Search

Background: Finger injuries caused by green onion cutting machines in Korean kitchens have unique characteristics of an incomplete amputation in which multiple parallel soft tissues and blood vessels are injured in the same form. In this study, we aimed to describe unique finger injuries and to report the treatment outcomes and experiences of performing possible soft tissue reconstructions. Methods: This case series study included 65 patients (82 fingers) from December 2011 to December 2015. The mean age was 50.5 years. We retrospectively classified the presence of fractures and the degree of damage in patients. The injured area involvement level was categorised as distal, middle or proximal. The direction was categorised as sagittal, coronal, oblique or transverse. The treatment results were compared according to the amputation direction and injury area. Results: Of the 65 patients, 35 had a partial finger necrosis and needed additional surgeries. Finger reconstructions were performed through stump revision or local or free flap use. The survival rate was significantly lower in patients with fractures. As for the injury area, distal involvement led to 17 out of 57 patients displaying necrosis and all 5 patients showing the same in proximal involvement. Conclusions: Unique finger injuries caused by green onion cutting machines can easily be treated with simple sutures. Then prognosis is affected by the extent of injury and the presence of fractures. Reconstruction is necessary for finger necrosis owing to extensive blood vessel damage and limitations when making this selection. Level of Evidence: Level IV (Therapeutic)

Forearm replantation is a challenging procedure for both patients and medical professionals. High survival rates are now being achieved owing to developments in microsurgical techniques. However, patient expectations for a “functional hand” are ever-increasing. To obtain satisfacto-ry functional results following major limb replantation, it is important to reduce the ischemic time. During forearm replantation, the time from the beginning of surgery to the anastomosis of the artery should be minimized. This step includes anesthesia, wound debridement, and bone fixation, which are key factors in choosing the most efficient method and reducing the time needed. Herein, we review the prognostic factors and report the general operative procedures for forearm replantation using our proposed surgical technique.

Purpose: We classified the articles published in the journal Hip & Pelvis and analyzed the relationship between study characteristics and citation rates. Materials and Methods: All articles published in Hip & Pelvis from 2009 to 2019 were included. We classified the articles according to the type, language, listing in PubMed Central (PMC), treatment modality, material, design, anatomical focus, number of authors, and number of cases. We analyzed the citation rate according to this classification, with yearly citation rate reflecting the exposure period until March 2020. Results: The yearly citation rate increased significantly after the language of the journal was changed from Korean to English in June 2014 (mean=0.96 vs. 1.63, P

Background Multilevel dysvascular injury of the hand can be treated with replantation or revision amputation. The authors compared both modalities regarding functional outcomes, patient-reported outcomes, and required resources, as relevant studies are scarce. Methods In this retrospective review of consecutive case series (replantation, n = 8; revision amputation, n = 11), clinical results and functional outcomes (including grip strength, range of motion, sensory recovery, and grip or pinch ability) were assessed. Patient-reported outcomes, required hospital resources, and treatment cost until 1 year after surgery were compared between both groups. Results Six patients used passive prostheses, two used body-powered prostheses, and three did not use a prosthesis in the revision amputation group. All patients in the replantation group could grip objects and had restored hands, with protective sensory recovery and substantial wrist motion, whereas six patients in the revision amputation group were unable to grip or pinch objects. Replantation was associated with superior patient-reported outcomes, but required more hospital resources and treatment costs. Conclusions This study suggests that in the treatment of multilevel dysvascular injury of the hand, the surgical method should be chosen on a case-by-case basis. For better functional and patient-reported outcomes, replantation is preferred. Revision amputation can be performed in the absence of sufficient hospital resources and to reduce treatment cost. These findings can aid in the preoperative counseling of patients with multilevel dysvascular injury of the hand. Clinical question/level of evidence Therapeutic, III.

Purpose: Distal radius fractures (DRFs) are often observed in simple trauma in older women with osteoporosis, and severe trauma caused by traffic or fall accidents. In this study, we aim to classify the DRFs according to injury mechanism, and statistically compare epidemiologic factors, radiological characteristics, and functional scores.Methods: From 2013 to 2018, 112 cases of trauma in 104 patients (70 monotrauma and 42 severe traumas) diagnosed with DRFs were included. Patients were divided into the low-energy monotrauma (ML), high-energy monotrauma (MH), and severe trauma (ST) groups and analyzed for differences in sex, Injury Severity Score (ISS), accompanying ipsilateral injuries, radiologic indices, AO classification, and functional outcome scores (disabilities of the arm, shoulder, and hand and Modified Mayo Wrist Score). Results: Significant differences were observed in sex, age, ISS, and accompanying ipsilateral injury among three group (p < 0.001). Distribution of AO classification was not significantly different among the groups. Especially, sex, age, and accompanying ipsilateral injury were significantly different between the ML and MH groups (p

Reducing ischemic time is the most important factor associated with good results in major limb replantation. This case describes the surgery and outcome of replantation of both major limbs in a patient with amputation of both lower extremities due to rope entanglement on a ship. Emergency surgery restored circulation in 3 hours and 40 minutes after amputation on the left side, and 4 hours and 50 minutes after amputation on the right side. The left knee of the patient had undergone joint fusion and the right knee could move from 0 degree to 100 degrees. At present, the patient is able to walk using crutches. These results demonstrate that good results can be obtained if bilateral anastomosis is possible in both knees.

Osborne’s modified decompression involves repairing Osborne’s ligament beneath the ulnar nerve after simple decompression for idiopathic cubital tunnel syndrome. In this retrospective interrupted time series, 31 patients underwent modified simple decompression and 20 patients underwent conventional simple decompression. In the modified simple decompression group, the ulnar nerve length was measured at operation in full elbow flexion and extension before and after repair of Osborne’s ligament. Ulnar nerve instability during elbow motion was measured using ultrasonography before operation and at 12 months after operation. In patients treated by modified simple decompression, the ulnar nerve length in full elbow flexion reduced significantly after repair of Osborne’s ligament. At 12 months after surgery, the grade of ulnar nerve instability was lower in the modified simple decompression group than in the conventional simple decompression group. The clinical outcomes did not differ significantly between the groups at 24 months after operation.Level of evidence: III

Background Septic arthritis of digits needs urgent treatment. When treatments delayed or insufficient, patients may be referred to the upper-level hospital due to uncontrolled infection. We reviewed the treatment history of referred patients and compared the microorganisms and the clinical course of both primary and referred patients as relevant studies are rare. Methods In this retrospective review of consecutive case series, 45 patients (primary, n = 11; referred, n = 34) were treated with multiple irrigation and debridement. Cefazolin was used as empiric antibiotics, then changed according to microbiologic study. Previously used antibiotics, treatment delay, surgical history of the referred patients were reviewed. Identified microorganisms, required surgical intervention, hospital stay, radiologic outcome, functional outcomes were compared between both groups. Results In the referred patients, methicillin-resistant Staphylococcus aureus (MRSA) was commonly found and cefazolin was susceptible in only 15% of the cases. Longer hospital stay, prolonged antibiotic therapy, more surgical intervention including flap surgery was required to treat the referred patients. Postoperative pain was not severe in daily activities, but the final range of motion was significantly less in the referred patients compared to the primary patients. Conclusions This study suggests that in the treatment of uncontrolled septic arthritis of the digits, antibiotic agents covering MRSA may shorten the duration of antibiotic therapy in areas of high MRSA incidence. Besides, more number of I & D including flap surgery may be required for the referred patients compared with the primary patients. These findings can help the surgeon in setting up a treatment plan or in counseling of referred patients with uncontrolled septic arthritis of the digits.

This study aimed to determine whether bone density correlates with radiologic and clinical outcomes after screw fixation of displaced intra-articular calcaneal fractures (DIACF) with the sinus tarsi approach.We retrospectively evaluated 43 consecutive cases of unilateral DIACF between March 2015 and December 2017. Radiologic evaluations were performed using preoperative, postoperative, and last follow-up calcaneal lateral and axial radiographs. In all patients, preoperative CT scanning of both injured and uninjured calcaneus were performed at one scanning and dual x-ray absorptiometry (DXA) scans were obtained. Hounsfield unit (HU) measurement values were determined by placing an elliptical region of interest confined to the cancellous region of the uninjured calcaneus. Clinical outcomes were assessed at a minimum of 12 months postoperatively using Foot and Ankle Outcome Scores (FAOS).Mean HU values of the uninjured calcaneus significantly correlated with bone mineral density scores obtained from DXA scans of the lumbar and femur (Spearman ρ = 0.656 - 0.748; p0.001 for both). Decreased HU values of the uninjured calcaneus significantly correlated with decreased Böhler's angle and widening of calcaneal width from postoperative to last follow-up. (Pearson r = 0.348, p = 0.022; Pearson r = -0.582, p0.001, respectively). Increased HU values of the uninjured calcaneus significantly correlated with improved clinical outcomes in three of five FAOS domains, including activities of daily living, sports, and quality of life (beta = 0.283 - 0.322; p0.05 for all).Decreased preoperative bone density significantly correlated with decreased Böhler's angle, widening of calcaneal width, and inferior short-term clinical outcomes after screw fixation of DIACF. By quantifying bone density using HU value in area where DXA cannot be performed, such foot bones, determining whether different fixation methods or systemic treatments can be tailored to bone density could help in optimizing clinical outcomes.Level III, Retrospective case series.

We compared clinical outcome between the Speed- Bridge technique and single-row techniques in patients with full-thickness rotator cuff tears and figured out the patterns of retear by computed tomography (CT) arthrogram and ultrasonography follow-up. In total 209 patients with full-thickness rotator cuff tears who underwent arthroscopic rotator cuff repair and were followed up for at least 2-year were enrolled retrospectively (group 1: single-row repair, group 2: Speed-Bridge repair). Pre- and postoperative data were reviewed to assess clinical and radiologic outcomes. There were no significant differences in clinical outcome between the 2 groups. The retear rates of medium and large-sized rotator cuff tear groups were higher in group 1 than in group 2 (p0.05). There was no significant difference in the medial row failure rate between the 2 groups. Present study showed that the knotless suture Bridge technique may be a considerable alternative method for treating full-thickness rotator cuff-tears. Level of evidence: Level III, Retrospective comparative study.

Purpose: Fingertip replantation is a challenging and technically demanding procedure. A variety of venous drainage techniques have been attempted for successful fingertip replantation. We present a new venous drainage technique, known as serial multifocal incision for fingertip replantation. Methods: Between 2006 and 2014, we performed 94 fingertip replantations without vein anastomosis. Eighty of the patients were male, and 14 were female, with an overall mean age of 42 years (range: 8–67 years). All patients suffered amputations distal to the distal phalanx joint (Ishikawa subzone I, II, or III). We performed only artery anastomosis. To relieve venous congestion, we incised the fingertip 2–3 mm using a number 11 scalpel blade and allowed the vein to drain naturally. We made small serial incisions every 2–3 days for 1 week. Results: The overall success rate for this procedure was 90%, with 85 surviving digits. Two patients with partial necrosis and nine patients with complete loss needed a second operation. Two patients received blood transfusions with an average of 1.5 units, but both had an accompanying injury at another site. No one complained of nail deformity or wound infection. Conclusions: Various external bleeding techniques have been reported to yield good results. The serial stab incision venous drainage technique is a modified fish-mouth external bleeding technique that overcomes the disadvantages of published methods. This technique is simple, allows for easy control of venous drainage, and reduces the need for blood transfusions compared to other venous drainage techniques that cause large amounts of bleeding. We propose a new method, the serial stab incision venous drainage technique, which is effective and associated with high rates of survival.

일반적으로 쇠살대 빗물받이는 도로 표면유출 흐름을 차집하여 도시배수 시설로 배제하기 위하여 설치된다. 빗물받이의 규모 및 설치간격을 결정하기 위하여 빗물받이 차집유량 산정식이 필요하다. 그러므로 쇠살대 빗물받이 유입구의 차집능력 분석이 필요하다. 본 연구에서는 도로 빗물받이의 차집유량 산정을 위해 수리...

This study aimed at the optimization and deve lopment of rice snack by response surface methodology (RSM). The effect of rice so aking time and additional ratio of soybean milk on physicochemical properties and sensory evaluation of dried rice flour for non-fried snack was studied. After soaking for 0 to 12 days, Baekjinju rice was milled and then air-dried. A quadratic model was selected for weight, volume, hardness, taste and appearance. Two-factor interaction model was selected for expansibility, color and overall preference. A linear model was selected for yellowness and flavor. Weight, hardness and appearance were increased and decreased thereafter as rice soaking time increased, but the volume was reversed. Expansibility, color, taste and flavor were decreased as rice soaking time increased, but yellowness was reversed. Weight and overall preference decreased as additional ratio of soybean milk increased, but volume, expansibility and yellowness were reversed. Hardness, taste and appearance were increased after initial decrease as additional ratio of soybean milk increased, color and flavor were not changed by additional ratio of soybean milk. The optimum conditions of each factor were set to where the rice soaking time and additional ratio of soybean milk were at their minimum. Weight, volume, expansibility, yellowness, hardness, color, taste, flavor, appearance and overall pref erence were established at maximum level where the objective of the optimum was in level. Our data indicated the st atistically predicted values of the highest desirability was 1. 24 day of rice soaking time and 15.80% of additional ratio of soybean milk.

To verify the anatomic results of combined repair of a full-thickness rotator cuff tear and superior labral anterior and posterior (SLAP) lesion. In addition, we compared the anatomic and functional outcomes according to the status of the repaired SLAP lesion.We enrolled 61 patients who underwent cuff repair with concomitant SLAP repair and were available for both functional and radiologic outcome evaluation at least 1 year after the operation. There were 40 male and 21 female patients with a mean age of 57.4 years (range, 39-70 years). We measured various clinical outcomes and evaluated the structural outcomes of the rotator cuff and the superior labrum and rotator cuff using computed tomography arthrography at the final follow-up visit. We also evaluated the functional outcome according to anatomic healing of the superior labrum.Labral healing to the bony glenoid was achieved in 49 patients (80.3%), and anatomic healing of the rotator cuff was observed in 44 patients (72.1%). The retear rate of the rotator cuff was not statistically different with respect to labral healing status. All functional outcomes improved significantly (P.001), and there were no statistical differences in functional outcome with respect to postoperative healing of the superior labrum.An unhealed SLAP lesion did not preclude the successful outcome of concomitant rotator cuff repair. Therefore, repair of a concomitant SLAP lesion may not be an essential procedure for a successful outcome of a rotator cuff repair.

Purpose:In Kienböck’s disease, the wrist displays certain characteristic radiological parameters, which have been reported to differ among countries. In the present study, we aimed to identify specific radiological parameters of the unaffected wrists in patients with unilateral Kienböck’s disease and to determine the extent of the association of each parameter with the disease in Korea.Methods:This retrospective case–control study assessed the radiological parameters of patients with Kienböck’s disease ( n = 53) and controls ( n = 53), who visited our institution between January 2000 and May 2013. Ulnar variance (UV), radial inclination, lunate fossa inclination, lunate diameter, lunate height, lunate tilting angle (LTA), lunate covering index (LCI), and Ståhl index (SI) were measured and analyzed using a binary logistic regression model.Results:We observed that wrists with a high LTA and LCI, and low UV and SI had a tendency to develop Kienböck’s disease.Conclusion:In the Korean population, a high LTA and LCI, and low UV and SI of the unaffected wrists on plain radiography might be associated with Kienböck’s disease. The radiographic characteristics of the unaffected wrists can differ between patients with unilateral Kienböck’s disease and normal individuals.

Objective: Cubital tunnel syndrome is the second most frequent nerve entrapment syndrome in upper extremity. Among treatment options, in situ decompression is an effective and safe procedure. However, nerve stretching or subluxation is a potential problem. In this study, we want to identify in situ decompression with cubital tunnel retinaculum repair that can relieve ulnar nerve stretching. Materials and Methods: In total, 35 patients (30 male, 5 female; mean age, 53.1 years) presenting with primary cubital tunnel syndrome operated by in situ decompression with cubital tunnel retinaculum repair were included in the repair group. Twenty-six patients (19 male, 7 female; mean age, 54.6 years) treated with in situ decompression were included in the control group. Intraoperatively in the repair group, the ulnar nerve length (UNL) from intermuscular septum to the first motor branch was measured before and after the cubital tunnel retinaculum repair. Ulnar nerve position at elbow extension and flexion was recorded by ultrasonography postoperative 1 year in both groups. The UNL before and after the retinaculum was analyzed by t test, and ulnar nerve position between the two groups was analyzed by Fisher’s exact test. Results: UNL at elbow extension was not different significantly before and after the retinaculum repair (before repair, 11.4 ± 0.7 cm; after repair, 11.4 ± 0.7 cm), but UNL at elbow flexion was significantly decreased after the retinaculum repair ( P < .001; before repair, 12.5 ± 0.7 cm; after repair, 11.8 ± 0.7 cm). The ulnar nerve position at both extension and flexion was different between groups ( P < .001). Conclusion: UNL was decreased after cubital tunnel retinaculum repair. In situ decompression with cubital tunnel retinaculum repair can be an effective procedure to relieve irritation due to ulnar nerve stretching.

The elbow joint is one of the most inherently stable articulations of the skeleton. Recurrent posterior dislocation of the elbow is a rare condition. We experienced a case of recurrent posterior dislocation of the elbow due to shallow trochlear notch and chronic radial head dislocation that was treated by transplantation of the biceps tendon to the coronoid process. We report on the case with a literature review.

31세 남자로 신장 168 cm, 몸무게 78.5 kg의 근육질의 건장한 환 자가 조선소에서 일하는 도중 3 m 높이에서 떨어지는 사고로 우 측 원위 요골 분쇄 골절, 우측 요골 두 3분 골절, 우측 구상돌기 골 절, 주관절 외측 측부 인대 파열, 다발성 우측 늑골 골절로 진단 되었다. 기타 과거력은 없었으며 내원 후 우측 제5수지의 저린 감 각을 호소하였으나 티넬(Tinel) 징후는 없었고 제4, 5수지 원위 지 간 관절 굴곡은 능동적으로 가능하였다. 수상 후 5일째에 내측 접 근을 통하여 척골신경을 내측 근위 근간막(medial intermuscular septum)에서부터 원위부 척수근굴근(flexor carpi ulnaris) 근막까 지 충분히 박리하여 척수근굴근으로 들어가는 2개의 운동분지까 지 압박 부위가 없음을 확인한 이후 척수근굴근의 두 기시부 사 이로 접근하여 구상돌기 골절에 대한 관혈적 정복술 및 금속판 고정술을 시행하였다. 척수근굴근의 발달 때문에 척골신경의 전 방 전위 시 오히려 신경의 주행 거리가 길어지는 양상이어서 척 골신경 전방 전위술은 시행하지 않았다. 이후 주관절 외측으로 Kocher 간격을 통하여 접근하여 요골 두 골절에 대한 나사 고정 술을 시행하고 봉합 나사를 이용한 외측 측부인대 봉합술을 시행 pISSN : 1226-2102, eISSN : 2005-8918 260

Purpose: Pigmented villonodular synovitis (PVNS) is a rare proliferative disorder of the synovium, and this can affect the joints, tendon sheaths or bursae. PVNS is histologically benign, but it has a high propensity for local recurrence. The purpose of this study is to identify the clinical and pathological factors that are associated with local recurrence of PVNS. Materials and Methods: Fifty-one patients with biopsy-proven PVNS were retrospectively reviewed. There were 20 men and 31 women with an average age of 34 years (range: 12-73). The average follow-up period was 4.1 years (range: 1-25 years). All lesions were located in large joints (knee 25, ankle 11, hip 7, foot 5, wrist 2, elbow 1). Of the 51 lesions in the large joints, 39 were the diffuse type and 12 were the localized type. The initial clinical presentation was pain or a painful mass in 32 patients and a painless mass in 19 patients. Complete surgical removal of the lesion was performed in 39 cases, whereas incomplete excision was performed in 12. No adjuvant therapy was given in any cases. Results: Sixteen local recurrences (31%) developed at an average of 24 months (range, 4-96). Factors related to local recurrence in the large joints were incomplete surgical removal (p＜0.001), diffuse type of the lesion (p=0.049) and the presence of bone erosion (p=0.037) Conclusion: In cases of PVNS in large joints, the factors that increased the local recurrence rate were incomplete surgical removal, diffuse type lesion and the presence of bone erosion.