Virtual platform to tackle challenges associated with lifelong medical education during the COVID-19 pandemic.

BACKGROUND: During the COVID-19 pandemic, large in-person conferences were mostly cancelled to avoid further disease contagion. Physicians continued to demand changes in form to enable participation in lifelong medical education programs, and the traditional model of in-person conferences needed to be rethought. As such, a regional branch of the national orthopedic association tried to move in-person conferences onto a virtual platform. This study aimed to investigate the effect of transitioning large in-person conferences to a virtual model during the COVID-19 pandemic, especially examining any differences in the attendance of each type of conference. METHODS: In this retrospective observational study, 776 participants in virtual conferences and 575 participants in in-person conferences were analyzed. Institutions were classified based on their location in a central city and two neighboring cities. Affiliated institutions were divided into resident training hospitals, general hospitals, and private clinics. The change in the number and proportion of participants between the virtual conference year and in-person conference year was calculated. RESULTS: The number of virtual conference participants was significantly greater than that of in-person conference participants (P = 0.01). Although the highest number of participants was from central city for both years, the proportion of participants from the two neighboring cities increased. Although the proportion of participants from resident training hospitals and private clinics decreased, the proportion of participants from general hospitals increased. CONCLUSIONS: We implemented a virtual platform to tackle challenges associated with lifelong medical education during the COVID-19 pandemic. The virtual platforms can be helpful for organizations that must hold regular lifelong medical education programs for members spread across a wide geographic region.

Sports-related fractures in the geriatric population at a level I trauma center.

BACKGROUND: The population is rapidly aging and remains active over the age of 65 years. An increasing number of sports-related fractures (SRFs) in individuals 65 and older are thus anticipated. Despite the increase in SRFs among the geriatric population, there are limited studies regarding the epidemiological data regarding SRFs in geriatric patients. This study examined the epidemiology of SRFs in a geriatric population who visited a level I trauma center. METHODS: Data from geriatric patients who visited a level I trauma center were collected between June 2020 and July 2023. Overall, 1,109 geriatric patients with fractures were included in the study. Among them, 144 (13.0%) had fractures during sports activities (SRF group) and 965 (87.0%) had fractures during non-sports activities (non-SRF group). We investigated the type of sport in the SRFs and compared SRFs and NSRFs to describe the differences in patient, fracture, and treatment characteristics. RESULTS: The mean age of SRFs was significantly lower (73.6 vs. 78.7 years; P < .001). The proportion of men was significantly higher in the SRF group than in the non-SRF group (51.4 vs. 29.6%; P < .001). We identified 13 types of sports associated with fractures, and the four most common were outdoor walking (36.1%), outdoor biking (27.8%), mountain hiking (19.4%), and gym (8.3%). There were no significant differences in the rate of hospitalization, operative treatment, or length of hospital stay between the two groups. However, compared to the non-SRF group, patients in the SRF group tended to return home after hospitalization (P = .002). CONCLUSION: This epidemiological study describes geriatric population that continues to be involved in sports and is thus susceptible to fractures. The identification of the type and distribution of SRFs in geriatric patients provides useful information for determining risk factors and appropriate preventive measures that may reduce their incidence.

Musculoskeletal Injuries in Table Tennis during Competition: A Systematic Review.

The study aimed to investigate the incidence of musculoskeletal injuries among table tennis players and identify their associated risk factors. We conducted a literature search in online databases using relevant search terms related to "table tennis" and "injury". To compare the rate of injuries according to player-related variables, we extracted information on sex, level of games, circumstances of injury, and duration of sport absence after injury. Furthermore, we calculated the odds ratios based on the number of injuries according to variables. Eight articles included 873 professional table tennis players, revealing an overall musculoskeletal injury rate of 3.6% (31 musculoskeletal injuries). The incidence was 10.0 injuries per 1,000 playing hours (range, 0-27.0). The rate of musculoskeletal injuries for female and male players were 3.2% and 3.8%, respectively, and those for Summer Olympic Games, Asian Games, and domestic national games was 4.8%, 15.4%, and 0%, respectively. More than half (52%) of injuries occurred during training, and most injuries (64%) were of a nature that did not cause time loss. This review provides valuable information about the incidence of musculoskeletal injuries in table tennis competitions. However, owing to the limitations of this study in identifying injury-related risk factors, future studies analyzing comprehensive variables are required.

Long-term Clinical Outcomes After TightRope Versus Hook Plate Fixation for Acute Acromioclavicular Joint Dislocation.

Background: There is limited information regarding the long-term efficacy of techniques for surgical fixation after acromioclavicular (AC) joint dislocation. Purpose: To evaluate the efficacy of hook plate (HP) and TightRope (TR) fixation for acute AC joint dislocations by comparing the long-term clinical and radiological patient outcomes. Study Design: Cohort study, Level of evidence, 3. Methods: This study retrospectively analyzed data from 61 patients with acute AC joint dislocation between July 2011 and November 2015. The patients were grouped according to surgical procedure: HP (n = 36) and TR (n = 25). Clinical outcomes at final follow-up were evaluated using the visual analog scale (VAS) for pain; the American Shoulder and Elbow Surgery score; the Korean Shoulder Score; and the University of California, Los Angeles (UCLA) shoulder score. Side-to-side coracoclavicular (CC) distance on radiographs, postoperative complications, and the rate of subacromial erosion in the HP group were also assessed between procedures. Results: The mean follow-up period was 7.0 ± 1.0 years, and there were no significant differences in pain or outcome scores between the HP and TR groups (all P > .05). Forward flexion was better in the TR group (172.6° ± 5.6°) versus the HP group (166.0° ± 10.8°; P = .002). The percentages of patients with a difference in the side-to-side CC distance of <5 mm were 83.3% and 72.0% in the HP and TR groups, respectively (P = .288). Complications were found in 2 patients in the HP group and 1 in the TR group (P ≥ .999). Subacromial erosion was observed in 41.7% of patients after HP fixation, with no difference in VAS pain scores at the final follow-up in patients with versus without subacromial erosion (P = .719). Conclusion: When comparing HP with TR fixation for the treatment of acute AC joint dislocations, there were no significant differences in functional outcome scores, final CC distance, or complications. Slightly better forward flexion was seen after TR fixation. Subacromial erosion occurred in 40% of patients after HP fixation, but this did not affect long-term VAS pain scores. Both surgical techniques are effective treatment options for AC joint dislocation.

Risk factors of tear progression in symptomatic small to medium-sized full-thickness rotator cuff tear: relationship between occupation ratio of supraspinatus and work level.

BACKGROUND: Previous studies reported that full-thickness rotator cuff tear (FTRCT) is a risk factor for tear progression. However, there is no clear consensus on the risk factors of tear progression in FTRCT. PURPOSE: To identify the demographic and radiologic risk factors of tear progression in small to medium FTRCTs. METHODS: We retrospectively reviewed 81 shoulders of patients diagnosed with small or medium FTRCTs using magnetic resonance imaging (MRI) who underwent conservative treatment from January 2017 to November 2021. Various demographic factors, including patient work level and radiological factors such as atrophy of rotator cuff muscles were analyzed to evaluate their association with tear progression. Work level was divided into high (heavy manual labor), medium (manual labor with less activity), and low (sedentary work activity). The atrophy of rotator cuff muscles was calculated by occupation ratio. RESULTS: Tear progression was observed in 48% (39/81) of patients (criterion for tear progression was medial-lateral or anterior-posterior tear length > 5 mm). In patients with tear progression, the lengths of medial-lateral and anterior-posterior tears progressed by 6 mm and 3 mm, respectively. Among the rotator cuff muscles, fatty degeneration and occupation ratio of the supraspinatus were only worsened (P = .014, P = 0.013, respectively). The mean MRI follow-up duration was 14.8 ± 9.0 months. The significant risk factors of tear progression were high work level (odds ratio [OR], 7.728; 95% CI, 1.204-49.610; P = .031), and occupation ratio of the supraspinatus muscle (OR, 0.308; 95% CI, 0.158-0.604; P = .001). The optimal cutoff value for the occupation ratio of the supraspinatus was 0.55 (sensitivity 74%, specificity 62%). CONCLUSIONS: Tear progression was observed in approximately 50% of patients with symptomatic small to medium FTRCTs. High physical work level and atrophy of the supraspinatus muscle were independent risk factors of tear progression. The risk of tear progression increases with occupation ratio of the supraspinatus muscle < 0.55 and heavy manual labor.

Progression of Symptomatic Partial-Thickness Rotator Cuff Tears: Association With Initial Tear Involvement and Work Level.

Background: Partial-thickness rotator cuff tears (PTRCTs) often progress to full-thickness rotator cuff tears (FTRCTs). Thus, it is important to analyze the risk factors for tear progression to determine the proper timing of repair. Purpose: To identify the risk factors associated with progression of PTRCT. Study Design: Case-control study; Level of evidence, 3. Methods: Included were 89 patients diagnosed with PTRCT on magnetic resonance imaging (MRI) scans who underwent nonoperative treatment at the authors' institution between August 2012 and August 2019. Patient characteristics, shoulder stiffness (compared with the contralateral shoulder); work level (classified as high [heavy manual labor], medium [manual labor with less activity], and low [sedentary activity]); and radiological factors including initial tear size, acromion type (flat, curved, hooked, or heel-shaped), and initial tear involvement (as a percentage of the rotator cuff tendon footprint length) were analyzed to assess their association with tear progression, defined as >20% increase in tear involvement. Results: The mean MRI follow-up period was 22.3 ± 17.2 months (median, 16.1 months; range, 6.4-89.5 months), and tear progression was observed in 12 patients (13.5%). In these 12 patients, tear involvement increased by 60% of the rotator cuff footprint, while mediolateral (ML) and anteroposterior (AP) tear sizes progressed by 1.1 and 1.8 mm, respectively. Univariate regression analysis showed that shoulder stiffness (P = .031), work level (P = .001), initial tear involvement (P < .001), ML and AP tear sizes (P < .001 and P = .005, respectively), and acromion type (P = .003) were significantly associated with tear progression. Multivariate regression analysis showed that initial tear involvement (odds ratio [OR], 1.053; 95% CI, 1.006-1.102; P = .026) and high work level (OR, 15.831; 95% CI, 1.150-217.856; P = .039) were independent risk factors for tear progression. The cutoff value for initial tear involvement was 47.5% (sensitivity, 81.8%; specificity, 85.7%). Conclusion: Tear progression was observed in 14% of patients with PTRCT in this study. To predict tear progression, evaluating the tear involvement during initial MRI is essential. The risk of tear progression increased with initial tear involvement >47.5% and a heavy work level.

Predictive Variables for Interventional Angiography among Patients with Knee Hemarthrosis.

Studies regarding the variables that could predict the success of conservative treatment for knee hemarthrosis are lacking. This retrospective study evaluated the laboratory variables of patients who had unsatisfactory results from conservative treatment for knee hemarthrosis. Twenty-nine patients conservatively treated for knee hemarthrosis were included and divided into two groups: group A comprised 14 patients who underwent interventional angiography and selective embolization due to failed conservative treatment, and group B comprised 15 patients with successful results after conservative treatment. The results of the serological and synovial fluid tests were evaluated. The mean number of synovial red blood cells (RBCs) was 1,905,857 cells/µL and 7730 cells/µL in groups A and B, respectively (p = 0.01), while the mean number of RBCs per high-power field (HPF) was 68.9 and 3.2, respectively (p < 0.01). Patients who underwent interventional angiography and selective embolization after failed conservative treatment for knee hemarthrosis had higher synovial RBC counts and RBC counts per HPF than those with successful outcomes after conservative treatment. It is necessary to carefully interpret the results of the synovial fluid analysis in patients with knee hemarthrosis; if the synovial fluid analysis shows a synovial RBC count greater than 81,500 and RBC count per HPF greater than 16.3, we recommend immediate interventional angiography rather than continuing conservative treatment.

Comparison of supraclavicular nerve injuries after clavicle mid-shaft surgery via minimally invasive plate osteosynthesis versus open reduction and internal fixation.

INTRODUCTION: Only a few previous studies have evaluated the factors related to supraclavicular nerve (SCN) injury after clavicle mid-shaft fracture surgery. We analyzed the frequency and risk factors for SCN injury after clavicle mid-shaft fracture surgery via open reduction and internal fixation (ORIF) versus minimally invasive plate osteosynthesis (MIPO) MATERIALS AND METHODS: We retrospectively reviewed the cases from 59 patients who had undergone surgery for clavicle mid-shaft fractures between January 2018 and April 2019. Twenty-nine patients had undergone ORIF and 30 had undergone MIPO. The frequency of SCN injury in the two groups was evaluated, and preoperative patient demographics (age, sex, body mass index, smoking, alcohol, diabetes mellitus, and trauma mechanism), and radiological parameters (fracture displacement and shortening) were measured and evaluated as risk factors for SCN injury. When neurological symptoms, such as numbness, were present on the anterior chest wall or at the incision site, electromyography (EMG) was conducted. RESULTS: Neurological symptoms were present in 12 patients. Numbness in the anterior upper chest around the incision site was present in eight and four patients who underwent ORIF and MIPO, respectively (p < 0.001). Furthermore, fracture displacement evaluated on preoperative three-dimensional computed tomography was significantly associated with the occurrence of SCN injury in patients who underwent MIPO (odds ratio, 1.038; 95% confidence interval, 1.001-1.077; p = 0.047). Although EMG was conducted in all patients with SCN injury, peripheral neuropathy was not found in any cases. CONCLUSIONS: SCN injury, which is a possible complication of clavicle mid-shaft fracture surgery, occurred significantly less frequently in MIPO than in ORIF. In MIPO, greater preoperative fracture displacement was associated with a higher risk of SCN injury. Additional studies are required to reach a consensus regarding accurate methods to evaluate SCN injuries. LEVEL OF EVIDENCE: IV, case series, treatment study.

Multimodal nerve injection provides noninferior analgesic efficacy compared with interscalene nerve block after arthroscopic rotator cuff repair.

PURPOSE: This randomized noninferiority trial aimed to evaluate whether combined suprascapular, axillary nerve, and the articular branch of lateral pectoral nerve block (3NB) is noninferior to interscalene nerve block (ISB) for pain control after arthroscopic rotator cuff repair (ASRCR). MATERIALS AND METHODS: Eighty-five patients undergoing ASRCR were randomized to either 3NB (n = 43) or ISB (n = 42) group. We used 5 and 15 ml of 0.2% ropivacaine for each nerve in the 3NB and ISB groups, respectively. The primary outcome was the visual analog scale (VAS) pain score at 4 h postoperatively measured assessed on an 11-point scale (ranging from 0 = no pain to 10 = worst pain) that was analyzed using noninferiority testing. The secondary outcome was VAS pain scores in the recovery room and at 8, 12, 24, 36, 48, and 72 h postoperatively. Rebound pain, IV-PCA usage during 48 h, dyspnea, muscle weakness, and satisfaction were evaluated. RESULTS: Regarding the primary outcome, the mean difference in VAS pain scores between the 3NB (2.5 ± 1.6) and ISB (2.2 ± 2.3) groups at 4 h postoperatively was 0.3, with a 95% confidence interval (CI) of -0.56 to 1.11. The upper limit of 95% CI is lower than the noninferiority margin of 1.3 (p < 0.001). At all other time points, except in the recovery room, 3NB showed noninferior to ISB. Rebound pain, IV-PCA usage during the second 24 h, and muscle weakness were lower in the 3NB group (all p < 0.005). The satisfaction was similar in both groups (p = 0.815). CONCLUSION: Combined 3NB is noninferior to ISB in terms of pain control after ASRCR; and is associated with low levels of rebound pain, IV-PCA usage, and muscle weakness. LEVEL OF EVIDENCE: Randomized controlled trial, Level I.

Minimally Invasive Plate Osteosynthesis Using a Screw Compression Method for Treatment of Humeral Shaft Fractures.

BACKGROUND: This study aims to compare the surgical outcomes of open reduction and internal fixation (ORIF) and minimally invasive plate osteosynthesis (MIPO) using a screw compression method in simple humeral shaft fractures. METHODS: This retrospective study was performed with 50 patients who had surgical interventions for the treatment of simple humeral shaft fractures and had follow-ups of at least 12 months in Ulsan University Hospital between August 2008 and June 2015. Group 1 included 23 patients treated with ORIF and group 2 included 27 patients treated with the MIPO technique using a locking screw plate. The time to clinical/radiographic union, the joint range of motion (ROM), and function were evaluated. RESULTS: The average time to clinical/radiographic bone union was shorter in group 2 (12.0 ± 3.7 weeks/14.8 ± 2.0 weeks in group 1 and 9.4 ± 1.3 weeks/12.0 ± 3.3 weeks in group 2; p = 0.022/p = 0.034). Shoulder and elbow joint function evaluated by joint ROM and visual analogue scale (VAS), Korean Shoulder Elbow Society (KSS), American Shoulder and Elbow Surgeons (ASES), and the University of California at Los Angeles (UCLA) scores was excellent in both groups. On the average shoulder ROM at 12 months after the operation, group 1 had forward elevation of 160°, external rotation of 30° in adduction and lumbar vertebra 10 level in internal rotation and group 2 had forward elevation of 170°, external rotation of 35° in adduction and lumbar vertebra 9 level in internal rotation. The mean VAS, KSS, ASES, and UCLA scores were 2.8, 87.0 ± 0.9, 89.4 ± 0.9, and 31.0 ± 1.4, respectively, in group 1 and 1.7, 89.1 ± 2.7, 91.0 ± 1.6, and 32.4 ± 3.2, respectively, in group 2. There were statistically significant intergroup differences in VAS score (p = 0.011). There were significantly less postoperative infections in group 2 (three cases, 10.7% in group 1 and 0 case in group 2; p = 0.041) although all of them were superficial infections and well-treated by an average 4-week course of antibiotics (range, 2 to 6 weeks). CONCLUSIONS: MIPO using a screw compression method in simple humeral shaft fractures demonstrated superior efficacy to ORIF in terms of the time to clinical/radiographic union, pain score, and postoperative infection rate.

Comparison of Arthroscopically Guided Suprascapular Nerve Block and Blinded Axillary Nerve Block vs. Blinded Suprascapular Nerve Block in Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial.

BACKGROUND: The purpose of this study was to compare the results of arthroscopically guided suprascapular nerve block (SSNB) and blinded axillary nerve block with those of blinded SSNB in terms of postoperative pain and satisfaction within the first 48 hours after arthroscopic rotator cuff repair. METHODS: Forty patients who underwent arthroscopic rotator cuff repair for medium-sized full thickness rotator cuff tears were included in this study. Among them, 20 patients were randomly assigned to group 1 and preemptively underwent blinded SSNB and axillary nerve block of 10 mL 0.25% ropivacaine and received arthroscopically guided SSNB with 10 mL of 0.25% ropivacaine. The other 20 patients were assigned to group 2 and received blinded SSNB with 10 mL of 0.25% ropivacaine. Visual analog scale (VAS) score for pain and patient satisfaction score were assessed 4, 8, 12, 24, 36, and 48 hours postoperatively. RESULTS: The mean VAS score for pain was significantly lower 4, 8, 12, 24, 36, and 48 hours postoperatively in group 1 (group 1 vs. group 2; 5.2 vs. 7.4, 4.1 vs. 6.1, 3.0 vs. 5.1, 2.1 vs. 4.2, 0.9 vs. 3.9, and 1.3 vs. 3.3, respectively). The mean patient satisfaction score was significantly higher at postoperative 4, 8, 12, 24, 36, and 48 hours in group 1 (group 1 vs. group 2; 6.7 vs. 3.9, 7.4 vs. 5.1, 8.8 vs. 5.9, 9.2 vs. 6.7, 9.5 vs. 6.9, and 9.0 vs. 7.2, respectively). CONCLUSIONS: Arthroscopically guided SSNB and blinded axillary nerve block in arthroscopic rotator cuff repair for medium-sized rotator cuff tears provided more improvement in VAS for pain and greater patient satisfaction in the first 48 postoperative hours than blinded SSNB.

The Influence of Arthroscopic Remplissage for Engaging Hill-Sachs Lesions Combined with Bankart Repair on Redislocation and Shoulder Function Compared with Bankart Repair Alone.

BACKGROUND: Recurrence of glenohumeral dislocation after arthroscopic Bankart repair can be associated with a large osseous defect in the posterosuperior part of the humeral head. Our hypothesis is that remplissage is more effective to prevent recurrence of glenohumeral instability without a severe motion deficit. METHODS: Engaging Hill-Sachs lesions were observed in 48 of 737 patients (6.5%). Twenty-four patients underwent arthroscopic Bankart repair combined with remplissage (group I) and the other 24 patients underwent arthroscopic Bankart repair alone (group II). Clinical outcomes were prospectively evaluated by assessing the range of motion. Complications, recurrence rates, and functional results were assessed utilizing the American Shoulder and Elbow Surgeons (ASES) score, Rowe score, and the Korean Shoulder Score for Instability (KSSI) score. Capsulotenodesis healing after remplissage was evaluated with magnetic resonance imaging. RESULTS: The average ASES, Rowe, and KSSI scores were statistically significantly higher in group I than group II. The frequency of recurrence was statistically significantly higher in group II. The average loss in external rotation measured with the arm positioned at the side of the trunk was greater in group II and that in abduction was also higher in group II. CONCLUSIONS: Compared to single arthroscopic Bankart repair, the remplissage procedure combined with arthroscopic Bankart repair was more effective to prevent the recurrence of anterior shoulder instability without significant impact on shoulder mobility in patients who had huge Hill-Sachs lesions.

Reliability of the classification and treatment of dislocations of the acromioclavicular joint.

BACKGROUND: We evaluated interobserver and intraobserver reliability of the classification and treatment of acromioclavicular (AC) joint dislocations and assessed the impact of adding 3-dimensional computed tomography (3D CT) on the reliability of classification and treatment choice. METHODS: Ten surgeons independently reviewed plain radiographs and 3D CT in 28 cases with AC joint dislocation. Images from each case were randomly presented to the observers, with plain radiographs alone being presented first, followed by plain radiographs plus 3D CT 2 weeks later. Four weeks later, they repeated the same survey to evaluate intraobserver reliability. Reliability was assessed on the basis of Fleiss κ values. RESULTS: On the basis of plain radiographs alone, interobserver and intraobserver reliability of the Rockwood classification were fair (κ = .214) and moderate (κ = .474), respectively. Interobserver and intraobserver reliability of treatment were both fair (κ = .213 and .399, respectively). On the basis of a combination of plain radiographs and 3D CT, interobserver and intraobserver reliability of the Rockwood classification were slight (κ = .177) and moderate (κ = .565), respectively. Interobserver and intraobserver reliability of treatment were fair (κ = .253) and moderate (κ = .554), respectively. There were no significant differences in reliability between the two groups in terms of any κ values. CONCLUSION: This study suggests an overall lack of reliability of the Rockwood classification of AC joint dislocations and of decisions regarding their treatment. There is especially poor agreement between experienced shoulder surgeons. The addition of 3D CT did not improve reliability of classification and treatment of AC joint dislocations.

Ultrasonography- or electrophysiology-guided suprascapular nerve block in arthroscopic acromioplasty: a prospective, double-blind, parallel-group, randomized controlled study of efficacy.

PURPOSE: To evaluate the efficacy of ultrasonography-guided (UG) and electrophysiology-guided (EG) suprascapular nerve block (SNB) for arthroscopic acromioplasty with regard to pain relief. METHODS: A prospective, double-blind, randomized controlled clinical trial was performed from June 2007 to April 2010. Patients who were scheduled for elective arthroscopic acromioplasty and who met the inclusion criteria were assigned to 1 of 2 experimental groups (UG or EG SNB) or to 1 blind group (using anatomic landmarks). Before surgery, an SNB was performed with either ultrasonographic or electrophysiologic guidance or with no assistive devices (blind). Variables were collected at 4, 24, 48, and 72 hours postoperatively. RESULTS: Sixty-three patients were initially enrolled in the study, but 11 dropped out for various reasons. In the UG group at 4 hours, the visual analog scale score at rest (30 ± 12.0 v 39 ± 9.9 for EG group and 41 ± 11.8 for blind group) and when the patient was moving (42 ± 15.2 v 52 ± 11.5 for EG group and 53 ± 12.6 for blind group) was significantly decreased compared with the EG and blind groups (P < .05). Opioid consumption during the first 24 hours was significantly reduced in the UG and EG groups (4.3 ± 1.9 mg and 3.8 ± 2.3 mg, respectively) compared with the blind group (5.1 ± 2.2 mg) (P < .05). The visual analog scale score at rest and when the patient was moving; the pain score on the University of California, Los Angeles questionnaire; and the activities of daily living score on the American Shoulder and Elbow Surgeons questionnaire in the EG and UG groups improved more than the values in the blind group over the follow-up intervals (P < .05). Morphine consumption in the EG and UG groups by the first, second, and third days was significantly smaller than that in the blind control group (P < .05). CONCLUSIONS: UG and EG SNB can reduce pain and painkiller consumption for up to 72 hours postoperatively. Ultrasonographic or electrophysiologic guidance is more effective than the blind method of SNB. LEVEL OF EVIDENCE: Level I, randomized controlled trial with significant difference.

Outcomes of minimally 1 year follow-up for the arthroscopic Remplissage technique with Hill-Sachs lesion.

PURPOSE: We evaluated minimal 1 year follow-up results for the Remplissage technique to fill a Hill-Sachs lesion with anterior instability. METHODS: The subjects were 12 patients, who could be followed-up for more than 12 months after the "Remplissage" procedures in our hospital from August 2008 to May 2010. Their mean age was 28.6 years old and the mean follow-up was 19 months. The evaluations included the ROM, the ASES score, the KSSI score, the ROWE score and postoperative MRI. RESULTS: On the postoperative functional evaluation after an average 16 months, the ASES score improved 51.4 in preoperative to 86.6 in postoperatively, the KSSI score improved from 46.6 preoperatively to 84.9 postoperatively and the ROWE score improved from 43.6 preoperatively to 91.4 postoperatively. After an average 14 months for all the cases, the range of movement was nearly in the normal range which is 174.3 ± 5.04 (170-180) degrees in foreward flexion, and 56.4 ± 9.60 (50-60) degrees in external rotation. CONCLUSION: For recurrent shoulder instability with a large Hill-Sachs lesion, the Remplissage technique has a good outcome after more than 1 year follow-up in terms of shoulder stability, and the clinical and functional results. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Cerebral oxygenation monitoring of patients during arthroscopic shoulder surgery in the sitting position.

BACKGROUND: Cerebral hypotension and desaturation can occur during shoulder surgery in the seated position. We evaluated the correlation of cerebral oxygen saturation (rSO(2)) using near infra-red spectroscopy (NIRS) and mean arterial pressures (MAP) (at the levels of the brain and heart). METHODS: Fifty patients, scheduled for the arthroscopic shoulder surgery in the seated position, were enrolled to monitor the rSO(2), bispectral Index (BIS), and MAPs at the levels of the brain and heart. The values of each parameter were collected at 5 min after intubation, immediately after placing the patient in the sitting position, 5 min after the patient was seated, immediately after the surgical incision, and every 30 min after incision. RESULTS: A correlation between the cerebral rSO(2) and the MAP at the level of brain were statistically significant. Cerebral rSO(2) and MAP after a change of posture from supine to sitting position were significantly decreased, compared to the baseline value. CONCLUSIONS: Monitoring cerebral rSO(2) and MAP at the level of brain can be helpful to detect the possibility of cerebral deoxygenation earlier.

Single row rotator cuff repair with modified technique.

Rotator cuff tear is a common medical condition. We introduce various suture methods that can be used for arthroscopic rotator cuff repair, review the single row rotator cuff repair method with modified technique, and introduce the Ulsan-University (UU) stich. We compare the UU stitch with the modified Mason-Allen (MA) suture method. The UU stitch configuration is a simple alternative to the modified MA suture configuration for rotator cuff repair.

Post-traumatic Lumbar Epidural Hematoma with Neurology: Report of 1 Case.

The purpose of this study was to report a case with post-traumatic spinal epidural hematomas with abnormal neurologic findings, which is uncommon. A 40-year-old man presented at our clinic after a blunt trauma caused by a traffic accident in which he was a pedestrian. After admission, abnormal neurologic symptoms developed including loss of sensation and motor function in his left lower extremity. Magnetic resonance imaging demonstrated a spinal epidural hematoma with 40% canal stenosis at the L5-S1 level. Decompression including hematoma evacuation was done. Symptoms started to be reduced 18 days after operation. He was treated conservatively with medications and all symptoms resolved completely during admission and there were no further neurologic sequelae. Post-traumatic lumbar spinal epidural hematoma with abnormal neurologic findings is an uncommon condition that may present belatedly after trauma with significant neurologic compromise.

Comparison of effects of morning versus evening administration of ezetimibe/simvastatin on serum cholesterol in patients with primary hypercholesterolemia.

BACKGROUND: Ezetimibe, a first-in-its-class inhibitor of cholesterol absorption, is an effective agent for combined use with statins to achieve low-density lipoprotein cholesterol (LDL-C) goals. Ezetimibe in combination with simvastatin as a single-tablet formulation has proven to be highly effective in reducing serum LDL-C through the dual inhibition of cholesterol absorption and biosynthesis. The effect of time of administration on efficacy of this combination therapy has not been evaluated. OBJECTIVE: To compare the effects of morning versus evening administration of ezetimibe/simvastatin on serum cholesterol levels of patients with primary hypercholesterolemia. METHODS: In this multicenter, open-label, randomized, 2-sequence, 2-period crossover study, patients with primary hypercholesterolemia randomly received ezetimibe/simvastatin 10 mg/20 mg once daily, either in the morning (within 1 hour of breakfast) or in the evening (within 1 hour of dinner) for 6 weeks. RESULTS: Data on 171 patients (87 in the morning administration group and 84 in the evening administration group) were analyzed. A significant reduction (p ≤ 0.001) in the total cholesterol, triglyceride, high-density lipoprotein cholesterol, LDL-C, apo-lipoprotein B, and high-sensitivity C-reactive protein (hs-CRP) from baseline was achieved after each treatment. Noninferiority of morning administration versus evening administration was shown in the percentage reduction of the LDL-C level from baseline (difference, -1.62%; 90% CI -4.94 to 1.70). No significant difference was found between groups with respect to the percentage of changes in other lipid parameters from baseline. Furthermore, there was no significant difference in the percentage of change in hs-CRP as an antiinflammatory marker between the morning and evening administration groups. The frequency of adverse events was similar between groups. CONCLUSIONS: Morning administration of ezetimibe/simvastatin 10 mg/20 mg is noninferior to evening administration with respect to LDL-C-lowering ability.

Effect of atorvastatin and clopidogrel co-administration after coronary stenting in korean patients with stable angina.

BACKGROUND AND OBJECTIVES: It was reported that atorvastatin co-administered with clopidogrel for 8 months did not affect the anti-platelet potency of clopidogrel in Korean patients with acute coronary syndrome, but not in patients with stable angina. We investigated whether co-administration of statins with clopidogrel affected the anti-platelet efficacy of clopidogrel in Korean patients with stable angina. SUBJECTS AND METHODS: This was a randomized, open-label and two-period crossover design study conducted at two centers. Two hundreds thirty three patients with stable angina scheduled for coronary stenting were randomized into two groups. In Group A, 119 patients first received atorvastatin (10 mg) followed by fluvastatin (80 mg) for 12 weeks per treatment. In Group B, 114 patients received the same treatments in reverse order. RESULTS: Baseline adenosine diphosphate (ADP, 10 µmol/L)-induced platelet aggregation was 54.4±9.1% in Group A and 53.8±9.0% in Group B (p=0.44), and significant differences were noted after each treatment period (p<0.001). Inhibition of platelet aggregation was similar between Group A and Group B at 24 hours following clopidogrel loading (29.2±11.0% vs. 30.4±12.7%; p=0.42). The two treatment least square means of 12-week ADP (10 mol/L)-induced platelet aggregation [29.50±0.79 {standard error (SE)}% on the atorvastatin treatment group vs. 28.16±0.70 (SE)% in the fluvastatin treatment group] in a 2×2 cross-over study were not significantly different (p=0.204). CONCLUSION: Statin and clopidogrel co-administration for 12 weeks is not associated with attenuated anti-platelet activity of clopidogrel in Korean patients with stable angina after coronary stenting, in support of the findings of similar studies conducted in Caucasian populations.