A Report on Diabetic Foot and Amputation from the Korean Health Insurance Review & Assessment Service Data / 대한족부족관절학회지

PURPOSE: This study reports on limb amputations in diabetic patients according to gender, age, and region based on the data from the Korean Health Insurance Review & Assessment Service. MATERIALS AND METHODS: The number of amputations was compared by region, age, gender, and year, as well as by femoral region, lower leg, foot, and toe in diabetic patients who received limb amputation. This analysis was performed based on the data from the Korean Health Insurance Review & Assessment Service, between January 2009 and December 2014. RESULTS: The total number of amputations between the study period was 9,155. The number of patients who were treated at hospitals for diabetes in 2009 was 1.9 million, among which, 1,214 patients underwent amputation. In 2014, the incidence of diabetes was 1,747 in 2.58 million individuals. With this rising incidence of diabetes, the amputation of limbs due to diabetes is increasing every year. In particular, the following regions were amputated more often: femoral region, 2.3%; lower legs, 19.6%; feet, 18.1%; and toes 60.0%. Regarding gender differences, males showed a higher amputation rate than females for all body parts. With respect to region, Seoul was the highest with 30.2%, followed by Gyeonggi with 19.9%, and Busan with 8.8%. According to age, older age showed greater diabetic amputation rate. CONCLUSION: In accordance with the rising incidence of diabetes, the diabetic amputation is also increasing. Here, we showed that toes were amputated with the highest percentage and males had greater amputation rate than females for all body parts. Moreover, amputation rate was highest in older diabetic patients, especially for those in their seventies. Additionally, Seoul was the region with highest amputation rate.

Analysis of Risk Factors of Adjacent Segment Disease with Lumbar and Lumbosacral Arthrodesis for the Degenerative Lumbar Spinal Disorders / 대한정형외과학회잡지

PURPOSE: The objective of this study is to confirm the effects of risk factors on Adjacent Segment Disease (ASD). MATERIALS AND METHODS: The subjects of this study were 793 patients who had degenerative lumbar spine disease and were followed-up for an average period of 7.2 years from January of 1999 to September of 2010 after undergoing spinal fusion. To confirm the risk factors, a study on patient factors, surgical factors and radiologic factors was performed. RESULTS: Of 793 patients, 69 patients (group A, 8.7%) underwent a secondary surgical treatment due to ASD. Age of patient, sex, bone mineral density, history of smoking and occupation were not statistically significant. Preoperative body mass index (BMI) (> or =25 kg/m2) and postoperative increase of BMI were the patient's factor in ASD (p=0.02, p<0.001). Regarding surgical factors, multilevel fusion (more than 3 levels) was higher risk in prevalence of ASD than short level fusion (p=0.01). Degeneration of intervertebral disc (p=0.01) and facet joints (p=0.02), and segmental instability (p=0.001) were also associated with the prevalence of ASD in radiologic factors. CONCLUSION: To prevent the occurrence of ASD after lumbosacral fusion, selection of the proper level of fusion preoperatively and modifying the life style with body weight control and reduction of hypermobility after fusion surgery are essential.

Comparison of Intramedullary K-Wire Nailing versus Plate for Fixation in Metacarpal Midshaft Fracture / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to compare the clinical and radiological results of patients with metacarpal midshaft fracture following surgery using either intramedullary K-wire nailing or internal fixation of plates. MATERIALS AND METHODS: This study was conducted with 39 metacarpal midshaft fracture patients between October 2008 and September 2012. Of these 39 patients, 15 patients underwent intramedullary K-wire nailing and 24 patients underwent internal fixation of metal plates. We analyzed bone union time and final posterior angulation radiologically and the range of motion, grip power, and quick-disabilities of the arm, shoulder and hand (DASH) scores, visual analogue scale (VAS) score clinically. RESULTS: Bone union was observed in all cases and bone union times were not significantly different between the two surgical methods. The final follow-up radiographs showed statistically significant differences in posterior angulation, which was 14°, on average, among the patients who underwent intramedullary K-wire nailing and 5°, on average, among the patients who underwent internal fixation of plates. No significant differences were found for the range of joint motion, power, and quick-DASH scores and VAS score were not significantly different between the two groups. CONCLUSION: Intramedullary K-wire nailing showed significant differences in posterior angulations, but both intramedullary K-wire nailing and internal fixation of plates produced good clinical outcomes in the treatment of metacarpal midshaft fracture. Therefore both techniques are considered good treatment methods.

Meniscal Ossicle / 대한정형외과학회잡지

Meniscal ossicle of the knee, an ossified tissue formed within the meniscus, is rare in humans. We experienced a case of a 48-year-old male with no history of trauma, who presented with intermittent locking symptoms and knee pain upon standing. The patient was diagnosed with meniscal ossicle and cartilage lesion in the medial femoral condyle accompanied by a medial meniscus posterior horn radial tear and treated with arthroscopic resection and microfracture. Therefore, we report on this case with relevant literature.

Logistic regression analysis of factors affecting the survival of first molars in Korean adults / 대한구강보건학회지

OBJECTIVES: This study aimed to analyze the variables affecting the survival of the four permanent first molars in an adult Korean population using logistic regression analysis. METHODS: The Korean government has been collecting oral health data at the national level at 3-year intervals since 2000. In addition, a national survey was conducted in 2006 among 15,777 persons aged 2-95 years who were stratified by age, gender, and region. The relationship between each of nine objective variables and tooth survival was analyzed by frequency, cross-tabulation, and logistic regression analysis, with age, gender, and economic status as functional variables. The inclusion level was alpha=0.05 and the exclusion level was alpha=0.10. The nine variables were age, occupational status, monthly family income, gender, frequency of brushing the teeth, snack intake per day, presence of diabetes, education level, and smoking (packs per year). RESULTS: The survival rate of the molars decreased with increased age. In individuals who engaged in farming, stock breeding, and fishing, the rate was 2-5 times lower than that of individuals in higher positions in terms of jobs and society. Furthermore, the survival rate for smokers was 5-10 percent lower, compared with non-smokers. CONCLUSIONS: The most significant predictor of the survival rate of the four permanent molars in Korean adults was age, followed by jobs, smoking, and gender.