Changes in Tip-Apex Distance by Position and Film Distance Measured by Picture Archiving and Communication System (PACS) / 대한고관절학회지

PURPOSE: The tip-apex distance (TAD) is used to predict the clinical outcome of intertrochanteric fracture fixation. We aimed to measure the changes in TAD by position and film distance using Picture Archiving and Communication System (PACS). MATERIALS AND METHODS: We used a femur replica with a 10degrees femoral neck anteversion and a 130degrees neck shaft angle. Proximal femoral nail antirotation nail and a helical blade were inserted into the replica. Radiographs were taken at the neutral position and after applying 10degrees, 20degrees, 30degrees, 40degrees internal/external rotation, 10degrees abduction, and 10degrees and 40degrees adduction to the mechanical axis. Radiographs were taken at the replica-film distance of 10 cm and 20 cm under the same conditions, mimicking the differences in Focus-film distance (FFD), which reflect the patient's contour in clinical settings. A radiologist and an orthopedic surgeon measured the TAD twice using PACS. The average error was 2 mm (4.5%) and the standard error was +/-3.04. TADs in the neutral position constituted the standard values to measure the relative errors. RESULTS: TADs increased with an increase in the external rotation and abduction of the replica. TADs decreased with an increase in the internal rotation and adduction of the replica. For comparable measurements, relative errors were higher at FFDs of 20 cm compared to FFDs of 10 cm. CONCLUSION: Since the femur is internally rotated and adducted for reduction, orthopedic surgeons would assess the lag screw to be closer to the apex of femur on intraoperative radiographs. To have a correct measurement of the TAD after fixation of intertrochanteric fractures, radiographs should be taken in neutral position and measurement errors should be considered based on the patient's size.

The Analysis of the Outcome of Short- and Long-Segment Posterior Instrumentation for Thoracolumbar Bursting Fractures

STUDY DESIGN: A retrospective study. SUMMARY OF THE LITERATURE REVIEW: The reports comparing short- and long-segment instrumentation are insufficient. OBJECTIVES: To determine the postoperative results and to analyze relative factors affecting results between short- and long-segment instrumentation in thoracolumbar fractures. MATERIALS AND METHODS: From March 2006 to March 2012, 97 patients with thoracolumbar fracture were treated with posterior instrumentation. They were divided into 2 groups, the short- (Group I) and long-segment groups (Group II). To analyze factors affecting results, several factors including age, anterior column height (ACH), and the kyphotic angle were reviewed. For radiologic evaluation, postoperative and follow-up radiographs were evaluated by measuring the kyphotic angle and ACH. Additionally, the presence of complications was reviewed. RESULTS: Groups I and II consisted of 45, 52 cases and had mean ages of 50.3, 55.8 years, respectively. In Group I, the ACH increased from 44.2% to 75.3% postoperatively, and remained 72.8% at follow-up. The kyphotic angle decreased from 19.4degrees to 10.6degrees postoperatively, and remained at 12.8degrees at follow-up. In Group II, the ACH recovered from 41.6% to 76.4% postoperatively, and was 74.8% at follow-up. The kyphotic angle decreased from 21.6degrees to 12.6degrees postoperatively, and was 13.9degrees at follow-up. The canal compromise, age, and comminution were not directly related with results. However, the mean age of the 7 cases showing complications was 72 years, and the 7 cases had severe comminuted fractures. CONCLUSIONS: The short- and long-segment instrumentations of thoracolumbar fractures are not significantly different with respect to the results attained. However, in order to decrease complications, we should pay attention to age and fracture comminution.

Emergency Residents' Current Status and Preferences for Shift Work During Extra-regular Working Time in Korea

BACKGROUND: The workload of emergency medicine residents (EMRs) is expected to be high. Especially, and working during extra-regular working time (ERT) provides them with great stress. In spite of this, their workload and preference for shift work during ERT has not been studied in Korea. METHOD: The postal survey was sent to the EMRs of training hospitals. The survey consisted of 10 questions which assessed their shift lengths, shift-length preferences, degree of fatigue after night shift, allowance for an ERT shift and so on. The analysis was done using the SPSS Win program. RESULT: Surveys were sent to 240 EMRs and eighty-two (82) EMRs responded. Most of them (85.4%) had more than 10 night shifts per month. The most common shift lengths were 12 hours (53.7%) and 24 hours (23.2%), and the most preferred shift length was 12 hours (50.0%). More than half of the EMRs felt very tired after night shifts. The desired allowance for an ERT night shift was 2.1 times on Saturday, 2.5 times on Sunday, and 3.6 times on holiday, compared to that for a weekday night shift. CONCLUSION: The current workload of an EMR is very high. The desire from ERT shift is low, so appropriate strategies should be sought to compensate the ERT workload.