論文

Purpose To assess the outcomes of our technique involving oblique headless compression screw for arthrodesis of the thumb interphalangeal joint and the distal interphalangeal joints of the other digits. Methods A total of 28 joints (19 thumb interphalangeal and 9 distal interphalangeal) in 23 patients with a mean age of 65 years (range, 58-74 y) were retrospectively analyzed. All operations were performed with the Acutrak2 micro-screw. After the resection of synovium and joint cartilage by a dorsal approach, a 0.88-mm diameter guide wire was inserted at the ulnar side of the proximal phalanx in the thumb and radial side of the middle phalanx in the other digits from proximal to distal to fix the joint obliquely. We verified its position under fluoroscopic control and placed the cannulated screw from proximal to distal over the guide wire. Results Intraoperative rigid fixation was obtained except for 1 case, which required additional K-wire fixation. The overall union rate was 96%. Average time to fusion was 11 weeks (range, 8-30 wk), with 76% achieving union within 3 months. There were 2 complications, 1 nonunion and 1 late infection. Other complications such as dorsal skin necrosis, nail deformity, and paresthesia did not occur. Conclusions Efforts to avoid invasion of the nailbed can be technically demanding. We believe that our proximal to distal technique with oblique placement of the headless compression screw is a straightforward and effective method with a relatively low risk of complication. Type of study/level of evidence Therapeutic IV. © 2013 by the American Society for Surgery of the Hand. All rights reserved.

Hypothesis: We hypothesized that the clavicle overrides the acromion during certain shoulder motions for individuals with acromioclavicular (AC) joint separation producing clinical symptoms. We measured 3-dimensional clavicular and scapular motions in AC joint separation models during humerothoracic motions, which should be impacted by the loss of AC joint continuity. Materials and methods: Ten shoulders from 6 whole cadavers were used. The scapular and clavicular motions were measured in intact and AC joint separation models using an electromagnetic tracking device. The measurement was performed during shoulder abduction with humerothoracic neutral rotation. It was also measured during shoulder abduction with humerothoracic internal rotation, which could cause clavicular overriding. The kinematic changes caused by ligament sectioning were evaluated in these 2 arm motions. Results: The clavicle completely overrode the acromion in all AC separation models during abduction with internal rotation, but not in any shoulders during abduction with neutral rotation. Upward clavicular rotation increased, posterior clavicular rotation decreased, and external scapular rotation decreased with ligament sectioning. These kinematic changes were common for both of the measured arm motions. Scapular upward rotation and posterior tilt did not change because of ligament sectioning during abduction with neutral rotation. However, these scapular rotations significantly decreased with ligament sectioning during shoulder abduction with internal rotation. Conclusion: Scapular and clavicular kinematics were affected in AC separation models. Abduction with humeral internal rotation resulted in a decrease in scapular posterior tilt and upward rotation in AC separation models, and thereby could lead to AC joint articulation dysfunction. © 2013 Journal of Shoulder and Elbow Surgery Board of Trustees.

Purpose: To evaluate the feasibility and effects of transcatheter arterial embolization with imipenem/cilastatin sodium (CS) to treat tendinopathy and enthesopathy that are refractory to traditional nonsurgical management. Materials and Methods: Transcatheter arterial embolization with imipenem/CS as an embolic agent was performed in seven patients (five men; mean age, 51.7 y) with tendinopathy and enthesopathy (patellar tendinopathy, n = 1; rotator cuff tendinopathy, n = 2; plantar fasciitis, n = 1; lateral epicondylitis, n = 1; iliotibial band syndrome, n = 1; and Achilles insertion tendinopathy, n = 1). All patients had unrelenting pain at the site of tendinopathy and enthesopathy before the procedure. Technical success, adverse events, and changes in visual analog scale (VAS) scores were assessed. Results: All procedures were technically successful, and no major adverse events developed. Compared with before the procedure, mean VAS scores were significantly decreased at 1 day, 1 week, and 1 and 4 months after the procedure (72.7 mm±9.9 vs 17.4 mm±18.5, 16.0 mm±18.1, 13.7 mm±7.3, and 9.7 mm±6.8, respectively; all P<.001). Conclusions: Transcatheter arterial embolization with imipenem/CS was feasible and effectively relieved unrelenting pain associated with tendinopathy and enthesopathy. © 2013 SIR.

Hypothesis: The clavicle serves as a strut between the thorax and scapula, and lack of this function could affect shoulder mobility. We hypothesized that clavicular discontinuity changes shoulder kinematics, particularly affecting scapular motion. Materials and methods: The study used 14 cadaveric shoulders. Cadavers were stabilized in the sitting position. Manual elevation in the sagittal, scapular, and coronal planes was performed in the intact and clavicular discontinuity models. The thorax-scapula distance and 3-dimensional scapular motion during shoulder elevation were recorded using an electromagnetic tracking device. The differences between the 2 experimental models at each position were analyzed. Results: Clavicular discontinuity resulted in a decreased thorax-scapula distance and in reduced external rotation, upward rotation, and posterior tilting of the scapula. The kinematic changes were observed during elevations in all 3 planes but were greatest in the sagittal plane compared with the scapular and coronal planes. Conclusions: The findings of this study revealed that discontinuity of the clavicle affects shoulder kinematics. Because of its anatomic shape and position, the clavicle stabilizes the external, upward, and posterior rotation of the scapula during arm movement. This function of the clavicle may assist glenohumeral joint motion and help prevent subacromial impingement. © 2013 Journal of Shoulder and Elbow Surgery Board of Trustees.

Background: Scapulothoracic dyskinesis is an important consequence of acromioclavicular joint dislocations. However, no reports have described changes in 3-dimensional motions of the scapula and clavicle with respect to the thorax caused by acromioclavicular joint dislocation. Hypothesis: Sectioning of the acromioclavicular (AC) and coracoclavicular (CC) ligaments affects scapular and clavicular motion in a whole-cadaver model. Study Design: Controlled laboratory study. Methods: We evaluated shoulder girdle motion (scapula, clavicle, and humerus) relative to the thorax of 14 shoulders from 8 whole cadavers after sequential sectioning of the AC and CC ligaments (trapezoid and conoid ligaments). An electromagnetic tracking device measured 3-dimensional kinematics of the scapula and clavicle during humerothoracic elevation in the coronal and sagittal planes and adduction in the horizontal plane. Results: Sectioning of the AC ligament increased clavicular retraction during sagittal plane elevation and horizontal plane adduction. Sectioning of the trapezoid ligament decreased scapular external rotation during sagittal plane elevation and horizontal plane adduction. Sectioning of the conoid ligament decreased scapular posterior tilting during sagittal plane elevation and horizontal plane adduction. Acromioclavicular and CC ligament sectioning also delayed clavicular posterior rotation and increased clavicular upward rotation during coronal plane elevation. Conclusion: Our study revealed that AC and CC ligament disruption affected in vitro shoulder girdle kinematics in the wholecadaver model. Clinical Relevance: The results of this cadaveric study revealed that AC and CC ligament disruption could cause dyskinesis of the scapula and clavicle. The kinematic changes could be a potential source of pain and dysfunction in the shoulder with AC joint dislocation, and therefore surgical reconstruction may be indicated in certain patients. © 2012 The Author(s).

BACKGROUND: The majority of type I coracoid fractures set out in Ogawa's classification constitute double disruption of the superior shoulder suspensory complex (SSSC) as proposed by Goss, frequently resulting in healing delay and adverse functional consequences. However, there are few reports alluding to strategies or concrete treatment methods of such injuries. The purpose of this report is to introduce our surgical strategy for treating the type I coracoid fracture with concurrent injuries and to describe our treatment method with their outcomes. METHODS: Thirty-six patients, who had acute type I coracoid fractures surgically treated and were followed up for 1 year or longer, constituted the present study population. Reduction and stabilization were undertaken beginning with the most medial unstable injury of SSSC and proceeding to the lateral ones. The respective coracoid fractures were finally reduced and fixed. In the follow-up, patients were directly examined and evaluated using the ratios of the Constant score for the injured side to that for the normal side. RESULTS: There were a total of 80 ipsilateral injuries of SSSC, including the coracoid fractures, and double disruption accounted for 94% of the patients. Of these, 62 injuries were surgically treated. No complications associated with surgery were observed. Bone union was achieved in all fractures; no patients required an additional operation. The Constant score ratio at the follow-up was 93% ± 7.4% on average. CONCLUSION: Although the majority of cases with type I coracoid fractures suffered double disruptions of SSSC, satisfactory results have been obtained with surgical treatment focusing on the assured reconstruction of a firm scapuloclavicular union. Copyright © 2012 by Lippincott Williams & Wilkins.

Background: In some short malunion cases, midshaft clavicular fractures are reported to result in unsatisfactory clinical outcomes. Shortening deformity of the clavicle could change the anatomical alignment of the shoulder girdle and is surmised to affect shoulder kinematics on arm movements. Nevertheless, no report has ever referred to documented changes. Hypothesis: Scapular motion will change with clavicular shortening in cadaveric models. Study Design: Controlled laboratory study. Methods: Twelve cadaveric shoulders were used, and sequential clavicular shortening by 0%, 5%, 10%, 15%, and 20% from the original length was simulated in this study. The scapulothoracic motion during passive arm elevation in 3 planes was monitored using an electromagnetic tracking device. Differences in kinematics of the scapula between the 0% shortening models and the other 4 experimental groups were analyzed. Results: During arm elevation, posterior tilting and external rotation of the scapula significantly decreased with > 10% shortening of the clavicle. Decreased posterior tilting was found with a shorter clavicle and at higher positions of arm elevation in all planes and became obvious during coronal plane elevation. Upward rotation of the scapula did not change with shortening at any elevated arm positions. Conclusion: The findings of this study clearly indicated that shortening of the clavicle affects the kinematics in the shoulder girdle. Clinical Relevance: The results of this cadaveric study suggest that clavicular shortening of > 10% affects scapular kinematics and might produce clinical symptoms.