Associations among Alzheimer disease, depressive disorder, and risk of end-stage kidney disease in elderly people

Alzheimer disease (AD) and depressive disorder (DD) are prevalent among elderly end-stage kidney disease (ESKD) patients. However, whether preexisting mental health disorders increase the risk of ESKD is not well understood. The risk of incident ESKD in patients with or without underlying AD or DD was evaluated in a nationwide cohort of elderly people in Republic of Korea. Methods: This study used data from the National Health Insurance Service-Senior cohort in Republic of Korea. Among the 558,147 total subjects, 49,634 and 54,231 were diagnosed with AD (AD group) or DD (DD group), respectively, during the follow-up period. Propensity score matching was conducted to create non-AD and non-DD groups of subjects. AD and DD diagnoses were analyzed as time-varying exposures, and the study outcome was development of ESKD. Results: The incidence rates of ESKD were 0.36 and 1.17 per 1,000 person-years in the non-AD and AD groups, respectively. After adjustment for clinical variables and competing risks of death, the risk of incident ESKD was higher in the AD group than in the nonAD group (hazard ratio [HR], 1.67; 95% confidence interval [CI], 1.34–2.08). The incidence rates of ESKD in the non-DD and DD groups were 0.36 and 0.91 per 1,000 person-years, respectively. The risk of ESKD development was also higher in the DD group than the non-DD group (HR, 1.44; 95% CI, 1.19–1.76). Conclusion: The risk of ESKD development was higher in subjects diagnosed with AD or DD, suggesting that central nervous system diseases can adversely affect kidney function in elderly people.

Treatment of Ankle Fracture and Dislocation

Ankle fractures are the most common type of foot and ankle fracture injury. Several types of fractures occur in the ankle structures (medial malleolus, lateral malleolus, posterior malleolus, and Chaput’s tubercle) with various mechanisms and extent of fracture force. Moreover, fractures can be accompanied by other injuries, such as distal tibiofibular syndesmotic injury, medial deltoid ligament rupture, and lateral ligament complex rupture. Ankle dislocation can be accompanied when an injury is caused by a greater fracture force. Non-surgical treatments or combined surgeries may be performed depending on the mechanism and fracture type. Generally, a stable fracture maintaining anatomical reduction is treated conservatively, but surgical treatment is performed when this is not the case. Furthermore, surgeries for stable fractures can be offered when the patients demand early weight bearing due to their occupation, age, and performance state. Restoring the ankle mortise in its anatomical shape before the injury and starting early rehabilitation for functional recovery simultaneously until a union is achieved is important. Traumatic arthritis can occur if the treatment focuses only on fractures and neglects ligament injuries, such as distal tibiofibular syndesmotic injury and medial deltoid ligament rupture. Shortening, angular deformation, and rotational deformation of the fibular promote the progression of traumatic ankle arthritis in the long term, which may further cause chronic ankle pain. An overlooked displaced posterior malleolus fracture also causes traumatic arthritis through anteroposterior instability of the ankle joint.

Clinical and Radiological Outcomes of ‘Blocking Kirschner Wire Technique’ in Displaced Intra-Articular Calcaneal Fractures via the Extended Sinus Tarsi Approach / 대한정형외과학회잡지

Purpose@#The purpose of this study was to retrospectively evaluate the effect of ‘Blocking Kirschner Wire (K-Wire) Technique’, which has been developed to reduce protrusion of the lateral wall, in maintaining the level of reduction through clinical and radiological outcomes. @*Materials and Methods@#Twenty-two patients with displaced intra-articular calcaneal fractures who used the blocking K-wire to maintain reduction (group A) and 44 patients that did not use blocking K-wire and were paired in 1:2 ratio with those Group A patients (group B), between January 2015 and December 2017 were enrolled in the study. All surgical procedures were performed via the extended sinus tarsi approach, and internal fixation using cannulated screws, Steinmann pins and K-wires was performed. American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scale and postoperative recovery of exercise ability were compared for postoperative clinical outcomes.The radiological results were compared the Böhler angle, Gissane angle, calcaneal height and width, step off of posterior calcaneal joint, and the degree of protrusion of the lateral wall. Moreover, postoperative complications in both groups were compared. @*Results@#There were no significant differences in the clinical outcomes of the two groups (p=0.924, p=0.961). The amount of Böhler angle, Gissane angle, calcaneal height and width, and step off of posterior calcaneal joint from the radiological results was not significantly different between the two groups (p=0.170, p=0.441, p=0.230, p=0.266, and p=0.400). However, the degree of protrusion of the lateral wall was 1.78 mm and 4.95 mm in group A and group B, respectively, and the difference between the two groups was significant (p=0.017). Although sural nerve entrapment and painful exostosis were more frequent in group B, they were occurred in a non-significant manner (p=0.293, p=0.655). @*Conclusion@#Most of the clinical and radiological results as well as the complications were not significantly different between the two groups. However, the degree of protrusion of the calcaneus lateral wall in group A was promising. The ‘Blocking K-Wires Technique’ established by the authors may be an effective surgical option for maintaining the reduction of the lateral wall protrusion in displaced intraarticular calcaneal fractures.

Lomens-P0 (mixed extracts of Hordeum vulgare and Chrysanthemum zawadskii) regulate the expression of factors affecting premenstrual syndrome symptoms

BACKGROUND/OBJECTIVES@#Premenstrual syndrome (PMS) is a disorder characterized by repeated emotional, behavioral, and physical symptoms before menstruation, and the exact cause and mechanism are uncertain. Hyperprolactinemia interferes with the normal production of estrogen and progesterone, leading to PMS symptoms. Thus, we judged that the inhibition of prolactin hypersecretion could mitigate PMS symptoms.MATERIALS/METHODS: Hordeum vulgare L. extract (HVE), Chrysanthemum zawadskii var. latilobum extract (CZE), and Lomens-P0 the mixture of these extracts were tested in subsequent experiments. The effect of extracts on prolactin secretion at the in vitro level was measured in GH3 cells. Nitric oxide and pro-inflammatory mediator expression were measured in RAW 264.7 cells to confirm the anti-inflammatory effect. Also, the hyperprolactinemic Institute for Cancer Research (ICR) mice model was used to measure extract effects on prolactin and hormone secretion and uterine inflammation. @*RESULTS@#Anti-inflammatory effects of and prolactin secretion suppress by HVE and CZE were confirmed through in vitro experiments (P < 0.05). Treatment with Lomens-P0 inhibited prolactin secretion (P < 0.05) and restored normal sex hormone secretion in the hyperprolactinemia mice model. In addition, extracts significantly inhibited the expression of pro-inflammatory biomarkers, including interleukin-1β, and -6, tumor necrosis factor-α, inducible nitric oxide synthase, and cyclooxygenase-2 (P < 0.01). We used high-performance liquid chromatography analyses to identify tricin and chlorogenic acid as the respective components of HVE and CZE that inhibit prolactin secretion. The Lomens-P0, which includes tricin and chlorogenic acid, is expected to be effective in improving PMS symptoms in the human body. @*CONCLUSIONS@#The Lomens-P0 suppressed the prolactin secretion in hyperprolactinemia mice, normalized the sex hormone imbalance, and significantly suppressed the expression of inflammatory markers in uterine tissue. This study suggests that Lomens-P0 may have the potential to prevent or remedy materials to PMS symptoms.

Reduction in proteinuria after immunosuppressive therapy and long-term kidney outcomes in patients with immunoglobulin A nephropathy

Background/Aims@#Despite controversy regarding the benefits of immunosuppressive therapy in immunoglobulin A nephropathy (IgAN), clinical outcomes may vary depending on the patient’s responsiveness to this therapy. This study evaluated long-term kidney outcomes according to the extent of proteinuria reduction after immunosuppression in IgAN patients. @*Methods@#Among 927 patients with biopsy-proven IgAN, 127 patients underwent immunosuppression. Time-averaged urine protein-creatinine ratio before and within 1 year after start of immunosuppression were calculated, and responsiveness to immunosuppression was assessed as the reduction of proteinuria between the two periods. Patients were classified into tertiles according to the extent of proteinuria reduction. We compared the slopes of estimated glomerular filtration rate (eGFR) decline using a linear mixed model, and estimated hazard ratios (HRs) for disease progression (defined as development of a ≥ 30% decline in eGFR or end-stage renal disease) using a Cox proportional hazard model. @*Results@#Median extent of proteinuria reduction was –2.1, –0.9, and –0.2 g/gCr in the first, second, and third tertiles, respectively. There were concomitant changes in the slopes of annual eGFR decline: –2.03, –2.44, and –4.62 mL/min/1.73 m2 among the first, second, and third tertiles, respectively. In multivariable Cox analysis, the HRs (95% confidence intervals) for disease progression were 0.30 (0.12 to 0.74) in the first tertile and 0.70 (0.34 to 1.45) in the second tertile compared with the thirdtertile. @*Conclusions@#This study showed that greater proteinuria reduction after immunosuppression was associated with a lower risk of disease progression in patients with IgAN, suggesting that responsiveness to immunosuppression may be an important determinant of kidney outcomes.

Reduction in proteinuria after immunosuppressive therapy and long-term kidney outcomes in patients with immunoglobulin A nephropathy

Background/Aims@#Despite controversy regarding the benefits of immunosuppressive therapy in immunoglobulin A nephropathy (IgAN), clinical outcomes may vary depending on the patient’s responsiveness to this therapy. This study evaluated long-term kidney outcomes according to the extent of proteinuria reduction after immunosuppression in IgAN patients. @*Methods@#Among 927 patients with biopsy-proven IgAN, 127 patients underwent immunosuppression. Time-averaged urine protein-creatinine ratio before and within 1 year after start of immunosuppression were calculated, and responsiveness to immunosuppression was assessed as the reduction of proteinuria between the two periods. Patients were classified into tertiles according to the extent of proteinuria reduction. We compared the slopes of estimated glomerular filtration rate (eGFR) decline using a linear mixed model, and estimated hazard ratios (HRs) for disease progression (defined as development of a ≥ 30% decline in eGFR or end-stage renal disease) using a Cox proportional hazard model. @*Results@#Median extent of proteinuria reduction was –2.1, –0.9, and –0.2 g/gCr in the first, second, and third tertiles, respectively. There were concomitant changes in the slopes of annual eGFR decline: –2.03, –2.44, and –4.62 mL/min/1.73 m2 among the first, second, and third tertiles, respectively. In multivariable Cox analysis, the HRs (95% confidence intervals) for disease progression were 0.30 (0.12 to 0.74) in the first tertile and 0.70 (0.34 to 1.45) in the second tertile compared with the thirdtertile. @*Conclusions@#This study showed that greater proteinuria reduction after immunosuppression was associated with a lower risk of disease progression in patients with IgAN, suggesting that responsiveness to immunosuppression may be an important determinant of kidney outcomes.

Midterm-clinical Outcomes after Hip Arthroscopy in Middle-aged Patients with Early Osteoarthritis / 대한고관절학회지

PURPOSE: Although the number of hip arthroscopies is rapidly increasing in non-elderly patients, outcomes of this procedure in middle-aged patients are not well documented or clearly understood. The purpose of this study was to evaluate the clinical and radiological outcomes after hip arthroscopy in middle-aged patients with early osteoarthritis.MATERIALS AND METHODS: This retrospective study analyzed 189 patients with early osteoarthritis of various diagnoses aged 40 years or older who underwent hip arthroscopy between January 2010 and December 2015. Clinical (e.g., modified Harris hip score [mHHS], hip outcome score-activities of daily living [HOS-ADL], visual analogue scale [VAS] for pain, range of motion) and radiological (change of Tönnis grade) outcomes were assessed at a minimum of 3-year follow-up.RESULTS: The mean preoperative and final mHHS and HOS-ADL improved from 61.2 and 60.6 to 79.5 and 81.8, respectively, while the VAS pain score decreased from 6.3 to 3.2 (P<0.001). Although the mean range of internal rotation and flexion increased from 14.2 and 100.7° preoperatively to 30.4 and 110.6° at 1-year postoperatively, they decreased slightly to 27.4 and 105.4° at the final follow-up, respectively. Eight cases (4.2%) underwent revision arthroscopic surgery and three cases (1.6%) were converted to total hip arthroplasty.CONCLUSION: Patients with early-stage osteoarthritis of various diagnoses achieved improved clinical outcomes. Therefore, using hip arthroscopy in middle-aged patients with early osteoarthritis, it is possible to achieve good surgical options.

Medication Use Evaluation of Denosumab in Postmenopausal Women with Osteoporosis or Osteopenia

Background@#The indication of denosumab for osteoporosis was expanded from second-line to first-line therapy in 2019. The aim of this study was to evaluate the efficacy of denosumab as both first- and second-line therapy in postmenopausal women with osteoporosis and osteopenia with risk factors by using the Fracture Risk Assessment Tool (FRAX). @*Methods@#We conducted a medication use evaluation of denosumab in 98 patients who had been treated three or more times for osteoporosis or osteopenia at Chungnam National University Hospital from July 1st , 2017 to January 31st , 2020. Risk factors were identified using quantitative Ngram analyses of FRAX estimations. Patient information, including menopause status and results of bone mineral density tests (Tscore), was obtained from electronic medical records. @*Results@#Age, body mass index (BMI), prior medication use, and T-score were identified as risk factors and were included as variables in the evaluation of denosumab use. Since no significant differences were detected between groups, denosumab is likely effective regardless of age or BMI. In addition, no significant difference was detected in T-scores following denosumab treatment, between groups who took bisphosphonates and selective estrogen receptor modulators (SERMs) with denosumab as first-line therapy for postmenopausal osteoporosis. Denosumab may, therefore, be effective as second-line therapy. @*Conclusion@#Efficacy of denosumab was evaluated in postmenopausal women with osteoporosis.Denosumab may be used as first- and second-line therapy regardless of age, BMI, and prior use of bisphosphonates and SERMs.

Centella asiatica extract prevents visual impairment by promoting the production of rhodopsin in the retina

BACKGROUND@#/OBJECTIVE: Centella asiatica, also known as Gotu kola, is a tropical medicinal plant native to Madagascar, Southeast Asia, and South Africa. It is well known to have biological activities, including wound healing, anti-inflammatory, antidiabetic, cytotoxic, and antioxidant effects. The purpose of this study was to determine the efficacy of extracts of C. asiatica against age-related eye degeneration and to examine their physiological activities.MATERIALS/METHODS: To determine the effects of CA-HE50 (C. asiatica 50% EtOH extract) on retinal pigment cells, we assessed the cytotoxicity of CoCl2 and oxidized-A2E in ARPE- 19 cells and observed the protective effects of CA-HE50 against N-methyl-N-nitrosourea (MNU)-induced retinal damage in C57BL/6 mice. In particular, we measured factors related to apoptosis and anti-oxidation and the protein levels of rhodopsin/opsin. We also measured glucose uptake to characterize glucose metabolism, a major factor in cell protection. @*RESULTS@#Induction of cytotoxicity with CoCl2 and oxidized-A2E inhibited decreases in the viability of ARPE-19 cells when CA-HE50 was administered, and promoted glucose uptake under normal conditions (P < 0.05). In addition, CA-HE50 inhibited degeneration/apoptosis of the retina in the context of MNU-induced toxicity (P < 0.05). In particular, CA-HE50 at 200 mg/kg inhibited the cleavage of pro-caspase-3 and pro-poly (ADP-ribose)-polymerase and maintained the expressions of nuclear factor erythroid 2-related factor 2 and heme oxygenase-1 similar to normal control levels. Rhodopsin/opsin expression was maintained at a higher level than in normal controls. @*CONCLUSION@#A series of experiments confirmed that CA-HE50 was effective for inhibiting or preventing age-related eye damage/degeneration. Based on these results, we believe it is worthwhile to develop drugs or functional foods related to age-related eye degeneration using CA-HE50.

Medication Use Evaluation of Denosumab in Postmenopausal Women with Osteoporosis or Osteopenia

Background@#The indication of denosumab for osteoporosis was expanded from second-line to first-line therapy in 2019. The aim of this study was to evaluate the efficacy of denosumab as both first- and second-line therapy in postmenopausal women with osteoporosis and osteopenia with risk factors by using the Fracture Risk Assessment Tool (FRAX). @*Methods@#We conducted a medication use evaluation of denosumab in 98 patients who had been treated three or more times for osteoporosis or osteopenia at Chungnam National University Hospital from July 1st , 2017 to January 31st , 2020. Risk factors were identified using quantitative Ngram analyses of FRAX estimations. Patient information, including menopause status and results of bone mineral density tests (Tscore), was obtained from electronic medical records. @*Results@#Age, body mass index (BMI), prior medication use, and T-score were identified as risk factors and were included as variables in the evaluation of denosumab use. Since no significant differences were detected between groups, denosumab is likely effective regardless of age or BMI. In addition, no significant difference was detected in T-scores following denosumab treatment, between groups who took bisphosphonates and selective estrogen receptor modulators (SERMs) with denosumab as first-line therapy for postmenopausal osteoporosis. Denosumab may, therefore, be effective as second-line therapy. @*Conclusion@#Efficacy of denosumab was evaluated in postmenopausal women with osteoporosis.Denosumab may be used as first- and second-line therapy regardless of age, BMI, and prior use of bisphosphonates and SERMs.

Stiff-Person Syndrome: Diagnostic Difficulty / 대한족부족관절학회지

Stiff-person syndrome is a rare disorder, and the natural history of the syndrome has not been completely ascertained. The symptoms range from mild to severe and can progress over time: the final result can be significant disability. However, this syndrome is often misdiagnosed due to a lack of understanding of the clinical manifestations. We report the case of a patient who presented with slowly progressing gait disturbance and lower extremity pain and was later diagnosed as suffering from stiff-person syndrome. The patient experienced symptomatic improvement after the administration of benzodiazepines. No recurrence of symptoms has been reported. If the characteristic clinical features and electromyography findings of the syndrome are accurately interpreted, diagnosis of patients with abnormal muscle tension can be effectively done.

Arthroscopic Treatment for Femoroacetabular Impingement with Extraspinal Diffuse Idiopathic Skeletal Hyperostosis

BACKGROUND: Patients with extraspinal diffuse idiopathic skeletal hyperostosis (DISH) involving the hip joint have symptoms like femoroacetabular impingement (FAI). To date, no reported study has determined the clinical outcomes of arthroscopic treatment in extraspinal DISH involving the hip joint. METHODS: A total of 421 hips with FAI that underwent arthroscopic treatment were reviewed retrospectively. We determined the extraspinal involvement of DISH with three-dimensional computed tomography (3D-CT) and simple radiography of the pelvis and hip joint. Clinical outcomes were evaluated at a minimum of 2 years postoperatively. The visual analog scale score (VAS), modified Harris hip score (MHHS), and hip outcome score–activity of daily living scale (HOS-ADL) were used, and hip range of motion (ROM) was evaluated pre- and postoperatively and at the time of the final follow-up. RESULTS: Among the 421 hips (372 patients) with FAI that underwent arthroscopic treatment, 17 hips (12 patients, 4.04%) had extraspinal DISH on the hip joints. The mean age of the patients was 51.5 years. The 3D-CT scans and simple radiographs showed extraspinal DISH on multiple points around the pelvis and hip joint. Nine of the 17 hips (seven of 12 patients) had spinal DISH. At the final follow-up, VAS, MHHS, and HOS-ADL improved significantly from 6.5, 65.3, and 66.6, respectively, to 1.2, 87.8, and 89.5, respectively, and hip flexion and internal rotation improved significantly from 97.7° and 7.9°, respectively, to 117.1° and 18.2°, respectively. CONCLUSIONS: This study has demonstrated that extraspinal DISH involving the hip joint could lead to FAI, and arthroscopic treatment could result in relief of symptoms, including pain and ROM limitation, in extraspinal DISH patients.

Surgical Outcomes of the Reinforcing Technique of a Weakened Medial Capsule in Severe Hallux Valgus Using Internal Brace / 대한족부족관절학회지

PURPOSE@#This study evaluated the clinical and radiological results after reinforcement of the weakened medial joint capsule using Internal Brace (Arthrex) for treating severe hallux valgus.@*MATERIALS AND METHODS@#This study reviewed 56 cases of 50 patients that were followed-up postoperatively for at least 12 months, from September 2017 until August 2018. An extended distal chevron osteotomy combined with a distal soft-tissue release was performed by a single surgeon to treat severe hallux valgus. Internal Brace was applied in 12 cases (group A) who had weakened medial joint capsules, and capsulorrhaphy was performed in 44 cases (group B), and these two groups were compared postoperatively for the clinical and radiological results. The postoperative complications were also investigated.@*RESULTS@#No significant differences at 1-year follow-up on the Manchester-Oxford Foot Questionnaire and the patients' satisfaction scores were found between the two groups (p=0.905 and p=0.668, respectively). For the radiology, the changes of the values between before surgery and at 1-year follow-up according to the group showed no significant differences in the hallux valgus angle, intermetatarsal angle, and the hallux interphalangeal angle (p=0.986, p=0.516, p=0.754, respectively). Recurrence of hallux valgus was reported in two cases in group A, and in three cases in group B. Transfer metatarsalgia occurred in 4 cases in group B.@*CONCLUSION@#Based on these results, we recommend the capsule reinforcing technique using Internal Brace as a successful operative option for treating a weakened medial capsule in patients with severe hallux valgus.

Associations Among Plasma Stress Markers and Symptoms of Anxiety and Depression in Patients with Breast Cancer Following Surgery

OBJECTIVE: The objective of present study is to analyze the prevalence of depression and anxiety following breast cancer surgery and to assess the factors that affect postoperative psychological symptoms. METHODS: The Hamilton Rating Scale for Depression (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), Body Image Scale (BIS), and Rosenberg Self Esteem Scale (RSES) were used to assess the psychological states of patients who had been diagnosed with and had undergone surgery for breast cancer. Blood concentrations of the stress markers adrenocorticotropic hormone, cortisol, arginine-vasopressin, and angiotensin-converting enzyme were measured. Pearson’s correlation analysis and multilinear regression analysis were used to analyse the data. RESULTS: At least mild depressive symptoms were noted in 50.5% of patients, while 42.4% of patients exhibited at least mild anxiety symptoms. HAM-D score was positively correlated with HAM-A (r=0.83, p < 0.001) and BIS (r=0.29, p < 0.001) scores and negatively correlated with RSES score (r=-0.41, p < 0.001). HAM-A score was positively correlated with BIS score (r=0.32, p < 0.001) and negatively correlated with RSES score (r=-0.27, p < 0.001). There were no statistically significant associations between stress markers and depression/anxiety. CONCLUSION: Patients with breast cancer frequently exhibit postoperative depression and anxiety, which are related to low levels of self-esteem and distorted body image.

Vertebral Body Fracture after Oblique Lumbar Interbody Fusion in 2 Patients: A Case Report

STUDY DESIGN: Although the frequency of the oblique lumbar interbody fusion (OLIF) procedure has increased in recent years, reports on its complications remain rare. We report 2 cases of vertebral fracture after OLIF. OBJECTIVES: We aimed to report 2 cases of coronal vertebral fracture after an OLIF procedure in non-osteoporotic patients without significant trauma, and to review the complications of OLIF. SUMMARY OF LITERATURE REVIEW: There is a growing but limited literature describing early postoperative complications after OLIF. MATERIALS AND METHODS: Patient 1 was an obese woman who underwent 2-level OLIF with posterior instrumentation procedures and subsequently experienced 2-level coronal plane fractures. Patient 2 was an elderly man who underwent 3-level OLIF without posterior instrumentation and experienced 1 coronal vertebral fracture. We report vertebral body fracture as a complication of OLIF through these 2 cases. RESULTS: Patient 1 was treated nonsurgically after the fractures. The fractures healed uneventfully. However, patient 2 underwent posterior instrumented fusion and had a solid bridging bone above and below the fracture. Factors potentially contributing to these fractures are discussed. CONCLUSIONS: OLIF is an effective procedure for several spinal diseases. However, fracture can occur after OLIF even in non-osteoporotic patients. Factors such as intraoperative end-plate breach, subsidence, cage rolling, and inadequate posterior instrumentation could contribute to the development of fractures after oblique interbody fusion.

Ultrasound-Guided Regional Nerve Block in Below-Knee Amputation / 대한정형외과학회잡지

PURPOSE: This study compared the clinical results of an ultrasound (US)-guided regional nerve block with those of general anesthesia in below-knee amputation (BKA) surgery. In addition, the 1-year mortality rate of BKA patients was evaluated in relation to the preoperative comorbidity and postoperative hemoglobin level. MATERIALS AND METHODS: Among 47 patients who underwent BKA between January 2011 and August 2016, 18 patients in the US-guided regional nerve block group (group 1) and 29 patients in the general anesthesia group (group 2) were analyzed retrospectively and compared. For the clinical assessment, the 30-day mortality, 1-year mortality, postoperative hemoglobin level, and postoperative complications of both groups were investigated. The visual analogue scale (VAS) pain scores at postoperative 1, 6, and 12 hours for both groups were evaluated. The 1-year mortality of BKA patients was also evaluated in relation to the preoperative comorbidity and postoperative hemoglobin level (hemoglobin < 7 g/dl). RESULTS: Significant differences in the 30-day mortality were observed between the two groups (p=0.023). Group 1 showed a higher 30-day mortality but the 1-year mortality was similar in both groups (p=0.051). The postoperative hemoglobin level was similar in the two groups (p=0.085). The VAS pain scores for the postoperative 1-hour and 6-hour differed significantly between the two groups (p < 0.001). The VAS pain scores for postoperative 12-hour showed no significant difference (p=0.10). The 1-year mortality rate of both groups was not affected by hypertension, diabetes mellitus, arteriosclerosis obliterans, and postoperative hemoglobin less than 7 g/dl, but was affected by chronic kidney disease (CKD) (Pearson's chi-square=14.39, p < 0.05). CONCLUSION: Although US-guided regional nerve block showed comparable 1-year mortality and postoperative hemoglobin levels compared to general anesthesia in BKA, it showed better results in postoperative 1, 6 hour pain control than general anesthesia. The 1-year mortality of BKA was affected by CKD. Therefore, careful consideration is needed for patients with CKD before undergoing BKA regardless of the anesthetic methods.

Efficacy of a Knee Walker for Foot and Ankle Patients: Comparative Study with an Axillary Crutch / 대한족부족관절학회지

PURPOSE: An axillary crutch is the most commonly used assistive device in foot and ankle patients who require nonweightbearing. On the other hand, its use frequently induces axillary or wrist pain and critical neurovascular injuries have been reported in several studies. This study compared the clinical outcomes of patients using the knee walker and axillary crutch. MATERIALS AND METHODS: A retrospective analysis was performed comparing the utility of a knee walker and axillary crutch as a nonweightbearing ambulatory aid for 62 foot and ankle patients treated between November 2016 and March 2018. A comparative study of the two orthosis could be performed because all the patients temporarily used an axillary crutch before or after the use of a knee walker. A demographic study and comparative analysis based on the visual analogue scale (VAS) satisfaction score (0~100), complications, and fall down history were evaluated. Furthermore, under the assumption of having retreatment, their preference of orthosis between the knee walker and axillary crutch was investigated. RESULTS: The mean age of the patients was 36.5 and the mean duration of ambulation with a knee walker and axillary crutch were 5.2 and 2.4 weeks. The VAS satisfaction score of the knee walker and crutch was 88.8 and 27.5, respectively (p < 0.05). The most frequent complications of the knee walker and crutch were ipsilateral knee pain (6 cases) and axillary or wrist pain (56 cases), respectively. No case of falling down occurred during knee walker ambulation, but there were two cases of crutch ambulation. Fifty-eight patients (93.5%) preferred the knee walker and four patients (6.5%) preferred a crutch. CONCLUSION: Compared to the axillary crutch, the knee walker afforded lower complication and higher satisfaction. Most patients preferred the knee walker to a crutch. Therefore, the knee walker is an efficient and safe orthosis for foot and ankle patients who require nonweightbearing.

Radiological and Clinical Effectiveness of a Novel Calcaneal Fracture Brace after Intra-articular Calcaneal Fracture Surgery

BACKGROUND: After calcaneal fracture surgery, a short leg splint and cast are typically applied. However, these restrict joint exercises, which is inconvenient for patients. In addition, there is a risk of complications, such as pressure ulcers or nerve paralysis with a short leg cast. In this study, we evaluated clinical and radiological outcomes of the use of a specially designed calcaneal brace after calcaneal fracture surgery. METHODS: From among patients who underwent open reduction and internal fixation for calcaneal fracture between July 9, 2013 and May 31, 2017, 102 patients who wore a calcaneal fracture brace (group A) and 82 patients who wore a postoperative short leg cast (group B) were randomly chosen for this study. Radiological changes and clinical factors were compared between the two groups. After swelling at the surgical site decreased, a special calcaneal brace was applied to patients in group A. They were allowed to perform early weight bearing and joint motion. Patients in group B were immobilized in a short leg cast and were told to avoid weight bearing for 6 weeks. In each group, the Böhler's angle and Gissane's angle were measured and compared using postoperative and final follow-up radiographs. Pain (measured using a visual analogue scale [VAS]) and ankle joint range of motion (dorsiflexion, plantar flexion, eversion, and inversion) were measured serially until the final follow-up visit. RESULTS: There were no significant differences in the Böhler's angle or Gissane's angle between the two groups as measured postoperatively and at the final follow-up (paired t-test). Differences in the VAS pain score and eversion were also statistically nonsignificant between the two groups. However, group A had a significantly higher range of dorsiflexion (p = 0.021), plantar flexion (p = 0.012), and inversion (p = 0.045) of the ankle than group B (independent t-test). CONCLUSIONS: Application of the calcaneal fracture brace after open reduction and internal fixation of a calcaneal fracture not only maintained the fracture reduction but allowed for greater joint motion than the short leg cast. Thus, the calcaneal fracture brace can be considered an effective postoperative management option that enables early resumption of daily activities and facilitates postoperative joint motion.

The Efficacy of Different Ropivacaine Concentrations (0.5%, 0.6%, vs . 0.75%) for Regional Nerve Block in Lower Extremity: A Prospective Randomized Controlled Trial / 대한정형외과학회잡지

PURPOSE: There have only been a few studies on optimal usage of injection material in the regional nerve block for lower extremity operations. The purpose of this study was to evaluate the efficacy of different concentrations of ropivacaine. MATERIALS AND METHODS: A total of 339 patients underwent lower extremity surgery under ultrasound-guided nerve block (combined femoral and sciatic nerve block) at a Chungnam National University Hospital between March 2016 and February 2017 and were randomly assigned to three groups: Group A (0.5%, 44 ml), group B (0.6%, 30 ml), and group C (0.75%, 30 ml). The interval between nerve block procedure and onset of the complete anesthetic effect (complete anesthetic time) was investigated. The degrees of intraoperative pain, and postoperative pain were evaluated using a visual analogue scale (VAS) score. Patient's satisfaction (0–10) was investigated. To evaluate the efficacy in accordance with the concentration under the same dose and same volume, group A and B were compared with group C respectively. RESULTS: There were 108, 118, and 113, in groups A, B, and C, respectively; and there were no significant differences with respect to the number, age, sex, and type of operation (p>0.05). The mean complete anesthetic times were 78.5, 76.4, and 58.6 minutes, respectively. The mean intraoperative VAS scores were 2.04, 0.62, and 0.24; and the mean postoperative VAS scores (6 hours/12 hours) were 2.41/4.08, 0.27/1.24, and 0.38/1.54. The mean patient's satisfactory scores were 8.53, 9.38, and 9.40, respectively. Compared with group C, group A showed significantly longer complete anesthetic time (p 0.05). Patient's satisfactory scores in both group A and B were similar to group C (p>0.05, p>0.05). There were no specific adverse reactions in all groups. CONCLUSION: Ropivacaine 0.6% as well as 0.75% are safe and effective anesthetics under the same volume (30 ml) for regional nerve block of the lower extremity. However, taking into account of the longer complete anesthetic time, the operation start time must be adjusted.

Intraoperative Ultrasound-Guided Percutaneous Repair of a Ruptured Achilles Tendon: A Comparative Study with Open Repair / 대한정형외과학회잡지

PURPOSE: To compare the clinical outcomes of ultrasound-guided percutaneous repair (USPR) and open repair in a ruptured Achilles tendon. MATERIALS AND METHODS: The outcomes of 12 patients with USPR (group A) and 18 patients with open repair (group B) from January 2015 to February 2017 were analyzed retrospectively. The postoperative clinical evaluations were performed using the Arner-Lindholm scale, American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Achilles tendon total rupture score (ATRS), and visual analogue scale for the overall satisfaction and cosmetic satisfaction with the scar, and the starting time of single heel raises. The complications were also evaluated. RESULTS: The Arner-Lindholm scale, AOFAS ankle-hindfoot score, ATRS, starting time of single heel raises were similar in both groups (all p>0.05). Group A showed a significantly higher overall patient's satisfaction and cosmetic satisfaction in than group B (all p < 0.05). Two cases of Achilles tendon elongation were encountered in group A, and 1 case of re-rupture with deep infection and 1 case of superficial infection were experienced in group B. CONCLUSION: USPR showed good clinical outcomes and high satisfaction as well as a low rate of complications, such as sural nerve injury. Therefore, USPR can be considered as an effective surgical treatment option for Achilles tendon ruptures.