Background: The use of electric scooters (e-scooters) continues to increase as a simple, inexpensive means of transport, resulting in a sharp increase in the incidence of scooter-related accidents. No study to date has closely examined the injury extent to the lower leg, joints, and extremities from e-scooter-related accidents. Here, we investigated the epidemiology and injury patterns of such accidents, focusing on injuries to the ankle and foot. Methods: Based on data from a single tertiary hospital’s database, the demographics of 563 patients with scooter-associated injuries were analyzed retrospectively. Among the patients, 229 patients who were injured by e-scooter riding were further investigated. Based on the data, the general demographics of whole scooter-associated injuries and the injury characteristics and fracture cases of the lower leg, ankle, and foot were analyzed. Results: During the 4-year study period, the number of patients injured by e-scooters increased every year. Lower extremities were the most common injury site (67.2%) among riders, whereas injuries to the head and neck (64.3%) were more common in riders of non-electric scooters. Among the lower leg, ankle, and foot injuries of riders (52 cases), the ankle joint (53.8%) was the most commonly injured site, followed by the foot (40.4%) and lower leg (21.2%). The fracture group scored significantly higher on the Abbreviated Injury Scale than the non-fracture group (p < 0.001). Among the fracture group (20 cases), ankle fractures (9 cases) were most common, including pronation external rotation type 4 injuries (4 cases) and pilon fractures (2 cases). Five patients (25%) had open fractures, and 12 patients (60%) underwent surgical treatment. Conclusions The ankle and foot are the most common injury sites in e-scooter-related accidents. Given the high frequency and severity of e-scooter-related ankle and foot injuries, we suggest that more attention be paid to preventing these types of injuries with greater public awareness of the dangers of using e-scooters.

STUDY DESIGN: Literature review. OBJECTIVE: The aim of this article is to introduce the EOS imaging device, with a focus on spinal and pelvic alignment. SUMMARY OF LITERATURE REVIEW: The EOS imaging device can obtain images of spinal and pelvic alignment with almost no distortion, using a low radiation dose. MATERIALS AND METHODS: We searched for studies related to the use of EOS imaging device for spinal and pelvic alignment. RESULTS: The EOS is not only capable of simultaneously obtaining paired anteroposterior and lateral X-ray images with a low radiation dose, but also can reconstruct the image as if it was acquired in the patient's reference plane, limiting the distortion to the patient's thickness instead of the whole distance between the source and detector. The EOS device also has the advantage of accurately measuring the sagittal alignment of the spine and pelvis and the torsional deformity of the lower limbs, as the subject can be imaged while standing upright in a weight-bearing posture. CONCLUSIONS: EOS is a new diagnostic technique that can detect spinal and pelvic alignment and deformities of the lower limbs under weight-bearing conditions with a low radiation dose.
Congenital Abnormalities ; Lower Extremity ; Pelvis ; Posture ; Spine ; Weight-Bearing

OBJECTIVE: The aim of this article is to introduce the EOS imaging device, with a focus on spinal and pelvic alignment.SUMMARY OF LITERATURE REVIEW: The EOS imaging device can obtain images of spinal and pelvic alignment with almost no distortion, using a low radiation dose. MATERIALS AND METHODS: We searched for studies related to the use of EOS imaging device for spinal and pelvic alignment. RESULTS: The EOS is not only capable of simultaneously obtaining paired anteroposterior and lateral X-ray images with a low radiation dose, but also can reconstruct the image as if it was acquired in the patient's reference plane, limiting the distortion to the patient's thickness instead of the whole distance between the source and detector. The EOS device also has the advantage of accurately measuring the sagittal alignment of the spine and pelvis and the torsional deformity of the lower limbs, as the subject can be imaged while standing upright in a weight-bearing posture. CONCLUSIONS EOS is a new diagnostic technique that can detect spinal and pelvic alignment and deformities of the lower limbs under weight-bearing conditions with a low radiation dose.

The aim of this project was to use 3D scanning data collected at incident scenes and various evidence to 1) develop surveying methods based on 3D data consisting of overall and detailed scene evidence, captured by long-range and micros-canner, which can be shared by personnel working in different fields such as forensic medicine, video analysis, physical analysis, traffic engineering, and fire investigation; 2) create digital storage for human skeletons and set the foundation for virtual anthropology; and 3) improve the credibility of 3D evidence by virtual remodeling and simulation of incident scenes and evidence to provide a basis for advanced and high-tech scientific investigation. Two complete skeletons of male and female were scanned using 3D micro-scanner. Each bone was successfully reproduced and assembled in virtual space. In addition, recreating evidence scheduled for invasive examination by creating RP (rapid prototype) was possible. These outcomes could play an important role in setting up the new field of virtual anthropology. Case-specific surveying methods were developed through analysis of 3D scanning data collected by long-range surface scanners at the scenes of vehicular accidents, falls, shootings, and violent crimes. A technique and recording method was also developed for detecting forged seals by micro-scanning the pressure exerted on the seal. Appraisal methods developed in this project could be utilized to secure 3D data of human skeletal remains and incident scenes, create a standard for application, and increase objectivity, reproducibility, and accuracy of scanning methods. We plan to develop case-specific 3D data analysis techniques to improve the credibility of analysis at the NFS and to establish a 3D data collection and analysis team.
Crime ; Data Collection ; Female ; Fires ; Forensic Medicine ; Forensic Sciences ; Humans ; Male ; Skeleton ; Statistics as Topic

BACKGROUND: Small proportions of all the elderly stroke patients receive recombinant tissue plasminogen activator (r-tPA) therapy, although old age is not a proven contraindication to intravenous thrombolytic therapy for acute ischemic stroke. The purpose of this study was to identify reasons for exclusion from r-tPA therapy and factors associated with the decision of r-tPA use in elderly patients with acute ischemic stroke. METHODS: From the acute stroke registries of 22 domestic university hospitals taking the r-tPA therapy from January 2007 to May 2010, we extracted data of all acute ischemic stroke patients who were aged 80 or over and arrived within onset 3 hours. For all patients, we assessed the eligibility of r-tPA therapy using National Institute of Neurological Disorders and Stroke (NINDS) r-tPA trial criteria. For eligible patients, we compared all clinical variables between patients who were treated with r-tPA and those who were not, and analyzed potential factors related to the decision of r-tPA use. RESULTS: A total of 494 patients were included in this study. 255 patients (51.6%) were excluded by NINDS r-tPA trial criteria and the major reasons for exclusion were minor neurological deficit (53.7%) and clinical improvement (17.3%). Among 239 patients who were eligible for r-tPA, 162 (32.8%) patients received r-tPA and 77 (15.6%) did not. Multivariable analysis showed that younger age, shorter time-delay from onset to admission, non-smoker, no history of prior stroke, good pre-stroke functional status and severe initial neurological deficit were independently associated with the decision of r-tPA use in the elderly stroke patients predictors for r-tPA treatment. CONCLUSION: In very elderly patients, mild neurological deficit on arrival and rapid clinical improvement in neurological symptoms were the main reasons for exclusion from thrombolytic therapy.
Aged ; Hospitals, University ; Humans ; National Institute of Neurological Disorders and Stroke ; Registries ; Stroke ; Thrombolytic Therapy ; Tissue Plasminogen Activator

Intramedullary spinal cord metastases occurring from any malignant tumor are usually accompanied by frequent metastases in the intracranium. The clinical features of this disease have been described as the rapid progression of neurologic deficit that can lead to complete paraplegia. In this case, the authors treated a 76-year-old woman, who was diagnosed with an intramedullary spinal cord metastasis arising from a small cell lung cancer without an invasion of the brain, with decompressive surgery and posterior instrumentation. The patient suffered from weakness of her legs, walking difficulties, and urinary and fecal incontinence. Her preoperative neurologic symptoms were improved significantly after surgery. The patient did not want to have further treatment for the primary cancer, and she died from pneumonia caused by aggravation of the underlying disease 3 months after surgery. We report this rare case, which was diagnosed as a metastasis of a small cell lung cancer postoperatively, with a review of the relevant literature.
Aged ; Brain ; Fecal Incontinence ; Female ; Humans ; Leg ; Neoplasm Metastasis ; Neurologic Manifestations ; Paraplegia ; Pneumonia ; Small Cell Lung Carcinoma ; Spinal Cord ; Walking

PURPOSE: To investigate clinical and radiographic results for cementless total hip arthroplasty (THA) using ceramic-on-ceramic articulation in patients over 60 years old. MATERIALS AND METHODS: Between May 2000 and February 2007, we analyzed 44 THAs that used ceramic-on-ceramic articulation in 34 patients aged 60 or older. The mean follow-up duration was 3.2 years; the mean age was 66.8 years. Clinical and radiographic evaluations were carried out. Risk factors for dislocation were evaluated. RESULTS: Final Harris hip scores increased to an average of 90 points from an average of 51 points preoperatively. Radiographic findings demonstrated that fixations around the stems and the acetabular cups were stable. There was no aseptic loosening and osteolysis around the implants. There were 10 cases of posterior dislocation within 3 months postoperatively. Two revisions were done, one due to a recurrent dislocation and one to a ceramic head fracture. Risk factors for dislocation were ASA score, cup anteversion angle and total anteversion angle. CONCLUSION: Cementless THAs using ceramic-on-ceramic articulation for patients aged sixty or more elicits good clinical and radiographic results. Because of the high rate of early dislocation and damage to the ceramic, we call attention to the position of the implants and postoperative management in elderly, debilitated patients.
Aged ; Aldosterone ; Arthroplasty ; Ceramics ; Dislocations ; Follow-Up Studies ; Head ; Hip ; Humans ; Osteolysis ; Risk Factors ; Tacrine ; Ursidae

BACKGROUND: To assess the radiographic results in patients who underwent transforaminal lumbar interbody fusion (TLIF), particularly the changes in segmental lordosis in the fusion segment, whole lumbar lordosis and disc height. METHODS: Twenty six cases of single-level TLIF in degenerative lumbar diseases were analyzed. The changes in segmental lordosis, whole lumbar lordosis, and disc height were evaluated before surgery, after surgery and at the final follow-up. RESULTS: The segmental lordosis increased significantly after surgery but decreased at the final follow-up. Compared to the preoperative values, the segmental lordosis did not change significantly at the final follow-up. Whole lumbar lordosis at the final follow-up was significantly higher than the preoperative values. The disc height was significantly higher in after surgery than before surgery (p = 0.000) and the disc height alter surgery and at the final follow-up was similar. CONCLUSIONS: When performing TLIF, careful surgical techniques and attention are needed to restore and maintain the segmental lordosis at the fusion level.
Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Intervertebral Disk Degeneration/*surgery ; Lordosis/*radiography ; Lumbar Vertebrae/pathology/*radiography/surgery ; Male ; Middle Aged ; Prosthesis Implantation ; Retrospective Studies ; *Spinal Fusion ; Spinal Stenosis/surgery ; Spondylolisthesis/surgery

PURPOSE: The purpose of the present study was to evaluate and analyze the clinical outcomes of the percutaneous repair of acute achilles tendon ruptures. MATERIALS AND METHODS: We performed a retrospective study on 14 patients with acute closed rupture of the Achilles tendon and they were managed with percutaneous repair from Jan. 2006 to Jun. 2007. The clinical outcomes were analyzed according to the causes of the injury and the postoperative functional performances. RESULTS: All the cases showed good or excellent outcomes, according to the Arner-Lindholm scale for the evaluation of acute Achilles tendon rupture. The average AOFAS score was 95.6 (range: 91-100). Nine patients were very satisfied and five patients were satisfied. They were satisfied especially because of the minimal postoperative scar. Two cases of sural nerve injury were reported as complications, and these cases fully recovered at postoperative three months. No evidence of surgical wound infection, necrosis of the wound or rerupture of the tendon was seen. CONCLUSION: The percutaneous repair of acute Achilles tendon rupture achieved high functional outcomes, a successful return to previous work and high satisfaction, with a relatively low incidence of complications.
Achilles Tendon ; Cicatrix ; Humans ; Incidence ; Necrosis ; Organic Chemicals ; Retrospective Studies ; Rupture ; Sural Nerve ; Surgical Wound Infection ; Tendons

We report an isolated anterior dislocation of the radial head in a 23-year-old man after a fall on the outstretched arm. At the time of the injury, the patient's elbow was in a position of mild flexion and pronation which was suddenly further pronated as he fell down. The radial head was incarcerated by the lateral portion of brachialis muscle, and annular ligament was interposed between capitellum and radial head. Open reduction was performed. During 12 months follow-up, reduction of radial head was well maintained without a limitation of range of motion.
Adult* ; Arm ; Dislocations* ; Elbow ; Follow-Up Studies ; Head* ; Humans ; Ligaments ; Pronation ; Range of Motion, Articular ; Young Adult