Increased Prehospital Emergency Medical Service Time Interval and Nontransport Rate of Patients With Fever Using Emergency Medical Services Before and After COVID-19 in Busan, Korea

Background@#In Korea, patients with fever have been preemptively isolated to isolation beds in the emergency department (ED) since the coronavirus disease 2019 (COVID-19) pandemic began. However, isolation beds were not always available, and transport delays or failure (nontransport), especially for infants, were reported in the media. Few studies have focused on delays and failure in transporting fever patients to the ED. Therefore, this study aimed to examine and compare the emergency medical service (EMS) time interval and nontransport rate of patients with fever using EMSs before and after COVID-19. @*Methods@#This retrospective observational study analyzed the prehospital EMS time interval and nontransport rate of fever patients who contacted EMSs in Busan, South Korea, from March 1, 2019 to February 28, 2022, using emergency dispatch reports. All fever patients (≥ 37.5°C) who contacted EMSs during this study were included. The EMS time interval was defined as the time between the patient’s EMS call and ED arrival time. Nontransport was defined as a case recorded as not being transported in the emergency dispatch reports.The study population of 2019 was compared to the population of 2020 and 2021 with the independent t-test, Mann-Whitney U test, and χ 2 test. As a subgroup, the EMS time intervals and nontransport rates of infants with fever were compared before and after COVID-19. @*Results@#A total of 554,186 patients accessed the EMS during the study period, and 46,253 patients with fever were included. The EMS time interval (mean ± standard deviation, minutes) of fever patients was 30.9 ± 29.9 in 2019, 46.8 ± 127.8 in 2020 (P < 0.001) and 45.9 ± 34.0 in 2021 ( P < 0.001). The nontransport rate (%) was 4.4 in 2019, 20.6 in 2020 (P < 0.001), and 19.5 in 2021 (P < 0.001). For infants with fever, the EMS time interval was 27.6 ± 10.8 in 2019, 35.1 ± 15.4 in 2020 (P < 0.001), and 42.3 ± 20.5 in 2021 (P < 0.001), and the nontransport rate (%) was 2.6 in 2019, 25.0 in 2020, and 19.7 in 2021. @*Conclusion@#After the emergence of COVID-19, in Busan, the EMS time interval of fever patients was delayed, and approximately 20% of fever patients were not transported.However, infants with fever had shorter EMS time intervals and higher nontransport rates than the overall study population. A comprehensive approach, including prehospital and hospital ED flow improvements, is required beyond increasing the number of isolation beds.

Early Clinical Outcomes of Manipulation under Anesthesia for Refractory Adhesive Capsulitis: Comparison with Arthroscopic Capsular Release

Background@#The purpose of this study was to compare early clinical outcomes of manipulation under anesthesia (MUA) and arthroscopic capsular release (ACR) in patients with refractory adhesive capsulitis (AC). @*Methods@#Thirty AC patients who underwent MUA (MUA group) were included. As a control group, thirty AC patients who underwent ACR (ACR group) were matched for age and sex with the MUA group. Visual analog scale (VAS) pain score, American shoulder and Elbow Surgeons (ASES) score, and range of motion (ROM) were evaluated preoperatively and at 3, 6, and 12 months after procedure. @*Results@#Both groups had significant improvements in the VAS pain score, ASES score, and ROM at 12 months after procedure. VAS pain score and ASES score were significantly better in the MUA group than in the ACR group at 3 months after procedure. Mean forward flexion was significantly greater in the MUA group than in the ACR group at 3 months after procedure. Mean external rotation and internal rotation were significantly greater in the MUA group than in the ACR group at 3, 6, and 12 months after procedure. Two patients required additional steroid injections at 3 and 6 months after MUA because of recurrent stiffness with pain. @*Conclusions@#Compared with ACR, MUA provided equivalent clinical outcomes in the early period after procedure. Our study suggests that MUA is a useful option to be considered as treatment for refractory AC before choosing ACR.

Definition, Diagnosis, Treatment, and Prognosis of Frozen Shoulder: A Consensus Survey of Shoulder Specialists

BACKGROUND: The objective of this study was to identify a consensus on definition, diagnosis, treatment, and prognosis of frozen shoulder (FS) among shoulder specialists.METHODS: A questionnaire composed of 18 questions about FS—definition, classification, utilization of diagnostic modalities, the propriety of treatment at each stage, and prognosis—was sent to 95 shoulder specialists in Korea. Most questions (15 questions) required an answer on a 5-point analog scale (1, strongly disagree; 5, strongly agree); three questions about the propriety of treatment were binary.RESULTS: We received 71 responses (74.7%). Of the 71 respondents, 84.5% agreed with the proposed definition of FS, and 88.8% agreed that FS should be divided into primary and secondary types according to the proposed definition. Only 43.7% of the respondents agreed that FS in patients with systemic disease should be classified as secondary FS. For the diagnosis of FS, 71.9% agreed that plain radiography should be used and 64.8% agreed ultrasonography should be used. There was a high consensus on proper treatment of FS: 97.2% agreed on education, 94.4%, on the use of nonsteroidal anti-inflammatory drugs; 76.1%, on intra-articular steroid injections; and 97.2%, on stretching exercise. Among all respondents, 22.5% answered that more than 10% of the patients with FS do not respond to conservative treatment.CONCLUSIONS: The survey revealed a general consensus among shoulder specialists on the definition and treatment of FS. However, classification of FS was found controversial.

Acute Displaced Fracture of Lateral Acromion after Reverse Shoulder Arthroplasty: A Case Report and Surgical Technique

Acromial fractures are well-documented complications subsequent to reverse shoulder arthroplasty (RSA), and most appear as stress fractures with no history of single trauma. To date, no study has reported the occurrence of acute displaced acromial fracture due to sudden strong deltoid contraction during heavy work. Displacement of the fracture results in a challenging surgery since it is difficult to obtain adequate fixation in thin and osteoporotic bones. We report a rare case of acute displaced acromial fracture after successful RSA treatment, using a novel technique of open reduction and internal fixation, applying two 4.5 mm cannulated screws and lateral clavicle precontoured plate.

Acute Displaced Fracture of Lateral Acromion after Reverse Shoulder Arthroplasty: A Case Report and Surgical Technique

Acromial fractures are well-documented complications subsequent to reverse shoulder arthroplasty (RSA), and most appear as stress fractures with no history of single trauma. To date, no study has reported the occurrence of acute displaced acromial fracture due to sudden strong deltoid contraction during heavy work. Displacement of the fracture results in a challenging surgery since it is difficult to obtain adequate fixation in thin and osteoporotic bones. We report a rare case of acute displaced acromial fracture after successful RSA treatment, using a novel technique of open reduction and internal fixation, applying two 4.5 mm cannulated screws and lateral clavicle precontoured plate.

Clinical Features and Characteristics of Greater Tuberosity Fractures with or without Shoulder Dislocation

PURPOSE: The purpose of this study was to compare the characteristics and clinical features of greater tuberosity fractures with or without a shoulder dislocation. MATERIALS AND METHODS: A total of 108 cases of greater tuberosity fractures (56 cases with shoulder dislocation, 52 cases without shoulder dislocation) were reviewed retrospectively. Age, sex, side, injury mechanism, fracture displacement, fracture morphology, number of fracture fragments, main fragment size, treatment, and combined injuries were investigated. RESULTS: The age, sex, side, injury mechanism, treatment, and combined injuries were similar in both groups (p>0.05). A statistically significant difference in fracture displacement, fracture morphology, number of fracture fragment, and main fragment size was observed between the two groups (p < 0.05). CONCLUSION: In greater tuberosity fractures with a shoulder dislocation, the prevalence of fracture displacement was high and the depression type of fractures occurred frequently. In addition, the number and size of the fracture fragment increased. Therefore, an understanding of these fracture patterns will be helpful for deciding treatment and prognosis.

Compartment Syndrome of the Upper Extremity Induced by Extravasation of Contrast Media after Computed Tomography: A Case Report

The incidence of contrast media extravasation has been increasing gradually. Most contrast media extravasations only can cause pain, swelling and erythema. However, in more severe cases, skin necrosis, ulceration, or compartment syndrome may occur, often necessitating a surgery. Early diagnosis and treatment should be established on the spot in order to avoid such a severe damage. We present a case of 42-year-old woman with a compartment syndrome in the right upper extremity caused by extravasation of computed tomography contrast media.

Compartment Syndrome of the Upper Extremity Induced by Extravasation of Contrast Media after Computed Tomography: A Case Report

The incidence of contrast media extravasation has been increasing gradually. Most contrast media extravasations only can cause pain, swelling and erythema. However, in more severe cases, skin necrosis, ulceration, or compartment syndrome may occur, often necessitating a surgery. Early diagnosis and treatment should be established on the spot in order to avoid such a severe damage. We present a case of 42-year-old woman with a compartment syndrome in the right upper extremity caused by extravasation of computed tomography contrast media.

The Efficacy of Trochanteric Flip Osteotomy in Cases of Femoral Head Fracture / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to evaluate the clinical and radiological results of the trochanteric flip osteotomy in cases of femoral head fractures. MATERIALS AND METHODS: Between May 2000 and January 2012, we evaluated 14 cases of femoral head fractures treated by trochanteric flip osteotomy in combination with the Kocher-Langenbeck approach after a minimum follow-up of one year. There were 13 men and one woman and the average follow-up period was 36.4 months. The clinical results were evaluated according to Merle d'Aubigne-Postel scores and the Thompson-Epstein scoring scale and the radiological results were evaluated according to time to union of fractures and osteotomy site. We also evaluated the incidence of complications. RESULTS: At the last follow-up, mean Merle d'Aubigne-Postel score was 16.4 and 11 cases out of 14 patients presented with good to excellent, two cases presented with fair, and one case presented with a poor clinical result according to the Thompson-Epstein scoring scale. Radiologically all cases achieved union of fractures and osteotomy site and the mean time to union of the osteotomy site was 7.9 weeks. Complications included one case of heterotopic ossification which did not disturb hip function, two cases of avascular necrosis of the femoral head, and one case of post-traumatic osteoarthritis. CONCLUSION: The trochanteric flip osteotomy in the case of a femoral head fracture showed good clinical and radiological results through good visualization and accurate reduction of the fracture site. However, conduct of further studies including larger number of patients is needed in order to evaluate the incidence of complications such as avascular necrosis of the femoral head.

When Does the Quality of Life Improve after Rotator Cuff Repair? / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to investigate when the quality of life improve after rotator cuff repair. MATERIALS AND METHODS: Eighty-five consecutive cases with rotator cuff repair were studied. Patients completed the visual analogue scale (VAS), University of California Los Angeles scale (UCLA), American Shoulder and Elbow Surgeon's scale (ASES), Korean Shoulder scale (KSS), and the World Health Organization Quality of Life Scale abbreviated version (WHOQOL-BREF) preoperatively and at postoperative 3, 6, and 12 months. For evaluation of serial recovery pattern, section I (preoperatively-postoperative 3 months), section II (postoperative 3 months-postoperative 6 months), and section III (postoperative 6 months-postoperative 12 months) were divided. RESULTS: The mean WHOQOL-BREF score was significantly improved from 58.8 preoperatively to 66.4 at postoperative 12 months, with improvement of VAS, ULCA, ASES, and KSS scores. On serial recovery pattern, all measurements in section I, VAS, UCLA, and KSS scores in section II, and UCLA score in section III, were significantly improved. Female sex had a negative effect on all outcome measurements at postoperative 12 months. CONCLUSION: Our results showed improvement of quality of life as well as reduced pain and increased function at 3 months after rotator cuff repair. Further recovery of clinical outcomes showed gradual progress until postoperative 12 months.

Effect of Intrathecal Fentanyl with Hyperbaric Bupivacaine on Unilateral Spinal Anesthesia for Knee Arthroscopy / 대한마취과학회지

BACKGROUND: Unilateral spinal anesthesia prolongs sensory blockade and provides hemodynamic stability. Intrathecal opioids enhance spinal anesthesia without prolonging motor recovery or hemodynamic side effects. The author evaluated the effect of intrathecal fentanyl on unilateral spinal blockade with hyperbaric bupivacaine for knee arthroscopy. METHODS: Thirty-six healthy patients undergoing unilateral knee arthroscopy randomly received unilateral spinal anesthesia with 0.5% hyperbaric bupivacaine 4 mg (Group I) or 0.5% hyperbaric bupivacaine 4 mg combined with fentanyl 10 microgram (Group II). A lateral decubitus position was maintained for 15 minutes after intrathecal injection. The level and duration of sensory and motor blockade were recorded. RESULTS: The regression time of sensory block by two segments on dependent site was prolonged on Group II more than Group I (P < 0.05). There was no significant difference between two groups in recovery time of sensory and motor block. Unilateral sensory block was observed in 18 patients in Group I (100%) and in 2 patients in Group II (11%). Hemodynamic side effects were minimal in both groups, but pruritus was observed in 6 patients in Group II (33%). CONCLUSIONS: Small dose of intrathecal fentanyl with bupivacaine unilateral spinal anesthesia prolonged the duration of sensory block on operated site, but did not increase side effects and the duration of motor block and recovery. But intrathecal fentanyl with bupivacaine made disturbance of successful unilateral spinal block by the sensory block of nonoperated site.

An outbreak of malaria in penguins at the Farm-land Zoo

In June of 1983 authors had investigated the occurrence of the avian malaria in the Humboldt penguins imported from Japan to the Farm-land Zoo in central district of Korea. The disease was characterized by acute course and high mortality. The peripheral blood smears from the affected penguins demonstrated different developmental stages of Plasmodium sp. in the mature erythrocytes. The predominant gross lesions noticed were pulmonary and epicardial edema and hepato-splenomegaly. Microscopically the lesions were characterized by extensive reticuloendothelial cell hyperplasia with striking feature of exoerythrocytic schizogony affecting a variety of tissues. The report also signifies the first description of a disastrous epizootic of avian malaria in Korea.