Dong Jun Kim

Reliability and Validity of Thoracolumbar Injury Classification and Severity Score (TLICS)

Study Design A new classification system for throacolumbar spine injury, Thoracolumbar Injury Classification and Severity Score (TLICS) was evaluated retrospectively. Purpose To evaluate intrarater and interrater reliability of newly proposed TLICS schemes and to estimate validity of TLICSs final treatment recommendation. Overview of Literature Despite numerous literature about thoracolumbar spine injury classifications, there is no consensus regarding the optimal system. Methods Using plain radiographs, computed tomography scanning, magnetic resonance imaging, and medical records, 3 clssifiers, consisting of 2 spine surgeons and 1 senior orthopaedic surgery resident, reviewed 114 clinical thoracolumbar spine injury cases retrospectively to classify and calculate injury severity score according to TLICS. This process were repeated on 4 weeks intervals and the scores were then compared with type of treatment that patient ultimately received. Results The intrarater reliability of TLICS was substantial agreement on total score and injury morphology, almost perfect agreement on integrity of the posterior ligament complex (PLC) and neurologic status. The interrater reliability was substantial agreement on injury morphology and integrity of the PLC, moderate agreement on total score, almost perfect agreement on neurologic status. The TLICS schems exhibited satisfactory overall validity in terms of clinical decision making. Conclusions The TLICS was demonstrated acceptable intrarater and interrater reliability and satisfactory validity in terms of treatment recommendation.

Comparison of united and nonunited fractures of the ulnar styloid following volar-plate fixation of distal radius fractures

INTRODUCTIONnThe purpose of this study was to determine whether associated nonunion of ulnar styloid fracture following plate-and-screw fixation of a distal radius fracture (DRF) has any effect on wrist functional outcomes, ulnar-sided wrist pain or distal radioulnar joint (DRUJ) instability.nnnMATERIALS AND METHODSnA total of 91 consecutive patients with a DRF and an accompanying ulnar styloid fracture treated by open reduction and volar locking plate fixation were included in this study. In the first part of the analysis, the 91 study subjects were subdivided according to the presence or not of ulnar styloid union (20 and 71, respectively) by radiography at final follow-up (average 23 months). These two cohorts were compared with respect to wrist functions at 3 months postoperatively and the final follow-up visit, and ulnar-sided wrist pain and DRUJ instability at the final follow-up visit and ulnar styloid length as determined radiographically at final follow-up. In the second part of the analysis, 49 of the 91 study subjects with an ulnar styloid base fracture were subdivided according to the presence or not of ulnar styloid base fracture union (12 and 37, respectively) at final follow-up by radiography. These two groups were also compared with respect to the above-mentioned parameters.nnnRESULTSnUlnar styloid fractures united in 20 (22%) of the 91 patients at final follow-up visit (average 23 months). No significant differences were found at any time during follow-up between patients who achieved or did not achieve ulnar styloid fracture union or ulnar styloid base fracture union.nnnCONCLUSIONnUlnar styloid nonunion does not appear to affect wrist functional outcomes, ulnar-sided wrist pain or DRUJ stability, at least when a DRF is treated by open reduction and volar plate fixation.

Treatment of Traumatic Anterior Shoulder Dislocation in Patients Older Than 60 Years

Background: The prevalence of traumatic anterior shoulder dislocation in the elderly population has increased; however, no consensus has been reached regarding the management of shoulder dislocations in elderly patients. Purpose: This study investigated the clinical manifestations of traumatic anterior shoulder dislocation in patients older than 60 years and evaluated the functional outcomes of different treatment modalities based on associated abnormalities and the number of dislocations. Study Design: Case series; Level of evidence, 4. Methods: Sixty-seven patients older than 60 at the time of primary shoulder dislocation were included. Magnetic resonance imaging or ultrasonography was performed on all patients to confirm associated injuries. Fifty-two patients were treated for primary shoulder dislocation and 15 for recurrent dislocation. Results: Postinjury examinations revealed no associated injuries in 31 patients with primary shoulder dislocation; these patients recovered shoulder function after rehabilitation (American Shoulder and Elbow Surgeons [ASES] score: 93 ± 6; Constant score: 89 ± 8). For the other 36 patients, 33 were found to have rotator cuff tears (isolated cuff tears in 16), and 3 were found to have an isolated Bankart lesion. The average ASES score of the 17 patients with primary shoulder dislocation who were treated operatively was 83 ± 10, and the average Constant score was 78 ± 13 at final follow-up. The average ASES score of patients with recurrent shoulder dislocation was 89 ± 9, and the average Constant score was 84 ± 13. No statistically significant differences in functional shoulder outcomes between patients with primary and recurrent dislocation were evident (P > .05). However, patients who were treated nonoperatively showed significantly better recovery of shoulder function than patients who were treated operatively regardless of the number of dislocations (P < .001). No recurrent shoulder dislocation was observed in any patient during an average follow-up period of 55 months. Conclusion: The accurate diagnosis of associated injuries after traumatic anterior shoulder dislocation in patients older than 60 is critical for the recovery of shoulder function because more than half of patients had rotator cuff tears or anterior capsulolabral lesions, which may lead to recurrent shoulder dislocation. Satisfactory clinical outcomes without recurrence were obtained after early detection of abnormalities and different treatment modalities based on associated injuries and the number of dislocations experienced.

The Effect of Displaced Dorsal Rim Fragment in a Distal Radius Fracture.

Backgroundu2003In intra-articular fracture of distal radius, the intra-articular fragments can be divided into some specific fragments. In particular, the poor outcomes have been well documented for reduction loss of the volar lunate facet, but the effect of a displaced dorsal rim fracture has rarely been addressed. Materials and Methodsu2003The records of 26 patients with dorsal rim fragment displaced by more than 2u2009mm after volar locking plate (VLP) fixation for a dorsally displaced distal radius fracture (DRF) treated from March 2006 to March 2009 were retrospectively reviewed. Clinical assessments including grip strengths, wrist range of motions, and Disabilities of Arm, Shoulder, and Hand (DASH) scores were performed at 12 months postoperatively. Widths of the distal ends of dorsal rims were determined by preoperative computed tomography (CT). Dorsal rim fragment displacements were measured in immediate postoperative plain lateral radiographs. Radial inclination, volar tilt, and ulnar variance were measured on immediate postoperative wrist radiographs. Arthritic changes of radiocarpal joints were graded using radiographs obtained at 12 months postoperatively. Description of Techniqueu2003DRFs were fixed using a VLP in the usual manner. Although DRF displacement was noticed after plate fixation, no further procedure was performed. The sizes of articular portions of dorsal rim fragments were measured arthroscopically in 5 of the 26 patients at the time of plate fixation. Resultsu2003At 12 months postoperatively, mean grip strength, wrist flexion arc, and mean wrist extension arc were 86u2009±u200913, 87u2009±u200911, and 91u2009±u200910%, respectively, of contralateral sides. Mean forearm supination and pronation were 96u2009±u20098 and 99u2009±u20095%, respectively, of contralateral sides. Mean DASH score was 11u2009±u200910 points. Preoperatively, mean width of the distal end of dorsal rim fragments and mean displacements of dorsal rim fragments were 2.0u2009±u20090.6 and 3.0u2009±u20090.9u2009mm, respectively. Mean width of the articular portions of dorsal rim fragment by arthroscopic examination was 1.0u2009±u20090.4 mm. Mean radial inclination was 21u2009±u20094.8 degrees, mean volar angulation was 4.8u2009±u20093.9 degrees, and mean ulnar variance was 0.6u2009±u20091.8u2009mm at immediate postoperatively. Two patients showed grade I arthritic changes at 12 months postoperatively. Conclusionsu2003The articular portions of dorsal rim fragments measured arthroscopically were smaller than determined by CT. Furthermore, the study shows that displaced dorsal rim fragments in dorsally displaced DRFs treated by VLP do not adversely affect wrist clinical outcomes.

Prognostic factors for the outcome of arthroscopic capsular repair of peripheral triangular fibrocartilage complex tears

BackgroundLittle information is available about prognostic factors of arthroscopic capsular repair for peripheral triangular fibrocartilage complex (TFCC) lesions. The purpose of this study was to analyze factors that affect the treatment outcomes of arthroscopic capsular repair for peripheral TFCC tears.MethodsThis study retrospectively enrolled 60 patients who were treated with arthroscopic outside-in capsular repair for peripheral TFCC tears. Functional survey, including pain numeric rating scale (NRS) on an ulnar provocation test, distal radio-ulnar joint (DRUJ) stress test, Disability of the Arm, Shoulder, and Hand (DASH) score, and satisfaction with treatment, was conducted at 12-month follow-up. Patients who were enthusiastic or satisfied comprised the satisfied group, and those who were noncommittal or disappointed the dissatisfied group. Demographic, clinical, and arthroscopic findings were compared between the satisfied and dissatisfied groups.ResultsThe mean pain NRS and DASH scores exhibited significant clinical improvement at the 12-month follow-up. Out of the total participants, 46 were satisfied and 14 were dissatisfied about the treatment, with significantly more female subjects in the dissatisfied group than in the satisfied one. The patients in the satisfied group had a shorter duration of symptoms, were more likely to have trauma history, and exhibited positive DRUJ stress test results compared to the dissatisfied group. There were no significant group differences in age, hand dominance, work level, and the extent of ulnar plus variance. Multivariable analysis revealed that female gender, a longer duration of symptoms, or negative DRUJ stress test results were associated with an increased disability after arthroscopic TFCC repair.ConclusionFemale gender, a longer duration of symptom, and a negative DRUJ stress test are associated with a higher likelihood of treatment failure after arthroscopic outside-in capsular repair of peripheral TFCC tears.