A case report of a carotid space abscess due to extraluminal migration of a fishbone into the deep cervical space / 고신대학교의과대학학술지

Laryngopharyngeal foreign bodies are among the cases most frequently encountered by otolaryngologists. Most foreign bodies can be easily removed without any complications. However, surgical removal is required in some cases. Therefore, a delayed diagnosis or misdiagnosis could cause fatal complications for patients who need a surgical approach. We report a rare case of extraluminal migration of a foreign body to the deep cervical space. The foreign body (a fishbone) was removed by a surgical approach. With a literature review, we also propose an algorithm for the management of suspicious foreign bodies in the neck.

Comparison of work stress, depression, insomnia, and fatigue of emergency department medical staff according to the emergency medical institutions and general characteristics during COVID-19 epidemic

Objective@#The objective of this study was to investigate job stress, depression, insomnia, and fatigue of coronavirus disease 2019 (COVID-19) medical staff and analyze the differences according to their general characteristics. @*Methods@#The study enrolled 98 workers at emergency medical institutions with COVID-19 treatment facilities located in Gangwon Province. An online survey was used to protect personal information. Data were analyzed using the statistical program SPSS version 28. The differences in job stress, depression, insomnia, and fatigue of COVID-19 medical staff were verified by t-test and analysis of variance. @*Results@#Analyzing job stress revealed that the average of the lowest relationship conflict stress for each sub-factor was 2.22, the average stress for job demand was the highest at 3.78, and the average whole job stress was 3.04. Contrarily, the average for depression was 1.69, insomnia 2.96, and fatigue 3.07. No statistically significant differences were observed for job stress, depression, insomnia, and fatigue when considering the type of workplace, gender, and occupation of COVID-19 medical staff. However, statistically significant differences were obtained in some variables including age, family members, working period, COVID-19 confirmed, and COVID-19-related education experience. @*Conclusion@#In this study, differences in job-related stress, depression, insomnia, and fatigue were confirmed considering the general characteristics of COVID-19 medical staff. In particular, the results of this study are significant since the difference in perceived stress in performing COVID-19 tasks was identified through empirical analysis by considering sub-factors of job stress.

Factors affecting mortality and complications of elderly patients with hip fracture

Objective@#The incidence of hip fractures in South Korea is increasing, and it is also a socioeconomic burden. This study analyzed the factors affecting the mortality and complications of hip fracture patients. @*Methods@#The Korean National Hospital Discharge In-depth Injury Survey was used to investigate the sex, age, Charlson comorbidity index (CCI), insurance type, pre-operation length of hospital stay, fracture type, operation type, and the number of beds in the hospital from 2009 to 2018. @*Results@#A total of 3,898 patients were enrolled. There were statistical differences in sex, age, insurance type, and CCI divided into the survival and the non-survival groups. There were statistical differences in age, CCI, and the number of beds divided into the group without complications and the group with complications. Multivariate logistic regression analysis revealed that men, age > 84 years (odds ratio [OR], 3.064; 95% confidence interval [CI], 2.000-4.692), medical aid (OR, 2.724; 95% CI, 1.672-4.436), and CCI≥3 (OR, 3.968; 95% CI, 2.555-6.162) were risk factors for the mortality and also revealed that age > 84 years (OR, 3.195; 95% CI, 2.18-4.683) and CCI≥3 (OR, 5.773; 95% CI, 4.174-7.986) were risk factors for the complications. @*Conclusion@#In this study, the factors affecting the mortality were men, old age, medical aid, and underlying diseases, and the factors affecting complications were old age and underlying diseases.

The incidence and characteristics of patients admitted to the hospital after a fall by the life cycle and risk factor for death

Objective@#This study aimed at identifying the incidence rate and characteristics of patients who had suffered falls, classifying them by life cycle and factors that affect mortality. @*Methods@#The Korean National Hospital Discharge In-depth Injury Surveys (KNHDIS) from 2007 to 2016 were used to investigate the sex, age, place, season, payment method, underlying disease, and the death of hospitalized patients due to falls. @*Results@#The number of hospitalized patients increased with age. In all life cycles except old age, men were hospitalized more than women. The payment method for treatment was 66.1% through national health insurance, 6.6% through medical aid, and 27.3% through other sources. Falls were most common in winter and occurred frequently at home and on the road. In terms of the number of patients, the compound annual growth rate was 0.9% for men and 3.7% for women. In terms of the number of deaths in hospitals, the compound annual growth rate was -1.9% for men and -7.2% for women. Mortality risk was high in men in middle adulthood and old age, in patients with underlying diseases, and in patients who suffered a fall in their homes. @*Conclusion@#The number of patients from falls is increasing, but the deaths of hospitalized fall patients are decreasing. Mortality risk was high in men in middle adulthood and old age, in patients with underlying diseases, and in patients who suffered falls in their homes.

The incidence and characteristics of patients admitted to the hospital after a fall by the life cycle and risk factor for death

Objective@#This study aimed at identifying the incidence rate and characteristics of patients who had suffered falls, classifying them by life cycle and factors that affect mortality. @*Methods@#The Korean National Hospital Discharge In-depth Injury Surveys (KNHDIS) from 2007 to 2016 were used to investigate the sex, age, place, season, payment method, underlying disease, and the death of hospitalized patients due to falls. @*Results@#The number of hospitalized patients increased with age. In all life cycles except old age, men were hospitalized more than women. The payment method for treatment was 66.1% through national health insurance, 6.6% through medical aid, and 27.3% through other sources. Falls were most common in winter and occurred frequently at home and on the road. In terms of the number of patients, the compound annual growth rate was 0.9% for men and 3.7% for women. In terms of the number of deaths in hospitals, the compound annual growth rate was -1.9% for men and -7.2% for women. Mortality risk was high in men in middle adulthood and old age, in patients with underlying diseases, and in patients who suffered a fall in their homes. @*Conclusion@#The number of patients from falls is increasing, but the deaths of hospitalized fall patients are decreasing. Mortality risk was high in men in middle adulthood and old age, in patients with underlying diseases, and in patients who suffered falls in their homes.

Symptomatic Mid-Substance Posterior Cruciate Ligament Calcification of the Knee Joint / 대한정형외과학회잡지

Calcification in the tendon is a common disease especially in the rotator cuff. The condition can be treated conservatively in the chronic stage, but surgically in the acute stage. On the other hand there are few reports of calcification in the cruciate ligament of the knee joint, especially calcification of the posterior cruciate ligament. A 51-year-old patient with symptomatic calcification in the mid-substance of the posterior cruciate ligament was treated conservatively. The symptoms did not improve after eight months of conservative treatment, so arthroscopic surgery was performed. During arthroscopic removal of the calcification, the ligament was damaged beyond preservation.Eventually a posterior cruciate ligament reconstruction was performed. At two years after surgery, radiography confirmed no recurrence of the calcification, and the patient was free. We report this case study with a review of the relevant literature.

Comparison of clinical outcomes and second-look arthroscopic evaluations between anterior cruciate ligament anteromedial bundle augmentation and single-bundle anterior cruciate ligament reconstruction

Background@#This study compared clinical outcomes and second-look arthroscopic evaluations between anterior cruciate ligament (ACL) anteromedial (AM) bundle augmentation and single-bundle ACL reconstruction.Purpose: We compared the clinical results and the second-look arthroscopic findings between (1) single-bundle ACL reconstruction in complete rupture and (2) ACL AM bundle augmentation in isolated AM bundle rupture. @*Materials and methods@#Two groups of patients underwent ACL surgery from January 2013 to December 2018. Group 1, who had 64 cases of single-bundle ACL reconstruction with second-look arthroscopy, and Group 2, who had 21 cases of AM bundle augmentation of ACL with second-look arthroscopy, were targeted. We evaluated and compared the clinical results (Lysholm score, Tegner activity score, Lachman test, and pivot-shift test) and synovialization at second-look arthroscopy before the operation and in the final follow-up period, between Group 1 and Group 2. @*Results@#The Lysholm score (p = 0.96) and Tegner activity score (p = 0.351) at final follow-up (mean 27.1 months) were 78.3 and 7.2 in Group 1 and 89.1 and 8.1 in Group 2, respectively. The Lachman test (p = 0.074) and pivot-shift test (p = 0.031) results at final follow-up were improved; however, there was no statistical significance. Second-look arthroscopy showed that percentages of synovialization area of grafted tendon at mean 15.6 months follow-up were 61.4% and 93.1% in Group 1 and Group 2, respectively (p = 0.008). The synovial coverage in Group 2 was higher than in Group 1. @*Conclusion@#The AM bundle augmentation for ACL injury in which the posterolateral bundle was preserved showed better clinical scores and synovial coverage than single-bundle ACL reconstruction for complete ACL rupture.

Comparative Analysis of the Results between the Early Period and the Midterm Period of a Single Surgeon’s Experience in the Treatment of Hallux Valgus Using Scarf Osteotomy / 대한족부족관절학회지

Purpose@#This study evaluated the results of two groups—the early group and midterm group—comparatively in the treatment of hallux valgus using a scarf osteotomy. @*Materials and Methods@#From January 2005 to December 2009 (Group 1) and from January 2010 to December 2013 (Group 2), this study compared hallux valgus cases treated by a scarf osteotomy by a single surgeon with at least a five-year follow-up. @*Results@#The average ages of Group 1 and Group 2 were 50.5 and 51.7 years old, respectively. The average follow-up of Groups 1 and 2 were 7.4 and 6.2 years, respectively. Groups 1 and 2 had 86 cases (53 patients) and 93 cases (64 patients) with at least a five-year followup, respectively. The average hallux valgus angle (HVA) and 1-2 intermetatarsal angle (IMA) of Group 1 were improved from 31.3° and 13.9° preoperatively to 11.3° and 6.8° at the final follow-up, respectively (p<0.001). The average HVA and 1-2 IMA of Group 2 were improved from 31.7° and 13.4° preoperatively to 8.9° and 6.6° at the final follow-up, respectively (p<0.001). The mean American Orthopaedic Foot and Ankle Society (AOFAS) score of both groups increased from 48.5 and 45.0 points preoperatively to 73.7 and 82.4 points at the final follow-up, respectively. The numbers of patient-assessed subjective satisfaction of Groups 1 and 2 at the final follow-ups were as follows: excellent, 27 and 36 (31.4%, 38.7%); good, 34 and 49 (39.5%, 52.7%); fair, 13 and 5 (15.1%, 5.4%); poor, 12 and 3 (13.9%, 3.2%);respectively. Neither troughing nor stress fractures occurred in both groups. @*Conclusion@#Scarf osteotomy for treating hallux valgus is an excellent surgical method with a relatively low incidence of complications.The results in Group 2 were better than those in Group 1, showing that more surgical experience and evolution of the techniques provided better results.

Comparison of clinical outcomes and second-look arthroscopic evaluations between anterior cruciate ligament anteromedial bundle augmentation and single-bundle anterior cruciate ligament reconstruction

Background@#This study compared clinical outcomes and second-look arthroscopic evaluations between anterior cruciate ligament (ACL) anteromedial (AM) bundle augmentation and single-bundle ACL reconstruction.Purpose: We compared the clinical results and the second-look arthroscopic findings between (1) single-bundle ACL reconstruction in complete rupture and (2) ACL AM bundle augmentation in isolated AM bundle rupture. @*Materials and methods@#Two groups of patients underwent ACL surgery from January 2013 to December 2018. Group 1, who had 64 cases of single-bundle ACL reconstruction with second-look arthroscopy, and Group 2, who had 21 cases of AM bundle augmentation of ACL with second-look arthroscopy, were targeted. We evaluated and compared the clinical results (Lysholm score, Tegner activity score, Lachman test, and pivot-shift test) and synovialization at second-look arthroscopy before the operation and in the final follow-up period, between Group 1 and Group 2. @*Results@#The Lysholm score (p = 0.96) and Tegner activity score (p = 0.351) at final follow-up (mean 27.1 months) were 78.3 and 7.2 in Group 1 and 89.1 and 8.1 in Group 2, respectively. The Lachman test (p = 0.074) and pivot-shift test (p = 0.031) results at final follow-up were improved; however, there was no statistical significance. Second-look arthroscopy showed that percentages of synovialization area of grafted tendon at mean 15.6 months follow-up were 61.4% and 93.1% in Group 1 and Group 2, respectively (p = 0.008). The synovial coverage in Group 2 was higher than in Group 1. @*Conclusion@#The AM bundle augmentation for ACL injury in which the posterolateral bundle was preserved showed better clinical scores and synovial coverage than single-bundle ACL reconstruction for complete ACL rupture.

Comparative Analysis of the Results between the Early Period and the Midterm Period of a Single Surgeon’s Experience in the Treatment of Hallux Valgus Using Scarf Osteotomy / 대한족부족관절학회지

Purpose@#This study evaluated the results of two groups—the early group and midterm group—comparatively in the treatment of hallux valgus using a scarf osteotomy. @*Materials and Methods@#From January 2005 to December 2009 (Group 1) and from January 2010 to December 2013 (Group 2), this study compared hallux valgus cases treated by a scarf osteotomy by a single surgeon with at least a five-year follow-up. @*Results@#The average ages of Group 1 and Group 2 were 50.5 and 51.7 years old, respectively. The average follow-up of Groups 1 and 2 were 7.4 and 6.2 years, respectively. Groups 1 and 2 had 86 cases (53 patients) and 93 cases (64 patients) with at least a five-year followup, respectively. The average hallux valgus angle (HVA) and 1-2 intermetatarsal angle (IMA) of Group 1 were improved from 31.3° and 13.9° preoperatively to 11.3° and 6.8° at the final follow-up, respectively (p<0.001). The average HVA and 1-2 IMA of Group 2 were improved from 31.7° and 13.4° preoperatively to 8.9° and 6.6° at the final follow-up, respectively (p<0.001). The mean American Orthopaedic Foot and Ankle Society (AOFAS) score of both groups increased from 48.5 and 45.0 points preoperatively to 73.7 and 82.4 points at the final follow-up, respectively. The numbers of patient-assessed subjective satisfaction of Groups 1 and 2 at the final follow-ups were as follows: excellent, 27 and 36 (31.4%, 38.7%); good, 34 and 49 (39.5%, 52.7%); fair, 13 and 5 (15.1%, 5.4%); poor, 12 and 3 (13.9%, 3.2%);respectively. Neither troughing nor stress fractures occurred in both groups. @*Conclusion@#Scarf osteotomy for treating hallux valgus is an excellent surgical method with a relatively low incidence of complications.The results in Group 2 were better than those in Group 1, showing that more surgical experience and evolution of the techniques provided better results.

Victim-oriented digital disaster emergency medical system

The fatality rate of a disaster is associated with the impact of the disaster and the case fatality rate. The severity of the disaster can be reduced by an efficient disaster management system, and the capacity of the trained disaster response system can lower the case mortality rate. The severity of a disaster is determined by the interaction of risk factors and vulnerabilities in a particular area, and the case-fatality rate is determined by a correlation between the capacity of the disaster response team and the survivability of the victims. The disaster management system and the disaster response system are complementary and interconnected, and the efficiency of cooperation and linkage can be improved by developing well organized digitalization. Efforts to increase the survival rate of victims through digitalization has been a continued process and new alternatives are being developed in accordance with the advances in information and communication technology to manage disaster risk factors and to improve disaster response capabilities. However, in case of mass casualty incidents, it is still difficult to reduce the case mortality rate by securing the survival time limit of the victims. Often, sharing the disaster scene information and communicating with the victim is not feasible. A lack of ability to provide real time escape route to exit or safe zone proves fatal. The communication revolution of the next generation wireless wide area network called 5G can overcome the disruption of communication network during the disaster incidents. It can enable real time tracking of the position of victim and linking the victims with its rescuers. Hence, it is possible to increase the survival rate of victims during mass casualty incidents by associating information and communication technologies with appropriate disaster management and response strategies, real-time information exchange and education and training of rescuers and citizens.

Efficacy of Ilizarov External Fixation and Autologous Bone Grafting for Performing Arthrodesis on the Ankle Arthropathy with Risk Factors / 대한족부족관절학회지

PURPOSE@#The aim of this study is to evaluate if the Ilizarov external fixation procedure with axial compression can help to obtain fusion across the ankle joint in patients with a high risk of nonunion.@*MATERIALS AND METHODS@#From January 2006 to December 2015, the study reviewed 17 patients who underwent ankle arthropathy with a high risk of nonunion and who underwent ankle fusion using the Ilizarov external fixator with axial compression and auto bone grafting. After the lateral surface of the ankle joint was exposed through a lateral trans-fibular approach, massive removal of the articular cartilage and excision of any loose or avascular bone were done. With the cortical bone harvested from the pelvis as corticocancellous bone blocks, we inserted the two cortical blocks longitudinally into the anterior and posterior part of the free ankle space from lateral to medial to make the rectangular chamber to fill the cancellous bones. After the Ilizarov external fixator was equipped, we tightened the frame by 5 mm to compress the bone graft space. We accessed the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score both preoperatively and postoperatively.@*RESULTS@#The average age at the time of operation was 63.4 years (range, 47~78 years). The mean frame time was 17.4 weeks (range, 15~23 weeks). The average follow-up period was 3.7 years (range, 2~6 years). Osseous fusion was obtained in 15 patients (88.2%). There were two stable pseudarthroses among the rheumatoid arthritis patients, and we continued their follow-up. The mean AOFAS Ankle-Hindfoot score improved from 48.5 to 73.7 points.@*CONCLUSION@#Ankle arthrodesis using the Ilizarov external fixation with axial compression and auto bone grafting on the ankle arthropathy that had difficult conditions to achieve union is considered one of the useful methods with a correspondingly low incidence of complications.

Victim-oriented digital disaster emergency medical system

The fatality rate of a disaster is associated with the impact of the disaster and the case fatality rate. The severity of the disaster can be reduced by an efficient disaster management system, and the capacity of the trained disaster response system can lower the case mortality rate. The severity of a disaster is determined by the interaction of risk factors and vulnerabilities in a particular area, and the case-fatality rate is determined by a correlation between the capacity of the disaster response team and the survivability of the victims. The disaster management system and the disaster response system are complementary and interconnected, and the efficiency of cooperation and linkage can be improved by developing well organized digitalization. Efforts to increase the survival rate of victims through digitalization has been a continued process and new alternatives are being developed in accordance with the advances in information and communication technology to manage disaster risk factors and to improve disaster response capabilities. However, in case of mass casualty incidents, it is still difficult to reduce the case mortality rate by securing the survival time limit of the victims. Often, sharing the disaster scene information and communicating with the victim is not feasible. A lack of ability to provide real time escape route to exit or safe zone proves fatal. The communication revolution of the next generation wireless wide area network called 5G can overcome the disruption of communication network during the disaster incidents. It can enable real time tracking of the position of victim and linking the victims with its rescuers. Hence, it is possible to increase the survival rate of victims during mass casualty incidents by associating information and communication technologies with appropriate disaster management and response strategies, real-time information exchange and education and training of rescuers and citizens.

Surgical Treatment of Chronic Tophaceous Gout in the 1st Metatarso-Phalangeal Joint / 대한족부족관절학회지

PURPOSE: Chronic tophaceous gout is a painful and disabling inflammatory disease. Surgical treatment for chronic tophaceous gout is very difficult with many complications. This study evaluated the efficacy of shortening scarf osteotomy on the treatment of chronic tophaceous gout in the 1st metatarso-phalangeal (MTP) joint. MATERIALS AND METHODS: From January 2006 to December 2015, 14 patients (19 cases) who underwent axial shortening scarf osteotomy for chronic tophaceous gout were reviewed. All patients were male. The average age at the time of surgery was 59.6 years (42~66 years). The minimum follow-up was 24 months. Total removal of the tophi mass with the adhered medial capsule of the 1st MTP joint was attempted. Axial shortening scarf osteotomy was done on the 1st metatarsal shaft. The visual analogue scale (VAS) for pain and the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score was assessed preoperatively and postoperatively. The range of motion (ROM) of the 1st MTP joint was also compared pre- and postoperatively. RESULTS: The average size of the extracted tophaceous mass was 32 mm. The mean amount of the length of metatarsal shortening was 4.9 mm. The mean ROM of the 1st MTP joint was improved from 30.4° to 62.3°. The mean AOFAS forefoot score improved from 51.4 to 86.6 points. The mean VAS for pain improved from 4.6 to 0.3 points. CONCLUSION: The axial shortening scarf osteotomy used on chronic tophaceous gout could reconstruct the 1st MTP joint with an improved ROM and was free of pain. Axial shortening scarf osteotomy is suggested as a useful and effective method for the treatment of chronic tophaceous gout.

Results of Autologous Osteochondral Transplantation of the Ostochondral Lesion on the Talus: A Comparison Study between Medial Malleolar Osteotomy Approach and Anterior Arthrotomy Approach / 대한족부족관절학회지

PURPOSE: Osteochondral lesion of the talus (OLT) has traditionally been treated using an autologous osteochondral graft via the medial malleolar approach. Here, we compare the traditional method with the anterior arthrotomy approach. MATERIALS AND METHODS: Between January 2005 and June 2015, 24 cases of patients who received autologus osteochondral graft for OLT and with at least 2 years of follow-up were evaluated. They were divided into two groups; one group receiving autologous osteochondral graft via the medial malleolar osteotomy approach (group 1, n=9) and another group via the anterior arthrotomy approach (group 2, n=15). The clinical outcomes were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) score. RESULTS: In all cases, the size of the subchondral cyst of the talus decreased, if not disappeared on the final follow-up radiograph. All osteochondral grafts were united. The mean AOFAS score increased from 61.5 preoperatively to 84.9 at the final follow-up. The mean AOFAS score of group 1 increased from 60.3 preoperatively to 78.0 (p=0.007) at the final follow-up, and the mean AOFAS score of group 2 also increased from 62.2 to 89.1 (p=0.006). The AOFAS score was statistically better in group 2 than in group 1 (p=0.034) at the final follow-up. CONCLUSION: Autologous osteochondral graft of the OLT yields satisfactory radiologic and clinical outcomes. Especially, better clinical outcome was observed in the group using the anterior arthrotomy approach (group 2) than in the group using the medial malleolar osteotomy approach (group 1).

Painful Osteochondroma of the Hallucal Sesamoid: A Case Report / 대한족부족관절학회지

Osteochondroma is one of the most common bone tumors. It can occur anywhere, although it is most frequent mainly around the metaphysis of long bones. Prediction sites are distal femur, proximal humerus, proximal tibia, and so on. However, osteochondroma in sesamoid is very rare. Herein, we report a case of a 56-year-old woman with symptomatic extra-articular osteochondroma in hallucal sesamoid with a brief literature review.

Shortening Scarf Osteotomy for Treatment of Hallux Rigidus Deformity / 대한족부족관절학회지

PURPOSE: To evaluate the effect of shortening scarf osteotomy on pain relief and range of motion (ROM) of the first metatarsophalangeal joint in hallux rigidus patients. MATERIALS AND METHODS: Twenty-three cases of 19 patients who had been treated with shortening scarf osteotomy for the hallux rigidus between January 2007 and December 2013 were reviewed. The mean follow-up period was 21.4 months, and the mean age was 59.2 years. The first metatarsal bone was shortened until the ROM of the first metatarsophalangeal joint was greater than 80° or 40° of dorsiflexion. The length shortened by scarf osteotomy was measured. The authors also measured and compared the joint interval difference of the standing foot using an anteroposterior radiography. Moreover, the difference of ROM of the first metatarsophalangeal joint between the preoperative and final follow-up periods was also compared. The clinical results were evaluated and compared using the American Orthopaedic Foot and Ankle Society (AOFAS) scoring system and visual analogue scale (VAS) score. RESULTS: The mean shortening length was about 6.5 mm (range, 4∼9 mm). The joint space has been increased to 1.8 mm, and the ROM of the first metatarsophalangeal joint has also been increased to 18.4° after the operation. In three cases, the postoperative ROM has been decreased to less 10°. The AOFAS score has been improved from 41.7 (range, 32∼55) to 86.2 (range, 65∼95), and the VAS score was also decreased from 3.7 (range, 3∼5) to 1.3 (range, 0∼3). Two cases have shown no decrease in pain even after the operation. CONCLUSION: Shortening scarf osteotomy was found to decrease joint pain by decompressing the pressure of the first metatarsophalangeal joint. This osteotomy also helped improve the ROM of the first metatarsophalangeal joint. Shortening scarf osteotomy can be considered one of the effective methods for joint preservation.

Efficacy of Veno-Venous Extracorporeal Membrane Oxygenation in Severe Acute Respiratory Failure

PURPOSE: The objective of this study was to evaluate our institutional experience with veno-venous (VV) extracorporeal membrane oxygenation (ECMO) in patients with severe acute respiratory failure (ARF). MATERIALS AND METHODS: From January 2007 to August 2013, 31 patients with severe ARF that was due to various causes and refractory to mechanical ventilation with conventional therapy were supported with VV ECMO. A partial pressure of arterial oxygen (PaO2)/inspired fraction of oxygen (FiO2) <100 mm Hg at an FiO2 of 1.0 or a pH <7.25 due to CO2 retention were set as criteria for VV ECMO. RESULTS: Overall, 68% of patients survived among those who had received VV ECMO with a mean PaO2/FiO2 of 56.8 mm Hg. Furthermore, in trauma patients, early use of ECMO had the best outcome with a 94% survival rate. CONCLUSION: VV ECMO is an excellent, life-saving treatment option in patients suffering from acute and life-threatening respiratory failure due to various causes, especially trauma, and early use of VV ECMO therapy improved outcomes in these patients.

Meta-analysis of the Incidence and Risk Factors for Squeaking after Primary Ceramic-on-ceramic Total Hip Arthroplasty in Asian Patients / 대한고관절학회지

PURPOSE: The purpose of this study was to assess the squeaking incidence and risk factors after primary ceramic-on-ceramic total hip arthroplasty (THA) in Asian patients using meta-analysis. MATERIALS AND METHODS: We performed a meta-analysis of published data on the squeaking incidence and risk factors from 2000 to 2013. Eight studies in Asians were analyzed for both squeaking incidence and risk factors and 25 studies in Western patients were analyzed for squeaking incidence. The data collected were: patient factors, surgical factors and implantation factors. RESULTS: The overall incidence of hip squeaking was 2.7% in Asians and 3.1% in Westerners. This difference was not statistically significant. The only significant risk factor was an increase in the acetabular cup abduction angle. Of the factors, the cup abduction angle was the only significant risk factor for the occurrence rate of squeaking, and the occurrence rate tended to increase with increasing angle. CONCLUSION: The incidence of squeaking in Asians after primary ceramic-on-ceramic THA is 2.7% and is similar to that in Westerners. The increased cup abduction angle is associated with squeaking; therefore, surgeons should be careful not to implant the cup at a too steep abduction angle.

Complications of Scarf Osteotomy for Hallux Valgus / 대한족부족관절학회지

PURPOSE: The purpose of this study was to evaluate the frequency of troughing and stress fracture, which are the major complications of scarf osteotomy, and to suggest methods to prevent these complications. MATERIALS AND METHODS: We reviewed 243 cases of 137 patients treated with the scarf osteotomy for hallux valgus from January 2005 to December 2012. The mean follow-up period was 2.8 years. During the scarf osteotomy, a long oblique longitudinal osteotomy was performed in order to decrease the possibility of troughing and stress fracture. Radiographs of lateral view of the foot were obtained and the thicknesses of the first metatarsal base at the sagittal plane were measured and compared. RESULTS: There was no troughing during fragment translation and screw fixation intraoperatively. Radiographs of lateral view of the foot taken preoperatively and at the last follow-up showed that the mean thickness of the first metatarsal was 22.4 mm preoperatively and 21.6 mm at the last follow-up, with a mean difference of 0.8 mm. And no stress fracture was observed. CONCLUSION: To prevent troughing and stress fracture, a long oblique longitudinal cut, parallel to the first metatarsal plantar surface, was performed, making both ends of the proximal segment truncated cone-shape, and securing the strong bony strut of the proximal segment. No troughing or stress fracture was experienced with scarf osteotomy.