT-arthrogram at a minimum 6 months postoperatively. RESULTS: At the final follow-up, the average UCLA, ASES, Constant, Rowe score, VAS pain score, and VAS for instability scores improved significantly, to 33.05, 92.33, 89.05, 94.86, 0.90 and 0.52, respectively, in the single-loaded group and to 32.19, 90.10, 89.05, 94.52, 0.90, and 0.86, respectively, in the double-loaded group. The clinical scores improved in both groups postoperatively (all P < 0.05); however, there was no significant difference between the two groups at final follow-up (P = 0.414, 0.508, 1.000, 0.917, 1.000, and 0.470, respectively). The re-tear rate was 2 (9.5%) in the shoulders that underwent single-loaded repair and 3 (14.3%) in the shoulders that underwent double-loaded repair; this difference was statistically not significant (P = 0.634). CONCLUSION: The double-loaded single-row technique resulted in comparable clinical outcomes, and re-tear rate compared with the single-loaded single-row technique in chronic anterior shoulder instability at short-term follow-up. Number of used suture anchor in double-loaded single-row technique was fewer than that of single-loaded single-row technique. LEVEL OF EVIDENCE: Comparative retrospective study, level III.

Risk factors for failure of eradicating infection in a single arthroscopic surgical procedure for septic arthritis of the adult native shoulder with a focus on the volume of irrigation.

BACKGROUND: Septic arthritis of a native joint is relatively rare but is still a challenging and important orthopedic emergency. Most previous reports have focused on the clinical outcomes rather than the risk factors for failure in arthroscopic surgery. METHODS: We retrospectively reviewed the records of patients with septic monoarthritis of the shoulder who underwent arthroscopic irrigation and débridement between January 2007 and January 2019. All patients were divided into 2 groups according to recurrence after a single arthroscopic surgical procedure: eradicated group or recurred group. To identify risk factors affecting the recurrence of septic arthritis of the shoulder after arthroscopic surgery, the following parameters were considered: age; sex; involved side; presentation of rotator cuff tear; volume of irrigation; bacterial organism involved; preoperative erythrocyte sedimentation rate, C-reactive protein level, and white blood cell count in blood and joint fluid; diabetes mellitus; and hypertension. We compared the eradicated and recurred groups regarding the presence of potential risk factors. RESULTS: The study included 97 patients with a mean age of 61 years. Septic arthritis of the shoulder was eradicated completely with a single arthroscopic surgical procedure in 85 patients. However, a second arthroscopic surgical procedure was necessary in 12 patients (12.4%) because of infection recurrence. No significant differences were found between groups except in the volume of irrigation (P < .001). CONCLUSIONS: Most patients with septic arthritis (87.6%) of native shoulders were effectively treated with a single arthroscopic irrigation and débridement. The amount of irrigation may be the most important factor for preventing the need for additional surgical management.

Early postoperative magnetic resonance imaging findings after arthroscopic rotator cuff repair: T2 hyperintensity of the capsule can predict reduced shoulder motion.

INTRODUCTION: The purpose of this study was to investigate whether postoperative shoulder magnetic resonance imaging (MRI) findings correlate with postoperative shoulder range of motion (ROM) at about 4 months after arthroscopic rotator cuff repair (ARCR). MATERIALS AND METHODS: Signal-intensity changes of the capsule, pericapsular soft tissue at the axillary recess, and subcoracoid fat triangle, as well as the thickness of the capsule at the axillary recess and coracohumeral ligament were assessed on preoperative and postoperative MR images of 232 patients. The ROM was evaluated preoperatively and at about 4 months after ARCR. RESULTS: T2 hyperintensity of the capsule, pericapsular soft tissue at the axillary recess, and signal change of the subcoracoid fat triangle were detected in 155, 107, and 89 cases, respectively, on postoperative MRI. Among these cases, 129, 98, and 69 cases, respectively, showed newly developed signal changes. The mean thicknesses of the capsule and coracohumeral ligament were 1.89 ± 0.69 and 1.64 ± 0.51 mm, respectively, on preoperative MRI and 3.74 ± 1.12 and 2.42 ± 0.56 mm, respectively, on postoperative MRI. At the 4-month follow-up, the mean external rotation (ER), internal rotation (IR), abduction, forward flexion, and extension were 77, 73, 76, 83, and 82%, respectively, of the contralateral side. Newly developed T2 hyperintensity of the capsule and pericapsular soft tissue at the axillary recess on postoperative MRI significantly correlated with the postoperative limitation of ER (p = 0.039) and IR (p = 0.020). CONCLUSIONS: Newly developed signal changes of the capsule, pericapsular soft tissue at the axillary recess, and subcoracoid fat triangle were often detected on postoperative MRI at 4 months after ARCR. Furthermore, newly developed T2 hyperintensity of the capsule and pericapsular soft tissue at the axillary recess correlated with limited ROM in ER and IR at 4 months after ARCR.

Anteroposterior translation of the glenohumeral joint in various pathologies: differences between shoulder MRI in the adducted neutral rotation and abducted externally rotated positions.

PURPOSE: The present study was performed to determine the translation of the glenohumeral joint in patients with and without shoulder lesions by comparing the magnetic resonance images obtained in the conventional adducted neutral rotation position with those obtained in the abducted externally rotated position. METHODS: Two hundred and eighty-five consecutive shoulders without rotator cuff tears that had been subjected to magnetic resonance imaging (MRI) without arthrography in the abducted externally rotated position were reviewed retrospectively. Among them, 50 shoulders without pathology were selected at random to be compared with three shoulder pathology groups, comprising shoulders with superior labrum, anterior-to-posterior (SLAP) lesions without range of motion (ROM) limitation (group I, 47 shoulders), with massive rotator cuff tears without ROM limitation (group II, 20 shoulders), and with full-thickness subscapularis tendon tears without ROM limitation (group III, 20 shoulders). Glenohumeral translation in the anterior-to-posterior direction relative to the glenoid face was evaluated using a method based on the glenohumeral contact point (CP) and humeral head centre (HHC) in the adducted neutral rotation and abducted externally rotated views, which were measured by three orthopaedic surgeons. For each shoulder, the differences in translation for the glenohumeral CP and HHC between the adducted neutral rotation and abducted externally rotated views were calculated as relative posterior translation in millimetres. RESULTS: The differences in ΔCP and ΔHHC between group I and the normal control group were not statistically significant. The differences in ΔCP (P = 0.001) and ΔHHC (P = 0.001) between group II and the normal control group were statistically significant. Additionally, the differences in ΔCP and ΔHHC between group III and the normal control group were not statistically significant. CONCLUSIONS: The MRI in abducted externally rotated view in patients with SLAP lesions or full-thickness subscapularis tendon tears diagnosed by conventional MRI alone showed no significant glenohumeral posterior translation relative to the adducted neutral rotation view in the present study. However, the abducted externally rotated view in patients with massive rotator cuff tears showed significant glenohumeral anterior translation relative to the adducted neutral rotation view.

Does fracture affect the healing time or frequency of recurrence in a simple bone cyst of the proximal femur?

BACKGROUND: Studies have focused on intramedullary nailing of femoral simple bone cysts but have not clarified the recurrence frequency or management of recurrent cysts. In particular, the affect of pathologic fractures on cyst healing, recurrence, and complications of treatment have not been reported. QUESTIONS/PURPOSES: We performed a retrospective comparative study to examine whether there were differences between simple bone cysts in the proximal femur nailed after pathologic fracture and those without pathologic fracture in terms of (1) healing time, (2) frequency and timing of recurrence, and (3) complications. METHODS: From 1995 to 2005, 54 patients diagnosed with femoral simple bone cysts were treated and followed for a minimum of 8 years. Flexible nails were inserted in a retrograde fashion in 25 patients with fractures and 29 patients without fractures. The healing period, degree of radiographic consolidation based on the criteria of Capanna et al., recurrence frequency, and final bony abnormalities were analyzed. The mean followups were 107 months (range, 96-124 months) and 103 months (range, 96-140 months) in the groups with and without fractures, respectively. With the numbers available, a post hoc calculation showed that this study had 80% power to detect a difference of 7 months of healing time as significant with a probability less than 0.05. RESULTS: With the numbers available, the mean healing period was not different between groups (25 versus 30 months in the groups with and without fractures, respectively; p = 0.16). Complete healing was observed at 19 versus 18 months, incomplete healing at 5 versus 8 months, and recurrence was observed in one and three patients in the groups with and without fractures, respectively. No differences were found in the distribution of healing grade based on the criteria of Capanna et al. A second surgery was performed using intramedullary nails in two patients with an open physis and compression hip screw fixation was performed in two patients with a closed physis. Finally, the recurrent cysts were classified as completely healed in three patients and incompletely healed in one. CONCLUSIONS: Whether a pathologic fracture had occurred before surgical treatment, intramedullary nailing of femoral simple bone cysts resulted in reliable healing, and the frequency of recurrence did not differ. Because this was a retrospective study, the optimal treatment for recurred cysts after intramedullary nailing should be further investigated through a comparative or prospective study.

Outcomes of the mini-open Outerbridge-Kashiwagi procedure according to preoperative radiocapitellar joint status.

PURPOSE: To compare the clinical and radiological outcomes in patients treated with the mini-open Outerbridge-Kashiwagi procedure according to radiological grading of the radiocapitellar joint. METHODS: Sixty-three patients with primary elbow arthritis diagnosed between March 2004 and February 2010 were enrolled. Patients without and with radiocapitellar arthrosis were assigned to groups 1 (n = 34) and 2 (n = 29), respectively. The mean follow-up period was 51 months. Clinical outcomes were compared between groups using the presence of resting elbow pain; Morrey pain score; the Mayo Elbow Performance Score; the Disabilities of the Arm, Shoulder and Hand score; and active range of motion. Radiological outcomes, including the presence of loose bodies and re-ossification of fenestration, were evaluated. RESULTS: No patient in group 1 and 4 patients in group 2 reported resting elbow pain at the final follow-up examination. All pain was on the radial side, and it was aggravated in 2 patients. The Mayo Elbow Performance Score and Disabilities of the Arm, Shoulder and Hand score and active motion improved in both groups. No significant difference in the Morrey pain score, Mayo Elbow Performance Score, Disabilities of the Arm, Shoulder and Hand score, or active range of motion was observed between groups. Postoperative deterioration of radiological joint status was similar in the ulnohumeral and radiocapitellar joints of both groups. Re-ossification of the fossa fenestration did not differ significantly between groups. CONCLUSIONS: We compared the outcomes of the mini-open Outerbridge-Kashiwagi procedure according to radiocapitellar joint status. Short-term results were satisfactory in both groups, but resting pain associated with newly developed anterior loose bodies led to a poor outcome in group 2. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.

Fixation of posterior process fractures of the olecranon using a modified suture bridge technique: report of 2 cases.

We encountered 2 patients with posterior process fractures of the olecranon and fixed the fragment using a modified suture bridge method without a metallic implant. The suture anchor was inserted distally through the fracture plane, and the small tip of proximal olecranon was reduced to the ulna. Computed tomography revealed bony union 4 and 5 months later. At the 1-year postoperative follow-up examination, the clinical outcomes were satisfactory in both patients. This suture bridge technique was reliable for small fragment fixation in posterior process fracture of the olecranon based on the tension band theory with no problems induced by metallic hardware.

Comparison of grip strength among 6 grip methods.

PURPOSE: To measure grip strengths using several methods by serially excluding 1 or 2 phalanges using a flexion-block orthosis and comparing those with standard grip posture in order to facilitate prediction of clinical or functional outcomes that relate to the contribution of each finger to grip strength. METHODS: Two hundred healthy men aged 25 to 30 years were included in the survey. Demographic variables were collected, and anthropometric measurements of the forearm and hand were obtained. Grip strength was measured using all fingers, all fingers except the thumb, all fingers except the index finger, all fingers except the middle finger, all fingers except the ring and little fingers, and all fingers except the little finger. The contribution of each finger to the total grip strength was estimated using the weight value concept. RESULTS: Grip strength using all 5 fingers was greatest, and the grip strength without the thumb was the second greatest. Grip strengths without the middle finger and without the ring and little fingers were the lowest. Various degrees of positive correlations between each grip method and 8 anthropometric parameters were found. Contributions of the thumb, index, middle, and ring and little fingers to the grip strength were 17%, 22%, 31%, and 29%, respectively. CONCLUSIONS: The middle finger was the most important contributor to grip strength. The next most important was the combination of the ring and little fingers. CLINICAL RELEVANCE: The present estimated contributions of each finger to grip strength may facilitate prediction of the clinical or functional outcomes of various pathological conditions.

Clinical and radiological outcomes of scaphoidectomy and 4-corner fusion in scapholunate advanced collapse at 5 and 10 years.

SUMMARY: This retrospective study examined clinical and radiological outcomes of scaphoidectomy and 4-corner fusion in patients with a scapholunate advanced collapse (SLAC) at 5 and 10 years. PURPOSE: Partial wrist arthrodesis is commonly performed to treat wrist arthritis because it provides pain relief without sacrificing complete wrist motion. The purposes of this retrospective study were to evaluate clinical and radiological outcomes after scaphoidectomy and 4-corner fusion after more than 10 years of follow-up and to compare the midterm and long-term results. METHODS: Forty-two patients were enrolled. The following were evaluated annually: pain (visual analog scale); Disabilities of the Arm, Shoulder, and Hand score; range of motion; grip strength; and Modified Mayo Wrist score. Bony union and arthritic changes in the radiolunate joint were also evaluated radiologically. Midterm and long-term results were compared. RESULTS: The mean (SD) follow-up period was 12.2 (1.43) years. Two patients were excluded from the study because of complications, so the final postoperative evaluation included 40 patients. Visual analog scale and Disabilities of the Arm, Shoulder, and Hand scores improved to a satisfactory level by 5 years after surgery and did not differ significantly between 5 and 10 years. Flexion, extension, and radial deviation were reduced after 5 years compared with preoperative measures, and no difference was found between 5 and 10 years. Ulnar deviation, pronation, and supination did not change significantly after surgery. Grip strength was significantly recovered from 29.7 (4.9) kg at 5 years after surgery to 32.1 (8.5) kg at 10 years. The Modified Mayo Wrist score improved significantly to 83.2 (4.1) at 5 years after surgery but did not differ significantly between 5 and 10 years. All cases showed radiological solid fusion, and the mean (SD) period of union was 9.34 (3.7) weeks. Further radiolunate arthritic change was verified in 2 patients, but Modified Mayo Wrist scores were fair. One patient experienced inexplicable pain; therefore, total wrist fusion was performed at 6 years after surgery. CONCLUSIONS: This retrospective cohort study of patients followed up for more than 10 years showed that the midterm and long-term results of 4-corner fusion for stage III SLAC were satisfactory, and arthritic changes in the radiolunate joint were minimal.

Clinical outcomes after arthroscopic trans-tendon suture-bridge technique in partial-thickness articular-side rotator cuff tear.

PURPOSE: We evaluated the functional and radiological outcomes of arthroscopic trans-tendon suture-bridge repair for partial-thickness articular-side rotator cuff tears. METHODS: From December 2008 to May 2010, 32 consecutive patients with partial-thickness articular-side rotator cuff tears prospectively underwent arthroscopic trans-tendon suture-bridge repair. We included patients with articular-side partial-thickness supraspinatus tears involving more than half the normal thickness. Patients underwent ultrasonography or magnetic resonance imaging postoperatively. The functional outcomes of patients were evaluated at a minimum 1 year postoperatively. The mean age and follow-up period for the patients were 51.8 ± 13.7 years and 17.4 ± 4.2 months, respectively. Five outcome measures were used before surgery and at the final follow-up: a visual analog scale (VAS) pain score, the American Shoulder and Elbow Surgeons (ASES) score, the Shoulder Rating Scale of the University of California at Los Angeles (UCLA), the Constant-Murley score and range of motion (ROM). RESULTS: The radiological follow-up rate was 87.5%, and the follow-up rate for clinical evaluation was 96.9%. Mean UCLA, ASES and Constant-Murley scores improved from 19.1 ± 5.4, 45.2 ± 16.0 and 58.0 ± 19.6 preoperatively to 35.7 ± 8.5, 79.0 ± 15.8 and 78.1 ± 12.9 at final follow-up, respectively (all p ≤ 0.001). Mean VAS score and ROM (forward flexion) improved from 6.1 ± 1.9 and 140 ± 36.6 preoperatively to 2.6 ± 1.9 and 163 ± 25.2 at the final follow-up, respectively (p ≤ 0.001). Additionally, the postoperative radiological examination showed cuff integrity without retear in all patients. CONCLUSIONS: Arthroscopic trans-tendon suture-bridge repair for partial-thickness articular-side rotator cuff tears resulted in significant improvement in function compared with that before the operation.

Simple excision vs the Kidner procedure for type 2 accessory navicular associated with flatfoot in pediatric population.

BACKGROUND: Recently, many studies have argued against the Kidner procedure and its several modifications, with the accessory navicular considered an irritant rather than a hindrance to foot function, and simple excision has been advocated. We designed this prospective, comparative study of simple excision and the Kidner procedure in children and adolescents with flatfoot and evaluated functional and radiographic outcomes. METHODS: From February 2004 to March 2009, we followed 50 consecutive feet of symptomatic type 2 accessory navicular. Simple excision and the Kidner procedure were performed in 25 feet each, respectively. The American Orthopaedic Foot and Ankle Society (AOFAS) Midfoot Scale, the visual analogue scale (VAS), and the talo-first metatarsal, talocalcaneal, and calcaneal pitch angles were evaluated preoperatively and postoperatively for a minimum of 3 years. Patient satisfaction was assessed. RESULTS: The preoperative AOFAS midfoot scale and VAS of each group were improved at final follow-up. The talo-first metatarsal and talocalcaneal angles were not significantly different pre- and postoperatively. However, the calcaneal pitch angle of both groups was improved at the final follow-up. At the final follow-up, we observed no significant differences between the 2 groups in the AOFAS midfoot scale, the VAS, and the talo-first metatarsal, talocalcaneal, and calcaneal pitch angles. The satisfaction frequencies were 86% and 82% in groups 1 and 2, respectively. CONCLUSIONS: We found that in children and adolescents with accessory navicular and flatfoot, simple excision and the Kidner procedure both gave satisfactory results and both minimally restored the medial longitudinal arch similarly. LEVEL OF EVIDENCE: Level II, prospective therapeutic study.

Changes in tendon length with increasing rotator cuff tear size.

PURPOSE: To investigate the change in tendon length with increasing size of rotator cuff tears in patients receiving arthroscopic rotator cuff repair. METHODS: This is a prospective evaluation of 100 consecutive patients who met the inclusion criterion of a U-shaped or crescent-shaped full-thickness tear and who were treated by arthroscopic rotator cuff (supraspinatus and/or infraspinatus) repair from 2009 to 2010. The anterior-to-posterior dimension of the cuff tear was estimated under arthroscopic guidance, and the medial-to-lateral dimension was estimated on pre-operative MRI. The tendon length, from its distal end to the musculotendinous junction, was estimated under arthroscopic observation after arthroscopic rotator cuff repair. The relationships between tendon length and the anterior-to-posterior and medial-to-lateral dimensions of the cuff tear were analyzed. RESULTS: The average tendon length in patients with full-thickness tears was 17.0 mm. The tendon length decreased significantly with an increase in cuff tear size, for both the anterior-to-posterior (r = -0.328, P = 0.001) and medial-to-lateral dimensions (r = -0.681, P < 0.001). When the full-thickness tears were grouped according to the lengths of the anterior-to-posterior and medial-to-lateral dimensions, tendon length differed significantly among the groups (P = 0.008 and P < 0.001, respectively). CONCLUSIONS: In full-thickness tears, the rotator cuff tendon length decreased with increases in the anterior-to-posterior and medial-to-lateral dimensions of the tear size, with a higher correlation between tendon length and the medial-to-lateral dimension. During arthroscopic rotator cuff repair, passing a suture too medially for complete footprint coverage using a strong fixation technique can lead to excess tension and medial cuff tears. LEVEL OF EVIDENCE: II.

Treatment of unstable distal ulna fractures associated with distal radius fractures in patients 65 years and older.

PURPOSE: To prospectively compare the clinical and radiological outcomes of 2 treatment methods for unstable distal ulna fractures associated with distal radius fractures in patients 65 years of age and older. METHODS: From February 2008 to March 2010, the first 29 ulnas were treated surgically (group 1) and the next 32 ulnas were treated nonoperatively (group 2). The mean final follow-up period was 34 months (range, 24-56 mo). All radiuses were fixed internally, in both groups. Clinical outcomes were compared between groups using a visual analog scale for postoperative pain; Disabilities of the Arm, Shoulder, and Hand scores; active range of motion; grip strength; and the modified system of Gartland and Werley. Radiological outcomes, including ulnar variance, were evaluated. Arthrosis was evaluated at the radiocarpal joint or distal radioulnar joint (DRUJ) according to the system of Knirk and Jupiter. RESULTS: There were no significant differences between the groups in any of the clinical outcomes. No significant differences were observed for radiological outcomes including ulnar variance, distal radius, and union rate. There were no patients in either group with symptomatic arthritic changes in the radiocarpal joint or DRUJ at the final follow-up. In group 2, 1 patient had malunion (angulated, 14°) on the anteroposterior view without evidence of arthrosis in the DRUJ, and functional outcomes were good. CONCLUSIONS: In this population distal ulna fractures can be successfully managed nonoperatively when they occur in combination with distal radius fractures.

Ulnar shortening for adolescent ulnar impaction syndrome: radiological and clinical outcomes.

PURPOSE: To determine the amount of shortening needed in an ulna to achieve final neutral ulnar variance in adolescents with ulnar impaction syndrome. Radiological and clinical outcomes were evaluated after ulnar shortening and after growth had stopped. METHODS: From February 2006 to February 2009, we prospectively followed 16 consecutive patients treated with a shortening osteotomy for positive ulnar variance. The study group included 10 boys and 6 girls with an average age of 16.1 years. The closed medial half-side of the physis of the distal radius was used to measure the variance as a reference for the ulna. Based on the radius without any growth potential, the amount of shortening was determined for the ulna with potential for further growth. The preoperative, postoperative, and final ulnar variances were evaluated. The clinical results were compared before surgery and at the time of growth termination. RESULTS: Preoperative ulnar variance was 3.4 mm ± 0.6 mm and the amount to be shortened was 6.1 mm ± 1 mm. The final ulnar variance was 0.2 mm ± 0.3 mm. The mean visual analog scale pain score improved from 6.6 ± 1.0 before surgery to 2.2 ± 0.5 after surgery. The mean range of forearm rotation increased from 132° ± 11° before surgery to 170° ± 16° at final follow-up. In addition, grip strength was 15.3 kg ± 7.6 kg (71% of grip strength on the unaffected side) before surgery and 19.8 kg ± 4.9 kg (90% of grip strength on the unaffected side) at final follow-up. The modified Mayo Wrist Score was 85 ± 8 at the final follow-up. No cases of complications or treatment failure occurred. CONCLUSIONS: Ulnar shortening was considered a useful procedure for adolescents with ulnar impaction syndrome, particularly if the measurement for the shortening amount was determined using the physis of the distal radius and ulna.

Percutaneous reduction and leverage fixation using K-wires in paediatric angulated radial neck fractures.

PURPOSE: We evaluated the usefulness of percutaneous reduction and leverage fixation using K-wires in children with radial neck fractures. MATERIALS AND METHODS: Between 2006 and 2008, we evaluated 13 paediatric patients with radial neck fractures who had been observed for at least two years and underwent percutaneous reduction and leverage fixation using K-wires. We measured radial angulation and radial translation using preoperative, postoperative and final follow-up radiographs, and we clinically investigated range of motion and carrying angle according to Steele's grading system. RESULTS: Excellent clinical results were achieved in 11 (84.6%) patients, good results in one (7.6%) and fair results in one (7.6%). There were no poor results. The patient in whom fair results were achieved also had an olecranon fracture, which was treated conservatively. Complications such as nonunion, infection, iatrogenic nerve injury and periarticular ossification were minimal. Radioulnar synostosis was absent between the radial neck fracture and the greenstick fracture of the olecranon. Growth arrest in the proximal radial epiphysis was also absent. CONCLUSION: Percutaneous reduction and leverage fixation using K-wires in children with radial neck fractures is a recommended surgical treatment that can achieve recovery of normal radial angulation and elbow motion.

Arthroscopic double-loaded single-row repair in chronic traumatic anterior shoulder dislocation.

PURPOSE: We evaluated the clinical results of arthroscopic double-loaded single-row repair for chronic anterior shoulder dislocation. METHODS: From January 2007 to December 2008, of the 47 shoulders with chronic anterior shoulder dislocation that consecutively underwent arthroscopic double-loaded single-row repair using bio-absorbable suture anchors containing two non-absorbable braided sutures, 45 shoulders (95.7 %) had successful follow-up for a minimum of 2 years. The mean age of patients was 23.7 years, the mean frequency of dislocations before surgery was 6.8 events, and the mean interval between the initial dislocation and surgery was 47.9 months. Clinical results were evaluated using ASES, Rowe, VAS score, and range of motion before surgery and at the final follow-up. RESULTS: The mean number of suture anchors was 3.38 (range 2-6) and the mean number of stitches was 6.32 (range 4-10). Four of the 45 cases had recurrence (8.9 %). Of these four, three cases underwent re-operation using the same method and the other one case showed no specific discomfort except a one-time dislocation that underwent conservative treatment. The preoperative and the final follow-up ASES and Rowe scores were statistically significantly improved (P < 0.001, each) and instability VAS score was significantly decreased (P < 0.001). No significant difference in forward flexion, extension, abduction, or internal rotation was found (P > 0.05), but external rotation at the side was significantly decreased (P = 0.001). CONCLUSIONS: Arthroscopic double-loaded single-row repair using suture anchors, containing two sutures in chronic anterior shoulder dislocation, is a reliable procedure with respect to recurrence rate, range of motion, and shoulder function.

Surgical treatment of displaced medial clavicle fractures using a small T-shaped plate and tension band sutures.

The surgical treatment of medial clavicle nonunion is associated with high complication and failure rates, particularly with regard to metal work migration. Therefore, we describe a simple surgical procedure for displaced medial clavicle fractures using a small T-shaped plate and multiple tension band sutures. After stabilizing the medial clavicle fracture using a small nonunion for the distal radius, our simple technique for preventing high complication and failure rates is performed easily and effectively, with sufficient tension band sutures.

Relationship between incidence of postoperative radial nerve palsy and surgical experience in the treatment of humeral shaft fractures through a posterior triceps splitting approach: A retrospective study.

OBJECTIVE: The aim of this study was to investigate the incidence of postoperative radial nerve palsy (PORNP) after the surgical treatment of humeral shaft fractures through a posterior triceps splitting approach by a single surgeon's experience in a consecutive case series from a single trauma center. METHODS: In this retrospective study, a total of 118 patients (82male, 36 female;mean age = 48 years, age range = 16 - 80 years)who underwent open reduction and plate fixation through posterior triceps splitting approach due to humeral shaft fractures at a level I trauma center were included. Level of the fractures was categorized as the proximal third, middle third, and distal third of the diaphysis, and then all the fractures were classified according to the AO/OTA classification system. The trend of incidence of PORNP was investigated. All the operations were performed by a single surgeon. The recovery time of PORNP was also recorded. RESULTS: There were 13 cases of proximal third, 67 cases of middle third, and 38 cases of distal third fracture. Based on AO/OTA classification, there were 29 cases of A1-type, 23 cases of A2-type, 42 cases of A3-type, 17 cases of B2-type, 3 cases of B3-type, and 4 cases of C2-type fracture. The overall incidence of PORNP was 11% (13 cases). All the PORNP cases fully recovered within 10.3 ± 10.4 weeks (range = 1 - 44) with conservative treatment. Incidence of PORNP significantly decreased with increase in surgical experience (P = 0.009). The incidence of radial nerve palsy was not significantly related to the level of the fracture (P = 0.199). The incidence of radial nerve palsy was not significantly related with the fracture pattern according to AO/OTA classification (P = 0.659). CONCLUSION: Evidence from this study has shown that the incidence of PORNP following the posterior triceps splitting approach for the treatment of humeral shaft fractures is significantly associated with the surgeon's experience. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.

Open Reduction and Stable Internal Fixation Using a 3.5-mm Locking Hook Plate for Isolated Fractures of the Greater Tuberosity of the Humerus: A 2-Year Follow-up Study Using an Innovative Fixation Method.

BACKGROUD: The best treatment for isolated greater tuberosity (GT) fractures is still controversial. Although previous studies have suggested surgical options, they are either unable to provide firm fixation or present with a variety of complications. METHODS: We retrospectively studied the records of patients with isolated GT fractures who underwent open reduction and internal fixation using a 3.5-mm locking hook plate between January 2016 and January 2018. The surgical indication was an at least 5-mm displacement of the GT as observed in either simple radiography or three-dimensional computed tomography. Clinical outcomes were assessed using the following five parameters shortly before implant removal and at the final follow-up: visual analog scale (VAS) pain score, American Shoulder and Elbow Surgeons (ASES) score, Shoulder Rating Scale of the University of California, Los Angeles (UCLA), Constant-Murley score, and range of motion. RESULTS: Twenty-one patients with a mean age of 64 years were included. Bone union was achieved within 12-20 weeks of the first surgery in all patients. Implant removal was performed between 13 and 22 weeks after surgery. At the final follow-up, the mean VAS pain score, forward flexion, abduction, external rotation, internal rotation, ASES score, UCLA score, and Constant-Murley score were significantly better when compared to outcomes shortly before implant removal (p < 0.001, p < 0.001, p < 0.001, p = 0.008, p = 0.003, p < 0.001, p < 0.001, and p < 0.001, respectively). CONCLUSIONS: The 3.5-mm locking hook plate provided sufficient stability and led to satisfactory clinical and radiological outcomes for isolated GT fractures. However, the hook plate may irritate the rotator cuff, and postoperative stiffness may be inevitable. Therefore, second surgery for implant removal is necessary after bone union is achieved.

Trifurcated radial nerve in the spiral groove of the humerus.

A 62-year-old man presented with a nonunion of the humerus shaft. Using a standard triceps splitting approach, a longitudinal incision along the posterior aspect of the arm was created. Three independent radial nerves coursed posteriorly and inferolaterally around the humerus were identified in spiral groove. Three nerves resembled in the size, color, and course in the operative field. Although the prevalence of the anomaly is probably quite low, the possibility of identification of this anomalous condition of radial nerve should be kept in mind when performing posterior approach on the humerus.