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Objective@#Traumatic brain injury (TBI) is one of the major causes of death and disability in children. Understanding the epidemiologic characteristics of TBI in children is the first step for developing preventative strategies, optimizing care systems, and rehabilitating the injury. @*Methods@#This is a cross-sessional study based on the Emergency Department-based Injury In-depth Surveillance (EDIIS) in Korea. We identified children (aged 0 to 18 years) who presented with TBI in emergency departments between January 2011 and December 2018. Subjects were classified into four groups according to age and development: infant and toddler group (0-2 years), pre-school group (3-5 years), school-aged group (6-11 years), and adolescent group (12-18 years). Epidemiologic characteristics and outcomes were compared according to age groups, and temporal variability in incidence was evaluated. @*Results@#During the 8-year study period, 45,734 children with TBI were included in the analysis. A higher incidence of TBI was observed in males, road accidents, and school/educational facilities as compared to the lesser-aged group (all P<0.01). Motor vehicle collisions were more common in the older group, but falls were more common in the younger group. Compared to the infant/toddler group, the adolescent group had higher intracranial injuries (8.1% vs. 16.8%; adjusted odds ratio [AOR], 1.8; 95% confidence interval [CI], 1.6-2.0) and mortality rate (0.2% vs. 1.3%; AOR, 2.0; 95% CI, 1.3-3.0). @*Conclusion@#The epidemiological characteristics of TBI in children are different for each group. It is necessary to develop differentiated preventative strategies and treatment systems based on the age groups of children.
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Osteoporosis and osteoporotic fractures cause socioeconomic concerns, and medical system and policies appear insufficient to prepare for these issues in Korea, where the older adult population is rapidly increasing. Many countries around the world are already responding to osteoporosis and osteoporotic fractures by adopting fracture liaison service (FLS), and such an attempt has only begun in Korea. In this article, we introduce the operation methods for institutions implementing FLS and characteristics of services, and activities of the FLS Committee for FLS implementation in the Korean Society for Bone and Mineral Research. In addition, we hope that the current position statement will contribute to the implementation of FLS in Korea and impel policy changes to enable a multidisciplinary and integrated FLS operated under the medical system.
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Background@#Our study evaluated the prevalence and pattern of T-score discordance between the spine and hip in Korean patients with atypical femoral fracture (AFF) and femur neck fracture (FNF). @*Methods@#A total of 49 patients (all women) who were treated for AFF and 1:3 matched 147 female patients with FNF were included from January 2012 to August 2022. A discordance of more than 1.5 between lumbar spine and femur neck bone mineral density (BMD) was defined as a difference and divided into 3 groups: lumbar low (LL; lumbar BMD is less than femur neck BMD), no discordance (ND), and femur neck low (FL; femur neck BMD is less than lumbar BMD). We compared the prevalence and pattern of discordance between 2 groups, and the associated risk factors of T-score discordance among the subjects were evaluated using regression analysis. @*Results@#The prevalence of discordance was significantly higher in patients with AFF (51%) than in those with FNF (25.2%; p<0.001). LL discordance was found in 46.9% of the patients with AFF but only 4.8% in those with FNF. Conversely, FL discordance was found in 4.1% of the patients with AFF and 20.4% in those with FNF, respectively. No specific risk factor was found as T-score discordance in the 2 groups. @*Conclusions@#Clinicians should be aware that the pattern of T-score discordance can vary depending on the location of osteoporotic fractures. In addition, a longitudinal study would be necessary to verify the pattern of T-score discordance related to the osteoporotic fracture location.
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Background@#T-score discordance between the spine and hip is commonly observed when dual energy X-ray absorptiometry (DXA) is used to diagnose osteoporosis. However, information is scarce regarding the prevalence and risk factors for this problem in Korea. This study evaluated the prevalence of major/minor discordance and associated risk factors in elderly Korean patients with osteoporotic vertebral compression fractures (OVCFs). @*Methods@#This study included 200 patients (37 men, 163 women) treated for thoracic or lumbar compression fractures between January 2015 and August 2021. DXA was performed to examine T‐scores and determine the prevalence of discordance, defined as a difference between the T-score categories of the femur and spine in the same individual. The t-tests, χ2 tests, and regression analyses were used to assess the associated risk factors of T-score discordance among the subjects. @*Results@#T-score concordance, minor discordance, and major discordance were observed in 137 (68.5%), 59 (29.5%), and 4 (2%) patients with OVCFs, respectively. The spinal T-score was lower than the femoral T-score in all major discordance and 81.3% (48/59) of minor discordant cases. Overall, the only factor related to T-score discordance was the age at fracture (odds ratio, -0.01; P=0.014). @*Conclusions@#The results of this study showed that a significant number of subjects (31.5%) showed spine-hip discordance, even with a mean age in their 80s. More attention should be paid to the appropriate evaluation and management of elderly patients with OVCFs. Moreover, a longitudinal study is necessary to verify the clinical importance of T-score discordance in this population.
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Purpose@#We compared the radiological and clinical results of fixation for distal femoral fracture (DFF) using a locking compression plate (LCP) or a retrograde intramedullary nail (RIN). @*Materials and Methods@#From October 2003 to February 2020, 52 cases of DFF with a minimum 1-year follow-up (with a mean follow-up of 19.1 months) were included: 31 were treated with LCP and 21 with RIN. The operation time, blood loss, and hospitalization period were compared, and the incidence of postoperative nonunion, malunion, delayed union and metal failure and other post-operative complications were evaluated and compared. @*Results@#There was no significant difference in the operating time between the two groups, but the mean blood loss was significantly higher in the LCP group (LCP 683.5 ml vs RIN; 134.9 ml; p=0.015). In 49 out of 52 cases, bone union was achieved without additional surgery in an average of 6.8 months, and a complete union was achieved after additional surgery in three cases of nonunion (LCP 2 cases vs RIN 1 case; p=0.065). One case of malunion and superficial infection was confirmed in each group. @*Conclusion@#Internal fixation using LCP and RIN give good outcomes with a low complication rate and can therefore be considered useful surgical treatments for DFF.
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Non-traumatic osteonecrosis of the femoral head (ONFH) usually affects adults younger than 50 years and frequently leads to femoral head collapse and subsequent arthritis of the hip.It is becoming more prevalent along with increasing use of corticosteroids for the adjuvant therapy of leukemia and other myelogenous diseases as well as management of organ transplantation. This review updated knowledge on the pathogenesis, classification criteria, staging system, and treatment of ONFH.
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Osteoporosis does not take a break while Coronavirus disease 2019 (COVID-19) stunned and overtook everyone’s lives. Medical resources were immediately shifted, self-isolation and telemedicine were expanded, ambulatory care services such as bone densitometry and osteoporosis-centered clinics came to a near halt. Progress with fracture prevention has been challenged because osteoporotic fracture with low energy injury is more prevalent even though restriction of people’s movement. Thus we must re-engage with chronic bone health concerns and fracture prevention. This review discusses challenges in management of osteoporosis during the COVID-19 pandemic and reinforces the need to implementing recommendations concerning the importance of bone fragility care with at least those patients who are already treated with antiosteoporotic drugs maintaining their adherence to treatments.
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Background@#Nine years have passed since the Journal of Bone Metabolism (JBM) was launched as an English journal in 2012; it was finally included in Scopus in January 2019. Therefore, this study aimed to provide evidence of increased international recognition based on journal metrics and reflect on its efforts to be recognized as a top-notch journal. @*Methods@#Databases, such as the Web of Science (WoS), Scopus, Korean Citation Index (KCI), and citation indicators, including the impact factor (IF) and SCImago journal rank (SJR) were reviewed and calculated according to years, and the results were drawn. Furthermore, country-wise contributions and top-cited articles were also investigated. @*Results@#The JBM 2020 IF was 2.17 in the WoS. The 2020 SJR in Scopus was 0.334, with a ranking of 165/219 (75.3%) in the Endocrinology, Diabetes, and Metabolism category. The 2020 KCI was 0.42. Of 263 articles, 260 were citable (98.9%), and of 176 original articles, 15 (8.5%) were supported by research grants. The total citation of JBM has increased from 16 in 2014 to 141 in 2020; however, its KCI remained stationary from 0.29 in 2015 to 0.42 in 2020. @*Conclusions@#Currently, JBM is increasingly cited by international researchers than Korean researchers, indicating that the journal’s content is valued at an international level. Its inclusion in PubMed Central appears to have increased its international relevance; however, publishing English-only articles may hinder its use domestically. Therefore, efforts should be made to increase citation rates and enhance domestic readership.
ABSTRACT
Non-traumatic osteonecrosis of the femoral head (ONFH) usually affects adults younger than 50 years and frequently leads to femoral head collapse and subsequent arthritis of the hip.It is becoming more prevalent along with increasing use of corticosteroids for the adjuvant therapy of leukemia and other myelogenous diseases as well as management of organ transplantation. This review updated knowledge on the pathogenesis, classification criteria, staging system, and treatment of ONFH.
ABSTRACT
Osteoporosis does not take a break while Coronavirus disease 2019 (COVID-19) stunned and overtook everyone’s lives. Medical resources were immediately shifted, self-isolation and telemedicine were expanded, ambulatory care services such as bone densitometry and osteoporosis-centered clinics came to a near halt. Progress with fracture prevention has been challenged because osteoporotic fracture with low energy injury is more prevalent even though restriction of people’s movement. Thus we must re-engage with chronic bone health concerns and fracture prevention. This review discusses challenges in management of osteoporosis during the COVID-19 pandemic and reinforces the need to implementing recommendations concerning the importance of bone fragility care with at least those patients who are already treated with antiosteoporotic drugs maintaining their adherence to treatments.
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Background@#Nine years have passed since the Journal of Bone Metabolism (JBM) was launched as an English journal in 2012; it was finally included in Scopus in January 2019. Therefore, this study aimed to provide evidence of increased international recognition based on journal metrics and reflect on its efforts to be recognized as a top-notch journal. @*Methods@#Databases, such as the Web of Science (WoS), Scopus, Korean Citation Index (KCI), and citation indicators, including the impact factor (IF) and SCImago journal rank (SJR) were reviewed and calculated according to years, and the results were drawn. Furthermore, country-wise contributions and top-cited articles were also investigated. @*Results@#The JBM 2020 IF was 2.17 in the WoS. The 2020 SJR in Scopus was 0.334, with a ranking of 165/219 (75.3%) in the Endocrinology, Diabetes, and Metabolism category. The 2020 KCI was 0.42. Of 263 articles, 260 were citable (98.9%), and of 176 original articles, 15 (8.5%) were supported by research grants. The total citation of JBM has increased from 16 in 2014 to 141 in 2020; however, its KCI remained stationary from 0.29 in 2015 to 0.42 in 2020. @*Conclusions@#Currently, JBM is increasingly cited by international researchers than Korean researchers, indicating that the journal’s content is valued at an international level. Its inclusion in PubMed Central appears to have increased its international relevance; however, publishing English-only articles may hinder its use domestically. Therefore, efforts should be made to increase citation rates and enhance domestic readership.
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Background@#Dual energy X-ray absorptiometry (DXA) has evolved from pencil-beam (PB) to narrow fan-beam (FB) densitometers. We performed a meta-analysis of the available observational studies to determine how different modes of DXA affect bone mineral density (BMD) measurements. @*Methods@#A total of 1,233 patients (808 women) from 14 cohort studies were included. We evaluated the differences in BMD according to the DXA mode: PB and FB. Additionally, we evaluated the differences in BMD between the 2 types of FB mode: FB (Prodigy) and the most recent FB (iDXA). Pairwise meta-analysis was performed, and weighted mean differences (WMD) were calculated for (total lumbar, total hip, and total body). @*Results@#No significant difference was observed in total lumbar (pooled WMD, -0.013; P=0.152) and total hip BMD (pooled WMD, -0.01; P=0.889), between PB and FB. However, total body BMD was significantly lower in the PB compared to the FB group (pooled WMD, -0.014; P=0.024). No significant difference was observed in lumbar BMD (pooled WMD, -0.006; P=0.567), total hip (pooled WMD, -0.002; P=0.821), and total body (pooled WMD, 0.015; P=0.109), between Prodigy and iDXA. @*Conclusions@#The results of this study warrant the recommendation that correction equations should not be used when comparing BMD from different modes. Further research is still needed to highlight the ways in which differences between DXA systems can be minimized.
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Background@#Femoral neck stress fractures (FNSFs) are rare but potentially disabling injuries if the diagnosis is missed or delayed and proper treatment is not provided. The aim of this study was to investigate and describe the characteristics and clinical course of FNSFs in South Korean male military recruits. @*Methods@#Between May 2015 and October 2019, 16 fractures in 12 young male military recruits were reviewed. The characteristics of the fractures were ascertained by detailed analysis of the history and clinical course, as well as radiographs, bone scintigrams, and magnetic resonance images. @*Results@#The median duration between endurance training and the development of hip pain was 5 weeks, while the median duration of pain before the patient sought medical attention was 3 weeks. Four patients (33.3%) exhibited bilateral fractures, and concomitant lesions involving the proximal tibia were found in 3 patients (25%). Fourteen of the 16 fractures (87.5%) were compression-type fractures, and surgery was performed for 7 hips. Complete union without malunion or osteonecrosis was achieved in all cases, and all cadets returned to their full activity levels in an average of 10 weeks. @*Conclusions@#We observed excellent prognosis of FNSFs. Our report highlights the importance of early reporting, detection, and treatment regarding the challenging management of FNSFs. When a military recruit reports hip pain, a FNSF should be considered; furthermore, the bilaterality of the fracture and the presence of concomitant lesions should also be investigated.
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We conducted an updated review of the evidence of teriparatide (TPTD) for fracture healing for the following questions. (1) Does it decrease fracture healing time?; (2) Can it be an alternative treatment for nonunion?; (3) Does it aid the union of atypical femoral fracture (AFF)? We searched PubMed, EMBASE, and Cochrane Library including “Fracture” AND “nonunion” AND “Teriparatide”. In total, 57 publications met our inclusion criteria were summarized. This systemic review of the available literature revealed that TPTD works positively with regard to enhancing fracture healing time and union of AFF. There are also many case studies on the use of TPTD could be a potential new safe treatment for nonunion with no side effects. However, level 1 studies on the evidence of TPTD are still lacking so far. Over the last decade, a growing body of evidence has accumulated suggesting that TPTD can be an adjunct to enhance fracture healing or a therapeutic option to treat nonunion, but greater evidences from large volume prospective trials are needed.
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The mainstream surgery for valgus-impacted femoral neck fractures (FNFs) is closed reduction and internal fixation under fluoroscopy. However, femoral neck shortening and anterior femoroacetabular impingement are common complications in healed valgus-impacted FNFs after in situ fixation. Some methods have been reported to prevent complications, but these techniques require the use of a transfixing guide wire that passes through the femoral head, which may cause articular cartilage damage. We introduce a simple reduction technique using one Steinmann pin (S-pin) for valgus-impacted FNFs without any interference of the femur head. A S-pin was placed percutaneously at the inferomedial margin of the fracture, and reduction was achieved by applying manual valgus force along the fracture line. By restoring the anatomical alignment, we confirmed the maximum contact area of the fracture and connection of the medial cortical buttress, so the risk of nonunion was also minimized.
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BACKGROUND: The purpose of this study was to identify the characteristics of appendicular lean mass (ALM) associated with rheumatoid arthritis (RA) and to analyze appendicular tissue components in patients with RA.METHODS: We prospectively reviewed of patients with RA who underwent dual energy X-ray absorptiometry in a single center. From data of 28 patients, ALM was calculated. Regression analysis was used to investigate the association between ALM and RA. Using propensity score matching, patients with RA were compared to the control group from 18,698 patients of Korea National Health and Nutrition Examination Surveys data. RA and control group were matched in a 1: 5, respectively.RESULTS: In regression model, there was significantly negative association between disease activity score and ALM index in patients with RA in unadjusted (β=−0.387, 95% confidence interval [CI], −0.729 to −0.045) and model adjusted for age, sex, and body mass index (β=−0.227, 95% CI, −0.451 to −0.003). In matching with age and sex, the arms fat mass and fat fraction of RA group were significantly lower than that of control group. In matching with age, sex, and body mass index, the ALM index and legs lean mass of RA group were significantly higher than control group.CONCLUSIONS: Patients with RA have a lower ALM with higher disease activity. In addition, we found that patients with RA had different tissue component in arms and legs compared to general population.
Subject(s)
Humans , Absorptiometry, Photon , Adiposity , Arm , Arthritis, Rheumatoid , Body Composition , Body Mass Index , Korea , Leg , Propensity Score , Prospective StudiesABSTRACT
PURPOSE: Currently, standard management of a peri-prosthetic infection is a two-stage revision precedure. However, removal of well-fixed cement is technically demanding and associated with numerous potential complications. For theses reasons, two-stage revision with preservation of the original femoral stem can be considered and several previous studies have achieved successful results. While most prior studies used cemented stems, the use of cementless stems during arthroplasty has been gradually increasing; this study aims to assess the comparative effectiveness of a two-stage revision of infected hip arthroplasties at preserving cemented and cementless stems.MATERIALS AND METHODS: Between December 2001 and February 2017, Inje University Sanggye Paik Hospital treated 45 cases of deep infections following hip arthroplasty with a two stage revisional arthroplasty using antibiotics-loaded cement spacers. This approach was applied in an effort to preserve the previously implanted femoral stem. Of these 45 cases, 20 were followed-up for at least two years and included in this analysis. Perioperative clinical symptoms, radiological findings, function and complications during insertion of an antibiotics-loaded cement spacer were analyzed in this study.RESULTS: Peri-prothetic infections were controlled in 19 of the 20 included cases. Clinical outcomes, as assessed using the Harris hip score, Western Ontario and McMaster University score, also improved. Importantly, similarly improved outcomes were achieved for both cemented and cementless femoral stems.CONCLUSION: In cases of deep infection following hip arthroplasty, two-stage revision arthroplasty to preserve the previously implanted femoral stem (cemented or cementless) effectively controls infections and preserves joint function.
Subject(s)
Arthroplasty , Hip , Joints , OntarioABSTRACT
BACKGROUND: Bibliometrics is increasingly used to assess the quantity and quality of scientific research output in many research fields worldwide. This study aims to update Korea's worldwide research productivity in the field of orthopedics using bibliometric methods and to provide Korean surgeons and researchers with insights into such research. METHODS: Articles published in the top 15 orthopedic journals between 2008 and 2017 were retrieved using the Web of Science. The number of articles, citations and h-index (Hirsch index), funding sources, institutions, and journal patterns were analyzed. RESULTS: Of the total 39,494 articles, Korea's contribution accounted for 5.6% (2,161 articles), ranking fifth in the world in the number of publications. Korea ranked sixth (with 29,456) for total citations worldwide but ranked 17th (13.64) in terms of average citation per item and 14th (55) in terms of h-index. Korea showed the most prolific productivity in the field of sports medicine and arthroscopy. The institution that produced the highest number of publications was Seoul National University (n = 386, 17.9%). CONCLUSIONS: Orthopedic research in South Korea demonstrated high productivity in terms of the number of publications in high-quality journals between 2008 and 2017. However, total citations and average citations per article were still relatively low. Efforts should be made to increase citation rates for further improvement in research productivity in the field of orthopedics.
Subject(s)
Arthroscopy , Bibliometrics , Efficiency , Financial Management , Journal Impact Factor , Korea , Orthopedics , Seoul , Sports Medicine , SurgeonsABSTRACT
BACKGROUND: Treating patients with osteopetrosis is very challenging even in very skilled surgeons with many experiences. We present an account of 5 patients treated for hip fracture related problems occurring throughout their life due to this disease. Difficulties encountered during their treatment prompted us to present some general management principles. METHODS: From January 2003 to December 2016, 5 patients with osteopetrosis (9 hips; 3 men, 2 women), who underwent operative or conservative treatment were retrospectively reviewed. We evaluated their clinical features and rate of union, malunion and post-operative infection. RESULTS: Four of 5 patients (80%) suffered bilateral fracture, and 8 of 9 fractures (89%) are transverse and occurred at subtrochanteric area resulted from minor trauma. Among 9 hips, surgery was performed in seven hips. Nonunion were found in 3 hips (33%), malunion in 1 hip (11%) and oteomyelitis was developed in 2 hips (22%) at a median of 8.1 years. CONCLUSIONS: Clinical features of hip fracture in osteopetrosis are very similar to atypical subtrochanteric femoral fractures. Patients should be informed of the possibilities of several anticipated complications including the risk of nonunion and infection after surgery.
Subject(s)
Humans , Male , Femoral Fractures , Fracture Fixation, Internal , Hip Fractures , Hip , Osteopetrosis , Retrospective Studies , SurgeonsABSTRACT
BACKGROUND: Hip fracture surgery (HFS) is often associated with perioperative blood loss, and it frequently necessitates transfusion. However, the hemoglobin (Hb) threshold for transfusion remains controversial in hip fracture patients. We evaluated the usefulness of the restrictive strategy and preoperative intravenous iron supplementation in HFS. METHODS: We retrospectively reviewed the medical records of 1,634 patients (> 60 years of age) who underwent HFS between May 2003 and June 2014 and were followed up for 1 year or more after surgery. We used the liberal transfusion strategy until May 2009 to determine the transfusion threshold; afterwards, we switched to the restrictive transfusion strategy. Patients with the restrictive transfusion strategy (restrictive group) received intravenous iron supplementation before surgery. We compared the transfusion rate, morbidity, and mortality of the restrictive group with those of the patients with the liberal transfusion strategy (liberal group). RESULTS: Preoperative intravenous iron supplementation was not associated with any adverse reactions. The transfusion rate was 65.3% (506/775) in the liberal group and 48.2% (414/859) in the restrictive group (p < 0.001). The mean hospital stay was shorter in the restrictive group (21.5 vs. 28.8 days, p < 0.001). There was no significant difference in the postoperative medical complications including myocardial infarction and cerebrovascular event. Mortality at postoperative 30, 60, and 90 days was similar between the two groups. CONCLUSIONS: Our blood management protocol involving restrictive strategy combined with preoperative intravenous iron supplementation appears to be effective and safe in HFS of elderly patients.