ABSTRACT
Purpose@#The purpose of this study was to prepare guidelines for the treatment of COVID-19-positive hip fractures based on the treatment experience of patients with COVID-19-positive hip fractures admitted to a COVID-19-dedicated hospital. @*Materials and Methods@#A retrospective analysis was performed on COVID-19-positive elderly hip fracture patients treated at a COVIDdedicated hospital when the number of domestic COVID-19 infections increased rapidly. The treatment results were analyzed by comparing the complications of patients who underwent surgery at a COVID-dedicated hospital and those who did not, the time taken from surgery to surgery, and the number of visits to medical institutions. @*Results@#The average surgery time for COVID-19 hip fracture patients in the author’s hospital was 3.74 days from the date of injury, and it took an average of 12.8 days for surgery at other hospitals. The average number of patients who visited medical institutions was 3.33 locations in the group who did not undergo surgery at the author’s hospital, which was significantly higher than the 2.83 locations in the group who had surgery. Among the patients unable to undergo surgery, no patient could not undergo surgery due to serious reasons. @*Conclusion@#The explosive increase in COVID-19 infections has delayed the time of surgery for COVID-19-positive elderly patients with hip fractures and increased the transfer rate of medical institutions, even for relatively non-dangerous causes. Clear criteria for treatment and effective policies are needed to prevent delay delays in treatment.
ABSTRACT
Background@#The purpose of this study was to compare clavicular tunnel complications after coracoclavicular (CC) reconstruction between a coracoid loop fixation group and a coracoid tunnel fixation group. We hypothesized that clavicular tunnel complications would be more common in the coracoid loop group. @*Methods@#This retrospective study evaluated 24 patients who underwent CC reconstruction using coracoid tunnel fixation (n = 14) and coracoid loop fixation (n = 10). Radiographic measurements included the CC distance and clavicular tunnel diameter. Clavicular tunnel complications such as tunnel widening and clavicular tunnel fractures were investigated. Clinical outcomes were assessed using the American Shoulder and Elbow Surgeons Shoulder score and the University of California at Los Angeles Shoulder score. @*Results@#The mean follow-up period was 17.5 months (range, 11–38 months). The final clavicular tunnel diameter and the increase in the clavicular tunnel diameter in millimeter and percentage were significantly greater in the coracoid loop group than in the coracoid tunnel group (all p < 0.05). Clavicular tunnel widening more than 100% was found in 5 patients, all belonging to the coracoid loop group. Clavicular tunnel fractures occurred in 3 patients (all in the coracoid loop group). Fracture was associated with severe tunnel widening (more than 100% increase). The mean value of the final clavicular tunnel diameter in patients with fractures was significantly larger than that in patients without (12.7 ± 3.3 mm vs. 8.4 ± 1.5 mm, p = 0.016). @*Conclusions@#Clavicular tunnel complications such as significant tunnel widening and fractures after CC reconstructions in acromioclavicular dislocations were common with the coracoid loop fixation technique. A greater clavicular tunnel widening and resultantly enlarged tunnel diameter might increase the risk of fracture through the clavicular tunnel.
ABSTRACT
Background@#Osteopenia patients have a risk of fracture and may develop osteoporosis.We investigated physicians’ management of osteopenia patients in South Korea. @*Methods@#A survey was conducted using a questionnaire including 6 items: (1) do you think anti-osteoporosis medications are necessary in osteopenia patients?; (2) what is your preference to manage osteopenia patients, except for anti-osteoporosis medications?; (3) what is your indication for the anti-osteoporosis medication in osteopenia patients?; (4) what kind of anti-osteoporosis medication do you prefer to treat osteopenia patients?; (5) do you use bisphosphonates?; and (6) if not, what is the reason for not using?. @*Results@#Among the 173 participants, 150 (86.7%) replied that anti-osteoporosis medications were necessary in osteopenia patients. Indications for the medication were (1) past medical history of pathologic fracture in 85 (49.1%); (2) T-score <-2.5 on dual energy X-ray absorptiometry in 73 (42.2%); (3) previous history of osteoporosis in 44 (25.4%);(4) risk of fracture according to fracture risk assessment tool in 34 (19.7%); and (5) progressive bone loss in 31 (17.9%). One hundred and sixteen (67.1%) favored bisphosphonates, 93 (53.8%) selective estrogen-receptor modulator, and 24 (13.9%) hormone replacement therapy. Thirty-one (17.9%) replied that they do not use bisphosphonates due to (1) restricted reimbursement by the health insurance in 24 (77.4%); and (2) bisphosphonate-related complications in 19 (61.3%). @*Conclusions@#Most respondents (86.7%) thought anti-osteoporosis medications were necessary in osteopenia patients, but 17.9% of the respondents did not use bisphosphonates. Restricted reimbursement by the national health insurance was the major obstacle against the use of bisphosphonates.