Journal of Southeast Asian Orthopaedics

Does Adapted Self-Exercise Have Benefits for Stiff Shoulders?

Kriangkrai Benjawongsathien, MD — Fri, 22 Mar 2024 00:00:00 +0700

Purpose: Stiff shoulders restrict shoulder motion and affect the quality of life. Several rehabilitation programs have been implemented to improve these conditions. Various exercises have been designed to achieve positive clinical outcomes. However, too many different sets of exercises can confuse patients and lead to infrequent exercises.

We aimed to compare the clinical outcomes of a small set of adapted self-exercises to a usual set in patients with stiff shoulders.

Methods: Seventy patients with stiff shoulders were randomly assigned to two groups, each performing self-exercises. Self-exercise in group I (the usual set) was composed of ‘wall climbing in front,’ ‘wall climbing at the side,’ and ‘shoulder stretching with a towel,’ and in group II (the adapted set), it was composed of ‘assisted forward flexion stretching in the standing position,’ ‘sleeper stretching in the standing position,’ and ‘doorway or corner stretching.’ The outcome measurements included pain score, functional score, and range of motion.

Results: There were no significant differences in the baseline patient characteristics between the groups in terms of sex (p=0.759), age (p=0.521), underlying disease (p=0.322), or body mass index (BMI) (p=0.687). Group II demonstrated significantly higher improvement in mean pain score decrement (-4.5±1.7 vs. -3.5±2.4, p=0.049), mean ASES score improvement (23.1±9.9 vs. 18.3±13.1, p=0.038) and mean degree improvement of shoulder motion in all directions than in group I.

Conclusions: The adapted self-exercise set may offer favorable results in treating patients with stiff shoulders and may also be a treatment option for overweight patients.

Association Between Sarcopenia and Functional Independence After Acute Fragility Hip Fracture at 6 Months

Wed, 24 Apr 2024 00:00:00 +0700

Purpose: The primary goal of hip fracture treatment is to allow ambulatory life as early as possible to avoid any subsequent complication after fracture. The European Working Group on Sarcopenia in Older People (EWGSOP) defined sarcopenia as the presence of both low muscle strength and low muscle quantity. Our purpose in this study was to identify the association between sarcopenia and functional independence after acute fragility hip fracture.

Methods: Patients 50 years old or more without neurologic diseases who encountered fragility hip fracture for the first time were included. Sarcopenia was assessed using EWGSOP revised 2018 criteria. Functional independence was assessed using the Barthel Index (BI) at 6 months after injury. Data were analyzed using multiple linear regression.

Results: A total of 240 patients were included; overall, 84 patients with and 156 without sarcopenia. Multiple linear regression analysis showed significant difference in BI at 6 months among those with and without sarcopenia (p<0.001). Specifically, the lower limb related components of BI were decreased four points in patients with sarcopenia, which is a more statistically significant result when compared to the overall BI score.

Conclusions: In this study, patients with sarcopenia were associated with functional independence impairment. Lower limb-related components of the BI must be specifically assessed in patients with hip fracture. Moreover, rehabilitation programs should be tailored to the specific needs of the patient.

Comparative Study of Union Rate in Closed Humerus Shaft Fracture After Operative Fixation with Anteromedial Versus Anterolateral Surface Plating Using the Anterolateral Approach: A Randomized Controlled Study

Tana Rattanakitkoson, MD, Narongrit Lothaisong, MD, Naruepol Ruangsillapanan, MD — Wed, 05 Jun 2024 00:00:00 +0700

Purpose: Plate osteosynthesis is considered the gold standard for treating humeral shaft fractures, and orthopedic surgeons widely use the anterolateral approach with anterolateral surface placement. However, surgeons may have difficulties with the non-smooth surface and proximity to the radial nerve during their use. To address this challenge, we propose introducing the anterolateral approach with anteromedial surface placement. This study aimed to compare the outcomes between anteromedial and anterolateral surface plating using the anterolateral approach.

Methods: This study included 74 patients who sustained a mid-shaft humerus fracture (AO 12) and underwent open reduction internal fixation between December 2020 and December 2022. Twelve patients were excluded based on the exclusion criteria. Among the remaining patients, 30 were randomized and allocated to surgery with anteromedial surface plating, while 32 patients were treated with anterolateral surface plating through an anterolateral approach. Postoperative clinical and radiographic results were recorded and analyzed.

Results: The union rate, blood loss, operative time, and complications were not significantly different between the two groups. All the patients healed radiographically except for two in the anterolateral surface plating group, who required reoperation. Although anteroposterior alignment was significantly better in the anteromedial surface plating group, it was not clinically significant.

Conclusions: Anteromedial plating demonstrated a commendable union rate, offered assured alignment, and presented itself as a secure option for addressing fractures of the humerus shaft.

Outcomes of Perilunate Dislocation and Perilunate Fracture Dislocation After a Minimum 1-Year Follow-Up Following Open Reduction and Internal Fixation Via the Dorsal Approach: A Retrospective Study

Phanumas Muennoi, MD, Thananit Sangkomkamhang, MD, PhD — Fri, 28 Jun 2024 00:00:00 +0700

Purpose: This study aimed to review and evaluate the functional and radiographic outcomes of patients with perilunate injuries after a minimum 1-year follow-up following open reduction and internal fixation with or without ligament repair.

Methods: This retrospective study included patients with perilunate injuries who underwent open reduction and internal fixation with or without ligament repair at our hospital between 2013 and 2021 with a minimum 1-year follow-up.

Results: Of the 22 enrolled patients, 18 and 4 exhibited perilunate fracture dislocation and perilunate dislocation, respectively. The mean follow-up period was 15.3 (12–20) months. The mean age of the patients was 30.5 ± 10.2 years. Notably, 20 (90.9%) and 2 (9.1%) patients were males and females, respectively. The mean flexion/extension angles were 67.2°/76.2°. The mean ulnar deviation/radial deviation was 25.4°/13.8°, and the mean pronation/supination was 85.6°/88.3°. As secondary outcomes, the mean grip strength was 80% of the uninjured side, modified Mayo wrist score was 73.6 (1 excellent, 6 good, 11 fair, and 4 poor), and visual analog scale was 0.59. For radiographic outcomes, the mean scapholunate angle (SL angle) was 50.4°, SL gap was 2.43 mm., and carpal height ratio was 0.50. Four and nine patients had an incongruent Gilula's line and arthrosis, respectively.

Conclusions: Satisfactory results can be achieved with open reduction and internal fixation using a dorsal approach. Although some patients had abnormal radiographic findings, the radiographic outcomes may not correlate with the functional outcomes.

Irreducible Fracture Dislocation of the Elbow Due to Medial Epicondyle Entrapment Associated with Median Nerve Palsy in Adult: A case report

Tue, 12 Mar 2024 00:00:00 +0700

Purpose: Medial epicondyle fractures are common elbow injuries in pediatric and adolescent population. However, this condition is extremely rare in adults, with only a few cases reported in the literatures. This report presents the case of an adult patient with an irreducible fracture dislocation of the elbow due to intra-articular entrapment of the medial epicondyle associated with median nerve palsy.

Methods: A case of 36-year-old man presented with posterolateral fracture dislocation of the left elbow with displaced medial epicondyle and median nerve palsy. Closed reduction was attempted, resulting in a grossly unstable elbow. Post-reduction radiographic study demonstrated the articular incongruence with the entrapped medial epicondyle. The patient underwent an open reduction and median nerve exploration. A fragment of the medial epicondyle was found comminuted and repaired using our novel technique with suture anchors. The lateral ulnar collateral ligament was repaired because of varus residual instability. The dislocated elbow was successfully reduced.

Results: At 6 months follow-up, the elbow was stable with nearly full range of motion, although radiographic studies demonstrated union fractures with partially fragment resorption. Both sensation and motor function of the median nerve were gradually recovered.

Conclusions: We presented a novel fixation technique for a rare case of irreducible fracture dislocation of the elbow due to intra-articular entrapment of the medial epicondyle associated with median nerve palsy in adults. The median nerve should be explored in every case, and delayed diagnosis should be avoided, which may lead to devastating complications.

Pediatric Olecranon Fracture with Coronoid Process Osteochondral Flap Fracture: A Rare and Challenging Case

Fri, 07 Jun 2024 00:00:00 +0700

Purpose: Osteochondral flap fracture is a variant of fracture in the pediatric age group. It is caused by a shearing force that separates the articular cartilage from the underlying subchondral bone. We present a pediatric case of an olecranon process fracture with an osteochondral flap fracture of the coronoid process.

Case report: A 10-year-old child presented with swelling and pain in the right elbow after an incident of direct trauma. A plain radiograph revealed multiple small fracture fragments, inconclusive of coronoid process involvement. Intraoperatively, we found an osteochondral fracture of the coronoid process with anteromedial facet displacement. The fracture was reduced and secured with two K-wires. The undisplaced olecranon fracture was fixed with a K-wire in situ.

Conclusions: Osteochondral flap fractures of the coronoid process can be easily missed and underestimated in imaging studies. Neglected fractures can lead to severe impairment of elbow motion and function and cause chronic pain. The anatomical reduction of the coronoid facet is crucial and yields the best outcome.

Osteochondroma at the Ventro-Medial Surface of the Scapula Causing Pseudo Winging Scapular Resection with Computer-Assisted Navigation: A Case Report and Literature Review

Teerapat Nakornnoi, MD — Mon, 24 Jun 2024 00:00:00 +0700

Purpose: Osteochondromas, the most common benign bone tumors, primarily occur in the long bones, with scapular osteochondromas constituting less than 1% of cases. A unique challenge in ventral scapular osteochondromas is limited visibility from the dorsal side. Computer-assisted surgery, which is widely employed in tumor surgery is a promising solution for minimally invasive resection with reduced muscle injury.

Methods: We present the case of a thirteen-year-old female with a ventral scapular osteochondroma that cause winging and snaping of her left arm. The patient underwent computer-assisted surgery under general anesthesia in the prone position. The procedure involved a minimal incision over the crest of the scapular spine, enabling precise identification of the tumor from the dorsal side using navigation tools.

Results: The tumor, identified as an osteochondroma on CT scans, was successfully resected with minimal soft tissue damage. Postoperatively, the patient's arm was immobilized for two weeks, followed by a pain-free return to normal activity. Radiographic evaluation confirmed complete tumor removal.

Conclusions: Computer-assisted navigation can help locate the ventral osteochondroma of the scapula with minimal soft tissue damage and a quicker recovery time.