Purpose: Treatment options for distal radius malunion with dorsal angulation include open-wedge osteotomy using a volar approach or closed-wedge osteotomy. An advantage of open-wedge osteotomy is that it preserves the length of the radius; however, it often requires bone grafting and presents difficulties in achieving reduction. In contrast, closed-wedge osteotomy makes correction easier, but it requires ulnar shortening osteotomy. Therefore, in this study, we propose an effective surgical method that compensates for the disadvantages of both techniques by using half-wedge osteotomy and rotational placement. Methods: This study presents five cases of distal radius corrective osteotomy and ulnar shortening osteotomy performed at our institution using half-wedge osteotomy and rotational placement for distal radius malunion between 2017 and 2021. Surgical efficacy was evaluated by assessing radiographic changes, visual analog scale scores, and the quick Disability of the Arm, Shoulder, and Hand score postoperatively. Results: The bone union was achieved in all cases, and computed tomography scans performed 6 months postoperatively showed ongoing bone healing. Postoperative dorsal tilt was restored to the normal range, and the clinical scores improved. Conclusion Half-wedge osteotomy and reverse repositioning for dorsal malunion distal radius are effective treatments, as they facilitate the correction of malunion, reduce the need for ulnar shortening length, and eliminate the need for bone grafting from the iliac crest.

Purpose: Treatment options for distal radius malunion with dorsal angulation include open-wedge osteotomy using a volar approach or closed-wedge osteotomy. An advantage of open-wedge osteotomy is that it preserves the length of the radius; however, it often requires bone grafting and presents difficulties in achieving reduction. In contrast, closed-wedge osteotomy makes correction easier, but it requires ulnar shortening osteotomy. Therefore, in this study, we propose an effective surgical method that compensates for the disadvantages of both techniques by using half-wedge osteotomy and rotational placement. Methods: This study presents five cases of distal radius corrective osteotomy and ulnar shortening osteotomy performed at our institution using half-wedge osteotomy and rotational placement for distal radius malunion between 2017 and 2021. Surgical efficacy was evaluated by assessing radiographic changes, visual analog scale scores, and the quick Disability of the Arm, Shoulder, and Hand score postoperatively. Results: The bone union was achieved in all cases, and computed tomography scans performed 6 months postoperatively showed ongoing bone healing. Postoperative dorsal tilt was restored to the normal range, and the clinical scores improved. Conclusion Half-wedge osteotomy and reverse repositioning for dorsal malunion distal radius are effective treatments, as they facilitate the correction of malunion, reduce the need for ulnar shortening length, and eliminate the need for bone grafting from the iliac crest.

Purpose: Treatment options for distal radius malunion with dorsal angulation include open-wedge osteotomy using a volar approach or closed-wedge osteotomy. An advantage of open-wedge osteotomy is that it preserves the length of the radius; however, it often requires bone grafting and presents difficulties in achieving reduction. In contrast, closed-wedge osteotomy makes correction easier, but it requires ulnar shortening osteotomy. Therefore, in this study, we propose an effective surgical method that compensates for the disadvantages of both techniques by using half-wedge osteotomy and rotational placement. Methods: This study presents five cases of distal radius corrective osteotomy and ulnar shortening osteotomy performed at our institution using half-wedge osteotomy and rotational placement for distal radius malunion between 2017 and 2021. Surgical efficacy was evaluated by assessing radiographic changes, visual analog scale scores, and the quick Disability of the Arm, Shoulder, and Hand score postoperatively. Results: The bone union was achieved in all cases, and computed tomography scans performed 6 months postoperatively showed ongoing bone healing. Postoperative dorsal tilt was restored to the normal range, and the clinical scores improved. Conclusion Half-wedge osteotomy and reverse repositioning for dorsal malunion distal radius are effective treatments, as they facilitate the correction of malunion, reduce the need for ulnar shortening length, and eliminate the need for bone grafting from the iliac crest.

Owing to a large-jeopardized myocardium, left main coronary artery disease (LMCAD) represents the substantial high-risk anatomical subset of obstructive coronary artery disease.For several decades, coronary artery bypass grafting (CABG) has been the “gold standard” treatment for LMCAD. Along with advances in CABG, percutaneous coronary intervention (PCI) has also dramatically evolved over time in conjunction with advances in the stent or device technology, adjunct pharmacotherapy, accumulated experiences, and practice changes, establishing its position as a safe, reasonable treatment option for such a complex disease. Until recently, several randomized clinical trials, meta-analyses, and observational registries comparing PCI and CABG for LMCAD have shown comparable long-term survival with tradeoffs between early and late risk-benefit of each treatment. Despite this, there are still several unmet issues for revascularization strategy and management for LMCAD. This review article summarized updated knowledge on evolution and clinical evidence on the treatment of LMCAD, with a focus on the comparison of state-of-the-art PCI with CABG.

Reconstructive options for multidigit or soft tissue defects of the hand are varied, yet complex hand defects remain particularly challenging. These cases often necessitate microvascular reconstruction using osteocutaneous free flaps to achieve functional limb salvage. This paper presents two cases of osteocutaneous lateral arm free flap surgery performed at our institution, demonstrating the efficacy of this technique in managing complex hand defects. One case involved a severe crushing injury on an index finger with only the ulnar neurovascular bundle remaining, and the other involved a crushing injury on the first web space with severe comminution of the first metacarpal bone. After an emergency simple debridement, reconstructive surgery using the osteocutaneous lateral arm free flap was performed a few days later. Both cases healed without necrosis. Although both patients lost interphalangeal joint function, they were able to maintain grasping function and finger length without amputation. The osteocutaneous lateral arm free flap is an effective reconstruction method for addressing small to moderate-sized segmental bone and soft tissue defects of the hand caused by trauma. This procedure can be conveniently performed in a single session under regional anesthesia.

Reconstructive options for multidigit or soft tissue defects of the hand are varied, yet complex hand defects remain particularly challenging. These cases often necessitate microvascular reconstruction using osteocutaneous free flaps to achieve functional limb salvage. This paper presents two cases of osteocutaneous lateral arm free flap surgery performed at our institution, demonstrating the efficacy of this technique in managing complex hand defects. One case involved a severe crushing injury on an index finger with only the ulnar neurovascular bundle remaining, and the other involved a crushing injury on the first web space with severe comminution of the first metacarpal bone. After an emergency simple debridement, reconstructive surgery using the osteocutaneous lateral arm free flap was performed a few days later. Both cases healed without necrosis. Although both patients lost interphalangeal joint function, they were able to maintain grasping function and finger length without amputation. The osteocutaneous lateral arm free flap is an effective reconstruction method for addressing small to moderate-sized segmental bone and soft tissue defects of the hand caused by trauma. This procedure can be conveniently performed in a single session under regional anesthesia.

Reconstructive options for multidigit or soft tissue defects of the hand are varied, yet complex hand defects remain particularly challenging. These cases often necessitate microvascular reconstruction using osteocutaneous free flaps to achieve functional limb salvage. This paper presents two cases of osteocutaneous lateral arm free flap surgery performed at our institution, demonstrating the efficacy of this technique in managing complex hand defects. One case involved a severe crushing injury on an index finger with only the ulnar neurovascular bundle remaining, and the other involved a crushing injury on the first web space with severe comminution of the first metacarpal bone. After an emergency simple debridement, reconstructive surgery using the osteocutaneous lateral arm free flap was performed a few days later. Both cases healed without necrosis. Although both patients lost interphalangeal joint function, they were able to maintain grasping function and finger length without amputation. The osteocutaneous lateral arm free flap is an effective reconstruction method for addressing small to moderate-sized segmental bone and soft tissue defects of the hand caused by trauma. This procedure can be conveniently performed in a single session under regional anesthesia.

Objective: Early prediction of the multiple organ dysfunction syndrome (MODS) and providing early innovative treatment may improve outcomes in patients with severe trauma. Lactate and serum albumin levels, which are widely used markers predicting the severity of critically ill patients, tend to diverge during clinical deterioration. This study aimed to evaluate the clinical utility of the lactate/albumin ratio (LAR) as a predictive factor for MODS and 30-day mortality in patients with severe trauma. Methods: This retrospective, observational cohort study was performed with patients prospectively integrated into a critical pathway for trauma. We analyzed severe trauma patients (Injury Severity Score≥16) admitted to the emergency department (ED), between January 1, 2011, and May 31, 2017. The outcomes were the development of MODS and 30-day mortality. Results: In total, 348 patients were enrolled, of which 18 (5.2%) died within 96 hours of ED admission, and the remaining 330 patients (94.8%) were evaluated for the development of MODS. An increase in the LAR at admission (odds ratio, 1.618; P=0.028) was an independent predictor of MODS development. The area under the receiver operating characteristic curve (0.755) and Harrell's C-index (0.783) showed that LAR could predict MODS and 30-day mortality. Conclusion Initial LAR is an independent predictor of MODS development in patients with severe trauma. Our study results suggest that an elevated LAR can be a useful prognostic marker in patients with severe trauma.

PURPOSE: HEMS is expected to shorten transportation time to an advanced facility and to enable administration of advanced treatment at the scene. In Korea, HEMS was launched in September 2011. The aim of this study is to provide an overview of HEMS in South Korea during the first year and to provide information for use in improvement. METHODS: Data were collected from September 23. 2011 to September 22. 2012; emergency patients on islands and in vulnerable areas were transported by helicopter. During the one-year study period, a prospective cohort study was conducted. Target diseases were acute coronary syndrome, stroke, and severe trauma. We classified patients according to two groups (severe group vs. mild group), whether they had been admitted to the intensive care unit (included death in the emergency room) or not. RESULTS: During this period, the total request mission number was 555 and the number of patients transported to base hospitals was 322. Differences between severe group and minor group were as follows: (1) final diagnosis; severe trauma (27.7% vs. 3.5%), cerebrovascular accident (CVA) (24.3% vs. 4.2%), and acute coronary syndrome (7.3% vs. 2.1%), p<0.001. (2) classification of transport area; islands (45.8% vs. 77.2%), bridge islands (26.0% vs. 15.9%), and inland area (28.3% vs. 6.9%), p<0.001. (3) the median time of call to hospital time was 52 vs. 55 minutes (p=0.289). and the median time of on scene time was 9 vs. 8 minutes (p=0.046). CONCLUSION: During the 12-month period, air ambulance played an important role in medically vulnerable areas (inclusion islands). However, the number of transport missions was still relatively low, and has shown a gradual increase.
Acute Coronary Syndrome ; Air Ambulances ; Aircraft* ; Classification ; Cohort Studies ; Diagnosis ; Emergencies* ; Emergency Medical Services* ; Humans ; Intensive Care Units ; Islands ; Korea ; Missions and Missionaries ; Prospective Studies ; Rural Health Services ; Stroke ; Transportation

PURPOSE: HEMS is expected to shorten transportation time to an advanced facility and to enable administration of advanced treatment at the scene. In Korea, HEMS was launched in September 2011. The aim of this study is to provide an overview of HEMS in South Korea during the first year and to provide information for use in improvement. METHODS: Data were collected from September 23. 2011 to September 22. 2012; emergency patients on islands and in vulnerable areas were transported by helicopter. During the one-year study period, a prospective cohort study was conducted. Target diseases were acute coronary syndrome, stroke, and severe trauma. We classified patients according to two groups (severe group vs. mild group), whether they had been admitted to the intensive care unit (included death in the emergency room) or not. RESULTS: During this period, the total request mission number was 555 and the number of patients transported to base hospitals was 322. Differences between severe group and minor group were as follows: (1) final diagnosis; severe trauma (27.7% vs. 3.5%), cerebrovascular accident (CVA) (24.3% vs. 4.2%), and acute coronary syndrome (7.3% vs. 2.1%), p<0.001. (2) classification of transport area; islands (45.8% vs. 77.2%), bridge islands (26.0% vs. 15.9%), and inland area (28.3% vs. 6.9%), p<0.001. (3) the median time of call to hospital time was 52 vs. 55 minutes (p=0.289). and the median time of on scene time was 9 vs. 8 minutes (p=0.046). CONCLUSION: During the 12-month period, air ambulance played an important role in medically vulnerable areas (inclusion islands). However, the number of transport missions was still relatively low, and has shown a gradual increase.
Acute Coronary Syndrome ; Air Ambulances ; Aircraft* ; Classification ; Cohort Studies ; Diagnosis ; Emergencies* ; Emergency Medical Services* ; Humans ; Intensive Care Units ; Islands ; Korea ; Missions and Missionaries ; Prospective Studies ; Rural Health Services ; Stroke ; Transportation