Suk-Woong Kang

Background: This study aimed to evaluate the long-term clinical and radiological outcomes in patients undergoing semi-constrained total elbow arthroplasty (TEA). Postoperative complications and implant survival rates were also investigated. Methods: Of 68 patients who underwent primary semi-constrained TEA, data from 62 with a minimum follow-up of 5 years were analyzed. The mean follow-up duration was 117.1 months (range, 60–246 months). Forty-one patients had posttraumatic conditions, 11 had rheumatoid arthritis, and 10 had osteoarthritis. Clinical outcomes were assessed using the Mayo Elbow Performance Score (MEPS) and Oxford Elbow Score (OES), whereas radiological outcomes were analyzed using radiolucent lines and bushing wear. Kaplan-Meier survival analysis was used to determine the implant survival rate. Results: At the final follow-up, the MEPS and OES were 88.2 (range, 55–100) and 31.6 (range, 22–42), respectively. Radiolucency of type 3 or 4 was observed on the humeral side in four patients and on the ulnar side in three patients. Grade 1 and 2 bushing wear was present in seven and three patients, respectively. The total complication rate was 25.8% (16/62), and the reoperation rate was 17.7% (11/62). Four patients underwent reoperation for periprosthetic infection after previous open reduction and internal fixation for acute fractures. In addition, three patients underwent hinge system change for hinge dissociation, four sustained periprosthetic fractures, one underwent revision TEA for gross loosening, and one underwent open repair for triceps rupture. Kaplan-Meier survival analysis revealed that the 5-, 10-, and 15-year survival rates of the implants were 100%, 92.8%, and 77.5%, respectively. Conclusions: Clinical and radiological outcomes of primary semi-constrained TEA were reasonably good at a mean 10-year follow-up. Type 3 or 4 radiolucency was observed in seven patients and complete bushing wear in three patients, while the 10-year implant survival rate was 92.8%. Level of evidence: IV.

Kyeong Baek Kim, Jung Yun Bae, Suk-Woong Kang, Won Chul Shin, Sang-Min Lee, Seung Hun Woo. JKFAS 2026;30:80-5. https://doi.org/10.14193/jkfas.2026.30.2.80

Background: The prevalence of adhesive capsulitis (AC) is estimated to be 2–5% in the general population. However, the etiology of AC remains unclear. Among the various proposed factors, the precise role of cervical disease, and the severity of cervical degeneration, in the development of AC has not been fully elucidated. This study aimed to analyze the contribution of cervical disease to AC in patients with shoulder pain. Methods: A total of 409 patients who visited the Department of Rehabilitation Medicine for shoulder pain were retrospectively reviewed. The outcome variable was the presence of AC. In addition to cervical disease, other independent variables affecting AC, including sex, diabetes, obesity, dyslipidemia, thyroid disease, immobilization after surgery, rotator cuff tear, subacromial spur, and shoulder joint osteoarthritis were reviewed. To compare the two groups, an independent t-test or chi-square test was performed for continuous and categorical data. Multivariate regression analysis was used to assess the effects of independent factors on AC, adjusting for confounders. Results: Among the 409 patients, 176 (43.0%) were diagnosed with AC. Multivariate analysis demonstrated that diabetes (OR 3.03, 95% CI 1.55–5.91, p = 0.001) and cervical disease (OR 3.03, 95% CI 1.75–5.25, p < 0.001) were significantly associated with increased odds of AC. In contrast, increasing age (OR 0.95, 95% CI 0.92–0.98, p = 0.007), dyslipidemia (OR 0.55, 95% CI 0.31–0.98, p = 0.044), and postoperative immobilization (OR 0.64, 95% CI 0.41–0.99, p = 0.046) were associated with decreased odds of AC. The prevalence of AC increased with the severity of cervical degeneration. Conclusion: In patients with shoulder pain, diabetes and cervical disease were positively associated with AC, whereas age, dyslipidemia, and postoperative immobilization showed inverse associations. These findings suggest that both metabolic and cervical factors may contribute to the development of AC, highlighting the importance of considering cervical pathology in patients with shoulder pain.

Background: Shoulder hemiarthroplasty (HA) is an established treatment option for complex proximal humeral fractures, particularly in cases involving severe comminution or osteoporotic bone. This study investigated the clinical and radiographic outcomes of HA with a minimum follow-up of 3 years and aimed to identify prognostic factors associated with postoperative function.Methods: We retrospectively reviewed 44 patients (16 males and 28 females; mean age, 61.2 years; range, 23–83 years) who underwent shoulder HA for complex proximal humeral fractures between 2005 and 2018. The mean follow-up duration was 70.4 months (range, 36–168 months). Clinical evaluations included the Constant score, visual analog scale pain score, patient satisfaction, and range of motion. Radiographic assessments examined tuberosity healing, radiolucent lines, acromiohumeral distance (AHD), and glenoid arthrosis.Results: At the 3-year follow-up, 64% of patients reported being satisfied or very satisfied. The mean Constant score was 46.6 (range, 13–71), and the age- and sex-adjusted Constant score was 53.5 (range, 19–92). Radiographically, 23% of patients demonstrated radiolucent lines, and 41% showed evidence of glenoid arthrosis. Tuberosity absorption occurred in 39% of patients, with a mean onset of 11.2 months postoperatively, and was significantly associated with lower Constant scores and reduced range of motion. Patients younger than 60 years demonstrated better functional outcomes and lower rates of tuberosity absorption. The mean AHD decreased from 8.4 mm postoperatively to 4.4 mm at the 3-year follow-up (P<0.001).Conclusions: Shoulder HA for complex proximal humeral fractures yielded satisfactory pain relief and functional outcomes, particularly when tuberosity healing was preserved. However, elderly patients with diminished bone quality were more likely to develop tuberosity absorption and experience poorer functional recovery. Meticulous surgical technique and careful postoperative surveillance remain essential to achieving optimal results.Level of evidence: III.

This study aims to compare the accuracy and reliability of computed tomography (CT) anteversion measurements between the conventional axial plane (CAP) and the functional coronal plane (FCP). We retrospectively examined 68 patients’ postoperative CT scans following primary unilateral total hip arthroplasty (THA). PolyWare software, which uses edge detection to determine radiographic anteversion of the acetabular component, served as the reference standard. We measured anatomical anteversion in the CAP and radiographic anteversion in the reformatted FCP using reconstruction software. Reliability was evaluated with the intraclass correlation coefficient. The mean anteversion of the acetabular component in the CAP and FCP CT images were 29.18 ± 6.06° and 21.17 ± 5.38°, respectively. The mean CT anteversion in the FCP was considered accurate owing to its similarity with the reference standard (20.70 ± 4.39°, P = .281). However, the mean CT anteversion in the CAP was significantly different and thus considered less accurate; the CT anteversion in the CAP was larger than that in the FCP, showing a significant linear correlation ( R = 0.673, P < .001), with a difference of 8.01°. The intraobserver and interobserver reliabilities were excellent for all measurement methods. Using radiographic anteversion defined by digital image analysis software as the reference standard, the anteversion measurement in the reformatted FCP proved more accurate than in the CAP. The reformatted FCP CT image facilitates precise post-THA anteversion measurement, with the method difference being around 8.01°. This study aids in measuring anteversion via CT.

Purpose: This study aimed to examine the factors associated with the cancellation of elective shoulder surgeries, focusing mainly on socioeconomic aspects, and to explore these associations stratified by rural and urban areas. Methods: A retrospective cross-sectional analysis was conducted using the electronic medical records of 1,001 adult patients scheduled for elective shoulder surgery under general anesthesia at a tertiary hospital in South Korea between April 2018 and December 2024. Surgery cancellation was defined as any procedure recorded as “canceled” before the scheduled surgery date. Sociodemographic, clinical, and surgery-related factors were analyzed using chi-squared tests and multivariate logistic regression models. Stratified analyses were also conducted based on residential area. Results: The overall surgical cancellation rate was 11.5%. Older age (≥65 years), severe disease, rural residence, manual labor, and complex surgical procedures were significantly associated with higher odds of cancellation. The multivariate analysis showed that patients aged 65 years or older (adjusted OR = 2.20, p < 0.001), those with severe disease (adjusted OR = 4.29, p = 0.004), manual laborers (adjusted OR = 2.93, p < 0.001), and rural residents (adjusted OR = 1.87, p = 0.006) were at a greater risk of cancellation. Stratified analysis revealed that Medical Aid coverage significantly increased the risk of cancellation in rural areas (adjusted OR = 5.76, p = 0.025). Conclusion: Elective shoulder surgery cancellations are influenced not only by clinical factors but also by socioeconomic and geographical disparities. Patient-centered surgical planning that incorporates individual socioeconomic circumstances is essential for reducing cancellation rates and promoting equitable surgical care.

Rationale: Excessive distal clavicle resection can result in severe bone loss and disruption of the coracoclavicular (CC) ligament attachment, leading to significant vertical instability of the acromioclavicular joint. The optimal surgical approach in such cases remains controversial due to the technical challenges associated with achieving anatomical fixation. Patient concerns: A 40-year-old male construction worker presented with persistent shoulder pain, limited range of motion, and visible clavicular prominence 1 year and 7months after undergoing distal clavicle resection at an outside hospital following a traumatic fracture. Diagnoses: Radiography and physical examination revealed substantial bone loss in the distal clavicle and vertical instability, with a CC distance of 15.16 mm, confirming CC ligament insufficiency. Interventions: The patient underwent a single-tunnel arthroscopically assisted CC ligament reconstruction with allograft augmentation using the TightRope system and a peroneus brevis tendon allograft. Outcomes: At the 60-month follow-up, radiographs demonstrated maintained joint stability. The CC distance was reduced to 6.01 mm immediately postoperatively and was 9.30 mm at the final follow-up. Clinical scores significantly improved (Visual Analog Scale: 6→1, American Shoulder and Elbow Surgeons: 13→95, and University of California at Los Angeles: 9→35), and the patient returned to heavy manual labor 6 months postoperatively, maintaining full function. Lessons: In patients with severe distal clavicle bone loss, single-tunnel arthroscopically assisted CC ligament reconstruction with allograft augmentation can yield excellent long-term clinical and radiological outcomes, serving as a viable and effective treatment option.

Jung Yun Bae, Suk-Woong Kang, Won Chul Shin, Sang-Min Lee, Seung Hun Woo. JKFAS 2025;29:125-9. https://doi.org/10.14193/jkfas.2025.29.3.125

Background and Objectives: Monteggia fracture-dislocations are rare but critical injuries in children. Accurate early diagnosis is essential to avoid long-term complications; however, such injuries are frequently missed. Therefore, this study aimed to assess the diagnostic accuracy of Monteggia fractures among physicians of varying specialties and experience levels and to identify factors influencing diagnostic performance. Materials and Methods: This retrospective study analyzed the radiographic interpretations of pediatric elbow and forearm injuries by six physician groups: orthopedic residents, general orthopedic surgeons, pediatric orthopedic surgeons, general radiologists, and subspecialized musculoskeletal radiologists. The final diagnosis established by pediatric radiology experts served as the reference standard. Influential variables, such as image quality, splint application, and age-related ossification, were evaluated. Results: In total, 120 patients were included, 40 (33.3%) of whom were diagnosed with Monteggia fractures and 80 (66.7%) with other fracture types. The diagnostic accuracy of Monteggia fractures varied significantly according to the physician’s experience. First-year residents and non-subspecialty radiologists had the highest rate of missed diagnoses. While other fracture types were occasionally influenced by technical factors, most missed Monteggia fracture cases stemmed from recognition failure. Subtle imaging features, plastic deformation of the ulna, and the omission of dedicated elbow views contributed to the misdiagnosis. Awareness and training improved performance, and a high index of suspicion was identified as crucial. Early follow-ups and standardized imaging protocols were identified as effective safeguards. Conclusions: Experience level, awareness, and imaging protocol quality were identified as being central to the accurate diagnosis of pediatric Monteggia fractures. Implementing educational strategies, promoting systematic imaging reviews, and reinforcing team-based approaches may reduce the rate of missed diagnoses.

Background/Objectives: Fluoroscopy has been widely adopted in interventional pulmonology, as it facilitates real-time visualization of the bronchoscope, endobronchial ultrasound, and biopsy tools during procedures. The purpose of this study was to evaluate the effectiveness of radiation shields in minimizing scattered X-ray dose to the bronchoscopist in a phantom study and to determine the dose of scattered X-ray dose to medical staff with radiation shields in clinical application. Methods: An anthropomorphic torso phantom was positioned on the fluoroscopic table between the C-arm X-ray tube and the image detector to mimic bronchoscopic operations. Upper and lower body lead shields were used to examine the effectiveness of radiation shielding. Scatter radiation rates were assessed at a first operator location using real-time dosimeters with and without protective devices. In clinical application, the scattered X-ray dose of the first operator and main assistant was measured using wearable radiation dosimeters during 20 procedures. Results: In the phantom study, scattered radiation without shielding was 266.34 ± 8.86 μSv/h (glabella), 483.90 ± 8.01 μSv/h (upper thorax), 143.97 ± 8.20 μSv/h (hypogastrium), and 7.22 ± 0.28 μSv/h (ankle). The combination of upper and lower body lead shields reduced the scattered X-ray dose by 98.7%, 98.3%, 66.2%, and 79.9% at these levels, respectively. In clinical application, mean scattered X-ray dose rates were 0.14 ± 0.05 μSv/procedure (eye), 0.46 ± 0.51 μSv/procedure (chest), 0.67 ± 0.50 μSv/procedure (hypogastrium), and 1.57 ± 2.84 μSv/procedure (assistant’s wrist). Conclusions: The combination of radiation shields significantly reduced the scattered X-ray dose at the operator site in the phantom study. The scattered X-ray dose to medical staff during bronchoscopy can be kept at a low level with the aid of a shielding system.