Severe midfoot Charcot neuroarthropathy (CN) presents a significant surgical challenge because of extensive bone loss and poor bone quality. This report presents the outcome of a case treated with realignment arthrodesis using a superconstruct technique, supplemented by the postoperative use of denosumab. A patient with Eichenholtz Stage III CN (Brodsky Type 1 and 2) underwent a single-stage surgical reconstruction. Postoperatively, denosumab was administered to enhance bone stability. The 1-year and 1-month follow-up showed that the severe deformity had been successfully corrected to a stable, plantigrade foot, confirmed by radiographic and clinical evaluation.This case suggests that a combined surgical approach using a superconstruct with adjuvant denosumab can be an effective treatment for severe midfoot CN.

Hallux valgus (HV) accompanied by metatarsus adductus (MA) is a surgical challenge because of its anatomical characteristics, often presenting with a high hallux valgus angle (HVA) despite a low intermetatarsal angle (IMA). This case report describes a 66-year-old female who presented with a 15-year history of left foot pain and deformity. The radiographs revealed an HVA of 45.0° and a low IMA of 7.2°, consistent with concomitant MA. Instead of a traditional proximal osteotomy for severe HV, the patient underwent a minimally invasive transverse distal metatarsal osteotomy along with distal metatarsal minimally invasive osteotomies (DMMOs) of the lesser metatarsals. At the 2-year follow-up, the radiographs showed excellent correction (HVA 12.5°, IMA 1.0°). The patient was asymptomatic and reported high functional and cosmetic satisfaction. This case shows that a minimally invasive transverse distal metatarsal osteotomy, combined with adequate ancillary procedures, can achieve a successful correction even in complex, severe HV with MA.

PURPOSE: The purpose of this study was to evaluate the cancer care cost during the last year of life of patients in Korea. MATERIALS AND METHODS: We studied the breakdown of spending on the components of cancer care. Cancer decedents in 2009 were identified from the Korean Central Cancer Registry and linked with the Korean National Health Insurance Claims Database. The final number of patients included in the study was 70,558. RESULTS: In 2009, the average cancer care cost during the last year of life was US $15,720. Patients under age 20 spent US $53,890 while those 70 or over spent US $11,801. Those with leukemia incurred the highest costs (US $43,219) while bladder cancer patients spent the least (US $13,155). General costs, drugs other than analgesics, and test fees were relatively high (29.7%, 23.8%, and 20.7% of total medical costs, respectively). Analgesic drugs, rehabilitation, and psychotherapy were still relatively low (4.3%, 0.7%, and 0.1%, respectively). Among the results of multiple regression analysis, few were notable. Age was found to be negatively related to cancer care costs while income level was positively associated. Those classified under distant Surveillance, Epidemiology, and End Results stages of cancer and higher comorbidity level also incurred higher cancer care costs. CONCLUSION: Average cancer care costs varied significantly by patient characteristics. However, the study results suggest an underutilization of support services likely due to lack of alternative accommodations for terminal cancer patients. Further examination of utilization patterns of healthcare resources will help provide tailored evidence for policymakers in efforts to reduce the burdens of cancer care.
Analgesics ; Comorbidity ; Delivery of Health Care* ; Drug Costs ; Epidemiology ; Fees and Charges ; Health Care Costs ; Humans ; Korea ; Leukemia ; National Health Programs ; Psychotherapy ; Rehabilitation ; Terminal Care ; Urinary Bladder Neoplasms