Perinatal Outcomes According to Accessibility to Maternal-Fetal and Neonatal Intensive Care Units by Region in Korea

Background@#Herein, we aimed to evaluate the maternal mortality ratio and perinatal mortality rate for different perinatal medical care service areas (PMCSAs), which were established by considering their geographical accessibility to maternal-fetal intensive care units (MFICUs) and neonatal intensive care units (NICUs), and to compare the PMCSAs according to their accessibility to these perinatal care services. @*Methods@#Based on the 70 hospital service areas (HSAs) across the country confirmed through the Dartmouth Atlas methodology analysis and gathering of expert opinions, the PMCSAs were designated by merging HSAs without MFICUs and NICUs to the nearest HSA that contained MFICUs and NICUs, based on which MFICU and NICU could be reached within the shortest amount of time from population-weighted centroids in HSAs. PMCSAs where 30% or more of the population could not access MFICUs and NICUs within 60 minutes were identified using the service module ArcGIS and were defined as having access vulnerability. @*Results@#Thirty-three of 70 HSAs in the country did not contain MFICUs and NICUs, and 39 PMCSAs were finally derived by merging 70 HSAs. Ten of 39 PMCSAs (25.6%) were classified as having access vulnerability to MFICUs and NICUs. The national maternal mortality ratio was 9.42, with the highest ratio seen in the region of Wonju (25.86) and the lowest in Goyang (2.79). The national perinatal mortality rate was 2.86, with the highest and lowest rates observed in the Gunsan (4.04) and Sejong (1.99) regions, respectively. The perinatal mortality rates for areas vulnerable and invulnerable to maternal and neonatal healthcare accessibility were 2.97 and 2.92, respectively, but there was no statistically significant difference in this rate (P = 0.789). The maternal mortality ratio for areas vulnerable and invulnerable to maternal and neonatal healthcare accessibility were 14.28 and 9.48, respectively; this ratio was significantly higher in areas vulnerable to accessibility (P = 0.022). @*Conclusion@#Of the PMCSAs across the country, 25.6% (10/39) were deemed to be vulnerable to MFICU and NICU accessibility. There was no difference in the perinatal mortality rate between the vulnerable and invulnerable areas, but the maternal mortality ratio in vulnerable areas was significantly higher than that in invulnerable areas.

Magnetic resonance imaging analysis of screw in-type lateral anchor pull-out in large to massive rotator cuff repair in patients older than 60 years

This study was performed to identify the incidence of screw in-type lateral anchor pull-out in patients older than 60 years who underwent rotator cuff repair for large to massive rotator cuff tear (RCT). Methods: We reviewed 25 patients over 60 who were diagnosed with large to massive RCT and underwent arthroscopic rotator cuff repair in our hospital from March 2017 to February 2021. Preoperative tear size (anterior to posterior, medial to lateral) was measured via preoperative magnetic resonance imaging (MRI). All 25 patients underwent MRI scanning on postoperative day 1 and at 3 months after surgery. The change of anchor position was measured in axial views on MRI images postoperative day 1 and 3 months after surgery. And it was statistically compared according to bone mineral density (BMD), sex, and number of lateral anchors. Results: Two MRIs (postoperative day 1 and 3 months) in 25 patients were compared. Anchor pull-out occurred in six patients during 3 months (6.7%), and the mean pull-out length difference was 1.56 mm (range, 0.16–2.58 mm). There was no significant difference in the number of pull-out anchors, degree of pull-out difference by comparing BMD (A, BMD≤–2.5; B, BMD>–2.5), sex, or number of anchors used in each surgery (C, two anchors; D, three anchors) (p>0.05). Conclusions: Pull-out of screw in-type anchors was rarely observed and the mean pull-out length difference was negligibly small in our study. The screw in-type lateral anchor seems to be a decent option without concern of anchor pull-out even in elderly patients.

Magnetic resonance imaging analysis of rotator cuff tear after shoulder dislocation in a patient older than 40 years

Background@#This study was designed to evaluate characters of the rotator cuff tear (RCT) recognized after primary shoulder dislocation in patients older than 40. @*Methods@#From 2008 to 2019, patients who visited two hospitals after dislocation were retrospectively reviewed. Inclusion criteria were patients over 40 who had dislocation, with magnetic resonance imaging (MRI) undergone. Exclusion criteria were patients who lost to follow-up, combined with any proximal humerus fracture, brachial plexus injury, and previous operation or dislocation history in the ipsilateral shoulder. Also patients who had only bankart or bony bakart lesion in MRI were excluded. We evaluated RCTs that were recognized by MRI after the primary shoulder dislocation with regard to tear size, degree, involved tendons, fatty degeneration, the age when the first dislocation occurred, and the duration until the MRI was evaluated after the dislocation. @*Results@#Fifty-five RCTs were included. According to age groups, the tear size was increased in coronal and sagittal direction, the number of involved tendons was increased, and the degree of fatty degeneration was advanced in infraspinatus muscle. Thirty-two cases (58.2%) conducted MRI after 3 weeks from the first shoulder dislocation event. @*Conclusions@#This group showed that the retraction size of the coronal plane was increased significantly and the fatty accumulation of the supraspinatus muscle had progressed significantly. Age is also a strong factor to affect the feature of RCT after the shoulder dislocation in patients over 40. And the delay of the MRI may deteriorate the degree of tear size and fatty degeneration.

Minimally Invasive Percutaneous Plate Osteosynthesis via a Deltoidsplitting Approach with Strut Allograft for the Treatment of Displaced 3- or 4-part Proximal Humeral Fractures

BACKGROUND: This study introduces a surgical technique with good clinical outcome useful in the treatment of osteoporotic displaced 3- or 4-part proximal humeral fractures. METHODS: From May 2014 to February 2016, 16 patients with displaced 3- or 4-part proximal humeral fractures were treated by application of a locking plate with an endosteal strut allograft via a deltoid splitting approach with a minimum follow-up of 12 months. The allograft was inserted through a fractured gap of the greater tuberosity to support the humeral head and then fixed by a locking plate with meticulous soft tissue dissection to protect the axillary nerve. Surgical outcomes were evaluated by the American Shoulder and Elbow Surgeons (ASES) and visual analogue scale (VAS) scores, radiological imaging, and clinical examination. Fixation failure on radiographs was defined as a >5° loss of neck shaft angle (NSA) compared to that on an immediate postoperative radiograph. Avascular necrosis (AVN) of the humeral head was also evaluated. RESULTS: In all cases, complete union was achieved. The ASES and VAS scores were improved to 85.4 ± 2.1 and 3.2 ± 1.3, respectively. Twelve patients (75.0%) had greater than a 5° change in NSA; the average NSA change was 3.8°. Five patients (31.3%) had unsatisfactory ranges of motion exhibiting a < 100° active forward flexion. No axillary nerve injuries or AVN were observed at the last follow-up. One patient was converted to reverse total arthroplasty due to severe pain and functional deficit. CONCLUSIONS: Minimally invasive fixation via a locking compression plate and an endosteal fibula strut allograft in Neer classification 3-or 4-part fractures with severe osteoporosis in elderly patients can achieve good clinical results.

Displaced Scapula Fracture (Ideberg Type IIb) Combined with a Large Rotator Cuff Tear in Anterior Shoulder Dislocation: A Case Report

Traumatic anterior shoulder dislocation combined with scapular fracture in elderly patients is relatively rare. In this case, a patient visited Emergency Room of Dong-A University Hospital for shoulder pain after falling off a ladder. Radiographs demonstrated anterior shoulder dislocation with displaced Ideberg type IIb scapula (glenoid fossa) fracture combined with a large rotator cuff tear on magnetic resonance imaging. We performed arthroscopic rotator cuff repair, but a large fragment in the inferior glenoid was left untreated. At the 1 year follow-up visit, the pain visual analogue scale of the patient was 2, the American Shoulder and Elbow Society score was 88 and the patient had gained nearly full range of motion without any apprehension.

Displaced Scapula Fracture (Ideberg Type IIb) Combined with a Large Rotator Cuff Tear in Anterior Shoulder Dislocation: A Case Report

Traumatic anterior shoulder dislocation combined with scapular fracture in elderly patients is relatively rare. In this case, a patient visited Emergency Room of Dong-A University Hospital for shoulder pain after falling off a ladder. Radiographs demonstrated anterior shoulder dislocation with displaced Ideberg type IIb scapula (glenoid fossa) fracture combined with a large rotator cuff tear on magnetic resonance imaging. We performed arthroscopic rotator cuff repair, but a large fragment in the inferior glenoid was left untreated. At the 1 year follow-up visit, the pain visual analogue scale of the patient was 2, the American Shoulder and Elbow Society score was 88 and the patient had gained nearly full range of motion without any apprehension.

Treatment of Calcaneal Fracture Malunion Using Lateral Exostectomy and Corrective Osteotomy: A Report of Three Cases / 대한족부족관절학회지

Inappropriate treatment for calcaneus fracture may result in malunion causing long-lasting pain and functional deficits. When such complications occur, the ideal principle of management is preserving congruence and motion of adjacent joints. For three patients with calcaneus fracture malunion, subtalar joint-preserving surgery using exostectomy and corrective osteotomy was performed, and satisfactory outcomes were achieved postoperatively.

Ultrasonography in Sternoclavicular Joint Posterior Dislocation in an Adolescent: A Case Report

Sternoclavicular joint posterior dislocations are considered a very uncommon, and type of injury where if esophagus or airway injury occurs behind the clavicle, it poses a high risk to the patient. In addition, if epiphyseal fracture occurs as a result of the sternoclavicular joint posterior dislocation, surgical treatment is often required. However, in the absence of a complete ossification of the clavicle, it is difficult to differentiate between a simple dislocation and epiphyseal fracture-dislocation solely based on simple radiographs or computed tomography scans. In this case report, the authors present a case in which a sternoclavicular joint posterior dislocation was diagnosed in a 14-year-old male athlete. The case report discusses how the posterior dislocation without epiphyseal fracture was diagnosed using an ultrasound and subsequently treated with successful outcomes using manual reduction. The case report presents our findings along with discussion that includes a literature review of relevant research.

Ultrasonography in Sternoclavicular Joint Posterior Dislocation in an Adolescent: A Case Report

Sternoclavicular joint posterior dislocations are considered a very uncommon, and type of injury where if esophagus or airway injury occurs behind the clavicle, it poses a high risk to the patient. In addition, if epiphyseal fracture occurs as a result of the sternoclavicular joint posterior dislocation, surgical treatment is often required. However, in the absence of a complete ossification of the clavicle, it is difficult to differentiate between a simple dislocation and epiphyseal fracture-dislocation solely based on simple radiographs or computed tomography scans. In this case report, the authors present a case in which a sternoclavicular joint posterior dislocation was diagnosed in a 14-year-old male athlete. The case report discusses how the posterior dislocation without epiphyseal fracture was diagnosed using an ultrasound and subsequently treated with successful outcomes using manual reduction. The case report presents our findings along with discussion that includes a literature review of relevant research.

Risk Factor of Depression after Amputation In Treatment of the Lower Extremity Open Fracture Associated with Severe Soft Tissue Injury / 대한정형외과연구학회지

PURPOSE: To evaluate the incidence rate and risk factors for depression after amputation in treatment of the lower extremity open fracture associated with severe soft tissue injury. MATERIALS AND METHODS: We carried out a retrospective case-control study of 30 patients, who underwent lower extremity amputation between March 2002 and February 2012 and subsequently followed up over 12 months. We classified the patients into two groups: group A (study group, depression expressed) and group B(control group, normal). The risk factors were then subdivided based on patient-related factors such as whether or not patients received psychiatric treatment, sociolopsychological environmental factors, and daily activities after recovery. RESULTS: The overall incidence rate of depression was 40%;20 patients were male, and 10 patients were female (66.7% and 33.3%, respectively). Age (odd ratio=1.14), Accompanying injury (odd ratio=2.06), underlying disease, Psychiatric treatment (odd ratio=44.73), sociopsychological environment (odd ratio=17.53),daily activities (odd ratio=8.76) were significant. CONCLUSION: We concluded that the risk factors for depression after amputation are age, accompanying injury, and underlying diseases, irrespective of whether or not patients received psychiatric treatment, and not associated with isolated sociopsychological environments, or hypoactivity of daily living.

Availability of Patella Resurfacing in Primary Total Knee Arthroplasty Through Evaluation and Analysis of the Patella in Revision Total Knee Arthroplasty / 대한정형외과연구학회지

PURPOSE: The aim of this study was to discuss about availability of patella resurfacing in primary total knee arthroplasty through evaluation and analysis of the patella in revision total knee arthroplasty. MATERIALS AND METHODS: The study was performed for 27 patients who could be followed up more than 12 months after having the revision TKA from March, 2004 to July 2008 among 105 patients (145 knees) who could be followed up more than 5 years after having primary TKA due to degenerative arthritis from 1989 to 1997. There were Group A (15 knees) which had patella resurfacing in revision TKA without patella resurfacing in primary TKA, Group B (12 knees) which had patella resurfacing in primary TKA, but didn't have patella resurfacing in revision TKA. There was difference of mean 11.2 years (6~15 years) between the time that the patients had primary TKA and the time that the patients had revision TKA. The patients consisted of 3 males and 24 females. The average age of the patients who had revision TKA was 76.2 years old (68~87). The Feller's patella score was used as clinical evaluation system after primary TKA, before and after revision TKA, and last follow-up. Ahlback's score was used by for the radiological evaluation of preoperative and postoperative outcome. And Outerbridge classification was used for the evaluation of group A which about wear of articular surface of patellofemoral joint in primary TKA and revision TKA, and positions of wear were classified. RESULTS: The Feller's patella score of group A, The outcome before revision TKA, 14.5 points, after 3 months TKA, 22.6 points, and 12 months follow-up, 24.2 points. The Feller's patella score of group B, The outcome before revision TKA, 24.2 points, after 3 months TKA, 24.3 points, and 12 months 24.8 points. The Ahlback score of group A decreased from 3.4 to 1.7 points, group B decreased from 1.6 to 1.5 points and group C decreased from 3.8 to 1.7 points. The Outerbridge classification of group A was mean 1.9 grade in primary TKA, and mean 3.6 grade in revision TKA. The wear of patella mainly occurred at medial facet. CONCLUSION: The patella resurfacing in primary TKA is considered as a useful treatment on the basis of these clinic and radiologic evaluation.