Treatment of open tibial shaft fracture is difficult, especially when there are severe soft tissue damage. Various complications are noted. The aims of treatment for the open fractures are to promote primary wound healing and union of the fractured bone. We have employed external skeletal fixation devices those are Hoffmann apparatus and pin & resin external fixator for the treatment of 34 cases of open tibial shaft fractures from March, 1981 to May, 1984. Each fixation method was divided into two type, one-plane bilateral frame (180' frame) and two-plane bilateral frame(120') Following results were obtained. 1. Open tibial shaft fracture was most commonly occured in age of high activity of male. 2. External fixation was very useful as a primary treatment method in open tibial shaft fracture. 3. The most common complication was pin tract infection. 4. Mean duration of fixation was 12.6 weeks. After removal of extemal fixation, 8 cases of delayed or nonunion were noted. In addition to bone graft, secondary open reduction and internal fixation with plate and screws (7 cases), only bone graft (1 case) were carried out. Good results were obtained. 5. There was no significant difference in bone union time between 180' frame and 120' frame. The complications were more frequently occured in 120' frame than in 180' frame.
External Fixators ; Fracture Fixation ; Fractures, Open ; Humans ; Male ; Methods ; Tibia ; Transplants ; Wound Healing

No abstract available.

The Mother and Child Act is the most important law set up to maintain and improve maternal-child healthcare. This act was established in 1973 and was revised to improve maternal-child healthcare. This act includes the establishment and management of a maternal-child healthcare center in the district, a maternal-child regional healthcare center in the province, and a national maternal-child medical center. In the baby boom era, maternal-child healthcare centers provided maternity care and delivery services as well as emergency obstetrical management, but those centers stopped providing maternity care in the low birth-rate era. The last revised act included the establishment of a national maternal-child medical center to care for the increase in the number of high-risk pregnancies. This review briefly evaluates the goals and roles of a maternal-child healthcare center and a national maternal-child medical center according to the Mother and Child Act, and integrates high risk pregnancies with a neonatal care center to renovate the maternity healthcare system.
Child ; Delivery of Health Care ; Emergencies ; Humans ; Jurisprudence ; Mothers ; Population Growth ; Pregnancy ; Pregnancy, High-Risk

High-risk pregnancy is the probability of adverse pregnancy out come is increased over the generalpregnant population. Some high-risk pregnancy is the result of a medical condition present beforepregnancy. In other cases, a medical condition that develops during pregnancy causes a pregnancy tobecome high risk. The reason why high-risk pregnancy is importa nt is detecting the risk factors forhigh risk pregnancy early and preventing the complicated pregnancy. Korean society of Obstetrics andGynecology (KSOG) announced the classification of high-risk pre gnancy including 95 risk factors:obstetrics risk factors, medical risk factors, physical risk factors and risk factors of current pregnancy.However, this announcement of high-risk pregnancy by KSOG was limited for maternal-fetal healthcareproviders to apply their working and making policy. First this didn't include the conception of thecomplicated pregnancy and high-risk delivery. Second this did not separate the risk factors depend onbefore and during pregnancy. This review briefly evaluates the classification of high-risk pregnancy byKSOG and suggest the new classification including the complicated pregnancy and high-risk delivery formaternal-fetal healthcare providers.

Background: We analyzed whether a maternity waiting home (MWH) for pregnant women in an obstetrically underserved area of Gangwon-do in Korea, which has been in operation since August 2018, has improved the accessibility of a maternity hospital and pregnancy outcomes. Methods: We compared and analyzed the accessibility of maternity hospitals for 170 pregnant women who applied for the MWH from August 2018 to May 2022. Among the 170 participants, 64 were MWH users and 106 non-users. The effect on pregnancy outcomes between MWH users and non-users was analyzed in the 160 people who achieved a pregnancy outcome. Results: Although the average distance and travel time from the pregnant women’s residence in the obstetrically underserved area to a maternity hospital were 56.4 ± 1.6 km and 63.4 ± 1.4 minutes, respectively, the average distance between the MWH and the MWH users’ maternity hospital was 2.7 ± 0.2 km, and the travel time was 10.7 ± 0.6 minutes. The distance was 55.6 km closer on average and the travel time 54.1 minutes shorter. MWH users gave birth at a significantly later gestation age (38.9 ± 0.2 vs. 38.3 ± 0.15 weeks, P = 0.024) and to infants with heavier birth weights (3,300 ± 60 vs. 3,100 ± 50 gm, P= 0.024) compared with non-users. The rate of Cesarean section was significantly higher in the MWH users (47.5% vs. 44.6%, P = 0.047). The MWH users tended to be associated with a lower rate of neonatal intensive care unit admission (5.1% vs. 11.0%, P = 0.204), lower birth weight (< 2.5 kg) (1.7% vs. 8.0%, P = 0.155), and lower fetal death rate in the uterus (0% vs. 1.0%, P = 1.0) compared with non-users, but the differences were not significant. Conclusion The MWH helped pregnant women in obstetrically underserved areas by improving accessibility to a maternity hospital and lengthening gestation. As a result, neonatal birth weight was heavier for MWH users than non-users. MWHs in Korea can provide an alternative way to improve accessibility to maternity healthcare for pregnant women in obstetrically underserved areas, where it is difficult to establish maternity hospitals, and thereby will improve their pregnancy outcomes.

The Korean healthcare delivery system has been operating for over 30 years since 1989. Despite a positive performance—providing quality medical services to the people by distributing medical resources—there are limitations to the maternity healthcare delivery system. If the maternity healthcare delivery system was operating successfully, there should have been sufficient delivery hospitals so that pregnant women can access the appropriate maternity medical services whenever needed. Unfortunately, according to the National Health Insurance Service, the number of maternity health facilities in Korea reduced from 1,371 in 2003 to 541 in 2019. Regrettably, a larger number of obstetric hospitals and clinics have closed in medically vulnerable areas, such as farming and fishing areas, than urban areas with sufficient medical infrastructure, creating obstetrically underserved areas. In 2020, 65 out of a total of 250 cities, counties, and districts had no obstetric hospitals or clinics. To improve the collapsing maternity healthcare delivery system, a different approach is required; one in which policy support to stop the closure of delivery hospitals is emphasized. New maternity-related medical insurance payments, such as delivery labor management fees, fetal heart monitoring reading fees, and newborn care in delivery rooms fees, and active support policies are needed to prevent the closure of delivery hospitals. In this era of low fertility, because the maternity healthcare system is essential to maintain the nation, a healthcare delivery system different from the existing one must be established.