Radiation Induced Hand Necrosis of an Orthopaedic Surgeon Who Had Treated a Patient with Fluoroscopy-Guided Spine Injection / 대한정형외과학회잡지

As the frequency of radiation exposure by fluoroscopy continues to increase in orthopaedic fields, the level of hazard for the orthopaedic surgeon increases at the same time. Exposure of the clinician's hand is highest during performance of surgery or procedures within the actual clinics. Studies on radiation exposure on thyroid, eye or whole body, or reports on radiation treatment of cancer or for dermal lesions occurring from therapeutic intervention on the body such as heart and liver, and studies on radioactive damage to hands derived from radioactive material handlers have been reported; however, no studies on radioactive damage to a clinician's hand have been reported. Therefore, we report on a case of chronic radiation dermatitis and necrosis of an orthopaedic surgeon's hand as well as its soft tissue defect.

A Survey on the Exercise Program after Surgery for the Herniated Lumbar Disc in the Hospital Websites

STUDY DESIGN: Exercise therapy after lumbar disc herniation surgery which is presented through hospital website was studied. OBJECTIVES: To assess the efficacy of exercise therapy after lumbar disc herniation surgery; the methods of evaluation are identified through the participating hospital's web site and exercise therapy that is presented on reference is compared. SUMMARY OF LITERATURE REVIEW: Exercise therapy after lumbar disc herniation surgery is effective; however, patient training is needed to ensure compliance. MATERIALS AND METHODS: After searching on five different portals using the term 'spine surgery,' 230 websites were retrieved. The performance of lumbar disc herniation surgery and presentation of postoperative exercise therapy was discovered and the presentation of exercise therapy for surgery type and departments difference were investigated. Exercise therapy were classified according to purposes and method for reference and the number of each exercise therapy was investigated. Exercises which were divided by postoperative period were also investigated. RESULTS: In 230 websites were retrieved; there were a total of 103 hospitals performing lumbar disc herniation surgery: 23 websites (22%)proposed exercise therapy after surgery is 23(22%), and 2(9%) of websites proposed exercise therapy for the type of surgery. The number of exercise therapy proposed by the website was 15; of the exercises mentioned, deep abdominal muscle contractions was the most commonly mentioned, using the treadmill was least. There were 5 websites that proposed exercise therapy divided by postoperative period. CONCLUSIONS: Only 22% of hospitals with websites that performed lumbar disc herniation surgery proposed postoperative exercise therapy. Although th common trends seem biased, postoperative exercise therapy needs more attention and the construction of websites for patient access is necessary to provide better rehabilitation for patients.

Proximal Femur and Lumbar Spine's DXA T-score Concurrence in Diagnosis of Osteoporosis / 대한골다공증학회지

OBJECTIVES: To evaluate the correlation between T-score of lumbar spine and that of proximal femur using dual energy x-ray absorptiometry (DXA) and the accuracy of the diagnosis of osteoporosis. MATERIAL AND METHODS: From December 2009 to January 2012, 300 female patients were selected who underwent bone mineral density (BMD) test using DXA. After measuring BMD of proximal femur and lumbar spine, the score of BMD in each age group was compared by two sites. Also, the concordance of the diagnosis of osteoporosis was evaluated. RESULTS: The result showed significantly lower T-score and BMD as it goes to the elderly group. As it goes for 60's age group and even more for 70's age group, lumbar spine showed lower BMD than proximal femur. In all age groups, lumbar spine and proximal femur T-score showed significant correlation; however, it showed the least states at 60's age group. Discordance rate of osteoporosis diagnosis was 33% and 47.3% each at lowest t-score and total t-score. 60's age group showed the highest discordance rate, and osteoporosis group showed the highest rate. CONCLUSIONS: When measuring BMD for diagnosis of osteoporosis, since it shows significant discordance between proximal femur and lumbar spine, it is necessary to measure BMD simultaneously on both parts.

The Comparison of Injury Pattern and Risk in First Time Skiers and Snowboarders / 대한스포츠의학회지

The purpose of this study was to explore the risk and pattern of injury which can happen to first time skier and snowboarder. From December 2006 to March 2008, questionnaires were provided to 7,786 patients injured from skiing or snowboarding and hospitalized. First time and experienced groups were distinguished through questionnaire and accidental reports. The differences in incidence, cause of injury, affected body region, type of injury, and severity of injury were compared between the two groups. Falling or slip down was the most common cause of injury in first timers, while collision with person was most common in experienced. Injured sites were similar in both ski and snowboard with arm and wrist as the most frequent injured body region. Sprain and contusion were the most common injury type for both groups. However, the incidence of ligament injury was higher in the first time skiers and concussion and dislocation in the first time snowboarders compared to the experienced. In conclusion, beginners in skiing and snowboarding happened to show different cause and features of injury compared to the experienced. Therefore beginners need effective programs differed from the ones of experienced, such as mentioning risks of skiing and snowboarding and reserving a porting of slopes to the beginners. Moreover, It is necessary to develop and effectively use protective gear in order to secure elbow joint and wrist eminence.

Comparison of Posterior-Cruciate Retaining versus Substituting P.F.C. Total Knee Arthroplasty (A Randomized Study) / 대한정형외과학회잡지

PURPOSE: To compare the functional results of posterior cruciate-retaining (PCR) and posterior sub- stituting (PS) replacement in patients undergoing primary total knee arthroplasty (TKA) for osteoarthritis. MATERIALS AND METHODS: A randomized controlled study was carried out to compare the clinical and radiological outcomes of PCR and PS primary P.F.C.(R) TKA. One hundred and sixty eight patients (188 cases), who had a primary diagnosis of osteoarthritis, and an intact functioning posterior cruciate ligament, were enrolled in this study. The patients were randomized regardless of the level of posterior cruciate ligament preservation. One hundred and eighty eight cases had a minimum 6-year follow-up, which included 96 and 92 cases in the PCR and PS groups, respectively. RESULTS: The Knee Society Score, the Hospital for Special Surgery (HSS) knee rating scores, average flexion contracture and radiologic alignment improved significantly, but there were no significant difference between the two groups. On the other hand, the mean postoperative flexion angles in the PCR and PS knees increased from 114.7degrees to 121.2degrees and 119.3degrees to 131.3degrees, respectively (p<0.05). CONCLUSION: There were no significant differences between PCR and PS TKA in the follow-up knee scores. However, the level of postoperative improvement in further flexion was better in the PS group.

Two-staged Delayed Minimally Invasive Percutaneous Plate Osteosynthesis for Distal Tibial Open Fractures

PURPOSE: To evaluate the outcomes of distal tibial open fractures treated by two-staged delayed minimally invasive percutaneous plate osteosynthesis (MIPPO) technique. MATERIALS AND METHODS: 25 cases of distal tibial open fractures were treated with temporary ring fixation and two-staged delayed MIPPO. A mean age was 46 years old, follow-up was 23 months. The type of fracture was evaluated using the AO/OTA classification. The type of open fracture was evaluated using the Gustilo-Anderson classification that revealed 6 cases of type I, 9 cases of type II, 8 cases of type IIIA and 2 cases of type IIIB. We analyzed the radiologic results and postoperative complications. The clinical and functional result were evaluated by using Teeny and Wiss scores. RESULTS: The average time of bone union was 18 weeks in 24 cases. There were three delayed union that achieved union twenty weeks after second operation, and 1 case underwent bone graft with additional plate fixation. 6 cases of skin necrosis were treated with skin graft, 2 cases were treated with flap. The clinical and functional assessment showed that 6 cases were excellent, 16 cases were good, 2 cases were fair, and 1 case were poor results. CONCLUSION: Two-staged MIPPO technique for distal tibia open fractures seems to be a good procedure to obtain bone union.