The posterior malleolar fracture is relatively common fracture of the foot and ankle, but several aspects of this are still controversial. If the posterior malleolus is involved in the ankle fracture, the prognosis is usually poor. A computed tomography scan is essential for accurate diagnosis and treatment planning. Although indirect reduction and the anterior to posterior screw fixation technique have the advantages of a small incision with the requirement of relatively simple skills, direct open reduction and fixation from the posterior side provide a more biomechanically stable and accurate reduction. The precise reduction of the posterior malleolar fragment helps to achieve congruency of the tibia and fibula in the incisura and contributes to syndesmotic stability. It is important to determine the indications for surgical treatment by comprehensively evaluating the three-dimensional structure of the posterior malleolar fracture and all related injuries to the ankle.

Purpose: To survey the perception, knowledge, wishes, and expectations of Korean radiology residents regarding artificial intelligence (AI) in radiology. Materials and Methods: From June 4th to 7th, 2019, questionnaires comprising 19 questions related to AI were distributed to 113 radiology residents. Results were analyzed based on factors such as the year of residency and location and number of beds of the hospital. Results: A total of 101 (89.4%) residents filled out the questionnaire. Fifty (49.5%) respondents had studied AI harder than the average while 68 (67.3%) had a similar or higher understanding of AI than the average. In addition, the self-evaluation and knowledge level of AI were significantly higher for radiology residents at hospitals located in Seoul and Gyeonggi-do compared to radiology residents at hospitals located in other regions. Furthermore, the self-evaluation and knowledge level of AI were significantly lower in junior residents than in residents in the 4th year of training. Of the 101 respondents, only 16 (15.8%) had experiences in AI-related study while 91 (90%) were willing to participate in AI-related study in the future. Conclusion Organizational efforts through a radiology society would be needed to meet the need of radiology trainees for AI education and to promote the role of radiologists more adequately in the era of medical AI.

Purpose: Ankle fractures are common in the orthopedic field. Lateral malleolar fractures are often treated with lag screws and locking plates. Cortical screws are typically used as lag screws to achieve absolute stability through compression. In osteoporotic bone, however, achieving sufficient compression with cortical screws can be challenging. Cancellous screws may offer better fixation in metaphyseal bone. This study compared the outcomes of using cortical screws as lag screws and cancellous screws as position screws for lateral malleolar fixation. Materials and Methods: This retrospective study included patients who underwent surgery for Weber type B ankle fractures at the authors’ hospital between March 2019 and March 2022. The patients were divided into two groups based on the screw type: cortical lag screws (n=70) and cancellous position screws (n=35). In both groups, a locking plate was applied in the same manner after screw fixation. The outcomes were evaluated using the visual analog scale (VAS), Olerud-Molander score (OMS), foot and ankle outcome score (FAOS), and foot function index (FFI). Complications, such as fixation failure, nonunion, and malunion, were recorded. Results: One hundred and five patients were included. The mean follow-up duration was 16 months (range, 12~28 months). The VAS (1.6±1.9 vs. 1.1±1.3, p=0.305), FFI (10.3±13.4 vs. 10.4±13.5, p=0.970), FAOS (83.0±14.4 vs. 83.5±14.4, p=0.899), and OMS (85.3±18.4 vs.84.7±17.6, p=0.910) scores were similar in the two groups. No complications were reported in either group. Conclusion For the fixation of Weber B fibular fractures, cortical lag screws and cancellous position screws showed comparable clinical outcomes. Cancellous screws with plate fixation may offer a viable alternative in cases with poor bone quality or difficulty applying lag screw techniques.

Purpose: Ankle fractures are common in the orthopedic field. Lateral malleolar fractures are often treated with lag screws and locking plates. Cortical screws are typically used as lag screws to achieve absolute stability through compression. In osteoporotic bone, however, achieving sufficient compression with cortical screws can be challenging. Cancellous screws may offer better fixation in metaphyseal bone. This study compared the outcomes of using cortical screws as lag screws and cancellous screws as position screws for lateral malleolar fixation. Materials and Methods: This retrospective study included patients who underwent surgery for Weber type B ankle fractures at the authors’ hospital between March 2019 and March 2022. The patients were divided into two groups based on the screw type: cortical lag screws (n=70) and cancellous position screws (n=35). In both groups, a locking plate was applied in the same manner after screw fixation. The outcomes were evaluated using the visual analog scale (VAS), Olerud-Molander score (OMS), foot and ankle outcome score (FAOS), and foot function index (FFI). Complications, such as fixation failure, nonunion, and malunion, were recorded. Results: One hundred and five patients were included. The mean follow-up duration was 16 months (range, 12~28 months). The VAS (1.6±1.9 vs. 1.1±1.3, p=0.305), FFI (10.3±13.4 vs. 10.4±13.5, p=0.970), FAOS (83.0±14.4 vs. 83.5±14.4, p=0.899), and OMS (85.3±18.4 vs.84.7±17.6, p=0.910) scores were similar in the two groups. No complications were reported in either group. Conclusion For the fixation of Weber B fibular fractures, cortical lag screws and cancellous position screws showed comparable clinical outcomes. Cancellous screws with plate fixation may offer a viable alternative in cases with poor bone quality or difficulty applying lag screw techniques.

Purpose: Ankle fractures are common in the orthopedic field. Lateral malleolar fractures are often treated with lag screws and locking plates. Cortical screws are typically used as lag screws to achieve absolute stability through compression. In osteoporotic bone, however, achieving sufficient compression with cortical screws can be challenging. Cancellous screws may offer better fixation in metaphyseal bone. This study compared the outcomes of using cortical screws as lag screws and cancellous screws as position screws for lateral malleolar fixation. Materials and Methods: This retrospective study included patients who underwent surgery for Weber type B ankle fractures at the authors’ hospital between March 2019 and March 2022. The patients were divided into two groups based on the screw type: cortical lag screws (n=70) and cancellous position screws (n=35). In both groups, a locking plate was applied in the same manner after screw fixation. The outcomes were evaluated using the visual analog scale (VAS), Olerud-Molander score (OMS), foot and ankle outcome score (FAOS), and foot function index (FFI). Complications, such as fixation failure, nonunion, and malunion, were recorded. Results: One hundred and five patients were included. The mean follow-up duration was 16 months (range, 12~28 months). The VAS (1.6±1.9 vs. 1.1±1.3, p=0.305), FFI (10.3±13.4 vs. 10.4±13.5, p=0.970), FAOS (83.0±14.4 vs. 83.5±14.4, p=0.899), and OMS (85.3±18.4 vs.84.7±17.6, p=0.910) scores were similar in the two groups. No complications were reported in either group. Conclusion For the fixation of Weber B fibular fractures, cortical lag screws and cancellous position screws showed comparable clinical outcomes. Cancellous screws with plate fixation may offer a viable alternative in cases with poor bone quality or difficulty applying lag screw techniques.

Purpose: Ankle fractures are common in the orthopedic field. Lateral malleolar fractures are often treated with lag screws and locking plates. Cortical screws are typically used as lag screws to achieve absolute stability through compression. In osteoporotic bone, however, achieving sufficient compression with cortical screws can be challenging. Cancellous screws may offer better fixation in metaphyseal bone. This study compared the outcomes of using cortical screws as lag screws and cancellous screws as position screws for lateral malleolar fixation. Materials and Methods: This retrospective study included patients who underwent surgery for Weber type B ankle fractures at the authors’ hospital between March 2019 and March 2022. The patients were divided into two groups based on the screw type: cortical lag screws (n=70) and cancellous position screws (n=35). In both groups, a locking plate was applied in the same manner after screw fixation. The outcomes were evaluated using the visual analog scale (VAS), Olerud-Molander score (OMS), foot and ankle outcome score (FAOS), and foot function index (FFI). Complications, such as fixation failure, nonunion, and malunion, were recorded. Results: One hundred and five patients were included. The mean follow-up duration was 16 months (range, 12~28 months). The VAS (1.6±1.9 vs. 1.1±1.3, p=0.305), FFI (10.3±13.4 vs. 10.4±13.5, p=0.970), FAOS (83.0±14.4 vs. 83.5±14.4, p=0.899), and OMS (85.3±18.4 vs.84.7±17.6, p=0.910) scores were similar in the two groups. No complications were reported in either group. Conclusion For the fixation of Weber B fibular fractures, cortical lag screws and cancellous position screws showed comparable clinical outcomes. Cancellous screws with plate fixation may offer a viable alternative in cases with poor bone quality or difficulty applying lag screw techniques.

PURPOSE: To evaluate the efficacy of catheter-directed thrombolysis in treating symptomatic deep venous thrombosis (DVT) in lower limbs. METHODS: Between Jan. 1999 and Dec. 2002, 29 consecutive patients with DVT had received thrombolytic therapy. The male: female ratio was 6: 23 and the mean age was 50.3+/-13.5 years. The mean duration of symptom was 9.9+/-22.1 days. Catheter-directed infusions of urokinase were administrated via ipsilateral popliteal veins and the angioplasty and stent placement performed after the thrombolytic procedure. The mean dosage of urokinase and duration of thrombolysis were 2, 435, 000+/-887, 000 units and mean duration of thrombolysis was 36.8+/-17.9 hours. Oral medication of warfarin continued at least six months or more. To evaluate the venous patency, duplex ultrasonography or CT venography were performed. RESULTS: Lysis was complete in 17 patients (58.6%, all acute DVT), partial in 11 (37.9%), with only one patient failing. Iliac vein stenosis had shown in 16 patient after thrombdysis. Which were treated with balloon angioplasty and stent insertion. As a postprocedural complication, vaginal bleeding occurred in two patients; one was treated with transfusion but the other stopped without treatment. CONCLUSION: Catheter-directed thrombolysis with urokinase is effective for the treatment of DVT in lower limbs. However further study will be reguired to evaluate the relationship between the incidence of postthrombotic syndrome and thrombolytic therapy alone.
Angioplasty ; Angioplasty, Balloon ; Constriction, Pathologic ; Female ; Humans ; Iliac Vein ; Incidence ; Lower Extremity ; Male ; Phlebography ; Popliteal Vein ; Postthrombotic Syndrome ; Stents ; Thrombolytic Therapy ; Ultrasonography ; Urokinase-Type Plasminogen Activator* ; Uterine Hemorrhage ; Venous Thrombosis* ; Warfarin

PURPOSE: Abdominal computed tomography (CT) is a widely recognized method to diagnose patients with acute abdominal pain in the emergency departments (EDs). We aimed to investigate the current state and interpretations of abdominal CT performed in the ED of a tertiary university hospital. METHODS: This was a retrospective study based on an abdominal CT database and medical records of patients over 15 years of age, who had visited our ED between January 1 and December 31, 2013. The data collected included CT types, final interpretations, characteristics of the patients, and location of pain at the time of CT. RESULTS: A total of 1,978 abdominal CTs were performed among 1,923 patients during the research period. The most frequent organs involved in the major diagnosis were those in the urinary system, followed by the appendix, liver, large intestine, and gallbladder. The most frequently interpreted diagnoses in these organs were in the order of urinary stone, appendicitis, liver cirrhosis, infectious colitis, and acute cholecystitis. The most frequent location of pain was the right lower quadrant (429 cases, 21.7%), and the most frequently performed CT types were contrast-enhanced abdominal and pelvic CT (1,260 cases, 63.7%). CONCLUSION: Various interpretations were derived based on the abdominal CTs, ranging from critical to mild diseases and from common to rare diseases. Based on this study, we have developed a preliminary interpretation checklist for abdominal CTs.
Abdominal Pain ; Appendicitis ; Appendix ; Checklist* ; Cholecystitis, Acute ; Colitis ; Diagnosis ; Emergencies* ; Emergency Service, Hospital* ; Gallbladder ; Humans ; Intestine, Large ; Liver ; Liver Cirrhosis ; Medical Records ; Methods ; Rare Diseases ; Retrospective Studies ; Tomography, X-Ray Computed ; Urinary Calculi

Background: Laser laryngeal microsurgery is a common treatment of vocal fold polyps (VFP), a leading causeof dysphonia. The CO2 laser is predominantly used for its precision in excising delicate tissues while minimizingdamage to the surrounding healthy tissue. The 532-nm diode laser can also be employed for the cauterization of the microvasculature within the vocal folds. This study aims to evaluate the efficacy of the 532-nm diode laser in the treatment of VFP. Methods: Forty-four patients diagnosed with VFP were enrolled and underwent laser laryngeal microsurgery using a CO2 laser. The patients were divided into two groups: one receiving additional treatment with the 532-nm diode laser. Voice status was assessed and compared preoperatively and postoperatively using acoustic analysis, aerodynamic analysis, voice range profile, the GRBAS scale, and the voice handicap index (VHI). Results: The mean flow rate and maximal pitch showed significant improvements from preoperative to postoperative measurements in additional 532-nm diode laser treatment group. All objective indicators demonstrated normalization and enhancement following surgery. Subjective perceptual assessments also indicated significant improvement postoperatively, and the VHI showed improvement across all domains.However, there was no significant difference in the test results between the two groups, regardless of the additional use of the 532-nm diode laser. Conclusion Laser phonomicrosurgery using both CO2 and 532-nm diode lasers is an effective in treating VFP. Although the additional benefit of the diode laser was not conclusively demonstrated, its potential for photocoagulating the vocal fold microvasculature suggests further research is warranted.

Background: Rheumatoid arthritis (RA) is a chronic autoimmune disorder that frequently causes forefoot deformities. Arthrodesis of the first metatarsophalangeal joint is a common surgery for severe hallux valgus. However, joint-preserving surgery can maintain the mobility of the joint. This study aimed to investigate the clinical and radiographic outcomes of distal chevron metatarsal osteotomy (DCMO) for correcting hallux valgus deformity associated with RA. Methods: Between August 2000 and December 2018, 18 consecutive patients with rheumatoid forefoot deformities (24 feet) underwent DCMO for hallux valgus with/without lesser toe surgery. Radiological evaluations were conducted, assessing the hallux valgus angle, the intermetatarsal angle between the first and second metatarsals, and the Sharp/van der Heijde score for erosion and joint space narrowing. Clinical outcomes were quantified using a visual analog scale for pain and the American Orthopaedic Foot and Ankle Society forefoot scores to measure function and alignment. Results: The mean hallux valgus angle decreased from 38.0° (range, 25°–65°) preoperatively to 3.5° (range, 0°–17°) at the final follow-up (p < 0.05). The mean intermetatarsal angle decreased from 14.9° (range, 5°–22°) preoperatively to 4.3° (range, 2°–11°) at the final follow-up. (p < 0.05). Regarding the Sharp/van der Heijde score, the mean erosion score (0–10) showed no significant change, decreasing from 3.83 (range, 0–6) preoperatively to 3.54 (range, 0–4) at the final follow-up (p = 0.12). Recurrent hallux valgus was observed in 1 patient and postoperative hallux varus deformity was observed in 2 feet. Spontaneous fusion of the metatarsophalangeal joint developed in 1 case. Conclusions DCMO resulted in satisfactory clinical and radiographic outcomes for correcting RA-associated hallux valgus deformity.