• Clinics in Shoulder and Elbow
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• v.11 no.2
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• pp.150-157
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• 2008

Purpose: We wanted to evaluate the results of surgical treatment for fracture of the scapular body. Materials and methods: The subjects of this study were seven patients with fracture of the scapular body and all these patients were managed surgically. We considered the operative indications as being 100% translation of the lateral border, or $25^{\circ}$ of angular deformity of the glenoid, or 1cm medialization or the variant of the double disruption of the superior scapular suspensory complex. There were five males and two females, and their ages ranged between 40 and 58 years (mean age: 49) with average follow up of 11 months (6~24 months). Two patients sustained multiple fractures of the ribs and spines. The surgical results were evaluated according to the subjective satisfaction, the UCLA score and the Korean shoulder score. Results: The mean UCLA score was 29 (17~33) and the mean Korean shoulder score was 86 (63~94). The self assessment for subjective satisfaction was 7.7 (4~9). There were two complications; one case of screw pull-out without the loss of the fracture fixation and the other case with screw penetration of the glenoid cavity. Conclusion: Surgical treatment may be effective for the management of severely displaced fracture of the scapular body in order to prevent the impairment of the shoulder function caused by the altered glenohumeral and scapulothoracic kinematics.

• Clinics in Shoulder and Elbow
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• v.11 no.1
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• pp.62-65
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• 2008

Isolated acromial fracture is not common and it frequently accompanies fractures to the coracoid process and glenoid bone and also injuries to the acromioclavicular joint. Furthermore, most of these combined acromial fractures have minimal displacement, which needs no additional treatment other than protection for a certain period of time. We have experienced a case of isolated fracture of the posterolateral angle of the acromion, which we reduced and fixated using K-wire and cannulated screws. We report on the technical aspects and clinical results of this reduction and fixation, along with a review of the literature.

• Clinics in Shoulder and Elbow
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• v.24 no.3
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• pp.125-134
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• 2021

Background: To evaluate clinical and radiological outcomes of bony increased offset-reverse total shoulder arthroplasty (BIO-RSA) in the Asian population at mid-term follow-up. Methods: From June 2012 to August 2017 at a single center, 43 patients underwent BIO-RSA, and 38 patients with minimum 2 years follow-up were enrolled. We evaluated the clinical and radiological outcomes, and complications at the last follow-up. In addition, we divided these patients into notching and no-notching groups and compared the demographics, preoperative, and postoperative characteristics of patients. Results: Visual analogue scale, American Shoulder and Elbow Surgeons, University of California-Los Angeles Shoulder Scale, and Simple Shoulder Test scores improved significantly from preoperative (5.00, 3.93, 1.72, 3.94) to postoperative (1.72, 78.91, 28.34, 7.66) (p<0.05) outcomes. All range of motion except internal rotation improved significantly at the final follow-up (p<0.05), and the bone graft was well-incorporated with the native glenoid in all patients (100%). However, scapular notching was observed in 20 of 38 patients (53%). In the comparison between notching and no-notching groups (18 vs. 20 patients), there were no significant differences in demographics, radiological parameters, and clinical outcomes except acromion-greater tuberosity (AT) distance (p=0.003). Intraoperative complications included three metaphyseal fractures and one inferior screw malposition. Postoperative complications included ectopic ossification, scapular neck stress fracture, humeral stem relaxation, and late infection in one case each. Conclusions: BIO-RSA showed improved clinical outcomes at mid-term follow-up in Asian population. However, we observed higher scapular notching compared to the previous studies. In addition, adequate glenoid lateralization with appropriate humeral lengthening (AT distance) might reduce scapular notching.

• Journal of Korean Academy of Oral and Maxillofacial Radiology
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• v.13 no.1
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• pp.7-15
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• 1983

The purpose of this study was to investigate the radiographic images of the condylar head in clinically normal subjects and the TMJ patients using standardized projection technique. 45 subjects who have not clinical evidence of TMJ problems and 96 patients who have the clinical evidence of TMJ problems were evaluated, but the patients who had fracture, trauma and tumor on TMJ area were discluded in this study. For the evaluation of radiographic images, the author has observed the condylar head positions in closed mouth and 2.54㎝ open mouth position taken by the standardized transcranial oblique lateral projection technique. The results were as follows: 1. In closed mouth position, the crest of condylar head took relatively posterior position to the deepest point of the glenoid fossa in 8.9 % of the normals and in 26.6% of TMJ patients. 2. In 2.54㎝ open mouth position, condylar head took relatively posterior position to the articular eminence in 2.2% of TMJ patients and 39.6% of the normals. 3. In open mouth position, the horizontal distance from the deepest point of the glenoid fossa to the condyla head was 13.96㎜ in the normals and 10.68㎜ in TMJ patients. 4. The distance of true movement of condyalr head was 13.49㎜ in the normals and l0.27㎜ in TMJ patients. 5. The deviation of mandible in TMJ patients was slightly greater than that of the normals.

• Clinics in Shoulder and Elbow
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• v.20 no.4
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• pp.195-200
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• 2017

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.

• Journal of the Korean Orthopaedic Association
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• v.54 no.2
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• pp.100-109
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• 2019

The rapidly increasing rate of shoulder arthroplasty is certain to increase the number of revision arthroplasties because of parallel increases in complication numbers. It has been widely reported that the causes of revision shoulder arthroplasty include rotator cuff deficiency, instability, glenoid or humeral component loosening, implant failure, periprosthetic fracture, and infection. Revision arthroplasty can be technically challenging, and surgical options available for failed shoulder arthroplasty are limited, especially in patients with glenoid bone loss or an irreparable rotator cuff tear. Furthermore, the outcomes of revision arthroplasty are consistently inferior to those of primary arthroplasty. Accordingly, surgical decision making requires a good understanding of the etiology of failure. Here, we provide a review of indications of revision arthroplasty and of the surgical techniques used by failure etiology.

• The Journal of the Korea Contents Association
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• v.10 no.6
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• pp.323-328
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• 2010

If a patient wearing arm sliding due to shoulder dislocation or fracture is impossible with abduction, the velpeau view is performed instead of superior-inferior axial projection view. However, it aggravates the patient's pain because it is difficult for the patient with dislocation or fracture to pull back the shoulders. Therefore, I suggest a new method of the 'modified velpeau view' that allows patients to lower their heads at examination. In order to investigate the easiness of fixing posture at examination and clinical utility, I conducted a study comparing the bone structures at the velpeau view and those at the modified velpeau view depending on wall-bucky and the patients' leaning forward angle ($30^{\circ},\;45^{\circ},\;60^{\circ}\;and\;75^{\circ}$), with the subjects of 20 velpeau view-prescribed patients amongst who had come to my hospital suspected of dislocation of shoulder or fracture and 30 healthy people from October of 2009 to January of 2010. Department of radiologists and orthopedics specialists evaluated the pictures for scales 0 to 5(best grade) under the given criteria. As a result of comparison in bone structures depending on wall-bucky and the leaning-forward angle in the group of healthy people, the velpeau view and the modified velpeau showed a similar diagnostic utility at $45^{\circ}$ and $60^{\circ}$. The picture evaluation result for proving diagnostic value showed that the anterior and posterior of shoulder heads and the anterior and posterior of glenoid fossa could be observed in the velpeau view; on the other hand, besides these areas acromioclavicular joint and coracoid process could be viewed in the modified velpeau view. This result verified that the modified velpeau view could replace the velpeau view for its diagnostic value as an examination method. This result, moreover, suggests that the modified velpeau view needs to be studied and improved from a variety of perspectives not only for an alternative for patients having troubles with the velpeau view position but also for clinical application of new test method for diagnosis of shoulder disorders other than dislocation of shoulder or fracture.

• Clinics in Shoulder and Elbow
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• v.1 no.1
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• pp.46-50
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• 1998

The superior shoulder suspensory complex is composed of glenoid fossa, coracoid process, coracoclavicular ligament, distal clavicle, acromioclavicular ligament, acromion. Traumatic double disruptions of this complex lose its suspensory action on the shoulder joint and result in functional loss and deformity. Careful radiologic evaluation and appropriate management are required for injuries to this complex. Ipsilateral fractures of clavicle and scapula create unstable anatomic situation on shoulder joint. Conservative treatment usually fails to achieve good functional recovery due to rotator cuff weakness, nonunion, delayed union, malunion and neurovascular injury. Authors studied the result of operative treatment of ipsilateral clavicle and scapular fractures to prevent such complications. Seven cases were treated with open reduction and internal fixations of clavicle alone or clavicle and scapula simultaneously and followed up for nineteen months(twelve months - thirty-eight months). All but one patient showed good or excellent functional result according to the scoring system of Rowe. Poor result was developed in the case which had brain injury. Rigid fixations of clavicle alone or clavicle and scapular fractures both can achieve stable reduction of the fractures and prevent sequelae. We concluded that operative treatment of ipsilateral fractures of clavicle and scapula is safe and yields predictable good results.

• Journal of the Korean Orthopaedic Association
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• v.54 no.2
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• pp.110-119
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• 2019

Proximal humerus fracture can be defined as a fracture that occurs in the surgical neck or proximal part of the humerus. Despite the appropriate treatment, however, various complications and sequelae can occur, and the treatment is quite difficult often requiring surgical treatment, such as a shoulder replacement. The classification of sequelae after a proximal humerus fracture is most commonly used by Boileau and can be divided into two categories and four types. Category I is an intracapsular impacted fracture that is not accompanied by important distortions between the tuberosities and humeral head. An anatomic prosthesis can be used without greater tuberosity osteotomy. In category I, there are type 1 with cephalic collapse or necrosis with minimal tuberosity malunion and type 2 related to locked dislocation or fracture-dislocation. Category II is an extracapsular dis-impacted fracture with gross distortion between the tuberosities and the humeral head. To perform an anatomic prosthesis, a tuberosity osteotomy should be performed. In category II, there are type 3 with nonunion of the surgical neck and type 4 with severe tuberosity malunion. In type 1, non-constrained arthroplasty (NCA) without a tuberosity osteotomy should be considered as a treatment. On the other hand, reverse shoulder arthroplasty (RSA) should be considered if types 1C or 1D accompanied by valgus or varus deformity or severe fatty degeneration of the rotator cuff. In general, the results are satisfactory when NCA is performed in type 2 sequelae. On the other hand, RSA can be considered as an option when there is no bony defect of the glenoid and a defect of the rotator cuff is accompanied. In type 3, it would be effective to perform internal fixation with a bone wedge graft rather than shoulder replacement arthroplasty. Recent reports on the results of RSA are also increasing. On the other hand, recent reports suggest that good results are obtained with RSA in type 3. In type 4, RSA should be considered as a first option.

• 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.