Publications by authors named "Jong Hun Baek"

32 Publications

Osteosarcoma Arising in Fibrous Dysplasia of the Long Bone: Characteristic Images and Molecular Profiles.

Diagnostics (Basel) 2022 Jul 4;12(7). Epub 2022 Jul 4.

Department of Pathology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul 02447, Korea.

Fibrous dysplasia (FD) is a benign fibro-osseous lesion that frequently involves the craniofacial bones and femur. Malignant transformation of FD is a rare occurrence. We report a 38-year-old woman with osteosarcoma (OS) arising from FD of the femur. Magnetic resonance imaging revealed a well-defined lesion in the medulla of the femur, with cortical thinning and local bone destruction. Wide excision of the femur was performed. Grossly, the inner part of the mass was hard and tan-gray in color, and the outer part of the mass adjacent to the cortex showed myxoid discoloration with infiltrative borders. Microscopically, most of the tumor consisted of curvilinear woven bone and fibrous stroma with bland spindle cells, which transitioned to the outer portion of the tumor, showing cellular proliferation of pleomorphic cells with frequent mitotic activity. Next-generation sequencing revealed and mutations, and the diagnosis of OS arising from FD was strongly supported. This case highlights the characteristic images and molecular features of the malignant transformation of FD.
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http://dx.doi.org/10.3390/diagnostics12071622DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9323252PMC
July 2022

Comparative Study of A1 Pulley Release and Ulnar Superficialis Slip Resection in Trigger Finger With Flexion Contracture of the Proximal Interphalangeal Joint.

J Hand Surg Am 2022 Jul 7. Epub 2022 Jul 7.

Department of Orthopaedic Surgery, Yeson Hospital, Bucheon, Korea. Electronic address:

Purpose: The purpose of this study was to compare the clinical outcomes of A1 pulley release with ulnar superficialis slip resection (group A) and simple A1 pulley release (group B) in trigger finger with flexion contracture of the proximal interphalangeal (PIP) joint.

Methods: From January 2016 to December 2019, the 2 surgical procedures were performed alternately every year for trigger fingers with preoperative PIP joint flexion contractures of ≥10°. Twenty-six fingers in group A and 29 fingers in group B that were followed up for >1 year were reviewed in this retrospective study. The visual analog scale (VAS) score; Disabilities of the Arm, Shoulder, and Hand (DASH) score; degree of PIP joint flexion contracture; grip strength; and pinch strength were measured after surgery and compared.

Results: The differences in postoperative PIP joint flexion contracture between groups were <4° at 2 and 6 weeks, and there were no clinically relevant differences at 6 weeks and 12 months. At the final follow-up, PIP joint flexion contractures of 5° were observed in 2 fingers in each group. The difference in VAS scores between groups was less than half of a point until 3 months, and there were no clinically relevant differences at 6 weeks and 12 months. The DASH score did not show any difference between groups at the final follow-up. There were clinically relevant differences in the grip and pinch strengths between groups at 6 weeks. However, there were no clinically relevant differences at the final follow-up.

Conclusions: Proximal interphalangeal joint flexion contracture measurements and clinical scores did not differ between groups at the final follow-up. Therefore, we recommend use of a simple A1 pulley release, which is simpler than an A1 pulley release with ulnar superficialis slip resection, in cases of trigger finger with PIP joint flexion contracture.

Type Of Study/level Of Evidence: Therapeutic IV.
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http://dx.doi.org/10.1016/j.jhsa.2022.04.021DOI Listing
July 2022

Characteristics of surgically treated Guyon canal syndrome: A multicenter retrospective study.

J Plast Reconstr Aesthet Surg 2022 Apr 27. Epub 2022 Apr 27.

Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea. Electronic address:

Guyon canal (GC) syndrome is a rare peripheral neuropathy involving the distal part of the ulnar nerve. Several causes are associated with GC syndrome, including anatomic variations, space-occupying tumors, and trauma. Because of disease rarity, the only reported studies of GC syndrome are case series with small sample size. We conducted a multicenter study to identify the basic characteristics of patients with surgically treated GC syndrome and the risk factors for the disease. This retrospective multicenter study was conducted between January 2001 and December 2020. We screened 70 patients who underwent GC release surgery by seven hand surgeons at six institutes. A total of 56 patients were included in this study, including 38 patients (67.9%) who underwent isolated GC decompression and 18 (32.1%) who underwent combined peripheral nerve decompression. The mean patient age was 48.4 years (range: 20-89 years), and 40 patients (71.4%) were male. The average preoperative symptom duration was 18.5 months, and most patients were office workers. Ultrasound was positive for GC syndrome in 7/10 patients evaluated, CT in 2/5, MRI in 17/23, and electrodiagnostic studies in 35/44. The most common cause of GC syndrome was tumor (n = 23), followed by idiopathic (n = 17), trauma (n = 12), anatomic variants (n = 3), and inflammation (n = 3). In conclusion, most patients with GC syndrome in this study were male and had symptoms in one wrist. The most common cause of GC syndrome in this study was a tumor, including a ganglion cyst. Level of Evidence: Level IV case series.
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http://dx.doi.org/10.1016/j.bjps.2022.04.049DOI Listing
April 2022

Risk Factors for Non-Union after Open Reduction and Internal Fixation in Patients with Distal Humerus Fractures.

J Clin Med 2022 May 10;11(10). Epub 2022 May 10.

Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University Hospital at Gangdong, Seoul 05278, Korea.

Background: Only a few studies have reported on the risk factors for non-union after open reduction and internal fixation (ORIF) in distal humerus fractures.

Methods: We retrospectively reviewed 155 patients who underwent ORIF for distal humerus fractures from January 2008 to June 2020. Various patient factors, including body mass index (BMI), diabetes mellitus (DM), and combined fracture, as well as surgical factors, including fixation methods (e.g., orthogonal plate/parallel plate/single plate/tension bend wiring [TBW]) and combined fracture operations, were evaluated as risk factors for non-unions.

Results: Among the patient factors, BMI (25.0 ± 3.4 vs. 22.7 ± 3.4, = 0.032), DM (5/13 [38.5%] vs. 20/142 [14.1%], = 0.038) and combined fracture (5/13 [38.5%] vs. 16/142 [11.3%], = 0.018) were significantly different between groups with non-union and union. Among the surgical factors, combined fracture operation (5 [38.5%] vs. 9 [6.3%], = 0.002) and the fixation method (3 [23.1%]/1 [7.7%]/4 [30.8%]/5 [38.5%] vs. 84 [59.2%]/7 [4.9%]/40 [28.2%]/11 [7.7%], = 0.005) showed a significant difference between groups with non-union and union. Multivariate regression analysis showed that combined fracture operation (OR 10.467; 95% CI 1.880-58.257; = 0.007) and TBW (OR 9.176; 95% CI 1.474-57.135; = 0.018) among the fixation methods posed as a significant risk factor for non-union.

Conclusions: The risk of non-union increased in patients who underwent surgery for another fracture combined with distal humerus fracture and in patients who underwent ORIF with TBW.
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http://dx.doi.org/10.3390/jcm11102679DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9147525PMC
May 2022

Dorsal plating versus volar plating with limited dorsal open reduction in the management of AO type C3 distal radius fractures with impacted articular fragments: A retrospective comparative study.

Acta Orthop Traumatol Turc 2022 Jan;56(1):42-47

Department of Orthopedic Surgery, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea.

Objective: The aim of this study was to compare the outcomes of dorsal plating versus volar plating with limited dorsal open reduction in the management of AO type C3 distal radius fractures with impacted articular fragments.

Methods: Thirty patients who underwent dorsal plating (Group A) (14 females, 16 males; mean age = 56.8 ± 10.1 years) and 28 who underwent volar plating with limited dorsal open reduction (Group B) (12 females, 16 males; mean age = 55.6 ± 17.7 years) for type C3 distal radius fractures with impacted articular fragments between 2006 and 2019 were retrospectively analyzed. The mean follow-up was 14.5 ± 3.2 months in group A and 13.2 ± 2.4 months in group B. The articular step-off, articular gap and joint penetration by screws on the computed tomography scans were used for radiologic evaluation. The functional outcomes were evaluated with range of motion, grip power, Quick Disabilities of the Arm, Shoulder, and Hand (DASH) score, and Mayo wrist score.

Results: No significant difference was found in the step-off distance at 1 year after surgery between the two groups (P < 0.05). The ranges of extension, rotation, and radial and ulnar deviations did not differ between the groups. However, group B had a significantly higher range of flexion in the wrist joint than Group A (P = 0.010). The grip power, DASH score, and Mayo wrist score did not also differ between the groups. Implant removal owing to any discomfort at the operative site was performed in 15 patients (63%) in Group A and 7 patients (28%) in Group B.

Conclusion: Similar clinical results can be obtained by both dorsal plating and volar plating with limited dorsal open reduction in treating type C3 distal radius fractures with impacted articular fragments. However, volar plating with limited dorsal open reduction can provide better wrist flexion with a low incidence of complications associated with implantation.

Level Of Evidence: Level III, Therapeutic Study.
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http://dx.doi.org/10.5152/j.aott.2022.21157DOI Listing
January 2022

Wrist Reconstruction Using Free Vascularized Fibular Head Graft Following Intralesional Excision for Campanacci Grade 3 Giant Cell Tumors Involving the Articular Surface of the Distal Radius.

J Hand Surg Am 2021 Dec 8. Epub 2021 Dec 8.

Department of Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, South Korea. Electronic address:

Reconstruction with a free vascularized fibular head graft after en bloc excision of a Campanacci grade 3 giant cell tumor of bone in the distal radius can effectively control local recurrence. However, it leads to the loss of wrist movement, subsequent radiocarpal subluxation, and an osteoarthritic change. Another treatment option for grade 3 lesions is intralesional excision and cementation, which preserves wrist movement but does not restore the articular surface. We report a case of wrist reconstruction using a free vascularized fibular head graft after the intralesional excision of a Campanacci grade 3 giant cell tumor of bone with invasion of the articular surface of the distal radius. In patients with this type of a lesion, wrist reconstruction using a free vascularized fibular head graft after intralesional excision can help prevent local tumor recurrence, restore the articular surface, and maintain movements of the wrist joint.
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http://dx.doi.org/10.1016/j.jhsa.2021.09.036DOI Listing
December 2021

Extension Block Pinning versus percutaneous Fragment Reduction with a Towel Clip and extension Block Pinning with direct Pin Fixation for Treatment of Mallet Fracture.

Handchir Mikrochir Plast Chir 2021 Sep 28;53(5):447-453. Epub 2021 Sep 28.

Kyung Hee University Hospital at Gangdong, Orthopaedic Surgery.

Purpose: This study compared the clinical and radiographic results between extension block pinning (Group A) and percutaneous reduction of the dorsal fragment with a towel clip followed by extension block pinning with direct pin fixation (Group B) for the treatment of mallet fractures.

Patients And Methods: A total of 69 patients (group A = 34 patients, group B = 35 patients) who underwent operative treatment for mallet fractures from June 2008 to November 2017 with ≥ 6 months post-surgical follow-up were analysed retrospectively. The extent of subluxation of the distal interphalangeal joint, articular involvement of fracture fragment, fracture gap, and articular step-off were examined on plain radiographs before and after surgery. The functional outcomes were evaluated with the Crawford rating system.

Results: The postoperative step-offs were 0.16 mm in group A and 0.01 mm in group B. Group B had a significantly better anatomical outcome than group A. Five patients in group A had a loss of reduction. Among them, two had malunion and post-traumatic arthritis. Meanwhile, no patients in group B presented with loss of reduction and nonunion. The mean extension lags were 4.2° in group A and 1.6° in group B. However, functional outcome did not differ between the two groups at the final follow-up.

Conclusion: Fracture reduction using a towel clip and extension block pinning with direct pin insertion for mallet fracture facilitated the anatomical reduction of fragments, and allowed for stable fixation of fragments. Compared with extension block pinning technique, this technique has shown better anatomical results and stability, but not better clinical results.
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http://dx.doi.org/10.1055/a-1554-5058DOI Listing
September 2021

Factors Affecting the Occurrence of Late Median Nerve Neuropathy After Open Reduction and Volar Locking Plate Fixation of Distal Radius Fracture.

Orthopedics 2021 May-Jun;44(3):e367-e372. Epub 2021 May 1.

It is well-known that late median nerve neuropathy can occur after open reduction and internal fixation (ORIF) of distal radius fracture (DRF). The current study investigated the predictive factors of late median nerve neuropathy after ORIF with a volar locking plate for DRF. The authors retrospectively reviewed 712 patients who underwent ORIF using a volar locking plate after DRF at 3 medical institutions between 2006 and 2017. Thirty-seven (5.2%) patients developed late median nerve neuropathy at a mean of 8.25±3.47 months (range, 3-19 months) after surgery. The radiographic data of 37 patients (group A) who had late median nerve neuropathy were compared with those of 148 patients (group B) who did not. Group A had a significantly higher proportion of type C3 fracture and Soong grade 2 than group B. Postoperative dorsal tilt in group A was greater than that in group B. On multivariable logistic regression analysis, the following predictive factors were associated with late median nerve neuropathy: increased postoperative dorsal tilt and Soong grade 2. The development of late median nerve neuropathy after ORIF using a volar locking plate for DRF was associated with increased postoperative dorsal tilt and the plate being placed distal to the volar rim. Physicians should consider the possibility of late median nerve neuropathy in patients with these factors during follow-up. [. 2021;44(3):e367-e372.].
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http://dx.doi.org/10.3928/01477447-20210414-08DOI Listing
July 2021

Complications associated with volar locking plate fixation for distal radius fractures in 1955 cases: A multicentre retrospective study.

Int Orthop 2020 10 26;44(10):2057-2067. Epub 2020 Jun 26.

Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, 351 Yatap-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea.

Purpose: Since volar locking plates (VLPs) have the benefits of more stable fixation and fewer complications, VLP osteosynthesis is now the preferred osteosynthesis method in the operative management of distal radius fractures (DRF). Along with the increases in operative management of VLP, the character and frequency of complications have changed. Thus, this multicentre study aimed to identify the characteristics of patients with DRFs who were treated with VLP fixation, describe the complication types and rates related to the procedure, and compare the results with those found in the literature.

Material And Methods: This retrospective multicentre study was conducted between January 2008 and December 2017. In total, data from 2225 patients over 17 years old who underwent VLP fixation for DRF were screened. Patients with closed reduction and pinning, external fixation, dorsal plate fixation, and screw-only fixation were excluded. Finally, 1955 wrists from 1921 patients (86.3%) were included. The following types of complications were investigated: (1) tendon injury, (2) nerve-related, (3) fixation- and instrument-related, (4) osteosynthesis-related, (5) infection, and (6) others.

Results: The mean age of the patients was 60.3 ± 14.6 years with 587 males (30.6%). Distal ulnar fractures were found in 940 wrists (48.1%). The mean interval between fracture and surgery was 6.2 days, while the mean operative time was 68.3 ± 30.3 minutes. The following complications were found: (1) nine (0.46%) and 12 (0.61%) cases of flexor pollicis longus and complete extensor pollicis longus tears, respectively; (2) nine cases (0.46%) of palmar sensory median nerve branch damage, 15 cases (0.77%) of complex regional pain syndrome, and 36 cases (1.84%) of carpal tunnel syndrome; (3) five cases (0.26%) of fracture displacement even after plate fixation, six cases (0.31%) of screw breakage, 26 cases (1.33%) of radiocarpal joint screw penetration, and 511 cases (26.14%) of implant removal; (4) five cases (0.26%) of delayed union and three cases (0.15%) of non-union; (5) 83 (4.25%) and two (0.1%) cases of superficial and deep infection, respectively; and (6) two cases (0.1%) of compartment syndrome and three cases (0.15%) of radial artery damage.

Conclusions: After 10 years of experience performing VLP fixation for DRFs in a multicentre setting, the results regarding complication types and rates support its use as a reasonable treatment option with low rates of complication.
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http://dx.doi.org/10.1007/s00264-020-04673-zDOI Listing
October 2020

Evaluation of Stress Radiographs Taken Before and After Spinal Anesthesia in Patients With Chronic Ankle Instability.

J Foot Ankle Surg 2020 Jan - Feb;59(1):53-58

Surgeon, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee Univeristy, Seoul, Korea. Electronic address:

Stress radiography is known as an important diagnostic tool for confirming mechanical instability in patients with chronic ankle instability. However, there are no reports on how muscle guarding caused by the stress applied on the ankle during stress radiography affects test outcomes. Thus, this study aimed to analyze the effects of muscle guarding caused by stress radiography on outcomes by performing stress radiography before and after anesthesia. This is a prospective study involving 32 patients who were diagnosed with chronic ankle instability through patient history, physical examination, and magnetic resonance imaging studies. Varus and anterior drawer stress radiographs were taken before and after anesthesia in the operating room, and the findings were compared. On the post-anesthesia stress radiographs of the affected ankle, talar tilt and talar anterior translation were significantly increased by 2.55° ± 2.64° and 1.54 ± 2.03 mm, respectively (mean ± standard deviation; p < .05). These parameters were also significantly increased by 2.08° ± 2.62° and 1.27 ± 1.37 mm, p < .05, on the post-anesthesia radiographs of the unaffected ankle. Before anesthesia, 26 of 32 patients had positive stress radiographs, but 31 patients had positive results after anesthesia. Talar tilt and talar anterior translation significantly increased after anesthesia. Therefore, in CAI patients, efforts to reduce muscle guarding should be made before stress radiographs are taken. Moreover, when interpreting results, it should be noted that muscle guarding might have reduced the measurements of stress radiographs, leading to diagnostic false negatives.
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http://dx.doi.org/10.1053/j.jfas.2019.01.020DOI Listing
July 2020

Comparison between simple release and Z-plasty of retinaculum for de Quervain's disease: a retrospective study.

J Hand Surg Eur Vol 2019 May 22;44(4):390-393. Epub 2019 Jan 22.

Orthopedic Surgery, School of Medicine, Kyung Hee University, Seoul Korea.

We compared two surgical procedures for de Quervain's disease that was not responsive to conservative treatment. Group A (simple release) consisted of 38 patients and group B (Z-plasty of the retinaculum) included 36 patients. The visual analogue scale score and the Disabilities of the Arm, Shoulder and Hand Score improved significantly after surgery; there were no statistical differences in outcome between the two groups. In group A, one patient required reoperation, two had subluxations of extensor tendons and two had temporary loss of sensation in the area of the radial nerve. In group B, two patients had temporary loss of sensation. The mean time to resolution of pain at the operative site was significantly shorter in group B. Both simple release and Z-plasty were effective surgical methods. Z-plasty allowed earlier return to activities of daily living but there was no statistical difference between the two groups in incidence of complication. Level of evidence: IV.
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http://dx.doi.org/10.1177/1753193418818341DOI Listing
May 2019

Onlay vascularized fibular grafting as a salvage procedure for the management of nonunion after reconstruction of the femur following tumor resection.

J Orthop Surg (Hong Kong) 2018 May-Aug;26(3):2309499018802490

Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea.

Purpose: The femur is prone to nonunion after biologic reconstruction following tumor resection, due to high bending forces. Nonunion at the host-graft junction is difficult to treat since the graft is in an avascular state. We aimed to investigate the clinical and radiographic results of an onlay free vascularized fibular grafting (VFG) as a salvage procedure for nonunion management after biologic reconstruction of the femur following bone tumor resection.

Methods: We retrospectively reviewed 10 patients (8 men and 2 women, median age: 15.5 years, range: 10-47) who underwent an onlay VFG for nonunion after intercalary reconstruction of the femur using an allograft ( n = 7) or pasteurized autograft ( n = 3), following tumor resection. The median follow-up period after VFG was 85.7 (24.6-163.5) months.

Results: The median time to union between the host bone and the VFG osteotomy sites was 3.5 (2.8-4.5) months. The median time to union at the host-graft junctions was 10.6 (6.6-12.7) months. Two postoperative complications requiring revision surgery occurred in two patients: one graft fracture and one deep infection with synchronous graft fracture. Internal fixation was required in the patient with graft fracture. The patient with the infection and synchronous graft fracture was treated using debridement, antibiotics, and an external fixator. The median Musculoskeletal Tumor Society functional score was 88% (60-97%) at the final follow-up.

Conclusion: Onlay VFG as a salvage procedure for nonunion of a biologic intercalary reconstruction of the femur after tumor resection is a useful treatment option.
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http://dx.doi.org/10.1177/2309499018802490DOI Listing
October 2019

Management of calcific myonecrosis with a sinus tract: A case report.

Medicine (Baltimore) 2018 Sep;97(38):e12517

Department of Orthopaedic Surgery, Kyung Hee University Hospital, College of medicine, Kyung Hee University, Seoul, Korea.

Rationale: Calcific myonecrosis is a very rare late sequela that occurs in patients who have had trauma accompanied by vascular compromise, in which a single muscle or entire muscles in a compartment undergoes necrosis and form a calcified mass. It is mostly a benign entity, but some cases cause bone destruction and form non-healing chronic sinuses. In such cases, wound management becomes difficult and there is a potential risk of secondary infection.

Patient Concerns: A 60-year-old male was referred for evaluation of a pain, erythematous changes, and draining sinus of the anterolateral aspect of his left leg. He had an open reduction and internal fixation as well as a stent insertion in the femoral artery owing to a distal femur fracture and femoral artery rupture.

Diagnoses: A thick fluid with a chalk-like material was discharged through the shiny skin via the sinus. The radiographs of the left leg showed a large, fusiform-shaped, radiopaque soft tissue mass in the space between the tibia and fibula. We performed an incisional biopsy to differentiated soft tissue sarcoma and malignant cells were found. Pathologic evaluation revealed acute and chronic inflammation with dystrophic calcification. These findings led to the diagnosis of calcific myonecrosis.

Interventions: We performed an extensive debridement of the anterior and deep posterior compartments to ensure definitive treatment. Upon performing extensive debridement, we inserted a drain tube and performed primary closure.

Outcomes: The fluid continued to be discharged through the drain even after the surgery; delayed wound healing occurred 4 weeks following the surgery, and there was no recurrence at follow-up conducted 2 years later.

Lessons: Calcific myonecrosis is mostly a benign entity, but some cases of calcific myonecrosis cause bone destruction and form non-healing chronic sinuses. In such cases, surgical treatment is required, during which the necrotic tissue and calcific material must be extensively debrided and drained.
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http://dx.doi.org/10.1097/MD.0000000000012517DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6160044PMC
September 2018

Assessment of Ankle Mortise Instability After Isolated Supination-External Rotation Lateral Malleolar Fractures.

J Bone Joint Surg Am 2018 Sep;100(18):1557-1562

Departments of Orthopaedic Surgery (B.O.J., T.Y.K., J.H.B., and S.H.S.) and Radiology (J.S.P.), College of Medicine, Kyung Hee University, Seoul, South Korea.

Background: The diagnosis of clinically important instability following isolated supination-external rotation (SER) distal fibular fractures is a challenge. The purpose of this study was to investigate the accuracy of clinical findings including medial tenderness, swelling, and ecchymosis, combined with the gravity stress test and magnetic resonance imaging (MRI), in the assessment of ankle mortise stability in association with isolated SER-type lateral malleolar fractures. The external rotation (ER) stress test was used as the reference with which the methods of assessment were compared.

Methods: Thirty-seven patients were enrolled prospectively. Using the ER stress test as a reference, we evaluated the sensitivity, specificity, likelihood ratio (LR), and post-test probability of instability when using clinical examination, the gravity stress test, and MRI for diagnosing ankle mortise instability after an isolated SER lateral malleolar fracture.

Results: The positive LR for clinical findings ranged from 1.45 to 2.54, and the negative LR ranged from 0.25 to 0.70, shifting the pre-test probability to a rarely important degree. In contrast, the positive LR for the gravity stress test was 5.71 with a 95% confidence interval (CI) of 1.52 to 21.48, a moderate shift from the pre-test probability, and the negative LR was 0.33 (95% CI = 0.16 to 0.66), indicating a small shift. In cases with a deep deltoid ligament disruption identified on MRI, the positive LR was 3.05 (95% CI = 1.03 to 9.02) and the negative LR was 0.53 (95% CI = 0.31 to 0.91), demonstrating a small but sometimes important shift.

Conclusions: The gravity stress test is a reliable method for diagnosing ankle mortise instability in patients with an isolated SER lateral malleolar fracture. Nevertheless, this test alone would not qualify as a replacement for the ER stress test. However, when the gravity stress test result is consistent with the clinical or MRI findings, its diagnostic value is almost equivalent to that of the ER stress test.

Level Of Evidence: Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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http://dx.doi.org/10.2106/JBJS.17.00993DOI Listing
September 2018

Analysis of the Changes in the Clinical Outcomes According to Time After Arthroscopic Microfracture of Osteochondral Lesions of the Talus.

Foot Ankle Int 2019 Jan 29;40(1):74-79. Epub 2018 Aug 29.

1 Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University Seoul, Korea.

Background:: Arthroscopic microfracture can effectively treat osteochondral lesions of the talus (OLTs). However, very few studies have reported on symptomatic improvement duration and time when symptomatic improvement ceases. This study aimed to investigate the clinical outcome changes after arthroscopic microfracture in patients with OLT.

Methods:: Among patients who underwent arthroscopic microfracture for OLT, 70 patients were available for follow-up for more than 3 years. Of these, 6 patients who showed worsening or no improvement in the 6 months after surgery were excluded, and a total of 64 patients were included in the analysis. To analyze and compare the clinical outcome changes according to time, the visual analog scale (VAS) and American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scores were evaluated every 3 months up to 1 year postoperatively and every 1 year thereafter. The clinical outcome differences based on the lesion size, lesion location, lesion containment, presence of cyst and bone marrow edema, age, sex, and obesity were analyzed.

Results:: The preoperative and final follow-up VAS scores significantly improved from 6.2 ± 1.1 to 1.2 ± 1.1 ( P< .05) and the AOFAS score from 63.1 ± 7.3 to 91.0 ± 7.3 ( P< .05). The overall success rate for arthroscopic microfracture in this study was 88.6%. The postoperative VAS and AOFAS scores at 3, 6, 9, 12, 24, and 36 months were 3.7 ± 1.4, 2.5 ± 1.3, 2.0 ± 1.1, 1.6 ± 1.2, 1.2 ± 1.2, and 1.3 ± 1.2 and 74.7 ± 10.3, 80.5 ± 8.9, 84.3 ± 7.4, 88.3 ± 7.3, 91.1 ± 7.2, and 90.8 ± 7.5, respectively, showing significant improvements up to 2 years. After 2 years, the symptoms did not improve but were maintained at a certain level up to 3 years. No clinical outcome differences based on the lesion size, lesion containment, presence of cyst and bone marrow edema, age, sex, and obesity were observed.

Conclusion:: Symptomatic improvement early after arthroscopic microfracture for OLT was observed continuously for up to 2 years postoperatively. Symptom improvement was maintained without worsening for up to 3 years after surgery. Determining the final outcome of microfracture at least after 2 years would be reasonable.

Level Of Evidence:: Level IV, case series.
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http://dx.doi.org/10.1177/1071100718794944DOI Listing
January 2019

Factors Causing Prolonged Postoperative Symptoms Despite Absence of Complications After A1 Pulley Release for Trigger Finger.

J Hand Surg Am 2019 Apr 25;44(4):338.e1-338.e6. Epub 2018 Jul 25.

Department of Orthopedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea. Electronic address:

Purpose: This study aimed to investigate the incidence and prognostic factors for prolonged postoperative symptoms after open A1 pulley release in patients with trigger finger, despite absence of any complications.

Methods: We reviewed 109 patients (78 single-finger involvement, 31 multiple-finger involvement) who underwent open A1 pulley release for trigger finger from 2010 to 2016, with 8 weeks or longer postsurgical follow-up and without postoperative complications. The group had 16 men and 93 women, with mean age of 56 years (range, 21-81 years), and average follow-up period of 24.8 weeks (range, 8.0-127.4 weeks). Prolonged postoperative symptoms were defined as symptoms persisting for longer than 8 weeks after surgery. Factors analyzed for delay in recovery included duration of preoperative symptoms; number of preoperative local corticosteroid injections; preoperative flexion contracture of proximal interphalangeal (PIP) joint; multiplicity of trigger finger lesions; occupation; presence of type 2 diabetes mellitus, other hand disorders like carpal tunnel syndrome, de Quervain disease, or Dupuytren contracture; and fraying or partial tear of the flexor tendon.

Results: Twenty-six fingers (19.3%) showed prolonged postoperative symptoms, with mean time until complete relief being 14.0 ± 6.4 weeks (range, 9-34 weeks). Risk factors associated with prolonged postoperative symptoms included duration of preoperative symptoms, preoperative flexion contracture of the PIP joint, and fraying or partial tear of the flexor tendon.

Conclusions: Physicians should consider the duration of preoperative symptoms and preoperative flexion contracture of the PIP joint when deciding timing of surgery for trigger finger patients. In addition, they should explain to patients with a positive history of these factors and in whom flexor tendon injury is found during surgery about the possibility of prolonged postoperative symptoms.

Type Of Study/level Of Evidence: Prognostic IV.
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http://dx.doi.org/10.1016/j.jhsa.2018.06.023DOI Listing
April 2019

Factors affecting surgical outcomes of digital glomus tumour: a multicentre study.

J Hand Surg Eur Vol 2018 Jul 12;43(6):652-658. Epub 2018 May 12.

5 Department of Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea.

This was a retrospective, multicentre study using data from four medical institutions of 72 patients of histologically confirmed digital glomus tumour removed by surgical excision. Mean follow-up period was 5.4 years. We investigated clinical outcomes and analysed the relationship between primary glomus tumour size, radiographic bony erosion, anatomic location, surgical approach, and surgical method as risk factors for recurrence. Complications and recurrence rate according to surgical approach and surgical method were compared. At final follow-up, recurrence was observed in five (6.9%) patients. Postoperative complications were observed in nine (12.5%), with two patients having numbness of fingertips, and seven having nail deformities. In a group with pulp lesions for which a direct approach was used and in a surgical loupe group, recurrence rates were high, however, this was not statistically significant. A nail-sparing approach and microscopic excision did not lower the incidence of nail deformities. No risk factors that significantly predicted recurrence were found.

Level Of Evidence: IV.
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http://dx.doi.org/10.1177/1753193418774176DOI Listing
July 2018

Ankle Arthritis Combined With Chronic Instability of the Syndesmosis After Ankle Fracture With Syndesmotic Injury: A Case Report.

J Foot Ankle Surg 2018 Sep - Oct;57(5):1000-1004. Epub 2018 Mar 28.

Orthopaedic Doctor, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea.

Syndesmotic injuries associated with ankle fractures are commonly treated with reduction and fixation using a transfixing screw. On rare occasions, however, progression to chronic instability of the syndesmosis is observed. Several surgical techniques have been applied in such cases but usually without a report on the results. We report a case of chronic syndesmotic instability and ankle joint osteoarthritis after ankle fracture-dislocation in a 21-year-old male patient who underwent distal tibiofibular arthrodesis. During the relatively long 4-year, 1-month follow-up period, the pain and activity improved from the patient's preoperative condition. Radiographs demonstrated cessation of arthritic changes in the ankle that had initially displayed joint space narrowing. Our findings suggest distal tibiofibular arthrodesis as an option to consider for the treatment of young and active patients with arthritic changes in the ankle joint with concomitant chronic instability of the syndesmosis.
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http://dx.doi.org/10.1053/j.jfas.2017.11.038DOI Listing
January 2019

Following the correction of varus deformity of the knee through total knee arthroplasty, significant compensatory changes occur not only at the ankle and subtalar joint, but also at the foot.

Knee Surg Sports Traumatol Arthrosc 2018 Nov 18;26(11):3230-3237. Epub 2018 Jan 18.

Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, 23 Kyunghee-daero, Dongdaemun-gu, Seoul, 02447, South Korea.

Purpose: This study aimed to assess radiological changes of the ankle joint, subtalar joint and foot following the correction of varus deformity of the knee with total knee arthroplasty (TKA). It was hypothesized that following the correction of varus deformity by TKA, compensatory reactions would occur at the subtalar joint in accordance with the extent of the correction.

Methods: For this prospective study, 375 knees of patients who underwent TKA between 2011 and 2012 were enrolled. The varus angle of the knee, talar tilt of the ankle joint (TT), ground-talar dome angle of the foot (GD), anterior surface angle of the distal tibia and lateral surface angle of the distal tibia, heel alignment ratio (HR), heel alignment angle (HA), and heel alignment distance (HD) were measured on radiographs obtained pre-operatively and at post-operative 6 months.

Results: The mean correction angle in varus deformity of the knee was 10.8 ± 4.1°. TT and GD changed significantly from 0.4 ± 1.9° and 6.5 ± 3.1° pre-operatively to 0.1 ± 1.8° and 0.2 ± 2.1°, respectively (p = 0.007, p < 0.001). No correlation was found between the preop-postop variance in mechanical axis of the lower extremity (MA) and TT, but there was a strong correlation between the preop-postop variance in MA and GD (r = 0.701). HR, HA and HD also changed significantly post-operatively, and the preop-postop variance in MA showed correlations with the preop-postop variances in HR, HA and HD (r = 0.206, - 0.348, and - 0.418). TT and the three indicators of hindfoot alignment all shifted to varus whereas GD was oriented in valgus.

Conclusion: Following the correction of varus deformity of the knee through TKA, significant compensatory changes occurred not only at the ankle and subtalar joints, but also at the foot. The findings of this study are useful in predicting the orientation of changes in the ankle and subtalar joints and the foot following TKA, and in determining the sequence of surgery when both the ankle and knee have a problem. In other words, changes in the parts of the lower extremity below the ankle joint following the correction of varus deformity of the knee must be considered when TKA is planned and performed. Patients who have problems at the ankle, subtalar, and foot joints in addition to varus deformity of the knee are recommended to undergo knee joint correction first.

Level Of Evidence: II.
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http://dx.doi.org/10.1007/s00167-018-4840-7DOI Listing
November 2018

Radiographic Change of the Distal Tibiofibular Joint Following Removal of Transfixing Screw Fixation.

Foot Ankle Int 2018 03 26;39(3):318-325. Epub 2017 Dec 26.

1 Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea.

Background: Syndesmosis disruptions in the ankle joint are typically treated with anatomic reduction followed by transfixing screw and/or suture button fixation. The purpose of our study was to analyze the effects of the removal of transfixing screws on syndesmosis integrity using plain radiographs and computed tomography (CT) scans.

Methods: Twenty-nine cases (29 patients) who had been treated with transfixing screw fixation for syndesmosis disruptions were studied prospectively. Plain radiographs and CT scans were obtained 1 day before and 3 months after the removal of transfixing screws. The tibiofibular clear space (TCS) and tibiofibular overlap (TFO) were measured on plain radiographs, and the anterior and posterior measurement ratio (A/P ratio) of the syndesmosis was measured on axial CT scans to radiographically analyze the effect of the removal of screws on syndesmosis integrity.

Results: On plain radiographs, syndesmosis diastasis was not observed before or after the removal of transfixing screws. No statistically significant difference was found in the TCS and the TFO between measurements at prescrew removal and at postscrew removal ( P = .761 and .628, respectively). However, the syndesmosis was found malreduced on CT scans in 7 cases (24.1%) before screw removal. All 7 cases showed anterior malreduction of the syndesmosis, 5 (71.4%) of which spontaneously reduced after screw removal. The A/P ratio of the 7 cases decreased from a mean of 1.37 (range, 1.26-1.61) at prescrew removal to a mean of 1.12 (range, 0.96-1.25) at postscrew removal ( P = .016).

Conclusion: Syndesmosis malreduction not observed on plain radiographs after performing transfixing screw fixation was identified with CT scans. Of the cases with a malreduced syndesmosis, 71.4% showed spontaneous reduction after screw removal. Therefore, we believe the removal of transfixing screws is recommended after confirming malreduction on CT scans, although plain radiographs demonstrate anatomic reduction.

Level Of Evidence: Level II, prospective prognostic study.
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http://dx.doi.org/10.1177/1071100717745526DOI Listing
March 2018

Interposition Tendon Graft and Tension in the Repair of Closed Rupture of the Flexor Digitorum Profundus in Zone III or IV.

Ann Plast Surg 2018 Mar;80(3):238-241

We report the results of interposition tendon grafts using the ipsilateral palmaris longus tendon in 12 patients with closed flexor digitorum profundus tendon ruptures in zone III or IV of 14 digits between June 2006 and October 2015. Before surgery, 2 patients were diagnosed with closed tendon ruptures that occurred after nonunion of hamate hook fractures. The other 10 patients were diagnosed with spontaneous tendon ruptures of unknown cause. In 2 of the 10 patients with spontaneous tendon rupture, the cause of the rupture was not found. In the other 8 patients, there was rough surface with deficient overlying soft tissue on the radial side of the hamate hook. In all cases, the ruptured flexor digitorum profundus was reconstructed by applying overtension on the tendon graft, causing greater flexion than for the other normal digits. Hamate hook excision was also performed on 10 subjects with abnormalities. Postoperatively, the patients were followed for an average of 22.5 months (range, 12-64 months). At the final follow-up, the mean Disabilities of the Arm, Shoulder, and Hand questionnaire score was 5.7 (range, 3.3-8.3). There were excellent results in all 14 digits according to Strickland and Glogovac criteria. The mean total active motion was 167 degrees (range, 160-180 degrees). There were no surgical complications, including infection, adhesions, or tendon rerupture. There were excellent clinical results with the interposition tendon graft using palmaris longus for closed tendon rupture in zone III or IV of the hand. Applying overtension to the grafted tendon appears to be beneficial.
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http://dx.doi.org/10.1097/SAP.0000000000001240DOI Listing
March 2018

Medialis pedis flap for reconstruction of weight bearing heel.

Microsurgery 2017 Oct 13;37(7):780-785. Epub 2017 Jul 13.

Department of Orthopedic Surgery, Kyung Hee University Hospital, School of Medicine, Kyung Hee University, Hoegi-dong, Dongdaemun-gu, Seoul, Korea.

Background: Among the various flaps available for the reconstruction of the heel, a medial plantar flap has been widely accepted as the most ideal. This flap, however, involves the medial plantar nerve and its cutaneous branches, which may lead to postoperative hyperesthesia and dual sensation. The purpose of this report was to report the outcomes of the use of the medialis pedis flap for the coverage of weight bearing heel soft tissue defect.

Patients And Methods: A total of 8 patients who had undergone reconstruction of the weight bearing heel with the medialis pedis flap were enrolled for this study. There were 6 male and 2 female patients and the mean age was 46 years. The causes of the defects included pressure sore, crushing injury and malignant melanoma. The mean size of the defects was 3 × 4 cm. Five cases were reconstructed with island flaps and 3 were covered with free flaps.

Results: The mean size of the flaps was 3×5 cm. All flaps survived. One case developed arterial insufficiency and was treated with a vein graft. Ambulation in normal shoes was possible in all the patients. Seven cases did not report pain, but 1 case complained of mild pain. No case reported complications including pain at the donor site, ulcerations, sensory loss, hyperesthesia, or sensory disturbance. The mean follow-up period was 14.4 months.

Conclusions: The medialis pedis flap may be considered a useful flap for the reconstruction of soft tissue defects smaller than 5 cm in the weight bearing heel.
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http://dx.doi.org/10.1002/micr.30198DOI Listing
October 2017

Effect of ligamentum teres tear on the development of joint instability and articular cartilage damage: an in vivo rabbit study.

Anat Sci Int 2018 Mar 15;93(2):262-268. Epub 2017 Jun 15.

Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, 23 Kyunghee-daero, Dongdaemun-gu, Seoul, 130-872, Korea.

The contribution of the ligamentum teres to the stabilization of the hip joint and the clinical influence of a compromised ligamentum teres are not well known. This study aimed to investigate joint stability and cartilage damage in a rabbit model by surgically inducing a complete ligamentum teres tear. Twenty adult New Zealand rabbits were used in this study. Rabbits were divided into complete ligamentum teres tear with capsulotomy (n = 9, group I) and capsulotomy only (n = 10, group II) groups. Unilateral surgery was performed on the left hip. Joint instability was assessed by measuring the preoperative and postoperative acetabulofemoral (A-F) distances. Rabbits were euthanized to assess cartilage damage at 24 weeks postoperatively. The median postoperative A-F distance of the operated side in group I [0.68 cm (0.37-1.04 cm)] was larger than that in group II [0.50 cm (0.30-0.65 cm)] (p = 0.041). The median postoperative A-F distance was larger in the operated side [0.68 cm (0.37-1.04 cm)] compared to the nonoperated side [0.45 cm (0.30-0.75 cm)] in group I; it also was larger in the operated side [0.50 cm (0.30-0.65 cm)] compared to the nonoperated side [0.44 cm (0.32-0.67 cm)] in group II, but only group I showed a significant difference (p = 0.016 and 0.395, respectively). Articular cartilage damage was detected at the apex of the femoral head in two rabbits (22.2%) in group I only. Rabbits with a complete ligamentum teres tear showed significant instability at the hip joint and articular cartilage damage in our rabbit model, supporting the potential clinical importance of ligamentum teres as a hip joint stabilizer.
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http://dx.doi.org/10.1007/s12565-017-0406-xDOI Listing
March 2018

Z-plasty of the flexor hallucis longus tendon at tarsal tunnel for checkrein deformity.

J Orthop Surg (Hong Kong) 2016 12;24(3):354-357

Departments of Orthopedic Surgery, Kyung Hee University Hospital, School of Medicine, Kyung Hee University, Korea.

Purposes: To review the outcome of Z-plasty of the flexor hallucis longus (FHL) tendon at the tarsal tunnel for checkrein deformity in 8 patients.

Methods: Records of 6 males and 2 females aged 14 to 67 (mean, 39.5) years who underwent Z-plasty (lengthening) of the FHL tendon at the tarsal tunnel for checkrein deformity in the first and second toes by a single surgeon were reviewed. All patients had undergone 3 months of conservative treatment. The mean time from injury to surgical treatment was 8.4 (range, 5-12) months. All patients had associated injuries including distal tibiofibular fracture (n=6), distal fibular fracture (n=1), and crush injury aroundthe ankle (n=1); they were treated with intramedullary nailing (n=6), long leg splinting (n=1), and short leg splinting (n=1).

Results: After a mean follow-up of 3.4 (range, 1-7) years, the FHL tendon was lengthened by a mean of 1.7 (range, 1.6-1.8) cm, and the mean American Orthopedic Foot and Ankle Society hallux score increased from 59 (range, 52-67) to 89 (range, 80-90). No patient had recurrence, nerve injury, or tarsal tunnel syndrome, although one patient had sensory disturbance of the posterior tibial nerve in the forefoot, which resolved spontaneously at week 2.

Conclusion: Z-plasty of the FHL tendon at the tarsal tunnel is a viable option for correction of checkrein deformity.
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http://dx.doi.org/10.1177/1602400316DOI Listing
December 2016

Distal femoral cortical hypertrophy after hip arthroplasty using a cementless doubletapered femoral stem.

J Orthop Surg (Hong Kong) 2016 12;24(3):317-322

Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea.

Purpose: To review 437 hips in 404 patients who underwent total hip arthroplasty (THA) or hemiarthroplasty using the Accolade TMZF stem to determine the incidence and risk factors of distal femoral cortical hypertrophy (DFCH).

Methods: Records of 437 hips in 169 men and 235 women aged 26 to 100 (mean, 65.7) years who underwent THA (n=293) or hemiarthroplasty (n=144) using the Accolade TMZF femoral stem by 2 senior surgeons and were followed up for a mean of 54.7 months were reviewed. Clinical outcome was assessed using the modified Harris Hip Score and visual analogue score for pain. Proximal femoral geometry and canal flare index were assessed on preoperative radiographs, and DFCH, stem position, subsidence, loosening, and stress shielding were assessed on postoperative radiographs according to the Gruen zone.

Results: Of 437 hips, 27 (6.2%) developed DFCH and 410 did not. Hips with DFCH had a higher incidence of thigh pain (18.5% vs. 2.2%, p<0.001) and earlier onset of thigh pain (12.3 vs. 20.8 months, p=0.015), compared with those without. Nonetheless, all femoral stems were well-fixed, and no osteolysis or loosening was detected. The 2 groups achieved comparable clinical outcome in terms of Harris Hip Score and pain. The mean canal flare index was higher in hips with than without DFCH (3.706 vs. 3.294, p=0.002). The mean vertical subsidence of the femoral stem was lower in hips with than without DFCH (1.5 vs. 3.4 mmp<0.001). Subsidence negatively correlated with the canal flare index (correlation coefficient= -0.110, p=0.022). The incidence of the DFCH increased with each unit of increment in canal flare index (odds ratio [OR]=1.828, p=0.043) and each year younger in age (OR=0.968, p=0.015).

Conclusion: The incidence of DFCH in hips withthe Accolade TMZF stem was 6.2%. Patients with a higher canal flare index and younger age had a higher incidence of DFCH. Nonetheless, DFCH did not affect clinical outcome or femoral stem stability.
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http://dx.doi.org/10.1177/1602400309DOI Listing
December 2016

Rotator Cuff Repair in Patients over 75 Years of Age: Clinical Outcome and Repair Integrity.

Clin Orthop Surg 2016 Dec 4;8(4):420-427. Epub 2016 Nov 4.

Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, Kyung Hee University School of Medicine, Seoul, Korea.

Background: Some studies have shown significant functional improvement after rotator cuff (RC) repair in elderly patients. However, few studies have reported the healing potential of RC tears in elderly patients.

Methods: Twenty-five patients aged ≥ 75 years who underwent RC repair were enrolled. The mean age at the time of surgery was 78.3 years (range, 75 to 88 years) while the mean follow-up was 36.3 months (range, 18 to 114 months). We evaluated clinical and structural outcomes after RC repair in the retear and healed groups.

Results: Of 25 patients, 16 (64%) had healed RC lesions and 9 (36%) had retorn cuff lesions. The retear rate increased significantly with increasing initial tear size (small to medium, 13%; large, 60%; massive, 80%; = 0.024) but not with increasing age ( = 0.072). The mean visual analog scale (VAS), University of California Los Angeles (UCLA), and Constant scores significantly improved from 5.2, 15.8, and 49.3 preoperatively to 1.4, 31.1, and 71.9 in the healed group and from 6.0, 14.4, and 39.5 preoperatively to 2.4, 28.3, and 63.6 in the retear group at the final follow-up ( < 0.05, respectively). There were no significant differences in clinical outcomes between the 2 groups at the final follow-up. Retear was significantly correlated with initial tear size ( = 0.001; odds ratio [OR], 2.771; 95% confidence interval [CI], 1.394 to 5.509 for large to massive tears) ( = 0.001; OR, 0.183; 95% CI, 0.048 to 0.692 for small to medium tears).

Conclusions: There were significant improvements in clinical outcomes after RC repair in patients ≥ 75 years. Structural integrity after cuff repair did not affect the final clinical outcome. Even in elderly patients aged ≥ 75 years, healing of repaired RC can be expected in cases of small to medium tears. Although the retear rate was relatively high for large to massive tears, clinical outcomes still showed significant improvement.
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http://dx.doi.org/10.4055/cios.2016.8.4.420DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5114255PMC
December 2016

A Reconstructive Stabilization Technique for Nontraumatic or Chronic Traumatic Extensor Tendon Subluxation.

J Hand Surg Am 2017 Jan 14;42(1):e61-e65. Epub 2016 Nov 14.

Department of Orthopedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea.

Subluxation of the extensor tendon results from a disruption to the sagittal band at the metacarpophalangeal joint. When conservative treatment fails to correct the subluxation, surgical treatment may be necessary. Surgical techniques for chronic cases vary in graft source and graft pathway. We present a surgical technique to recentralize and stabilize the extensor tendon using a residual ruptured sagittal band. This technique is simple and effective without donor site morbidity and seems to provide potential biomechanical advantages by restoring nearly normal anatomy.
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http://dx.doi.org/10.1016/j.jhsa.2016.10.008DOI Listing
January 2017

Computer-assisted navigation decreases the change in the tibial posterior slope angle after closed-wedge high tibial osteotomy.

Knee Surg Sports Traumatol Arthrosc 2016 Nov 11;24(11):3433-3440. Epub 2016 Feb 11.

Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, 23 Kyunghee-daero, Dongdaemun-gu, Seoul, 130-872, South Korea.

Purpose: The purpose of the present study was to compare the change in tibial posterior slope angle (PSA) between patients treated via computer-assisted and conventional closed-wedge high tibial osteotomy (CWHTO). It was hypothesized that a decrease in the PSA would be less in the computer-assisted group than in the conventional group.

Methods: Data on a total of 75 computer-assisted CWHTOs (60 patients) and 75 conventional CWHTOs (49 patients) were retrospectively compared using matched pair analysis. The pre- and postoperative mechanical axis (MA) and the PSA were radiographically evaluated. The parallel angle was defined as the angle between the joint line and the osteotomy surface. The data were compared between the two groups.

Results: The postoperative radiographic MA averaged 1.3° ± 2.6° valgus in the computer-assisted group and 0.3° ± 3.1° varus in the conventional group. The change in PSA averaged -0.8° ± 0.9° in the computer-assisted group and -4.0° ± 2.2° in the conventional group. The parallel angle averaged 0.2° ± 3.0° in the computer-assisted group and 6.2° ± 5.3° in the conventional group.

Conclusion: Computer-assisted CWHTO using four guide pins could avoid inadvertent change in the PSA. The navigation can be used in anticipation of decreasing the risk of change in the PSA in CWHTO, especially in patients whose preoperative PSA is small. The special attention should be paid to locate the hinge axis acutely and to make the parallel proximal and distal osteotomy surfaces during CWHTO.

Level Of Evidence: III.
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http://dx.doi.org/10.1007/s00167-016-4032-2DOI Listing
November 2016

Morphological Study of the Proximal Fibular Articular Surface Using Computed Tomography: Which Side Is Preferred for Proximal Fibular Flap in Wrist Arthroplasty?

J Reconstr Microsurg 2017 Feb 21;33(2):118-123. Epub 2016 Oct 21.

Department of Radiology, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, Republic of Korea.

 Although proximal fibular flaps have been widely applied in wrist arthroplasty, controversy remains regarding which side of the proximal fibula is better for reconstruction of the distal radius. If the articular surface of the proximal fibula shows dorsal tilting, the ipsilateral (right) proximal fibula should be harvested in right wrist arthroplasty because the articular surface of the distal radius normally has volar tilt. This study investigated anatomical similarities between the proximal fibular articular surface and the distal radius articular surface based on morphologic analysis of the proximal fibula using computed tomography (CT).  A total of 18 proximal fibulae from 18 adult volunteers were analyzed using CT. Tilt and length of the proximal fibular articular surface were measured in the section plane parallel to the proximal tibiofibular articular surface (simulated sagittal plane). The inclination angle of the articular surface was measured in the section plane perpendicular to the proximal tibiofibular articular surface (simulated coronal plane).  In the simulated sagittal plane, the articular surface of the proximal fibula showed a mean dorsal tilt of 4.1 degrees; the articular surface for each scan was 17.1 mm. In the simulated coronal plane, two articular surfaces were studied. The inclination angle of these surfaces was measured as 32.2 and 54.4 degrees, respectively.  CT analysis of the proximal fibular articular surfaces suggested that ipsilateral proximal fibular transfer can result in improved anatomic restoration of normal volar tilt of the distal radius due to dorsal tilt of the proximal fibular articular surface.
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http://dx.doi.org/10.1055/s-0036-1593745DOI Listing
February 2017

Comparison of patellofemoral outcomes after TKA using two prostheses with different patellofemoral design features.

Knee Surg Sports Traumatol Arthrosc 2017 Dec 10;25(12):3747-3754. Epub 2016 Aug 10.

Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, 23 Kyunghee-daero, Dongdaemun-gu, Seoul, 130-872, Korea.

Purpose: The purpose of the present study was to compare the clinical and radiographic results after TKA using two prostheses with different sagittal patellofemoral design features, including outcomes related to compatibility of the patellofemoral joint.

Methods: The clinical and radiographic results of 81 patients (100 knees) who underwent TKA using the specific prosthesis (group A) were compared with those in a control group who underwent TKA using the other prosthesis (group B). The presence of anterior knee joint pain, patellar crepitation, and patellar clunk syndrome was also checked.

Results: The function score and maximum flexion angle at the last follow-up were slightly better in group A than those in group B (92.0 ± 2.3 vs. 90.6 ± 4.2) (133.6° ± 8.4° vs. 129.6° ± 11.4°). Anterior knee pain was observed in 6 knees and patellar crepitation in four knees in group A. In group B, these symptoms were observed in 22 knees and 18 knees, respectively. There was no patellar clunk syndrome in either group. The alignment was corrected with satisfactory positioning of components. The patellar height remained unchanged after TKA in the two groups. The differences between preoperative and postoperative patellar tilt angle and patellar translation were small.

Conclusion: When comparing the clinical and radiographic results after TKA using two prostheses with different sagittal patellofemoral design features, TKA using the specific prosthesis provided satisfactory results with less clinical symptoms related to the patellofemoral kinematics with TKA using the other prosthesis.

Level Of Evidence: III.
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http://dx.doi.org/10.1007/s00167-016-4264-1DOI Listing
December 2017
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