Il-Hyun Koh

Endoscopic versus open release in patients with de Quervain's tenosynovitis: a randomised trial.

The purpose of this study was to compare the outcome and complications of endoscopic versus open release for the treatment of de Quervains tenosynovitis. Patients with this condition were randomised to undergo either endoscopic (n = 27) or open release (n = 25). Visual Analogue Scale (VAS) pain and Disabilities of Arm, Shoulder, and Hand (DASH) scores were measured at 12 and 24 weeks after surgery. Scar satisfaction was measured using a VAS scale. The mean pain and DASH scores improved significantly at 12 weeks and 24 weeks (p < 0.001) in both groups. The scores were marginally lower in the endoscopic group compared to the open group at 12 weeks (p = 0.012 and p = 0.002, respectively); however, only the DASH score showed a clinically important difference. There were no differences between the groups at 24 weeks. The mean VAS scar satisfaction score was higher in the endoscopic group at 24 weeks (p < 0.001). Transient superficial radial nerve injury occurred in three patients in the endoscopic group compared with nine in the open release group (p = 0.033). We conclude that endoscopic release for de Quervains tenosynovitis seems to provide earlier improvement after surgery, with fewer superficial radial nerve complications and greater scar satisfaction, when compared with open release.

A central threadless shaft screw is better than a fully threaded variable pitch screw for unstable scaphoid nonunion: A biomechanical study

INTRODUCTION An interpositional wedge bone graft is a procedure performed to restore carpal height and scaphoid length for displaced scaphoid nonunions with carpal instability. The purpose of this study was to investigate which headless screw design (threadless central shaft screw or fully threaded variable pitch compression screw) is biomechanically preferred when an interpositional bone graft is needed. METHODS A total of 24 cadaveric scaphoid interpositional bone grafts were divided into three groups and fixed with HCS 3.0, Herbert-Whipple or Acutrak mini-screws, and the relative biochemical stability of each was measured. The specimens were tested using an Instron tensile testing machine to calculate stiffness and load to failure. To measure compression forces at different interfragmentary gaps, 30 interpositional polyurethane bone graft models were generated with three pieces of cancellous sawbone block, and two custom-made load-cells were inserted in each gap. The models were then divided into three groups and fixed with the above screw types. The compression forces at different interfragmentary gaps were measured immediately and 30 min after screw fixation. RESULTS The average stiffness and load to failure were similar among the three groups (p>0.05). The average compression force measured at each interfragmentary gap was highest in the HCS 3.0 fixation group, followed by the Herbert-Whipple and Acutrak mini-screw fixation groups both immediately after screw fixation and after 30 min (at which time there were significant decreases in force). The compression forces measured at different interfragmentary gaps were almost identical in the HCS 3.0 and Herbert-Whipple screw fixation groups; however, the force measured at the leading side was significantly lower than that measured at the trailing side in the Acutrak mini-screw fixation group. CONCLUSION The threadless central shaft screw design is biomechanically preferred over the fully threaded variable pitch screw design because it achieves higher and identical compression forces at different interfragmentary gaps with similar stiffness and load to failure.

Ulnar nerve stability-based surgery for cubital tunnel syndrome via a small incision: a comparison with classic anterior nerve transposition

ObjectiveThe purpose of this study was to compare the clinical outcomes of ulnar nerve stability-based surgery via a small incision with those of classic anterior transposition of the ulnar nerve for cubital tunnel syndrome.MethodsFrom March 2008 to December 2013, 107 patients with cubital tunnel syndrome underwent simple decompression or anterior transposition via a small incision, according to an ulnar nerve stability-based decision based on an assessment of intraoperative ulnar nerve stability (group A, n = 51), or anterior transposition via a classic incision (group B, n = 56). Clinical outcome was assessed using grip and pinch strength, two-point discrimination, the mean of the disabilities of arm, shoulder, and hand (DASH) survey, and the modified Bishop scale.ResultsAt the final follow-up, all outcome measures improved significantly in both groups and there were no significant differences between the two groups. However, there were fewer operation-related complications in group A (one revision surgery) than in group B (one superficial infection, two painful scars, and five cases of numbness at the medial elbow).ConclusionsOutcomes after the ulnar nerve stability-based approach and anterior transposition were similar, although more patients experienced operation-related complications after anterior transposition via a classic incision. Making an ulnar nerve stability-based decision to perform either simple decompression or anterior transposition via a small incision seems to be a better strategy for patients with cubital tunnel syndrome.

Operative Treatment for Nonunion of the Distal Scaphoid

Purpose: The purpose of this study was to analyze the clinical and radiological outcomes of distal scaphoid nonunion patients who underwent operative treatment. Methods: From July 2006 to May 2014, there were a total of 9 distal scaphoid nonunion patients, with a mean age of 32 years. The mean time from symptom onset to operation was 15 months. Operative treatment was performed through a volar approach, osteosynthesis with an auto-iliac bone graft was performed. Union was determined through radiographs and computed tomography, while the scapholunate angle (SLA) and lateral intrascaphoid angle (LISA) were measured. Clinical outcomes were evaluated by assessing range of motion (ROM) of the wrist, the visual analogue scale (VAS), Mayo wrist score, and disabilities of arm, shoulder and hand (DASH) score. Results: The incidence of distal scaphoid nonunion was 11.8% (9/76), with all patients demonstrating union after the operation. Mean union time was 5 months and mean follow-up period was 23 months. Both SLA and LISA decreased, returning to normal range. The ROM of the wrist joint increased but not statistically significant. The postoperative VAS pain score improved, while grip strength advanced. In addition, both postoperative Mayo wrist and DASH scores document better results than those of pre-operation. Overall, there were two postoperative complication cases of joint motion limitation and pin site irritation. Conclusion: Osteosynthesis with auto-iliac bone graft for nonunion of the distal scaphoid showed good clinical and radiological outcomes. Thus, it is considered a recommendable operation in the treatment of distal scaphoid nonunion.