Patient Perception on Osteoporosis in Korean Female Patients with Osteoporosis.

BACKGROUND: Patient perception is a key element in improving compliance with medications for osteoporosis. This study evaluated the awareness, perception, sources of information, and knowledge of osteoporosis among Korean women with osteoporosis. METHODS: A questionnaire survey was conducted from July 22, 2021 to 13 August 2021. Patients who were followed up in endocrinology (Endo), orthopedic surgery (OS), and gynecology (GY) were recruited (N=40, 40, and 20 in each group). Patients were allocated according to their age, as follows: 15, 15, and 10 patients in their 60s, 70s, and 80s for Endo and OS, and 10 and 10 patients in their 60s and 70s for GY. The questionnaire was composed of the following topics: patient journey to the hospital, drug-related issues, communication with medical doctors, patient knowledge, and sources of information about osteoporosis. RESULTS: The results of medical check-ups were the most common reason for patient visits to the hospital for an initial diagnosis of osteoporosis (61%). A knowledge gap regarding mortality, refracture, and drug-induced osteoporosis was observed. Doctors were the most preferred and trustful source of information, while health-related TV shows were the second most common source of information. Patients with OS reported lower perceived severity and higher drug discontinuation, along with a higher proportion of fractures, as the initial reasons for hospital visits for osteoporosis. CONCLUSIONS: Variations in perceptions according to the issue and group were identified. These should be considered during patient consultations to improve compliance with osteoporosis treatment.

Seasonal Variations and Common Places of Hip Fractures in Elderly Patients: Nine Year Consecutive Survey.

BACKGROUND: Fall prevention is important for reducing hip fractures. The aim of this study was to determine the relationship between variables related to hip fractures according to sex and season. METHODS: This study included patients admitted for fragility hip fractures between 2012 and 2021. Patients were interviewed by a junior resident before discharge. Data on sex, age, diagnosis, osteoporosis treatment, direction, voiding problems, ambulatory function, seasons, weather, time of day, place, location, floor condition, activity during fall, and perceived reason for fall were collected and analyzed. RESULTS: A total of 1,118 patients were included (279 males and 839 females). In both sexes, indoor falls were prevalent throughout all seasons, but males showed a higher proportion of outdoor falls, especially in winter during cloudy or snowy weather. Rooms and walking were the most common locations and activities during falls. The poor ambulatory function was associated with a higher prevalence of indoor falls. Osteoporosis treatment rates were low and did not differ according to Koval stage. Winter was associated with higher osteoporosis non-treatment group. Urgency/incontinence in female patients caused a higher proportion of falls during the evening time. CONCLUSIONS: Strategies for indoor fall prevention and vigilant osteoporosis diagnosis and treatment are important for all seasons, especially for frail elderly patients. Outdoor fall prevention emphasized for male patients, and education around nighttime falls should be provided for female patients with voiding dysfunction.

Prevalence, Clinical Implication, and Cause of Spine Hip Discordance in Elderly Patients with Fragility Hip Fracture.

BACKGROUND: Spine-hip discordance (SHD) increases fracture risk. However, its prevalence and clinical implications have not been investigated in patients with hip fractures. This study determined the prevalence and association of SHD with mortality and investigated the cause of SHD in patients with hip fractures. METHODS: This study included patients admitted for fragility hip fractures between 2011 and 2020. All patients underwent dual energy X-ray absorptiometry and anteroposterior and lateral views of the lumbosacral spine during admission. Data on demographics, diagnosis, American Society of Anesthesiologists score, and mortality were collected. A T-score difference of more than 1.5 between L1-4 and the femur neck was considered discordant, and 3 groups (lumbar low [LL] discordance, no discordance [ND], and femur neck low [FL] discordance) were compared. In the discordance group, lumbar radiographs were reviewed to determine the cause of discordance. RESULTS: Among 1,220 eligible patients, 130 were excluded due to patient refusal or bilateral hip implantation; therefore, this study included 1,090 patients (271 male and 819 female). The prevalence of LL, ND, and FL was 4.4%, 66.4% and 29.2% in men and 3.9%, 76.1%, and 20.0% women. Mortality was not associated with discordance. The most common causes of discordance were physiological in the LL group and pathological in the FL group for both sexes. CONCLUSIONS: Patients with hip fractures showed lower rates of ND and higher rates of FL compared to the general population. True discordance should be carefully judged for pathological and artifact reasons. The clinical implications of SHD require further investigation.

Poor Dietary Protein Intake in Elderly Population with Sarcopenia and Osteosarcopenia: A Nationwide Population-Based Study.

BACKGROUND: Our purpose in this study was to evaluate any deficiency of protein intake for different types of sarcopenia, including osteosarcopenia and sarcopenic obesity and to establish a cut-off value for the relationship between malnutrition, sarcopenia, and osteosarcopenia. METHODS: The cross-sectional study was performed using data from the Korea National Health and Nutrition Examination Survey. A total of 4,020 participants (men, 1,698 and women, 2,322) were analyzed in the present study. Sarcopenia is defined according to the criteria for the Asia Working Group for Sarcopenia. To evaluate the adequacy of protein intake, the value obtained by dividing the amount of protein consumed through food by the daily recommended protein amount (50 g/day) of Korean males was defined as the nutrient intake ratio. RESULTS: Total protein (P<0.001 in men, P<0.001 in women) and low dietary intake protein (P<0.001 in men, P=0.046 in women) were significantly lower in the sarcopenia group than in the normal group, and were significantly lower in the osteosarcopenia group than in the normal group for both men and women. The cut-off value of the adjusted weight of protein intake for sarcopenia was 0.58 g/kg/day in men and 0.98 g/kg/day in women. The cut-off value for adjusted weight of protein intake for osteo-sarcopenia was 0.8 g/kg/day in men and 0.5 g/kg/day in women. CONCLUSIONS: A comprehensive dietary assessment to detect nutritional deficits that predispose one to or aggravate muscle atrophy is important for establishing a treatment plan for patients with malnutrition.

Biomechanical comparison of three tension band wiring techniques for transverse fracture of patella: Kirschner wires, cannulated screws, and ring pins.

PURPOSE: The purpose of this study is to compare biomechanical characteristics of tension band wiring using Kirschner wires (TBWKW), cannulated screws (TBWCS), and ring pins (TBWRP) for transverse fracture of the patella. METHODS: A total of 48 polyurethane synthetic patellae were biomechanically tested. All patellae were osteotomized to create a transverse fracture. Each TBWKW, TBWCS, and TBWRP fixed 16 broken patellae. A specially designed fixation board simulated a knee with 90° flexion. Ten static tests and six dynamic tests were performed on each method. The static test is measuring maximum strength (N) during traction until breakage of the fixation. The dynamic test consisted of measuring the fracture gap (mm) after 10,000 repetitive loading cycles between 100 N and 300 N that simulated actual daily activity. A gap of 2 mm or more was defined as a failure in both tests. RESULT: The failure load was 438.6 ± 138.6 N, 422.2 ± 72.7 N, and 1106.8 ± 230.3 N for TBWKW, TBWRP, and TBWCS, respectively. TBWCS showed a statistically significant difference compared to TBWKW and TBWRP in the static test (p < 0.001). All the groups had no failure in the dynamic test. The mean fracture gap after completion of the dynamic test was 0.3267 ± 0.3395 mm, 0.2938 ± 0.2165 mm, and 0.0360 ± 0.0570 mm for TBWKW, TBWRP, and TBWCS, respectively (p = 0.044). The mean values in the dynamic test showed no statistical difference. There was a significant difference between TBWRP and TBWCS (p = 0.009), but others showed no difference with statistical significance. CONCLUSION: All three methods have sufficient stability at a daily activity. TBWCS showed a better failure load compared with TBWKW and TBWRP. TBWRP showed compatible mechanical characteristics with traditional tension band wiring. TBWRP could be an alternative method for TBWKW.

Difference in Mortality Rate by Type of Anticoagulant in Elderly Patients with Cardiovascular Disease after Hip Fractures.

BACKGROUND: The purpose of this study was to investigate the difference in mortalilty rate between cardiovascular disease (CVD) patients and non-CVD patients after hip fracture surgery performed in elderly patients. In addition, we compared the effect of CVD medication on mortality after hip fracture surgery. METHODS: Patients who underwent surgery for femoral intertrochanteric or neck fracture from January 2003 to December 2013 were enrolled in this study. After applying exclusion criteria, we categorized patients into group I (833 patients, non-CVD group) and group II (811 patients, CVD group). The CVD group was subcategorized as group IIa (332 patients, no medication), group IIb (381 patients, antiplatelet agents), and group IIc (98 patients, anticoagulation agents). Cumulative mortality rate at 30 days, 60 days, 3 months, and 1 year were compared between the groups. RESULTS: In the 1,644 patients, the cumulative mortality rate at 30 days, 60 days, 3 months, and 1 year was 0.1%, 0.5%, 0.7%, and 8.2%, respectively, in group I and 1.0%, 1.6%, 2.5%, and 8.8%, respectively, in group II (p = 0.02, p = 0.03. p = 0.01, and p = 0.72, respectively). In the 811 group II patients, the cumulative mortality rate at 30 days, 60 days, 3 months, and 1 year was 0.3%, 0.6%, 1.2%, and 6.6%, respectively, in group IIa; 0.8%, 1.6%, 2.1%, and 9.4%, respectively, in group IIb; and 4.1%, 5.1%, 8.2%, and 13.3%, respectively, in group IIc (p = 0.003, p = 0.01, p = 0.004, and p = 0.10, respectively). CONCLUSIONS: CVD increases short-term mortality within 30 days, 60 days, and 3 months in elderly hip fracture patients. The use of anticoagulants in CVD patients increases the rate of surgical delay and short-term mortality within 30 days, 60 days, and 3 months.

Sarcopenic Obesity in Elderly Korean Women: A Nationwide Cross-sectional Study.

BACKGROUND: Sarcopenia causes loss of muscle mass in the elderly and is associated with development of metabolic syndrome in those with obesity. This study evaluated the prevalence of sarcopenic obesity (SO) in healthy Korean elderly women. METHODS: This study was based on data from the Korea National Health and Nutrition Examination Survey IV and V, 2008-2011. Whole body dual energy X-ray absorptiometry and body mass index measurement were performed for all patients. Women aged 65 years or older were included in this study. Total appendicular extremity muscle mass was used to determine the skeletal muscle mass index. RESULTS: Of 2,396 women aged 65 years or older, a total of 1,491 (62.2%) were underweight, normal weight, or overweight, while 905 (37.8%) were obese. The prevalence of sarcopenia using a cut-off value of 5.4 kg/m2 was 64.9% (63/97) in underweight women, 38.2% (320/838) in normal weight women, 17.1% (95/556) in overweight women, and 6.1% (55/905) in obese women. CONCLUSIONS: The prevalence of sarcopenia was different among groups. The prevalence rate in obese women was lower than that in non-obese women. SO is a new category of obesity in older adults with high adiposity coupled with low muscle mass. The prevalence of SO was lower than that in previous studies because of differences in the definition. A consensus definition of SO needs to be established.

Erratum to: Vitamin D Deficiency Is Highly Concomitant but Not Strong Risk Factor for Mortality in Patients Aged 50 Year and Older with Hip Fracture.

[This corrects the article on p. 205 in vol. 22, PMID: 26713312.].

Clinical comparison of two different plating methods in minimally invasive plate osteosynthesis for clavicular midshaft fractures: A randomized controlled trial.

AIM: The aim of this study was to compare the clinical and radiographic outcomes between two different plating methods (superior vs. anteroinferior) in minimally invasive plate osteosynthesis (MIPO) for acute displaced clavicular shaft fractures. MATERIALS AND METHODS: A prospective, randomized controlled trial was performed in a single centre. Nineteen patients were treated with superior plating and 18 with anteroinferior plating using the MIPO technique. A 3.5-mm locking reconstruction plate was bent preoperatively and applied to either the anteroinferior or superior aspect of the clavicle through two separate incisions. The operating time, time to union, the proportional length difference, complications, and functional outcome of the shoulder joint were evaluated using the Constant score and the University of California Los Angeles (UCLA) score. RESULTS: There was no statistically significant difference in the Constant score and UCLA score. The mean time to union was 16.8 weeks for superior plating and 17.1 weeks for anteroinferior plating (p=0.866). The average operation time was 77.2min in superior plating and 79.4min in anteroinferior plating (p=0.491). One patient in the superior plating group showed plate failure. Despite no significant difference, one patient had nonunion in the superior plating group (p>0.999). CONCLUSIONS: From a clinical perspective, although MIPO with anteroinferior plating provides better outcomes especially in complications without statistically significant difference, both plating methods provided satisfactory clinical and radiographic outcomes. LEVEL OF EVIDENCE: Level I, a single-centre, prospective, randomized controlled trial.

Sexual activity after total hip replacement in Korean patients: how they do, what they want, and how to improve.

BACKGROUND: Concerns of patients on sexual activity after total hip arthroplasty have not been well studied in Asian patients. This study aimed to determine the following: (1) what are the concerns of patients related to sexual activity after total hip arthroplasty? (2) what are the changes in sexual activity after total hip replacement in Korean patients? METHODS: Details of sexual activity and concerns were obtained using a questionnaire designed specifically for the study. The questionnaire was administered to 64 patients in a face-to-face interview at an outpatient clinic. RESULTS: Preoperatively, 53.1% of patients experienced difficulties, primarily due to hip pathology and limitations of motion. The median time to the resumption of sexual activity was 3 months postoperatively, and most patients had no increase in the frequency of sexual activity after the total hip replacement. In 39.1% of patients were seen having difficulties with leg positioning following total hip replacement, and they were likely to change coital positions. The most common concern regarding sexual activity of patients was the fear of dislocation. Furthermore, patients with a higher stress level had lower satisfaction rates. Most patients were unable to obtain information on sexual activity following the total hip arthroplasty, and they did not consult with a physician due to the private nature of the topic. CONCLUSIONS: Dislocation was the most common concern of patients during sexual activity following a total hip arthroplasty, and a higher stress level was found to be associated with a lower satisfaction rate. Because most patients were unprepared to consult a physician, the provision of appropriate information before a consultation might be beneficial.

Use of simple algorithms to predict screw length facilitates navigation-controlled medial opening-wedge osteotomy using the TomoFix HTO system.

This study was performed to establish simple algorithms to predict proper screw lengths for the 4 proximal holes of TomoFix plates (Synthes GmbH; Solothurn, Switzerland) based on radiographic mediolateral (ML) and anteroposterior (AP) dimensions of the proximal tibia and to determine how well these algorithms function for navigation-controlled medial opening-wedge high tibial osteotomy (HTO) using TomoFix. Experimental HTO surgery was performed in proximal tibial models manufactured for 30 patients undergoing HTO to determine the longest screw lengths for the 4 proximal holes of TomoFix plates. Eight algorithms were created for the 4 proximal screws by investigating the relationships between measured screw lengths and radiographic dimensions and were used for 30 navigation-controlled medial opening-wedge HTOs. The algorithms used to predict screw length were: screw A=ML width-20 mm and AP length+5 mm; screw B=ML width-25 mm and AP length; screw C=ML width-35 mm and AP length-10 mm; and screw D=ML width-40 mm and AP length-15 mm. All 30 surgeries were performed with no perioperative adverse events. Mean operative time was 47.1 minutes, and no far cortex perforation of more than 3 mm was observed for any of the 4 proximal screws. Mean mechanical tibiofemoral angle and weight load line coordinate at the knee joint were valgus 3.7° and 62.9%, respectively. Targeted alignment was achieved in 28 (93%) knees for a mechanical tibiofemoral angle between valgus 2° and 6°, and in 25 (83%) knees for a weight load line coordinate between 55% and 70%. The authors propose the use of the developed algorithms to select proper screw lengths for medial opening wedge HTO using the TomoFix HTO system.

Comparisons of femoral tunnel position and length in anterior cruciate ligament reconstruction: modified transtibial versus anteromedial portal techniques.

PURPOSE: We aimed to compare the modified transtibial and anteromedial (AM) portal techniques of anterior cruciate ligament reconstruction with respect to femoral tunnel position and length, as well as to identify factors associated with tunnel length. METHODS: After exclusions, 105 primary anterior cruciate ligament reconstructions (55 in transtibial group and 50 in AM portal group) were studied. Femoral tunnel positions were assessed on postoperative tunnel-view radiographs, and tunnel lengths were measured during surgery. Differences between femoral tunnel positions in the coronal plane and lengths in these 2 groups were examined, and factors associated with tunnel lengths were investigated. RESULTS: The AM portal group had a significantly more oblique femoral tunnel position than the transtibial group. However, femoral tunnels in the AM portal group were substantially shorter than tunnels in the transtibial group (34.2 v 43.3 mm, P < .001); the proportions of knees with femoral tunnels measuring less than 30 mm in the AM portal and transtibial groups were 26% and only 2%, respectively. In addition, a more oblique femoral tunnel position and a shorter distal femur mediolateral width were found to be significantly associated with a shorter femoral tunnel. CONCLUSIONS: This study shows that the AM portal technique can achieve a more oblique femoral tunnel position but that resultant tunnels are substantially shorter than tunnels produced by the modified transtibial technique.

Frequency, risk factors, and prognosis of prolonged delirium in elderly patients after hip fracture surgery.

BACKGROUND: Delirium in elderly patients after hip fracture surgery is believed to be a transient event, although it frequently lasts for more than 4 weeks. QUESTIONS/PURPOSES: We determined the incidence, risk factors, morbidity, and mortality of prolonged delirium in elderly patients after hip fracture surgery. PATIENTS AND METHODS: We evaluated 232 elderly patients (older than 65 years) (232 hips) who underwent hip fracture surgery for the development and duration of delirium and categorized them into three groups; nondelirium group, transient (≤ 4 weeks) delirium group, and prolonged (> 4 weeks) delirium group. Patients underwent a global geriatric evaluation, which included postoperative complications, mortality, and functional and mental status evaluations. The three groups were compared with respect to these variables. RESULTS: Seventy patients (30.2%) had delirium develop, and among these, 14 (20%) had prolonged delirium with a total incidence of 6%. Multivariate analysis showed preinjury dementia was a risk factor of prolonged delirium. At the final followup, five (62.5%) of the eight patients who were ambulatory outdoors in the prolonged delirium group became housebound, whereas only 18 (16.4%) of the 110 patients who were ambulatory outdoors in the nondelirium group became housebound. Survival at 40 months was 81.0% (95% confidence interval, 72.6%-89.3%) in the nondelirium group and 63.6% (95% confidence interval, 35.2%-92.1%) in the prolonged delirium group. CONCLUSIONS: Prolonged delirium was found to be associated with a poor functional outcome and increased mortality. LEVEL OF EVIDENCE: Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

Lateral calcaneal artery adipofascial flap for reconstruction of the posterior heel of the foot.

BACKGROUND: Soft tissue defects of the posterior heel of the foot present difficult reconstructive problems. This paper reports the authors' early experience of five patients treated with a lateral calcaneal artery adipofascial flap. METHODS: Between 2003 and 2007, five patients (3 males and 2 females) with soft-tissue defects over the posterior heel underwent a reconstruction using a lateral calcaneal artery adipofascial flap and a full-thickness skin graft. The flap sizes ranged from 3.5 x 2.5 cm to 5.5 x 4.0 cm. RESULTS: All five flaps survived completely with no subsequent breakdown of the grafted skin, even after regularly wearing normal shoes. The adipofascial flap donor sites were closed primarily in all patients. CONCLUSIONS: Lateral calcaneal artery adipofascial flaps should be included in the surgical armamentarium to cover difficult wounds of the posterior heel of the foot. These flaps do not require the sacrifice of a major artery to the leg or foot, they are relatively thin with minimal morbidity at the donor site, and leave a simple linear scar over the lateral aspect of the foot.