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.

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.

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.

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.

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.

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.

With growing interest in novel digital healthcare devices, such as artificial intelligence (AI) software for medical diagnosis and prediction, and their potential impacts on healthcare, discussions have taken place regarding the regulatory approval, coverage, and clinical implementation of these devices. Despite their potential, ‘digital exceptionalism’ (i.e., skipping the rigorous clinical validation of such digital tools) is creating significant concerns for patients and healthcare stakeholders. This white paper presents the positions of the Korean Society of Radiology, a leader in medical imaging and digital medicine, on the clinical validation, regulatory approval, coverage decisions, and clinical implementation of novel digital healthcare devices, especially AI software for medical diagnosis and prediction, and explains the scientific principles underlying those positions. Mere regulatory approval by the Food and Drug Administration of Korea, the United States, or other countries should be distinguished from coverage decisions and widespread clinical implementation, as regulatory approval only indicates that a digital tool is allowed for use in patients, not that the device is beneficial or recommended for patient care. Coverage or widespread clinical adoption of AI software tools should require a thorough clinical validation of safety, high accuracy proven by robust external validation, documented benefits for patient outcomes, and cost-effectiveness. The Korean Society of Radiology puts patients first when considering novel digital healthcare tools, and as an impartial professional organization that follows scientific principles and evidence, strives to provide correct information to the public, make reasonable policy suggestions, and build collaborative partnerships with industry and government for the good of our patients.
Artificial Intelligence ; Delivery of Health Care ; Device Approval ; Diagnosis ; Diagnostic Imaging ; Humans ; Insurance Coverage ; Korea ; Patient Care ; Societies ; Software Validation ; United States ; United States Food and Drug Administration

With growing interest in novel digital healthcare devices, such as artificial intelligence (AI) software for medical diagnosis and prediction, and their potential impacts on healthcare, discussions have taken place regarding the regulatory approval, coverage, and clinical implementation of these devices. Despite their potential, ‘digital exceptionalism’ (i.e., skipping the rigorous clinical validation of such digital tools) is creating significant concerns for patients and healthcare stakeholders. This white paper presents the positions of the Korean Society of Radiology, a leader in medical imaging and digital medicine, on the clinical validation, regulatory approval, coverage decisions, and clinical implementation of novel digital healthcare devices, especially AI software for medical diagnosis and prediction, and explains the scientific principles underlying those positions. Mere regulatory approval by the Food and Drug Administration of Korea, the United States, or other countries should be distinguished from coverage decisions and widespread clinical implementation, as regulatory approval only indicates that a digital tool is allowed for use in patients, not that the device is beneficial or recommended for patient care. Coverage or widespread clinical adoption of AI software tools should require a thorough clinical validation of safety, high accuracy proven by robust external validation, documented benefits for patient outcomes, and cost-effectiveness. The Korean Society of Radiology puts patients first when considering novel digital healthcare tools, and as an impartial professional organization that follows scientific principles and evidence, strives to provide correct information to the public, make reasonable policy suggestions, and build collaborative partnerships with industry and government for the good of our patients.

PURPOSE: Establishment of an appropriate protocol for breast magnetic resonance imaging (MRI) in the study of image quality standards to enhance the effectiveness of medical image information exchange, which is part of the construction and activation of clinical information exchange for healthcare informatization. MATERIALS AND METHODS: The recommended protocols of breast and MRI scans were reviewed and the questionnaire was prepared by a responsible researcher. Then, a panel of 9 breast dedicated radiologists was set up in Korea. The expert panel conducted a total of three Delphi agreements to draw up a consensus on the breast MRI protocol. RESULTS: The agreed breast MRI recommendation protocol is a 1.5 Tesla or higher device that acquires images with prone position using a breast dedicated coil and includes T2-weighted and pre-contrast T1-weighted images. Contrast enhancement images are acquired at least two times, and include 60–120 seconds between images and after 4 minutes. The contrast enhancement T1-weighted image should be less than 3 mm in thickness, less than 120 seconds in temporal resolution, and less than 1.5 mm² in-plane pixel resolution. CONCLUSION The Delphi agreement of the domestic breast imaging specialist group has established the recommendation protocol of the effective breast MRI.

PURPOSE: The goal of this study was to evaluate the clinicopathological and imaging features of thyroid nodules surgically diagnosed as hyaline trabecular tumor (HTT), and to assess the role of cytology and frozen sections (FS) in the diagnosis of HTT. METHODS: This study included 21 thyroid nodules in 21 patients treated from August 2005 to March 2015 (mean age, 53.3 years) who were either diagnosed as HTT or had HTT suggested as a possible diagnosis based on cytology, FS, or the final pathology report. Patients' medical records were retrospectively reviewed for cytopathologic results and outcomes during the course of follow-up. Sonograms were reviewed and categorized. RESULTS: Twelve nodules from 12 patients were surgically confirmed as HTT. Ultrasonography (US)-guided fine needle aspiration (FNA) was performed on 11 nodules, of which six (54.5%) were papillary thyroid carcinoma (PTC) or suspicious for PTC and three (27.3%) were HTT or suspicious for HTT. Intraoperative FS suggested the possibility of HTT in seven nodules, of which four (57.1%) were confirmed as HTT. US-FNA suggested the diagnosis of HTT in 10 nodules, of which three (30.0%) were confirmed as HTT. Common US features of the 12 pathologically confirmed cases of HTT were hypoechogenicity or marked hypoechogenicity (83.4%), absence of calcifications (91.7%), parallel shape (100.0%), presence of vascularity (75.0%), and probable benignity (58.3%). CONCLUSION: HTT should be included in the differential diagnosis of solid tumors with hypoechogenicity or marked hypoechogenicity and otherwise benign US features that have been diagnosed as PTC through cytology.
Biopsy, Fine-Needle ; Diagnosis* ; Diagnosis, Differential ; Follow-Up Studies ; Frozen Sections* ; Humans ; Hyalin* ; Medical Records ; Pathology ; Retrospective Studies ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroid Nodule ; Ultrasonography*