Kang HJ, et al. J Korean Med Sci. 2022 Sep;37(38):e288. https://doi.org/10.3346/jkms.2022.37.e288

Surgical site infection (SSI) is a major complication after the surgical treatment of ankle fractures that can result in catastrophic consequences. This study aimed to determine the incidence of SSI in several cohorts from national insurance databases over the past 12 years and identify its predictors. The claimed data for patients (n = 1,449,692) with ankle fractures between 2007 and 2019 were investigated, and a total of 41,071 patients were included in the final analysis. The covariates included were age, sex, season, fracture type (closed vs. open), type of surgical fixation procedure, and comorbidities of each patient. All subjects were divided into two groups according to the SSI after the surgical fixation of the ankle fracture (no infection group vs. infection group). The number of SSIs after the surgical treatment of ankle fractures was 874 (2.13%). Open fractures [odds ratio, (OR) = 4.220] showed the highest risk for SSI, followed by the male sex (OR = 1.841), an increasing number of comorbidities (3–5, OR = 1.484; ≥6, OR = 1.730), a history of dementia (OR = 1.720) or of myocardial infarction (OR = 1.628), and increasing age (OR = 1.010). The summer season (OR = 1.349) showed the highest risk among the four seasons for SSI after ankle fracture surgery.

Purpose. The aim of this study was to demonstrate the joint fragment that mostly affects the outcome of the distal radius fracture surgically treated with a volar locking plate (VLP). Methods. The outcomes of 69 patients with the distal radius fractures were evaluated at their final follow‐up. The articular surface was divided into six specific fragments, and computed tomography (CT) was used to evaluate the degree of mismatch of each fragments. A plain radiograph was also obtained for evaluation of the distal radius alignment. Clinical outcomes were measured by using the Disabilities of the Arm, Shoulder and Hand (DASH) and Modified Mayo Wrist Score (MMWS). Univariate analyses were performed, with subsequent multiple logistic regression analyses. Results. The mean follow‐up period was 14.8 (range, 12 to 52) months. The group with a worse DASH score showed significantly greater mismatch in the volar and dorsal lunate facets, as well as the central depression of the distal radius (p = 0.042, 0.031, and 0.023, respectively). There was a significant positive correlation between the DASH score and degree of mismatch of the dorsal lunate facet and central depression of the distal radius (p = 0.040 and 0.011, respectively). Groups with worse MMWS showed significantly greater mismatch in the dorsal lunate facet (p = 0.025). There was a significant negative correlation between MMWS and abnormal ulnar variance and mismatch of the dorsal lunate facet and central depression of the distal radius (p = 0.041, 0.004, and 0.018, respectively). The result of multiple logistic regression analysis demonstrated that a mismatch of the dorsal lunate facet is a significant predictor for a worse MMWS (odds ratio = 3.072, p = 0.043). Conclusions. Articular surface mismatch of the dorsal lunate facet appears to mostly affect the surgical outcomes of the distal radius fractures using VLP. In cases where the dorsal lunate facet is heavily involved, surgeons should be cautious about its reduction and fixation.

Background/Objective: The rise in sports participation among children and adolescents has led to an increase in ACL injuries in skeletally immature individuals. This study analyzed nationwide trends in the anterior cruciate ligament (ACL) reconstruction surgeries in pediatric and adolescent populations, addressing concerns about growth plate disturbances with surgery and risks of secondary injuries with nonoperative treatment. Methods: We conducted a retrospective population-based cohort study using the National Health Insurance Corporation database in South Korea, analyzing ACL reconstruction trends from 2011 to 2018. Patients were categorized into four age groups (≤12 years, 13–15 years, 16–17 years, and ≥18 years). The Chi-square linear-by-linear association test was used to analyze trends in procedural volumes, age groups, and regions. Poisson regression was used to examine whether differences over time were statistically significant by modeling count data and estimating incidence rate ratios (IRRs) with 95% confidence intervals (CIs). It also evaluates the statistical differences by age, gender, and hospital location. Results: A total of 83,132 patients underwent ACL reconstruction during the study period. The ≤12-year-old group accounted for a stable, low percentage of surgeries (16.6% in 2011 to 23.7% in 2018) with no significant trends observed (IRR = 0.99, p = 0.683). Conversely, significant increases were noted in patients aged 13–15 years (IRR = 1.04, p < 0.001), 16–17 years (IRR = 1.03, p < 0.001), and aged ≥18 years (IRR = 1.03, p < 0.001). Male patients and urban hospital locations were associated with higher surgical rates. Conclusions: During the study period, ACL reconstruction is rare in children ≤12 years old due to concerns about growth disturbances, while adolescents 13–17 years old show increased surgical rates due to evolving practices supporting early intervention. These findings emphasize the need for individualized treatment balancing early benefits and growth plate risks.

Background: Alzheimer’s disease (AD) is the most common neurodegenerative disease in the older adult population and is often associated with reduced physical activity. Reduced activity and mechanical loading subsequently reduce bone mineral density and increase risk of osteoporosis. Bisphosphonates (BPs) offer preventative effects on osteoporotic fractures in the general population, but their effects on patients with AD are less known. This study aimed to assess the impact of BPs on osteoporotic fractures and survival in patients with AD. Methods: In this nationwide retrospective cohort study, 43,469 patients from the Korea National Health Insurance Service database between 2004 and 2018 were included. All patients were diagnosed with AD and subsequently diagnosed with osteoporosis. Continuous use of BPs was defined as having prescriptions for BP medications one year after the diagnosis of osteoporosis. Propensity score matching paired 12,519 BP users with 12,518 non-users for post-fracture survival analysis. Results: Continuous use of BPs showed a significant preventative effect on the Cox regression model [hazard ratio (HR), 0.890–0.895; p < 0.001] but not on the logistic regression model. The occurrence of osteoporotic fractures in the hip or spine significantly increased the risk of death [hip, HR, 2.036; 95% confidence interval (CI), 1.789–2.316; p < 0.001; spine, HR, 1.465; CI, 1.305–1.644; p < 0.001]. Conclusions: Continuous use of BPs was associated with reduced occurrence of osteoporotic fractures in patients with AD. Patients with AD showed significantly higher mortality rates after the occurrence of osteoporotic fractures. Further studies with detailed patient characteristics and compliance are warranted.