• Clinics in Shoulder and Elbow
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• v.26 no.4
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• pp.351-356
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• 2023

Background: Total elbow arthroplasty (TEA) is uncommon, but growing in incidence. Traditionally an inpatient operation, a growing number are performed outpatient, consistent with general trends in orthopedic surgery. The aim of this study was to compare TEA outcomes between inpatient and outpatient surgical settings. Secondarily, we sought to identify patient characteristics that predict the operative setting. Methods: Patient data were collected from the American College of Surgeons National Quality Improvement Program. Preoperative variables, including patient demographics and comorbidities, were recorded, and baseline differences were assessed via multivariate regression to predict operative setting. Multivariate regression was also used to compare postoperative complications within 30 days. Results: A total of 468 patients, 303 inpatient and 165 outpatient procedures, were identified for inclusion. Hypoalbuminemia (odds ratio [OR], 2.5; P=0.029), history of chronic obstructive pulmonary disorder or pneumonia (OR, 2.4; P=0.029), and diabetes mellitus (OR, 2.5; P=0.001) were significantly associated with inpatient TEA, as were greater odds of any complication (OR, 4.1; P<0.001) or adverse discharge (OR, 4.5; P<0.001) and decreased odds of reoperation (OR, 0.4; P=0.037). Conclusions: Patients undergoing inpatient TEA are generally more comorbid, and inpatient surgery is associated with greater odds of complications and adverse discharge. However, we found higher rates of reoperation in outpatient TEA. Our findings suggest outpatient TEA is safe, although patients with a higher comorbidity burden may require inpatient surgery. Level of evidence: III.

• Journal of Veterinary Clinics
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• v.41 no.4
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• pp.228-233
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• 2024

A 7-month-old, 5.2 kg spayed female Norwegian Forest cat was referred for chronic, non-weight-bearing lameness in the left pelvic limb that has been present since 3 months old and has not responded to medical conservative therapy. Based on orthopedic and radiographic examination, concomitant cranial cruciate ligament rupture (CCLR) and medial patellar luxation (MPL) of the left hind limb were diagnosed. In this case, cranial tibial wedge osteotomy (CTWO) was adopted to overcome side effect of performing other osteotomy techniques such as impairing the growth plates in the proximal tibia. Additionally, patient-specific surgical guides were applied to improve surgical accuracy. The patient showed an improvement in weight-bearing scores and gait condition during follow-up periods without complications. In our case, CTWO combined with corrective surgery for MPL can be used to treat concomitant CCLR and MPL without damaged on the growth plates and shows good clinical outcomes in an immature cat. Furthermore, the use of a surgical guide facilitates surgical procedures that minimize surgical error and increase surgical precision. This case study suggests that CTWO assisted by patient-specific surgical guides may be a viable surgical option for treating an immature cat with concomitant CCLR and MPL.

• Journal of the Korean Orthopaedic Association
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• v.55 no.4
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• pp.281-293
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• 2020

An anterior cruciate ligament (ACL) reconstruction is one of the most frequent surgical procedures in the knee joint, but despite the better understanding of anatomy and biomechanics, surgical reconstruction procedures still fail to restore rotational stability in 7%-16% of patients. Hence, many studies have attempted to identify the factors for rotational laxity, including the anterolateral ligament (ALL), but still showed controversies. Descriptions of the ALL anatomy are also confused by overlapping nomenclature, but it is usually known as a distinctive fiber running in an anteroinferior and oblique direction from the lateral epicondyle of the femur to the proximal anterolateral tibia, between the fibular head and Gerdy's tubercle. The importance of the ALL as a secondary restraint in the knee has been emphasized for successful ACL reconstructions that can restore rotational stability, but there is still some controversy. Some studies reported that the ALL could be a restraint to the tibial rotation, but not to anterior tibial translation. On the other hand, some studies reported that the role of ALL in rotational stability would be limited as a secondary structure because it bears loads only beyond normal biomechanical motion. The diagnosis of an ALL injury can be performed by a physical examination, radiology examination, and magnetic resonance imaging, but it should be assessed using a multimodal approach. Recently, ALL was considered one of the anterolateral complex structures, as well as the Kaplan fiber in the iliotibial band. Many studies have introduced many indications and treatment options, but there is still some debate. The treatment methods are introduced mainly as ALL reconstructions or lateral extra-articular tenodesis, which can achieve additional benefit to the knee stability. Further studies will be needed on the indications and proper surgical methods of ALL treatment.

• The Journal of Korean Orthopaedic Ultrasound Society
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• v.7 no.1
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• pp.33-38
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• 2014

Purpose: To determine the therapeutic effectiveness of ultrasound-guided medial branch block (MBB) for the herniated lumbar disc patients who did not relieve their symptoms after percutaneous epidural neuroplasty (PEN). Materials and Methods: From August 2011 to February 2013, 559 patients with herniated lumbar disc have undergone PEN. Among them, ultrasound-guided MBBs were performed for the patients who had sustained low back pain and refered pain to lower extremities. Eighty eight patients were followed at 1 month and 39 patients could be followed at 6 month. All procedures have been performed by the one operator, and 23 G, 10 cm needle was placed and 0.5% lidocaine was injected under ultrasound guide. To target medial branches from L1 to L5, the groove at the root of transverse process and the base of superior articular process has been identified on transverse scan. Patients were evaluated by Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) at each follow-up. Significant pain relief was described as a 50% or more reduction in VAS and significant improvement in function was described as at least a 40% reduction in ODI. Results: VAS showed that preprocedure pain ($7.35{\pm}1.68$; $mean{\pm}SD$) significantly decreased 1 month after block ($3.36{\pm}2.98$) and 6 month ($3.05{\pm}2.27$) (p<0.05). ODI also showed that preprocedure score ($32.82{\pm}8.77$) significantly decreased at 1 month ($15.14{\pm}14.01$) and 6 month ($12.97{\pm}8.82$) (p<0.05). Significant pain relief was observed in 64.49% at 1 month and 64.10% at 6 month. Significant functional improvement in 59.81% at 1 month and 61.54% at 6 month. Conclusion: Ultrasound-guided medial branch block may sufficiently treat the facet problems secondary from disc disease.

• The Journal of the Korean bone and joint tumor society
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• v.19 no.1
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• pp.1-8
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• 2013

Purpose: Primary bone tumors of hindfoot are uncommon compared with other locations, and there have been few large-group studies. This study was designed to analyze the characteristics and the clinical results of the primary bone tumors of hindfoot. Materials and Methods: Forty five cases in 44 patients who have been diagnosed from 1989 to 2011 were reviewed. The minimum follow-up period was 1 year. We retrospectively reviewed the medical records and images. Results: Twenty six cases were male and 18 cases were female. Mean follow-up period was 33.1 months and mean age was 25.1 years. Forty four cases were benign and 1 case was malignant. Thirty six cases occurred in calcaneus and 9 cases were in talus. The most common benign bone tumor was simple bone cyst (20 cases), followed by intraosseous lipoma (12 cases), and chondroblastoma (4 cases). In calcaneus, there were 18 cases of simple bone cyst, and 12 cases of intrasosseous lipoma. In talus, there were 3 cases of chondroblastoma, 2 cases of simple bone cyst, and 2 cases of intraossesous ganglion. Many patients with hindfoot bone tumors presented with pain, but some were found accidentally. Patients received surgical procedures, such as curettage and bone graft, open reduction and internal fixation, tumor resection, and below knee amputation. Conclusion: Primary bone tumors of hindfoot are rare and can be misdiagnosed as ankle sprain or contusion. Although most are benign, malignant tumors cannot be ruled out, so early diagnosis and appropriate treatment is important.

• Journal of Korean Academy of Nursing
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• v.6 no.1
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• pp.72-79
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• 1976

Contemper nursing literature place much importance on human- centered and individualized care. Nursing research has related stress during hospitalization of adolescent patients to adaptation to a new environment, isolation from friends, limitation due to illness, over protection of parents and communication with member of the medical team. The investigator conducted this study in the hope that an understanding of adolescents responses to hospitalization, their perceptions, the kinds and levels of stress, and the relationships between stressors and individual characteristics would contribute to the improvement of adolescent patient care. The objective of the study was to obtain informations related to the adolescents psychological stress experience during hospitalization, specifically stress from interpersonal relationships and communication, isolation from the family, social or economic problems, illness and from the treatment environment and nursing care. An interview schedule adopted from Holmes and Rahe's Social Readjustment Rating Scale and selected items from Voicer's instrument on stress-producing events was used with 120 adolescent inpatients aged 13 to 18 years three general hospitals in Seoul during Aug. 10, to Sep. 30, 1975. 1. The sample consisted of 66 male and 54 female patients. Sixty-six percent were late adolescents, aged 16 to 18 years: 4% were early adolescents, aged 13 to 15 years. The primary cause for hospitalization was for orthopedic problems (35.8%). More than half of these (54.4%) were due to injury or accident. 2. Stress eclated to illness revealed the highest score (4.97), followed by stress related to treatment environment and nursing care (4.34) , isolation from family and social or economic problems (4.01) and interpersonal relationships and communication (3.96). 3. The perceived indifference of doctors and nurses was a serious cause of stress (mean=4.83). Fellow patients and visitors caused least stress (mean=2.06). 4. Discontinuation of education or unemployment were major stressful events (mean=4.71). Least stressful was isolation from the family (mean=3.47). 5. More than 94% of the respondents expressed fears related to body image (mean=4.97) 6. Within the category of treatment environment and nursing care, items related to restrictions because of treatment, discomfort because of treatment, inadequate explanation from nurses about procedures were rated as severe stress events (mean=4.6). Items related to the ward environment and to having a relative stay with them were seen by the group as less serious events (mean=3.7). 7. Stress related to interpersonal relationships and communication was correlated positively with female patients and those preferring passive activities. (P〈0.05) 8. Stress related to family problems was positively related to female and early adolescent patients (P< 0.05). Stress related to social problems was positively , elated to students and those preferring active pursuits (P< 0.05). 9. There were no correlation between the high stress related to disease and any of the characteristic items. (P> 0.05) 10. Stress related to treatment environment and nursing care was positively related of early adolescent and female and student patients. (P< 0.05) This group of hospitalized adolescents reported high level of stress related to treatment environment and nursing care, due to lack of consideration of normal growth and development and individual characteristics. The findings have important implications for the planning of effective, individualized, comprehensive nursing care of adolescents during hospitalization.

• Archives of Reconstructive Microsurgery
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• v.7 no.1
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• pp.62-67
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• 1998

The gracilis muscle is well suited to small and medium-sized soft tissue defects that cannot be adequately handled by simple rotational flaps and it will conform well to irregular contours, can be split longitudinally at both ends to allow cavities and awkwardly shaped spaces and can be transferred in part or in whole. The gracilis muscle used as a free muscle or musculocutaneous flap is small with a long, narrow contour and its vascular pedicle is a terminal branch of the medial femoral circumflex artery and vein. The aims of soft tissue reconstruction are to cover soft tissue defects, to clear up infection and to prepare for further surgical procedures. Authors have performed 12 gracilis muscle flaps in the lower extremities at Chonbuk National University Hospital from June 1994 through March 1998. The results were as follows. 1. 11 cases of 12(91.7%) were sustained from the crushing injury and secondary complications from the traffic accident. 2. The microsurgical anastomosis of one artery and two veins have performed in 6 cases(50%) of 12 and 11(91.7%) cases of 12 were successful at the third postoperative week and in the final result. 3. Gracilis muscle flap is the infetion-resistant and aesthetically acceptable performed in the lower leg 1/3 and the foot.

• Journal of the Korean Society of Radiology
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• v.5 no.5
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• pp.295-302
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• 2011

To n the field of nuclear medicine, with regard to checking regular patients, from the moment they register up to the doctor's diagnosis, the person in charge of the checks can find errors in the diagnosis, reexamine, reanalyze the results or save images to PACS. Through this process, the results obtained from the readings are delayed due to checks and additional tests which occur in hospitals, causing patient satisfaction and affected reliability. Accordingly, the purpose is to include visual inspection of the results to minimize error, improve efficiency and increase patient satisfaction. Nuclear medicine and imaging tests from examines at Asan Medical Center, Seoul, from March 2008 to December 2008, were analyzed for errors. The first stage, from January 2009 to December 2009, established procedures and know-how. The second stage from January 2010 until June 2010 conducted Pre-and Post-filtering assessment, and the third stage from July 2010 until October 2010 consisted of cross-checks and attaching stickers and comparing error cases. Of 92 errors, the 1st, 2nd and 3rd stage had 32 cases, and there were 46 cases after the 4th stage, with the overall errors reduced by 74.3% from 94.6%. In the field of general nuclear medicine, where various kinds of checks are performed according to the patient's needs, analysis, image composition, differing images in PACS, etc, all have the potential for mistakes to be made. In order to decrease error rates, the image can continuously Cross-Check and Confirm diagnosis.