Publications by authors named "Young Ho Shin"

36 Publications

Effect of pre-treatment expectations on post-treatment expectation fulfillment or outcomes in patients with distal radius fracture.

J Hand Ther 2021 May 13. Epub 2021 May 13.

Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.

Background: The influence of patient expectations on patient-rated outcomes (PRO) after elective orthopedic procedures has been addressed in previous studies. However, the influence of pre-treatment expectations on post-treatment PRO was rarely examined in patients with extremity fractures.

Purpose: The purpose of this study was to determine if pre-treatment expectations have an effect on post-treatment expectation fulfillment or PRO in patients surgically and conservatively managed for distal radius fractures (DRFs).

Study Design: Prospective cohort study METHODS: For this study, 114 consecutive patients treated for DRF between January 2017 and February 2018 were enrolled. Of the 114 patients, 81 underwent surgical treatment (surgical group), and 33 were managed conservatively (conservative group). All patients completed a 7-item pre-treatment expectation questionnaire initially. There were 66 patients in the surgical group and 25 patients in the conservative group available at the 1-year follow-up and completed a 6-item post-treatment expectation fulfillment questionnaire and patient-reported wrist evaluation (PRWE) questionnaire.

Results: The surgical group showed a significantly higher median pre-treatment expectation score than the conservative group. However, no significant differences in post-treatment expectation fulfillment scores and PRWE scores were observed between groups. Higher pre-treatment expectation score was moderately correlated with higher post-treatment expectation fulfillment score (r = 0.36, P = 0.003) and lower PRWE score (r = -0.3, P = 0.02) in the surgical group. However, the pre-treatment expectation score was not significantly correlated with the post-treatment expectation fulfillment score (r = -0.09, P = 0.65) or PRWE score (r = -0.02, P = 0.93) in conservative group. In the surgical group, multivariable linear regression analysis showed that post-treatment expectation fulfilment score could be explained by the pre-treatment expectation score (Beta = 0.41, P = 0.001), accounting for 15% of the variance, and PRWE score was also explained by the pre-treatment expectation score (Beta = 0.39, P = 0.001), accounting for 14% of the variance.

Conclusions: In conclusion, higher pre-treatment expectation score was moderately correlated with higher the post-treatment expectation fulfillment score and lower PRWE score, and the pre-treatment expectation score could only explain a small amount of variance seen in the post-treatment expectation fulfillment and PRWE scores in the surgical group. However, there was no association between the pre-treatment expectation score and the post-treatment expectation fulfillment score or the PRWE score in the conservative group.
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http://dx.doi.org/10.1016/j.jht.2021.04.023DOI Listing
May 2021

Complications and safety of the transplanted organ after upper extremity surgery in patients receiving immunosuppressant therapy after solid organ transplantation.

Int Orthop 2021 Jul 2. Epub 2021 Jul 2.

Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.

Purpose: The purpose of this study was to evaluate the complications and safety of transplanted organs after upper extremity surgery in patients taking immunosuppressants after solid organ transplantation (SOT).

Methods: Seventy-two transplant recipients underwent 99 upper extremity surgeries while on immunosuppressants after SOT at our institution between January 2009 and December 2018. We retrospectively reviewed the clinical data of these patients, including their demographic information and data related to the SOT and upper extremity surgery.

Results: Trigger/tendon release (n = 31, 31.3%) was the most frequently performed upper extremity surgery, followed by incision and drainage for an infection (n = 16, 16.2%). Post-operative complications occurred after ten upper extremity operative procedures (10.1%), among which uncontrolled infection after surgery for an infection (n = 4) was the most common. According to the Clavien-Dindo classification, the complications of three surgical procedures were grade I, three were grade II, and four were grade III, and all were treatable. The occurrence rate of the complications was not significantly different between emergent and elective surgery. All transplanted organ-specific indicators did not worsen significantly after emergent or elective upper extremity surgery.

Conclusions: Since the function of the transplanted organ was well-preserved after emergent or elective upper extremity surgery, common upper extremity procedures do not seem to be a worrisome practice for SOT patients. However, when treating hand and upper extremity infections in SOT patients, surgeons should explain the possible need for multiple operations  and the high complication rate.
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http://dx.doi.org/10.1007/s00264-021-05129-8DOI Listing
July 2021

The Characteristics of Women with Subsequent Distal Radius Fracture after Initial Distal Radius Fracture.

J Bone Metab 2021 May 31;28(2):123-129. Epub 2021 May 31.

Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Background: The purpose of this study was to investigate the characteristics of women with subsequent distal radius fracture (DRF) and to compare bone fragility variables in women with initial and subsequent DRF.

Methods: We enrolled 227 women who experienced DRF (203 women with initial DRF and 24 women with subsequent DRF) between September 2016 and April 2019. We compared demographic characteristics and bone fragility variables, including bone mineral density, trabecular bone score, hip geometry, bicortical thickness of the distal radius, and fracture risk assessment tool (FRAX) scores between the 2 groups. To reduce bias, patients with subsequent DRF were propensity score-matched in a 1:2 manner with patients affected by initial DRF, and additional comparisons were performed.

Results: Patients in the subsequent DRF group were older than those in the initial DRF group, but this difference was not significant (P=0.091). The proportion of patients receiving treatment with osteoporosis medication was significantly higher in the subsequent DRF group (41.7% vs. 19.2%, P=0.011). Bone fragility variables did not differ significantly between the 2 groups. However, the ten-year probability of major osteoporotic fractures based on FRAX scores was significantly higher in patients with subsequent DRF (7.5% vs. 10.8%, P<0.001). Similar results were observed when comparing the propensity score-matched initial and subsequent DRF groups.

Conclusions: These findings suggest that the occurrence of subsequent DRF after initial DRF can be attributed to multiple factors rather than bone fragility alone. Systematic and multidisciplinary management would be helpful in preventing the occurrence of subsequent DRF after the initial DRF.
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http://dx.doi.org/10.11005/jbm.2021.28.2.123DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8206611PMC
May 2021

The effect of reformatting axis of computed tomography scans on the measurement of deformities in scaphoid waist nonunion.

Orthop Traumatol Surg Res 2021 Jun 5:102980. Epub 2021 Jun 5.

Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. Electronic address:

Background: Computed tomography (CT) has been used to understand the deformity of scaphoid nonunion, but no standard protocol for the reformatting of scaphoid CT imaging exists. The purpose of this study was to compare the reliability of measurements of the deformity of scaphoid waist nonunion between CT-scans reformatted in line with the scaphoid long axis and CT-scans reformatted in line with the wrist axis.

Hypothesis: We hypothesized that CT-scan which was reformatted along the scaphoid long axis is more reliable for understanding the deformity of scaphoid waist nonunion.

Patients And Methods: CT-scans of 28 wrists with a scaphoid waist nonunion were reformatted along both the long axis of the scaphoid and of the wrist. For each set of CT-scans, the nonunion gap in axial, coronal and sagittal series, the intrascaphoid angle, and the height to length ratio were measured. All scans were reviewed twice by three observers and intraclass correlation coefficients (ICCs) for inter- and intraobserver reliability were assessed.

Results: For the measurement of nonunion gaps and height to length ratio, neither inter- nor intraobserver reliability showed significant differences between the two reformatting scans. However, for the intrascaphoid angle, both inter- (ICC: 0.202 vs. 0.419, p<0.001) and intraobserver (ICC: 0.614 vs. 0.790, p<0.001) reliability were significantly higher on scaphoid axis CT-scan than on wrist axis CT-scan.

Discussion: In the assessment of deformity in patients with scaphoid waist nonunion, scaphoid axis reformatting CT-scans showed superior reliability for the measurement of intrascaphoid angle than did wrist axis reformatting CT-scans. Although there are several limitations for the correct assessment of all three-dimensional deformity, scaphoid axis reformatting CT-scans could help in assessing the extent of humpback deformity in patients with scaphoid waist nonunion.

Level Of Evidence: IV; diagnostic.
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http://dx.doi.org/10.1016/j.otsr.2021.102980DOI Listing
June 2021

Epidemiology of congenital upper limb anomalies in Korea: A nationwide population-based study.

PLoS One 2021 9;16(3):e0248105. Epub 2021 Mar 9.

Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

This study aimed to analyze the epidemiology of congenital upper limb anomalies (CULA) in Korea. We evaluated the incidence of each type of CULA, the presence of coexisting anomalies and the surgical treatment status in CULA patients. We conducted a retrospective cohort study of patients aged < 1 year between 2007 and 2016 who were registered with CULA in the Health Insurance Review and Assessment Service of Korea. In total, 10,704 patients had CULA, including 6,174 boys (57.7%) and 4,530 girls (42.3%). The mean annual incidence of CULA was 23.5 per 10,000 live births; it was significantly higher in boys than in girls (26.3 vs. 20.5, p < 0.001). Among the four categories of CULA-polydactyly, syndactyly, limb deficiency, and other anomalies-polydactyly was the most common. In total, 4,149 patients (38.8%) had other congenital anomalies and coexisting anomalies of the circulatory system (24.9%) were the most common. In total 4,776 patients (44.6%) underwent operative treatment for CULA within minimum three years of the diagnosis. The proportion of patients who underwent surgical treatment was significantly higher for polydactyly (73.4% vs. 16.8%, p < 0.001) and syndactyly (65.3% vs. 41.5%, p < 0.001), but it was significantly lower in limb deficiency (27.6% vs. 45.4%, p < 0.001) and other anomalies (10.0% vs. 69.8%, p < 0.001) than rest of CULA patients. Among the patients who had operations, 21.5% underwent multiple operations. The proportion of patients who underwent multiple operations was significantly higher in syndactyly (35.6% vs. 18.1%, p < 0.001), but it was significantly lower in polydactyly (4.0% vs. 95.5%, p < 0.001) and other anomalies (17.9% vs. 21.9%, p < 0.001) than rest of CULA patients. These results could provide a basis for estimating the national healthcare costs for CULA and the required number of CULA specialists.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0248105PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7943020PMC
March 2021

Treatment of forearm diaphyseal non-union: Autologous iliac corticocancellous bone graft and locking plate fixation.

Orthop Traumatol Surg Res 2021 Jan 29:102833. Epub 2021 Jan 29.

Department of orthopedic surgery, Asan Medical center, University of Ulsan college of medicine, Seoul, Korea. Electronic address:

Introduction: Studies conducted on forearm bone diaphysis non-union are limited due to the rarity of this condition. The present study aimed to evaluate the outcome of our technique using autologous iliac corticocancellous bone graft fixed by locking plate system for the forearm bone diaphyseal non-union without infection.

Patients And Methods: We treated eight patients with non-union of radial or ulnar shaft fracture (four men, four women) aged 38 years (range: 18-52 years) on average. The average follow-up period was 18 months (range: 12-24 months). In our technique, we applied the locking plate to the diaphyseal bone fragment, before grafting the bone block to the non-union site. After excision of sclerotic ununited bone, the autologous iliac corticocancellous bone was grafted to the defect and fixed with single locking screw. Pain, grip strength, and disabilities of the arm, shoulder, and hand (DASH) score were measured and compared before and 12 months after the surgery. Radiographs were taken at each follow-up, and the time of bony union was determined.

Results: The mean time to radiological union was 4.2 months (range: 3-6 months), and bony union was achieved in all cases within 6 months. All measured values, visual analog scale, DASH score, and grip strength, were significantly improved at 12 months after surgery (p<0.05). No minor/major complications including infection, non-union, or malunion were reported.

Conclusions: Locking compression plate fixation and autologous iliac corticocancellous bone grafting with a holding locking screw appears to be a reliable primary procedure for non-union of the forearm diaphyseal fracture without infection.

Level Of Evidence: IV; therapeutic study.
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http://dx.doi.org/10.1016/j.otsr.2021.102833DOI Listing
January 2021

Mesenchymal Stem Cells Derived from Wharton's Jelly Can Differentiate into Schwann Cell-Like Cells and Promote Peripheral Nerve Regeneration in Acellular Nerve Grafts.

Tissue Eng Regen Med 2021 06 30;18(3):467-478. Epub 2021 Jan 30.

Asan Peripheral Nerve Regeneration Lab Institute for Life Sciences, Seoul, South Korea.

Background: Schwann cells (SCs) secrete neurotrophic factors and provide structural support and guidance during axonal regeneration. However, nearby nerves may be damaged to obtain primary SCs, and there is a lack of nervous tissue donors. We investigated the potential of Wharton's Jelly-derived mesenchymal stem cells (WJ-MSCs) in differentiating into Schwann cell-like cells (WJ-SCLCs) as an alternative to SCs. We also examined whether implantation of WJ-SCLCs-laden acellular nerve grafts (ANGs) are effective in inducing functional recovery and nerve regeneration in an animal model of peripheral nerve injury.

Methods: The differentiation of WJ-MSCs into WJ-SCLCs was determined by analyzing SC-specific markers. The secretion of neurotrophic factors was assessed by the Neuro Discovery antibody array. Neurite outgrowth and myelination of axons were found in a co-culture system involving motor neuron cell lines. The effects of ANGs on repairing sciatic nerves were evaluated using video gait angle test, isometric tetanic force analysis, and toluidine blue staining.

Results: Compared with undifferentiated WJ-MSCs, WJ-SCLCs showed higher expression levels of SC-specific markers such as S100β, GFAP, KROX20, and NGFR. WJ-SCLCs also showed higher secreted amounts of brain-derived neurotrophic factor, glial cell-derived neurotrophic factor, and granulocyte-colony stimulating factor than did WJ-MSCs. WJ-SCLCs effectively promoted the outgrowth and myelination of neurites in motor neuron cells, and WJ-SCLCs laden ANGs significantly facilitated peripheral nerve regeneration in an animal model of sciatic nerve injury.

Conclusion: WJ-MSCs were readily differentiated into WJ-SCLCs, which effectively promoted the regeneration of peripheral nerves. Transplantation of WJ-SCLCs with ANGs might be useful for assisting peripheral nerve regeneration.
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http://dx.doi.org/10.1007/s13770-020-00329-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8169733PMC
June 2021

Preparation of human decellularized peripheral nerve allograft using amphoteric detergent and nuclease.

Neural Regen Res 2021 Sep;16(9):1890-1896

Department of Orthopedic Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

Animal studies have shown that amphoteric detergent and nuclease (DNase I and ribonuclease A) is the most reliable decellularization method of the peripheral nerve. However, the optimal combination of chemical reagents for decellularization of human nerve allograft needs further investigation. To find the optimal protocol to remove the immunogenic cellular components of the nerve tissue and preserve the basal lamina and extracellular matrix and whether the optimal protocol can be applied to larger-diameter human peripheral nerves, in this study, we decellularized the median and sural nerves from the cadavers with two different methods: nonionic and anionic detergents (Triton X-100 and sodium deoxycholate) and amphoteric detergent and nuclease (3-[(3-cholamidopropyl)dimethylammonio]-1-propanesulfonate (CHAPS), deoxyribonuclease I, and ribonuclease A). All cellular components were successfully removed from the median and sural nerves by amphoteric detergent and nuclease. Not all cellular components were removed from the median nerve by nonionic and anionic detergent. Both median and sural nerves treated with amphoteric detergent and nuclease maintained a completely intact extracellular matrix. Treatment with nonionic and anionic detergent decreased collagen content in both median and sural nerves, while the amphoteric detergent and nuclease treatment did not reduce collagen content. In addition, a contact cytotoxicity assay revealed that the nerves decellularized by amphoteric detergent and nuclease was biocompatible. Strength failure testing demonstrated that the biomechanical properties of nerves decellularized with amphoteric detergent and nuclease were comparable to those of fresh controls. Decellularization with amphoteric detergent and nuclease better remove cellular components and better preserve extracellular matrix than decellularization with nonionic and anionic detergents, even in large-diameter human peripheral nerves. In Korea, cadaveric studies are not yet legally subject to Institutional Review Board review.
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http://dx.doi.org/10.4103/1673-5374.306091DOI Listing
September 2021

Polydactyly of the thumb: a modification of the Wassel-Flatt classification.

J Hand Surg Eur Vol 2021 May 10;46(4):346-351. Epub 2021 Jan 10.

Department of Orthopedic Surgery, University of Ulsan College of Medicine, Seoul, South Korea.

Although the Wassel-Flatt classification system has been widely used for radial polydactyly, it has some limitations. We modified the classification system by introducing the hypoplastic types and refining the definition of triphalangeal thumb without changing the main structure of the original classification system. A total of 200 consecutive duplicated thumbs of 183 patients treated surgically from June 2016 to June 2018 were included. We evaluated intra-observer and inter-observer reliability using the kappa coefficient in the modified and original Wassel-Flatt classification systems (three examiners evaluated each case twice, with an interval of 4 weeks). We also evaluated the surgical methods according to the types of deformity in the modified and original Wassel-Flatt classification systems. The modified Wassel-Flatt classification system had good inter-observer reliability and provides useful information for determining the surgical plan according to the types of radial polydactyly. IV.
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http://dx.doi.org/10.1177/1753193420981541DOI Listing
May 2021

Increased expression of macrophages and inflammatory cytokines at tendon origin in patients with chronic lateral epicondylitis.

J Shoulder Elbow Surg 2021 Jul 13;30(7):1487-1493. Epub 2020 Nov 13.

Department of Orthopedic Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea. Electronic address:

Background: The success of anti-inflammatory medications and corticosteroid injections in controlling chronic lateral epicondylitis symptoms suggests an underlying inflammatory pathology that is also causative of the pain experienced by patients; however, evidence regarding inflammatory mediators and cells remains inconclusive.

Methods: We conducted a case-control study that included a total of 24 participants (10 patients and 14 controls). Extensor carpi radialis brevis tendon samples were obtained from patients, and flexor carpi radialis tendon samples were obtained from control subjects. We then performed immunohistochemical assessment to determine the expression levels of neuropeptides (substance P and calcitonin gene-related peptide), glutamate receptors (N-methyl-d-aspartate receptor type 1 and metabotropic glutamate receptor 5), inflammatory cytokines (interleukin 1α and tumor necrosis factor α), and inflammatory cells (M1 macrophages [CD68], M2 macrophages [CD163 and CD206], T-lymphocytes [CD3], and B-lymphocytes [CD20]).

Results: Patients' sampled extensor carpi radialis brevis tendons showed significantly elevated expression levels of neuropeptides, glutamate receptors, and inflammatory cytokines, along with a number of macrophages, compared with controls (P < .001 or P < .0001); however, there were no differences in the number of T- and B-lymphocytes between the 2 groups.

Conclusion: The findings of this study showed that inflammation is involved in the pathology of chronic lateral epicondylitis.
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http://dx.doi.org/10.1016/j.jse.2020.10.008DOI Listing
July 2021

Effect of Osteoporosis Medication on Fracture Healing: An Evidence Based Review.

J Bone Metab 2020 Feb 29;27(1):15-26. Epub 2020 Feb 29.

Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

A systematic search was conducted and relevant studies that evaluated the influence of osteoporosis medications (bisphosphonates [BPs], denosumab, selective estrogen receptor modulators [SERMs], recombinant human parathyroid hormone teriparatide [TPTD], and strontium ranelate [SrR]) on wrist, hip, and spine fracture healing, were selected. BPs administration did not influence fracture healing and clinical outcomes after distal radius fracture (DRF). Similar results were observed in hip fracture, but evidence is lacking for spine fracture. Denosumab did not delay the non-vertebral fractures healing in one well-designed study. No studies evaluated the effect of SERMs on fracture healing in humans. One study reported shorter fracture healing times in TPTD treated DRF patients, which was not clinically meaningful. In hip fracture, recent studies reported better pain and functional outcomes in TPTD treated patients. However, in spine fracture, recent studies found no significant differences in fracture stability between TPTD treated patients and controls. Evidence is lacking for SrR, but it did not influence wrist fracture healing in one study. In comparisons between TPTD and BPs, fracture healing and physical scores were not significantly different in hip fracture by 1 study. In spine fracture, controversy exists for the role of each medication to the fracture stability, but several studies reported that fracture site pain was better in TPTD treated patients than BPs treated patients. Considering no clinical data of negative fracture healing of the antiresorptive medication and the danger of subsequent fracture after initial osteoporotic fracture, there is no evidence to delay initiation of osteoporosis medications after fracture.
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http://dx.doi.org/10.11005/jbm.2020.27.1.15DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7064359PMC
February 2020

Prospective randomized comparison of ultrasonography-guided and blind corticosteroid injection for de Quervain's disease.

Orthop Traumatol Surg Res 2020 Apr 31;106(2):301-306. Epub 2019 Dec 31.

Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic road 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea. Electronic address:

Background: Ultrasonography (US)-guided corticosteroid injection (CI) has been attempted to improve injection accuracy in de Quervain's disease (dQD), but its role in improving clinical outcomes and decreasing skin hypopigmentation or atrophy was not established well.

Hypothesis: We hypothesized that the US-guided CI is superior to blind CI in symptom improvement and development of skin hypopigmentation or atrophy.

Patients And Methods: Forty-four patients (48 wrists) with dQD received ultrasonography-guided CI (24 wrists/22 patients, group A) or blind CI (24 wrists/22 patients, group B) between December 2016 and February 2018. The visual analogue scale for pain and the Patient-rated Wrist Evaluation (PRWE) were used for evaluation. Skin hypopigmentation or atrophy was evaluated using the modified Vancouver scar scale (mVSS) RESULTS: At 4 weeks post-injection, pain and PRWE scores improved for 22 wrists in group A and 21 wrists in group B. At 3 months post-injection, 10.0% (2/20) and 26.3% (5/19) of wrists in group A and B, respectively, had symptom recurrence after initial improvement. Improvement and aggravation rates were not significantly different between the groups. The incidence of skin hypopigmentation or atrophy was 69.6% (16/23 wrists) and 70.0% (14/20 wrists) in group A, and 59.1% (13/22 wrists) and 78.9% (15/19 wrists) in group B at 4 weeks and 3 months post-injection, respectively. The mean mVSS scores at the injection site in group A and B were 2.0 (0-4.0) and 1.8 (0-5.0) at 4 weeks post-injection and 2.4 (0-7.0) and 2.9 (0-6.0) at 3 months post-injection, respectively. The incidence and severity of skin hypopigmentation or atrophy were not significantly different between the groups at both time points.

Discussion: Pain and clinical outcomes significantly improved after CI in dQD. Pain, clinical outcomes, and the incidence and severity of skin hypopigmentation or atrophy were not significantly different between ultrasonography-guided and blind CI.

Level Of Evidence: I, Therapeutic.
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http://dx.doi.org/10.1016/j.otsr.2019.11.015DOI Listing
April 2020

Evaluation of Hip Geometry Parameters in Patients With a Distal Radius Fracture.

J Clin Densitom 2020 Oct - Dec;23(4):576-581. Epub 2019 Jun 12.

Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.

Background: Patients with a distal radius fracture (DRF) have an increased risk of subsequent fractures including hip fractures. The purpose of this study was to evaluate whether women with a DRF have certain hip geometry parameters known to indicate susceptibility to hip fractures.

Methods: We compared bone mineral density (BMD) and hip geometry parameters (hip axis length, neck shaft angle, mean cortical thickness, femur neck width, cross-sectional area [CSA], cross-sectional moment of inertia, section modulus, and buckling ratio) in 181 women with a DRF (DRF group) and 362 propensity score-matched women without a fracture (control group). We evaluated the associations between DRF and hip geometry parameters using logistic regression analysis.

Results: The DRF group had lower hip BMD; lower cortical thickness, CSA, and section modulus; and higher buckling ratio than the control group (all p < 0.05). The occurrence of a DRF was significantly associated with decreases in neck shaft angle (odds ratio [OR], 1.047; 95% confidence interval [CI], 1.008-1.088) and CSA (OR, 3.114; 95% CI, 1.820-5.326) after adjusting for age, BMI, and total hip BMD.

Conclusions: In this study, women with a DRF were more likely than women without a DRF to have hip geometry parameters known to indicate susceptibility to hip fractures. Our results suggest that not only low hip BMD but also a decreased CSA could account for the increased risk of subsequent hip fracture in patients with a DRF.
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http://dx.doi.org/10.1016/j.jocd.2019.06.001DOI Listing
June 2019

AGSM Proficiency and Depression Are Associated With Success of High-G Training in Trainee Pilots.

Aerosp Med Hum Perform 2019 Jul;90(7):613-617

High-gravity (G) training is used to educate trainee pilots about anti-G straining maneuvers (AGSM) in an environment similar to that of a real fighter aircraft, and to enhance their G tolerance. The success or failure of high-G training could be multifactorial, but most previous studies have only focused on the effect of pilots' physical condition. A total of 138 male trainee pilots participated in this study. All trainee pilots had received AGSM training from experienced instructors and then underwent centrifuge high-G training. Participants completed questionnaire surveys about body size, lifestyle, self-reported AGSM proficiency, resilience (Connor-Davidson Resilience Scale, CD-RISC), and depression level (Center for Epidemiologic Studies Depression Scale, CES-D). Of the 138 subjects, 100 (72.5%) successfully completed high-G training without experiencing G-induced loss of consciousness (G-LOC) within two trials; these were allocated to the success group. The remaining 38 (27.5%) subjects who completed the training after three or more attempts, or who failed to complete the training at all, were allocated to the failure group. Multivariate analyses revealed that the success of centrifuge training was positively associated with age and self-reported AGSM proficiency, and negatively associated with depression level. The success of high-G training was significantly associated with self-reported AGSM proficiency and depression level. Instructors should emphasize the importance of AGSM proficiency and offer practice-based learning to trainee pilots. In addition, they should pay attention to not only trainee pilots' physical condition, but also their psychological status.
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http://dx.doi.org/10.3357/AMHP.5323.2019DOI Listing
July 2019

Comparison of systematically combined detergent and nuclease-based decellularization methods for acellular nerve graft: An ex vivo characterization and in vivo evaluation.

J Tissue Eng Regen Med 2019 07 14;13(7):1241-1252. Epub 2019 Jun 14.

Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.

Little consensus exists regarding which decellularization technique best removes the cellular components while maintaining structural integrity. We aimed to identify the most efficient and safest decellularization method by combining previously established chemical (detergent based) and biological (nuclease based) methods in a systematic manner. Sixty sciatic nerves were harvested from Sprague-Dawley rats and prepared in 120 nerve fragments with 1-cm length. Nerve fragments were randomly divided into six groups and decellularized with six different methods: A, nonionic detergent + amphoteric detergent; B, nonionic detergent + anionic detergent; C, anionic detergent + amphoteric detergent; D, nonionic detergent + nuclease; E, amphoteric detergent + nuclease; and F, anionic detergent + nuclease. The remaining cellular components were evaluated with H&E, DAPI, and S-100 immunohistochemical staining, and DNA content was measured in each sample. The remaining extracellular matrix (ECM) integrity was evaluated with H&E, Masson's trichrome, periodic acid-Schiff, Luxol fast blue, and laminin immunohistochemical staining, and collagen content was measured in each sample. The amphoteric detergent + nuclease method was the best protocol for both cell removal and ECM preservation. In the in vivo study, the nerve allograft that was decellularized with amphoteric detergent + nuclease showed an inferior recovery rate based on the tibialis anterior muscle weight to autograft, but considerable recovery was observed. In conclusion, among the possible systematic combinations of detergent- and nuclease-based methods, the combination of amphoteric detergent and nuclease is currently the most suitable for nerve decellularization in terms of adequate cell removal and sufficient preservation of the ECM.
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http://dx.doi.org/10.1002/term.2874DOI Listing
July 2019

Pronator quadratus pedicled bone graft in the treatment of Kienböck disease: follow-up 2 to 12 years.

J Hand Surg Eur Vol 2020 May 24;45(4):396-402. Epub 2019 Mar 24.

Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

We inserted a pronator quadratus pedicled bone graft into the avascular lunate with preservation of its corticocartilaginous portion for the treatment of Kienböck disease. Twenty-seven patients (14 men, 13 women; mean age, 42 years (range 17-66 years)) were treated between September 2005 and July 2014 and followed up from 2 to 12 years. Three patients had Lichtman stage II disease, 13 had stage IIIA, and 11 had stage IIIB. Among them, 18 patients showed radiological improvement in lunate morphology. The Lichtman stage was unchanged in 23 patients and aggravated in four patients. The Stahl index was significantly decreased, but grip strength was significantly improved and 18 patients did not have any wrist pain during daily activities. Although our technique did not restore the already changed carpal malalignment, it improved lunate morphology. Clinically, it provided satisfactory pain levels in two-thirds of the patients and grip strength was improved. IV.
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http://dx.doi.org/10.1177/1753193419836628DOI Listing
May 2020

A Wearable Pulse Oximeter With Wireless Communication and Motion Artifact Tailoring for Continuous Use.

IEEE Trans Biomed Eng 2019 06 9;66(6):1505-1513. Epub 2018 Oct 9.

Advances in several engineering fields have led to a trend toward miniaturization and portability of wearable biosensing devices, which used to be confined to large tools and clinical settings. Various systems to continuously measure electrophysiological activity through electrical and optical methods are one category of such devices. Being wearable and intended for prolonged use, the amount of noise introduced on sensors by movement remains a challenge and requires further optimization. User movement causes motion artifacts that alter the overall quality of the signals obtained, hence corrupting the resulting measurements. This paper introduces a fully wearable optical biosensing system to continuously measure pulse oximetry and heart rate, utilizing a reflectance-based probe. Furthermore, a novel data-dependent motion artifact tailoring algorithm is implemented to eliminate noisy data due to the motion artifact and measure oxygenation level with high accuracy in real time. By taking advantages of current wireless transmission and signal processing technologies, the developed wearable photoplethysmography device successfully captures the measured signals and sends them wirelessly to a mobile device for signal processing in real time. After applying motion artifact tailoring, evaluating accuracy with a continuous clinical device, the blood oxygenation measurements obtained from our system yielded an accuracy of at least 98%, when compared to a range of 93.6%-96.7% observed before from the same initial data. Additionally, heart rate accuracy above 97% was achieved. Motion artifact tailoring and removal in real time, continuous systems will allow wearable devices to be truly wearable and a reliable electrophysiological monitoring and diagnostics tool for everyday use.
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http://dx.doi.org/10.1109/TBME.2018.2874885DOI Listing
June 2019

Lower Trabecular Bone Score is Associated With the Use of Proton Pump Inhibitors.

J Clin Densitom 2019 Apr - Jun;22(2):236-242. Epub 2018 Jul 4.

Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, South Korea.

Introduction: Trabecular bone score (TBS) provides indirect indices of trabecular microarchitecture and bone quality. Several studies have evaluated the influence of proton pump inhibitors (PPIs) on bone mass and geometric parameters, but no studies have evaluated the influence of PPIs on TBS.

Methods: We reviewed the medical records of 1505 women aged 40-89 yr who had bone mineral density (BMD) examinations as a part of the medical diagnosis and disease prevention program and who did not have osteoporotic fractures or conditions that could affect bone metabolism. Among these, we identified 223 women with exposure to PPIs and selected the same number of age- and body mass index (BMI)-matched control patients. We compared TBS and BMD between the PPI exposure group and the control group and performed multivariate regression analyses to determine whether TBS and BMDs are associated with age, BMI, and PPIs exposure. We also examined whether TBS and BMDs are associated with PPIs exposure timing (current, recent, and past).

Results: TBS and BMDs were significantly lower in the PPI exposure group than in the control group. In a multivariable linear regression analysis, TBS was significantly associated with age (p < 0.001) and PPI exposure (p = 0.02). In addition, all BMDs were found to be significantly associated with age, BMI, and PPI exposure. Lower TBS was associated with current PPIs use (p = 0.005), but not with recent or past PPIs usage. However, the influence of PPI exposure timing on the BMDs was not consistent between BMD measurement sites.

Conclusions: This study found that TBS is lower in subjects with PPIs exposure than in controls. The association of lower TBS with current PPIs use suggests that trabecular bone quality could be affected early by PPIs, and but the effect might be reversible.
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http://dx.doi.org/10.1016/j.jocd.2018.06.008DOI Listing
June 2020

Comparison of Long-Term Outcomes of Radial Osteotomy and Nonoperative Treatment for Kienböck Disease: A Systematic Review.

J Bone Joint Surg Am 2018 Jul;100(14):1231-1240

Departments of Orthopedic Surgery (Y.H.S., J.K.K., T.K.L., and J.O.Y.) and Clinical Epidemiology and Biostatistics (M.H.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.

Background: Radial osteotomy has shown favorable clinical results for early to advanced stages of Kienböck disease. However, it is not clear whether this technique could change the natural course of the disease, or whether its clinical results are actually superior to those of nonoperative treatment. The purpose of this study was to compare radial osteotomy with nonoperative treatment in terms of long-term radiographic and clinical outcomes in patients with Kienböck disease.

Methods: We systematically reviewed retrospective studies of radial osteotomy and nonoperative treatment for Kienböck disease with long-term follow-up (mean of ≥10 years). A systematic search was conducted across 3 databases (CENTRAL, PubMed, and Embase) and relevant articles were selected. Data regarding patient demographics, treatment details, and radiographic and clinical outcomes were abstracted from the selected studies.

Results: Seventeen studies (5 of nonoperative treatment and 12 of radial osteotomy) were included. Before treatment, the mean age of patients and mean proportion of wrists with Lichtman stage III or higher were not significantly different between the 2 groups. Neither the mean proportion of wrists that showed worsening of the Lichtman stage after treatment nor the proportion that showed no change in the stage were significantly different between the 2 groups. However, the mean proportion of wrists that had more than moderate pain at the time of final follow-up was significantly lower in the radial osteotomy group (5.7%; range, 0% to 18.2%) than in the nonoperative treatment group (23.2%; range, 17.4% to 35.3%). In addition, the total arc of wrist motion at the time of final follow-up was significantly greater in the radial osteotomy group (107.4° ± 10.0°; range, 93.0° to 126.0°) than in the nonoperative treatment group (88.8° ± 13.2°; range, 68.5° to 103.5°).

Conclusions: Systematic review of long-term follow-up studies showed that radial osteotomy was not superior to nonoperative treatment in terms of disease progression according to the Lichtman stage. Nevertheless, radial osteotomy was reported to have better outcomes with respect to the extent of pain and range of wrist motion.

Level Of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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http://dx.doi.org/10.2106/JBJS.17.00764DOI Listing
July 2018

The peritrapezial view: New radiograph for evaluating joints around trapezium.

J Orthop Surg (Hong Kong) 2018 Jan-Apr;26(1):2309499018762846

3 Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea.

Purpose: The purpose of this study was to present a new radiograph of peritrapezial view and examine whether this view could supply clear and reliable radiographs of the joints around trapezium.

Methods: The radiographs of peritrapezial and Robert views were taken on both hands of the 30 healthy volunteers (15 men and 15 women). The four peritrapezial joints were evaluated by two trained hand surgeons to find out whether these views could clearly show the joint spaces around the trapezium. Intra- and interobserver agreement for evaluation of each joint space and the ratio of joints which both of the two observers rated as clear joint space were compared between peritrapezial and Robert views.

Results: The κ values of inter- and intra-observer reliability were, respectively, 0.559 and 0.715 in peritrapezial view and 0.462 and 0.355 in Robert view. The ratios of joints, which both of the two observers rated as clear joint space in each of the two time evaluations, were slightly higher in peritrapezial view than Robert view for the thumb carpometacarpal (100% vs. 96.7%) and scaphoid-trapezium joints (100% vs. 93.3%). In addition, these ratios were significantly higher in peritrapezial view than Robert view for the trapezium-index metacarpal (90.0% vs. 46.7%, p < 0.001) and trapezium-trapezoid joints (93.3% vs. 50.0%, p < 0.001).

Conclusion: The peritrapezial view clearly shows the joint spaces around the trapezium. This view showed better inter- and intra-observer reliability for peritrapezial joints than Robert view especially in trapezium-index metacarpal and trapezium-trapezoid joint. This radiograph could provide a preliminary step for evaluating and managing pathologies of the peritrapezial joints.
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http://dx.doi.org/10.1177/2309499018762846DOI Listing
September 2019

Psychological Status Is Associated With Symptom Severity in Patients With Carpal Tunnel Syndrome.

J Hand Surg Am 2018 05 3;43(5):484.e1-484.e8. Epub 2018 Jan 3.

Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. Electronic address:

Purpose: The purpose of this study was to investigate whether psychological status is associated with symptom severity or functional disability of carpal tunnel syndrome (CTS) patients.

Patients And Methods: Sixty patients diagnosed with CTS and treated with carpal tunnel release (CTR) were asked to complete a self-administered questionnaire consisting of 3 validated measures obtained before and 3 months after surgery. The Boston Carpal Tunnel Questionnaire (BCTQ) was administered to assess symptoms (BCTQ-S) and functional disabilities (BCTQ-F), and the Center for Epidemiologic Studies Depression Scale (CES-D) and Pain Anxiety Symptoms Scale (PASS) were administered to assess depression and pain anxiety. The preoperative scores and those obtained 3 months after CTR were compared. Bivariate and multivariable regression analyses were performed to determine whether the variance of CES-D and PASS scores are associated with the variance of symptom severity or functional disability of CTS patients.

Results: The CES-D and PASS scores significantly improved after surgery. In a multivariable linear regression model, the CES-D and PASS scores were significantly associated with the BCTQ-S scores both before and 3 months after surgery. In addition, the changes in CES-D and PASS scores were significantly associated with the change in BCTQ-S scores.

Conclusions: The depression level and pain anxiety of CTS patients were significantly improved at 3 months after CTR. The depression level and pain anxiety were significantly associated with the CTS symptoms in both the preoperative and the postoperative period. In addition, the improvement of depression and pain anxiety were associated with the improvement of CTS symptoms. Thus, our findings indicate that the depression and pain anxiety of CTS patients are associated with the symptom severity of CTS.

Type Of Study/level Of Evidence: Prognostic II.
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http://dx.doi.org/10.1016/j.jhsa.2017.10.031DOI Listing
May 2018

A modified deltoid splitting approach with axillary nerve bundle mobilization for proximal humeral fracture fixation.

Injury 2017 Nov 8;48(11):2569-2574. Epub 2017 Sep 8.

Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.

Introduction: The deltopectoral and the deltoid splitting approach are commonly used for the treatment of proximal humeral fractures. While the deltopectoral approach requires massive soft tissue devascularization, the deltoid splitting approach needs an additional skipped incision to avoid axillary nerve injury. The purpose of this study was to describe a modified anterolateral deltoid splitting approach with axillary nerve bundle mobilization in the treatment of proximal humeral fractures and to assess its radiologic and clinical outcomes.

Patients And Methods: Twenty-two consecutive patients with proximal humeral fractures were treated with minimally invasive plate osteosynthesis by using a modified anterolateral deltoid splitting approach with axillary nerve bundle mobilization. The patients were divided into two groups: 10 patients of Neer type 2 or 3 fractures vs. 12 patients of Neer type 4 fractures. The mean age of the study population was 63.5 years (range: 30-80 years). Six patients had valgus impacted fractures, and nine had fractures with medial comminution.

Results: Fracture union was achieved in all cases. The mean time to union was 8.6 weeks (range: 6-12 weeks). Major complications, such as avascular necrosis of the humeral head and varus collapse at the fracture site, were not observed. No patients had clinically detectable sensory deficits in the axillary nerve distribution or paralysis of the anterior deltoid muscle. The mean neck-shaft angle at the final follow-up was 136.9° (range, 115°-159°). The mean visual analog score for patient satisfaction was 9.1 (range, 6-10), and the mean Neer scores were 93.5 (range, 84-100). There were no significant differences between the two groups with respect to radiologic and clinical outcomes except Neer scores: 95.8 (range: 86-100) in Neer type 2 or 3 fractures and 91.7 (range: 84-99) in Neer type 4 fractures.

Conclusion: The use of a modified anterolateral deltoid splitting approach with axillary nerve bundle mobilization in the treatment of proximal humeral fractures yielded excellent outcomes. This approach is a useful alternative to the deltopectoral or the deltoid splitting approaches in the treatment of proximal humeral fractures.
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http://dx.doi.org/10.1016/j.injury.2017.09.007DOI Listing
November 2017

Clinical Outcome of Lateral Wedge Osteotomy of the Radius in Advanced Stages of Kienböck's Disease.

Clin Orthop Surg 2017 Sep 4;9(3):355-362. Epub 2017 Aug 4.

Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea.

Background: Radius osteotomies showed favorable clinical outcome in Kienböck's disease. However, few articles have been published on the long-term outcome of lateral wedge osteotomy of the radius in patients with advanced stage Kienböck's disease.

Methods: Eleven patients with Lichtman stage IIIB/IV Kienböck's disease (group A; mean follow-up period, 86.1 months; range, 48 to 163 months) and 14 patients with Lichtman stage IIIA Kienböck's disease (group B; mean follow-up period, 85.1 months; range, 49 to 144 months) underwent radial wedge osteotomy between August 2004 and August 2012. Radiological changes of the lunate and radiocarpal joint were compared between two groups after osteotomy. The wrist flexion/extension angle, grip strength, and Disabilities of the Arm, Shoulder and Hand (DASH) scores were evaluated preoperatively and at the final follow-up. The Nakamura Scoring System (NSSK) was used for comprehensive understanding of radiological and clinical outcomes.

Results: Nine patients of group A and 11 patients of group B showed radiological improvement in the lunate regarding sclerosis, cystic changes, or fragmentation. No patients showed progression of arthritic changes in radiocarpal and midcarpal joints. The wrist flexion/extension angle, grip strength, and DASH score were significantly improved in both groups after operation, but intergroup difference was not statistically significant at the final follow-up ( = 0.149, = 0.267, and = 0.536, respectively). The mean NSSK was 21.6 (range, 15 to 27) in group A and 21.8 (range, 15 to 26) in group B.

Conclusions: Radial wedge osteotomy yielded excellent radiological and functional outcomes in advanced stages of Kienböck's disease and these results were comparable to those of Lichtman stage IIIA disease. This technique could be a useful alternative to salvage procedures in the treatment of Lichtman stage IIIB/IV Kienböck's disease without severe radiocarpal arthritis.
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http://dx.doi.org/10.4055/cios.2017.9.3.355DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5567032PMC
September 2017

Beveled posteromedial corner of the radial head: a three-dimensional micro-computed tomography modeling study.

J Anat 2017 Nov 15;231(5):690-697. Epub 2017 Aug 15.

Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.

The posteromedial quadrant of the radial head is known to be different from the other quadrants. However, the explanation of this unique anatomical feature remains elusive. Hence, this study was designed to address this unique anatomical variance using three-dimensional μCT (micro-computed tomography) analysis. Nine fresh cadaveric radial heads were scanned using μCT. Three-dimensional subchondral bone and cartilage models were rendered. Both models were separated into the four quadrants at both the periphery (rim) and the articulating dish (fovea): anteromedial (AM), posteromedial (PM), posterolateral (PL), and anterolateral (AL). Each quadrant was analyzed in terms of (1) subchondral bone porosity (SBP), (2) mean subchondral bone thickness (MSBT), and (3) mean cartilage thickness (MCT). There was a significant difference between the fovea and the rim in terms of its microarchitectural features. Although within the fovea, the PM quadrant did not differ significantly from the other quadrants, a significant difference was found within the rim. In terms of SBP, PM, AM, PL and AL were calculated as 33, 37, 36 and 35%, respectively. In terms of MSBT, PM, AM, PL and AL were calculated as 0.11, 0.10, 0.09, and 0.09 mm, respectively. In terms of MCT, PM, AM, PL and AL were calculated 1.09, 0.81, 0.84 and 0.83 mm, respectively. The PM corner of the radial head between the 8 and 9 o'clock positions, was beveled. This might explain why the PM quadrant of the rim differed significantly from the other quadrants in terms of its microarchitectural features.
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http://dx.doi.org/10.1111/joa.12672DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5643919PMC
November 2017

Older Age and Higher Body Mass Index Are Associated With a More Degraded Trabecular Bone Score Compared to Bone Mineral Density.

J Clin Densitom 2019 Apr - Jun;22(2):266-271. Epub 2017 Jul 13.

Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.

Trabecular bone score (TBS) may detect subjects with a more degraded microarchitecture but whose bone mineral density (BMD) reflects normal or osteopenia. The purpose of this study was to evaluate whether age and body sizes were associated with the discordance between BMD and TBS. We analyzed BMD and TBS in 1505 Korean women over 40 yr of age who had no history of osteoporotic fractures or conditions that affect bone metabolism. We considered 3 groups to have TBS values that reflected a more degraded TBS than their BMD values: (1) normal BMD but partially degraded TBS, (2) normal BMD but degraded TBS, and (3) osteopenia but degraded TBS. We compared subjects in these 3 groups with other subjects in terms of age and body sizes, and used multivariable logistic regression to analyze the odds ratios (ORs) for the occurrence of a more degraded TBS than their BMD level using age and body mass index (BMI). One hundred sixty subjects (10.6%) were found to have a more degraded TBS than their BMD level; these subjects were older, heavier, and had higher BMIs than the other subjects. Age (OR: 1.038, 95% confidence interval: 1.020-1.057, p< 0.001) and BMI (OR: 1.223, 95% confidence interval: 1.166-1.283, p< 0.001) were statistically significant in the multivariable analysis for the occurrence of this feature. Women with a more degraded TBS than their BMD level are older and have higher BMIs than the other subjects. It may be helpful to consider the possibility of trabecular bone degradation when clinically evaluating fracture risk in patients who are older or who have high BMIs with normal BMD or osteopenia.
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http://dx.doi.org/10.1016/j.jocd.2017.06.006DOI Listing
June 2020

Cervical Spine Status of Pilots and Air-Controllers of Airborne Early Warning and Control Aircraft.

Aerosp Med Hum Perform 2017 May;88(5):476-480

Introduction: Many countries have developed their own airborne early warning and control (AEW&C) systems for use in surveying their territorial sky in real time. However, a review of the literature suggests that no studies have been conducted to analyze the cervical spine of pilots and air-controllers of AEW&C aircraft.

Methods: The study subjects were 80 pilots and air-controllers of AEW&C aircraft with a period of service of > 1 yr and had data on physical examinations, simple radiographs and functional scores of the axial skeleton, and questionnaires about lifestyle and working conditions. Information about physical characteristics and experience of neck pain were collected. Functional scores including the neck disability index and short-form 36-item health survey were obtained. Radiological measurements were performed for the C2-7 Cobb angle and degree of forward head posture.

Results: Of the 80 subjects, 33 (41.3%) had experienced neck pain and 63 (78.8%) had impaired cervical lordosis. The results of functional and radiological evaluations were not significantly different between pilots and air-controllers. In multivariate analysis, only the age was significantly related to the occurrence of impaired cervical lordosis. However, there were no significant factors related to the occurrence of neck pain.

Discussion: The results of this study suggest that the working environment of pilots and air-controllers of AEW&C aircraft has a negative effect on their cervical spine. Age seemed to be the most significant factor affecting the occurrence of impaired cervical lordosis in these subjects.Shin YH, Yun C, Han AH. Cervical spine status of pilots and air-controllers of airborne early warning and control aircraft. Aerosp Med Hum Perform. 2017; 88(5):476-480.
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http://dx.doi.org/10.3357/AMHP.4734.2017DOI Listing
May 2017

Use of a decision aid did not decrease decisional conflict in patients with carpal tunnel syndrome.

BMC Musculoskelet Disord 2017 03 21;18(1):118. Epub 2017 Mar 21.

Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea.

Background: Although a model for shared decision-making is important for patient-centered care, decisional conflict can emerge when patients participate in the decision-making. A decision aid is proposed to provide information and to involve patients more comfortably in the decision-making process. We aimed to determine whether a decision aid helps patients with carpal tunnel syndrome (CTS) experience less decisional conflict regarding their decision-making for surgery.

Methods: Eighty patients with CTS were randomized into two groups. The test group was given a decision aid in addition to regular information and the control group regular information only. The decision aid consisted of a 6-min videoclip that explains diagnosis and information regarding surgery for CTS with other treatment options. We evaluated patients' decisional conflict regarding surgery, knowledge about CTS, and symptom severity as measured by the Disabilities of Arm, Shoulder, and Hand (DASH) Questionnaire.

Results: There was no difference in the decisional conflict scale (DCS) between both groups (p = 0.76). The test group had significantly better knowledge than the control group (p = 0.04). There was no correlation between the knowledge score and the DCS (p = 0.76). However, less severe symptoms were correlated with greater decisional conflict (r = -0.29, p = 0.02).

Conclusions: We found that a decision aid does not reduce decisional conflict in patients with CTS, although it can help them be better informed. This study suggests that although a decision-aid is effective for patient education, doctor-patient communication should be more emphasized for patients with less severe symptoms, as they can have greater decisional conflict.

Trial Registration: SNUBH Registry 1510/317-003 Registered November 13, 2015.
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http://dx.doi.org/10.1186/s12891-017-1478-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5360048PMC
March 2017

Recent Update in the Diagnosis and Treatment of Bone Frailty in Patients with a Distal Radius Fracture.

J Hand Surg Asian Pac Vol 2016 10;21(3):307-12

1 Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.

Distal radius fracture (DRF) is the most common upper extremity fracture in the elderly. Patients with a DRF have a two to fourfold higher risk of a subsequent fracture than those with no history of fractures, and DRFs occur on average 15 years earlier than hip fractures. Therefore, patients with a DRF offer physicians an important opportunity to diagnose and treat osteoporosis to prevent a secondary fracture. In this review, we provide recent update in the diagnosis and treatment of bone frailty in patients with a DRF.
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http://dx.doi.org/10.1142/S2424835516400117DOI Listing
October 2016

Acute spinal injury after centrifuge training in asymptomatic fighter pilots.

Aerosp Med Hum Perform 2015 Apr;86(4):386-91

Introduction: Many countries have hypergravity training centers using centrifuges for pilots to cope with a high gravity (G) environment. The high G training carries potential risk for the development of spinal injury. However, no studies evaluated the influence of centrifuge training on the spines of asymptomatic fighter pilots on a large scale.

Methods: Study subjects were 991 male fighter pilots with high G training at one institution. Subject variables included information about physical characteristics, flight hours of pilots prior to the training, and G force exposure related factors during training. The two dependent variables were whether the pilots developed acute spinal injury after training and the severity of the injury (major/minor).

Results: The incidence of acute spinal injury after high G training was 2.3% (23 of 991 subjects). There were 19 subjects who developed minor injury and 4 subjects who developed a herniated intervertebral disc, which is considered a major injury. In multivariate analysis, only the magnitude of G force during training was significantly related to the development of acute spinal injury. However, there was no significant factor related to the severity of the injury.

Discussion: These results suggest that high G training could cause negative effects on fighter pilots' spines. The magnitude of G force during training seemed to be the most significant factor affecting the occurrence of acute spinal injury.
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http://dx.doi.org/10.3357/AMHP.4062.2015DOI Listing
April 2015

Patent foramen ovale and asymptomatic brain lesions in military fighter pilots.

Clin Neurol Neurosurg 2014 Oct 18;125:9-14. Epub 2014 Jul 18.

Department of Neurology, Cerebrovascular Center, Chonnam National University Hospital, Gwangju, South Korea.

Background And Purpose: Previous studies have reported higher incidence of white matter lesions (WMLs) in military pilots. The anti-gravity straining maneuver, which fighter military pilots perform numerously during a flight is identical to the valsalva maneuver. We sought to investigate the prevalence of right-to-left shunt (RLS) associated with WMLs in military pilots.

Methods: A prospective study was performed involving military pilots who visited the Airomedical Center. The pilots underwent brain magnetic resonance imaging (MRI) scan and transcranial Doppler (TCD) with intravenous injection of agitated saline solution for the detection of RLS. Periventricular WMLs (PVWMLs) on MRI were graded using Fazeka's scale, and deep WMLs (DWMLs) were graded using Scheltens's scale.

Results: This study included 81 military pilots. RLS on TCD was observed less frequently in non-fighter pilots than in fighter pilots (35.5% vs. 64.5%, p=0.011). Fighter pilot was an independently associated factor with RLS on the TCD. DWMLs were independently associated with RLSs through a patent foramen ovale (PFO) (OR 3.507, 95% CI 1.223-10.055, p=0.02).

Conclusion: The results suggest that DWMLs in military pilots may significantly be associated with RLS via PFO. Additional investigations are warranted.
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http://dx.doi.org/10.1016/j.clineuro.2014.07.011DOI Listing
October 2014
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