Tong Joo Lee

Background: Distal humerus fractures in older patients, particularly those with osteoporosis, pose substantial treatment challenges because of increased fracture complexity and compromised bone stock. Open reduction and internal fixation (ORIF) is the preferred treatment but may be complicated by fixation failure. This study investigated the outcomes of ORIF in older osteoporotic and nonosteoporotic patients with complete articular distal humerus fractures.Methods: This retrospective study included 19 patients with Arbeitsgemeinschaft für Osteosynthesefragen/ Orthopaedic Trauma Association (AO/OTA) 13C distal humerus fractures who underwent surgical treatment between 2012 and 2024. The mean patient age was 79.1 years. Patients were divided into osteoporotic (n=11) and nonosteoporotic (n=8) groups based on the lowest recorded dual-energy X-ray absorptiometry T-score at the femoral neck or lumbar spine. Osteoporosis was defined as a T-score of −2.5 or lower, and the nonosteoporotic group included patients with osteopenia. All fractures were treated with ORIF using bicolumnar plating. All included patients completed 12 months of clinical follow-up for visual analog scale (VAS) and Mayo Elbow Performance Score (MEPS) assessments. Radiographic follow-up was recorded separately and continued until union was confirmed; imaging follow-up extended to 12 months or longer in 14 patients and was limited to 6 months in five asymptomatic patients after confirmed union.Results: Both groups showed significant within-group improvement in pain, as assessed using the VAS, and function, as assessed using the MEPS, over time. Between-group comparisons at each follow-up time point showed no statistically significant differences in VAS or MEPS. No radiographic nonunion was observed during the available imaging follow- up, and complications were limited to one case of screw pullout/loosening and one case of postoperative stiffness.Conclusions: ORIF provides reliable outcomes for older patients with complex distal humerus fractures, regardless of osteoporosis status, when stable reconstruction is achievable. These findings suggest that ORIF remains a viable treatment option, with satisfactory functional recovery and low complication rates in this population.Level of evidence: III.

Purpose: Rupture of the thumb’s radial collateral ligament (RCL) is relatively uncommon compared to ulnar collateral ligament injuries. Given the close anatomical relationship between the RCL and surrounding structures, associated injuries must be carefully evaluated to ensure appropriate repair. Recent studies suggest that early surgical intervention may yield superior long-term outcomes compared to conservative or delayed repair. This study aimed to highlight the importance of surgical repair of the thumb’s RCL and its adjacent anatomical structures.Methods: A retrospective analysis was conducted at a single institution, including 14 patients diagnosed with RCL tears. Two cases involving associated structural injuries were examined in detail. Patients were followed up over a short-term period to assess range of motion (ROM), joint stability, and pain levels.Results: Both acute and chronic RCL ruptures demonstrated significant recovery in ROM, stability, and pain management within 8 weeks of follow-up, regardless of the surgical technique employed.Conclusion: Surgical repair of the RCL appears effective in restoring both the functional integrity of the metacarpophalangeal joint and in alleviating pain. During the initial surgical procedure, it is crucial for the surgeon to thoroughly assess and address any concomitant injuries to adjacent structures.

Author correction: “Comparison of outcomes of reinforced tension band wiring and precontoured plate and screw fixation in the management of Mayo type IIIB olecranon fractures”

Background: Mayo type IIIB olecranon fractures are characterized by significant displacement and comminution, presenting a challenge in selecting the appropriate fixation technique. This study compared the clinical and radiographic outcomes, complications, and reoperation rates of reinforced tension band wiring (TBW) and precontoured plate and screw fixation (PF) in the surgical treatment of Mayo type IIIB olecranon fractures.Methods: This retrospective review analyzed 24 patients diagnosed with Mayo type IIIB olecranon fractures, who were treated between 2005 and 2023. Of these, 11 patients underwent reinforced TBW, and 13 received precontoured PF. Clinical outcomes were assessed using Disabilities of the Arm, Shoulder, and Hand (DASH) scores and the Mayo Elbow Performance Score (MEPS). Radiographic outcomes focused on fracture union. Operative times, complication rates, and reoperation rates were compared between the groups.Results: Both the reinforced TBW and PF groups achieved satisfactory clinical outcomes, with no significant between-group differences in DASH and MEPS scores (P>0.05). Radiographic union was achieved in all patients. The reinforced TBW group demonstrated a significantly shorter operative time than the PF group (93.6±7.4 min vs. 132.3±13.7 min; P<0.001). Complication rates were similar between the two groups (reinforced TBW, 38.4%; PF, 36.3%), but hardware-related irritation occurred more frequently in the reinforced TBW group. Reoperations were required in 15.8% of the reinforced TBW group due to hardware irritation, whereas no reoperations were necessary in the PF group.Conclusions: Reinforced TBW and PF are both effective surgical options for managing Mayo type IIIB olecranon fractures, yielding comparable clinical and radiographic outcomes. While reinforced TBW offers shorter operative times and lower costs, PF is associated with fewer hardware-related complications. Further prospective studies are needed to optimize treatment strategies for these complex fractures.Level of Evidence: Level III.

Background and Objectives: Since the neck is the weakest part of the metacarpals, the most common metacarpal fracture is a neck fracture, a type which accounts for 38% of all hand fractures. Such fractures can be fixed using a variety of conventional techniques, including intramedullary pinning and K-wire pinning. However, conventional techniques involve complications, such as angulation, stiffness, and rotational deformity. The purpose of this study was to compare the usefulness of our new technique, combined intramedullary pinning with K-wire pinning (IPKP), with those of intramedullary pinning (IP) and K-wire pinning (KP). Materials and Methods: This was a single-center, randomized controlled trial conducted between January 2005 and April 2023. A total of 158 patients with acute displaced fractures of the fifth-metacarpal neck were randomly assigned to either the IPKP group (n = 48), the KP group (n = 60), or the IP group (n = 50). We radiographically evaluated angulation and shortening in three visits: pre-operatively, post-operatively, and at a 1-year follow-up. We clinically evaluated the ranges of motion and Quick-DASH scores to assess daily living performance and the cosmetic scores, using the SBSES score, to assess patients’ satisfaction with their cosmetic outcomes. Results: The IPKP group was superior to the KP group and the IP group regarding radiographical and clinical assessments at the 1-year follow-up visit. The angulation was 15.7° (±7.7) in the KP group, 17.0° (±5.9) in the IP group, and 12.6° (±2.5) in the IPKP group (p < 0.001) at the 1-year follow-up visit. The shortening was 0.9 mm (±0.3) in the KP group, 1.4 mm (±0.2) in the IP group, and 0.4 mm (±0.1) in the IPKP group (m < 0.001) at the 1-year follow-up visit. The TAM was 272.6° (±17.5) in the KP group, 271.1° (±18.0) in the IP group, and 274.1° (±14.9) in the IPKP group (p = 0.42). Four patients (6.6%) in the KP group and two patients (4%) in the IP group were reported as having stiffness, while no patients were found to have stiffness in the IPKP group. The average Quick-DASH score was 2.3 (±0.5) in the KP group, 2.5 (±0.4) in the IP group, and 1.9 (±0.4) in the IPKP group (p > 0.05). The average cosmetic score was 3.7 (±1.2) in the KP group, 3.8 (±0.9) in the IP group, and 4.7 (±0.8) in the IPKP group (p < 0.001). A complication involving nonunion occurred in one case (1.6%) in the KP group, while there were three cases (6%) of rotational deformity in the IP groups. Conclusions: With the IPKP technique, accurate reduction can be achieved to improve hand function and cosmetic outcomes.

Background and Objectives: Although distal interphalangeal (DIP) arthrodesis is an effective surgical method for end-stage osteoarthritis of the phalangeal joint, the nonunion rate of DIP arthrodesis has been reported to range from 15% to 20%. To this end, we devised an inlay technique with a cortico-cancellous olecranon bone graft for failed DIP arthrodesis. This study aimed to introduce the inlay bone grafting technique for failed arthrodesis of the DIP joint and demonstrate its advantages. Materials and Methods: We reviewed consecutive 19 digits (15 patients) who had undergone DIP revision arthrodesis using the technique at our institution between January 2010 and December 2020. The observed outcome measures were the bone union rate, and related complications. Bone union was evaluated using follow-up radiography. The quick Disabilities of the Arm, Shoulder and Hand (DASH), visual analog scale (VAS) for pain, and VAS for satisfaction assessed patient function and perceived clinical outcomes. Results: No major complications were observed at the recipient site. The average VAS for pain and satisfaction and DASH score improved from preoperatively to 6 months after surgery (both, p = 0.001). Conclusions: The inlay technique with cortico-cancellous olecranon bone grafts showed excellent bone union rates and functional scores with nonunion of the DIP joint. This technique may be an adequate surgical option for patients with confirmed nonunion of the DIP joint and persistent symptoms.

Purpose: Local corticosteroid injections are routinely used as first-line treatment for trigger finger. However, accurate delivery of steroids into the tendon sheath is important for the effectiveness of the treatment and the prevention of complications. This study aimed to introduce our steroid injection technique for trigger finger, which uses tendon excursion of the flexor tendon, and evaluate the clinical outcomes in patients who were treated with this technique.Methods: A total of 171 patients with trigger finger who were treated with steroid injections were retrospectively reviewed. The efficacy of injection and complications were investigated. The evaluation of the efficacy was classified into “good,” “fair,” and “poor.” The results were analyzed according to the type of finger and the Quinnell grading system.Results: The total efficacy was 83.6% (good/fair, 143 digits; poor, 28 digits). The treatment success rate for Quinnell grade IV was 43.8% (7 of 16), which was significantly lower than those of Quinnell grades II and III, which were 88.9% (88 of 99) and 87.5% (49 of 56), respectively (II vs. IV, p=0.004; III vs. IV, p=0.010). In four fingers (excluding the thumb), the success rate was significantly higher than that of the thumb (88.2% vs. 75.4%, p=0.048).Conclusion: The steroid injection technique using tendon excursion showed excellent results and low complication rates. In particular, the second to fourth fingers and low-grade fingers showed more effective results.

The accessory palmaris longus is a rare anatomical variant in the wrist and forearm, which has been reported as the cause of carpal tunnel syndrome. This paper reports a case of the accessory palmaris longus incidentally found during carpal tunnel surgery. The paucity of awareness on the accessory palmaris longus in carpal tunnel surgery may lead to accidental iatrogenic injury to the median nerve or insufficient decompression of the median nerve.

권대규, et al. J Korean Orthop Assoc. 2020 Jun;55(3):271-275. https://doi.org/10.4055/jkoa.2020.55.3.271