• Clinics in Shoulder and Elbow
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• v.15 no.2
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• pp.130-137
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• 2012

Purpose: To evaluate and report the clinical outcome after surgical treatment of intra-articular comminuted fracture of distal humerus in the elderly with osteoporosis. Materials and Methods: From January 2007 to October 2009, 24 patients aged older than 65 years with intra-articular comminuted fracture of distal humerus underwent surgical treatment. 18 patients (Group I) were managed using primary open reduction and internal fixation (OR IF) through the modified posterior approach and 6 patients (Group II) were taken primary total elbow arthroplasty. The average follow up period was 17.2 months. According to the AO classification, there were 8 C2, 16 C3 type fractures. All enrolled patients were evaluated radiographically and clinically. Clinical outcomes were assessed with the Mayo Elbow Performance, Disabilities of Arm and Shoulder and Hand, and Musculoskeletal Functional Assessment functional questionnaires. Results: The bony union was observed in 18 patients in group I at average 14 weeks. There were 2 patients with neurapraxia of whom the ulnar nerve symptom did not improve despite of anterior transposition. And non-union at osteotomy sites was seen in 2 patients. The mean Mayo Elbow Performance score was 87.0. The mean DASH score was 32.4. The average arc of elbow flexion was $121.0^{\circ}$ (range, $95{\sim}145^{\circ}$) with mean flexion-contracture of $12.0^{\circ}$ (range, 0 to 35). 6 patients in Group II showed no complication during follow up periods. The mean Mayo Elbow Performance score was 89.1. The mean DASH score was 44.3. The average arc of elbow flexion was $125.1^{\circ}$ (range, $100{\sim}145^{\circ}$) with mean flexion-contracture of $12.6^{\circ}$ (range, 0 to 30). Conclusions: With careful patient selection, Total elbow arthroplasty as well as OR IF could achieve good outcomes in elderly of comminuted intra-articular distal humerus fracture with osteoporosis.

• Clinics in Shoulder and Elbow
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• v.16 no.2
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• pp.100-106
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• 2013

Purpose: The purpose of this study is to evaluate the relationship between trochlear medial facet osteophyte (TMFO) and elbow flexion in the elbow joints without trauma history. Materials and Methods: Twenty five patients, who underwent computed tomography without elbow trauma history, were reviewed. Patients were checked for osteophyte or loose bodies in the coronoid and olecranon sides. The height and length of TMFO were measured. Results: The average elbow flexion contracture was $18.6^{\circ}$, and further flexion was $112.1^{\circ}$. The TMFO height and length was 2.2 mm and 4.7 mm, respectively. The average elbow further flexion was $105.1^{\circ}$ in the coronoid block group (n=14) and $119.1^{\circ}$ (p=0.011) in the coronoid free group (n=11). The relationship between further elbow flexion and TMFO was significant with a partial correlation coefficient of 0.687(p<0.000) in the TMFO length. Conclusion: Elbow joints with longer TMFO length decrease further flexion.

• Clinics in Shoulder and Elbow
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• v.9 no.1
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• pp.50-59
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• 2006

Purpose: The nonoperative outcome of elbow dislocations with associated radial head and coronoid fractures are often unsatisfactory because of chronic instability and stiffness from proloned immobilization, Therefore we managed these injuries with well programed surgical appproaches. Method: Ten patients with this injury were evaluated retrospectively from May 1998 to June 2004 after a minimum of 12 months. These injuries include elbow dislocation and associated fractures of both the radial head and the coronoid process. All ten patients were treated by one clinic operatively with similar scheduled surgical methods which started on the lateral side and terminated on the medial side of the elbow. Radial head and neck fractures were classified Mason types, as two and three types respectively with six and four cases and six cases were fixated. Coronoid process were fixated with screws anteroposterior directly or anchor suture in all cases, each type was classified one, two and three. where were three type one, four type two, and three type three were according to Regan and Morrey classification. Results: The outcome was three resulting in excellent, four good, two normaland and the remaining case was one poor according to the Mayo Elbow Performance score. At a terminal follow up, the range of motion of the elbow averaged flection contracture, $6^{\circ}(0{\sim}20^{\circ})$ and further flection, $129^{\circ}(115{\sim}140^{\circ})$. Two patients had complications requiring additional care. One, displaced coronoid process which was repaired with capsule and the other patient experienced, palsy of ulnar nerve and contracted elbow joint. Conclusions: Usage of early operation as the minimum injury of medial ligaments complex and the rigid fixation of fractures to prompt motion with our scheduled management for elbow dislocations with associated radial head and coracoid fractures provided excellent results.

• The Journal of Korean Orthopaedic Ultrasound Society
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• v.7 no.2
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• pp.89-97
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• 2014

Purpose: To evaluate the ultrasonographic findings of the elbows on group screening of middle school baseball players. Materials and Methods: Ninety-three players (age: 12-15, mean 13.5 years) of four middle school baseball team were evaluated with bilateral elbow ultrasonographies in the field regardless of elbow pain. Medial and anterolateral ultrasound examination of the both elbow were performed in the field to detect any abnormalities including medial epicondylar separation or fragmentation and capitellar osteochondritis dissecans respectively. We analyzed the relationship among elbow pain, physical findings and sonographic abnormalities and the differences of sonographic abnormalities between pitchers and fielders. Results: Thirty-six of 93 (39%) players had sonographic abnormalities of elbow in dominant arm, 30 with medial epicondylar apophyseal separation or fragmentation, 2 with osteochondritis dissecans, 4 with both lesions. Twenty-nine of 37 (78%) players with elbow pain had sonographic abnormalities. On physical examination, players with medial epicondylar abnormalities had medial epicondylar tenderness (59%) and pain on valgus stress test (52%), and 5 of 6 (83%) players with osteochondritis dissecans showed flexion contracture more than $5^{\circ}$. The incidence of medial epicondylar abnormalities between pitchers and fielders was statistically not significant but osteochondritis dissecans was more prevalent in pitchers (p<0.05). Conclusion: Elbow sonography is a simple and useful screening tool in the field and also effective for early detection of medial epicondylar abnormalities or osteochondritis dissecans that could be the main causes of elbow pain in adolescent baseball players.

• Journal of Korean Neurosurgical Society
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• v.48 no.3
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• pp.236-239
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• 2010

Objective : The purpose of this study was to investigate the effectiveness and outcome of selective musculocutaneous neurotomy (SMcN) for spastic elbow. Methods : We retrospectively reviewed the medical records of 14 patients with spasticity of their elbows. The patients were selected using clinical and analytical scales, as well as nerve block tests, for assessment. Their mean age was 37.29 years (range, 19-63 years). SMcN was performed for these patients, and the mean follow-up period was 30.71 months (range, 19-54 months). Results : The modified Ashworth scale (MAS) scores recorded before and after the SMcN showed that the patients' mean preoperative MAS score of $3.28{\pm}0.12$ was improved to $1.71{\pm}0.12$, $1.78{\pm}0.18$, $1.92{\pm}0.16$ and $1.78{\pm}0.18$ at postoperative 3, 6, 12 months and last follow-up, respectively. On the basis of a visual analogue score ranging from 0-100, the patients' mean degree of satisfaction score was $65.00{\pm}16.52$ (range, 30-90). Conclusion : We believe that SMcN can be a good and effective treatment modality with low morbidity in appropriately selected patients who have localized spastic elbow with good antagonist muscles and without joint contracture.

• Clinics in Shoulder and Elbow
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• v.4 no.1
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• pp.1-12
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• 2001

Purpose: To evaluate the histologic effect(LM and EM findings)of nonablative LASER and thermal energy on knee joint capsule of rabbit. Material and Methods: The nonablative LASER and thermal energy was applied to the rabits(average age 36 weeks, weight 5 ㎏). There were divided into 4 groups with 6 rabbits in each. The group I received 6 watts of LASER, group Ⅱ 12 watts of LASER, group Ⅲ 60° of thermal energy, and group Ⅳ 70° of thermal energy. The histologic study included H-E, Massons trichrome stain and electron microscopy at immediate, 3 weeks and 6 weeks after operation. Results: The histologic finding in immediate after operation was shown a fibrous degeneration of collagen on all groups and related to the energy level. The histologic finding after 3 weeks showed fibrosis and this fibrosis related the level of energy. Especially the group IV was shown flattening of capsule and deep fibrosis. The histologic finding after 6 weeks was shown marked recovery of collagen arrangement and capillary proliferation in group Ⅰ,Ⅱ and Ⅲ. But in the group Ⅳ not recovered. Conclusion: The nonablative LASER or thermal energy can cause degeneration, fibrosis and contracture of joint capsular collagen.

• Clinical and Experimental Pediatrics
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• v.49 no.8
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• pp.821-829
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• 2006

Hemophilia is the most common coagulation disorder. It has a long history. Hemophilia A is caused by FVIII gene mutation, and hemophilia B by FIX gene mutation. Those genes are located on X chromosome long arm. Bleedings in hemophiliacs predominantly occur in joints and muscles. Because those site are insufficient in tissue factor to induce hemostasis. Among joints knee, ankle and elbow are most frequently affected because their synovial structure is vulnerable to injury compared to other joints. Hemophilia is diagnosed with factor assay. Severe hemophilia is below 1% of FVIII : C, moderate between 1% and 5%, mild over 5%. Carrier detection and prenatal diagnosis have been conducted with RFLP-based linkage analysis and DNA sequencing. Mainstay of treatment is factor replacement therapy so far. Bleedings can be controlled by infusion of factor concentrates. Hemophilc arthropathy and muscle contracture are representative sequelae. Complications of facotor replacement therapy are inhibitor development and infections. Hemophiliacs with inhibitor should be managed with large dose factor concentrate, bypassing agent, ITI and immunosuppression. Ultimately, hemophilia could be cured by gene therapy.

• Archives of Plastic Surgery
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• v.44 no.5
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• pp.420-427
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• 2017

Background It can be difficult to select an appropriate flap for various defects on the hand. Although defects of the hand usually must be covered with a skin flap, some defects require a flap with rich blood supply and adequate additive soft tissue volume. The authors present their experience with the anconeus muscle free flap in the reconstruction of various defects and the release of scar contractures of the hand. Methods Ten patients underwent reconstruction of the finger or release of the first web space using the anconeus muscle free flap from May 1998 to October 2013. Adequate bed preparations with thorough debridement or contracture release were performed. The entire anconeus muscle, located at the elbow superficially, was harvested, with the posterior recurrent interosseous artery as a pedicle. The defects were covered with a uniformly trimmed anconeus muscle free flap. Additional debulking of the flap and skin coverage using a split-thickness skin graft were performed 3 weeks after the first operation. Results The average flap size was $18.7cm^2$ (range, $13.5-30cm^2$). All flaps survived without significant complications. Vein grafts for overcoming a short pedicle were necessary in 4 cases. Conclusions The anconeus muscle free flap can be considered a reliable reconstructive option for small defects on the hand or contracture release of the web space, because it has relatively consistent anatomy, provides robust blood supply within the same operative field, and leads to no functional loss at the donor site.

• Clinics in Shoulder and Elbow
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• v.12 no.1
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• pp.53-60
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• 2009

Purpose: Primary osteoarthritis on the elbow is the result of the growth of osteophytes and contracture of the capsule. It often causes disability on joint motion and pain while exercising. As arthroscopy has developed, the arthroscopic diagnosis and treatment of the elbow have recently become more generalized as well. Therefore, we like to report on arthroscopy for treating elbow arthritis and its results. Materials and Methods: This study includes 23 cases of elbow arthritis that were seen between 2005 June to 2007 June and these patients didn't response to conservative treatment. From this we excluded 18 cases that underwent arthroscopic surgery and among these 18 cases, 6 cases underwent ulnar nerve transfer. The average observation time was 21.3 months and the average age was 48.4 years (range: 22-66 years). The pre and post operative pain was evaluated with using the Visual Analogue Scale (VAS) and functional evaluation was done with using the Mayo elbow Performance Score (MEPS) with the range of joint motion. Results: The VAS score at the last follow up was significantly decreased from 3.4 to 1.9 compare to the preoperative score. The range of joint motion was improved by 25 (0-40) to 8.5 (0-20) in extension and 101.7 (80-140) to 125.2 (85-140) in flexion (p<0.05). The MEPS always showed significant improvement by showing an increase from 65.4 (40-85) to 87.9 (55-100). However, 3 cases showed a decreased range of motion after the operation. One case showed ulnar nerve symptoms after surgery. Conclusion: An arthroscopic procedure can treat the pathologic processes associated with arthritis of the elbow and it was safe and effective in this series.

• Clinics in Shoulder and Elbow
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• v.7 no.1
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• pp.41-45
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• 2004

In adhesive capsulitis of the shoulder of no response to nonoperative treatment, an arthroscopic capsular release and manipulation improves range of motion and pain relief. We performed an arthroscopic examination in the stiff shoulder, of which she had no response to nonoperative treatment, after the conservative treatment of a clavicular shaft fracture by motorcycle-driver traffic accident. We found the intra-articular 'rotator interval bridging scar adhesion' between subscapularis tendon and antero-superior glenoid fossa under the rotator interval which was no adhesion and contracture itself. We performed the scar adhesion removal and synovectomy, maintaining the rotator interval. We recommended nonsteroidal anti-inflammatory drug for postoperative pain relief and continuous active and passive range of motion (ROM) exercise to gain motions. Preoperatively, active and passive range of motion were 70° for forward elevation, 60° for abduction and especially 0° for external rotation. After postoperative 2 months, active ROM were 150° for forward elevation, 130° for abduction and 80° for external rotation. After postoperative 6 months, passive and active ROM were full. UCLA score improved from preoperative 9 points to postoperative 29 points.