The Effect of Patient Age on the Success Rate of Digital Replantation.

BACKGROUND: The purpose of this study was to evaluate outcomes and risk factors for failure after digital replantation in elderly patients, with a special focus on the effect of patient age on replantation success. METHODS: Replantation patients older than 60 years were analyzed thoroughly to characterize outcomes and risk factors for failure in older patients. Survival rates of all age groups older than 20 years were then analyzed to determine the specific effect of patient age on replantation success. The clinical and functional outcomes and risk factors for failure were evaluated at a minimum 1-year follow-up. RESULTS: Among 161 patients older than 60 years, 189 of 208 replanted digits survived completely (91 percent survival). The only factors predictive of failure were mechanism of injury and age. Excellent or good results (Chen criteria) were obtained in 58 percent of patients, and 94 percent of patients were completely or fairly satisfied. Analysis of all age groups older than 20 (1648 patients) demonstrated a significant increase in failure rate in those aged 70 years and older. CONCLUSIONS: The authors demonstrated a high rate of digit replantation success in elderly patients. However, 70 years and older was identified as an important factor predicting replantation failure. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

Incidence and Mortality after Distal Radius Fractures in Adults Aged 50 Years and Older in Korea.

The purpose of this study was to assess the incidence and mortality of distal radius fracture among patients 50 years of age and older with diagnosis code (ICD10; S52.5, S52.6) and treatment code using a nationwide claims database from 2008 to 2012. All patients were followed using patient identification code to identify deaths. Standardized mortality ratios (SMRs) of distal radius fracture were calculated based on age and gender-specific rates in the entire Korean population. The number of distal radius fractures increased by 54.2% over the 5-year study (48,145 in 2008 and 74,240 in 2012). The incidence of distal radius fracture increased from 367.4/100,000 in 2008 to 474.1/100,000 in 2012. The cumulative mortality rate over the first 12 months after distal radius fracture was decreased from 2.0% (968/48,145) in 2008 to 1.4% (1,045/74,240) in 2012. The mean year mortality over 5 years in men (2.6%, 1,279/50,128) over the first 12 months was 1.7-times higher than in women (1.5%, 3,952/257,045). The mean of SMR of distal radius fracture at 1 year post-fracture was 1.45 in men and 1.17 in women. This study using a nationwide database demonstrates that the distal radius fractures are increasing with a decreasing mortality in Korea.

Clinical outcomes of a simultaneous replantation technique for amputations of four or five digits.

PURPOSE: Replantation of amputations separated by more than four digits is challenging microsurgery because of the technical demands and long operation time. The purpose of this report was to present the clinical and functional outcomes in patients with amputations of four or five digits using a simultaneous replantation technique. PATIENTS AND METHODS: Among the 43 patients who visited our institution due to amputation of four or five digits from 2004 to 2013, 35 patients (28 males and seven females) underwent simultaneous replantation of four or five digits. The age range of the patients was 25-64 years (mean, 40.6 years). Simultaneous replantation technique included that bone was fixed and flexor tendons were repaired first and then digital vessels and nerves were simultaneously anastomosed for all amputated digits. The clinical and functional outcomes were evaluated at a minimum 1-year follow-up. RESULTS: Ischemic time was 150-510 min. Mean operation time was 313.2 min. In total, 127 of the 145 (87.5%) digits remained viable survived 2-weeks postoperatively, and four patients (16 digits) were lost to follow up. Of the 31 patients (129 digits), 19 (61.3%) had excellent and good outcomes using the criteria of Chen, and 21 patients (71%) were satisfied completely. Mean grip strength of the injured hand was 67% at the last follow-up. CONCLUSION: The results from this series of cases showed that the simultaneous replantation technique for four or five digit amputations may provide an alternative method to shorten surgical time, reduce complication rates, and enhance high survival rate.