Hyun Dae Shin

Arthroscopic Transosseous Rotator Cuff Repair

This technique may be considered a surgical option if an inserted suture anchor on the greater tuberosity is pulled out with a small amount of tension, especially during arthroscopic rotator cuff repair in osteoporotic elderly patients.

Beach-chair lateral traction position using a lateral decubitus distracter in shoulder arthroscopy.

The beach-chair traction position is designed to allow the use of traction while allowing the surgeon to orient the shoulder In an upright position and convert to an open procedure, if necessary.

Post-traumatic cerebral fat embolism prior to operative repair of femoral and tibial fractures.

Rare cases of primary cerebral fat embolism as a postoperative complication have been reported. In addition, cerebral fat embolism occurring before operative repair without shunt lesion are more rarely reported. We report a patient with a posttraumatic cerebral fat embolism resulting in severe neurologic dysfunction without right to left shunt. A 25-year-old man was brought to the hospital immediately after a traffic accident. He sustained a right segmental femoral shaft fracture and a left tibial shaft fracture. The patient was alert with no neurological deficits. Approximately 13 hours after injury, the patient developed acute mental status deterioration and dyspnea. Magnetic resonance imaging of the brain revealed extensive multifocal infarction owing to embolic showering throughout nearly the entire brain parenchyma. Computed tomography with intravenous contrast revealed no evidence of embolism in the lung, abdomen, and pelvis. Transthoracic and transesophageal echocardiogram revealed no circulating embolic particles or intracardiac shunt. The patient underwent closed reduction and internal fixation with a reamed intramedullary nail in the tibia and underwent open reduction and internal fixation with a reamed nail in the femur at 5 days after injury. We performed decompression of a hematoma containing a large number of lipid droplets via a small incision in the femur shaft fracture, established suction drainage of the tibia medullar cavity, and applied a tourniquet to the thigh in the tibia shaft fracture. Supportive medical treatment included endotracheal ventilatory support and tracheostomy. The patient was discharged from the hospital 50 days after admission. On follow-up 2 months later, he had returned to activities of daily living, however a speech disturbance remained.

Arthroscopic Treatment of Symptomatic Malunion of the Greater Tuberosity of the Humerus Using the Suture-Bridge Technique

Arthroscopic tuberoplasty of a malunited greater tuberosity followed by footprint reconstruction of the rotator cuff with the suture-bridge technique may be a useful surgical option for treating a malunited greater tuberosity of the humerus.

Modified margin convergence technique using suture anchors for footprint reconstruction of rotator cuff tears.

An arthroscopic modified margin convergence technique using suture anchors may be effective in achieving footprint reconstruction of the rotator cuff by avoiding undue tension in patients with mobile or partially mobile massive rotator cuff tears.

Percutaneous temporal wiring method for minimally invasive plate osteosynthesis of a distal tibial fracture.

Reduction of distal tibial fractures-especially fractures that include an oblique or spiral fracture component-during operative treatment with minimally invasive plate osteosynthesis is not always easy. Unexpected and unacceptable displacement can sometimes be seen after plate fixation. We designed an effective fracture reduction method involving a percutaneous temporal wiring technique for the reduction of distal tibial fractures, including fractures that contain oblique or spiral fracture components, during the minimally invasive plate osteosynthesis procedure. Our method can consistently accomplish satisfactory reduction of these fractures and easily maintain reduced fractures, fix the plate, reduce the level of radiation exposure during the operation.

Limited Intercarpal Arthrodesis in Kienbock's Disease

Purpose : To compare the treatment results of triscaphe and scaphocapitate arthrodesis in Lichtmans stage III Kienbocks disease. Materials and Methods : Among 25 cases of Kienbocks disease (Lichtmans stage III), who were followed up more than 1 year after surgery from 1997 March to 2005 March, 15 cases of scaphocapitate and 10 cases of triscaphe arthrodesis were reviewed. The average age was 42.6 and the mean follow-up period was 33 months. The clinical and radiology results were analyzed before surgery and at the last follow-up. Results : In the clinical assessments, there was good pain relief after each procedure and there was a similar limitation of the carpal range of motion before and after surgery. The radiology assessments revealed no difference between the two arthrodeses according to the carpal height ratio and lunate index. Regarding complications, there were 4 cases with a scaphocapitate including 1 nonunion and 4 cases with triscaphe arthrodesis including 2 superficial infections. Conclusion : The scaphocapitate arthrodesis is a technically simple, easy reducible to the anatomical position and produces similar clinical and radiology results to triscaphe arthrodesis. Overall, scaphocapitate arthrodesis appears to be an effective method for treating Lichtmans stage III Kienbocks disease.

Arthroscopic Bankart Repair and Rotator Interval Plication by Transglenoid Technique: Preliminary Report

Purpose: To evaluate the clinical results of arthroscopic Bankart repair and rotator interval plication by the transglenoid technique on Traumatic Unidirectional Bankart Surgery (TUBS) with concomitant rotator interval widening. Materials and Methods: From May 2002 to May 2003, 13 cases who underwent arthroscopic Bankart repair and rotator interval plication by the transglenoid technique were studied, out of the 14 cases that were diagnosed as TUBS with concomitant rotator interval widening. Follow up period was at least 1 year. Results were evaluated by Rowe score before and after surgery. Results: All the cases were male. Nine cases were on the right shoulder and 4 on the left. The mean age was 22 years old (range, 14-26 years old). The mean duration from injury to operation was 4.3 (range, 1.3-10) years. The Rowe score was improved from 58.3 to 86.4 (p=0.00). Overall outcomes were excellent in 10 cases, good in 2 and fair in 1 at final follow up. There was no sulcus sign in any of the cases at the last follow up, and redis location did not appear in any of the cases during the follow up period. Conclusion: In the treatment of TUBS with concomitant rotator interval widening, arthroscopic Bankart repair and rotator interval plication by the transglenoid technique have made good results.

Avulsion Fracture of the Index Metacarpal Base - Two Case Reports -

Avulsion fractures involving insertions of the radial extensors at the base of the index and middle metacarpals are quite rare. However, avulsion fractures at the insertion site of the extensor carpi radialis longus on the index metacarpal and avulsion fractures involving the extensor carpi radialis brevis insertion at the base of the middle finger metacarpal have been reported. Although there are many reports of fractures of the base of the first metacarpal, there are few recommendations available for treatment of these injury. We report two avulsion fractures at the extensor carpi radialis longus insertion, which were treated with an open reduction and internal fixation of the avulsed bony fragment using a miniplate and screw.