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Noboru Matsumura, Hiroyasu Ikegami, Kiyohisa Ogawa, Shuzo Kobayashi
2012 Volume 36 Issue 2 Pages
307-310
Published: 2012
Released on J-STAGE: October 25, 2012
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Background: Two-dimensional computed tomography (CT) scan method is appropriate for clinical use and it has been utilized in most of past studies. However, the defined axes of the proximal and distal part of the humerus have not been standardized yet. The purpose of this study was to ascertain a normal value of the humeral version using different measuring methods using CT and to clarify a reliable method in determining the humeral version.
Methods: We used bilateral shoulder CT scans of 167 healthy volunteers. Surface axis, anatomical axis, neck axis, and metaphysis axis were used as the proximal axis to measure the individual humeral head retroversion. Differences and correspondence between shoulder dominance and between measuring methods were examined.
Results: The mean value of humeral retroversion measured by the several methods was within the range between 28.6 and 29.9 degrees in the dominant side and the range between 24.4 and 25.1 degrees in the non-dominant side. There was no significant difference and excellent correspondence was found between measuring methods. The value in dominant shoulder was significantly larger than the value of non-dominant shoulder, and the correspondence in shoulder dominance was fair to good.
Discussion: The measured values of the humeral version showed strong correspondence between the measuring methods that we used in this study. We concluded that all of the measuring methods were reliable in clinical cases and we should choose an adequate measuring method for the respective cases.
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Atsushi Tsuchiya, Naoko Ohyabu, Hideyuki Goto, Masahito Yoshida, Tetsu ...
2012 Volume 36 Issue 2 Pages
311-314
Published: 2012
Released on J-STAGE: October 25, 2012
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Background: The usefulness and importance of ultrasonography of the shoulder joint have been recognized by orthopedic surgeons. However, there is no report about the evaluation of ultrasonography of the shoulder joint by patients. The purpose of this study was to investigate the evaluation of ultrasonography of the shoulder joint by patients.
Methods: Thirty nine patients (32 males, 7 females) who had undergone ultrasonography of shoulder joint by an orthopedic surgeon who was familiar with ultrasonography were enrolled in this study. We asked about the usefulness of ultrasonography, and examination fee in the questionnaires.
Results: Regarding the usefulness of ultrasonography, the number of “very useful”, “somewhat useful”, “not so useful” were 34, four and one respectively. Regarding the examination fee, the number of “reasonable”,“MRI is expensive”, “inexpensive ” and “no answer” were 31, four , two and one respectively.
Conclusion: Most patients judged ultrasonography of the shoulder joint was useful and the examination fee was reasonable.
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Takashi Hayakawa, Nobuyuki Yamamoto, Hirotaka Sano, Eiji Itoi, Takayuk ...
2012 Volume 36 Issue 2 Pages
315-318
Published: 2012
Released on J-STAGE: October 25, 2012
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Background: Real-Time Tissue Elastography (RTE), a newly introduced ultrasound technique to evaluate tissue elasticity, has been widely used to make a diagnosis of breast and thyroid cancer. We investigated the difference between the elasticity of the rotator cuff tendons in healthy young and elderly volunteers with use of RTE.
Methods: The rotator cuff tendons of 60 shoulders/31 healthy volunteers (young group: mean age, 29 years old) and 34 shoulders/24 healthy volunteers (elderly group: mean age, 70 years old) without any shoulder symptoms were examined using a linear-array transducer (Hi-vision Avius, HITACHI-Aloka). The elasticity of the superficial layer and deep layer of the supraspinatus and infraspinatus tendons was measured with a newly developed coupler with known elasticity. Strain of the tissue was calculated from the color changes on the longitudinal images. The ratio of the tendon strain divided by the coupler strain (strain ratio) was compared between the tendons.
Results: The strain ratio of the deep layer was significantly smaller than that of the superficial layer in both groups (P<0.001). Between the groups, there was no difference in the strain ratio of the superficial layers, but the elderly group tended to show lower strain ratio in the deep layers.
Conclusion: The superficial layer of the rotator cuff tendon is more deformable than the deep layer. Rotator cuff tear may be related to the difference in material properties of the superficial and deep layers of the tendon.
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Katsumasa Sugimoto, Hideyuki Goto, Masato Yoshida, Atsushi Tsuchiya, T ...
2012 Volume 36 Issue 2 Pages
319-321
Published: 2012
Released on J-STAGE: October 25, 2012
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Background: Shoulder pain and injuries are common in throwing athletes. Ultrasonography(US) is well suited to evaluate the soft tissue of the shoulder and plays an important role for screening. The purpose of this study was to evaluate findings of US images in throwing athletes who were treated for anterosuperior corner injury (SLAP lesion, middle glenohumeral ligament (MGHL) injury, etc) confirmed at arthroscopy.
Methods: We treated 19 athletes, (17 men, 2 women) with a clinical diagnosis of SLAP lesion and tear or elongation of MGHL, using suture anchor in 2010. In this study, pre and postoperative US evaluation of these patients were reviewed retrospectively. Our equipment was LOGIQ e (GE medical system) with 9.0MHz microconvex-type probe. Rotator Interval and anterosuperior labrum between humeral head and coracoid process was investigated with the long axis plane. The mean age of subjects was 24.2 years old ranging from 16 to 45. Acute traumatic cases were excluded in the present study.
Results: A low echoic spot was found between humeral head and coracoid process in 17 cases. Comparing this to the arthroscopic findings, a low echoic spot at the anterosuperior corner may show some correlation with injury of MGHL, SLAP lesion, inflammation or tear of anterior-superior capsule and the synovium of the rotator interval.
Conclusion: Additional work is necessary to further define objective radiographic evidence.
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Emi Mizushima, Toshiaki Hirose, Shinsuke Nonaka, Shigekazu Ueno, Shota ...
2012 Volume 36 Issue 2 Pages
323-325
Published: 2012
Released on J-STAGE: October 25, 2012
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Background: The purpose of this study was to investigate the efficiency of MR imaging for diagnosing SLAP lesions associated with rotator cuff tear.
Methods: 57 shoulders with rotator cuff tear were examined and all patients underwent MRI before arthroscopic rotator cuff repair. Intensity and morphological changes of superior labrum in T2 and PD weighted images by the spin echo method, and multiple echo recombined gradient echo (MERGE) method were evaluated and categorized by Yamasaki's classification. Then we compared the evaluation by MRI with arthroscopic findings. In evaluation by MRI, SLAP lesion was diagnosed with Type II-B, type III or type IV according to Yamazaki's classification.
Results: In MERGE method, sensitivity is 100%, specificity is 67% and accuracy is 73%. In T2 weighted images, sensitivity is 45%, specificity is 80% and accuracy is 73%. In PD weighted images, sensitivity is 72%, specificity is 56% and accuracy is 59%.
Conclusion: MERGE method had the highest sensitivity and accuracy. So this becomes useful as a screening test of SLAP lesion.
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Tomonori Kenmoku, Genyo Miyajima, Masaru Tsukano, Nobuyasu Ochiai, Hir ...
2012 Volume 36 Issue 2 Pages
327-330
Published: 2012
Released on J-STAGE: October 25, 2012
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Background: The purpose of this study was to assess the movement of rotator cuff in internal and external rotation of the shoulder, by MRI.
Methods: Subjects were twenty-one volunteer who had no shoulder problems (11 males, 10 females). The average age at the time of investigation was 28.7 years old. All scans were done on a GE Signa MRI 1.5T scanner. A linear shoulder coil was used. We used Fast Imaging Employing Steady state Acquisition (FIESTA) images of MRI to assess rotator cuff movement (TR: 4.6msec, TE: Min Full 2.1msec, Flip Angle:20 degree, Bandwidth:+62.5, Matrix:256x224, NEX:1.0, FOV:28x28, Slice Thickness: 6.0mm). An axial scout scan at the middle of the smaller tuberosity of humerus was done. Subjects reciprocated their shoulder from maximum internal rotation to maximum external rotation in 20 seconds in drooping position. We assessed congruity, rotation angle and cross-section ratio of muscles. The cross-section ratio of subscapularis and infraspinatus at maximum internal and external rotation, and neutral position were compared.
Results: All cases kept congruity of the glenohumeral joint during rotation. Internal and external rotation angles were 45.3 ± 27.2 degrees and 55.4 ± 22.3 degrees, respectively. The subscapularis ratio of neutral to external rotation, and to internal rotation were 1.10 ± 0.10, 0.94 ± 0.11, respectively, and the infraspinatus ratios were 0.95 ± 0.09, 1.02 ± 0.08, respectively.
Discussion: FIESTA was able to shoot the rotator cuff movements with vivid clarity. In concentric contraction of subscapularis and infraspinatus, the cross-section area that was parallel to the direction of muscle fibers became significantly smaller than the area in eccentric contraction. FIESTA was able to assess rotator cuff function.
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Naomi Oizumi, Naoki Suenaga, Chika Yoshioka
2012 Volume 36 Issue 2 Pages
331-335
Published: 2012
Released on J-STAGE: October 25, 2012
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Background: The purposes of this study were to investigate glenohumeral translation in normal and instable shoulders using open MRI and to investigate the correlation between the results and sulcus sign under anesthesia.
Methods: Eleven shoulders of 11 patients with traumatic anterior instability (8 men, 3 women, average age; 23.3 years old) were included in this study. In supine position, axial and oblique-coronal images of the glenohumeral joint were obtained by 0.4T open MRI. The examined shoulder positions were Series 1; abduction (Abd) 30°, 60°, 90°, 120°, and 150° at scapular plane, and Series 2; internal rotation (IR) 60°, 30°, external rotation (ER) 0°, 30°, 60°, and 90° at abduction 90° at frontal plane. Translation of the center of the humeral head from the center of the glenoid was measured. Eight normal shoulders (6 men, 2 women, average age; 28.4 years old) were also examined as a control group.
Results: Series 1; In the control group, centered movement was observed in both anterior-posterior and superior-inferior directions. The instability group showed significant posterior translation at Abd 30°. Series 2; The control group showed gradual anterior translation from IR to ER position. The instability group showed significant posterior translation at IR 30°. In superior-inferior translation, both groups showed gradual inferior translation from IR to ER position, however, the translation was significantly larger at IR 30°, 60°, ER 60° in the instability group. Remarkable inferior translation was observed in 2 shoulders out of 6 that showed positive sulcus sign.
Discussion: Open MRI analysis demonstrated anterior-inferior translation at ER position and posterior-inferior translation at IR position in instable shoulders.
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Takahiko Aoyagi, Toshiyuki Tsuruta, Mitsunori Komine
2012 Volume 36 Issue 2 Pages
337-341
Published: 2012
Released on J-STAGE: October 25, 2012
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Background: This study was designed to clarify the differences in functional recovery between conservative and operative therapy in young athletes with first shoulder joint dislocation involving Bankart lesion. Furthermore, we wish to make a helpful contribution to the decision of future treatment for patients with first shoulder joint dislocation involving Bankart lesion with the current research.
Methods: This study enrolled 24 young athletes (17 men and 7 women, age: 18.5 ± 5.2 years) with first shoulder joint dislocation involving Bankart lesion. The treatment performed was 13 conservative and 11 operative therapy (arthroscopic Bankart repair technique).
Results: The JSS-IS, JSS-SS and DASH scores were significantly better in the operative therapy patients compared to the conservative therapy patients (p<0.05, respectively). The gratification for treatment was significantly higher in the operative therapy group compared to the conservative therapy group (p<0.05). The muscle strength (inner/lateral rotation, flexion/extension and adduction/abduction in shoulder joint) was significantly higher in the operative therapy group in comparison to the conservative therapy group (p<0.05). The re-dislocation was observed in only two patients in the conservative therapy group (15.4%).
Conclusion: These results suggest that arthroscopic Bankart repair technique was an effective treatment to be able to obtain good results compared to the conservative therapy. Therefore, patients with first shoulder joint dislocation involving Bankart lesion might be positively treated with operative treatment because re-dislocation was observed in only conservative therapy.
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Takayuki Dohke, Toshiaki Hirose, Shinsuke Nonaka, Shigeharu Kimura, Sh ...
2012 Volume 36 Issue 2 Pages
343-346
Published: 2012
Released on J-STAGE: October 25, 2012
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Background: The purpose of this study was to compare the clinical results between the collision and contact sports, and between the arthroscopic and open methods.
Methods: In the case collision sports, twenty-three shoulders(group CLA) underwent arthroscopic Bankart repair(AB method), 25 shoulders(group CLB) had modified Bankart and Bristow procedure(BB method), and in contact sports, 19 shoulders(group CTA) had AB method, 10 shoulders(group CTB) had BB method. The mean age of the patients at the time of surgery was 20.3 years old, and the mean follow-up period was 61.7 months. Indication for AB method was that the glenoid bone loss was 25% or less and we can lift up AIGHL to the articular surface. We evaluated clinical outcome by JSS score, level of return to sports activities, the recurrence rate of dislocation, satisfaction levels and complications.
Results: Postoperative JSS score improved in all groups. Although almost all patients returned to sports, the rate of return to pre-injury sports activity levels, of re-dislocation and satisfaction levels in group CLA were the worst of all the groups. Satisfaction levels in group CLA was significantly worse than group CLB.
Discussion: Although in the contact sports group, clinical outcomes had no significant difference between AB and BB methods, in the collision sports group, clinical outcomes in AB method were significantly worse. We think BB method is better than AB method for traumatic anterior shoulder instability in collision sports athletes.
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Shigeto Nakagawa, Naoko Mizuno
2012 Volume 36 Issue 2 Pages
347-350
Published: 2012
Released on J-STAGE: October 25, 2012
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Background: The frequency and timing of bony absorption of bony Bankart lesions in shoulders with traumatic anterior instability were investigated.
Methods: 161 shoulders were examined by CT scan. In shoulders with bony Bankart lesion, rates of bony defect of the glenoid and bony absorption of bony fragment were measured and their correlation with the period after the first traumatic episode was investigated. The findings at operation were also investigated in 113 shoulders.
Results: Regarding bony defect, there were no defects in 73 cases, erosion in 12, 0-10% in 11, 10-20% in 36, 20-30% in 20, and 30-40% in 9 cases. Bony defect was slightly enlarged with time. Regarding bony absorption, among 76 shoulders with bony defect several kinds of bony absorption was seen, except in 7 shoulders with first time dislocation. The degree of bony absorption was less than 50% in 31 cases, more than 50% in 32 cases, and 100% in 13 cases. Regarding the relation with the period of time after the first traumatic episode, the average rates of bony absorptions were 35.5% at less than 1 year, 61.1% between 1-2 years, and 74.7% at more than 2 years. In shoulders with large bony defect, more than 20 %, those were 31.9%, 76.2 %, and 71.3%, respectively. As characteristic findings of shoulders with bony erosion, no first time dislocation, long period after first traumatic episode, small bony defects, or small bony fragment at operation were detected.
Conclusion: Most of the bony fragments were absorbed by one year after the first traumatic episode. Bony erosion might be the complete absorption of small bony fragments.
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Kenji Yasui, Yoshiharu Kato, Atsushi Nakamura, Katsuaki Kanbe
2012 Volume 36 Issue 2 Pages
351-353
Published: 2012
Released on J-STAGE: October 25, 2012
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Background: The purpose of this study is to evaluate the clinical outcomes of the conservative therapy for old anterior dislocation of the shoulder.
Methods: We performed conservative therapy on 5 patients (average age, 76 years old) who suffered from old anterior dislocation of the shoulder. All cases were just followed closely without treatment. The follow-up mean period was 17.5 months. 2 patients have had incomplete paralysis by cerebral apoplexy, 1 patient has had Parkinson's disease, and another patient suffered from dementia. We investigated the cause and background of old anterior dislocation of the shoulder, and evaluated their clinical outcomes using JOA score.
Results: The causes of old anterior dislocation of the shoulder were 2 cases. One was false self-judgment and delayed treatment, the other was wrong diagnosis and inadequate treatment. The mean JOA score was 57.8/100 points, in particular the mean pain score was 27/30 points. Failure cases were the inactive patient before injury and the patient complicated with reducing hand function owing to peripheral neuropathy for this dislocation.
Conclusion: The patients suffering from old anterior dislocation of the shoulder were satisfied with the conservative therapy in their own way. The activities of daily living could be maintained relatively well. If the patients did not need high level shoulder function, as is the case for the elderly or inactive patients, we could choose the conservative therapy for them.
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Hiroyasu Ikegami, Noboru Matsumura, Yoshiaki Toyama, Kiyohisa Ogawa, N ...
2012 Volume 36 Issue 2 Pages
355-358
Published: 2012
Released on J-STAGE: October 25, 2012
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Background: The treatment of chronic unreduced dislocation of the shoulder is a difficult case in shoulder surgery. The purpose of this study is to investigate clinical results of surgical treatments for chronic unreduced dislocation of the shoulder by implants.
Methods: 10 shoulders of 10 patients were studied. The average age at the time of the surgery was 60 (range: 34 to 89) years old. The period from trauma to surgery ranged from 3 months to 34 years. We investigated the surgical approach, operative findings, complications and postoperative results by JOA score.
Results: Six cases were treated by hemi shoulder arthroplasty and four cases by total shoulder arthroplasty. The surgical approach was combined anterior and posterior in 2 out of 4 cases of chronic unreduced posterior dislocation. For chronic unreduced anterior dislocation, the surgical approach was only anterior. We repaired the bone defect of the scapula by bone graft in six cases. In all cases, pain was reduced and the shoulder joint was reduced. The average JOA score improved from 25 points preoperatively to 78 points postoperatively.
Conclusion: When we treat chronic unreduced dislocation of the shoulder surgically, we have to pay great attention to both soft tissues and bones. The combined approach from anterior and posterior is useful for chronic unreduced posterior dislocation. Posterior capsule release is very important for chronic unreduced anterior dislocation. We have to repair the bone defect of the articular surface of the scapula.
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Atsuko Kanno, Toshitake Aizawa
2012 Volume 36 Issue 2 Pages
359-362
Published: 2012
Released on J-STAGE: October 25, 2012
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Background: There are numerous methods of treatment of acromioclavicular dislocation. The object of our study was to investigate the results of acromioclavicular dislocations using ACJ plate
®, which is an anatomical hook plate.
Methods: The subjects were 23 patients who had acromioclavicular dislocation and were treated with ACJ plate in our hospital. The mean age was 40.3 years old. There were 4 cases of Rockwood type III, 1 case of type IV, and 18 cases of type V. The hardware was removed 6 months after fixation. The flexion angle and pain were investigated. The distance between clavicle and coracoid process (C-C distance) was measured in X-ray photos, which were taken before and after operation, just after removal of hardware, and at the last follow-up, 1 month after removal. By questionnaire, American Shoulder Elbow Score (ASES) and pain visual analog score (VAS) were investigated.
Results: The mean flexion angle was 143.1 degrees. In 3 of 5 cases in who motion pain remained, shoulder contracture remained. The mean C-C distance before and after operation, after removal, and at last follow-up was 17.4mm, 6.9mm, 8.2mm, and 10.2mm, respectively. In one case, cutout occurred. In 2 cases, the position of the plate was insufficient, and revision surgery was necessary. The mean ASES was 85.3. The mean VAS was 2.1.
Conclusion: In the measurement, the result of this procedure was satisfactory; however, there were similar clinical problem to other types of hook plate, such as shoulder contracture and cutout.
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Hitoshi Shitara, Hiroyuki Sugaya, Norimasa Takahashi, Nobuaki Kawai, N ...
2012 Volume 36 Issue 2 Pages
363-366
Published: 2012
Released on J-STAGE: October 25, 2012
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Background: 947 patients have been treated with arthroscopic procedure in the last 6 years. The purpose of this study was to assess the clinical outcomes of arthroscopic stabilization after recurrent glenohumeral instability in soccer players.
Methods: 64 patients, who played soccer before surgery, underwent arthroscopic stabilization for recurrent glenohumeral instability between January 2004 and April 2010. Causes of first time dislocation, details of arthroscopic surgery and clinical outcomes which including JSS-SIS, JSS-SSS, Rowe score, ranges of motion and recurrence rate were investigated retrospectively.
Results: The first time dislocation in 56% of the patients occurred while playing soccer.
During arthroscopic surgery, bony Bankart lesion, capsular tear, SLAP lesion and HAGL lesion were observed 43%, 7%, 49% and 0%, respectively. The post operative JSS-SIS, JSS-SSS and Rowe scores were significantly improved when compared with each preoperative score (P<0.0001). No significant differences were observed in external rotation range at side and at 90° shoulder abduction. On the other hand, there were significantly increased differences in anterior elevation (P<0.05). Five patients (7.1%) experienced re-injury after return to sport.
Discussion and Conclusion: There was no report focusing on arthroscopic stabilization for anterior glenohumeral instability in soccer players. 5 patients (7.1%) experienced re-injury after return to soccer. In particular, goal keepers seem to be at high risk because 1 out of 5 re-injured after return (20%) to sport. In addition, young active patients are also at high risk, as the recurrence cases in our series were all age 18 or under when re-injured during playing soccer or other sports activities.
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Norimasa Takahashi, Hiroyuki Sugaya, Nobuaki Kawai, Hirokazu Nagai, No ...
2012 Volume 36 Issue 2 Pages
367-371
Published: 2012
Released on J-STAGE: October 25, 2012
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Background: Baseball, which includes both overhead and contact sport aspects, is one of the most popular sports in Japan. The purpose of this study is to report the treatment outcome after arthroscopic stabilization for recurrent glenohumeral instability in baseball players.
Methods: Subjects consisted of 45 baseball players who underwent arthroscopic stabilization for recurrent anterior glenohumeral instability. All patients were males with a mean age of 17.8 years old. Among them, the dominant arm was affected in 29 patients (D group) and the non-dominant arm was affected in 16 patients (ND group). All patients were followed for a minimum of one year after surgery. The causes of first time dislocation and clinical outcomes were investigated.
Results: The first time dislocation mostly occurred when they played baseball. Among them, 17 patients (57%) were injured by head-first sliding in the D group. Head-first sliding (43%) and diving catch (36%) were the two major causes in ND group. Patients initiated the throwing activity at 4.5 months after surgery in D group and 3.5 months after surgery in ND group, on average. They returned to competition at 9.6 months after surgery in D group and 6.2 months after surgery in ND group, on average. Three patients (6.7%) experienced re-injury after return to baseball.
Conclusion: The most frequent cause of first time dislocation in baseball players was head-first sliding. Arthroscopic stabilization for these patients yielded a satisfactory outcome. However, in dominant shoulders, 3.5 additional months were required to return to competition when compared with the non-dominant arm.
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Noriaki Shimada, Hiroyuki Sugaya, Norimasa Takahashi, Nobuaki Kawai, H ...
2012 Volume 36 Issue 2 Pages
373-376
Published: 2012
Released on J-STAGE: October 25, 2012
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Background: The purpose of this study was to evaluate clinical outcome of arthroscopic Bankart repair in martial arts players.
Methods: Subjects consisted of 57 martial arts players who underwent arthroscopic stabilization for recurrent anterior glenohumeral instability between 2004 and 2010. These included 49 males and 8 females with a mean age of 24.5 years old. Among them were, 15 karate players, 10 wrestlers, 10 mixed-martial-arts players, 8 boxers, 7 kick boxers, 2 kendo players, 2 aikido players and 3 others were included. Arthroscopic Bankart repair is performed using 4 suture anchors between 2 and 6 o'clock on the face of the glenoid. Rotator interval closure was utilized depending on the patients risk factors which included the bone morphologies, age, joint laxity and sports activity. The causes of first time dislocation, details of surgery and clinical outcomes were reviewed retrospectively.
Results: The first time dislocation occurred in 44 patients at the time of contact with the opponent. Typical cases of contact were crossing each arm with the opponent when punching and the arm taken by the opponent when grappling. Thirty-six SLAP lesions, 6 capsule tears, 4 rotator cuff tears and one HAGL lesion were addressed in addition to Bankart repair. Rotator interval closure was performed in 52 shoulders. Fifty patients returned to their sports at an average of 7.7 months after surgery. No significant motion loss was evident at the final follow up. Rowe score was significantly improved postoperatively.
Conclusion: Three patients experienced re-injury after return to their sports. Arthroscopic stabilization for this high demand population yielded satisfactory outcomes in terms of recurrence and sports return rate.
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Hiroyuki Shiozaki, Yoshiaki Kon, Takayuki Murayama
2012 Volume 36 Issue 2 Pages
377-381
Published: 2012
Released on J-STAGE: October 25, 2012
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Background: Although the main pathology of recurrent anterior shoulder dislocation in younger patients is proved to be the injury of the anterior capsular mechanism such as Bankart lesion, the pathology in older patients has not been thoroughly discussed. The purpose of this study was to clarify the pathological condition of the recurrent anterior shoulder dislocation in the middle aged or older patients, and to investigate the results of arthroscopic surgery.
Methods: Twenty-eight patients of recurrent anterior shoulder dislocation had arthroscopic surgery performed at the age of forty or older, between 2003 and 2009. There were 13 men and 15 women, and the mean age at the surgery was 53.6 years old. The pathological condition which causes anterior instability was investigated according to the imaging findings and arthroscopic findings. The results of arthroscopic treatment were checked in twenty-two patients who were followed for at least one year after surgery.
Results: A variety of anterior capsular mechanism injuries were present in all patients, whereas rotator cuff tear was likely present in older patients. Among the injuries of anterior mechanism, AIGHL tear or HAGL lesion were frequently seen. Arthroscopic stabilization procedure resulted in a favorable outcome.
Conclusion: Anterior capsular mechanism injury was the main pathology of the recurrent anterior shoulder dislocation in older patients as well as in younger patients. Arthroscopic repair of the anterior mechanism seemed to be the most important treatment even in the case of concomitant rotator cuff tear.
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Hiroyuki Sugaya, Norimasa Takahashi, Nobuaki Kawai, Hirokazu Nagai, No ...
2012 Volume 36 Issue 2 Pages
383-387
Published: 2012
Released on J-STAGE: October 25, 2012
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Background: The purpose of this study is to evaluate the short term outcome after arthroscopic iliac bone grafting with capsulolabral reconstruction for shoulders with significant glenoid bone loss.
Methods: Subjects consisted of 20 patients, including 18 males and 2 females, who underwent the index surgery and were followed for more than one year. The average age at surgery was 28 years old and the average follow-up period was 21.0 months. There were 14 primary and 6 revision surgeries. Iliac crest was harvested with the patients in the supine position under general anesthesia. Arthroscopic iliac bone grafting was then performed in the beach-chair position followed by capsulolabral reconstruction. In addition, rotator interval closure was performed as an augmentation. Postoperative outcomes including Rowe score and sports return, ROM, and 3DCT findings were evaluated at the final follow-up.
Results: The postoperative average Rowe score improved significantly from 21.3 to 92.0. Sixteen out of 17 patients who were engaged in sports returned to their sports after surgery. Postoperative ROM was 170 degrees in elevation, 51 degrees in external rotation, and T10 in internal rotation. Postoperative 3DCT, which was performed more than one year after surgery, demonstrated optimal remodeling of the graft in 3, moderate remodeling and absorption in 4, and fair remodeling and distinct absorption in 3 patients. Graft position was strongly related with postoperative bone remodeling and absorption. No patients experienced re-dislocation after the index surgery.
Conclusion: Although technically demanding, arthroscopic iliac bone grafting for shoulders with significant bone loss yielded successful outcomes with minimum morbidity.
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Yoshiyasu Uchiyama, Hiroko Omi, Hiroyuki Hashimoto, Joji Mochida, Akiy ...
2012 Volume 36 Issue 2 Pages
389-392
Published: 2012
Released on J-STAGE: October 25, 2012
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Background: Traumatic anterior shoulder instability (TASI) is associated with approximately 50% of chronic bony Bankart (CBB) lesions; however, an optimal repair method for CBB lesions is not known. This retrospective study compared the postoperative instability and repair of TASI-related CBB lesions by using 3-dimensional-computed tomography (3D-CT).
Methods: We operated on 91 patients for TASI from 2007 to 2010, and we reviewed the results for CBB repair of TASI in 40 patients 44% (38 males; 2females). The mean values for age at the time of operation and follow-up period were 23.3 years old (range, 14-46 years) and 19.8 months (range, 12-30 months), respectively. Arthroscopic Bankart repair and open inferior capsular shift were used for 33 and 7 patients, respectively. Bone loss in the anterior glenoid and nonunion rate of the bony fragment were estimated using pre- and postoperative 3D-CT, and postoperative instability (reinstability and apprehension) was determined to assess bony fragment repair.
Results: The CBB lesions were classified into the nonunion (32 patients, 80%) and union (8 patients, 20%) types. The average bone loss in the lower circular glenoid portion was 16.9% (range, 3-37%). Shoulder dislocation and subluxation did not recur; however, positive anterior apprehension was noted in 3 patients (7.5%) who had a large bony fragment (average bone loss was 32.4%, range, 25-37%) and insufficient improvement of the bony fragment and residual nonunion.
Conclusion: Sufficient improvement of the bony fragment and bone union is required to relieve anterior instability in TASI-related CBB lesions.
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Kazuhiko Kikugawa, Nobuyoshi Okuhira
2012 Volume 36 Issue 2 Pages
393-396
Published: 2012
Released on J-STAGE: October 25, 2012
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Background: Osteoarthritis pre and post open surgery for traumatic anterior shoulder instability was well reported, but that of pre and post arthroscopic surgery was rarely reported. The purpose of this study is to evaluate the presence of osteoarthritis pre and post arthroscopic Bankart repair for traumatic anterior shoulder instability.
Methods: 78 cases of traumatic anterior shoulder instability (male 48, female 30; mean age 21.2years old) treated by arthroscopic Bankart repair were investigated. Osteoarthritis was evaluated by Samilson methods for preoperative, postoperative 6months, 1year, 2years XP.
Results: Osteoarthritis existed in 7 shoulders (9%) in postoperative 2years XP. Osteoarthritis existed in 4 shoulders in preoperative XP. They were related with age, numbers of shoulder dislocations, large bony defect in glenoid. In 3 shoulders, osteoarthritis was newly developed postoperatively. They were related with large bony defect in glenoid and number of strong sutures in operation. 2 shoulders developed osteoarthritis with knot impingement by strong sutures.
Conclusion: Osteoarthritis, post arthroscopic Bankart repair, was newly developed in a few cases, we must be careful in case of large bony defect in glenoid, and of excessive use of strong sutures.
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Yasushi Fukaya, Hiroki Oba, Yoshitoshi Higuchi
2012 Volume 36 Issue 2 Pages
397-400
Published: 2012
Released on J-STAGE: October 25, 2012
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Background: Anterior shoulder dislocation is one of the most common injuries seen at emergency rooms (ER) and would be problematic if it became a recurrent instability. However, in fact, we fail to see most patients after the treatment at ER due to some reasons like complete pain relief obtained with reduction. In this study, we assessed the prognosis of the patients who underwent closed reduction with the diagnosis of anterior shoulder dislocation.
Methods: Fifty nine patients with acute anterior shoulder dislocation, who had undergone closed reduction at ER in our institute between March 2006 and December 2008, were retrospectively investigated with medical records and via telephone interview as of April 2011. The mean age at the time of injury was 35.9 years old.
Results: Of 59 patients who had closed reduction at ER in our institute between March, 2006 and December, 2008, 12 patients (20.3 %) came back to see an orthopedic doctor after the treatment for outpatient care. Regarding the telephone review, after an average of 3.5 years (2 to 5 years) from reduction, reconnection with the patient via phone was obtained in 30 cases (50.8%). Among the 30 patients, 20 patients did not return to the orthopedic clinic with the reason of self-judgment (65%) and visiting another clinic or osteopath (35%).
Tenpatients (33.3%) experienced recurrent dislocation after the reduction at ER.
The plausible factorthat affected the re-dislocation in this study was age at the time of reduction (P=0.025).
Conclusion: Our study showed the rate of re-visit was only 20.3%. It might be necessary for us to make more effort to educate the residents working at ER for the understanding of pathogenesis and prognosis of shoulder dislocation.
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Hiroshi Iwaso, Hisao Kumamoto
2012 Volume 36 Issue 2 Pages
401-404
Published: 2012
Released on J-STAGE: October 25, 2012
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Hideki Hiraiwa, Tadahiro Sakai, Takashi Hamada, Takaaki Ohmachi, Yohei ...
2012 Volume 36 Issue 2 Pages
405-408
Published: 2012
Released on J-STAGE: October 25, 2012
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Background: To investigate the effect of the glenoid bone-deficit for shoulder stability, we examined the correlation between the load-and-shift (LAS) test and the glenoid bone-deficit in patients with recurrent dislocation of shoulder (RDS).
Methods: 24 patients who underwent surgery for RDS with glenoid bone-deficit between 2007 and 2010 were studied. Under general anesthesia, the LAS test at 45°, 90° and 120° shoulder abduction (LAS45, LAS90, LAS120) was performed by an examiner and each LAS-point (0-3) according to Hawkins' classification(0-3)was recorded. Using CT-image, we calculated the glenoid width ratio and divided the morphology of bone-deficit into "avulsion type (A-group)" and "compression type (C-group)".
Results: Mean LAS-point was high in the order of LAS90(2.58), LAS45(1.29) and LAS120(1.00). As well as bone-deficit size, mean LAS-point in A-group was significantly higher than that in C-group at LAS90, but was lower at LAS120. Mean glenoid width ratio was 77.1% (A-group), 85.6% (C-group) and 81.0% (whole group). Significant correlation between LAS-point and glenoid width ratio was seen at LAS90 in C-group and whole group.
Discussion: Although the bone-deficit in C-group was smaller than in A-group, the point of LAS120 in C-group was higher than A-group. These results suggest that it was because the humeral head and glenoid contact on different areas, and the ligament restriction of the anterior translation of humeral head is also different at different glenohumeral abduction angles. About the correlation between LAS-point and glenoid width ratio, we speculate that it was because LAS-point does not increase more than three points even if the bone-deficit is larger.
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Masayuki Abe, Minoru Yoneda, Wataru Sahara, Shin-ichi Yamada
2012 Volume 36 Issue 2 Pages
409-412
Published: 2012
Released on J-STAGE: October 25, 2012
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Background: Glenoid bony defect is known as a risk factor of postoperative recurrence of anterior glenohumeral instability. The purpose of this study was to measure the glenoid bony defect by three different methods with 3D-CT, and to evaluate the reliability of these methods.
Methods: We used the en face 3D-CT views of the glenoid and measured bony defect of the glenoid by three methods in 20 patients with unilateral anterior shoulder instability. Method 1 (Fitting circle): a circle was fitted to the posterior-inferior glenoid contour and the bony defect was determined as the distance between the anterior edge of the glenoid rim and the anterior contour of the circle. Method 2 (Based on the glenoid long axis): The bony defect was determined by subtracting the distance between the glenoid long axis and posterior edge of the glenoid rim from the distance between the long axis and anterior edge of the glenoid rim. Method 3 (Comparing both shoulders): The bony defect was determined as the difference of antero-posterior widths of the glenoid comparing between both shoulders. Two observers calculated the ratios of bony defect twice by the three methods.
Results: The ratios of bone defect of method 1 was significantly larger than those of the other methods (P<0.01). Intraclass correlation coefficients (ICC) revealed excellent intraobserver and interobserver reliability for method 3 (0.91-0.96), and moderate reliability for method 1 (0.43-0.67).
Conclusion: The most reliable method for measurement of the glenoid bony defect was comparing antero-posterior widths between both shoulders.
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Daisuke Kurokawa, Nobuyuki Yamamoto, Yasushi Omori, Hirotaka Sano, Eij ...
2012 Volume 36 Issue 2 Pages
413-416
Published: 2012
Released on J-STAGE: October 25, 2012
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Background: A large Hill-Sachs lesion has been considered as a risk factor for postoperative recurrence. However, there are few reports describing the incidence of Hill-Sachs lesions that engage with the glenoid. The purpose of this study was to clarify the incidence of engaging Hill-Sachs lesions using a new concept of the glenoid track.
Methods: We retrospectively reviewed CT images of 74 patients with unilateral recurrent anterior dislocation (average age: 26 years old). The DICOM data were reconstructed to 1-mm-thick slices in the oblique coronal plane perpendicular to the line connecting the medial margin of the cuff attachment site. In these slices, we measured the maximum distance from the medial margin of the Hill-Sachs lesion to the medial margin of the footprint of the rotator cuff. The location of the Hill-Sachs lesion in the glenoid track was assessed.
Results: Among 74 shoulders, 70 shoulders showed Hill-Sachs lesions. The most medial margin of the Hill-Sachs lesion was located 14.2 ± 3.6 mm (mean ± SD) medial from the footprint, which was equivalent to 67% ± 19% of the glenoid track width. In four out of 70 cases with Hill-Sachs lesions (5.7%), the most medial margin of the Hill-Sachs lesion extended medially over the glenoid track.
Discussion: Burkhart et al. reported that the incidence of engaging Hill-Sachs lesion was 1.5%. In our series of 74 cases, the prevalence was 5.4%. Hill-Sachs lesions that need to be treated surgically are proved to be rare.
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Shintaro Yamane, Naoki Suenaga, Naomi Oizumi, Chika Yoshioka
2012 Volume 36 Issue 2 Pages
417-420
Published: 2012
Released on J-STAGE: October 25, 2012
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Background: The purpose of this study was to evaluate the predictors of fracture-induced avascular necrosis of the humeral head according to our fracture type classification.
Methods: Since 2006, 43 comminuted proximal humeral fractures were treated by open surgery with interlocking intramedullary nail. The average age at the time of surgery was 70.1 years. Fracture morphology was assessed with radiographic findings. In Neer's classification, 3part fracture occurred in 31 cases, 3part fracture dislocation occurred in 1, 4part fracture occurred in 7, and 4part fracture dislocation occurred in 4 cases. In our classification, type1; non-dislocated fracture was in 38 cases, type2; extra-articular fracture with dislocation in 4 cases, type3; intra-articular fracture with dislocation in 1 case, and type4; comminuted articular surface fracture in 0.
Results: There were 6 cases (13.9%) of avascular necrosis of humeral head. In Neer's classification, 3part fracture occurred in 1 case, 4part fracture occurred in 4 cases, and 4part fracture dislocation occurred in 1 case. In our classification, type1 occurred in 5 cases and type3 occurred in 1 case.
Discussion: Perfusion of the humeral head is an important factor when deciding on the treatment of comminuted proximal humeral fractures. We try to predict the incidence of post-traumatic avascular necrosis of the humeral head from the initial fracture type. The existence of medial neck fragment or medial hinge is considered a very important factor even in intracapsular fractures. In our modified classification, we expect that the incidence of necrosis is higher in type1B,3,4.
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Tetsuya Takenaga, Katsumasa Sugimoto, Naoya Takada, Naoko Oyabu, Atsus ...
2012 Volume 36 Issue 2 Pages
421-423
Published: 2012
Released on J-STAGE: October 25, 2012
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Background: The purpose of this study was to evaluate the clinical results of osteosynthesis with locking plates (LP) for 3 or 4-part proximal humeral fractures (PHFs).
Methods: We studied 22 PHFs of 22 patients who underwent osteosynthesis with LP from 2001 to 2010. From 2001 to 2006, we used Locking Humerus Spoon Plate (LHSP) and from 2006 to 2010, we used Proximal Humeral Internal Locking System (PHILOS). There were 4 male and 18 female patients. According to Neer's classification, there was one 4-part fracture-dislocation (group (1)), four 4-part fractures (group (2)), six 3-part fracture-dislocations in patients over 50 years old (group (3)), and fifteen 3-part fractures in patients over 50 years old (group (4)). The average age at operation was 69.3 ((1) 82 (2) 52.7 (3) 77.0 (4) 69.2) years old. The mean follow-up period was 17.0 ((1) 10 (2) 25.3 (3) 15.6 (4) 16.2) months.
Results: The average JOA score was 81.1 ((1) 90 (2) 73.0 (3) 72.6 (4) 85.9) points. The mean active elevation was 120.5 ((1) 80 (2) 123.3 (3) 103.0 (4) 129.6) degrees. There was one deep infection in group (2) and one avascular necrosis (AVN) in group (3).
Discussion: Neer reported the incidence of AVN was 21% in 3 and 4-part PHFs. Our study showed the decreased incidence of AVN (4.5%) in 3 and 4-part PHFs treated with LP. The functional outcome of ORIF for PHFs has been getting better and the incidence of AVN has been decreasing since the appearance of LP. So, it is possible that locking plates increase the indication of osteosynthesis for proximal humeral fractures.
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Hiroko Omi, Yoshiyasu Uchiyama, Hiroyuki Hashimoto, Joji Mochida, Akiy ...
2012 Volume 36 Issue 2 Pages
425-428
Published: 2012
Released on J-STAGE: October 25, 2012
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Background: The purpose of this study was to evaluate the outcomes of minimally invasive plate osteosynthesis (MIPO) for proximal humeral fractures using variable polyaxial locking compression plates and screws.
Methods: We evaluated a total of 20 shoulders (11 men and nine women; mean age, 53.3 years old; age range, 24-75 years) treated with MIPO. The average follow-up period was 14.1 (range, 6-32) months. Fracture type by AO classification was A in 9 cases, B in 9 cases, and C in 2 cases. Clinical evaluation included postoperative range of motion (ROM) of the shoulder and Japanese Orthopedic Association (JOA) score at final follow-up. X-rays (A-P view) were used to evaluate the proximal humeral deformities after union.
Results: All cases showed bone union. There was only one complication during treatment in which humeral head necrosis on valgus impacted the fracture case. Postoperative elevated motion of the shoulder was 136.7 degrees and the JOA score was 85.0 points. There were 6 cases (30%) of varus deformity, and 5 cases showed loss of head-shaft angle after surgery. More proximal humeral varus deformities were in type A fractures compared with other fracture types.
Conclusion: The outcome of MIPO for proximal humeral fractures was satisfactory in all cases. However, proximal humeral deformities such as varus displacement in type A fractures which showed loss of head-shaft angle after surgery, were observed in some cases. MIPO should be carried out correctly and fixedly in order to obtain more satisfactory outcomes and to avoid such deformities.
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Kazuya Inoue, Naoki Suenaga, Naomi Oizumi, Yukiyoshi Hisada, Yoshihiro ...
2012 Volume 36 Issue 2 Pages
429-431
Published: 2012
Released on J-STAGE: October 25, 2012
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Background: The aim of this study was to compare the clinical outcomes of open reduction internal fixation by intramedullary nail (ORIF group) and humeral head replacement (HHR group).
Methods: Twenty-six elderly patients who were over 65 years-old were followed for more than 6months after 1998. In ORIF group, there were 17 shoulders (2 men, 15 women) and the average follow-up period was 20.5 months (6-54 months). In HHR group, there were 9 shoulders (1 man, 8 women) and the average follow-up period was 29.7 months (6-60 months). Five shoulders which had necrosis of the humeral head were excluded. All patients were evaluated with the Modified-Neer classification, range of motion of flexion and external rotation.
Results: In Modified-Neer classification, two shoulders were classified as excellent, 13 shoulders as satisfactory and 2 shoulders as unsatisfactory in ORIF group, and no shoulders were classified as excellent, 2 shoulders as satisfactory and 7 shoulders as unsatisfactory in HHR group. Postoperative flexion angle was 115.4 degrees in ORIF group and 87.9 degrees in HHR group. Postoperative external rotation angle was 30.5 degrees in ORIF group and 18.6 degrees in HHR group.
Discussion: ORIF group has a better clinical result than HHR group. ORIR was desirable if possible, however, when there was high risk of humeral head necrosis in elderly patiants, HHR must be chosen. After this, surgical technique and postoperative protocol of humeral head replacement need to be improved.
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Chika Yoshioka, Naoki Suenaga, Naomi Oizumi, Shintaro Yamane
2012 Volume 36 Issue 2 Pages
433-436
Published: 2012
Released on J-STAGE: October 25, 2012
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Background: Intramedually nailing is widely used for proximal humerus fractures. The purpose of this study was to evaluate our incidence of complications following surgeries for proximal humerus fractures using one of locking intramedullary nails, the New Straight Nail System.
Methods: We performed a retrospective multicenter study about proximal humerus fractures treated with the New Straight Nail System (Nakashima, Japan) at our affiliated hospitals. 193patients (193fractures) with mean age 70 years were treated at the twelve hospitals between January 2008 and February 2011. In the 193fractures, there was one patient with one part fracture according to Neer's classification, 114patients with two parts, 49patients with three parts and 29patients with four parts. All the surgeries followed the standard protocol using the New Straight Nail. Intraoperative, and postoperative complications were investigated. The average duration of follow-up was 18.5 months.
Results: Complications were seen in 21patients(10.9%). Two patients had temporal axillary nerve palsy as an intraoperative complication. Postoperative complications were seen in 19patients. Three patients had a screw back-out. Re-displacement was seen in four patients, progress of the collapse of the humeral head in three patients, nonunion and subacromial impingement in two patients, bone resorption of the greater tuberosity, a hematoma and deep infection in one patient. There were two patients who had ischemic stroke at seven days and 16days postoperatively. The second surgeries were required in eight patients (4.1%) who had a screw back-out, nonunion, collapse of the humeral head, hematoma and deep infection.
Conclusion: The current study shows low complication rate of surgeries with the New Straight Nail System.
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Mitsuko Yamada, Tetsuo Yamaji
2012 Volume 36 Issue 2 Pages
437-440
Published: 2012
Released on J-STAGE: October 25, 2012
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Background: Treatment of proximal humeral fractures is very challenging in elderly patients with osteoporosis. To get the good stability at the fracture site we need to know the suitable region to insert screws. We examined cadavers' proximal humeral heads to know the difference of bone mineral density (BMD) and pull out strengths of screws at each region.
Methods: 16 cadavers' humeri (mean age 85 years old) were used. In the humeral head we decided region 1; 30 degrees above the medial surgical neck, 2;60 degree above the medial surgical neck, 3; GT, 4: the medial surgical neck, 5: the lateral surgical neck, 6; 1 cm medial side from 4, 7; 1cm medial side from 5. BMD on each region was measured by DEXA. We inserted 2 screws; one was inserted into region 1, the other was inserted into region 7. The pull out strength of screws was measured using the universal material examination machine.
Results: The mean BMD(g/cm
2) at each region was 1; 0,268, 2; 0,184, 3; 0,119, 4; 0,102, 5; 0,037, 6; 0,122, 7; 0,059. The mean maximum pull out strength(N) at each region was 1; 296, 6, 7; 92,6. Concerning the pull out strength of screws region 1 was significantly higher than 7(p < 0.001).
Conclusion: Our result shows that BMD and pull out strength of screws are different in the proximal humeral head. During operation we should consider the above result and insert screws into the subchondral bone 30 degrees up from the surgical neck to get good stability at the fracture site.
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Tetsuya Takenaga, Katsumasa Sugimoto, Naoya Takada, Naoko Oyabu, Atsus ...
2012 Volume 36 Issue 2 Pages
441-444
Published: 2012
Released on J-STAGE: October 25, 2012
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Background: The purpose of this study was to evaluate the clinical results of osteosynthesis with locking plate (LP) or angle-stable nail (ASN) for proximal humeral fractures (PHFs).
Methods: We studied 63 PHFs of 62 patients who underwent osteosynthesis using LP or ASN. We compared clinical results of the LP group with the ASN group in 2-part surgical neck fractures (SNFs). We also compared clinical results between two locking plates: LHSP and PHILOS. Mann-Whiteney U test was used for Statistical analysis.
Results: In comparison of LP with ASN in 2-part SNFs, each group consisted of 16 patients. The mean age was 64.0 years old in the LP Group and 71.2 years old in the ASN group. The average JOA score was 93.5 points in the LP group and 88.8 points in the ASN group. The mean active elevation was 143.4 degrees in the LP group and 128.1 degrees in the ASN group.
In comparison of LHSP with PHILOS, the LHSP group consisted of 18 PHFs and the PHILOS group contained 29 PHFs. The mean age was 57.0 years old in the LHSP group and 65.8 years old in the PHILOS group. The average JOA score was 87.3 points in the LHSP group and 88.1 points in the PHILOS group. The mean active elevation was 138.6 degrees in the LHSP group and 131.4 degrees in the PHILOS group.
Conclusion: We performed osteosynthesis with LP or ASN for PHFs and got satisfactory outcomes in most cases. There was no statistically significant difference between LP and ASN. No statistically significant difference was found between LHSP and PHILOS.
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Yuji Hatakeyama, Moto Kobayashi
2012 Volume 36 Issue 2 Pages
445-448
Published: 2012
Released on J-STAGE: October 25, 2012
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Background: The purpose of this study was to evaluate the operative outcome of proximal humeral fractures using a locking proximal humerus plate.
Methods: Thirty-two patients who underwent open reduction and internal fixation (ORIF) between March 2007 and November 2010 were evaluated. There were 5 males and 27 females. The mean age was 70.1 years old (29-88) and the average follow-up period was 16.2 months (6-50). 17 patients had surgical neck 2-part fracture, 5 patients had 3-part fracture, 10 patients had valgus-impacted 3-part fracture.
Results: The postoperative mean active flexion: 130.3 degrees (60-170) , External Rotation/Internal Rotation: 44.4 degrees (0-75)/T12/L1 (T4-buttock). The average JOA score was 89.6 points (48-100). The average humeral head (HH) inclination angle was 131.1 degrees (102-160) immediately and 130.4 degrees(97-160) at final follow-up. Seven complications were encountered in 7 patients (21.9%) 2 months after operation. Four patients (12.5%) had screw perforation of the HH: three patients (9.4%) had HH necrosis. Two patients (6.3%) had displacement of greater tuberosity, and two patients (6.3%) had loss of HH inclination angle. There were no wound infections and neurological lesions. Five patients (15.6%) had a second operation.
Discussion: ORIF with the locking proximal humerus plate was a useful procedure. To minimize screw perforation and loss of correction, and to avoid forcible correction, a decision on suitable operative procedure and preventive fixation for the greater tuberosity were needed.
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Masahiko Matsuda
2012 Volume 36 Issue 2 Pages
449-452
Published: 2012
Released on J-STAGE: October 25, 2012
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Background: The aim of this study is to clarify the problems, evaluating the clinical results of surgical treatment for proximal humeral fractures in patients over 80 years old.
Methods: Nineteen cases (2 male, 17 female), who were over 80 years old and treated with osteosynthesis or hemiarthroplasty for proximal humeral fractures were investigated. There were 12 cases of osteosynthesis (group P using locking plate system: 4cases, group C using intramedullary cement augmentation: 3cases, group R using Rush pin: 5 cases) and 7 cases of hemiarthroplasty (group H). We evaluated ROM of the shoulder elevation, external rotation, and also JOA score.
Results: The average age was 85.4 years old (80-91). The average elevation (group P, C, R, H) were 82.5, 70.0, 69.0, 67.1 degrees respectively. The average external rotations were 17.5, 16.7, 9.0, 15.0 degrees respectively. The average JOA score were 63.8, 62.7, 63.0, 64.3 points respectively. One case (group R) had non-union.
Conclusion: The clinical results of surgical treatment for proximal humeral fractures in patients over 80 years old were fair. It is necessary to make further improvement in the surgical treatment.
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Ken Yamaguchi, Kenichi Mihara, Kazuhide Suzuki, Katsuhiro Ota, Daisuke ...
2012 Volume 36 Issue 2 Pages
453-456
Published: 2012
Released on J-STAGE: October 25, 2012
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Background: Fractures of the proximal humerus are common. In elderly patients, osteoporosis makes internal fixations problematic. We developed a new intramedullary nail (pin lock nail; PLN) for a proximal humeral fracture. The purpose of this study was to evaluate the surgical outcome for a proximal humeral fracture with PLN.
Methods: We operatively treated 20 patients with PLN. There were 8 males and 12 females, with a mean age of 65 years. Mean duration of follow-up was 9 months. There were 7 Neer's 2-part fractures, 12 3-part fractures and a valgus impacted fracture. Clinical results were evaluated using the JOA score (pain, activity of daily life (ADL) and range of motion (ROM)). Elevation range of the affected shoulder was expressed as a percentage of the unaffected side.
Results: All fractures had healed. No backing out of the pin and screw was seen at the time of last follow-up. The mean pain score was 24.0 points. The mean ADL score was 8.5 points . The mean ROM score was 22.3 points. The percentage of elevation range was 82.1%.
Conclusion: PLN has an original locking system to fix the pins in high-density born area by means of a plug. This system prevents backing out of the pins. Furthermore, the nail, with a curvature of 15°, avoid splitting the supraspinatus. The present study showed good clinical results without complication. PLN seemed to be useful internal fixation method for a proximal humeral fracture.
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Satoshi Ikebe, Hideo Nishikawa, Ai Umemura, Keizou Morisawa
2012 Volume 36 Issue 2 Pages
457-460
Published: 2012
Released on J-STAGE: October 25, 2012
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Hypothesis: The purpose of this study was to evaluate the surgical results of arthroscopic treatment for glenoid fracture of the scapula.
Methods: We studied 9 shoulders in 9 patients who underwent arthroscopic treatment for acute glenoid fracture of the scapula and were followed-up for more than 6 months between January 2006 and November 2010. Three were male and six were female. We had 6 bony Bankart type fractures, 2 transverse type fractures and 1 postero-inferior fracture. The average age was 61.3 years old (30-83 years old) and the average follow up period was 11.3 months (6-24 months). We used suture anchor and screw. We investigated the surgical results using the Japanese Orthopaedic Association score (JOA score).
Results: The average post operative JOA score was 86.5 points. The JOA score of 2 cases of transverse type fracture treated with screw was 100 points.
Conclusion: The clinical outcome of arthroscopic treatment for acute glenoid fracture of the scapula was satisfactory.
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Katsumi Takase, Yasushi Banba, Ryohei Kono, Kotaro Shinmura, Kengo Yam ...
2012 Volume 36 Issue 2 Pages
461-464
Published: 2012
Released on J-STAGE: October 25, 2012
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Background: Distal clavicle fractures are divided into three types according to Neer's classification. Type 1 and 3 fractures are treated with a sling. However, the treatment of type 2 fractures is controversial. We paid attention to the anatomic basis of type 2 fractures where the disruptions of the conoid ligament lead to the distraction between the two bony fragments. In this study, we describe the arthroscopic procedure to reconstruct the disrupted ligament and stabilize the fracture as a minimally invasive method.
Methods: The subjects were 7 patients with distal clavicle fractures. Our surgical procedure was performed with the patient in the beach chair position. We used the artificial ligament with an EndoButton as the substitute ligament to reconstruct the disrupted conoid ligament. The mean duration of postoperative follow-up was 1 year and 5 months.
Results: Bony union was achieved in all patients at final follow-up. Concerning the range of motion at final examinations, mean forward flexion was 171 degrees, mean abduction was 165 degrees, mean internal rotation was Th11, and mean horizontal adduction was 132 degrees.
Conclusion: It is possible to treat distal clavicle fractures by a minimally invasive arthroscopic procedure without opening the fracture site of the clavicle.
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Masahiko Morishige
2012 Volume 36 Issue 2 Pages
465-468
Published: 2012
Released on J-STAGE: October 25, 2012
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Background: There are several surgical procedures for distal clavicle fracture, but it's indication is unclear. The purpose of this study is to investigate which is safer and less-invasive, LCP Clavicle Hook Plate
® (Synthes, inc, West Chester, PA.USA), or Tension Band Wiring.
Methods: 34 patients who were operated on for distal clavicle fracture, were divided two groups, regardless of fracture type, sex, and age. The 1
st group were treated by CHP. The 2
nd group were treated by TBW. The average age of CHP group patients was 39 (range, 23-51) years old, and TBW group patients was 43 (range, 21-65) years old. Those cases were classified according to Craig and Takubo's classifications; CHP group: 5 in typeIIa, 6 in typeIIb, 5 in typeV, 1 in typeVI, TBW group: 2 in typeIIa, 8 in typeIIb, 5 in typeV, 1 in typeVI. The mean follow-up period of CHP group was 12.8 (3 ∼ 29) months, TBW group was 14.4 (10 ∼ 25) months. Investigation items were operation time, length of incisions, complications, JOA score, Elevation range. JOA score and elevation range were assessed 3 months after removal surgery.
Results: There were no significant differences in operation time, JOA score, or elevation range. Mean incision size of CHP was 9.7 (7 ∼ 12)cm, TBW was 8.3 (6 ∼ 12)cm(P=0.03). Complication rate of CHP was 5.8%, TBW was 29.4%(p=0.06).
Conclusion: TBW is less invasive surgery than CHP, but the safer procedure is CHP for unskilled surgeons.
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Keizo Morisawa, Yoshihisa Soejima, Hideo Nishikawa, Ai Umemura
2012 Volume 36 Issue 2 Pages
469-472
Published: 2012
Released on J-STAGE: October 25, 2012
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Background: The hook-pointed plates and the side-hook plates are used mainly for a fracture in the distal end of clavicle. But, it is difficult to fix reliably in the case of comminuted fracture, so, we tried to treat these fracture with a new plate system. The aim of this study was to investigate the outcomes of this plate system compared with the other plates.
Methods: Our new plate system has some benefits. Locking screw located at the distal part of the plate will realize reliable fixation. A wiring structure integrated with the plates can deal with crush fractures. 29 fractures in 28 patients were studied. 17 cases were treated with SCORPION etc. (group 1) (12males and 4females) (2008.2 ∼ 2010.6).
12 cases were treated with our plate(group 2)(8males and 4females)(2010.11 ∼ 2011.7). We investigated complications, the ROM of the shoulder and the bone fusion.
Results: In group 1, nine cases needed another procedure to fix strongly. There was one non-union case and three delayed-union cases. The ROM of shoulder joint was 143 degrees(110 ∼ 170). The periods for bone fusion were 6 ∼ 14 weeks.(excluding the non-union case)
In group 2, there were no non-union cases. One complication was cable detaching from the clamp. This case had no pain and no ADL disturbance. The ROM of shoulder was 155 degrees (120 ∼ 180).The periods for bone fusion were 5 ∼ 7weeks.
Conclusion: The cable wiring and locking screw plate system for the fracture could get superior results compared with another type of plate system.
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Satoshi Inoue, Shinichi Kuriyama
2012 Volume 36 Issue 2 Pages
473-475
Published: 2012
Released on J-STAGE: October 25, 2012
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Background: Scorpion Plate doesn't cross AC joint, so can released the abduction limit early. But comminuted fractures and small bone fragments cannot be fixed, so it has been suggested that those fractures should not be treated by Scorpion Plate. The purpose of this study is to investigate the patients fixed by Scorpion Plate retrospectively, and examine the operative indication.
Methods: We evaluated 24 patients who were treated by Scorpion Plate at Japanese Red Cross Society, Wakayama Medical Center from 2005 to 2010, and investigated the patients by X-ray and CT scan.
Results: The mean size of a major fragment was 17mm at superior aspect and 28mm at inferior aspect. There were 20 patients with 3rd fragment. 12 patients were additionally fixed by the strong suture rolling. The plate position was more distal over the AC joint in 13 patients. One patient displaced postoperatively and was fixed by Wolter Plate, but other patients were able to gain bone union.
Conclusions: Comminuted fracture and small bone fragments were fixed in most cases by shifting plate position more distally and using rolling strong suture. So the indication of Scorpion Plate may be wider by using such methods.
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Yuki Shiota, Atsuhiko Mogami, Kengo Kirimura
2012 Volume 36 Issue 2 Pages
477-480
Published: 2012
Released on J-STAGE: October 25, 2012
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Background: There are Antegrade intramedullary nail and locking plate technique is among the fixation devices available for humeral shaft fixation. The conventional approach for antegrade intramedullary nailing of humerus fractures is associated with persistent pain and compromised shoulder function. This study describes a new entry portal through the rotator interval with an arthroscopic surgery. It minimizes iatrogenic damage to the rotator cuff at its insertion and solves the disappointing postoperative shoulder functions and pain associated with conventional antegrade nailing techniques.
Methods: This study consisted of 7 patients with 7 humeral fractures that were operated on in our hospital since October 2010.
Results: 6 patients were almost free of postoperative shoulder pain(a patient complicated with a clavicle fracture had shoulder pain for 4 weeks). The average of anterior elevation range was 155 degrees at the time of 2 days after surgery.
Conclusion: Using the rotator interval technique, we achieved no postoperative shoulder pain and almost full of shoulder range of motion.
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Daisaku Tsuruta, Nariyuki Mura, Toshihiko Ogino
2012 Volume 36 Issue 2 Pages
481-483
Published: 2012
Released on J-STAGE: October 25, 2012
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Background: It is unclear whether pathological fatty infiltration in torn rotator cuff muscles affects the postoperative outcome of the rotator cuff repair. The purpose of this study is to clarify the relationship between pathological findings associated with torn rotator cuff muscles and postoperative outcome at one year after the operation.
Methods: 36 shoulders in 34 patients with rotator cuff tears, were treated with cuff repair in our hospital. 25 were males, and 11 were females. Pathological Fatty infiltration between muscle fibers was graded 0 to 2. We defined 0 was negative for fatty infiltration (-), 1 and 2 were positive (+). Postoperative abduction and external rotation strength was examined with a microFET
TM, and compared with preoperative strength. Postoperative results were evaluated with JOAscore. Re-tear of the cuff in MRI was evaluated by the Sugaya's classification. Type IV and V were defined re-tear (+). We analyzed the relationship between pathological fatty infiltration in the supraspinatus and infraspinatus, and JOA score, muscle strength, and re-tear.
Results: There was no relationship statistically in the supraspinatus and infraspinatus, between fatty infiltration and JOA score. There was no relationship statistically between fatty infiltration and muscle strength too. At the supraspinatus, there were 6 re-tears in fatty infiltration (+) group, and none in (-) group, and there was significant difference (P = 0.043). At the infraspinatus there was no difference.
Conclusion: If there is no pathological fatty infiltration in the supraspinatus before operation, re-tear after the operation is unlikely to occur.
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Tsuyoshi Ichinose, Atsushi Yamamoto, Tsutomu Kobayashi, Hitoshi Shitar ...
2012 Volume 36 Issue 2 Pages
485-488
Published: 2012
Released on J-STAGE: October 25, 2012
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Background: The location of rotator cuff tears (RCTs) is related to the shoulder pain in RCTs.
Methods: A medical checkup was conducted for 402 residents of a mountain village. The subjects included 104 individuals with 200 shoulders in which RCTs were detected through ultrasonography (males; 80 shoulders, females; 120shoulders, mean age; 72.2 years old). The presence of pain in shoulders at the time of the checkup was confirmed using an interview form, and the locations of RCT as well as complication in the long head of the biceps (LHB) were diagnosed using an ultrasonography. The location of the tear was recorded under the three categories of the superior facet (SF) and the middle facet (MF) of the greater tubercle as well as the lesser tubercle (LT).
Results: Complete RCTs showed a higher rate of pain in the shoulder than incomplete RCTs. In complete tears, RCTs which exceed the SF showed a higher rate of pain in the shoulder than RCTs which were limited to the SF. The presence or absence of LHB lesion was unrelated to the pain.
Conclusion: The results of this study showed that rotator cuff tears started at the superior facet of the greater tubercle and more cases showed pain along with the widening of tears to the middle facet of the greater tubercle and lesser tubercle.
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Yoichi Koike, Atushi Kita, Hirotaka Sano, Eiji Itoi
2012 Volume 36 Issue 2 Pages
489-492
Published: 2012
Released on J-STAGE: October 25, 2012
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Hypothesis: Many rotator cuff tears (RCTs) are asymptomatic. In contrast, RCTs encountered in clinical settings are symptomatic. One cause of pain may be inflammation associated with symptomatic RCTs. Our hypothesis was that shoulders with a symptomatic RCT exhibit increased radioisotope (RI) uptake as an indicator of inflammation while those with an asymptomatic RCT show no increase in RI uptake.
Methods: After bone scintigraphy, ultrasonography was performed on 140 shoulder joints of 70 patients without shoulder pain to diagnose the presence of a RCT. RI uptake of shoulder joints were measured and reported as standardized relative intensities. Shoulder joints without a RCT and 28 shoulders from 28 patients with a symptomatic RCT (14 men, 14 women; mean age, 62years old) were served as controls.
Results: Of the 140 shoulder joints, we diagnosed asymptomatic RCTs in 34 joints from 26 patients (10 men, 16 women; mean age, 72 years old) and no tear in 32 joints from 20 patients (10 men, 10 women; mean age, 59 years old). RI uptake in the asymptomatic RCT group was comparable to that in the no RCT group (1.7 [0.3] vs. 1.7 [0.4], non-significant). A significant increase in RI uptake occurred only in the symptomatic RCT group (2.2 [0.4], P<0.05).
Discussion: RI uptake did not increase in shoulder joints with asymptomatic rotator cuff tears. Our results support the claim that the inflammation is one of the causes of pain associated with symptomatic RCTs. Shoulder pain associated with RCT may be managed effectively by controlling inflammation.
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Shoji Fukuta, Akihiro Kanamaru, Takahiko Tsutsui, Hideyuki Doi, Takao ...
2012 Volume 36 Issue 2 Pages
493-496
Published: 2012
Released on J-STAGE: October 25, 2012
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Background: Erosion on the undersurface of the acromion has been recently reported as complication after cuff repair using suture anchors, however its incidence is varied. Although we had lower a rate of these complications than those of other studies, postoperative MRIs often show subacromial effusion. The purpose of this study was to determine clinical significances of the subacromial effusion.
Methods: Ninety-two shoulders from 88 patients were included in this study. The average age at surgery was 66.8 years old. There were 9 small, 63 medium, 18 large, and 2 massive tears. Subacromial effusion was noted in 50 shoulders (54.3%), acromial bony erosion was found in 17 (18.4%) on MRI 12 months after surgery. Patients were divided into two groups according to the presence or absence of subacromial erosion; SE(+) and SE(-).
Results: There was no significant difference in age of the patients, size of the tear, duration of operation, and number of anchors or sutures used. Pre and postoperative JOA score was similar in the two groups. Active flexion was significantly better in SE(+) at six months after surgery. The incidence of acromial erosion was significantly higher in SE(+) when compared with SE(-).
Conclusion: Subacromial effusion was found in more than half of the cases, which did not affect clinical outcomes. Subacromial effusion should be followed carefully, since these may closely correlate with acromial erosion.
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Shuro Komatsu, Hideya Yoshimura, Tomoyuki Mochizuki
2012 Volume 36 Issue 2 Pages
497-501
Published: 2012
Released on J-STAGE: October 25, 2012
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Background: The purpose of this study was to reveal the prognostic factors affecting outcomes of an arthroscopic rotator cuff repair: the postoperative outcomes of shoulders which were evaluated by pressure pain threshold(PPT), visual analog scale(VAS) , range of motions(ROM), clinical scores and tear size.
Methods: The study included 33 patients (23 men and 10 women) with a mean age of 66 years old who underwent an arthroscopic rotator cuff repair. The arthroscopic diagnosis was a small tear in 8 patients, a medium tear in 13, and a large tear in 12.An electric pressure algometer was used to measure PPT on the rotator interval of bilateral shoulders.
Results: PPT and VAS correlated with the ROM and clinical scores at same phase postoperatively. PPT at 1 and 6 months had a significant correlation with ROM at 12 months postoperatively. Small cuff tear cases had the tendency of PPT at 1 month postoperatively.
Conclusion: These results indicated that peripheral nociceptive nerve sensitization, changing the PPT in the affected area, caused for lower ROM and poorer clinical outcomes. There is a possibility that PPT were useful for predicting objective factors in the intensity of postoperative function.
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Masafumi Gotoh, Yasuhiro Mitui, Fujio Higuchi, Kenjiro Nakama, Isao Sh ...
2012 Volume 36 Issue 2 Pages
503-505
Published: 2012
Released on J-STAGE: October 25, 2012
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Hypothesis: We hypothesized that in patients with rotator cuff tears, the clinical outcome of suture bridge repair (BR) is superior to that of simple suture repair (SR).
Methods: Thirty-seven patients with rotator cuff tears were candidates for this study and divided into 2 groups: 21 patients with SR and 16 patients with BR. Patient profile was as follows: average age of 62.0years in the SR group and 61.1years in the BR group; average tear size (longitudinal X transverse) of 10.7cm
2 in the SR group and 8.4cm
2 in the BR group; average symptom period of 7.2months in the SR group and 5.0months in the BR group. Traumatic onset was noted in 13 patients in the SR group and 10 patients in the BR group. Passive elevation of the shoulder was commenced immediately after surgery, and at 6 weeks after surgery, active motion of the shoulder was allowed. Range of motion, muscle strength, visual analogue scale, and Japanese Orthopaedic Association (JOA) score were measured preoperatively and postoperatively. Postoperative re-tear was evaluated using MRI at 1 year after the surgery. The Mann-Whitney test and Chai-square test were used for statistical analysis. A P value less than 0.05 was considered significant.
Results: No statistical differences between the 2 groups were found in the preoperative patient profile, postoperative JOA score, and re-tear rate (8/21 cases in the SR group and 5/16 in the BR group, P = 0.481).
Conclusion: We failed to observe any apparent difference of the clinical outcome between SR and BR. It remains to be clarified in a larger-scale study.
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