Impact on Bisphosphonate Persistence and Compliance: Daily Postprandial Administration

BACKGROUND: Bisphosphonate (BP) is an effective drug for the prevention and treatment of osteoporosis. However, gastrointestinal distress caused by BP is a well-known side effect for low compliance. The aim of our study was to compare the 1-year persistence, compliance and T-scores between the aperitif medication group and the postprandial medication group. METHODS: Three hundred patients were included in this study to determine their persistence and compliance with the prescribed daily BP (Maxmarvil®, alendronate 5 mg and calcitriol 0.5 µg; YuYu Pharm) following distal radius fractures. Patients in Group 1 (aperitif medication) were asked to adhere to the general guidelines for BPs before breakfast. Patients in Group 2 (postprandial medication) were recommended medication after breakfast. We compared the persistence and compliance of this daily BP therapy using the medication possession ratio (MPR) and T-scores between the 2 groups after 1 year. RESULTS: Bone mineral density in hip and lumbar spine was improved significantly in 2 groups (P < 0.001). Significant differences existed between 2 groups, including 73 of 150 patients (48.7%) in Group 1, and 111 of 150 patients (73.3%) in Group 2 for 1-year persistence (P=0.001). The mean MPR is 0.66 in Group 1 (range, 0.50–0.86) and 0.71 in Group 2 (range, 0.54–0.87). A significant difference was detected between the 2 groups (P=0.002). CONCLUSIONS: Postprandial administration improved persistence and compliance with daily BP therapy, resulting in better clinical outcomes.

Ecthyma gangrenosum and agranulocytosis in a previously healthy 12-month-old girl: Report of 1 case with a literature review

Ecthyma gangrenosum (EG) is a rare skin manifestation which starts with a maculopapular eruption and followed by a necrotic ulcer covered with black eschar. EG usually occurs in immunosuppressed patients with Pseudomonas aeruginosa sepsis. We present a previously healthy 12-month-old girl with EG by P. aeruginosa and agranulocytosis due to influenza A and then rhinovirus infection, without bacteremia. It is important for allergists to culture wound and differentiate EG from other skin disorders including Tsutsugamushi disease and initiate appropriate empiric antipseudomonal antibiotic treatment, and to evaluate for possible immunodeficiency, even in a healthy child.

Traumatic Triangular Fibrocartilage Complex Injuries and Instability of the Distal Radioulnar Joint / 대한정형외과학회잡지

Traumatic triangular fibrocartilage complex (TFCC) injuries require multidisciplinary approach and plan. Trauma to TFCC can lead to instability of the distal radioulnar joint (DRUJ). Injury to TFCC is classified as a stable type that does not cause unstable lesions for DRUJ or unstable type that can cause instability of DRUJ. According to the location and severity of the injury, arthroscopic debridement or arthroscopic repair may be considered. In the ulnar side avulsion of TFCC, which could cause DRUJ instability, arthroscopic examination should be performed to identify an accurate location of the damaged structures, followed by arthroscopic debridement and repair. In the event of TFCC and DRUJ injuries with ulnar positive variance, arthroscopic TFCC repair or ulnar shortening osteotomy after arthroscopic debridement could be considered to solve the instability and ulnar side pain. However, if peripheral TFCC tear with ulnar impaction syndrome and DRUJ instability, it combined operation of ulnar shortening osteotomy and TFCC foveal fixation could be considered. An accurate classification of TFCC and DRUJ injuries is necessary. It is important to resolve and prevent recurrence of ulnar wrist pain caused by instability.

Factors Affecting Length of Hospital Stay and Mortality in Infected Diabetic Foot Ulcers Undergoing Surgical Drainage without Major Amputation

This study aimed to investigate factors affecting length of hospital stay and mortality of a specific group of patients with infected diabetic foot ulcer who underwent surgical drainage without major amputation, which is frequently encountered by orthopedic surgeons. Data on length of hospital stay, mortality, demographics, and other medical information were collected for 79 consecutive patients (60 men, 19 women; mean age, 66.1 [SD, 12.3] yr) with infected diabetic foot ulcer who underwent surgical drainage while retaining the heel between October 2003 and May 2013. Multiple linear regression analysis was performed to determine factors affecting length of hospital stay, while multiple Cox regression analysis was conducted to assess factors contributing to mortality. Erythrocyte sedimentation rate (ESR, P=0.034), glycated hemoglobin (HbA1c) level (P=0.021), body mass index (BMI, P=0.001), and major vascular disease (cerebrovascular accident or coronary artery disease, P=0.004) were significant factors affecting length of hospital stay, whereas age (P=0.005) and serum blood urea nitrogen (BUN) level (P=0.024) were significant factors contributing to mortality. In conclusion, as prognostic factors, the length of hospital stay was affected by the severity of inflammation, the recent control of blood glucose level, BMI, and major vascular disease, whereas patient mortality was affected by age and renal function in patients with infected diabetic foot ulcer undergoing surgical drainage and antibiotic treatment.

Comparative Study Using of Treatment with Minimally Invasive Plate Osteosynthesis Using Periarticular Plate and Interlocking Intramedullary Nailing in Distal Tibia Fractures

PURPOSE: To compare the result of treatment between minimally invasive plate osteosynthesis (MIPO) using periarticular plate and intramedullary nailing in treatment of distal tibia fractures. MATERIALS AND METHODS: 28 cases of distal tibia fractures form Jan. 2006 to Mar. 2008 were divided into two group. Minimum follow-up was for 12 month. Group 1 consisted of 14 patients who were treated by MIPO technique and group 2 consisted of 14 patients who were treated by interlocking intramedullary nailing. The results were compared by assessing radiologic and clinical result. RESULTS: The mean bony union time was 14 weeks (8~17) in group 1 and 15 weeks (11~20) in group 2. Operation time was 58 minutes (55~65) in group 1 and 82.7 minutes (70~100) in group 2. The average angulation in AP view was 1.5 degrees (0~2) in group 1 and 2 degrees (0~5) in group 2, in lateral view was 1.8 degrees (0~4) in group 1 and 2.3 degrees (0~12) in group 2. The average range of motion for dorsi flextion was 17.5 degrees (15~20) in group 1 and 18 degrees (16~20) in group 2, for plantar flextion was 45 degrees (42~50) in group 1 and 44 degrees (42~50) in group 2, which means that there were no severe limitation of motion in all patients, resulting in satisfactory ambulation. There was no post operative complications such as skin irritation problem caused by internal device and no implant failure and superficial wound infection. CONCLUSION: There were no difference in bony union time, clinical result and anatomical reduction between Group 1 and Group 2 in distal tibia fractures, but operation time was shorter in MIPO than nailing.

Measurement of the Normal Lumbar Intervertebral Disc Space Using Magnetic Resonance Imaging

STUDY DESIGN: This is a retrospective study. PURPOSE: We wanted to measure the distance of the normal intervetebral disc space of Koreans. Overview of the Literature: For judging the distance of the normal intervertebral disc space of Koreans, we studied young adults who didn't have degenerative spinal change to determine the distance of the normal intervertebral disc space of each lumbar vertebral segment, and we did so by performing magnetic resonance imaging (MRI). METHODS: We studied a total of 178 outpatients who had low back pain and they underwent lumbar MRI. There were 138 males and 40 females, and their average age was 20.7 years (range, 15 to 25 years). On MRI, the segments with observed Modic change or other abnormalities were excluded from this investigation. To improvement the accuracy of measurement, two spine specialists measured the distances 2 times, and we calculated the mean value. We used paired t-tests for statistical analysis. RESULTS: In the total 178 patients, the average distance of intervertebral space from the 1st to the 2nd lumbar vertebrae was 24.83% (range, 18 to 32%), that from the 2nd to the 3rd was 26.92% (range, 19 to 40%), that from the 3rd to 4th was 28.88% (range, 19 to 41%), that from the 4th to 5th was 29.60% (range, 21 to 43%) and that from the 5th lumbar vertebra to the 1st sacrum was 27.52% (range, 19 to 38%). CONCLUSIONS: In this study, we expect that knowing the normal distance of the lumbar intervertebral space of Koreans can be helpful for surgical reconstruction to treat many lumbar spine diseases, to predict the appropriate size of the devices inserted in the intervertebral space and to produce proper devices for Koreans.

Comparative Study between In Situ Decompression of the Ulnar Nerve and Medial Epicondylectomy for Cubital Tunnel Syndrome

PURPOSE: We present our experience of operative results between in situ decompression of the ulnar nerve and medial epicondylectomy for cubital tunnel syndrome. MATERIALS AND METHODS: In 50 cases, we analyzed 32 cases followed more than 12 months. In 32 cases, 17 patients underwent in situ compression and 15 patients underwent medial epicondylectomy. After average follow-up period, we analyzed the operative results. The average follow-up period was 27 months(12~51 months). The results were divided into pain, sense, motor, and function using Gabel & Amadio grade (Table 1), and then estimated by 4 steps. Also, we divided into 3 grades using McGowan grade (Table 2), and then compared the score. RESULTS: The results of in situ decompression were 3 excellent cases, 5 good cases, 7 fair cases, and 2 poor cases by Gabel & Amadio grade. The results of medial epicondylectomy were 3 excellent cases, 4 good cases, 7 fair cases, and 1 poor case by Gabel & Amadio grade. However, there was no significant difference between the in situ decompression(5.45) and medial epicondylectomy(5.78). The results of McGowan grade I were 3 excellent cases, 1 good case. According to Gabel & Amadio grade, the average score was 8.5(range, 7~9) and the results of McGowan grade II were 3 excellent cases, 5 good cases, 5 fair cases, and 1 poor case. According to Gabel & Amadio grade, the average score was 6.7(range, 3~9). Finally, the results of McGowan grade III were 3 good cases, 9 fair cases, 2 bad cases. According to Gabel & Amadio grade, the average score was 4.85(range, 2~7), which was statistically significant difference. CONCLUSION: Statistically there was no significant difference between in situ decompression of the ulnar nerve and medial epicondylectomy for cubital tunnel syndrome. Both operative methods have short operation time, which makes it possible to exercise the joints earlier than other operations. In conclusion, we consider both methods are available for the treatment of cubital tunnel syndrome.

Results of Ceramic on Ceramic Bearing Total Hip Arthroplasty Using Cemented Femoral Stem and Cementless Femoral Stem

PURPOSE: The purpose of this study was to evaluate the results of ceramic-on-ceramic bearing primary total hip arthroplasty (THA) using cemented femoral stems and cementless femoral stems. MATERIALS AND METHODS: We studied 59 cases (52 patients) of THAs using ceramic-on-ceramic bearing cemented femoral stems and 64 cases (58 patients) of THAs using ceramic-on-ceramic bearing cementless femoral stems. All THAs were performed between January 2004 and February 2005 and were followed up for more than 3 years. The clinical results were evaluated using the Harris hip score (HHS), WOMAC score, sense of discomfort, and thigh pain. Radiographic results were assessed with serial radiographs. RESULTS: The mean HHS improved from 62.7 points preoperatively to 92.4 points at the last follow-up in the cemented stem group and improved from 61.5 points to 91.8 points in the cementless stem group (p>0.05). And mean WOMAC score improved from 37.9 points to 7.0 points in the cemented stem group and from 38.5 points to 12 points in the cementless stem group (p<0.05). There were 5 patients with a sense of discomfort and 9 patients with thigh pain in the cementless stem group and no cases in the cemented stem group. There were no instances of acetabular loosening in either group. Subsidence of the cemented femoral stem was less than 1 mm in 57 cases and less than 2 mm in 2 cases. All cementless femoral stems acquired firm bony union. CONCLUSION: Ceramic-on-ceramic bearing THA using a cemented stem showed clinical results superior to those achieved using a cementless stem. Cemented THA is thought to be good for complementing the problems caused by the hardness of ceramic-on-ceramic bearings.