• Clinics in Shoulder and Elbow
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• 제21권4호
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• pp.234-239
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• 2018

Background: In elbow fracture-dislocation, partial excision of the comminuted radial head fracture that is not amenable to fixation remains controversial considering the accompanying symptoms. This study was undertaken to evaluate the results of radial head partial excision when the comminuted radial head fracture involved <50% of the articular surface in all-arthroscopic repair of elbow fracture-dislocation. Methods: Patients were divided into two groups based on the condition of the radial head fracture. In Group A, the patients had a radial head comminuted fracture involving <50% of the articular surface, and underwent arthroscopic partial excision. Group B was the non-excision group comprising patients with stable and non-displacement fractures. Follow-up consultations were conducted at 6 weeks and at 3, 6, 12, and 24 months after surgery. Results: In all, 19 patients (Group A: 11; Group B: 8) met the inclusion criteria and were enrolled in the study. At the final follow-up, all 19 patients showed complete resolution of elbow instability. No significant differences were observed in the range of motion, visual analogue scale score, and Mayo elbow performance score between groups. Radiological findings did not show any complications of the radiocapitellar joint. However, nonunion of the coracoid fracture was observed in 3 patients (Group A: 1; Group B: 2), without any accompanying instability and clinical symptoms. Conclusions: Considering that the final outcome is coronoid fracture fixation and lateral collateral ligament complex repair for restoring elbow stability, arthroscopic partial excision for radial head comminuted fractures involving <50% of articular surface is an effective and acceptable treatment for elbow fracture-dislocation.

• Clinics in Shoulder and Elbow
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• 제23권3호
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• pp.131-135
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• 2020

Background: Resection of the radial head is a surgical indication for comminuted radial head fracture in which internal fixation is inaccessible. Some complications from the surgery can alter the function of the patient's elbow. The objective of this study was to assess functional outcome of the elbow after resection of the radial head. Methods: A retrospective longitudinal study was performed with patients who underwent radial head resection between 2008 and 2018. Elbow function was assessed by the Mayo Elbow Performance Index (MEPI) for 11 patients comprising three women and eight men. The mean follow-up was 47.6 months. The mean age was 41±10.3 years. Results: Nine patients had a stable and painless elbow. The mean extension-flexion arc was 97.73°±16.03°. The mean values of pronation and supination were 76.8° and 74.5°, respectively. The mean MEPI score was 83.2 points, and restoration of overall function was achieved in 81% of the cases. Poor function was noted in one in 10 that presented with a terrible triad. Conclusions: Resection of the radial head restored elbow functionality at a rate of 81%, which was a good outcome for patients.

• Clinics in Shoulder and Elbow
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• 제14권1호
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• pp.140-145
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• 2011

목적: 금속 요골두 치환술은 주관절 불안정성을 동반한 고정할 수 없는 분쇄된 요골두 골절의 치료로 최근 다양한 임플란트의 개발로 널리 사용되고 있다. 저자는 금속성 요골두 치환술의 적응증과 국내에 사용중인 임플란트의 종류와 수술 술기를 문헌 고찰과 함께 기술하고자 한다. 대상 및 방법: 요골두 치환술의 주 적응증은 동반된 연부조직 손상으로 인한 주관절의 불안정성이 있고, 요골두의 분쇄 골절로 안정적인 내고정이 불가능한 골절이다. 이러한 경우 과거 시행되었던 요골두 절제술은 많은 합병증의 발생으로 금기시되고 있다. 현재 국내에서는 양극성, 압박 고정 단극성 및 이완 고정 단극성 임플란트의 3종류가 수입되어 사용되고 있다. 요골두 치환술은 궁극적으로 원래의 요골두의 크기와 길이로 복원하는 것이 중요하다. 과도하게 긴 요골두의 삽입은 흔한 합병증으로 수술 시 주의가 필요하다. 결과 및 결론: 요골두 치환술은 적절한 적응증과 정확한 수술 술기로 만족할 만한 임상적 결과를 얻을 수 있다. 향후 장기추시 연구와 다양한 치환물들의 임상적인 비교 연구가 필요하다.

• Clinics in Shoulder and Elbow
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• 제26권2호
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• pp.205-207
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• 2023

A Monteggia fracture is a proximal ulnar fracture with proximal radioulnar ligamentous instability. While there is no precise definition, Monteggia-equivalent fractures are generally considered Monteggia fractures accompanied by radial head fractures. These are rare. In this study, we report a rare variation of a Bado type IV Monteggia-equivalent lesion (fracture of proximal ulnar shaft, proximal radial shaft, and radial head) and its management.

• 대한정형외과스포츠의학회지
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• 제5권1호
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• pp.75-80
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• 2006

목적: 해부학적 정복이 가능한 요골두 골절에 대하여 Acutrak 나사를 이용한 고정술의 치료 결과와 유용성에 대해 알아보고자 하였다. 대상 및 방법: 2001 년 5월부터 2003년 2월까지 본원에서 요골두 골절에 대해 수술한 12 예중 Acutrak 나사 고정술로 치료한 7 예를 대상으로 하였다. 추시 기간은 최소 6개월부터 최장 30개월로 평균 1.2년이었고, 평균 나이는 47세였다 손상의 원인은 낙상이 4예, 교통사고가 3예이었다. 치료 결과 평가 방법은 Mayo Clinic에서 발표한 Functional Rating index를 이용하였다 결과: Mayo Clinic의 Functional Rating Index를 이용한 기능적 평가상 우수가 2예, 양호가 5예였다 방사선학적 소견 상 모든 예에서 골유합 소견을 보였고, 부정 유합이나 나사 이완, 이소성 골형성, 감염, 외상 후 퇴행성 변화 등의 합병증은 없었고 수술 후 건측과 비교하여 운동장애도 보이지 않았다. 결론: 본원에서 시행한 요골두 골절의 Acutrak 나사 고정은 요골두 부분의 안전지대에 대한 고려없이 시행 가능하며 방사선학적 및 임상적 평가에서 만족할 만한 결과를 보였고, Acutrak 나사의 형태학적 특성상 골절의 선상 형태에 대하여 근위 요척골관절에 영향을 주지 않으며, 강한 고정력을 얻을 수 있는 술식으로 사료된다.

• Clinics in Shoulder and Elbow
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• 제10권1호
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• pp.84-91
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• 2007

목적: 총 7예의 금속형 요골 골두 치환술을 경험하여 적응증을 바탕으로 국내 요골두 치환술의 실태와 필요성을 소개하고자 하였다. 대상 및 방법: 2006년 4월부터 고려대학교 정형외과 교실에서 경험하였던 총 7예의 환자를 대상으로 수술 적응증, 수술 소견 및 수술 후 상태를 조사하였다. 그리고 치환물의 술 전 준비상태와 보험 적용 여부를 조사하였다. 금속형 치환물은 양극성 유형의 요골두 치환물(Tornier SA. Saint-Ismier, France)을 사용하였다. 결과: 전 예에서 요골두 분쇄 골절 이외에 $1{\sim}2$ 곳의 다른 골절 및 연부조직 손상을 동반한 복합 손상으로 요골두 치환술의 적응증에 해당되었다. 요골두 골절은 Mason 분류상 III형이 3예, IV형이 4예였고 분쇄골절로 인해 만족할만한 내고정을 얻지 못해 치환술을 시행하였다. 술 후 평가에서는 우수 2예, 양호 4예, 불량 1예였고 추시 시 치환물의 문제로 인한 합병증은 보이지 않았다. 술 전 수술 기구의 공급 부족으로 2예에서 수술 날짜를 변경하였고 치환물에 대한 비용은 산재 환자 2예를 제외한 5예에서 환자 개인이 부담하였다. 결론: 요골 골두의 분쇄를 포함한 주관절의 복합 손상에서 금속형 치환물은 술 전 계획 하에 준비되어야 하며, 의료보험의 적용으로 의사 및 환자들의 치료 선택에 도움을 주어야 할 것으로 생각되었다.

• Clinics in Shoulder and Elbow
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• 제26권2호
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• pp.156-161
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• 2023

Background: We analyzed association between viewing two-dimensional computed tomography (2D CT) images in addition to radiographs with radial head treatment recommendations after accounting for patient and surgeon factors in a survey-based experiment. Methods: One hundred and fifty-four surgeons reviewed 15 patient scenarios with terrible triad fracture dislocations of the elbow. Surgeons were randomized to view either radiographs only or radiographs and 2D CT images. The scenarios randomized patient age, hand dominance, and occupation. For each scenario, surgeons were asked if they would recommend fixation or arthroplasty of the radial head. Multi-level logistic regression analysis identified variables associated with radial head treatment recommendations. Results: Reviewing 2D CT images in addition to radiographs had no statistical association with treatment recommendations. A higher likelihood of recommending prosthetic arthroplasty was associated with older patient age, patient occupation not requiring manual labor, surgeon practice location in the United States, practicing for five years or less, and the subspecialties "trauma" and "shoulder and elbow." Conclusions: The results of this study suggest that in terrible triad injuries, the imaging appearance of radial head fractures has no measurable influence on treatment recommendations. Personal surgeon factors and patient demographic characteristics may have a larger role in surgical decision making. Level of evidence: Level III, therapeutic case-control study.

• Anatomy and Cell Biology
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• 제56권1호
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• pp.39-45
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• 2023

Fixation of radial head fracture with minimally invasive posterior approach remains a significant challenge. The aim of this study was to determine the feasibility of trans-anconeus posterior elbow approach and to observe lateral ulnar collateral ligament (LUCL) in extended elbows. This cadaveric study was performed in twenty upper limbs of fresh fixed adult male cadavers. An oblique incision was made in the middle segment of anconeus until the lateral ligament complex and the joint capsule had been revealed. A deep dissection was explored to observe the anatomical relationship of the LUCL to the anconeus. Measurements of the LUCL were recorded while the elbow was fully extended. The mean distance between the edge of the radial head and the proximal insertion of the LUCL was 13.3 mm (11.5-16.2 mm); the mean distance between the edge of the radial head and the distal insertion of the LUCL was 20.9 mm (19.2-23.4 mm); the distance between the edge of the radial head and the distal edge of the annular ligament was 11.2 mm (8.22-11.7 mm). By estimate correlation of the previous measurements, the direct and accessible way to expose the posterolateral articular capsule of the elbow joint was through a window in medial 2/3 of the middle segment of anconeus muscle. These trans-anconeus approach is useful. It provides good visualization, facilitates applying the implants, and lessens the risk of radial nerve injury. Awareness of the anatomy is mandatory to avoid injury of LUCL.

• Journal of Yeungnam Medical Science
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• 제4권2호
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• pp.131-138
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• 1987

1. 총 8예중 남자 6례, 여자 2례이었다. 2. 손상의 원인은 낙상이 4례로 가장 많았다. 3. Bado 분류에 의한 빈도는 I형이 4례(50%), II형 1예(12.5%), III형 3예(37.5%)이었다. 4. 척골골절의 위치는 상 1/3 이상 부위가 7예이었다. 5. 요골두 탈구 방향은 전방이 3예로가장 많았다. 6. 치료는 소아는 2예 모두 비수술적 방법으로 하였으며 성인 6예중 2예는 도수정복하고 4례는 골골절윤 압박금속판을 사용하여 내고정하였으며 골두 탈구는 모두 도수정복하였다. 7. 결과는 Bruce 등에 의한 판정으로 excellent 3예, good 2례, fair 1예, poor 2례이었다.

• Clinics in Shoulder and Elbow
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• 제5권1호
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• pp.37-41
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• 2002

Purpose : To evaluate the effect of radial head resection on longevity in nonconstrained total elbow arthroplasty, Materials and Methods : The results of 20 cases of radial head replaced Pritchard ERS and 18 cases of radial head excised Kudo elbow was followed for 6 to 16 years, 10.6 years in average. The rate of loosening, osteolysis, radial head subluxation, joint dislocation and valgus deformity were compared between the two groups. Results'There was no exaggerated cubitus valgus in Pritchard ERS group. However there developed one case of delayed subluxation of radial head occurred in 6 years postoperatively, one case of loosening, and one case of sponta- neous fracture of humeral shaft due to osteolysis. In Kudo elbow group,5 cases (27.8%) showed exaggerated valgus deformity with instability. There were one case of loosening and one case of delayed dislocation occurred in a year postoperatively. Conclusion : The most clear feature of Kudo elbow was exaggerated cubitus valgus. However, the ostolysis was developed in both groups and there was no difference in rate of the other complications between the two groups.