PURPOSE: To assess union and complication rates associated with the use of 2 small diameter headless compression screws and volar wedge bone grafting for the treatment of scaphoid fracture waist nonunions with collapse. METHODS: A total of 12 patients (11 male and 1 female) at an average age of 32.5 years were treated with open reduction and internal fixation with 2 small diameter headless compression screws for scaphoid nonunions with a mean follow-up of 11 months. Tricortical wedge shaped autograft were harvested from the iliac crest and placed into the nonunion site to restore length and alignment in all patients. Union was determined by radiographs and computed tomography, and scapholunate and radiolunate angles, and height-to-length ratio were calculated on final radiographs and follow-up computed tomography. RESULTS: All 12 scaphoids united with a mean time for 2.8 months. The mean postoperative scapholunate angle was significantly reduced from 73° preoperatively to 56° postoperatively. The mean radiolunate angle was significantly improved from 21° from neutral preoperatively to 12° postoperatively. The height-to-length ratio was also demonstrated significant improvement from 0.73 preoperatively to 0.60 postoperatively. No hardware problems were identified and no revision procedures have been necessary. CONCLUSION: Our results indicate that the use of 2 small diameter headless compression screws with volar structural bone graft stabilizes the fracture for predictable union, while reducing the deformity reliably from a collapsed scaphoid nonunion. The presented technique is safe and effective, and may provide superior biomechanical stability, especially against the torsional force.
Autografts ; Bone Transplantation ; Congenital Abnormalities ; Follow-Up Studies ; Humans ; Male ; Torsion, Mechanical ; Transplants

OBJECTIVE: Dystonia is a movement disorder in which muscles contract uncontrollably. Acute drug-induced dystonia (DID) can be diagnosed through detailed history taking and physical examination. This study aimed to identify the clinical characteristics of DID in children, which could help emergency physicians diagnose these conditions more efficiently. METHODS: We reviewed medical records of children aged below 18 years diagnosed with drug-related dystonia after discharge from the emergency department over 10 years. We collected the patients’ age, sex, suspected causative drugs, initial diagnosis of the prescribing physician, duration of drug-taking, diagnostic evaluations, treatment methods, and prognosis. RESULTS: Seventy-nine patients were enrolled. The mean age was 11.3±4.9 years (range, 4.0 months to 18.0 years), and 41 patients (51.9%) were boys. The most common cause of DID was gastrointestinal medications in 45 patients (57.0%), followed by antipsychotics in 23 patients (29.1%). Eleven (24.4%) out of 45 patients with DID due to gastrointestinal medications had the initial diagnosis of upper respiratory infection, and seven (30.4%) out of 23 patients with DID due to antipsychotics had the initial diagnosis of non-psychotic diseases. Younger children received more diagnostic procedures and were more frequently admitted. A benzodiazepine (67.1%) was the most common single drug for treatment. CONCLUSION: Physicians should not only acknowledge DID in order to reduce unnecessary workup and admission, but also know that antiemetics and antipsychotics are common causes of DID. Therefore, physicians should try to avoid multidrug prescriptions in children.
Antiemetics ; Antipsychotic Agents ; Benzodiazepines ; Child ; Diagnosis ; Dystonia* ; Emergencies ; Emergency Service, Hospital ; Humans ; Medical Records ; Movement Disorders ; Muscles ; Pharmaceutical Preparations ; Physical Examination ; Prescriptions ; Prognosis

Purpose: This study compared the radiologic and clinical outcomes of metacarpal fractures treated with two minimally invasive surgical techniques: Kirschner wire (K-wire) fixation and headless screw fixation. Materials and Methods: This study included 52 patients (46 males and 6 females; age 18-55 years) with distal metacarpal fractures (middle and distal shaft, including the neck) who had undergone K-wire fixation or headless screw fixation. All subjects were followed up for at least six months. The radiologic assessments were performed to evaluate the angular deformity and shortenings. The total active motion (TAM), grip strength, and patients’ subjective functional assessment were measured to evaluatethe hand function. The time taken to return to work (RTW) and adverse events were analyzed. Results: Of the 52 cases, metacarpal fractures treated with headless screw fixation and K-wire fixation showed a significant difference associated with early RTW (p<0.05). There were no significant differences between the subjects treated with K-wire fixation and those with headless screw fixation in terms of the radiologic measurement, hand function examinations, complications, and adverse events (p>0.05). Conclusion After a six-month follow-up, minimally invasive K-wire fixation and headless screw fixation produced similar clinical and radiologic outcomes in subjects with metacarpal fractures. Compared to K-wire fixation, however, headless screw fixation led to earlier functional recovery and might be a better option for treating metacarpal fractures in this regard.

Tuberculosis involving the central airway occasionally results in diffuse stenosis in the distal trachea and main bronchus. When the stenosis is more limited to the main bronchus, sleeve resection can be performed with high likelihood of a good result. Bronchial stenosis limited to 2 cm is considered favorable for bronchial sleeve resection. However, a longsegment stenosis may make sleeve resection difficult or impossible, and pneumonectomy or therapeutic bronchoscopy may be performed. An extended sleeve lobectomy is a procedure to remove more than one lobe using a bronchoplasty technique and its applications to the patients with locally advanced lung cancer were reported. We performed an extended sleeve lobectomy in a patient with tuberculous bronchial stenosis involving the right main bronchus, bronchus intermedius, right middle lobar bronchus and right lower lobar bronchus, and report this case with review of literatures.
Bronchi ; Bronchoscopy ; Constriction, Pathologic ; Humans ; Lung Neoplasms ; Pneumonectomy ; Trachea ; Tuberculosis

Purpose: We analyzed the choroidal thickness in the subfoveal area and area of retinal detachment (RD) in monocular primary rhegmatogenous retinal detachment (RRD) patients and compared the RD eye with the fellow eye. Methods: We retrospectively analyzed, optical coherence tomography data of both eyes at the first visit in patients who underwent surgery for monocular RRD from January 2013 to December 2016. Choroidal thickness was examined manually in the subfoveal and RD areas by two independent ophthalmologists; subjects without data from at least one of the two investigators were excluded. Results: Ninety-five subjects were included in this study. Of the 95 RD eyes, 61 (64.2%) and 44 (46.3%) eyes showed macula and fovea invasion, respectively. The subfoveal choroidal thickness was statistically significant in the RD eye compared with the fellow eye (244.7 ± 79.0 µm vs. 220.1 ± 78.9 µm; p < 0.001). Moreover, the choroidal thickness of the RD area in the RD eye was thicker compared with the non-detachment area and corresponding area in the fellow eye (273.8 ± 53.4 µm vs. 215.2 ± 44.0 µm and 233.3 ± 56.7 µm, respectively; p < 0.001). Conclusions In the primary RRD eye, the choroidal thickness in the detachment area was thicker than that of the fellow eye. Further studies are needed to investigate the mechanism of choroidal thickness change and its impact on RD.

Methods: Thirty-six patients with calcific tendinitis of the shoulder treated by US-guided barbotage with a spinal needle and subacromial steroid injection were included in the study. We evaluated clinical outcomes based on American Shoulder and Elbow Surgeons (ASES) score, Constant score, and visual analog scale (VAS) for pain score. Radiological outcomes were assessed by X-ray imaging at each visit. Results: Our results showed that US-guided barbotage and subacromial steroid injection produced good clinical and radiological outcomes in patients with calcific tendinitis of the shoulder. Of the 36 patients, only one required surgical treatment, while the others showed improvement without any complications. Compared to values before the procedure, calcific deposit size and VAS, ASES, and Constant scores showed significant improvement 6 weeks after the procedure. No significant correlation was found between the initial calcific deposit size and clinical outcomes at each time point. Conclusions In patients with calcific tendinitis of the shoulder, US-guided barbotage using a spinal needle and subacromial steroid injection can yield satisfactory clinical and radiological results.

Purpose: We analyzed the choroidal thickness in the subfoveal area and area of retinal detachment (RD) in monocular primary rhegmatogenous retinal detachment (RRD) patients and compared the RD eye with the fellow eye. Methods: We retrospectively analyzed, optical coherence tomography data of both eyes at the first visit in patients who underwent surgery for monocular RRD from January 2013 to December 2016. Choroidal thickness was examined manually in the subfoveal and RD areas by two independent ophthalmologists; subjects without data from at least one of the two investigators were excluded. Results: Ninety-five subjects were included in this study. Of the 95 RD eyes, 61 (64.2%) and 44 (46.3%) eyes showed macula and fovea invasion, respectively. The subfoveal choroidal thickness was statistically significant in the RD eye compared with the fellow eye (244.7 ± 79.0 µm vs. 220.1 ± 78.9 µm; p < 0.001). Moreover, the choroidal thickness of the RD area in the RD eye was thicker compared with the non-detachment area and corresponding area in the fellow eye (273.8 ± 53.4 µm vs. 215.2 ± 44.0 µm and 233.3 ± 56.7 µm, respectively; p < 0.001). Conclusions In the primary RRD eye, the choroidal thickness in the detachment area was thicker than that of the fellow eye. Further studies are needed to investigate the mechanism of choroidal thickness change and its impact on RD.

Background: Femoral neck fractures need to be treated in their early stages with accurate reduction and stable fixation to reduce complications. The authors compared the early radiologic outcomes of femoral neck fractures treated with the recently introduced Femoral Neck System (FNS, Depuy-Synthes) with conventional cannulated screws (CS) in a multicenter design. Furthermore, the factors associated with early failure after FNS were analyzed. Methods: The FNS group included 40 patients treated between June 2019 and January 2020, and the CS group included 65 patients treated between January 2015 and May 2019. The operation was performed in 3 university hospitals. Patient demographics, fracture classification, postoperative reduction quality, sliding distance of FNS or CS, union and time to union, and complication rates were examined. Logistic regression analysis was performed on candidate factors for early failure of the FNS group. Results: The FNS group had a 90% union rate and a mean time to union of 4.4 months, while the CS group had similar results with an 83.1% union rate and a mean time to union of 5.1 months. In the subgroup analysis of Pauwels type III fractures, the union rates were 75.0% and 58.8% in the FNS and CS groups, respectively, and the time to union was significantly shorter in the FNS group with 4.8 months compared to 6.8 months in the CS group. Early failure rate within 6 months of FNS fixation was observed to be 10%, which included 3 reduction failures and 1 excessive sliding with a broken implant. Risk factors for early failure after FNS were identified as displaced fractures (Garden classification type III or IV), poor reduction quality, longer tip-apex distance, greater sliding distance, and 1-hole implants, of which sliding distance was the only significant risk factor in multivariate analysis. Conclusions In femoral neck fractures, FNS and CS did not show significant differences for short-term radiologic results. FNS resulted in shorter operative time than cannulated screw fixation and favorable outcomes in Pauwels type III femoral neck fractures.The FNS could be considered a reliable and safe alternative to CS when treating femoral neck fractures.

Neuropsychiatric systemic lupus erythematosus (NPSLE) involves the central and peripheral nervous system in patients with systemic lupus erythematosus (SLE). It is essential to specify the problems faced by patients with NPSLE because it causes diverse disabilities and impairs quality of life. After performing a comprehensive evaluation, tailored management should be provided for the patient's specific problems. We report here the case of a 30-year-old female with SLE who experienced serious neuropsychiatric symptoms cerebral infarction followed by posterior reversible encephalopathy syndrome and peripheral polyneuropathy. We systemically assessed the patient using the International Classification of Functioning, Disability and Health model as a clinical problem-solving tool and provided comprehensive rehabilitation by focusing on her problems.
Adult ; Cerebral Infarction ; Female ; Humans ; International Classification of Functioning, Disability and Health ; Lupus Erythematosus, Systemic ; Lupus Vasculitis, Central Nervous System* ; Peripheral Nervous System ; Polyneuropathies ; Posterior Leukoencephalopathy Syndrome ; Quality of Life ; Rehabilitation*

PURPOSE: In recent, years, an increase of syphilis infections has become an issue in Korea as well as globally. Herein, we report a recent clinical manifestation of syphilitic uveitis in a Korean population. METHODS: Over a 5-year period (2007-2012), we collected and analyzed the medical records of 16 patients with syphilitic uveitis in three tertiary eye clinics in Pusan. Sixteen patients were confirmed to have syphilis based on serological tests. Retrospective chart review was performed to determine the best corrected visual acuity, anterior and posterior segments, and treatment regimen, as well as ancillary test results including fluorescein angiogram (FAG). RESULTS: Of the 16 patients, 12 were males and four were females. The mean age of the patients was 51.16 years. Non-granulomatous anterior uveitis was observed in nine eyes (47.4%). Vitritis was the most frequently observed posterior segment finding (16 eyes, 84.2%). Retinal vasculitis and chorioretinitis were found in 11 (57.9%) and five eyes (26.3%), respectively. All patients had negative results in the serum HIV antibody test. Of the 16 patients, 15 were treated with penicillin or ceftriaxone due to neurosyphilis. Mean visual acuity improved from 1.33 +/- 1.1 to 0.58 +/- 0.68 after treatment. CONCLUSIONS: Clinical manifestation of syphilitic uveitis in Korean patients is different from occurrences in Western countries. Ophthalmological findings of syphilitic uveitis are diverse; thus, serological testing for syphilis is recommended for all uveitis patients. Further research regarding long-term treatment, relapse of syphilitic uveitis, and complications is necessary.
Busan ; Ceftriaxone ; Chorioretinitis ; Female ; Fluorescein ; HIV ; Humans ; Korea ; Male ; Medical Records ; Neurosyphilis ; Penicillins ; Recurrence ; Retinal Vasculitis ; Retrospective Studies ; Serologic Tests ; Syphilis ; Uveitis* ; Uveitis, Anterior ; Visual Acuity