Publications by authors named "Jun-Ku Lee"

28 Publications

  • Page 1 of 1

Anatomic Repair of the Central Slip with Anchor Suture Augmentation for Treatment of Established Boutonniere Deformity.

Clin Orthop Surg 2021 Jun 9;13(2):243-251. Epub 2021 Mar 9.

Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea.

Backgroud: The rupture of the central slip of an extensor tendon of a finger causes a boutonniere (or buttonhole) deformity, characterized by pathologic flexion at the proximal interphalangeal (PIP) joint and hyperextension at the distal interphalangeal (DIP) joint. Currently, there are no standard treatment guidelines for this deformity. This study aimed to report clinical results of surgery to correct chronic boutonniere deformity.

Methods: This retrospective case series was conducted between January 2010 and December 2018 and only 13 patients with trauma-induced chronic deformity were included. After excision of elongated scar tissue, a direct anatomic end-to-end repair using a loop suture technique with supplemental suture anchor augmentation was conducted. Total active motion was assessed before and after surgery and self-satisfaction scores were collected from phone surveys.

Results: All patients presented with Burton stage I deformities defined as supple and passively correctable joints. The initial mean extension lag of the PIP joint (43.5°) was improved by an average of 21.9° at the final follow-up ( < 0.001). The mean hyperextension of the DIP joint averaged 19.2° and improved by 0.8° flexion contracture ( < 0.001). The average total active motion was 220.4° (range, 160°-260°). Based on the Souter's criteria, 69.2% (9/13) of the patients had good results. Only 1 patient reported fair outcome and 23.1% (3/13) reported poor outcome. The average Strickland formula score was 70 (range, 28.6-97.1). In total, 10 patients (77%) had excellent or good results. Of 10 patients contacted by phone, self-reported satisfaction score was very satisfied in 2, satisfied in 3, average in 3, poor in 1, and very poor in 1. Three patients reported a relapse of the deformity during range of motion exercises, 1 of whom underwent revision surgery. One patient complained of PIP joint flexion limitation, and 2 complained of DIP joint flexion limitation at final follow-up.

Conclusions: In chronic boutonniere deformity, central slip reconstruction with anchor suture augmentation can be an easily applicable surgical option, which offers fair to excellent outcome in 77% of the cases. The risk of residual extension lag and recurrence of deformity should be discussed prior to surgery.
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http://dx.doi.org/10.4055/cios20170DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8173229PMC
June 2021

Angiographic Findings of the Median Artery in Two Patients with Carpal Tunnel Syndrome.

J Hand Surg Asian Pac Vol 2021 Mar;26(1):96-99

Department of Orthopaedic Surgery, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea.

Carpal tunnel syndrome (CTS) is the most common type of entrapment neuropathy. The majority of CTS cases are idiopathic and affect females between 40 and 60 years old. Conversely, this report describes two female patients in their mid-30's diagnosed with CTS caused by a median artery in the carpal tunnel using ultrasonography. We visualized the median artery which emerged from the radial artery and common interosseous artery in the proximal forearm of each patient by magnetic resonance angiography (MRA) before surgery. After the vertical incision of the transverse carpal ligament, the anomalous vessel was encountered, which ran over the median nerve at the radial aspect, and a simple mini-open procedure was performed for carpal tunnel release. Postoperatively, the CTS symptoms were relieved in both patients. The purpose of this report is to describe the persistent median artery using MRA in two patients and to report on their postoperative mini-open carpal tunnel release outcomes.
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http://dx.doi.org/10.1142/S2424835521720024DOI Listing
March 2021

Prosthetic Replacement Has a Clinical Outcome Superior to That of Trapeziectomy With Ligament Reconstruction and Tendon Interposition: A Meta-Analysis.

Orthopedics 2021 Mar-Apr;44(2):e151-e157. Epub 2021 Jan 8.

A meta-analysis was performed to compare trapeziectomy with ligament reconstruction and tendon interposition (LRTI) vs prosthetic replacement for first carpometacarpal joint osteoarthritis. Seven prospective and retrospective comparison trials were retrieved. A total of 459 patients receiving trapeziectomy with LRTI and 374 patients receiving prosthesis replacement with a follow-up of 12 to 69 months were identified. There were no differences in visual analog scale scores or complications. However, the mean Disabilities of the Arm, Shoulder and Hand score was 3.73 points lower and the mean pinch power was 1.16 points higher in the prosthesis replacement group, and this was significant. Prosthetic replacement led to a superior clinical outcome compared with trapeziectomy with LRTI, with no difference in complications. [. 2021;44(2):e151-e157.].
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http://dx.doi.org/10.3928/01477447-20210104-06DOI Listing
January 2021

Differences in patient and injury characteristics between sports- and non-sports related distal radius fractures.

Orthop Traumatol Surg Res 2020 Dec 5;106(8):1605-1611. Epub 2020 Nov 5.

CHA Bundang Medical Centre, CHA University School of Medicine, Seongnam, Republic of Korea. Electronic address:

Introduction: The incidence of distal radius fractures (DRFs) is increasing as the number of people in recreational or sporting activities rises, due to a combination of increased leisure time and greater public awareness of the health-related benefits of sports. Despite the increases in sports-related distal radius fractures (SR-DRFs), there are limited studies regarding the characteristics of treatment and recovery.

Hypothesis: There are characteristics specific to SR-DRF treated with conservative or operative management.

Material And Methods: Retrospective review was carried out between January 2010 and December 2017. Overall, 1706 patients were included in the study analysis. Among them, 317 patients were injured during sports activity (18.6%) and 1389 were injured during non-sports activity (81.4%). Demographic data were compared between the two groups. The type of sports was investigated in SR-DRF. Also, we compared surgically treated DRF patients to describe differences in patient characteristics, fracture characteristics, and postoperative complications.

Results: The mean age of patients with SR-DRFs was significantly younger (28 vs. 52 years). The proportion of men was also significantly higher in SR-DRF group compared to NSR-DRF group (62.8 vs. 33.8%). We identified 27 kinds of sports associated with DRFs and the 5 sports topping the list associated were soccer (22.7%), cycling (17.7%), snowboarding (11.0%), ice-skating (9.1%), and mountain hiking (9.1%). There was no difference in terms of the treatment method. However, SR-DRF group had higher proportion of AO/OTA type A fracture (32.6 vs. 13.7%), and NSR-DRF group had higher proportion of type C fracture (79.5 vs. 64.2%). Postoperative complications showed no significant differences, except higher implant removal rate in SR-DRF.

Discussion: Patients with SR-DRF were significantly younger and had higher proportion of men. Proportion of AO/OTA type A was higher in SR-DRF group and proportion of AO/OTA type C was higher in NSR-DRF group. Proportion of surgical treatment was similar in two groups. Given the growing population participating in sports activity worldwide, SR-DRFs are predicted to increase and further study is required.

Level Of Evidence: III; retrospective, epidemiological study.
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http://dx.doi.org/10.1016/j.otsr.2020.06.021DOI Listing
December 2020

Carpal Tunnel Release Despite Normal Nerve Conduction Studies in Carpal Tunnel Syndrome Patients.

Ann Plast Surg 2021 01;86(1):52-57

Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam-si, Gyeonggi-do, South Korea.

Purpose: Carpal tunnel syndrome (CTS) is a common entrapment neuropathy, often requiring carpal tunnel release (CTR) surgery. Often, a nerve conduction study (NCS) is performed before CTR; however, there are various reports questioning the sensitivity of NCS, and some patients do undergo CTR despite normal NCS results. We had the following purposes: (1) to report clinical outcome of CTS patients who undergo CTR despite normal NCS, (2) to identify the characteristics and compare those with abnormal NCS patients in terms of basic features and risk factors, and (3) to analyze and compare normal and abnormal NCS results.

Materials And Methods: Medical records of 546 CTS (30 normal NCS and 516 abnormal NCS) patients were retrospectively reviewed. Of 30 normal NCS patients, 7 were excluded, leaving 23 patients in the experimental group. We investigated the influence of age, sex, operative arm, and body mass index, as well as medical conditions known to be risk factors for CTS. In normal NCS patients, as a functional score, we investigated Boston carpal tunnel scores before and after CTR. The NCS results were compared in terms of median motor and median sensory testing. In normal NCS patients, NCS data were compared with that of the contralateral nonoperated wrists.

Results: There were 18 women and 5 men in the normal NCS group (mean age 43.7 years). On physical examination, 22 (94.7%) patients showed a positive Tinel test, 19 (82.6%) showed a positive Phalen test, 8 (34.8%) complained of nocturnal paresthesia, and only 1 (4.3%) presented with thenar atrophy. In 19 of 23 patients, the Boston CTS scores showed significant improvement after CTR. Normal NCS patients were significantly younger and significantly heavier and more likely to be a current smoker. In NCS analysis of normal NCS patients, the operated wrists were closer to the reference values than nonoperated wrists.

Conclusions: Surgeons should evaluate the possibility of other combined lesions before CTR in normal NCS patients. Normal NCS can be present with a CTS diagnosis, especially in younger patients. Nevertheless, CTR after failed conservative management, despite normal NCS, could relieve subjective symptoms and function.
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http://dx.doi.org/10.1097/SAP.0000000000002570DOI Listing
January 2021

Volar locking plate removal after distal radius fracture: a 10-year retrospective study.

Arch Orthop Trauma Surg 2020 Oct 29. Epub 2020 Oct 29.

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.

Introduction: Distal radius fracture (DRF) is the most common upper extremity fracture. After the introduction of volar locking plate (VLP) fixation, treatment has shifted from conservative management to more operative management. The implant removal rate after VLP fixation in patients with DRF varies and the reasons for removal and associated patient characteristics have not been clearly defined. This study aimed to compare the characteristics of patients who underwent VLP with and without subsequent implant removal. Second, the rate of implant removal according to the implant position and type was investigated. Finally, we summarized clinical outcome with implant removal, the reasons for, and complications associated with implant removal.

Methods: In this retrospective study, patient data were collected between January 1, 2008, and December 31, 2017. The study population was divided into two groups based on subsequent implant removal. Data on patient characteristics, such as age, sex, comorbidities, side of the fractured arm, the AO Foundation and Orthopaedic Trauma Association classification of the DRF, plate position grade based on the Soong classification type, type of inserted plate, insurance coverage, and treatment costs were collected. Furthermore, we investigated the reason for implant removal, clinical outcomes, and post-removal complications.

Results: After applying the exclusion criteria, 806 patients with a total of 814 DRFs were included in the study. Among the 806 patients who underwent VLP fixation for DRF, 252 (31.3%) patients underwent implant removal. Among the patients undergoing implant removal, the mean age was 50.8 ± 14.0 years, 94 (37.3%) were male. The average time to implant removal from the fracture fixation was 12.1 ± 9.2 months (range 1-170 months). When comparing groups, patients who underwent implant removal were significantly younger and had fewer cases of diabetes, hypertension, and cancer history. According to the Soong plate position grade, the most common position was G1 in both groups. Although there was no significant difference (p = 0.075), more G2 cases were found in the removal group (15.0%) than in the retention group (10.2%). About 66.5% of the patients with implant removal had other health insurance as well as the national service, compared with 47% of the patients with implant retention. In total, 186 patients (73.8%) underwent implant removal despite being asymptomatic after the bony union. The patient satisfaction scores improved from 4.1 to 4.4 after implant removal, and 93% of the patients answered that they would choose implant removal again. Only 10% of the patients who underwent removal reported minor complications. No major complications were reported.

Conclusion: Although the implant removal was conducted without clinical symptoms in the majority of patients, overall patients presented improved functional outcomes with implant removal. The evidence is inconclusive regarding its necessity, however, implant removal after VLP fixation for DRF is not a challenging procedure and is not associated with major complications.

Level Of Evidence: Level IV.
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http://dx.doi.org/10.1007/s00402-020-03637-7DOI Listing
October 2020

Muscle mass measurements in hip fracture patients and control general population depending on dual-energy X-ray absorptiometry device used: The General Electric Lunar and Hologic systems.

Osteoporos Sarcopenia 2020 Jun 23;6(2):88-93. Epub 2020 May 23.

Department of Orthopaedic Surgery, CHA Bundang Medical Center, School of Medicine, CHA University, Seongnam, South Korea.

Objectives: The prevalence of sarcopenia, an independent risk factor for fragility fractures, is high in geriatric hip fracture patients. We aim to compare patients with hip fractures to the general population using different dual-energy X-ray absorptiometry (DXA) devices - General Electric (GE) Lunar and Hologic.

Methods: We retrospectively reviewed data of patients diagnosed with osteoporotic hip fractures. At our institute, 252 patients with hip fractures were measured with the GE Lunar DXA. The control group included 252 matched individuals from a general population dataset whose data were measured with the Hologic DXA; controls were selected using nearest-neighbor propensity score matching. Measurements included appendicular lean mass (ALM), bone mineral density, and subsequent rates of sarcopenia and osteoporosis.

Results: The BMD T-score was significantly lower in patients with hip fractures than in matched controls (-2.7 vs. -2.1, respectively; P < 0.001). However, mean lean body mass of the arm was significantly greater in the hip fractures group compared to the matched control groups (4.092 kg vs. 3.869 kg, respectively; P = 0.024). Additionally, mean lean body mass of the leg was similar between groups (11.565 kg vs. 11.986 kg, respectively; P = 0.084). ALM/height and subsequent sarcopenia rates were not different between groups (hip fractures and 6.257 kg/m and 38.5%; matched controls, 6.198 kg/m and 33.7%).

Conclusions: Despite experiencing hip fractures, muscle mass measurements and sarcopenia prevalence were similar between the groups. Muscle mass measurements for evaluating sarcopenia present significant discrepancies according to the DXA used.
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http://dx.doi.org/10.1016/j.afos.2020.05.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7374243PMC
June 2020

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

Outcomes Following Open Reduction and Internal Fixation in Proximal Phalangeal Fracture with Rotational Malalignment.

J Hand Surg Asian Pac Vol 2020 Jun;25(2):219-225

Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea.

The rotational malalignment in proximal phalanx fracture is unacceptable. Authors attempted to describe clinical and radiographic outcomes as well as complications after open reduction and internal fixation with screw only or plate for phalangeal fractures accompanied by rotational malalignment. Authors conducted a retrospective review of 46 patients who had been treated between Jan. 2010 and Dec. 2016. The average follow-up period was 16.7 months. A total active motion (TAM), Disability of Arm, Shoulder and Hand score (DASH), and tip pinch power between thumb and fractured finger were measured at the final follow-up. Complications were investigated during the follow up. We assessed the amount of rotation by measuring angle between 3rd ray and fractured finger. The measurement was divided into two groups depending on rotation direction, divergent and convergent direction group. Twenty-eight cases were fixed with mini LCP plate, 12 cases with lag screws, and rest 6 cases with combined. All patients showed solid bony union on radiographs on average follow-up of 68 days (range, 41-157 days). Average TAM of the injured finger was 244 degrees and average DASH score was 4.9 at the last follow-up. Tip pinch power was 3.2 kg, which was not significantly different from that of the contralateral side at 3.4 kg ( = 0.21). The preexisting rotational angle was significantly adjusted (overall, 11.1°). Depending on rotation direction, preoperative 21.7° to postoperative 12.1° in 27 patients of convergent group and preoperative -5.0° to postoperative 8.3° in 19 patients of divergent group were achieved. The rotation from proximal phalanx fractures could be corrected with anatomic reduction by open reduction. Our results showed that open reduction and rigid internal fixation after physical examination for acute proximal phalanx fractures accompanied by rotational malalignment could achieve good clinical results.
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http://dx.doi.org/10.1142/S2424835520500265DOI Listing
June 2020

Paget's Disease of Bone Affecting Peripheral Limb: Difficulties in Diagnosis: A Case Report.

J Bone Metab 2020 Feb 29;27(1):71-75. Epub 2020 Feb 29.

Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea.

In terms of management of Paget's disease of bone (PDB), early diagnosis and proper management achieving remission is essential with lifelong specialist follow-up. We present the case of a 40-year-old woman with PDB affecting mainly the distal extremities (ankle and wrist). The patient visited our hospital in 2012 with heel pain. Plain radiography revealed osteoporosis, and a bone scan revealed hot uptake. Initial laboratory investigations showed normal serum calcium, 25-hydroxy-vitamin D, and parathyroid hormone levels; however, osteocalcin, C-terminal telopeptide of type I collagen, and bone alkaline phosphatase levels were elevated. A bone mineral density scan showed T- and Z-scores of -2.5 and -2.7, respectively, and bisphosphonate treatment was initiated. Biopsy performed on the calcaneal lateral wall revealed inconclusive findings. Follow-up biopsy on the left distal radius was performed 7 years later to investigate wrist pain, and this examination led to a final diagnosis as PDB. We suggest inconclusive biopsy result during the early phase of PDB and highly recommend follow-up evaluation in osteoporosis with atypical behavior.
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http://dx.doi.org/10.11005/jbm.2020.27.1.71DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7064361PMC
February 2020

Open Reduction and Internal Fixation for Dorsal Fracture-dislocation of the Proximal Interphalangeal Joint.

Handchir Mikrochir Plast Chir 2020 Feb 5;52(1):18-24. Epub 2020 Mar 5.

Bundang CHA Medical Center Department of Orthopaedic Surgery.

Purpose:  The purpose of this study was to investigate and compare the clinical and radiological results of ORIF with inter-fragment screw or buttress plate fixation of acute PIP joint fracture dorsal dislocation.

Patients And Methods:  Between January 2007 to December 2016, nineteen patients - 14 men and 5 women with an average age of 40.9 (19 to 64) years - were included in this study; 9 patients underwent small sized interfragmentary screw fixation and 10 patients underwent small buttress plating. The average follow-up period was 45.1 (13 to 78) months. Clinical assessment included measurement of range of motion (ROM) of the proximal and distal interphalangeal joint (PIP, DIP), grip and pinch strength, and pain with use of the Visual Analog Scale (VAS). At the postoperative X-ray, articular step off, gap, and degree of dorsal subluxation was measured, and maintenance of the reduction, fracture union, and the presence of degenerative changes were assessed.

Results:  All patients achieved solid unions without instability. The overall average range of motion of PIP joint were from 9° to 85° (10-83° in the screw group, 8-87° in the plate group without significant difference). However, the screw group (average: 53°) presented more flexion in the distal interphalangeal joint than the plate group (average: 34°). Plate fixation can cause limited DIP flexion. Six of the ten patients from the plate group, underwent implant removal and two of these patients required PIP joint arthrolysis due to the PIP flexion contracture of more than 30°. Three of the nine patients in screw group underwent implant removal and two of the three patients required PIP joint arthrolysis.

Conclusion:  Mini plate and screw fixation of acute PIP joint fracture dorsal dislocation can achieve comparable favorable clinical and radiographic outcomes through stable fixation and early range of motion exercise. Screw fixation, if possible, is probably preferable to plate fixation because of better DIP joint ROM and lower incidence of hardware removal. If there is a need for plate fixation the use of a short plate is recommended to avoid joint stiffness.
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http://dx.doi.org/10.1055/a-1075-2668DOI Listing
February 2020

Extensor pollicis longus tendon rupture caused by a displaced dorsal "beak" fragment of Lister's tubercle in distal radius fractures.

Handchir Mikrochir Plast Chir 2019 Jun 8;51(3):199-204. Epub 2019 May 8.

CHA Bundang Medical Center, Department of Orthopaedic Surgery.

Introduction: Ruptures of the extensor pollicis longus (EPL) tendon are a well-known complication of distal radius fractures (DRF). There are a lot of suspected mechanisms, including mechanical friction, vascular impairment, injury associated with reduction, and local adhesion. However, there have been limited reports about a closed rupture of the EPL tendon associated with a relatively large, displaced dorsal "beak" fracture fragment. We report about the management outcomes and clinical significance of closed ruptures of the EPL tendon caused by a displaced dorsal fracture fragment of beak-like appearance in DRF.

Patients/material And Methods: Our study included 7 cases of a complete closed rupture of the EPL tendon after open reduction internal fixation. All cases showed a similar pattern involving a relatively large dorsal beak fragment originating from Lister's tubercle, and we treated them with a palmar locking plate within 7 days from the initial fracture without separate dorsal fragment management. All patients were diagnosed with a delayed EPL tendon rupture.

Results: The study included 5 female and 2 male patients. Mean patient age was 59 years. In all cases we explored the extensor compartment III to verify the exact cause of the EPL rupture. Six patients underwent an extensor indicis transfer and one patient underwent tendon grafting.Mean fragment width and length were 7.0 mm and 13.3 mm, respectively. The fragments were dorsally elevated (mean, 2.4 mm) and distally displaced (mean, 3.5 mm). At the last follow-up, the mean DASH score was 4.4. Mean thumb MP joint flexion and extension were 4 degrees and 62 degrees, respectively.

Conclusion: We support the possibility of EPL tendon rupture caused by displaced sharp Lister's tubercle fracture fragments.
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http://dx.doi.org/10.1055/a-0826-4731DOI Listing
June 2019

Risk Factors of Carpal Tunnel Syndrome for Male Patient Undergoing Carpal Tunnel Release.

Handchir Mikrochir Plast Chir 2018 Sep 7;50(5):335-340. Epub 2018 Nov 7.

Bundang CHA Medical Center Department of Orthopedic surgery.

Introduction: Although the major cause of carpal tunnel syndrome (CTS) remains idiopathic, many male CTS patients are clinically different from female patients and often have specific risk factors associated with their conditions. An accurate analysis of such propensity has yet to be established. The purpose of this study is to compare male and female patients by analyzing the risk factors associated with CTS patients who underwent surgical treatment, with focus on their occupation.

Patients/material And Methods: retrospective chart review of 818 patients with CTS was performed to identify the associated risk factors. Patients were stratified by gender: female (n = 707, 86.4 %) and male (n = 111, 13.6 %). The mean patient age was 54.5 (range: 16-85 yr.) for all groups. The medical history and risk factors of each patient was thoroughly reviewed by medical charts and telephone survey. We categorized the risk factors of CTS into 7 categories: anatomic, neuropathic, inflammatory, alteration of fluid balance, distal radius fracture associated, occupational risk factor related, and idiopathic. Occupations of CTS patients were divided into high risk occupations (vibratory tools, assembly jobs, and food processing and packaging jobs, and other occupations of repetitive wrist motion and forceful gripping) and nonrisk occupations. All variables were analyzed with chi-square or Fisher's exact test for differences between men and women.

Results: The number of individuals with known risk factors of CTS was greater in male, compared to that of female patients; 97 (87.4 %) male patients had the risk factors of CTS, while 361 (51.1 %) female patients (p < 0.001) did. In subgroup analysis of risk factors, male patients had frequent risk factors in neuropathic, inflammatory, and alteration of fluid balance (p < 0.001). Occupational risk was strongly associated with male gender (p < 0.001).

Conclusion: Male CTS patients who underwent surgery are more likely to have a reason and have many occupational risk factors than women.
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http://dx.doi.org/10.1055/a-0747-5982DOI Listing
September 2018

Is Sarcopenia a Potential Risk Factor for Distal Radius Fracture? Analysis Using Propensity Score Matching.

J Bone Metab 2018 May 31;25(2):99-106. Epub 2018 May 31.

Department of Orthopaedic Surgery, Bundang CHA Medical Center, CHA University School of Medicine, Seongnam, Korea.

Background: Cases of low-energy-induced distal radius fracture (DRF) are increasing. Sarcopenia is considered to be an independent risk factor for fragility fractures. We compared body appendicular lean muscle mass (ALM) and bone mineral density (BMD) in patients with DRF and a comparable control population. This study aimed to investigate the correlation between skeletal muscle mass and DRF.

Methods: We performed a retrospective review of patients diagnosed with fragility DRF. The DRF group included 87 patients treated at our institute. The control group comprised data for 87 individuals in the general population from among 2,124 selected using nearest-neighbor propensity scoring, based on age, weight, height, and body mass index. All medical conditions and past history were also compared between the two groups.

Results: The relative overall ALM, combining arm and leg lean body mass divided by height squared, was not significantly different (DRF group, 6.093 kg/m; controls, 5.945 kg/m). T-score, a parameter of BMD, was significantly different between groups (DRF, -2.42; controls, -2.05). The proportion of patients with osteoporosis was significantly different (DRF, 44 [50.6%] vs. control, 29 [33.3%], respectively).

Conclusions: Patients with DRF did not have significantly lower average lean body mass. BMD was significantly lower in patients with DRF than in controls.
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http://dx.doi.org/10.11005/jbm.2018.25.2.99DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5995757PMC
May 2018

Juxta-articular Plate Fixation in Distal Radius Intra-articular Fractures with Accompanying Volar Free Fragments beyond the Watershed Line.

Clin Orthop Surg 2018 Jun 18;10(2):135-141. Epub 2018 May 18.

Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea.

Background: Although distal radius fractures (DRF) are common fractures, intra-articular comminuted DRF with volar free fragments are uncommon. There is considerable difficulty in the fixation of free fragments beyond the watershed line using the existing volar locking plate. We aimed to examine the efficacy and potential complications associated with the use of juxta-articular volar plates in intra-articular DRF accompanied by free fragments beyond the watershed line.

Methods: The patients were enrolled in a consecutive manner between 2007 and 2016. In cases of DRF with free fragments beyond the watershed line, we employed a 2.4-mm small fragment juxta-articular volar locking compression plate using a volar Henry approach. A total of 32 patients were included in this study. There were 15 males and 17 females with a mean age of 52.3 years (range, 33 to 69 years). The mean follow-up period was 14.5 months (range, 10 to 24 months). Preoperative radiographs and three-dimensional computed tomography images were used to analyze fracture patterns and assess the free fragments beyond the watershed line. The mean number of free fracture fragments beyond the watershed line was 2.33. Plain radiographs of immediate postoperative and last follow-up were used to confirm fracture union, incongruence, radial height, volar tilt, radial inclination, and arthritic changes. For functional assessment, we measured grip strength, range of motion (ROM), modified Mayo wrist score (MMWS) and determined Disabilities of Arm, Shoulder and Hand (DASH) scores at the last follow-up. Postoperative complications were monitored during the follow-up period.

Results: All patients obtained sound union without significant complications. At the last follow-up, 16 cases presented with an articular step-off of more than 1 mm (mean, 1.10 mm). The mean MMWS was 76.3 (range, 55 to 90), mean DASH score was 15.38 (range, 9 to 22), mean visual analogue scale score for pain was 1.2 and mean grip strength was 75.5% of the opposite side. The mean ROM was 74.3° for volar flexion and 71.5° for dorsiflexion.

Conclusions: In cases of intra-articular DRF with free fragments beyond the watershed line, a volar approach with use of a juxtaarticular plate provided favorable outcomes without significant complications.
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http://dx.doi.org/10.4055/cios.2018.10.2.135DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5964260PMC
June 2018

A case of severe gouty tophi-induced carpal tunnel syndrome: Operative finding and its outcome.

Handchir Mikrochir Plast Chir 2018 02 28;50(1):19-21. Epub 2018 Mar 28.

Gout is a disease featuring acute arthritis, joint deformity and severe pain caused through the deposition of monosodium urate crystals in and around synovial tissue 1. Tophi are stone-like deposits of monosodium urate in the soft tissues, synovial tissues, or bones adjacent to the joints. The tophi can compromise joint motion and deteriorate bony structure, finally leading to functional disability. Therefore, early treatment using uric acid lowering agents is standard practice in gout patients to prevent the formation of tophi through controlling uric acid levels.
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http://dx.doi.org/10.1055/a-0576-7299DOI Listing
February 2018

Prevalence and Associated Risk Factors of Sarcopenia in Female Patients with Osteoporotic Fracture.

J Bone Metab 2018 Feb 28;25(1):59-62. Epub 2018 Feb 28.

Department of Orthopaedic Surgery, Bundang CHA Medical Center, CHA University School of Medicine, Seongnam, Korea.

Background: We determined the prevalence of sarcopenia according to fracture site and evaluated the associated risk factors in female patients with osteoporotic fractures.

Methods: A total of 108 patients aged 50 years or older with an osteoporotic fracture (hip, spine, or wrist) were enrolled in this retrospective observational study. A diagnosis of sarcopenia was confirmed using whole-body densitometry for skeletal muscle mass measurement. Logistic regression analysis was used to analyze the risk factors for sarcopenia.

Results: Of 108 female patients treated for osteoporotic fractures between January 2016 and June 2017, sarcopenia was diagnosed in 39 (36.1%). Of these, 41.5% (17/41) had hip fractures, 35% (14/40) had spine fractures, and 29.6% (8/27) had distal radius fractures. Body mass index (BMI; =0.036) and prevalence of chronic kidney disease (CKD; =0.046) and rheumatoid arthritis (=0.051) were significantly different between the groups. In multivariable analysis, BMI (odds ratio [OR], 0.76; 95% confidence interval [CI], 0.55-1.05, =0.098) and CKD (OR 2.51; 95% CI, 0.38-16.2; =0.233) were associated with an increased risk of sarcopenia; however, this was not statistically significant.

Conclusions: This study evaluated the prevalence of sarcopenia according to the fracture site and identified associated risk factors in patients with osteoporotic fractures. A longterm, observational study with a larger population is needed to validate our results.
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http://dx.doi.org/10.11005/jbm.2018.25.1.59DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5854824PMC
February 2018

Comparison of Bone Mineral Density and Appendicular Lean Body Mass between Osteoporotic Distal Radius Fracture and Degenerative Rotator Cuff Tear in Women Patients.

J Bone Metab 2017 Nov 30;24(4):235-240. Epub 2017 Nov 30.

Department of Orthopaedic Surgery, Bundang CHA Medical Center, CHA University School of Medicine, Seongnam, Korea.

Background: Authors assessed lean body mass (fat free tissue), upper and lower, and bone mineral density (BMD) in patients of osteoporotic bone distal radius fracture (DRF) and degenerative rotator cuff tear (RCT) patients of shoulder. We predict inferior muscle mass and osteoporosis are more frequent in DRF group than RCT group.

Methods: Between January 2016 and June 2017, overall 38 of DRF and 30 of RCT were eligible for this retrospective comparison study after excluding of patients with compounding factors. BMD and other body composition, fat and lean body mass, were assessed with a single dual energy X-ray absorptiometry in one hospital.

Results: T-score of spine were -2.2 and -1.6 in DRF and RCT patients with significant difference (=0.040). Final BMD score, lower score of patient between spine and femoral score, of both group also presented difference with significance, -2.4 of DRF and -1.9 of RCT patients (=0.047). Diagnosis of osteoporosis was confirmed in 19 patients (50%) from DRF compared with 9 patients (30%) from RCT. The mean lean soft tissue mass of the arm was 3.7 kg and 3.8 kg in the DRF and RCT, respectively, without significant difference (=0.882). The mean lean body mass of the leg was 11.0 kg and 10.5 kg in the DRF and RCT, respectively, without significant difference (=0.189). The relative overall appendicular lean mass was not significantly different between groups.

Conclusions: Even though BMD difference, we did not find muscle mass difference between DRF and RCT patients.
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http://dx.doi.org/10.11005/jbm.2017.24.4.235DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5734949PMC
November 2017

Multiple glomus tumours in multidigit nail bed.

Handchir Mikrochir Plast Chir 2017 Oct 17;49(5):321-325. Epub 2017 Oct 17.

Bundang CHA Medical Center, Department of Orthopaedic Surgery.

Glomus tumours are lesions of the glomus body. A solitary glomus tumour is a more common, characteristically painful lesion, frequently located under the nail, whereas multiple glomus tumours are a rare clinical and genetic entity. Multiple glomus tumours are rarely subungual and do not show preference for any particular region of the body. We report a rare case of painful multidigit subungual glomus tumours in both hands.A 34-year-old male patient complained of painful fingertips (right: thumb, index finger, long finger, and ring finger; left: thumb, long finger, ring finger, small finger) on both hands for more than 5 years. Magnetic resonance imaging (MRI) detected multiple subungual glomus tumours in the fingertips (right long finger, ring finger, and left thumb, long, ring, and small finger) of both his hands, so the authors conducted tumour resection and sent biopsies for relevant fingers. We found the glomus tumour underneath the nail bed and achieved final diagnosis with histological confirmation. No remnant or newly developed lesion was detected at the 1 year outpatient clinic.Our case differed from the usual multiple glomus tumours because its characteristics were similar to those of a solitary glomus tumour, including the classic symptom triad: severe pain, localised pain, and cold hypersensitivity. In case report, we suggest the possibility that multidigit subungual glomus tumour is different from the common single subungual glomus tumour.
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http://dx.doi.org/10.1055/s-0043-115115DOI Listing
October 2017

Open reduction and internal fixation for intraarticular fracture of metacarpal head.

Orthopade 2017 Jul;46(7):617-624

Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, 59 Yatap-ro, Bundang-gu, 463-712, Seongnam-si, Gyeonggi-do, Korea (Republic of).

Intraarticular fracture of the metacarpophalangeal (MP) joint presents complex problems related to the sophisticated functional aspects of the hand. Injury to the metacarpal head may have a severe effect on hand function but few studies have investigated the management of this condition. In this study, we applied open reduction and internal fixation for the displaced fracture of the metacarpal head and report the clinical and radiographic outcomes of our experience. Thirteen patients (12 men, 1 woman; mean age 21 years) were included in this study, and medical records and radiographs were reviewed retrospectively. The average follow-up period was 12.5 months. Range of motion (ROM) and Disabilities of the Arm, Shoulder, and Hand (DASH) scores were analyzed, and functional results and serial radiographs were investigated for the maintenance of articular congruity and fracture union. The injured fingers were 5 long, 4 small, 2 ring, and 2 index. Five cases were fixed with K‑wires, 5 cases with headless screws, and 3 cases with screw and K‑wire. The average range of injured MP joint motion was 89°, total active range of motion (TAM) was 265°, and the average DASH score was 3.8 at the last follow-up. All patients showed fracture union on the radiographs and no patient showed significant articular surface incongruence or degenerative change. Open reduction and internal fixation of the metacarpal head fracture had favorable outcomes in our study. The authors suggest accurate reduction and stable fixation for better functional results in metacarpal head fractures.
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http://dx.doi.org/10.1007/s00132-017-3392-8DOI Listing
July 2017

Dual plate fixation on distal third diaphyseal fracture of the humerus.

Int Orthop 2017 08 1;41(8):1655-1661. Epub 2016 Dec 1.

Orthopaedic Surgery, CHA Bundang Medical center, CHA University, Pocheon-si, Gyeonggi-do, Republic of Korea.

Introduction: Displaced unstable distal third fractures of the humeral diaphysis are treated surgically through open reduction and internal fixation. Conventionally, surgeons prefer using long plates for secure fixation; however, we performed short plate dual plating for robust fixation that required a smaller incision and less dissection through an anterior approach. In this study, we report the results of dual plating of fractures of the humeral shaft, with radiographic evidence and clinical analysis.

Methods: This retrospective study included 29 patients with distal third diaphyseal fractures of the humerus. There were 18 men and 11 women, with an average age of 43 years, and a mean follow-up period of 21.2 months. We investigated the type of fracture, plate length, number of fixed screws, and fracture union. Range of motion, Disabilities of Arm, Shoulder, and Hand (DASH) score, and complications during follow-up were analyzed for clinical results.

Results: All fractures were classified according to AO classification. We used 4.5-mm narrow locking compression plates (LCP) and 3.5-mm LCP reconstruction plates. Fracture union was achieved in all cases during the follow-up. All patients recovered favourable elbow range of motion at final follow-up. At the final follow-up, average DASH score was 10.0, and no patient showed postoperative complications.

Conclusions: Satisfactory radiographic evidence and clinical results suggest that dual plating for distal diaphyseal humeral fractures may be considered a surgical option, with the advantages of strong fixation, less invasion of soft tissue, and early rehabilitation.
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http://dx.doi.org/10.1007/s00264-016-3355-4DOI Listing
August 2017

Comparative Analysis of Radiographic Hip Joint Geometry Using Measurement Tools on Picture Archiving and Communication System: A Prospective Study of 100 Pelvic Radiographs of Koreans.

J Arthroplasty 2016 11 11;31(11):2597-2602. Epub 2016 May 11.

Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.

Background: A contralateral normal hip joint has been often used as a reference standard in preoperative planning and intraoperative assessment of hip arthroplasty, with the assumption that bilateral hip joint geometries have no significant differences. However, one previous study using analog measurements on hardcopy films reported significant bilateral variation in hip joint geometry. We therefore investigated the level of agreement between the right and left hips for each measurement and determined index values and the range of normal bilateral variations.

Methods: We assessed 100 standard anteroposterior radiographs of the pelvis in this study. Two independent observers measured the actual value of femoral head diameter, location of the femoral head center, acetabular offset, femoral offset, hip offset, greater trochanteric height, neck-shaft angle, medullary canal diameter, and proximal femoral diameter. Intraclass correlation coefficients (ICCs) and values of mean difference were calculated for each measurement.

Results: The results demonstrated perfect agreement (ICC >0.8) between the right and left hips for most parameters and substantial agreement for greater trochanteric height (ICC = 0.735) and femoral offset (ICC = 0.773). The mean difference and standard deviation in the measurement between the right and left hips for the location of the femoral head center and the acetabular offset were 0.60 ± 0.48 mm and 0.42 ± 0.30 mm, respectively.

Conclusion: Hip joint geometry is not influenced by side. In hip arthroplasty, a contralateral normal hip can be reliably used as a guide for preoperative planning using measurement tools on a picture archiving and communication system.
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http://dx.doi.org/10.1016/j.arth.2016.04.038DOI Listing
November 2016

The result of surgical treatment of medial epicondylitis: analysis with more than a 5-year follow-up.

J Shoulder Elbow Surg 2016 Oct 1;25(10):1704-9. Epub 2016 Aug 1.

Department of Orthopaedic Surgery, CHA Bundang Medical Center, School of Medicine, CHA University, Gyeonggi, Republic of Korea.

Background: Angiofibroblastic changes of a musculotendinous origin at the medial epicondyle characterize medial epicondylitis of the elbow. Although nonsurgical treatment is the primary approach for medial epicondylitis, surgical treatment should be considered when conservative therapy fails. This study reports the results of surgical treatment of medial epicondylitis monitored for more than 5 years.

Methods: This study included 55 patients with 63 cases of medial epicondylitis between 2000 and 2010. The conservative treatment periods lasted for a minimum of 1 year, and steroid injections were administered more than twice before surgery. One surgeon conducted the surgical procedures. The Nirschl and Pettrone grades, visual analog scale (VAS) scores, Disabilities of the Arm, Shoulder and Hand (DASH) scores, Mayo Elbow Performance scores, and grip strengths were analyzed. Statistical analyses were performed using paired t tests.

Results: The mean VAS score improved from 8.5 to 2.4 (P <.001). Nirschl and Pettrone grades rated 43% (27 elbows) as excellent and 51% (32 elbows) as good. The Mayo Elbow Performance scores improved from 72 to 88 (P <.001) and DASH scores from 57 to 23 (P <.001). The mean grip strength of the affected side improved from 30 to 43 lb (P <.001). The mean time required to return to work and exercise was 2.8 months and 4.8 months, respectively. One case of heterotrophic ossification, which had no functional instability afterward, was seen.

Conclusion: The results indicate that surgical treatment of medial epicondylitis could be an effective and safe treatment when conservative treatment fails.
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http://dx.doi.org/10.1016/j.jse.2016.05.010DOI Listing
October 2016

Prevalence of Vitamin D Deficiency in Korean Children Presenting with Nonspecific Lower-Extremity Pain.

Yonsei Med J 2015 Sep;56(5):1384-8

Department of Orthopedic Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea.

Purpose: Although interest in the role played by vitamin D in bone health is increasing, little is known about the role of this vitamin in musculoskeletal pain in children. This study aimed to assess the prevalence of vitamin D deficiency in children presenting with nonspecific lower extremity pains.

Materials And Methods: From 2011 to 2012, 183 children underwent evaluation for nonspecific lower-extremity pains. Patients with valid causes, such as fractures or transient synovitis, were excluded, as were those with underlying medical conditions, such as cerebral palsy and metabolic disease. Ultimately, 140 patients met the inclusion criteria. Levels of serum 25-hydroxy vitamin D [25-(OH)D], the ideal indicator of vitamin D status, were measured in these children.

Results: Eighty-seven boys (62.1%) and 53 girls (37.9%) were included. The mean age at presentation was 5.2 years (range, 2-15). Serum 25-(OH)D levels were <10 ng/mL in 5.7% of patients, 10 to <20 ng/mL in 51.4%, 20 to <30 ng/mL in 37.9%, and ≥30 ng/mL in only 5.0%. Most patients visited the hospital in the winter (41.4%) (summer, 12.9%), and serum 25-(OH)D levels were also lowest in the winter (17.2±5.5 ng/mL).

Conclusion: This study found a high prevalence of vitamin D deficiency or insufficiency in Korean children with nonspecific lower-extremity pains, indicating a positive association between vitamin D deficiency and growing pains. More attention should be directed toward vitamin D and its role in the optimization of bone health.
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http://dx.doi.org/10.3349/ymj.2015.56.5.1384DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4541671PMC
September 2015

Outcome After Arthroscopic Decompression of Inferior Labral Cysts Combined With Labral Repair.

Arthroscopy 2015 Jun 11;31(6):1060-8. Epub 2015 Mar 11.

Department of Orthopedic Surgery, College of Medicine, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, South Korea. Electronic address:

Purpose: To analyze the clinical and radiologic outcomes of arthroscopic cyst decompression and labral repair in patients with inferior paralabral cysts with chronic shoulder pain.

Methods: Between March 2006 and September 2012, 16 patients who were identified as having inferior paralabral cysts presented with chronic shoulder pain. All patients underwent a thorough physical examination and preoperative magnetic resonance arthrographic evaluation. The mean age was 30 years (range, 17 to 50 years). The mean follow-up period was 38 months (range, 16 to 60 months). Clinical outcome scores (American Shoulder and Elbow Surgeons; University of California, Los Angeles; and Simple Shoulder Test) and passive shoulder range of motion were evaluated at last follow-up. Follow-up magnetic resonance imaging was performed at a mean of 8 months to determine the labral healing status and assess for cyst recurrence.

Results: The incidence of isolated inferior paralabral cysts was 0.6% (16 of 2,656 cases). Of the patients, 8 had multiple cysts and 8 had a single cyst. The mean length and width of the cysts were 1.0 cm and 0.4 cm, respectively. Eight cases had a history of trauma, and 13 patients were involved in sports activities. Seventy-five percent of cases showed a positive relocation test. The mean American Shoulder and Elbow Surgeons; University of California, Los Angeles; and Simple Shoulder Test scores improved from 64, 22, and 8.7, respectively, preoperatively to 83, 31, and 10, respectively (P < .001), at final follow-up. Shoulder range of motion did not show any significant improvement. The location of the labral tear was as follows: anteroinferior tear in 5 cases, posteroinferior tear in 8 cases, and combined anteroinferior and posteroinferior tear in 3 cases. All cysts were found to be in association with a labral tear. A mean of 2.7 anchors were used for inferior labral repair. These cysts were found only in male patients. None of the patients showed any evidence of cyst recurrence on follow-up magnetic resonance imaging.

Conclusions: Inferior labral tears treated with cyst decompression and labral repair showed satisfactory clinical results without any recurrence. Inferior paralabral cysts should be considered in the differential diagnosis in patients presenting with chronic shoulder pain, particularly active male patients.

Level Of Evidence: Level IV, therapeutic case series.
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http://dx.doi.org/10.1016/j.arthro.2015.01.008DOI Listing
June 2015

Hallux valgus deformity of foot with tumoral calcinosis: an unusual presentation.

Foot Ankle Surg 2014 Mar 13;20(1):e15-8. Epub 2013 Nov 13.

Department of Orthopedics, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, South Korea.

Tumoral calcinosis is an uncommon disorder and characterized by development of calcified masses within the soft tissues near the large joints such as the hip, elbow, and shoulder and rarely occurs in the foot. We report a case of tumoral calcinosis at the first meta-tarso-phalangeal (MTP) joint of foot with hallux valgus deformity associated with bunion which required resection. Surgical excision of the calcific mass alone, without surgery to the minimal hallux valgus, resulted in resolution of symptoms, without recurrence of the lesion. Subsequently, speculative etiology, differential diagnostic considerations as well as the therapeutic interventions for tumoral calcinosis are discussed taking into consideration the current literature. We conclude that tumoral calcinosis should be considered in the differential diagnosis of a painful mass that develops in the small joints of the foot.
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http://dx.doi.org/10.1016/j.fas.2013.10.007DOI Listing
March 2014

A rare hyperextension injury in thoracic spine presenting with delayed paraplegia.

Asian Spine J 2013 Jun 22;7(2):126-30. Epub 2013 May 22.

Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea.

Hyperextension injury in the thoracic spine is uncommon with only a few cases documented in the literature. The mechanism of these injuries is hyperextension combined with axial or shearing force. These types of injuries are associated with a high risk of dural tears and paraplegia. A 91-year-old female presented with acute back pain from a hyperextension injury in thoracic spine with no neurological deficit. Lumbar magnetic resonance imaging showed a intervertebral disc rupture. On day 20 of hospitalization, the herniated intervertebral disc compressed the spinal cord with incomplete paraplegia. Hyperextension injuries involving the three columns are very unstable and we recommend surgical treatment as soon as possible, not only because of the initial trauma, but a ruptured disc herniation can damage the spinal cord.
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http://dx.doi.org/10.4184/asj.2013.7.2.126DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3669698PMC
June 2013

Anterior approach for fixation of isolated type III coronoid process fracture.

Eur J Orthop Surg Traumatol 2013 May 30;23(4):395-405. Epub 2012 May 30.

Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, 351 Yatap-dong, Bundang-gu, Sung-nam, South Korea.

Authors chose anterior approach through the antecubital fossa for better exposure in that case of isolated coronoid process fracture. The objective of the study was to report validity of anterior approach for the Regan and Morrey type III, isolated fracture of the coronoid process of the ulna without residual valgus or varus instability. From January 2007 and January 2010, we evaluated eleven consecutive patients (7 men, 4 women; mean age 44 years; range 25-67 years) who underwent surgical fixation through the anterior approach. The mean follow-up period was 21 months (range 15-34 months). Preoperative and follow-up roentgenograms were evaluated for assessment of the fracture configuration and confirmation of fracture union. Clinical evaluation included an analysis of surgical complication, range of motion, Mayo elbow performance score, and DASH (disability of the arm, shoulder, and hand) score. Fractures were mainly fixed with plate and screws in 8 cases, cannulated screws in 3 cases. There was no residual joint instability after fracture fragment fixation. All fractures were united, and the average union time was 15.2 weeks with a range of 11-20 weeks. Mean flexion contracture of the elbow was 3.6° (range 0°-10°), and further flexion was 130.9° (range 125°-140°) at the last follow-up. Mean Mayo elbow performance score was 92.3 (range 80-100 points), and mean DASH score was 5.9 (range 1.6-8.3 points). In conclusion, Primary fixation of the coronoid process fractures through the anterior approach could be particularly useful in the Regan and Morrey type III isolated coronoid process fractures.
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http://dx.doi.org/10.1007/s00590-012-1007-yDOI Listing
May 2013