PubMed Health⌕ Search

Biomedical subjects

A Y Shin

Publications and source records attributed to A Y Shin.

At least 19 recordsLinked to original sources
PubMed2002

Acetabular stress fractures in military endurance athletes and recruits: incidence and MRI and scintigraphic findings.

OBJECTIVE: To evaluate the incidence and the MRI and scintigraphic appearance of acetabular stress (fatigue) fractures in military endurance athletes and recruits. DESIGN AND PATIENTS: One hundred and seventy-eight active duty military endurance trainees with a history of activity-related hip pain were evaluated by both MRI and bone scan over a 2-year period. Patients in the study ranged in age from 17 to 45 years. They had hip pain related to activity and had plain radiographs of the hip and pelvis that were interpreted as normal or equivocal. The study was originally designed to evaluate the MRI and scintigraphic appearance of femoral neck stress fractures. Patients had scintigraphy and a limited MRI examination (coronal imaging only) within 48 h of the bone scan. Twelve patients demonstrated imaging findings compatible with acetabular stress fractures. RESULTS: Stress fractures are common in endurance athletes and in military populations; however, stress fracture of the acetabulum is uncommon. Twelve of 178 patients (6.7%) in our study had imaging findings consistent with acetabular stress fractures. Two patterns were identified. Seven of the 12 (58%) patients had acetabular roof stress fractures. In this group, two cases of bilateral acetabular roof stress fractures were identified, one with a synchronous tensile sided femoral neck stress fracture. The remaining five of 12 (42%) patients had anterior column stress fractures, rarely occurring in isolation, and almost always occurring with inferior pubic ramus stress fracture (4 of 5, or 80%). One case of bilateral anterior column stress fractures was identified without additional sites of injury. CONCLUSIONS: Stress fractures are commonplace in military populations, especially endurance trainees. Acetabular stress fractures are rare and therefore unrecognized, but do occur and may be a cause for activity-related hip pain in a small percentage of military endurance athletes and recruits.

Acetabulum↗
PubMed2001

Vascularized bone grafts for scaphoid nonunions and kienböck's disease.

Vascularized bone grafts offer the ability to transfer bone with viable osteoclasts and osteoblasts with a preserved circulation. The resultant primary bone healing without creeping substitution through necrotic bone is an attractive alternative to conventional bone grafting in aiding or accelerating healing, replacing deficient bone, and revascularizing necrotic bone. Recent advances in the anatomy and physiology of vascularized bone grafts have increased the understanding and ability to apply them to various of carpal maladies. This article focuses on the principles, anatomy, application, and experimental and clinical studies of vascularized bone grafts for the treatment of scaphoid nonunions and Kienböck's disease.

Bone Transplantation↗
PubMed2001

Long-term results of cemented Steffee arthroplasty of the thumb metacarpophalangeal joint.

A retrospective evaluation of the Steffee metacarpophalangeal (MCP) thumb joint prostheses was performed to determine the long-term outcome and survivorship of the prosthesis. Fifty-four primary thumb arthroplasties (49 patients) were performed for pain, weakness, or instability involving the thumb MCP joint secondary to arthritis. Underlying etiology included rheumatoid (49 thumbs), psoriatic (1 thumb), scleroderma (2 thumbs), and degenerative (2 thumbs) arthritis. Thirty-one thumbs had concomitant interphalangeal joint instability and underwent interphalangeal joint fusions. At an average follow-up period of 57 months, the average motion of the MCP joint was 21 degrees (range, 0 degrees to 40 degrees ), with a significant improvement in position and stability. Thumb axis length was maintained or increased in 98%. Although there was not a consistent long-term improvement in grip or pinch strength, 87% of the patients reported subjective improvement in strength and function as a result of surgery. Pain was relieved in all thumbs with preoperative pain. Complications included a periprosthetic fracture, 2 late infections, and 1 gross loosening of the implant. The survivorship of the implant was 93% survivorship at 5 years and 89% survivorship at 10 years, with only 4 failures in 54 thumbs. The Steffee thumb MCP arthroplasty resulted in excellent long-term survivorship, patient satisfaction, and functional outcome.

Adult↗
PubMed2001

Volar A1 pulley approach for fixation of avulsion fractures of the base of the proximal phalanx.

Avulsion fractures of the base of the proximal phalanx associated with collateral ligament instability, excluding the thumb, are relatively rare. While the indications for surgical intervention vary, dorsal approaches have been advocated despite the volar location of the fracture fragment and orientation of the collateral ligaments. Ten patients with 11 avulsion fractures at the base of the proximal phalanx associated with collateral ligament instability were treated with open reduction and internal fixation using a volar A1 pulley approach. Anatomic restoration of the articular surface and collateral ligament stability were obtained in all patients. All fractures healed between 5 and 9 weeks (average, 6 weeks). After an average 19.4-month follow-up period all patients had full range of motion of the metacarpophalangeal joint, collateral ligament stability, and grip strength of at least 90% of the uninjured hand. No perioperative complications occurred. The average DASH score at last follow-up examination was 1.8 (range, 0-6). All patients were satisfied with the outcome of surgery. The volar A1 pulley approach is a direct and effective approach for reduction and fixation of avulsion fractures of the base of the proximal phalanx associated with collateral ligament instability.

Adolescent↗
PubMed2001

The role of midcarpal arthroscopy in the diagnosis of disorders of the wrist.

The findings of midcarpal versus radiocarpal arthroscopic examinations were compared in the diagnosis of a variety of wrist pathology in 89 patients. During 15 months 89 midcarpal arthroscopic examinations were performed in conjunction with radiocarpal arthroscopic examinations. Eighty-one wrists underwent arthroscopy for acute or chronic intracarpal instability. Eight wrists underwent arthroscopy for arthroscopy-assisted intra-articular distal radius fracture reduction. In the acute wrist instability group midcarpal arthroscopy added to the radiocarpal diagnosis in 21 of 26 (82%) of the wrists. In the chronic wrist instability group midcarpal arthroscopy added to the radiocarpal diagnosis in 46 of 55 (84%) of the wrists. In the distal radius group 5 of 8 wrists had additional pathology on the midcarpal arthroscopy examination, leading to additional surgical intervention. These results demonstrate that midcarpal arthroscopy added statistically significant information to the radiocarpal examination compared with wrist arthroscopy performed without a midcarpal examination.

Adult↗
PubMed2001

Transthecal digital block at the proximal phalanx.

This study assessed the efficacy of a modified transthecal digital block. Three-hundred-and-sixty consecutive digits were anaesthetised with this technique for the treatment of fractures, infections and foreign bodies. Complete palmar and dorsal anaesthesia was achieved in 357 of the 360 digits (99%), including 52 of 53 thumbs (98%). The technique was extremely easy to perform and no complications occurred.

Finger Injuries↗
PubMed2001

Upper extremity peripheral nerve anatomy: current concepts and applications.

The nerve anatomy of the upper extremity is studied constantly through surgical findings, electrodiagnostic studies, and cadaveric dissections. Although it is recognized that the anatomy is not changing rapidly, knowledge of the anatomic relationships and their significance is increasing. The purpose of the current study is to provide a comprehensive analysis of the nerve anatomy of the upper extremity to include innervation patterns, critical landmarks, and clinical applications, with particular focus on recent contributions in the literature.

Arm↗
PubMed2001

Vascular anatomy of the distal radius: implications for vascularized bone grafts.

The vascular anatomy of the distal radius and ulna is complex with a series of longitudinal vessels anastomosing with a series of arches. This complex anastomotic network of vessels has a consistent spatial relationship to surrounding anatomic structures and is constant in nature. Knowledge of the vascular anatomy of the distal radius and ulna has allowed the creation of numerous reverse flow pedicled vascularized bone grafts, which can be applied to carpal pathologic features to assist in the healing of difficult fractures or avascular necrosis. The anatomy and terminology of the vascular network and the implications, indications, and applications of this anatomy to carpal pathologic features is reviewed.

Bone Transplantation↗
PubMed2001

Treatment of isolated injuries of the lunotriquetral ligament. A comparison of arthrodesis, ligament reconstruction and ligament repair.

We studied 57 patients with isolated lunotriquetral injuries treated by arthrodesis, direct ligament repair, or ligament reconstruction. The outcomes were compared by using written questionnaires, the Disabilities of the Arm, Shoulder and Hand (DASH) score, range of movement, strength, morbidity and rates of reoperation. Isolated lunotriquetral injury was confirmed by arthroscopy or arthrotomy. The mean age of the patients was 30.7 years (15.4 to 53.7) and the injuries were subacute or chronic in 98.2%. Eight patients underwent lunotriquetral reconstruction using a distally-based strip of the tendon of extensor carpi ulnaris, 27 had lunotriquetral repair and 22 had lunotriquetral arthrodesis. The mean follow-up was 9.5 years (2 to 22). The probability of remaining free from complications at five years was 68.6% for reconstruction, 13.5% for repair, and less than 1% for arthrodesis. Of the lunotriquetral arthrodeses, 40.9% developed nonunion and 22.7% developed ulnocarpal impaction. The probability of not requiring further surgery at five years was 68.6% for reconstruction, 23.3% for repair and 21.8% for arthrodesis. The DASH scores for each group were not significantly different. Objective improvements in strength and movement, subjective indicators of pain relief and satisfaction were significantly higher in the lunotriquetral repair and reconstruction groups than in those undergoing arthrodesis.

Adolescent↗
PubMed2001

Percutaneous screw fixation or cast immobilization for nondisplaced scaphoid fractures.

BACKGROUND: Nondisplaced scaphoid fractures treated with prolonged cast immobilization may result in temporary joint stiffness and muscle weakness in addition to a delay in return to sports or work. Fixation of scaphoid fractures with a percutaneous cannulated screw has resulted in a shorter time to union and to return to work or sports. The purpose of this prospective, randomized study was to compare cast immobilization with percutaneous cannulated screw fixation of nondisplaced scaphoid fractures with respect to time to radiographic union and to return to work. METHODS: Twenty-five full-time military personnel with an acute nondisplaced fracture of the scaphoid waist consented to be randomized to either cast immobilization or fixation with a percutaneous cannulated Acutrak screw (Acumed, Beaverton, Oregon) for the purpose of this study. Time to fracture union, wrist motion, grip strength, and return to work as well as overall patient satisfaction at the time of a two-year follow-up were evaluated. RESULTS: Eleven patients were randomized to percutaneous cannulated screw fixation, and fourteen were randomized to cast immobilization. The average time to fracture union in the screw fixation group was seven weeks compared with twelve weeks in the cast immobilization group (p = 0.0003). The average time until the patients returned to work was eight weeks compared with fifteen weeks in the cast immobilization group (p = 0.0001). There was no significant difference in the range of motion of the wrist or in grip strength at the two-year follow-up evaluation. Overall patient satisfaction was high in both groups. CONCLUSIONS: Percutaneous cannulated screw fixation of nondisplaced scaphoid fractures resulted in faster radiographic union and return to military duty compared with cast immobilization. The specific indications for and the risks and benefits of percutaneous screw fixation of such fractures must be determined in larger randomized, prospective studies.

Adult↗
PubMed2001

Open Galeazzi fracture with concomitant radial head dislocation.

Galeazzi fractures are uncommon, but a combination of open Galeazzi fracture and radial head dislocation has not been described. This article reports on a variant of an open Galeazzi fracture in which concomitant radial head dislocation and coronoid process fracture occurred. Thorough understanding of the mechanisms and influences of pronation injuries of the forearm is essential in order to properly treat this fracture-dislocation. Our evaluation of the individual elements of this composite injury has allowed us to propose a mechanism of injury.

Fractures, Open↗
PubMed2001

Traumatic and reconstructive problems of the scaphoid.

The management of acute scaphoid fractures should be oriented on the concept of fracture stability, ease of reduction, associated ligamentous injury, and risk of impaired blood supply, rather than the direction of the fracture line or location of the fracture within the scaphoid. The lack of predictability of successful fracture union and prognostic discrepancies of historic and contemporary classifications may be related to subtle differences of the internal vascular architecture of each scaphoid. Because the possibility of impaired vascularity is greater with fractures located in the proximal third, stable internal fixation is indicated to provide mechanical stability and fracture surface contact to enhance revascularization. Improved healing rates in a shorter time and earlier rehabilitation with percutaneous techniques of internal fixation have produced a clear shift from classic conservative treatment to internal skeletal fixation. Although the rates of union of well-vascularized nonunions have not been dramatically improved with the use of internal fixation as compared with inlay bone grafting, the restoration of scaphoid anatomy and prevention of malunion and associated carpal collapse with interpositional bone grafting techniques will reduce the risk of osteoarthritis.

Bone Transplantation↗
PubMed2001

Chondrolysis and joint destruction secondary to snake envenomation.

Although snakebite injuries to the hand are common, intra-articular envenomation has rarely been reported. In this article, we describe a patient who was bitten by a rattlesnake and whose left-index-finger distal interphalangeal joint sustained intra-articular envenomation that resulted in aseptic chondrolysis and severe joint destruction 1.5 years later. Multiple cultures and biopsies were negative, and histology was consistent with nonspecific degenerative changes secondary to necrosis of the articular cartilage from retained toxins. The patient chose arthrodesis; 24 months postoperatively, he was pain-free and had returned to work.

Adult↗
PubMed2000

Clinical results of intraarticular fractures of the base of the fifth metacarpal treated by closed reduction and cast immobilization.

This retrospective study evaluated the results of closed reduction and cast immobilization for isolated intraarticular fractures of the base of the fifth metacarpal. Twenty-two of 37 such fractures were available for follow-up at an average of 43 months, and these had all healed at an average of 5 weeks without any cast complications. Twenty patients reported excellent or good results, and two reported fair or poor results. At follow-up, 13 had no arthrosis and nine had mild arthrosis of the carpometacarpal joint. However, outcome was not influenced by fracture type, the degree of subluxation or articular step off, or the presence of arthrosis. We conclude that isolated fractures of the base of the fifth metacarpal can be reliably treated with closed reduction and cast immobilization.

Adult↗
PubMed2000

T incision for exposure of the distal radius and wrist.

A retrospective review of 66 T-shaped incisions for exposure of the dorsal distal radius and wrist was performed. The incision provided excellent exposure in all cases and no additional incisions were required. Cosmesis was considered acceptable by all patients. Complications occurred in 6% and were more likely in patients undergoing fixation of acute distal radius fractures using Kirschner wires which protruded through the skin flaps.

Adolescent↗
PubMed2000

Disability outcomes in a worker's compensation population: surgical versus nonsurgical treatment of carpal tunnel syndrome.

A retrospective record review of patients with occupational carpal tunnel syndrome, nerve conduction velocity studies, and a closed Workers' Compensation case was undertaken to compare the outcome of surgical versus nonsurgical treatment with respect to disability and return to work status. Between January 1, 1991, and December 31, 1993, 182 patients who met the inclusion criteria were identified. Surgical release of the carpal tunnel was performed in 57% of patients and the other 43% were treated conservatively. Overall, 82% of patients returned to full work status, whereas 18% had duty modifications. Surgical treatment decreased the rate of duty modifications and disability ratings compared with nonsurgical treatment and reduced the odds of incurring disability. Severity of carpal tunnel syndrome was also a significant factor affecting disability. Despite the generally held belief that the outcome of treatment of occupational carpal tunnel syndrome is poor, the present study shows that both surgical and nonsurgical treatment is effective. However, patients treated with surgery had decreased disability when compared with those who were treated conservatively.

Adolescent↗
PubMed1999

Dynamic axial carpal instability: a case report.

The concept of distal carpal row dissociation is not new. It has occurred secondary to high-energy crush or blast injuries, with resultant axial dislocations of both carpal rows and metacarpals. Axial carpal sprains without disruption or dynamic axial carpal instability have not been previously described. The evaluation of this new type of carpal instability with radiographs, tomography, arthrography, and magnetic resonance imaging failed to demonstrate its etiology. Arthroscopic evaluation of the midcarpal and radiocarpal joints demonstrated a dynamic axial carpal instability with incompetence of the capitohamate and scapholunate ligaments. Stabilization of the axial instability by capitohamate arthrodesis relieved the chronic wrist pain.

Adult↗