Wiring Techniques for the Fixation of Trochanteric Fragments during Bipolar Hemiarthroplasty for Femoral Intertrochanteric Fracture: Clinical Study and Technical Note / 대한고관절학회지

PURPOSE: Femoral intertrochanteric fractures are common in the elderly. Appropriate surgical fixation of trochanteric fracture fragments can restore normal anatomical structure and ambulation, and can aid in the recovery of biomechanical function of the hip. We evaluated clinical outcomes of bipolar hemiarthroplasty using a wiring technique for trochanteric fracture fragment fixation. MATERIALS AND METHODS: From September 2006 to February 2015, a total of 260 cases underwent simultaneous bipolar hemiarthroplasty and wire fixation. A total of 65 patients (69 hips) with an average age of 78 years and more than one year of follow-up was included in the study. Using pre-, postoperative and follow-up radiograms, we evaluated wire fixation failure and also assessed changes in walking ability. RESULTS: Loosening or osteolysis around the stem was not observed; however, we did observe bone growth around the stem (54 cases), cortical hypertrophy (6 cases), a wide range of sclerotic lines but no stem subsidence (1 case), wire breakage (9 cases), and fracture fragment migration with no significant functional deficiency (2 cases). CONCLUSION: Our study showed that additional wiring for trochanteric fracture fragment fixation following bipolar hemiarthroplasty can help restore normal anatomy. The added stability results in faster rehabilitation, and good clinical and radiographic outcomes. We recommend this procedure in this type of fracture.

Non-Structural Cancellous Bone Graft and Headless Compression Screw Fixation for Treatment of Scaphoid Waist Nonunion

PURPOSE: The authors performed an autologous cancellous bone graft from the iliac crest and headless compression screw fixation for the treatment of Mack-Lichtman type II scaphoid waist nonunion. The purpose of this study was to determine whether this procedure was effective in achieving bony union and restoration of alignment. METHODS: We retrospectively reviewed medical records and radiographs of 30 patients who underwent a cancellous bone graft and headless compression screw fixation for scaphoid waist nonunion. There 28 men and 2 women with a mean age of 32.8 year-old (range, 21–63 year-old). The mean time to surgery from initial injury was 10 months (range, 3–25 months) and the average follow-up duration was 37.5 months (range, 15–52 months). The authors analyzed bony union, lateral intrascaphoid angle (LISA), scapholunate angle (SLA), radiolunate angle (RLA), and scaphoid length in radiographs and evaluated the modified Mayo wrist score (MMWS) as a functional outcome. RESULTS: Bony union was achieved in all cases. In lateral plain X-ray, preoperative anatomic alignment including LISA, SLA, RLA, and scaphoid length was recovered at immediate postoperative measurement. Those alignment restoration was likely to maintain in final follow-up in despite of statistical difference. The wrist motion and the MMWS improved significantly at the last follow-up. CONCLUSION: A non-structural autologous cancellous bone graft from the iliac crest and headless screw fixation provided reliable results and can be one of the effective treatment options for patients with symptomatic Mack-Lichtman type II nonunion in the middle one-third of the scaphoid.

Surgical Outcomes after Olecranon Plating with Retrograde Coronoid Process Screw Fixation through the Plate Hole in the Bifocal Fracture of the Proximal Ulna / 대한정형외과학회잡지

PURPOSE: Bifocal fracture of the proximal ulna is a fracture of the olecranon accompanied by fracture of the coronoid process. The purpose of the current study was to analyze the clinical results of the author's technique in bifocal fracture of the proximal ulna. MATERIALS AND METHODS: Fifteen patients (10 men, 5 women) treated at CHA Bundang Medical Center from April 2006 to October 2014 were analyzed retrospectively. All patients underwent internal fixation using a locking compression plate (LCP) with retrograde screw fixation of the coronoid process through a screw hole of the plate. Mean age of the patients was 42.6 years and the mean follow-up period was 18.6 months. Comminuted coronoid fractures with hard to screw fixation, complex injuries combined with open damage, and complete ligament rupture were excluded. Fracture union and articular congruity were examined on the follow-up radiographs. Range of motion, disability of the arm, shoulder and hand (DASH) score, and Mayo elbow performance score were evaluated for functional analysis. RESULTS: Fracture union was achieved and articular step off was less than 2 mm in all patients on the follow-up radiographs. The mean value of modified Mayo elbow score was 92.14 (80–100) and DASH score was 7.11 at last follow-up. The mean range of motion of elbow was 128o. There was one case of small heterotopic ossification as a radiographic complication which had no functional deficit. CONCLUSION: Internal fixation of bifocal multifragmentary articular fractures of the proximal ulna with anatomically contoured LCP olecranon plate and retrograde long screws could be a recommendable surgical procedure. This study showed that the precontoured plate with retrograde coronoid process screw fixation can produce good clinical and radiographic outcomes in bifocal fractures of the proximal ulna. We recommend this procedure in this type of fracture.

Meteorological Conditions Related to the Onset of Idiopathic Sudden Sensorineural Hearing Loss

PURPOSE: The objective of this study was to evaluate the effect of meteorological factors on the onset of idiopathic sudden sensorineural hearing loss (ISSHL). MATERIALS AND METHODS: Meteorological data from 2005 to 2011 were obtained from the web-based "Monthly Weather Reports of the Meteorological Administration" database. Patients with ISSHL who visited our hospital during this same period and presented the precise day on which hearing loss developed were included in this retrospective study. Twelve meteorological factors were analyzed between the days when ISSHL onset was observed as well as the days when ISSHL did not occur. The weather conditions occurring 1-7 days before ISSHL onset were also analyzed to assess any possible delayed effects of meteorological factors on the onset of ISSHL. RESULTS: During the study period, 607 patients were included for the study. Although mean and maximal wind velocities were higher for the days when ISSHL occurred than the days without ISSHL onset, after adjusting the value for multiple comparisons, we cannot find any significant relationship between any of meteorological factors and the onset of ISSHL. However, in analysis of time lag effect of the weather conditions, we found that there was still a significant difference in maximum wind speed on 5 days before ISSHL onset even after applying Bonferroni correction. CONCLUSION: The result of this study suggests that stronger wind speed may be related to the occurrence of ISSHL.

A Study on the Policy Making Process of the Mental Health Act (1995) in Korea : A Comparative Analysis of Two Different Legislation Periods / 신경정신의학

The purpose of this paper is to produce a policy decision making model most appropriate for formulating mental health policy in Korea. This research will also illuminate the legislation process and make accurate predictions about the revision process of the Mental Health Act. Using the Allison Models, we analyzed the legislation process of for the Korean Mental Health Act from the 1980s to 1995, which was largely divided into two periods. We applied the three types of model to each of these two periods. The results of the comparative analysis show that the process of the Mental Health Act enactment can be explained through by each of the three types of Allison models and that there is no dominant model. However, the analysis shows that, compared with the 'Rational Actor' model, the 'Organizational Behavior' model and the 'Governmental Politics' model are better able to explain the decision making process compared to the 'Rational Actor' model.