Achilles tendon rupture is a common sports injury encountered in younger populations. Various treatment methods are used for acute and chronic rupture. Several treatments for each condition are available, each having their advantages and disadvantages. In an acute rupture, surgical treatment may be a priority for younger patients or those wishing a quick return to play, but the long-term functional outcome is similar to non-surgical treatment. In addition, the re-rupture rate shows a slight difference between the two treatments. The clinical outcomes are similar regardless of the surgical treatment, but an accelerated rehabilitation program should be accompanied by good results. In chronic and neglected rupture, surgical treatment is preferred over non-surgical treatment. Treatments are chosen based on the size of the tendon defect. This article reviews the current updates in the treatment of Achilles tendon rupture that will help clinicians choose the appropriate treatment.
Achilles Tendon ; Athletic Injuries ; Humans ; Rehabilitation ; Return to Sport ; Rupture ; Tendons

Open reduction in an AO 33-A3 class distal femur transverse and comminuted fracture is often difficult due to frequent reduction loss during surgery, leading to longer operative time and increased blood loss intra-operation. In this study, the authors report a case in which the use of an offset grid plate (OsteoMed, USA) using 2.4 mm HPS (hand plating system) eased the process of fracture reduction and achieved a stable internal fixation, ultimately leading to successful osteosynthesis. The authors experienced no need for temporary fixation devices such as K-wires or screws, which are otherwise required to stabilize the reduction. The fracture reduction was stable throughout the primary fixation of the fracture using a locking plate and screws. The authors report that the advantage of the HPS plate is fitting into the cortical contour and providing stable maintenance of fracture reduction intra-operation, which would be beneficial in certain distal femoral fracture patterns.

In comminuted patellar fractures, we performed modified tension band wiring using a FiberWire (Arthrex) instead of the conventional methods. From March 2016 to March 2018, 63 patients with patellar fractures who needed surgical treatment were treated with modified tension band wiring using two Kirschner wires (K-wires) and FiberWire. We inserted two 1.6-mm K-wires perpendicular to the fracture line after accurate reduction. With the knee flexed over 90°, we sutured around the patella using a FiberWire. Visual analog scale score and Levack's score were improved postoperatively. The mean bone union time was 5.6 months. None of the patients had breakage of wires, and nonunion with deformity occurred in one patient. We think that our method can be easier to handle and reduce irritation or breakage of the wires than conventional methods. In addition, early rehabilitation can be allowed. Therefore, we suggest that this method could be a useful method for the treatment of patellar fractures.
Bone Wires ; Congenital Abnormalities ; Humans ; Knee ; Methods ; Patella ; Rehabilitation ; Visual Analog Scale

Recurrent spontaneous hemarthrosis is a relatively rare complication of total knee arthroplasty. This paper reports a case of a patient treated with arterial embolization for recurrent spontaneous hemarthrosis even after undergoing arthroscopic surgery. The patient had several relapses after total knee arthroplasty.

This study was conducted to evaluate the association of single serum total cholesterol (TC) measurement with cardiovascular diseases (CVD) deaths in Korean adults. The study subjects were taken from the multi-site collaborative dynamic prospective cohort for epidemiologic investigation on cancer risk in residents nearby nuclear power plants in Korea. A total of 12,740 adults aged 40 to 69 yr who underwent a mass screening examination were followed up from 1993 to 2008. Occurring CVD deaths were confirmed by the death certificates in the National Statistical Office, Korea. Groups with the lowest group having TC < 160 mg/dL as well as the highest group having >= 240 mg/dL were associated with higher CVD mortality in Cox proportional hazards analysis adjusting for age, sex, smoking and drinking status, body mass index, level of blood pressure, triglyceride and high density lipoprotein cholesterol. The distribution of adjusted hazard ratios showed the U-shaped curve. Based on the results of this study, caution should be taken in prescribing statins for primary prevention among people at low cardiovascular risk in Korean adults.
Adult ; Age Factors ; Aged ; Alcohol Drinking ; Blood Pressure ; Body Mass Index ; Cardiovascular Diseases/*blood/epidemiology/*mortality ; Cholesterol/*blood ; Cohort Studies ; Female ; Humans ; Male ; Middle Aged ; Proportional Hazards Models ; Prospective Studies ; Republic of Korea/epidemiology ; Risk Factors ; Sex Factors ; Smoking ; Triglycerides/blood

Statement of problem: Many factors influence shade determination in clinical practice and shade matching is highly affected by the viewing conditions. Purpose: This study investigated the differences in shade perception among distinct groups of dental personnel (10 prosthodontists, 10 general practitioners, 10 last-year dental students and 10 dental technicians). Material and method: Four groups of dental personnel were investigated. They were tested to eliminate color blindness. To compare shade selection ability, they were asked to match four test tabs of shades A3, B2, C2 and D4 (VITAPAN. Classical shade guide. The identification codes of the shade tabs were masked to prevent shade memory.) against another full set of VITAPAN. Classical shade guide under similar lighting conditions. Shade selections were randomly repeated five times every week and then the repeatability between dental personnel was evaluated. To compare value perception ability, they were asked to arrange randomly selected five test tabs (B1, A2, D2, C3, A4) in descending order from the brightest to the darkest. To compare hue determination ability, they were asked to divide selected eight test tabs (A2, A3, B2, B3, C2, C3, D2, D3) into four groups by manufacturer as follows: Group A-Reddish brown, Group B-Reddish yellow, Group C-Grey, Group D-Reddish grey. Results and conclusion: The obtained results were as follows: 1. For the value perception ability and hue determination ability, there was no significant difference among 4 groups: prosthodontists, general practitioners, dental students, dental technicians(P>.05). 2. For shade selection ability, the prosthodontists and dental technicians were significantly higher than dental students(P<.05). 3. The repeatability of selected shade in the dental technicians was significantly higher than that of general practitioners and dental students(P<.05). 4. The prosthodontists and dental technicians had significantly higher selection ability than dental students for shade B2(P<.05).
Color Vision Defects ; Dental Technicians ; General Practitioners ; Humans ; Masks ; Perception* ; Students, Dental

PURPOSE: To evaluate the radiological and clinical outcomes of the standard total knee arthroplasty without internal fixation or extended long stem in tibial bone defect with severe varus deformity. MATERIALS AND METHODS: Between July 2012 and April 2014, 32 patients (45 cases; 4 men and 41 women with a mean age of 74.2 years) who underwent total knee arthroplasty with autologous bone grafting were enrolled for analysis. The mean follow-up period was 34.4 months. The cancellous bone defect site was exposed, and a longitudinal sulcus was made. Subsequently, a premolded bone graft was inserted in the sulcus at 45°. The defect size was measured, and the radiological and clinical results were evaluated. RESULTS: The mean defect size according to the radiograph was found to be 15.31×30.36 mm in the frontal view and 15.46×45.98 mm in the sagittal view. The mean defect size of depth during the operation was found to be 8.38 mm. The preoperative mean varus angle was 14.1° (4.0°–26.9°), and the follow-up mean valgus angle was 5.4° (0.5°–10.5°). The implant position was α=95.7°, β=90.4°, γ=2.1°, δ=89.1° on the follow-up. No implant loosening was observed, and the mean bone union period was 4.3 months. The Hospital for Special Surgery score was improved from a preoperative mean of 50.1 to a postoperative mean of 90.4. CONCLUSION: Standard total knee arthroplasty using autologous structural bone grafting without internal fixation in a tibial bone defect demonstrated a rapid, stable bone healing and excellent radiological and clinical results. Thus the index procedure was considered to be simple, and effective for bone grafting.
Arthroplasty, Replacement, Knee* ; Bone Transplantation ; Congenital Abnormalities ; Female ; Follow-Up Studies ; Humans ; Male ; Transplants*

PURPOSE: The purpose of this study was to assess the effectiveness and complications of an ultrasound-guided axillary brachial plexus block performed by orthopedic surgeons. MATERIALS AND METHODS: From March to May 2017, an ultrasound-guided axillary brachial plexus block was performed on a total of 103 cases of surgery. A VF13-5 transducer from Siemens Acuson X300 was used. The surgical site was included in the range of the anatomic sensory distribution of the blocked nerve, except for the case where an operation time of more than 2 hours was expected due to multiple injuries and the operation of the upper arm. The procedure was performed by 2 orthopedic surgeons in the same method using 50 ml of solution (20 ml of lidocaine HCl in 2%, 20 ml of ropivacaine in 0.75%, 10 ml of normal saline in 0.9%). The success rate of anesthesia induction during surgery, anesthetic induction time, anatomical range of operation, duration of postoperative analgesia and complications were investigated. RESULTS: The results from the 2 practices were similar. The anesthesia was successful in 100 out of 103 patients (97.1%). In these patients, the average needling time was 5.5 minutes (2.5–13.2 minutes), the average induction time to complete anesthesia was 18.4 minutes (5–40 minutes), and the average duration of postoperative analgesia was 402.8 minutes (141–540 minutes). The post-anesthesia immediate complications were dizziness in 1 case, nausea and vomiting in 4 cases, and peri-oral numbness in 2 cases, but surgery was performed without problems. All these 7 cases with complications recovered on the same day. A total of 3 cases failed with anesthesia, and they were treated by an injection with local anesthesia in the operation room in 2 cases and switched to general anesthesia in 1 case. CONCLUSION: An ultrasound-guided axillary brachial plexus block, which was performed by orthopedic surgeons allows anesthesia in a brief period and the high success rates of anesthesia for certain surgeries of the elbow and surgeries on forearm, wrist and hand. Therefore, it can reduce the waiting time to the operating room. This technique is a relatively safe procedure and dose selective anesthesia is possible.
Analgesia ; Anesthesia ; Anesthesia, General ; Anesthesia, Local ; Arm ; Brachial Plexus Block* ; Brachial Plexus* ; Dizziness ; Elbow ; Forearm ; Hand ; Humans ; Hypesthesia ; Lidocaine ; Methods ; Multiple Trauma ; Nausea ; Operating Rooms ; Orthopedics* ; Surgeons* ; Transducers ; Vomiting ; Wrist

Background: Before publication of the new classification system named the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) in 2018, there was no standard classification for salivary gland lesions obtained by fine-needle aspiration (FNA). We therefore aimed to evaluate the diagnostic utility of this system by retrospectively reviewing FNA samples using the MSRSGC and to determine their risk of developing into neoplasms and becoming malignant. Methods: Retrospective slide review and classification of salivary gland FNAs obtained over a 6-year period (2013–2018) at a single center were performed by two pathologists. The risks of neoplasm and malignancy for each category also were calculated. Results: This study surveyed 374 FNAs (371 patients) performed over a six-year period and selected 148 cases that included documented surgical follow-up (39.6%). Among the surgically treated cases, the distributions of FNA categories were as follows: non-diagnostic (ND; 16.9%), non-neoplastic (NN; 2.7%), atypia of undetermined significance (AUS; 3.4%), benign (BN; 54.7%), salivary gland neoplasm of uncertain malignant potential (SUMP; 10.1%), suspicious for malignancy (SM; 6.8%), and malignant (M; 5.4%). The risk of malignancy (ROM) was 24.0% for ND, 0% for NN, 40.0% for AUS, 2.5% for BN, 46.7% for SUMP, 100% for SM, and 87.5% for M. The overall diagnostic accuracy was 95.9% (142/148 cases). Conclusions The newly proposed MSRSGC appears to be a reliable system for classification of salivary gland lesions according to the associated ROM.

The recent increase in the number of cases of indigenous hepatitis E virus (HEV) infection highlights the importance of identifying the transmission routes for the prevention of such infections. Presented herein is the first case of acute HEV infection after ingesting wild roe deer meat in South Korea. A 43-year-old male presented with abdominal discomfort and jaundice. He had not recently traveled abroad, but had eaten raw roe-deer meat 6-8 weeks before the presentation. On the 7th day of hospitalization the patient was diagnosed with acute viral hepatitis E. Phylogenetic analysis of his serum revealed genotype-4 HEV. This case supports the possibility of zoonotic transmission of HEV because the patient appears to have been infected with genotype-4 HEV after ingesting raw deer meat.
Adult ; Alanine Transaminase/blood ; Animals ; Bilirubin/blood ; Deer/virology ; Genotype ; Hepatitis E/*diagnosis/transmission/virology ; Hepatitis E virus/classification/*genetics/isolation & purification ; Humans ; Male ; Phylogeny ; RNA, Viral/analysis ; Republic of Korea ; Travel