The Risk Factors of Delirium in Elderly Patients with Hip Fracture: A Prospective Study

PURPOSE: The purpose of this study was to report on the incidence and risk factors of perioperative delirium in elderly patients with hip fracture. MATERIALS AND METHODS: There were seventy four patients who were older than 65 years and who underwent an operation for hip fracture between April 2006 and February 2008. All the patients were tested with the Mini-Mental State Examination Korean version after admission and they were checked daily for the duration of their hospitalization. We diagnosed delirium by the Confused Assessment Method and we evaluated the risk factors for perioperative delirium. RESULTS: Delirium occurred in 21 patients (28.4%). The delirium group had a lower Mini-Mental State Examination Korean version score compared with that of the control group. The percentage of patients cared for in the intensive care unit (ICU) was significantly higher in the delirium group. There were statistically significant differences between the delirium group and the control group for the serum electrolytes, albumin and a past history of diabetes, stroke and CNS medications. CONCLUSION: Delirium is common in the elderly patients with hip fracture. Electrolyte disequilibrium and a low albumin level showed significant positive correlation between the delirium group and the control group. A history of stroke, diabetes and CNS medications are risk factors for delirium.

Treatment of Intra-articular Calcaneal Fracture with Open Reduction and Internal Fixation / 대한족부족관절학회지

PURPOSE: To evaluate the clinical outcomes and radiographic results of open reduction and internal fixation for intra- articular calcaneal fractures. MATERIALS AND METHODS: We reviewed 20 cases of calcaneal fractures managed with open reduction and internal fixation from March 2003 to January 2005. We used the computed tomographic classification system proposed by Sanders et al to classify these fractures. Preoperative and postoperative Bohler's angle, heel height (calcaneal facet height) and calcaneal length, calcaneal width were measured. The Creighton-Nebraska Health Foundation Assessment score was used for clinical evaluation. RESULTS: There were 12 cases of type II fractures, 5 of type III fractures and 3 of type IV fractures. The mean clinical score was 84.3 for type II, 82.6 for type III and 56.1 for type IV. The mean preoperative B?hler angle was 6.1 degrees and final was 22.8 degrees. The mean preoperative calcaneal facet height was 76.6 mm and final was 80.3 mm (The mean calcaneal facet height was changed from preop 76.6 mm to postop 80.3 mm). The mean preoperative calcaneal length was 88.2 mm and final was 92.6 mm. The mean preoperative width was 38.1 mm and final was 35.6 mm. CONCLUSION: Open reduction and internal fixation showed good results for type II and III fractures, but for type IV fractures the clinical result was significantly worse than the other types. However, type IV fractures still had restoration of (should be restored in) Bohler's angle, calcaneal facet height, calcaneal length and width which may be helpful in later subtalar fusion.

The Efficacy of the Treatment of Thoracolumbar Spine Fractures with Short-segment Posterior Instrumentation and Fusion

PURPOSE: To evaluate the safety and usefulness of the short-segment posterior instrumentation and fusion in the treatment of thoracolumbar spine fractures. MATERIALS AND METHODS: Forty-two patients were treated by short-segment pedicle screw instrumentation and fusion between Oct. 1998. and Jan. 2004 by single surgeon. All patients were treated posteriorly and all the pedicle screws are monoaxial. Intraoperative rod bending and fixation technique was used to reduce the collapsed vertebral body and correct the kyphotic angle. The follow up duration is mean 2.1 year (1~6 year). The mean age is 40.2 year (18~60 year) old. The fractures were classified by Denis' classification and Load-Sharing Classification. Preoperative and postoperative changes of kyphotic angle and vertebral body height were measured. Denis' Pain Score and Work scales, Frankel neurologic grade were obtained during follow-up evaluation for patients. RESULTS: All the cases got solid bony union. Mean Load-Sharing Score was 7.3. Clinical results were good. The mean kyphotic angle was preoperatively 14.5 degree, immediate postoperatively 7.5 degree, and last follow up 9.2 degree. The mean anterior vertebral heights s were 60.8% preoperatively, 83.4% immediate postoperatively, and 79.5% last follow up. There was only one case of screw breakage but no revision operation due to loss of reduction. All the cases showed satisfactory clinical results. CONCLUSION: This study suggest that short-segment instrumentation and fusion using pedicle screw system for thoracolumbar spine fractures could lead to good results, if comminution of vertebral body is considered in the selection of approach.

Multiple dose methotrexate chemotherapy in suspected medical treament failure of ectopic pregnancy / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to determine the efficacy of multiple dose methotrexate (MTX) chemotherapy approved as a primary treatment of ectopic pregnancy in suspected medical treatment failure of ectopic pregnancy. METHODS: This study included 77 hemodynamically stable high risk ectopic pregnants diagnosed from January 1995 to June 2000 at department of Obstetrics & Gynecology, Sanggye Paik hospital, Inje university. High risk criteria of our study were adnexal ectopic mass 3.5 cm or serum-hCG 4,000 mIU/ml or presence of fetal heart beat(FHB) or presence of peritoneal fluid and fresh blood on culdocentesis. Statistics were analyzed with 2-test, Student t-test and odds ratio of each risk factors. RESULTS: The response rate of multiple dose MTX chemotherapy was 85.7%(66/70). There was no statistically difference of risk factors between success and failure group except fetal heart beat. Among 11 failure patients, there were 3 patients with adnexal ectopic mass 3.5 cm (odds ratio=1.4, 0.3~5.7), 3 patients with presence of FHB, 7 patients with presence of peritoneal fluid(odds ratio=1.0, 0.3~3.8), 8 patients with serum-hCG 4,000 mIU/ml (odds ratio=2.8, 0.7~11.6). CONCLUSION: There results suggest that multiple dose MTX chemotherapy can be treated regardless of ectopic mass size, presence of pretoneal fluid, serum beta-hCG level. But we must pay attention to treat ectopic pregnancy with presence of fetal heart beat.