• Clinics in Shoulder and Elbow
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• v.20 no.2
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• pp.90-94
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• 2017

Background: Proximal humerus fracture is considered to be the third most common fracture for patients aged 65 years or older. Conservative treatment has been known to treat most of humerus fracture. However, fractures with severe displacement or dislocation may require surgical treatment. Intramedullary fibular allograft with a locking plate is frequently used in patients accompanying medial metaphyseal disruption. In this study, author intends to evaluate clinical and imaging results based on patients who underwent surgical treatment using fibular allograft with a locking plate. Methods: This study is conducted prospectively at Wonju Severance Christian Hospital, targeting patients who previously underwent surgical treatment using open reduction and intramedullary fibular allograft with a locking plate between 2011 and 2015. A total of 26 patients were evaluated on the following: postoperational clinical assessment measuring Constant score, American Shoulder and Elbow Society (ASES) score, and the Disabilities of the Arm, Shoulder and Hand (DASH) score. Postoperational imaging assessments are evaluated via measuring the neck-shaft angle. The study subject were Neer classification type 3, 4 proximal humerus fracture cases with disrupted medial hinge and having cortical comminution in the region of the surgical neck. Results: The average period of progression was 22.5 months, and the average age of patients was 72.6 years. At the final follow-up, the average Constant, average ASES, and average DASH scores were 80.1, 78.5, and 20.6 respectively. The average neck-shaft angle was $127.5^{\circ}$. Conclusions: In conclusion, fibular allograft augmentation with a locking plate showed satisfying results in both clinical and imaging studies.

• The Academic Congress of Korean Shoulder and Elbow Society
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• 2007.11a
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• pp.196-198
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• 2007

• The Academic Congress of Korean Shoulder and Elbow Society
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• 2008.11a
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• pp.215-220
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• 2008

• The Journal of Korean Orthopaedic Ultrasound Society
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• v.5 no.1
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• pp.15-21
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• 2012

Primary radial nerve palsy occurs in association with approximately 10% of humerus shaft fractures. Secondary radial nerve palsy, which is iatrogenic, occurs in association with approximately 10% to 20% of humerus shaft fractures. Whether the radial nerve palsy is caused primarily by the fracture or secondarily by the surgery, it is necessary to determine whether the radial nerve is being disrupted or compressed by the surrounding structures. This evaluation will dictate whether to await natural recovery or to perform surgical exploration. The current authors report one case of primary radial nerve palsy, due to the humerus fracture, and one case of secondary radial nerve palsy, associated with the osteosynthesis procedure. In both patients, the radial nerve was assessed for anatomical integrity with ultrasonography. Nerve disruption was found in one patient, and a sural nerve graft was performed. Nerve adhesion was found in the other patient, and neurolysis was performed. In both cases, the clinical results were satisfactory. This report focuses on the usefulness of ultrasonography in radial nerve assessment in patients with radial nerve palsy.

• Clinics in Shoulder and Elbow
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• v.6 no.2
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• pp.149-160
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• 2003

Purpose: to determine the results after open intramedullary nailing and tension band suture technique in proximal humerus fracture for improving the stability and decreasing the complications. Materials and Method: Authors reviewed 27 patients treated by open intramedullary nailing and tension band suture technique. Mean follow-up period was 39 months (24-59months). Surgical neck fracture were 6 cases, surgical neck fracture with shaft fracture were 3 cases, three part fracture with greater tuberosity fracture were 17 cases, four part fracture was 1 case and fracture and dislocation were 2 cases Results: We got the bony union in 26 cases. Average pain scale was 1 point (0-6), Neer score was 86 point(45-99) and ASES score was 85 point(40-100). We separate all cases in two groups based on age (65 years), L-spine t-score (-2.5) and Neer classification (2 and 3 part). There is no significance in pain scale, Neer score and ASES score between each group. Conclusion: As a method of surgical treatment on severe proximal humeral fractures, we recommend intramedullary nailing and tension band suture technique and it may have particular advantages in early exercise and satisfactory functional outcome.

• Clinics in Shoulder and Elbow
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• v.13 no.2
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• pp.202-208
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• 2010

Purpose: In this study we introduced minimal invasive plate osteosynthesis (MIPO) and analyzed clinical outcomes to determine the effectiveness of this intervention in proximal humerus fractures. Materials and Methods: We studied 27 patients including 16 cases with a 2-part fracture, 10 cases with a 3-part fracture, and 1 case with a 4-part fracture. Clinical outcomes were evaluated using UCLA score, KSS score and recovery of range of motion. Time to union and humerus neck-shaft angle change were estimated by radiologic assessment. The average follow up period was 19 months. Results: UCLA scores were "excellent" for 15 patients, "good" for 12 patients. The mean KSS score was 91.4 at final follow-up. The average shoulder range of motion was $167.2^{\circ}$ in forward elevation. Bone union occurred by 14.1 weeks postoperatively. Humerus neck-shaft angle recovery was "excellent" in 24 patients and "moderate" in 3 patients. There were no complications such as axillary nerve paralysis, deep infection, or subacromial impingement of the plate. Conclusion: MIPO for proximal humerus fractures is an effective procedure if performed with sufficient understanding of the anatomical structures. MIPO leads to minimized dissection of soft tissue, low complication rates and early recovery of range of motion.

• The Academic Congress of Korean Shoulder and Elbow Society
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• 2006.03a
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• pp.80-80
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• 2006

• The Academic Congress of Korean Shoulder and Elbow Society
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• 2009.03a
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• pp.161-161
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• 2009

To prevent distraction and varus deformity between the humeral head and shaft, tension band sutures placed between the head of the interlocking screw and the rotator cuff, and we recommend using nonabsorbable sutures. We describe our simple procedure to overcome these difficulties in tension band suturing after reducing a proximal humerus fracture to maintain the reduction.

• Clinics in Shoulder and Elbow
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• v.23 no.3
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• pp.152-155
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• 2020

Periprosthetic fracture after total elbow replacement surgery is a difficult complication to manage, especially when it comes together with implant loosening. If stem revision and internal fixation of the periprosthetic fracture are performed simultaneously, this would be a very challenging procedure. Most of total elbow replacement implants are cemented type. Cement usage at periprosthetic fracture site may interfere healing of fractured site. Authors underwent internal fixation with use of locking plate and cerclage wire for periprosthetic fracture, allogenous fibular strut bone inserted into the humerus intramedullary canal allowing the fractured site to be more stable without cement usage. At 10-month follow-up, the complete union and good clinical outcome was achieved. We present a novel technique for treating periprosthetic fracture with implant loosening after total elbow replacement surgery, using intramedullary allogenous fibula strut bone graft.

• Clinics in Shoulder and Elbow
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• v.12 no.1
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• pp.44-52
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• 2009

Purpose: We assessed the radiographic and clinical results of one surgeon's experience treating proximal humerus fractures with a locked proximal humeral plate. Materials and Methods: Twenty patients with unstable proximal humerus fractures were treated with a locking compression plate between February 2005 and September 2007. The average age of the patients was 60.6 years, and the average postoperative follow-up period was 22.3 months. The clinical results were evaluated using the Constant and DASH scores. The radiologic results were evaluated by the Paavolainen method, which measures the neck shaft angle and humeral head height. Results: At the last follow-up examination, the mean Constant score was 75.3 and 15 cases (75%) had excellent or good results; the mean DASH score was 16.4. The mean neck shaft angle was $137.1^{\circ}$, and 19 cases (95%) had good results by the Paavolainen method. There was one delayed union, malunion, and screw loosening. Conclusion: The patients treated with a locking compression plate had relatively good clinical and radiologic results, and a low complication rate. Moreover, the patients could exercise earlier due to good reduction and initial stability. Treatment of unstable proximal humerus fractures with a locking compression plate is a reliable method.