• The Academic Congress of Korean Shoulder and Elbow Society
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• 2009.03a
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• pp.208-208
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• 2009

Eleven shoulders (9 patients) with refractory scapulothoracic dysfunction were treated with scapulothoracic arthrodesis between 2000 and 2006. Refractory shoulder dysfunction included facioscapulohumeral muscular dystrophy in five shoulders (3 patients), refractory scapular winging with long thoracic nerve palsy in one shoulder, scapular winging caused by serratus anterior palsy with trapezius dysfunction in one shoulder, post-surgical thoracic outlet syndrome due to medial clavicle resection in two shoulders, refractory scapular winging with spinal accessory nerve injury in one shoulder, and chronic trapezius rupture caused by cervical spine surgery in one shoulder. The mean active flexion was improved from 82 degrees preoperatively to 112 degrees postoperatively. The mean Constant score was improved from 27.2 points to 68.0 points. Two shoulders (1 patient) that had facioscapulohumeral muscular dystrophy had broken wires due to nonunion, and one patient had a reactive pulmonary effusion. In ten of the eleven shoulders, the patients were satisfied with their results. The scapulothoracic arthrodesis can cause significant pain relief and functional improvement in refractory scapulothoracic and/or shoulder dysfunction. By selecting patients that present with appropriate indications, and using experienced surgical technique through complete preoperative evaluation, we can diminish the complication rate and make good clinical outcomes.

• The Academic Congress of Korean Shoulder and Elbow Society
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• 2003.03a
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• pp.17-17
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• 2003

• Archives of Reconstructive Microsurgery
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• v.18 no.2
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• pp.55-61
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• 2009

Purpose: To analyze the clinical and radiologic results of the shoulder arthrodesis in brachial plexus injury patients with flail upper extremity. Material and Method: From Aug 1978 to April 2008, 29 shoulders in 29 patients with brachial plexus injury with shoulder fusion, we evaluated 20 shoulders in 20 patients, more than 1 year follow up. The average follow-up period was 6.45years (range: 1year~24years). There were 13 men and 7 women, and the mean age at the time of trauma was 32.0years(2~65 years). The type of injury was a motorcycle accident in 11 patients, in car accident in 5, pedestrian accident in 3, and fall from a height in 1. The lesion of injury was root and trunk in 1 patient, trunk and cord in 1, trunk in 18. Surgery was performed on the whole arm type paralysis in 12 patients, lower arm type paralysis in 8 patients. The preoperative visual analog scale score was 8.7(7~10). When the trapezius and serratus anterior muscle were in function, operation was performed. 18 patients were processed to the additional operation. Gracilis free flap in 6 patients, neurotization in 3, Steindler flexor plasty in 6, and tendon transfer in 3 were performed. Fixation was conducted with cancellous screws in 13 patients, Knoles pins in 5, and cancellous screws and Knoles pins in 2. The position of the arthrodesis at operation was $28.5^{\circ}$($20~45^{\circ}$) in abduction, $30.3^{\circ}$($20~45^{\circ}$) in flexion, and $30.8^{\circ}$($20~40^{\circ}$) in internal rotation. Result: The follow up visual analog scale score was 3.4(0~7). Postoperatively, shoulder spica cast was applied for 15.3weeks(8-20weeks). The median time to bony union was 17.7weeks(9~28weeks). Average range of motion was $32.0^{\circ}$($15~40^{\circ}$) of abduction, $24.0^{\circ}$($10~40^{\circ}$) of flexion, and $18.5^{\circ}$($10~30^{\circ}$)of internal rotation. Conclusion: The shoulder fusion in brachial plexus injury patients is one of the good methods to relieve pain, improve the function and stabilize the flail shoulder joint.

• Clinics in Shoulder and Elbow
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• v.10 no.2
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• pp.246-250
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• 2007

Total elbow arthroplasty is a relatively rare procedure compared with total knee or total hip arthroplasty. Total elbow arthroplasty for bony ankylosis is even rarer, and the results are often unsatisfactory. We report a patient who gained good mobility of the elbow after total elbow arthroplasty for the treatment of fractured arthrodesis site with which the patient had lived with for 12 years.

• Archives of Reconstructive Microsurgery
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• v.24 no.2
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• pp.41-49
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• 2015

Free or pedicled vascularized fibular grafts (VFG) are useful for the reconstruction of large skeletal defects, particularly in cases of scarred or avascular beds, or in patients with combined bone and soft tissue defects. Compared to non-VFG, VEG, which contains living osteocytes and osteoblasts, maintains its own viability and serves as good osteoconductive and osteoinductive graft. Due to its many structural and biological advantages, the free fibular osteo- or osteocutaneous graft is considered the most suitable autograft for the reconstruction of long bone defects in the injured extremity. The traditional indication of VFG is the long bone and soft tissue defect, which cannot be reconstructed using a conventional operative method. Recently, the indications have been widely expanded not only for defects of midtibia, humerus, forearm, distal femur, and proximal tibia, but also for the arthrodesis of shoulder and knee joints. Because of its potential to allow further bone growth, free fibular epiphyseal transfer can be used for the hip or for distal radius defects caused by the radical resection of a tumor. The basic anatomy and surgical techniques for harvesting the VFG are well known; however, the condition of the recipient site is different in each case. Therefore, careful preoperative surgical planning should be customized in every patient. In this review, recently expanded surgical indications of VFG and surgical tips based on the author's experiences in the issues of fixation method, one or two staged reconstruction, size mismatching, overcoming the stress fracture, and arthrodesis of shoulder and knee joint using VFG are discussed with the review of literature.

• The Journal of the Korean bone and joint tumor society
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• v.1 no.1
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• pp.68-76
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• 1995

To evaluate the clinical result of surgical treatment of malignant tumors in shoulder girdle, nine patients who were treated in Department of Orthopedics, Catholic University Medical College between January 1991 and December 1993, were evaluated. There were 5 men, 4 women. The mean age at operation was 47 years(range from 22 to 64 years). Of 9 patiens, 2 were soft tissue tumors(1 MFH, 1 dermatofibrosarcoma protuberance); one was treated with forequarter amputation, and the other with wide excision, Seven were bone tumor(2 chondrosarcoma, 1 osteosarcoma, 1 MFH, 1 plasmacytoma, 1 thyroid carcinoma metastasis, 1 malignant schwannoma); one patient was treated with segmental excision of proximal humerus, 4 with Malawer type I-A resection and arthroplasty or arthrodesis, 1 with Malawer type V-B resection and arthrodesis. Five patients received adjuvant chemotherapy, with or without local radiation therapy, and one patient received radiation therapy alone. All patients have survived now, but I had local recurrence. Functional results of arthrodesis and arthroplasty were similar.

• The Journal of the Korean bone and joint tumor society
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• v.8 no.3
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• pp.96-105
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• 2002

Purpose: The purpose of this study was to assess the oncologic results and functional outcomes of limb salvage surgery performed in patients of primary bone tumors of the shoulder girdle. Materials and Methods: Twenty-nine patients who underwent limb sparing resection for shoulder girdle neoplasm between 1982 and 2001 were analyzed. Follow up periods averaged 7 years and 1 month. Mean age of the patients was 35 (11~71) years. There were 14 males and 15 females. Primary malignant bone tumors of shoulder girdle (proximal humerus 21, scapula 3, both 1) were 23 cases; osteosarcomas 7, chondrosarcoma 14, parosteal osteosarcoma 1, hemangioendothelioma 1, and giant cell tumor of proximal humerus were 6 cases. Limb salvage surgery was performed by curettage and cementing in 7 patients, by cement molding arthroplasty in 10 patients, and by tumor prosthesis in 7 patients, by other method such as resection only, bone graft, arthrodesis in 5 patients. The Musculoskeletal Tumor Society functional rating system was used to assess functional outcomes. Results: One osteosarcoma and 2 chondrosarcoma patients died, and the survival of the salvaged limb was 88.6% at the final follow-up. There were 6 local recurrences, 2 lung metastases, 2 local recurrences and lung metastases. The functional outcome was 80%. There was statistically significant difference of functional results among the patients treated by cement filling (86%), cement molding arthroplasty and IM nailing (71%), and tumor prosthesis (83%). (p=0.034) There were three complications including 1 radial nerve palsy and 1 axillary nerve palsy, and 1 wound infection. Dislodgement of vascularized fibular graft in one patient was treated by internal fixation. Conclusion: Limb salvage surgery seems to be useful method to treat bone tumors of the shoulder girdle.