Tong Joo Lee

Minimally Invasive Coracoclavicular Stabilization with Suture Anchors for Acute Acromioclavicular Dislocation

Background The management of acute acromioclavicular (AC) joint dislocation is controversial. Purpose The authors describe a surgical technique involving securing the clavicle to the coracoid process using suture anchors for the treatment of acute AC joint injury. Study Design Case series; Level of evidence, 4. Methods Twenty patients were evaluated retrospectively, clinically, and radiographically, for a mean of 41.2 months. Results At last follow-up, the mean Constant score for the 20 patients was 89.5. Eighteen patients (90%) maintained complete AC joint reduction in both anteroposterior and axillary views. Slight loss of reduction was noted in 2 patients (10%), but their functional outcomes were good. No fixation failure or pulling out of suture anchors was encountered. Conclusion This minimally invasive technique using a suture anchor for the treatment of acute AC dislocation is easily performed.

Modified Combined Approach for Distal Humerus Shaft Fracture: Anterolateral and Lateral Bimodal Approach

Background Due to the anatomical nature of the radial nerve, dissection and attainment of an adequate operative field in mid to distal humerus fracture is dangerous and limited. We devised a combined anterolateral and lateral approach that ensures protection of the radial nerve. This is achieved by performing bimodal dissection of the proximal humerus anteriorly and the distal humerus laterally. Methods Thirty-five consecutive patients were treated using a combined anterolateral and lateral approach for a minimum follow-up period of 24 months. We analyzed time to bony union, time to return to daily work, range of motion, elbow joint function as assessed by the Mayo elbow performance index and complications. Results Radiologic bony union was observed at 11.2 weeks (range, 8 to 20 weeks) on average. Four cases of incomplete radial nerve palsy before surgery all recovered. Time to return to work was 10.2 weeks (range, 2 to 32 weeks) on average. The average range of motion of the elbow was 3.3° (range, 0° to 10°) of extension and 135.9° (range, 125° to 145°) of flexion. There were 21 cases of excellent and 13 cases of good or better recovery, comprising over 97.1% on the Mayo elbow performance index. There were no complications of radial nerve palsy, non-union, mal-union, or infection. Conclusions Our a modified combined anterolateral and lateral approach is a clinically effective surgical method of achieving protection of the radial nerve and securing easy and firm internal fixation.

Subsequent Hip Fracture in Osteoporotic Hip Fracture Patients

Purpose A significant number of patients who have experienced previous surgical treatment for an osteoporotic hip fracture experience a subsequent hip fracture (SHF) on the opposite side. This study aims to analyze the risk factors and the correlation between osteoporosis and SHF on the opposite side in order to assess the usefulness of bisphosphonate treatment for the prevention of SHFs. Materials and Methods We included 517 patients treated from March 1997 to April 2009 in this study. The inclusion criteria included previous unilateral hip fracture, without osteoporotic treatment, and a T-score less than -3.0 at the time of the fracture. We studied these patients in terms of death, SHF, alcoholism, living alone, dementia, dizziness, health status, osteoporotic treatment after fracture and bone mineral density (BMD). In total, 34 patients experienced a SHF. We selected another 34 patients without a SHF who had similar age, sex, body mass index, BMD, diagnosis, treatment and a follow up period for a matched pair study. We compared these two groups. The average follow up was 8.3 years and 8.1 years, respectively. Results The mortality rate of the 517 patients was 138 (27%). The BMD at the time of fracture demonstrated no statistical difference between the two groups (p>0.05). Nine patients (26%) within the SHF group were prescribed Risedronate and 18 patients (53%) received the same treatment in the non-SHF group. There was a statistical relationship with the treatment of osteoporosis (p=0.026). The average BMD of patients with SHF was -5.13 and -5.02 in patients without SHF was (p>0.05). Conclusion Although primary surgical treatments are important for an excellent outcome in osteoporotic hip fractures, treatment of osteoporosis itself is just as important for preventing SHFs.

Correlation between stress shielding and clinical outcomes after total hip arthroplasty with extensively porous coated stems.

Relations between stress shielding and the clinical outcomes of total hip arthroplasty(THA) remain topics of debate. This study was performed on 51 patients that underwent unilateral primary THA with an extensively porous coated stem. Contralateral normal femurs were used as controls. Dual energy x-ray absorptiometry data was used to quantify bone mineral density(BMD) on proximal femurs. Clinical outcomes were estimated by using Harris hip scores (HHSs). BMD in operated sides were lower than in control sides. HHS and pain scores were not related to BMD changes. An extensively porous coated stem can be used for THA and that concerns regarding the effects of stress shielding of the proximal femur are unwarranted.

Femoral Nerve Palsy with Patella Fracture

Femoral neuropathy may be associated with various etiologies and can cause severe walking disability. We present the case of a 25-year-old woman who underwent surgical repair for a patella fracture and complained of lower extremity pain, paresthesia, and weakness postoperatively. Electromyography and magnetic resonance imaging (MRI) revealed partial peripheral neuropathy of the left femoral nerve associated with the patella fracture. To our knowledge, this is the first reported case of femoral neuropathy associated with a patella fracture.

Brachial Artery Transection with Closed Elbow Dislocation - A Case Report -

Vascular injury in the arm associated with trauma usually results from penetrating injury. However, this vascular injury can also be caused by open dislocation of the elbow or closed fracture of the humerus. Although the elbow joint is the third most common site of joint dislocation, closed elbow dislocations without associated fractures rarely have concomitant arterial injury. The authors report a case of complete disruption of the brachial artery associated with closed dislocation of the elbow and massive soft tissue damage. The patient was successfully managed by early diagnosis, prompt reduction of the dislocation, and end to end anastomosis of the brachial artery and fasciotomy.