Kyu Jung Cho

Minimally Invasive Coracoclavicular Stabilization with Suture Anchors for Acute Acromioclavicular Dislocation

Background The management of acute acromioclavicular (AC) joint dislocation is controversial. Purpose The authors describe a surgical technique involving securing the clavicle to the coracoid process using suture anchors for the treatment of acute AC joint injury. Study Design Case series; Level of evidence, 4. Methods Twenty patients were evaluated retrospectively, clinically, and radiographically, for a mean of 41.2 months. Results At last follow-up, the mean Constant score for the 20 patients was 89.5. Eighteen patients (90%) maintained complete AC joint reduction in both anteroposterior and axillary views. Slight loss of reduction was noted in 2 patients (10%), but their functional outcomes were good. No fixation failure or pulling out of suture anchors was encountered. Conclusion This minimally invasive technique using a suture anchor for the treatment of acute AC dislocation is easily performed.

How Does Chronic Back Pain Influence Quality of Life in Koreans: A Cross-Sectional Study

Study Design A cross-sectional study. Purpose To explore the impact of chronic low back pain (CLBP) on individuals quality of life; to understand current treatment practices and level of satisfaction with treatment in patients with CLBP. Overview of Literature Assessing subjective, patient-reported outcomes such as quality of life is essential to health care research. Methods Influences of the CLBP were analyzed via a questionnaire, which contained the character of CLBP, effect of pain management, Korean version Oswestry Disability Index (K-ODI) and Korean version of 12-item Short Form Health Survey (SF-12v2). Results Of 3,121 subjects who responded, 67.3% had moderate to severe pain; 43.5% presented prolonged CLBP of more than two years; and 32.4% had suffered from sleep disturbance due to pain. 22.8% of the patients were not satisfied with current pain management. The mean K-ODI score was 37.63; and it was positively correlated with the mean pain intensity (r=0.6, p<0.001). The SF-12v2 result was negatively correlated with mean pain intensity (PCS: r=-0.5, p<0.001; MCS: r=-0.4, p<0.001) and also negatively correlated with the K-ODI score (PCS: r=-0.75, p<0.001; MCS: r=-0.5, p<0.001). The conformity between patients and doctors in pain assessment was fair (κ=0.2463). Conclusions CLBP negatively affects quality of life. Of total 22.8% of the patients were not satisfied with current pain management. Such needs to be taken more seriously by doctors for improvement of satisfaction and quality of life in patients with CLBP.

Subsequent Hip Fracture in Osteoporotic Hip Fracture Patients

Purpose A significant number of patients who have experienced previous surgical treatment for an osteoporotic hip fracture experience a subsequent hip fracture (SHF) on the opposite side. This study aims to analyze the risk factors and the correlation between osteoporosis and SHF on the opposite side in order to assess the usefulness of bisphosphonate treatment for the prevention of SHFs. Materials and Methods We included 517 patients treated from March 1997 to April 2009 in this study. The inclusion criteria included previous unilateral hip fracture, without osteoporotic treatment, and a T-score less than -3.0 at the time of the fracture. We studied these patients in terms of death, SHF, alcoholism, living alone, dementia, dizziness, health status, osteoporotic treatment after fracture and bone mineral density (BMD). In total, 34 patients experienced a SHF. We selected another 34 patients without a SHF who had similar age, sex, body mass index, BMD, diagnosis, treatment and a follow up period for a matched pair study. We compared these two groups. The average follow up was 8.3 years and 8.1 years, respectively. Results The mortality rate of the 517 patients was 138 (27%). The BMD at the time of fracture demonstrated no statistical difference between the two groups (p>0.05). Nine patients (26%) within the SHF group were prescribed Risedronate and 18 patients (53%) received the same treatment in the non-SHF group. There was a statistical relationship with the treatment of osteoporosis (p=0.026). The average BMD of patients with SHF was -5.13 and -5.02 in patients without SHF was (p>0.05). Conclusion Although primary surgical treatments are important for an excellent outcome in osteoporotic hip fractures, treatment of osteoporosis itself is just as important for preventing SHFs.

A Nationwide Retrospective Study of Opioid Management Patterns in 2,468 Patients with Spinal Pain in Korea

Study Design Retrospective patient data collection and investigator survey. Purpose To investigate patterns of opioid treatment for pain caused by spinal disorders in Korea. Overview of Literature Opioid analgesic prescription and adequacy of consumption measures in Korea have markedly increased in the past decade, suggesting changing patterns in pain management practice; however, there is lack of integrated data specific to Korean population. Methods Patient data were collected from medical records at 34 university hospitals in Korea. Outpatients receiving opioids for pain caused by spinal disorders were included in the study. Treatment patterns, including opioid types, doses, treatment duration, outcomes, and adverse drug reactions (ADRs), were evaluated. Investigators were interviewed on their perceptions of opioid use for spinal disorders. Results Among 2,468 analyzed cases, spinal stenosis (42.8%) was the most common presentation, followed by disc herniation (24.2%) and vertebral fracture (17.5%). In addition, a greater proportion of patients experienced severe pain (73.9%) rather than moderate (19.9%) or mild (0.7%) pain. Oxycodone (51.9%) and fentanyl (50.8%) were the most frequently prescribed opioids; most patients were prescribed relatively low doses. The median duration of opioid treatment was 84 days. Pain relief was superior in patients with longer treatment duration (≥2 months) or with nociceptive pain than in those with shorter treatment duration or with neuropathic or mixed-type pain. ADRs were observed in 8.6% of cases. According to the investigators survey, excellent analgesic effect was a perceived advantage of opioids, while safety concerns were a disadvantage. Conclusions Opioid usage patterns in patients with spinal disorders are in alignment with international guidelines for spinal pain management. Future prospective studies may address the suitability of opioids for spinal pain treatment by using appropriate objective measurement tools.

Analgesic efficacy and safety of prolonged-release oxycodone/naloxone in Korean patients with chronic pain from spinal disorders

Background A prolonged-release formulation of oxycodone/naloxone has been shown to be effective in European populations for the management of chronic moderate to severe pain. However, no clinical data exist for its use in Korean patients. The objective of this study was to assess efficacy and safety of prolonged-release oxycodone/naloxone in Korean patients for management of chronic moderate-to-severe pain. Methods In this multicenter, single-arm, open-label, phase IV study, Korean adults with moderate-to-severe spinal disorder-related pain that was not satisfactorily controlled with weak opioids and nonsteroidal anti-inflammatory drugs received prolonged-release oral oxycodone/naloxone at a starting dose of 10/5 mg/day (maximum 80/40 mg/day) for 8 weeks. Changes in pain intensity and quality of life (QoL) were measured using a numeric rating scale (NRS, 0–10) and the Korean-language EuroQol-five dimensions questionnaire, respectively. Results Among 209 patients assessed for efficacy, the mean NRS pain score was reduced by 25.9% between baseline and week 8 of treatment (p < 0.0001). There was also a significant improvement in QoL from baseline to week 8 (p < 0.0001). The incidence of adverse drug reactions was 27.7%, the most common being nausea, constipation, and dizziness; 77.9% of these adverse drug reactions had resolved or were resolving at the end of the study. Conclusions Prolonged-release oxycodone/naloxone provided significant and clinically relevant reductions in pain intensity and improved QoL in Korean patients with chronic spinal disorders. (ClinicalTrials.gov identifier: NCT01811238)

Brachial Artery Transection with Closed Elbow Dislocation - A Case Report -

Vascular injury in the arm associated with trauma usually results from penetrating injury. However, this vascular injury can also be caused by open dislocation of the elbow or closed fracture of the humerus. Although the elbow joint is the third most common site of joint dislocation, closed elbow dislocations without associated fractures rarely have concomitant arterial injury. The authors report a case of complete disruption of the brachial artery associated with closed dislocation of the elbow and massive soft tissue damage. The patient was successfully managed by early diagnosis, prompt reduction of the dislocation, and end to end anastomosis of the brachial artery and fasciotomy.

Change of Periprosthetic Bone Mineral Density after Cementless Total Hip Arthroplasty - Using Extensively Porous Coated Femoral Stem -

Purpose : To investigate the annual change of bone mineral density (BMD) around the femoral stem and identified the factors that influence the stress shielding effect in patients who have received extensively porous coated cementless stem. Materials and Methods : We reviewed seventy-four patients who were followed up for longer than three years after unilateral primary total hip replacement arthroplasty. The BMD was measured annually using a DEXA QDR on the proximal femur according at the Gruen zone. We analyzed the relationship between the results and the possible variates of periprosthetic bone remodeling. Results : In first year after operation, the BMDs of all Gruen zone decreased significantly. From the second year, the BMDs in Gruen zones 1, 2, and 7 were decreased significantly, but those in Gruen zones 3, 5, and 6 were increased. After three years, the BMD showed no significant change. Among the examined variables including sex, patient’s age, stem size, and preoperative Singhs index, stem size and age were found to have strong predictive value. Conclusion : Our findings suggest that periprosthetic BMD decreased in all areas over first postsurgical year. From the third year, the BMD stabilized.