2024 Consensus Statement on Coronary Stenosis and Plaque Evaluation in CT Angiography From the Asian Society of Cardiovascular Imaging-Practical Tutorial (ASCI-PT)

The Asian Society of Cardiovascular Imaging-Practical Tutorial (ASCI-PT) is an instructional initiative of the ASCI School designed to enhance educational standards. In 2021, the ASCI-PT was convened with the goal of formulating a consensus statement on the assessment of coronary stenosis and coronary plaque using coronary CT angiography (CCTA). Nineteen experts from four countries conducted thorough reviews of current guidelines and deliberated on eight key issues to refine the process and improve the clarity of reporting CCTA findings. The experts engaged in both online and on-site sessions to establish a unified agreement. This document presents a summary of the ASCI-PT 2021 deliberations and offers a comprehensive consensus statement on the evaluation of coronary stenosis and coronary plaque in CCTA.

How to Solve Anatomical Mismatch in Fixation of Acetabular Fractures Using an Anatomical Quadrilateral Surface Plate

The anatomical quadrilateral surface buttress plate developed for the quadrilateral surface in an acetabular fracture, a type of fracture difficult to reduce using screws and plates due to its thinness, is a useful implant that makes surgical treatment easier. However, the anatomical structure is different for each patient, and it often does not match the contour of this plate, making detailed bending difficult. Here, we introduce a simple method for controlling the degree of reduction using this plate.

Utilities and Limitations of Cardiac Magnetic Resonance Imaging in Dilated Cardiomyopathy

Dilated cardiomyopathy (DCM) is one of the most common types of non-ischemic cardiomyopathy. DCM is characterized by left ventricle (LV) dilatation and systolic dysfunction without coronary artery disease or abnormal loading conditions. DCM is not a single disease entity and has a complex historical background of revisions and updates to its definition because of its diverse etiology and clinical manifestations. In cases of LV dilatation and dysfunction, conditions with phenotypic overlap should be excluded before establishing a DCM diagnosis. The differential diagnoses of DCM include ischemic cardiomyopathy, valvular heart disease, burned-out hypertrophic cardiomyopathy, arrhythmogenic cardiomyopathy, and non-compaction.Cardiac magnetic resonance (CMR) imaging is helpful for evaluating DCM because it provides precise measurements of cardiac size, function, mass, and tissue characterization. Comprehensive analyses using various sequences, including cine imaging, late gadolinium enhancement imaging, and T1 and T2 mapping, may help establish differential diagnoses, etiological workup, disease stratification, prognostic determination, and follow-up procedures in patients with DCM phenotypes. This article aimed to review the utilities and limitations of CMR in the diagnosis and assessment of DCM.

Fracture Liaison Service in Korea: 2022 Position Statement of the Korean Society for Bone and Mineral Research

Osteoporosis and osteoporotic fractures cause socioeconomic concerns, and medical system and policies appear insufficient to prepare for these issues in Korea, where the older adult population is rapidly increasing. Many countries around the world are already responding to osteoporosis and osteoporotic fractures by adopting fracture liaison service (FLS), and such an attempt has only begun in Korea. In this article, we introduce the operation methods for institutions implementing FLS and characteristics of services, and activities of the FLS Committee for FLS implementation in the Korean Society for Bone and Mineral Research. In addition, we hope that the current position statement will contribute to the implementation of FLS in Korea and impel policy changes to enable a multidisciplinary and integrated FLS operated under the medical system.

A Case of Primary Lymphoma Involving the Heart

Primary cardiac lymphoma is a rare extranodal malignant lymphoma that involves only the heart and pericardium without dissemination. The prognosis of primary cardiac lymphoma is poor. But, recent advances in imaging diagnosis and chemotherapy have improved survival. We report histologically diagnosed diffuse large B cell lymphoma involving the heart with computed tomography and magnetic resonance imaging images.

Orthopedic Patients with Mental Disorder: Literature Review on Preoperative and Postoperative Precautions

Because of the increasing global trend of patients with mental disorders, orthopedic surgeons are more likely to encounter orthopedic patients with mental disorders in clinical settings. Identifying the characteristics of these patients and implementing psychiatric management can affect the clinical outcome of orthopedic treatment. Thus, orthopedic surgeons need to assess the psychiatric medical history of orthopedic patients with mental disorders before surgery and understand the psychological and behavioral patterns of patients with mental disorders. In addition, appropriate psychiatric consultations and evaluations are necessary to prevent worsening of mental disorders before and after surgery.

Differential Diagnosis of Thick Myocardium according to Histologic Features Revealed by Multiparametric Cardiac Magnetic Resonance Imaging

Left ventricular (LV) wall thickening, or LV hypertrophy (LVH), is common and occurs in diverse conditions including hypertrophic cardiomyopathy (HCM), hypertensive heart disease, aortic valve stenosis, lysosomal storage disorders, cardiac amyloidosis, mitochondrial cardiomyopathy, sarcoidosis and athlete’s heart. Cardiac magnetic resonance (CMR) imaging provides various tissue contrasts and characteristics that reflect histological changes in the myocardium, such as cellular hypertrophy, cardiomyocyte disarray, interstitial fibrosis, extracellular accumulation of insoluble proteins, intracellular accumulation of fat, and intracellular vacuolar changes. Therefore, CMR imaging may be beneficial in establishing a differential diagnosis of LVH. Although various diseases share LV wall thickening as a common feature, the histologic changes that underscore each disease are distinct.This review focuses on CMR multiparametric myocardial analysis, which may provide clues for the differentiation of thickened myocardium based on the histologic features of HCM and its phenocopies.

Semi-Quantitative Scoring of Late Gadolinium Enhancement of the Left Ventricle in Patients with Ischemic Cardiomyopathy: Improving Interobserver Reliability and Agreement Using Consensus Guidance from the Asian Society of Cardiovascular Imaging-Practical Tutorial (ASCI-PT) 2020

Objective@#This study aimed to evaluate the effect of implementing the consensus statement from the Asian Society of Cardiovascular Imaging-Practical Tutorial 2020 (ASCI-PT 2020) on the reliability of cardiac MR with late gadolinium enhancement (CMR-LGE) myocardial viability scoring between observers in the context of ischemic cardiomyopathy. @*Materials and Methods@#A total of 17 cardiovascular imaging experts from five different countries evaluated CMR obtained in 26 patients (male:female, 23:3; median age [interquartile range], 55.5 years [50–61.8]) with ischemic cardiomyopathy. For LGE scoring, based on the 17 segments, the extent of LGE in each segment was graded using a five-point scoring system ranging from 0 to 4 before and after exposure according to the consensus statement. All scoring was performed via webbased review. Scores for slices, vascular territories, and total scores were obtained as the sum of the relevant segmental scores. Interobserver reliability for segment scores was assessed using Fleiss’ kappa, while the intraclass correlation coefficient (ICC) was used for slice score, vascular territory score, and total score. Inter-observer agreement was assessed using the limits of agreement from the mean (LoA). @*Results@#Interobserver reliability (Fleiss’ kappa) in each segment ranged 0.242–0.662 before the consensus and increased to 0.301–0.774 after the consensus. The interobserver reliability (ICC) for each slice, each vascular territory, and total score increased after the consensus (slice, 0.728–0.805 and 0.849–0.884; vascular territory, 0.756–0.902 and 0.852–0.941; total score, 0.847 and 0.913, before and after implementing the consensus statement, respectively. Interobserver agreement in scoring also improved with the implementation of the consensus for all slices, vascular territories, and total score. The LoA for the total score narrowed from ± 10.36 points to ± 7.12 points. @*Conclusion@#The interobserver reliability and agreement for CMR-LGE scoring for ischemic cardiomyopathy improved when following guidance from the ASCI-PT 2020 consensus statement.

Factors Associated with Mechanical Complications in Intertrochanteric Fracture Treated with Proximal Femoral Nail Antirotation / 대한고관절학회지

Purpose@#Although proximal femoral nail antirotation (PFNA; Synthes, Switzerland) has demonstrated satisfactory results when used for the treatment of intertrochanteric fractures, mechanical complications may occur. To better quantify the risk of mechanical complications when proximal femoral nail antirotation is used to treat intertrochanteric fractures, this study aimed to: (1) characterize the frequency of mechanical complications and extent of blade sliding and their correlation with reduction quality and (2) identify factors associated with mechanical complications. @*Materials and Methods@#A review of medical records from 93 patients treated for intertrochanteric fractures with a minimum of 6-months of follow-up between February 2014 and February 2019 was conducted. Blade position was evaluated using Tip-apex distance (TAD) and Cleveland index. The extent of blade sliding was evaluated using the adjusted Doppelt’s method for intramedullary nailing. Individuals were classified as having or not having mechanical complications, and reduction quality and radiologic outcomes were compared between the two groups. @*Results@#Mechanical complications occurred in 12 of 94 hips (12.8%), with 11 out of 12 being from the intramedullary reduction group. There was no significant difference in TAD between groups; however, there were significant differences were noted in Cleveland index, AO/OTA classification, reduction quality and extent of blade sliding. The mean blade sliding distance was 1.17 mm (anatomical group), 3.28 mm (extramedullary group), and 6.11 mm (intramedullary group), respectively (P<0.001). Data revealed that blade sliding was an associated factor for mechanical complications (odds ratio 1.25, 95% confidence interval 1.03-1.51). @*Conclusion@#The extent of blade sliding determined using the adjusted Doppelt’s method was significantly associated with mechanical complications suggesting that prevention of excessive sliding through proper intraoperative reduction is important to help achieve satisfactory treatment outcomes.

Touchless Control of Picture Archiving and Communication System in Operating Room Environment:A Comparative Study of Input Methods

Background@#The advancement of computer information technology would maximize its potential in operating rooms with touchless input devices. A picture archiving and communication system (PACS) was compared with a touchless input device (LMC-GW), relaying to another person to control a mouse through verbal guidance, and directly controlling a mouse. @*Methods@#Participants (n = 34; mean age, 29.6 years) were prospectively enrolled and given nine scenarios to compare the three methods. Each scenario consisted of eight tasks, which required 6 essential functions of PACS. Time elapsed and measurement values were recorded for objective evaluation, while subjective evaluation was conducted with a questionnaire. @*Results@#In all 8 tasks, manipulation using the mouse took significantly less time than the other methods (all p < 0.05). Study selection, panning, zooming, scrolling, distance measuring, and leg length measurement took significantly less time when LMC-GW was used compared to relaying to another person (all p < 0.01), whereas there were no significant differences in time required for measuring the angles and windowing. Although the touchless input device provided higher accessibility and lower contamination risk, it was more difficult to handle than the other input methods (all p < 0.01). @*Conclusions@#The touchless input device provided superior or equal performance to the method of verbal instruction in the environment of operating room. Surgeons agreed that the device would be helpful for manipulating PACS in operating rooms with less contamination risk and disturbance of workflow. The touchless input device can be an alternative option for direct manipulation of a mouse in operation rooms in the future.

Touchless Control of Picture Archiving and Communication System in Operating Room Environment:A Comparative Study of Input Methods

Background@#The advancement of computer information technology would maximize its potential in operating rooms with touchless input devices. A picture archiving and communication system (PACS) was compared with a touchless input device (LMC-GW), relaying to another person to control a mouse through verbal guidance, and directly controlling a mouse. @*Methods@#Participants (n = 34; mean age, 29.6 years) were prospectively enrolled and given nine scenarios to compare the three methods. Each scenario consisted of eight tasks, which required 6 essential functions of PACS. Time elapsed and measurement values were recorded for objective evaluation, while subjective evaluation was conducted with a questionnaire. @*Results@#In all 8 tasks, manipulation using the mouse took significantly less time than the other methods (all p < 0.05). Study selection, panning, zooming, scrolling, distance measuring, and leg length measurement took significantly less time when LMC-GW was used compared to relaying to another person (all p < 0.01), whereas there were no significant differences in time required for measuring the angles and windowing. Although the touchless input device provided higher accessibility and lower contamination risk, it was more difficult to handle than the other input methods (all p < 0.01). @*Conclusions@#The touchless input device provided superior or equal performance to the method of verbal instruction in the environment of operating room. Surgeons agreed that the device would be helpful for manipulating PACS in operating rooms with less contamination risk and disturbance of workflow. The touchless input device can be an alternative option for direct manipulation of a mouse in operation rooms in the future.

Review on factors affecting the optical properties of dental zirconia

Clinical applications of translucent zirconia as well as traditional zirconia (3 mol% yttria stabilized tetragonal zirconia polycrystal, 3Y-TZP) are increasing. For this reason, studies on factors affecting the optical properties of dental zirconia have been continuously reported. The optical effect of dental zirconia may vary depending on the yttria content, the thickness of the prosthesis, the sintering process, polishing, glazing and cementation in laboratory and clinical procedures. Increasing the yttria concentration can reduce the masking effect. Translucency decreases as the thickness of the restoration increases, but the required thickness may vary depending on the properties of the zirconia block. The high-speed sintering method can shorten the manufacturing time, but in some cases, the translucency of the prosthesis may decrease. In addition, the optical properties can be affected by the surface roughness of zirconia and the polishing process. The use of an appropriate colored cement can help with the masking effect of zirconia and can be useful for color matching for more esthetic results.

Effect of Opioids on All-cause Mortality and Sustained Opioid Use in Elderly Patients with Hip Fracture: a Korea Nationwide Cohort Study

Background@#The purpose of our study was to assess the use of opioids before and after hip fracture in elderly patients in order to determine the effect of opioid use on all-cause mortality, and to analyze how the history of opioid use before fracture increases the risk of sustained use following hip fracture using a Korea nationwide cohort. @*Methods@#Our study identified hip fracture patients from the Korean National Health Insurance Service-Senior cohort. The index date was defined as 90-days after admission to the acute care hospital that fulfilled the eligibility criteria of elderly hip fracture. Patients were classified into past user, current user, and sustained user according to the use of opioid at each period based on the time of admission and index date. The opioids were classified into strong opioids and tramadol. A generalized estimating equation model with a Poisson distribution and logarithmic link function was performed to estimate the adjusted rate ratios (aRRs) and 95% confidence intervals (CIs) to assess the association between past use and sustained use. A multivariable-adjusted Cox proportional hazard model was used to investigate the effects of strong opioid and tramadol use on all-cause mortality. @*Results@#A total of 12,927 patients were included in our study. There were 7,384 (57.12%) opioid past-users, 11,467 (88.71%) opioid current-users, and 7,172 (55.48%) sustained users. In comparison of the death risk according to current use or the defined daily dose of the opioids or past opioid use, there were no significant differences in the adjusted hazard ratio for death in all groups, compared to the current non-users (P > 0.05). Among survivors 1 year after hip fracture, opioid past-use increased the risk of opioid sustained use by 1.52-fold (aRR; 95% CI, 1.45–1.8; P < 0.001). @*Conclusion@#Current use and past use of opioid did not increase all-cause mortality after hip fracture in elderly patients over 65 years of age. Past use of opioid before hip fracture increased risk of sustained use of opioid compared to the current opioid used without past use.

Effect of Opioids on All-cause Mortality and Sustained Opioid Use in Elderly Patients with Hip Fracture: a Korea Nationwide Cohort Study

Background@#The purpose of our study was to assess the use of opioids before and after hip fracture in elderly patients in order to determine the effect of opioid use on all-cause mortality, and to analyze how the history of opioid use before fracture increases the risk of sustained use following hip fracture using a Korea nationwide cohort. @*Methods@#Our study identified hip fracture patients from the Korean National Health Insurance Service-Senior cohort. The index date was defined as 90-days after admission to the acute care hospital that fulfilled the eligibility criteria of elderly hip fracture. Patients were classified into past user, current user, and sustained user according to the use of opioid at each period based on the time of admission and index date. The opioids were classified into strong opioids and tramadol. A generalized estimating equation model with a Poisson distribution and logarithmic link function was performed to estimate the adjusted rate ratios (aRRs) and 95% confidence intervals (CIs) to assess the association between past use and sustained use. A multivariable-adjusted Cox proportional hazard model was used to investigate the effects of strong opioid and tramadol use on all-cause mortality. @*Results@#A total of 12,927 patients were included in our study. There were 7,384 (57.12%) opioid past-users, 11,467 (88.71%) opioid current-users, and 7,172 (55.48%) sustained users. In comparison of the death risk according to current use or the defined daily dose of the opioids or past opioid use, there were no significant differences in the adjusted hazard ratio for death in all groups, compared to the current non-users (P > 0.05). Among survivors 1 year after hip fracture, opioid past-use increased the risk of opioid sustained use by 1.52-fold (aRR; 95% CI, 1.45–1.8; P < 0.001). @*Conclusion@#Current use and past use of opioid did not increase all-cause mortality after hip fracture in elderly patients over 65 years of age. Past use of opioid before hip fracture increased risk of sustained use of opioid compared to the current opioid used without past use.

Single-nucleotide polymorphismbased epidemiological analysis of Korean Mycobacterium bovis isolates

Background@#Bovine tuberculosis (TB) is caused by Mycobacterium bovis, a well-known cause of zoonotic tuberculosis in cattle and deer, and has been investigated in many physiological and molecular studies. However, detailed genome-level studies of M. bovis have not been performed in Korea. @*Objectives@#To survey whole genome-wide single-nucleotide polymorphism (SNP) variants in Korean M. bovis field isolates and to define M. bovis groups in Korea by comparing SNP typing with spoligotyping and variable number tandem repeat typing. @*Methods@#A total of 46 M. bovis field isolates, isolated from laryngopharyngeal lymph nodes and lungs of Korean cattle, wild boar, and Korean water deer, were used to identify SNPs by performing whole-genome sequencing. SNP sites were confirmed via polymerase chain reaction using 87 primer pairs. @*Results@#We identified 34 SNP sites with different frequencies across M. bovis isolates, and performed SNP typing and epidemiological analysis, which divided the 46 field isolates into 16 subtypes. @*Conclusions@#Through SNP analysis, detailed differences in samples with identical spoligotypes could be detected. SNP analysis is, therefore, a useful epidemiological tracing tool that could enable better management of bovine TB, thus preventing further outbreaks and reducing the impact of this disease.

Single-nucleotide polymorphismbased epidemiological analysis of Korean Mycobacterium bovis isolates

Background@#Bovine tuberculosis (TB) is caused by Mycobacterium bovis, a well-known cause of zoonotic tuberculosis in cattle and deer, and has been investigated in many physiological and molecular studies. However, detailed genome-level studies of M. bovis have not been performed in Korea. @*Objectives@#To survey whole genome-wide single-nucleotide polymorphism (SNP) variants in Korean M. bovis field isolates and to define M. bovis groups in Korea by comparing SNP typing with spoligotyping and variable number tandem repeat typing. @*Methods@#A total of 46 M. bovis field isolates, isolated from laryngopharyngeal lymph nodes and lungs of Korean cattle, wild boar, and Korean water deer, were used to identify SNPs by performing whole-genome sequencing. SNP sites were confirmed via polymerase chain reaction using 87 primer pairs. @*Results@#We identified 34 SNP sites with different frequencies across M. bovis isolates, and performed SNP typing and epidemiological analysis, which divided the 46 field isolates into 16 subtypes. @*Conclusions@#Through SNP analysis, detailed differences in samples with identical spoligotypes could be detected. SNP analysis is, therefore, a useful epidemiological tracing tool that could enable better management of bovine TB, thus preventing further outbreaks and reducing the impact of this disease.

Disadvantage during Perioperative Period of Total Hip Arthroplasty Using the Direct Anterior Approach:a Network Meta-Analysis

Background@#The purpose of this study was to analyze complications of complete hip arthroplasty through systematic review and network meta-analysis of comparative studies of direct anterior approach (DAA), anterolateral approach (LA), and posterolateral approach (PA). @*Methods@#Prospective randomized controlled trials (RCTs) or quasi-experimental designs evaluating clinical outcomes of DAA, LA, and PA for complete hip arthroplasty are valid if they meet the following criteria: 1) Comparison of clinical outcomes between the three methods for main complete hip arthroplasty (total hip arthroplasty, THA); 2) Compared at least one of the following outcomes: blood loss, operating time, and transfusion volume; 3) Sufficient data were available to extract and pool, i.e., mean reported, standard deviation and number of subjects. A network meta-analysis was used to determine the results of treatment across various surgical approaches. Indirect comparisons between the two surgical approaches was made by borrowing details from the standard comparator (i.e., the posterior approach). @*Results@#Eight prospective RCTs were included in the meta-analysis of the network. The operation time of the LA was longer than that of PA (standardized mean difference [SMD], 0.96; 95% confidence interval [CI], 0.74–1.18; P < 0.001). DAA also had significantly longer operation time than PA (SMD, 0.45; 95% CI, 0.24–0.66; P < 0.001). However, blood loss of the DAA was the highest compared to other approaches (SMD, 0.60; 95% CI, 0.39–0.82; P = 0.002). @*Conclusion@#When performing THA with DAA, we should pay attention to increased operation time and blood loss.

Effect of Pneumonia on All-cause Mortality after Elderly Hip Fracture: a Korean Nationwide Cohort Study

BACKGROUND@#The purposes of this study were 1) to investigate the incidence of pneumonia during hospitalization in elderly hip fracture patients, 2) to evaluate the effect of pneumonia on 30 day to 1 year mortality and 3) to analyze the impact of age and gender on the mortality rate in the pneumonia patients using a nationwide cohort of Korea.@*METHODS@#The Korean National Health Insurance Service (NHIS) database included approximately 5.5 million Korean enrollees > 60 years of age. A total of 588,147 participants were randomly selected for senior cohort using 10% simple random sampling. We identified senile (> 65 years old) patients who underwent hip fracture surgery from January 2005 to December 2014 and those who developed pneumonia during hospitalization from the NHIS-Senior cohort. The index date of hip fracture occurrence was defined as the date of admission to the acute care hospital. The last date of follow-up was defined as the date of death or 31 December 2015, whichever came first. A multivariable-adjusted Cox proportional hazards model was used to investigate the effects of pneumonia on all-cause mortality.@*RESULTS@#During the enrollment period, a total of 14,736 patients, who were older than 65 years, underwent hip fracture surgeries. Among them, 1,629 patients (11.05%) developed pneumonia during the hospitalization. The pneumonia incidence was 16.39% (601/3,666) in men patients and 9.29% (1,028/10,042) in women patients. Compared to 13,107 non-pneumonia patients, adjusted relative risk (aRR) of death in pneumonia patients was 2.69 (95% confidence interval [CI], 2.14–3.38; P < 0.001) within postoperative 30-day, 3.40 (95% CI, 3.01–3.83; P < 0.001) within postoperative 90-day, 2.86 (95% CI, 2.61–3.15; P < 0.001) within postoperative 180-day and 2.31 (95% CI, 2.14–2.50; P < 0.001) within postoperative 1-year. According to patient's age, the aRR of death in pneumonia patients was 5.75 (95% CI, 2.89–11.43) in adults aged < 70 years, 5.14 (95% CI, 4.08–6.46) in those aged 70–79 years, 3.29 (95% CI, 2.81–3.86) in those aged 80–89 years and 2.02 (95% CI, 1.52–2.69) in those aged ≥ 90 years. The aRR was 3.63 (95% CI, 3.01–4.38) in men pneumonia patients, and 3.27 (95% CI, 2.80–3.83) in women pneumonia patients.@*CONCLUSION@#The prevalence of pneumonia in elderly hip fracture patients was 11.05%. Men had higher incidence (16.39%) than women (9.29%). Compared to non-pneumonia patients, the pneumonia patients had higher 30-day to 1-year mortalities with aRR of 2.31 to 3.40. They had increased mortality in all age groups older than 65 years with aRR of 1.52 to 4.08. Both genders of pneumonia patients had higher risk of mortality (aRR, 3.63 in men and 3.27 in women) compared to non-pneumonia patients.

Effect of Pneumonia on All-cause Mortality after Elderly Hip Fracture: a Korean Nationwide Cohort Study

BACKGROUND@#The purposes of this study were 1) to investigate the incidence of pneumonia during hospitalization in elderly hip fracture patients, 2) to evaluate the effect of pneumonia on 30 day to 1 year mortality and 3) to analyze the impact of age and gender on the mortality rate in the pneumonia patients using a nationwide cohort of Korea.@*METHODS@#The Korean National Health Insurance Service (NHIS) database included approximately 5.5 million Korean enrollees > 60 years of age. A total of 588,147 participants were randomly selected for senior cohort using 10% simple random sampling. We identified senile (> 65 years old) patients who underwent hip fracture surgery from January 2005 to December 2014 and those who developed pneumonia during hospitalization from the NHIS-Senior cohort. The index date of hip fracture occurrence was defined as the date of admission to the acute care hospital. The last date of follow-up was defined as the date of death or 31 December 2015, whichever came first. A multivariable-adjusted Cox proportional hazards model was used to investigate the effects of pneumonia on all-cause mortality.@*RESULTS@#During the enrollment period, a total of 14,736 patients, who were older than 65 years, underwent hip fracture surgeries. Among them, 1,629 patients (11.05%) developed pneumonia during the hospitalization. The pneumonia incidence was 16.39% (601/3,666) in men patients and 9.29% (1,028/10,042) in women patients. Compared to 13,107 non-pneumonia patients, adjusted relative risk (aRR) of death in pneumonia patients was 2.69 (95% confidence interval [CI], 2.14–3.38; P < 0.001) within postoperative 30-day, 3.40 (95% CI, 3.01–3.83; P < 0.001) within postoperative 90-day, 2.86 (95% CI, 2.61–3.15; P < 0.001) within postoperative 180-day and 2.31 (95% CI, 2.14–2.50; P < 0.001) within postoperative 1-year. According to patient's age, the aRR of death in pneumonia patients was 5.75 (95% CI, 2.89–11.43) in adults aged < 70 years, 5.14 (95% CI, 4.08–6.46) in those aged 70–79 years, 3.29 (95% CI, 2.81–3.86) in those aged 80–89 years and 2.02 (95% CI, 1.52–2.69) in those aged ≥ 90 years. The aRR was 3.63 (95% CI, 3.01–4.38) in men pneumonia patients, and 3.27 (95% CI, 2.80–3.83) in women pneumonia patients.@*CONCLUSION@#The prevalence of pneumonia in elderly hip fracture patients was 11.05%. Men had higher incidence (16.39%) than women (9.29%). Compared to non-pneumonia patients, the pneumonia patients had higher 30-day to 1-year mortalities with aRR of 2.31 to 3.40. They had increased mortality in all age groups older than 65 years with aRR of 1.52 to 4.08. Both genders of pneumonia patients had higher risk of mortality (aRR, 3.63 in men and 3.27 in women) compared to non-pneumonia patients.

Analysis of the Changes in Femoral Varus Bowing and the Factors Affecting Nonunion for the Treatment of Femoral Shaft Fractures over 60 Years Old Using Piriformis Fossa Insertion Intramedullary Nailing

Purpose@#This study examined the bony morphological changes to analyze the factors affecting bony union in the treatment of elderly femoral shaft fractures with varus bowing using piriformis fossa insertion intramedullary nailing. @*Materials and Methods@#This study included 26 patients over 60 years of age, who were admitted for femoral shaft fractures between January 2005 and December 2014 and treated with piriformis fossa insertion intramedullary nailing. Age, sex, height, weight, bone mineral density, injury mechanism, fracture type, diameter and length of the nail, postoperative lengthening of the femur, postoperative change in varus angle, contact between the lateral and anterior cortex, and the gap between the fracture line and the bony union were checked. The patients were divided into a varus group and nonvarus group, as well as a bone union group and nonunion group. Logistic regression analysis was performed to analyze the factors affecting nonunion. @*Results@#The patients were classified into 11 in the varus group and 15 in the non-varus group and 24 in the union group and 2 in the nonunion group. The varus group showed a larger increase in leg length and varus angle reduction than the non-varus group (p<0.05). The union group had more contact with the lateral cortical bone than that of the nonunion group (p<0.05). The factor affecting bone union in regression analysis was contact of the lateral cortical bone (p<0.05). @*Conclusion@#Treatment of a femoral shaft fracture in elderly patients with a varus deformity of the femur using piriformis fossa insertion intramedullary nail increases the length of the femur and decreases the varus deformity. For bony union, the most important thing during surgery is contact of the lateral cortical bone with the fracture site.