A Comparison of Clinical Outcomes in Rotator Cuff Re-Tear Patients Who Had Either an Arthroscopic Primary Repair or Arthroscopic Patch Augmentation for Large-to-Massive Rotator Cuff Tears.

BACKGROUND AND PURPOSE: Despite the prevalent incidence of re-tear following rotator cuff repair, there is a notable lack of comparative studies investigating the outcomes between patients with re-tear who underwent primary repair versus those who received patch augmentation for large-to-massive tears. We assessed clinical outcomes of these techniques through a retrospective, randomized controlled trial. METHODS: 134 patients diagnosed with large-to-massive rotator cuff tears from 2018 to 2021 underwent surgery; 65 had primary repair and 69 had patch augmentation. A total of 31 patients with re-tears were included, split into two groups; Group A (primary repair, 12 patients) and Group B (patch augmentation, 19 patients). Outcomes were evaluated using several clinical scales and MRI imaging. RESULTS: Most clinical scores improved postoperatively in both groups. No significant difference in clinical outcomes was observed between groups, except for pain visual analog scale (P-VAS) scores. P-VAS scores showed greater decrease in the patch-augmentation group, a statistically significant difference. CONCLUSIONS: for large-to-massive rotator cuff tears, patch augmentation led to greater decreases in pain than primary repair, despite similar radiographic and clinical results. Greater tuberosity coverage of the supraspinatus tendon footprint may impact P-VAS scores.

Clinical outcomes of open-wedge corrective osteotomy using autogenous or allogenic bone grafts for malunited distal radius: A novel parameter for measuring the rate of bone union.

OBJECTIVE: The aims of the study were (1) to compare outcomes in terms of malunited distal radius bone union in open-wedge corrective osteotomy using autogenous or allogenic bone and (2) to introduce a new parameter that quantifies the rate of the bone union. METHODS: This retrospective study included 22 patients (14 males, 8 females) who underwent open-wedge corrective osteotomy with bone grafting for a malunited distal radius fracture between January 2006 and December 2018 were enrolled. The mean follow-up duration was 57.2 weeks (SD 46.1, range 12-206). All the patients were then divided into 1 of the 2 groups based on the graft material used: autog- enous bone graft group (n=10, 5 males and 5 females) and allogenic bone graft group (n=12, 9 males and 3 females). We introduced the "duration of union/correction gap ratio" to represent the healing potential of each graft materials. Radiologic parameters including initial correction gap, radial inclination, radial length, palmar tilt, and ulnar variance were also measured pre- and postoperatively. Functional outcomes were assessed by grip strength, range of motion, and the disability of the Arm, Shoulder, and Hand score. RESULTS: Of the 22 patients, 16 (72.7%) achieved complete union within 12 weeks, 3 (13.6%) in over 12 weeks, and the other 3 (13.6%) showed nonunion. Excluding the 3 nonunion cases, the mean union duration was 10.6 weeks, and the mean correction gap was 10 mm. The mean correction gap was wider in the autogenous bone graft group, and the mean union duration was longer in the allogenic bone graft group. Autogenous bone grafts had a significantly lower duration of bone union/correction gap ratio than allogenic bone grafts (0.76 vs. 1.61, P < 0.001). According to the correction method (simple open-wedge corrective osteotomy vs. open-wedge corrective oste- otomy OWCO), only duration of bone union/correction gap ratio reflected the actual difference between values. CONCLUSION: Despite autogenous bone graft donor site morbidities, in our study, autogenous bone showed better bone healing potential than allogenic bone. In terms of bone union, autogenous bone has the benefit of better union in larger gaps than allogenic bone. Surgeons can take advantage of the newly introduced "duration of bone union/correction gap ratio" to compare the bone healing potential by graft materials or surgical options. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.

Long-term mortality of patients discharged from the hospital after successful critical care in the ICU in Korea: a retrospective observational study in a single tertiary care teaching hospital.

BACKGROUND: The long-term outcomes of patients discharged from the hospital after successful care in intensive care unit (ICU) are not briskly evaluated in Korea. The aim of this study was to assess long-term mortality of patients treated in the ICU and discharged alive from the hospital and to identify predictive factors of mortality. METHODS: In 3,679 adult patients discharged alive from the hospital after ICU care between 2006 and 2011, the 1-year mortality rate (primary outcome measure) was investigated. Various factors were entered into multivariate analysis to identify independent factors of 1-year mortality, including sex, age, severity of illness (APACHE II score), mechanical ventilation, malignancy, readmission, type of admission (emergency, elective surgery, and medical), and diagnostic category (trauma and non-trauma). RESULTS: The 1-year mortality rate was 13.4%. Risk factors that were associated with 1-year mortality included age (hazard ratio: 1.03 [95% CI, 1.02-1.04], P < 0.001), APACHE II score (1.03 [1.01-1.04], P < 0.001), mechanical ventilation (1.96 [1.60-2.41], P < 0.001), malignancy (2.31 [1.82-2.94], P < 0.001), readmission (1.65 [1.31-2.07], P < 0.001), emergency surgery (1.66 [1.18-2.34], P = 0.003), ICU admission due to medical causes (4.66 [3.68-5.91], P < 0.001), and non-traumatic diagnostic category (6.04 [1.50-24.38], P = 0.012). CONCLUSIONS: The 1-year mortality rate was 13.4%. Old age, high APACHE II score, mechanical ventilation, malignancy, readmission, emergency surgery, ICU admission due to medical causes, and non-traumatic diagnostic category except metabolic/endocrinologic category were associated with 1-year mortality.

Undiagnosed light chain systemic amyloidosis: does it matter to anesthesiologists? -a case report-.

Light chain systemic amyloidosis is rare but may accompany laryngeal or pulmonary involvement, which may increase the risk in airway management. We present a case of a patient planned for resection of cervical epidural mass. The patient had face and neck ecchymoses and purpuras with an unknown cause. Mask ventilation and intubation were successful, but the operation was cancelled to evaluate bleeding from facial skin lesions. A diagnosis of light chain systemic amyloidosis prompted evaluation of involvement of other organs and treatment. This case shows the importance of preoperative evaluation and careful airway management in patients with systemic amyloidosis.