Survey of Preferences in Patients Scheduled for Carpal Tunnel Release Using Conjoint Analysis

BACKGROUND: This study aimed to investigate the preferences of patients scheduled for carpal tunnel release using conjoint analysis and also introduce an example of how to apply a conjoint analysis to the medical field. The use of conjoint analysis in this study is new to the field of orthopedic surgery. METHODS: A total of 97 patients scheduled for carpal tunnel release completed the survey. The following four attributes were predefined: board certification status, distance from the patient's residency, medical costs, and waiting time for surgery. Two plausible levels for each attribute were assigned. Based on these attributes and levels, 16 scenarios were generated (2 × 2 × 2 × 2). We employed 8 scenarios using a fractional factorial design (orthogonal plan). Preferences for scenarios were then evaluated by ranking: patients were asked to list the 8 scenarios in their order of preference. Outcomes consisted of two results: the average importance of each attribute and the utility score. RESULTS: The most important attribute was the physician's board certificate, followed by distance from the patient's residency to the hospital, waiting time, and costs. Utility estimate findings revealed that patients had a greater preference for a hand specialist than a general orthopedic surgeon. CONCLUSIONS: Patients considered the physician's expertise as the most important factor when choosing a hospital for carpal tunnel release. This suggests that patients are increasingly seeking safety without complications as interest in medical malpractice has increased.

Bone Mineral Density and Prevalence of Osteoporosis in Postmenopausal Korean Women with Low-Energy Distal Radius Fractures

The aim of this study was to evaluate the bone mineral density and the prevalence of osteoporosis in postmenopausal Korean women with low-energy distal radius fractures and compared with those of aged-matched normal Korean women. Two hundred and six patients with distal radius fractures between March 2006 and March 2010 were included in this study. Patients were divided into three groups by age; group 1 (50-59 years), group 2 (60-69 years), and group 3 (70-79 years). Controls were age-matched normal Korean women. The bone mineral density values at all measured sites, except for the spine, were significantly lower in group 1 than those of control. While the bone mineral density values in group 2 and 3 were lower than those of controls, these differences were not statistically significant. All groups had significantly higher prevalence of osteoporosis at the Ward's triangle; however, at the spine, femoral neck and trochanteric area it was not significantly different from those of age-matched controls. Although the prevalence of osteoporosis of the postmenopausal women with low-energy distal radius fractures may not be higher than that of the control, osteoporosis should be evaluated especially in younger postmenopausal patients to prevent other osteoporotic hip and/or spine fractures.

Redisplacement of Distal Radius Fracture after Initial Closed Reduction: Analysis of Prognostic Factors

BACKGROUND: To evaluate risk factors of redisplacement and remind surgeons of key factors regarding conservative treatment of distal radius fracture. METHODS: A total of 132 patients who received conservative treatment for distal radius fractures between March 2008 and February 2011 were included in this study. Radial inclination, radial length, volar tilting angle, ulnar variance, fragment translation, and presence of dorsal metaphyseal comminution were measured on the X-rays taken immediately after reduction, one week after injury during the first follow-up outpatient clinic visit, and after the gain of radiological union. Secondary displacement was defined as a loss of reduction during the follow-up period, and was divided into 'early' and 'late' categories. We analyzed the influence of initial displacement radiologic variables, dorsal cortex comminution, and patient age on the development of secondary displacement. RESULTS: Development of secondary displacement was significantly associated only with initial displacement radiologic variables (p < 0.001), development of the late secondary displacement was significantly associated with age (p = 0.005), and initial displacement radiologic variables were associated significantly with a serial increase in ulnar variance (p = 0.003). CONCLUSIONS: Greater displacement on the initial radiographs indicates a higher possibility of development for secondary displacement, and older patients had a higher probability of late secondary displacement development. Furthermore, dorsal comminutions did not affect secondary displacement directly.

Cubital Tunnel Syndrome / 대한정형외과학회잡지

Cubital tunnel syndrome is compressive neuropathy, entrapment of the ulnar nerve around the medial epicondyle of the elbow joint, and the second most common neuropathy after carpal tunnel syndrome. Patients complain of hypoesthesia or paresthesia in the ulnar half of the ring and small fingers early in the disease. Advanced disease is complicated by irreversible muscle weakness or atrophy and claw hand deformity of the ring and small fingers. Although traditional decompression and anterior transposition of the ulnar nerve is known as standard treatment, according to recent reports only simple decompression has a good outcome. So, variety of surgical treatment options are available. In this paper, we purpose to describe the causes, clinical features and recent surgical treatments of cubital tunnel syndrome.

Musicians' Medicine: Musculoskeletal Problems in String Players

There is increasing attention to medical problems of musicians. Many studies find a high prevalence of work-related musculoskeletal disorders in musicians, ranging from 73.4% to 87.7%, and string players have the highest prevalence of musculoskeletal problems. This paper examines the various positions and movements of the upper extremities in string players: 1) basic postures for holding instruments, 2) movements of left upper extremity: fingering, forearm posture, high position and vibrato, 3) movements of right upper extremity: bowing, bow angles, pizzicato and other bowing techniques. These isotonic and isometric movements can lead to musculoskeletal problems in musicians. We reviewed orthopedic disorders that are specific to string players: overuse syndrome, muscle-tendon syndrome, focal dystonia, hypermobility syndrome, and compressive neuropathy. Symptoms, interrelationships with musical performances, diagnosis and treatment of these problems were then discussed.

Closed Reduction and Cast Immobilization for the Treatment of Distal Radius Fracture: Does Dorsal Metaphyseal Comminution Predict Radiographic and Functional Outcomes?

PURPOSE: The purpose of this study was to determine the relationship between dorsal metaphyseal comminution and the radiographic and functional outcomes of patients with distal radius fractures treated by closed reduction and cast immobilization. METHODS: Twenty-six patients with acute distal radius fractures were retrospectively reviewed. The mean age of this patient group was 62.8 years (range, 45-87 years). Eighteeen cases were AO type-A3 and 8 were AO type-A2. Radiographic and functional parameters were analyzed and compared between the patients who presented with or without dorsal metaphyseal comminution on their initial radiographs in order to assess the clinical outcomes. The radiographic parameters included radial inclination, radial length, volar/dorsal tilt, and ulnar variance. In order to measure the functional outcomes, each patient's range of motion, grip strength, Quick disabilities of the arm, shoulder, and hand (DSAH), visual analog scale (VAS), and Mayo score were determined. RESULTS: Seventeen patients (65%) presented with dorsal metaphyseal comminution on the initial radiographs. Radial inclination, radial length, and volar/dorsal tilt were decreased and ulnar variance was increased on the final radiographs in comparison with the postreduction. However, there were no statistically significant differences between the two groups that presented with or without dorsal metaphyseal comminution (p>0.05). None of the functional parameters (i.e., range of motion, grip strength, DASH, Mayo, and VAS score) were significantly different between the two groups (p>0.05). CONCLUSION: Dorsal metaphyseal comminution seems to have no significant impact on radiographic and functional outcomes when closed reduction and cast immobilization was planned for the treatment of distal radius fracture.

Osteosynthesis with Structural Bone Grafting and Plate-screw Fixation for the Treatment of Forearm Bone Nonunion

PURPOSE: We reported clinical results of autologous tricorticocancellous bone grafting and plate-screw fixation for nonunion of the forearm bones. MATERIALS AND METHODS: Ten patients with nonunion of the forearm bones that underwent surgical treatment were evaluated. Tricorticocancellous bone grafting which was harvested from the iliac crest and plate-screw fixation were performed. Radiologic bone union was evaluated based on the simple radiographs. At the final follow-up, range of motion was measured and the Anderson scale was used for functional evaluation. RESULTS: Radiologic bone union was achieved in all cases. The mean range of motion was 139degrees of elbow flexion, 3degrees of flexion contracture, 73degrees of forearm pronation, 72degrees of supination, 70degrees of wrist flexion, and 70degrees of wrist extension. Anderson scale was excellent in 6 patients, satisfactory in three, and unsatisfactory in one. CONCLUSION: Autologous tricorticocancellous bone grafting and rigid plate-screw fixation is a reliable method to achieve successful healing of forearm bone nonunions.

The Medical Doctors' Opinion of Public Health Center on the Development and Supply of Medical Doctor for Public Health Sector / 農村醫學 地域保健

OBJECTIVES: This study, as for activating measures for capable medical physicians to penetrate into the public health sector, is to provide a basic informations which are used for the enlargement of human resources of physicians in the public health sector, by investigating the perception of physicians, who are now working in the public health center, on the training and development of physicians in the public health sector. METHODS: The subjects of this study were 126 individuals. The data was analyzed by frequency analysis using SPSS ver. 17.0K. RESULTS: According to the investigation of 'how to support physicians in public health sector', the necessity of almost questions is considered to be important. Especially, regarding to investigation on 'obstacles of physicians' entrance to public health sector', 'relatively low salary' and 'lack of promotion chances' were thought to be considerable. The most significant education programs to work for public health sector is to improve the ability of health administration planning and service performance. CONCLUSIONS: The important methods to reinforce and easily obtain the human resources of physicians in public health sector are not only to improve the penetration of physicians to public health sector, but also to enhance the ability of present physicians, even though sufficient recruitment of physicians is essential.

The Availability of Three-Dimensional Computed Tomography Reconstructions on the Classification and Treatment Plan of Distal Radius Fractures

PURPOSE: The purpose of this study is to determine whether the three-dimensional computed tomography (3D-CT) images would increase the reliability of fracture classification and influence treatment plan of distal radius fractures. MATERIALS AND METHODS: Four independent observers evaluated radiographic images of thirty patients with distal radius fractures. The fracture classification has been performed based on (1) AO classification, (2) Fernandez classification, (3) Frykman classification. And then treatment plan was planned based on (1) closed reduction with Sugar-tong splint, (2) closed reduction with pinning, (3) closed reduction with external fixator, (4) open reduction with plate (volar approach), (5) open reduction with plate (dorsal approach). Two rounds of evaluation were compared regarding: (1) simple radiographs alone, and (2) simple radiographs and 3D-CT together two weeks after that. This cycle was then repeated to assess intraobserver reliability. RESULTS: 3D-CT improved the intraobserver and interobserver reliability regarding the fracture classification and treatment plan. And the addition of 3D-CT to simple radiographs influenced treatment recommendations, resulting in a significantly greater number of decisions for an open approach (p<0.05, McNemar test). CONCLUSIONS: 3D-CT is a reliable tool of fracture classification and improves treatment plan of distal radius fractures.

The Reverse Sural Artery Flap for Soft Tissue Defect of Foot and Ankle in Diabetic Patient / 대한정형외과학회잡지

PURPOSE: A reverse sural artery flap is a useful method for the soft tissue coverage of the lower leg, around the foot and ankle. We present our experience with the reverse sural artery flap for the coverage of a soft tissue defect due to ulceration, necrosis, and trauma in diabetic patients. MATERIALS AND METHODS: We treated 5 diabetic patients who showed soft tissue defects around their lower leg, foot and ankle. The causes of the soft tissue defect were an ulcer and infection in 4 cases, and trauma in 1 case. The sites of the soft tissue defect were around the ankle in 2 cases. In the other cases, the defect site were the lower third of the leg, the hind foot, the foot dorsum. The mean follow up period was 12.4 months. The size of the soft tissue defect ranged from 4 x 3 cm to 15 x 10 cm. RESULTS: All the flaps survived. The donor site was covered with a split thickness skin graft. There was no recurrence of the soft tissue defect during the follow-up period. Conclusion: The reverse sural artery flap is a valuable method for covering certain types soft tissue defect of foot and ankle in diabetic patients.

Multiple Subungual Osteochondromas: A Case Report / 대한정형외과학회잡지

The osteochondroma is a common benign bone tumor, which is only rarely observed in a subungal location, especially in the fingers. We present a case of multiple subungal osteochondromas, which occurred in the distal phalanges causing nail deformities and pain.

Arterialized Venous Free Flap with Palmaris Longus Tendon for the One-Stage Reconstruction of Defects of Skin and Extensor Tendon / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to introduce our new modified surgical method using a tendocutaneous flap, which is an arterialized venous free flap with palmaris longus tendon, to reconstruct composite defects of the dorsal skin and extensor tendons of the hand and to evaluate the clinical results. MATERIALS AND METHODS: Between March 1994 and December 2001, composite defects of the hands in 39 patients were reconstructed using various modifications of arterialized venous free flap. Among these patients, eight cases of tendocutaneous type were included in this study. The mean age of the patients was 33.2 years (ranging from 19 to 49), and the flap sizes ranged from 1.5x2 cm to 4x7 cm. In 2 of the 8 cases, neurorrhaphy using forearm cutaneous nerve was performed simultaneously for of digital nerve reconstruction. RESULTS: All flaps survived successfully and covered exposed bone and tendon. Marginal necrosis occurred partially in one case by less than 10% and this was completely recovered without any further surgical treatment. A functional range of motion (ROM) at the involved joint was achieved in an average ROM of 70 degrees at the PIP joint and 25 degrees at the DIP joint. CONCLUSION: Tendocutaneous arterialized venous free flap with palmaris longus tendon, is was found to be especially useful surgical foro reconstruct in a composite defects of the dorsal skin and extensor tendon of the hand.

The Clinical Results of Total Hip Replacement Arthroplasty for Infection Hip Sequelae with Dislocation and Severe Shortening / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to evaluate the results of total hip replacement arthroplasty (THRA) in sequelae of the infected hip with dislocation and severe shortening. MATERIALS AND METHODS: We reviewed 22 cases of THRA performed from January 1985 to March 1995, for painful, dislocated hips secondary to infection in childhood, with shortening of the limb more than 5 cm. Among 22 cases, seventeen were pyogenic infection sequelae, and five were tuberculous infection sequelae. RESULTS: Mean followup period was 44 months (range: 24-111 months) . The mean value of the Harris score was increased to 86.7, which had been 61. The mean postoperative limb-length discrepancy was 1.8 cm and amount of correction ranged from 2.5 cm to 6.1 cm (average : 4.2 cm) . There was remarkable difference between the Crowe Group I and combined Group II and III in correction of shortening. The incidence of radiological loosening was not related to preoperative morbid period or the age of patients. CONCLUSION: The main resistant factor in lengthening of the affected limb was soft tissue contracture related to old age or long term after infection, and complication rate (14%) was higher than that in the other kinds of disease on hip.