Objective: To evaluate if acromial locking in hook plate is necessary for surgical treatment of acromioclavicular dislocation by compare Wolter plate and AO hook plate. Methods: Seventy one patients who have Rockwood type III to V acromioclavicular joint dislocation treated with AO hook plate and Wolter plate were involved. Among them, 39 patients were treated with Wolter hook plate and 32 patients with AO hook plate. The Constant-Murley score and the range of motion of shoulder joint were measured on postoperative 1st , 3 rd , 6 th and 12 th months, and the radiological complications involving plate and bone were investigated. Results: Constant-Murley score of postoperative one year were 83.2 6.8 in AO hook plate group and 85.2 5.3 in Wolter plate group without statistical difference (p<0.05). Faster recover of forward elevation and external rotation were examined in Wolter plate group at first and third months after surgery than those of AO hook plate group, but there were no significant difference between after six months or later after surgery. Four cases of loosen or broken screws and one case of pull-out of plate were found in Wolter plate group. Seven cases of subacromial bony erosion and one periprosthetic fracture were found in AO hook plate group. Conclusion: Although clinical outcomes of both two methods were same, no matter if acromial locking system was or not. More radiological complication of plate and bone were found in AO hook plate than that of Wolter plate. However also had disadvantage like larger incision during surgery.

Background: Normal elbow joint kinematics has been widely studied in cadaver, whilst in vivo study, especially of the forearm, is rare. Our study analyses, in vivo, the kinematics of normal forearm and of malunited forearm using a three-dimensional computerized simulation system. Methods: We examined 8 patients with malunited Monteggia fracture and 4 controls with normal elbow joint. The ulna and radius were reconstructed from CT data placing the forearm in three different positions; full pronation, neutral, and full supination using computer bone models. We analyzed the axis of rotation 3-dimentionally based on the axes during forearm rotation from full pronation to full supination. Results: Axis of rotation of normal forearm was pitch line, with a mean range of 2 mm, from full pronation to full supination, connecting the radial head center proximally and ulnar fovea distally. In normal forearm, the mean range was 1.32 mm at the proximal radioulnar joint and 1.51 mm at the distal radioulnar joint. However in Monteggia fracture patients, this range changed to 7.65 mm at proximal and 4.99 mm at distal radoulnar joint. Conclusions: During forearm rotation, the axis of rotation was constant in normal elbow joint but unstable in malunited Monteggia fracture patients as seen with radial head instability. Therefore, consideration should be given not only to correcting deformity but also to restoring AOR by 3D kinematics analysis before surgical treatment of such fractures. (Clin Shoulder Elb 2014;17(1):25-30)

Purpose:We evaluated clinical and radiological results for open reduction and internal fixation of acromioclavicular dislocation without coracoclavicular ligament repair after removal of implants. Materials and methods: Clinical and radiological results were obtained for 53 patients who underwent open reduction and internal fixation of an acromioclavicular joint dislocation between 1998 and 2007. A total of 21 patients were treated with a modified-Phemister method and 32 patients were treated with a Hook plate method. All subjects were surveyed after removal of their implants. The Constant scoring system was administered postoperatively to evaluate clinical results. Radiologic outcomes were evaluated by both coracoclavicular intervals on plain films. Results: Constant scores were 87.59±7.8 in the Phemister group and 89.35±5.3 in the Hook plate group. For both groups, the mean coracoclavicular interval at preoperative radiography was 15.9 mm at the injured site and 8.0 mm at the opposite site. After metal removal, the mean difference between coracoclavicular distances between normal and injured sites were 1.0 mm for the Hook plate group and 1.2 mm for the modified Phemister method group (p>0.05). Conclusion: Open reduction and internal fixation of an acromioclavicular joint without coracoclavicular ligament repair shows good long-term clinical and radiological results. 목적: 오구 쇄골 인대를 봉합하지 않고 견봉 쇄골 관절의 관혈적 정복만 시행한 환자군에서의 임 상적, 방사선학적 추시 결과를 확인하고자 하였다. 대상 및 방법: 1998년부터 2007년까지 변형 Phemister 술식과 갈고리 금속판 (AO hook 금속 판, Wolter 금속판)을 사용하여 견봉 쇄골 관절 탈구로 수술 받은 환자 중 삽입물 제거한 53예를 대상으로 하였다. 변형 Phemister 술식을 사용한 군이 21명, 갈고리 금속판을 사용한 군이 32 명 이였다. 임상적 평가는 Constant score를 이용하였으며, 양측 쇄골과 오구돌기 사이의 수직 거리를 비교하여 방사선적 평가를 하였다. 결과: Constant score는 변형 Phemister 술식을 사용한 군에서는 87.59±7.8, 갈고리 금속판 을 사용한 군에서는 89.35±5.3로 통계학적 차이는 없었다. 두 군에서 수술 전 손상 부위의 쇄골 오구돌기의 평균 거리는 15.9 mm 이였으며, 건측 견관절은 평균 8.0 mm 이였다. 갈고리 금속 판 환자군에서 건측과 비교하여 평균 1.0 mm, 변형 Phemister 환자군에서는 평균 1.2 mm 의 수직 전위가 관찰되었으며 통계학적 차이는 없었다. 결론: 오구쇄골 인대를 복원 하지 않은 견봉 쇄골 관절 탈구의 관혈적 정복술 및 내고정술은 양호 한 임상적, 방사선학적 결과를 보였다. 색인 단어: 견봉 쇄골 관절 탈구, 오구 쇄골 인대 봉합, 변형 Phemister, 갈고리 금속판 초 초 록 록

Purpose:To evaluate the long-term results (minimum 7 Years'follow-up) of cementless total hip arthroplasty using an Anatomic Locking Medullary (AML) hip prosthesis. Materials and Methods:Fifty-one patients (57 hips) underwent total hip arthroplasty between January 1995 and July 2002. They were followed up for a minimum of seven years (7.1 to 14.6) after the initial operation. The mean age of the patients was 56.8 years. The radiographs were reviewed and the clinical results were evaluated. Results:The mean Harris hip score improved from 52.4 points preoperatively to 88.2 points postoperatively. Of the 40 hips showing a good press-fit, 29 hips (72.5%) exhibited bone ingrowth fixation. Of the remaining 17 hips with a poorer press-fit, 7 hips (35.3%) showed bone ingrowth fixation and 6 hips (35.3%) had unstable fixation.Of the 36 hips showing bone ingrowth fixation, 28 hips (77.8%) exhibited stress mediated bone resorption. On the last follow-up radiographic examination, osteolysis occurred around the femoral stem and acetabular cup in 21 (36.8%) and 6 (10.5%) hips, respectively. Conclusion:The results of cementless AML total hip arthroplasty were acceptable up to 7 years but polyethylene wear and osteolysis should be followed carefully over the long term.