Kwang-Jin Rhee

Can the Glenopolar Angle be Used to Predict Outcome and Treatment of the Floating Shoulder

OBJECTIVE Displaced ipsilateral fractures of the clavicle and the glenoid neck are usually the result of high-energy trauma. The objective of this study is to evaluate the association of the glenopolar angle (GPA) with the clinical outcome of the floating shoulders. METHODS Seven patients treated conservatively and nine patients with clavicular fracture treated operatively were evaluated retrospectively. The GPA of the affected (a-GPA) and unaffected (u-GPA) shoulders, and the change (d-GPA) were measured. The Constant-Murley score of the affected (a-CS) and unaffected (u-CS) shoulders, and the change (d-CS) were measured at the last follow-up. RESULTS The mean follow-up was 25 months, and the score was 69.7 points. Patient age had no effect on the clinical outcome, and the change in GPA in the affected shoulder between the initial and last follow-up for the nonoperated and operated groups did not differ statistically (p > 0.05). There were positive correlations between a-CS and a-GPA (r = 0.760, p < 0.05) and between d-GPA and d-CS (r = 0.643, p < 0.05) and negative correlations between a-GPA and d-CS (r = -0.962, p < 0.05) and between d-GPA and a-CS (r = -0.703, p < 0.05). CONCLUSION The simple measurement of GPA may yield useful prognostic information and help in making decisions concerning the floating shoulder.

Displaced fracture of the coracoid process associated with acromioclavicular dislocation: a two-bird-one-stone solution.

We describe a surgical treatment for a displaced fracture of the coracoid process associated with acromioclavicular dislocation. This treatment involves fixing the coracoid process using a cannulated screw without acromioclavicular fixation under fluoroscopic guidance. The benefits of this treatment are that fixation with a cannulated screw simultaneously reduces both the displaced fracture of the coracoid process and the acromioclavicular joint via the intact coracoclavicular ligament, thus reducing the complications associated with transacromial pin fixation.

Tension Band Sutures Using a Washer for a Proximal Humerus Fracture

To prevent distraction and varus deformity between the humeral head and shaft, tension band sutures placed between the head of the interlocking screw and the rotator cuff, and we recommend using nonabsorbable sutures. We describe our simple procedure to overcome these difficulties in tension band suturing after reducing a proximal humerus fracture to maintain the reduction.

Trifurcated radial nerve in the spiral groove of the humerus.

A 62-year-old man presented with a nonunion of the humerus shaft. Using a standard triceps splitting approach, a longitudinal incision along the posterior aspect of the arm was created. Three independent radial nerves coursed posteriorly and inferolaterally around the humerus were identified in spiral groove. Three nerves resembled in the size, color, and course in the operative field. Although the prevalence of the anomaly is probably quite low, the possibility of identification of this anomalous condition of radial nerve should be kept in mind when performing posterior approach on the humerus.