Subluxation of a Lateral Meniscus That Was Intact on Arthroscopic Probing / 대한정형외과학회잡지

Several mechanisms for subluxation of the lateral meniscus, such as a bucket-handle tear, popliteomeniscal fascicle tear or meniscocapsular junction separation, have been recognized. The cause can be identified through a magnetic resonance imaging (MRI) examination and the arthroscopic findings, and treatment can proceed accordingly. The authors report a case of a 28-year-old male in whom the lateral meniscus was subluxated and reduced without any abnormal findings on arthroscopic probing contrary to preoperative MRI findings.

Surgical Repair of Tibialis Anterior Muscle Herniation Using a Synthetic Mesh That Was Beneath the Fascia after a Military Training Program: A Case Report

Tibialis anterior muscle herniation is the most common type of skeletal muscle herniation of the lower legs. The treatment of muscle herniation relies on the patient's symptoms. For patients with chronic large fascial defects, fascial grafting with synthetic mesh can be considered. In this case of a patient who was exposed to excessive strain on his lower legs during a military training program, the use of a secure repair technique with synthetic mesh was required. This paper presents a case of tibialis anterior muscle herniation that was treated successfully with a monofilament knitted polypropylene mesh covered by the tibialis anterior fascia. The advantages of this technique include early rehabilitation and an early return to work. No significant difference in the clinical results compared to other methods were observed and there were no complications. The military training program appeared to have aggravated the patient's symptoms of tibialis anterior muscle herniation. On the other hand, larger scale study will be needed to determine if this program actually affects the clinical outcomes.

Navigated versus Conventional Technique in High Tibial Osteotomy: A Meta-Analysis Focusing on Weight Bearing Effect

PURPOSE: We aimed to determine whether navigated opening wedge high tibial osteotomy (HTO) is superior to the conventional technique in terms of accuracy of the coronal and sagittal alignment correction, functional outcome, and operative time. METHODS: Studies comparing navigated and conventional HTO were included in this meta-analysis. We compared the incidence of radiological outliers in coronal alignment and tibial slope maintenance, mean differences in functional outcome scales, and operative time. Subgroup analyses were performed on coronal alignment accuracy based on the intraoperative method of alignment confirmation: fluoroscopy vs. gap measurement method. RESULTS: Twelve studies were included: there were 434 knees in the navigated HTO studies and 405 knees in the conventional HTO studies. The risk of outlier was lower in navigated HTO than in conventional HTO; however, the difference was not significant when navigated HTO was compared with conventional HTO performed using the gap measurement method. Tibial slope maintenance was comparable or better in navigated HTO. No difference was found in the American Knee Society function and Lysholm scores. Navigated HTO necessitated a longer operative time of approximately 10 minutes. CONCLUSIONS: The use of navigation in HTO can improve accuracy in both coronal and sagittal alignments, but its clinical benefit is unclear.

Arthroscopic Treatment of Popliteal Cysts with and without Cystectomy: A Systematic Review and Meta-Analysis

PURPOSE: To compare the clinical outcomes of the arthroscopic treatments for popliteal cysts with and without cystectomy. METHODS: PubMed/MEDLINE, EMBASE, KoreaMed, and Cochrane Library were searched from the earliest available date of indexing through August 2016. The methodological quality of all articles was assessed according to the Coleman methodology score (CMS). Studies were grouped according to the surgical method, and a meta-analysis was conducted to identify the unsuccessful clinical outcome and complication rates. RESULTS: Nine studies were included; the mean CMS was 67.33 (standard deviation, 8.75 points). Cystectomy was reported in five studies; cystectomy was not performed in four studies. The odds ratio of unsuccessful clinical outcomes evaluated by Rauschning and Lindgren score was 122.05 (p<0.001) with cystectomy and 58.12 (p<0.001) without cystectomy. The effect size of complications was 0.16 (p<0.001) with cystectomy and 0.03 (p<0.001) without cystectomy. The recurrence rate was 0% with cystectomy and 6.4% without cystectomy. CONCLUSIONS: All the currently available studies showed satisfactory outcomes in both with and without cystectomy groups. However, arthroscopic cystectomy concurrently performed with management of intra-articular lesions was associated with a relatively low recurrence rate and a relatively high incidence of complications.

Intra-Articular Injection of Bone Marrow-Derived Mesenchymal Stem Cells Leading to Better Clinical Outcomes without Difference in MRI Outcomes from Baseline in Patients with Knee Osteoarthritis

PURPOSE: Bone marrow (BM) is frequently used as a source of mesenchymal stem cells (MSCs) because they have a high potential for differentiation. However, it is unclear whether BM-derived MSCs lead to better clinical and magnetic resonance imaging (MRI) outcomes postoperatively. MATERIALS AND METHODS: This meta-analysis compared the clinical and MRI outcomes in patients with knee osteoarthritis (OA) treated with BM-derived MSCs. Eight studies comparing the clinical and MRI outcomes assessed with various measurement tools in patients with knee OA treated with BM-derived MSCs were included. RESULTS: The range of motion (95% confidence interval [CI], −13.05 to 4.24; p=0.32) and MRI outcomes (95% CI, −0.16 to 1.40; p=0.12) did not differ significantly between the baseline and final follow-up. In contrast, pain (95% CI, 0.89 to 1.87; p < 0.001) and functional outcomes (95% CI, 0.70 to 2.07; p < 0.001) were significantly improved at the final follow-up when compared to the baseline. CONCLUSIONS: This meta-analysis found no significant difference in the tested range of motion and MRI outcomes between the baseline and the final follow-up in patients treated with BM-derived MSCs, whereas significant functional improvement and pain relief were noted when compared with the baseline. Thus, BM-derived MSCs appear to be a viable alternative for patients with knee OA, although long-term and high-quality randomized controlled trials are needed to confirm the clinical benefits.

Diagnosis and Current Trends of Medial Meniscus Posterior Root Tear / 대한정형외과학회잡지

Medial meniscal root tears with extrusion result in the loss of transmission of circumferential hoop stresses, leading to significantly increased tibiofemoral contact pressure and changes in knee biomechanics and kinematics. Therefore, medial meniscal root tears have attracted attention in recent years with regard to their early diagnosis. With the remarkable development of magnetic resonance imaging and arthroscopy, early diagnosis of medial meniscal root tears is on the rise. This report includes diagnosis and current trends of medial meniscal root tears.

Popliteal Artery Pseudoaneurysm Following Primary Total Knee Arthroplasty

An early diagnosis of popliteal artery pseudoaneurysm-a sequela of popliteal artery trauma-is difficult owing to its late presentation following total knee arthroplasty. The incidence of a popliteal artery pseudoaneurysm with a hematoma presenting only a peripheral nerve injury after total knee arthroplasty is also uncommon in the absence of common diagnostic features such as a pulsatile swelling with an audible bruit on auscultation. In the present report, we describe popliteal artery pseudoaneurysm following total knee arthroplasty.

Basic Principles and Current Trends of Medial Opening-Wedge High Tibial Osteotomy / 대한정형외과학회잡지

High tibial osteotomy (HTO) is a popular surgical procedure for osteoarthritis of the knee with varus deformity. In general, HTO has shown sufficient clinical outcomes with careful patient selection and correct surgical technique. Among various surgical techniques, medial opening-wedge and lateral closing-wedge HTO are widely used. This report includes basic principles and current trends in patient selection and preoperative evaluations and planning, operative technique, complications, and rehabilitation protocol in medial opening-wedge HTO.

Artificial Fusion of Infected Total Knee Arthroplasty Using a Flexible Intramedullary Rod Bundle and an Antibiotic-Loaded Cement Spacer / 대한정형외과학회잡지

Multiple total knee arthroplasty (TKA) failure resulting from a recurrent infection is a challenging problem. Knee arthrodesis is one treatment option that normally involves the application of an external fixator, plate fixation, and intramedullary nailing. However, these approaches are not always successful, and a reinfection is a risk, particularly in older, medically compromised patients. This paper reports a new arthrodesis technique that uses a bundle of flexible intramedullary rods and an antibiotic-loaded cement spacer. This technique was used in two cases of multiple TKA failure that resulted from a recurrent infection. The procedure was successful in both cases with no evidence of rod or cement failure. Two advantages of this procedure are infection eradication and mechanical strength. However, this procedure should only be used for medically compromised elderly patients at high risk of rerevision TKA failure resulting from persistent periprosthetic infection because rod fracture or loosening can occur with time.

Unusual Excessive Callus Formation in the Intertrochanteric Fracture Treated with Teriparatide / 대한고관절학회지

This is the first case report on the effects of teriparatide on the course of healing of an intertrochanteric hip fracture with unusually excessive callus formation even after discontinuation of treatment in an elderly woman. This case highlights the long-term effects of parathyroid hormone, even after administration of short-term, intermittent dosages for healing of osteoporotic fracture.

The Treatment Principles and Latest Knowledge of External Fixator in the Treatment of Fractures

No abstract available.

Deep Femoral Vessel Injury Following Subtrochanteric Hip Fracture: A Case Report

Arterial trauma associated with hip fracture treatment is still a rare complication. We present a case in which an arterial injury was discovered during closed reduction and intramedullary nail fixation of a subtrochanteric hip fracture. The preoperative thigh circumference was increased due to severe swelling, and the vascular injury was located substantially proximal to the fracture and the instrumentation area. An interventional angiogram revealed a damaged vessel originating from one of the minor proximal branches of the right deep femoral artery while filling a 2 cm-sized pseudoaneurysm. Embolization was performed without further complications.

30 Years of Korean Health Insurance: Its Success, Failure, and Future Directions

At the juncture of cerebrating the 30-year anniversary of Korean Health Insurance (KHI), which has been introduced since 1977, this paper reviews a brief history of KHI development, and its impacts on the health and the health care system in Korea. It took only 12 years that KHI had accomplished the total coverage of Korean population. The remarkable success of KHI can be compared with other OECD countries which had taken some 30 years to over 100 years to establish the total coverage of the population. In the year of 2005, Korean people enjoyed 14.1 times of ambulatory visits in a year, which is one of the highest levels in OECD countries. Life expectancy at birth and the infant mortality rate in Korea in 2005 both surpassed the average figures of the OECD countries, The main reason for the success of KHI can be delineated with the three characteristics in KHI development ; low premiums, low benefits, and low fee-schedule charges. However, these three characteristics of KHI, which had been the key for the rapid development of the system, have become tremendous drawbacks for the secure development of KHI. The dissatisfaction and discontent of health care providers are ever increasing. The population is reluctant to pay more premiums though it seems essential for the better care coverage. The health care system has been heavily distorted toward high technologyoriented expensive care. There should be several factors seriously tackled for the secure development of KHI in the future. The Korean society is anticipating an unprecedently rapid increase of the elderly population. The consumers' expectation toward higher quality of care is ever increasing. The growth rate of Korean economy is lower than it used to be. All these factors critically affect sustainable development of KHI in the future.

Assessing the Quality of Internet Health Information Using DISCERN / 대한의료정보학회지

OBJECTIVE: This study was conducted to evaluate the quality of health information on the internet using DISCERN. METHODS: Breast cancer, asthma, depression, obesity were selected to be the tracer conditions of the health information. To collect information about these 4 tracer conditions, we first select top 9 popular Korean websites which provide health information in January 2004. Nine websites include 6 commercial, 3 hospital. To compare quality of internet health information provided by Korean public institute and other countries', we select Healthguide in Korea, MEDLINEplus in USA and NHS direct online in UK. Overall, a total of 45 heath information provided by 10 Korean, 2 other countries' websites were evaluated by two nurses independently using DISCERN. DISCERN is a heath information quality assessment instrument consists of sixteen five-point- scale item questionnaire. The score was compared between Korean commercial and hospital websites and between Korean public institute's website and those of USA and UK. RESULTS: Korean internet health information scored 2.0 for overall quality score. Internet health information of commercial websites scored 1.8 for overall quality score that was lower than hospital websites(2.4). Internet health information provided by Korean public institute scored 3.0 compared 3.3(MEDLINEplus) and 3.8(NHS direct online). CONCLUSION: Internet health information in Korea hardly meets DISCERN standard that means Korean health information have a problem in quality. Especially, Internet health information of commercial websites needs relatively urgent improvement in quality.

Disability Weights for Diseases in Korea / 예방의학회지

OBJECTIVES: This study aimed to develop an evaluation protocol of disability weights using person trade-off, and to test the reliability of the developed protocol in a Korean context. METHODS: To develop the valuation protocol, the Global Burden of Disease (GBD) and the Dutch studies were replicated and modified. Sixteen indicator conditions were selected from the Korean version of disease classification, which was based on that of the GBD Study, and the person trade-off method referred to the Dutch method. RESULTS: The disability weights were valued in a two step panel study. The first step was a carefully designed group process by three panels, using person trade-off to establish the disability weights for sixteen selected indicator conditions. The second step consisted of interpolation of the remaining diseases, on a disability scale, by the individual members of three panels. The members of three panels were all medical doctors, with sufficient knowledge of the consequences of a broad variety of diseases. The internal consistency of the Korean disability weights was satisfactory. Considerable agreement existed within each panel and among the panels. CONCLUSIONS: It was feasible to use a modified evaluation protocol from those used in GBD and Dutch studies. This would provide a rational basis for an international comparative study of disability weights.

Study of Disability-Adjusted Life Expectancy(DALE) Using National Health Interview Survey in Korea / 예방의학회지

OBJECTIVES: To measure DALE (Disability-Adjusted Life Expectancy) in Korea to find out how long Koreans live in a state of full heath. METHODS: DALE was calculated using the life table of 1999 and the disability prevalence from the National Health Interview Survey (NHIS), which was conducted with a sample of 13,523 households in 1998. The disability prevalence was measured using the annual prevalence of the long-term limitation of activities, which were divided into classes 1, 2, 3, 4, 5 and 6 according to the severity of the limitation. The disability weights were measured for each 6 class by conducting a survey of 16 healthcare professionals. The severity-adjusted disability prevalence was calculated by multiplying the disability prevalence of each class by the disability weights respectively. Healthy life years lost due to disability was calculated by multiplying the life expectancy by the severity-adjusted disability prevalence. Finally DALE was measured as the life expectancy minus healthy life years lost due to disability. RESUJLTS: DALE for 1999, which refers to the expectation of equivalent years of good health, were 72.5, 69.5 and 75.3 years, for total, for males and for females, respectively. The percentages for DALE out of the life expectancy were 95.8, 96.6 and 94.4% for total, for males and for females, respectively. CONCLUSIONS: DALE is a newly developed indicator, which could effectively show the healthy life expectancy of populations. A greater notice and use of DALE would be expected as life expectancies increase and the quality of life changes in Korea.

Study of Disability-Adjusted Life Expectancy(DALE) Using National Health Interview Survey in Korea / 예방의학회지

OBJECTIVES: To measure DALE (Disability-Adjusted Life Expectancy) in Korea to find out how long Koreans live in a state of full heath. METHODS: DALE was calculated using the life table of 1999 and the disability prevalence from the National Health Interview Survey (NHIS), which was conducted with a sample of 13,523 households in 1998. The disability prevalence was measured using the annual prevalence of the long-term limitation of activities, which were divided into classes 1, 2, 3, 4, 5 and 6 according to the severity of the limitation. The disability weights were measured for each 6 class by conducting a survey of 16 healthcare professionals. The severity-adjusted disability prevalence was calculated by multiplying the disability prevalence of each class by the disability weights respectively. Healthy life years lost due to disability was calculated by multiplying the life expectancy by the severity-adjusted disability prevalence. Finally DALE was measured as the life expectancy minus healthy life years lost due to disability. RESUJLTS: DALE for 1999, which refers to the expectation of equivalent years of good health, were 72.5, 69.5 and 75.3 years, for total, for males and for females, respectively. The percentages for DALE out of the life expectancy were 95.8, 96.6 and 94.4% for total, for males and for females, respectively. CONCLUSIONS: DALE is a newly developed indicator, which could effectively show the healthy life expectancy of populations. A greater notice and use of DALE would be expected as life expectancies increase and the quality of life changes in Korea.

Current Status of Subspecialists Training Programs and Factors Affecting Subspecialists' Job Selection after Training / 한국의학교육

PURPOSE: This study was designed to identify current status of the subspecialist training programs and related factors affecting subspecialists' job selection. METHODS: The study subjects were 5,569 subspecialist trainees in 61 hospitals between 1989 and 1999. Among them, 1,260 subjects were selected to identify employment status after training. Also we analysed factors affecting career selection for 863 subspecialists on which basic information was available. RESULTS: About 26.6% of all subspecialist trainees trained in 1999 was for subspecialties in internal medicine, the largest majority, and 89.3% was in metropolitan areas. Also 91.1% were trained in teaching hospitals. Among subspecialists completed training, 79.5% selected career to work at general or teaching hospitals as of 1999, but 13.5% practised at clinics. The factors affecting career selection after training were gender, ownership of medical school, and specialty. CONCLUSION: The fact that not a few subspecialists work at primary care clinics means there are unreasonable human resource allocation and planning, with probable poor quality of primary care. Therefore, it is necessary to have a human resource plan at the national level for appropriate number of subspecialists, based on each specialty, in particular. Any structural factors affecting destination of subspecialist trainees, such as gender and graduated medical school, etc, should be dealt with in the long run.

Application of the Theory of Planned Behavior and the Theory of Reasoned Action to Predicting Cervix Cancer Screening Behavior / 예방의학회지

BACKRGROUND: Cervix cancer is the most common form of cancer among Korea women. In spite of proof that cervical cancer screening could reduce death rates substantially, the screening rates reported by previous Korean studies remain stubbornly very low. Behavioral studies to increase the cervix cancer screening rate are essential in order to develop the cancer screening program. OBJECTIVE: To evaluate the factors which are related to the intention and behavior for cervix cancer screening using the Theory of Planned Behavior (TPB) and the Theory of Reasoned Action (TRA). METHODS: The survey was conducted from July 21st to 26th in 1998. Of 3,218 women, 393(12.2%) between 30 and 65 years old, voluntarily participated in the survey in the 3 Myeons in Choongju city. Charge-free cervix cancer screening was provided for the subjects 3 months later. RESULTS: The R-square of both TPB and TRA to the intention (30% and 42%, respectively) was greater than the actual behavior (21% and 13%, respectively. TPB and TRA were found to provide an appropriate framework for the study of cervix cancer screening behavior. However, TRA was more powerful in explaining the intention, not only because the perceived behavioral control component exhibited lower reliability and validity than other components(attitude and subjective norm), but also because there may have been a few limitations in this study design. Consequently, the use of TRA is preferred in attempting to explain intention and actual behavior in this study. CONCLUSIONS: This study suggests that a successful intervention program should focus on changing attitudes and reducing psychologic barriers, rather than on just providing information. Physician recommendations, and the support of family members and friends are also very important factors in cervix cancer program participation. Physicians, friends, family members, and opinion leaders in rural areas, all of whom could affect the individual subjective norm, may all have the potential to play great roles as facilitators.

Changes in Quality of Care for Cesarean Section after Implementation of Diagnosis-Related Groups/Prospective Payment System / 예방의학회지

OBJECTIVES: To determine the impacts of Diagnosis-Related Groups/Prospective Payment System (DRG/PPS) on the quality of care in cases of Cesarean section and to describe the policy implications for the early stabilization of DRG/PPS in Korea. METHODS: Data was collected from the medical records of 380 patients who had undergone Cesarean sections in 40 hospitals participating in the DRG/PPS Demonstration Program since 1999. Cesarean sections were performed in 122 patients of the FFS(Fee-For-Service) group and 258 patients of the DRG/PPS group. Measurements of quality used included essential tests of pre- and post-operation, and the PPI(Physician Performance Index) score. The PPI was developed by two obstetricians. RESULTS: Univariate analysis demonstrated significant differences in PPI scores according to the payment systems. With respect to the mean of PPI scores, a higher score was found in the DRG/PPS group than in the FFS group. However, the adjusted effect did not show significant differences between the FFS group and the DRG/PPS group. CONCLUSION: This study suggested that the problem of poor quality may not be related to the implementation of DRG/PPS in Cesarean section. However, this study did not consider the validity and reliability of the process measurement, and it did not exclude the possibility of data omission in medical records.