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.

Group Education Program on Quality of Life of Burn Rehabilitation Patients

PURPOSE: This study was designed to compare the quality of life and physical function after group education program in burn rehabilitation program. METHODS: In a prospective clinical trial, group rehabilitation education program was done in 20 burn injury patients. One group pretest-post test design was done. After 2 weeks group education session, we measured stress test, quality of life (Burn specific health scale) and range of motion. Stress status was assessed with objective measurement tools such as heart rate variability. RESULTS: Stress resistance and parameter value was changed significantly (P0.05). CONCLUSION: Group therapy in burn rehabilitation patients could be an alternative rehabilitation treatment for quality of life. In the future, more studies are yet to come how group education program may affect the burn rehabilitation patients' disability.

A Preliminary Study of Attentional Blink of Rapid Serial Visual Presentation in Burn Patients with Posttraumatic Stress Disorder

OBJECTIVES: Trauma patients have attentional bias which enforces traumatic memories and causes cognitive errors. Understanding of such selective attention may explain many aspects of the posttraumatic stress disorder(PTSD) symptoms. METHODS: We used the rapid serial visual presentation(RSVP) method to verify attentional blink in burn patients with PTSD. International affective picture system(IAPS) was used as stimuli and distracters. In the 'neutral test', patients have been presented series of pictures with human face picture as target stimuli. Each picture had 100ms interval. However the distance between target facial pictures was randomized and recognition of second facial picture accuracy was measured. In the 'stress test', the first target was stress picture which arouses patient emotions instead of the facial picture. Neutral and Stress tests were done with seven PTSD patients and 20 controls. In '85ms test' the interval was reduced to 85ms. The accuracy of recognition of second target facial picture was rated in all three tests. Eighty-five ms study was done with eighteen PTSD patients. RESULTS: Attentional blinks were observed in 100-400ms of RSVP. PTSD patients showed increased recognition rate in the'stress test' compared with the 'neutral test'. When presentation interval was decreased to 85 ms, PTSD patient showed decrease of attentional blink effect when target facial picture interval was 170ms. CONCLUSION: We found attentional blink effect could be affected by stress stimulus in burn patients. And attentional blink may be affected by stimulus interval and the character of stimulus. There may be some other specific mechanism related with selective attention in attentional blink especially with facial picture processing.

What Kind of Factors Is Influencing Resting Energy Expenditure on Major Burn Patients?

PURPOSE: Burn injury is among the most severe type of trauma that the body can sustain. The major burn increases energy expenditure as the result of its induction of the hypermetabolic and catabolic state. It is well-documented that nutritional support may improve morbidity and mortality after severe burn injury. Therefore, adequate nutritional support is essential in burned patients to prevent the detrimental consequences of overfeeding and underfeeding. The purpose of this study was to analyze the factors influencing resting energy expenditure on major burn patients. METHODS: In 199 patients with > or =20% total body surface area (TBSA) burn were monitored with 403 measurement of resting energy expenditure (REE) from January 2004 to December 2008 in burn center of the Hangang Sacred Heart Hospital. Gender, age, burn size, inhalation injury, ventilator were included in the factors which influence the REE of massive burn patients. RESULTS: The measured REE and REE/basal metabolic rate (BMR) were significantly higher in males (p<0.05). The measured REE and REE/body mass index (BMI) showed significant difference between age groups (p<0.01). The measured REE and REE/BMI showed significant difference between burn size groups (p<0.01). The measured REE, REE/BMR and REE/BMI for patients with inhalation injury were significantly higher than patients without inhalation injury (p<0.01). The measured REE, REE/BMR and REE/BMI for patient needs ventilator were significantly higher than the other group (p<0.01). CONCLUSION: Indirect calorimetry is useful in detecting variations in energy expenditure among individuals and in detecting changes in metabolism. Unlike indirect calorimetry measurements, static formulas may not consider hypermetabolic and catabolic states. Because adequate nutritional support is essential in burned patients, it should be considered the factors influencing resting energy expenditure on major burn patients.

Rehabilitation of Amputee with Recurrent Squamous Cell Carcinoma Arising from Postburn Scar: A Case Report

A 73-year-old woman who has been suffering from ulcer pain on left lower leg of burn scars visited our clinic for prosthesis rehabilitation. Symptom has been developed since 12 months ago. She burned herself with oil at the age of 40. Biopsy on the skin lesion revealed squamous cell carcinoma. Marjolin's ulcer is a rare but highly aggressive squamous cell cancer that is most often associated with chronic burn wounds. Patient had undergone multiple prior split-thickness skin grafts for recurrent squamous cell carcinoma. She had undergone a trans-tibial amputation and subsequently given adjuvant chemotherapy for recurrent disease. After amputee training the patient was able to walk by herself and could perform all activities of daily living independently. Cancer induced amputees need prostheses with intensive rehabilitation training program for ambulation to prevent deterioration of physical function and mental health due to immobilization. However, she developed another recurrence and decided not to undergo further surgery and eventually died in hospice care due to progressive metastatic disease.

Effect of Laughter Therapy on Recovery of Facial Burn Scar

PURPOSE: To compare the scar formation after laughter therapy in facial burn scar and to make facial burn rehabilitation program. METHODS: In a prospective clinical trial, laughter therapy was done in 12 facial burn injury patients. One group pretest-posttest design was done. After 8 weeks group laughter therapy session, we measured scar condition. Facial burn scar were checked. Scars were assessed with objective measurement tools such as pigmentation, erythema, pliability, transepidermal water loss, thickness and perfusion. RESULTS: Pigmentation value was decreased significantly: 211.6+/-71.9 to 177.8+/-57.1 (p0.05). Transepidermal water loss value changed from 40.7+/-15.9 g/h/m2 to 37.8+/-15.4 g/h/m2 (p>0.05). Microcirculation value was decreased significantly (0.80+/-0.05 volt to 0.43+/-0.19 volt)(p<0.05). Skin elasticity level (R0) was significantly increased (p<0.05). CONCLUSION: Laughter therapy in burn patients could be an alternative treatment to control burn scar contracture. In the future, more studies are needed how laughter therapy may affect the skin condition of the burn injuries.