Short-Term Outcomes and Influencing Factors After Ankle Fracture Surgery

The present study investigated the factors influencing the early clinical outcomes after ankle fracture surgery. We included 88 patients, who had undergone implant removal surgery at 1 year after ankle fracture surgery, with ankle computed tomographic (CT) scans obtained before ankle fracture surgery and at implant removal available. We collected demographic information, including age, sex, the presence of diabetes mellitus, level of trauma energy, and fracture classification from the medical records. We also recorded the fracture height using the radiographs and CT images. The medial joint space and articular incongruity were assessed on the follow-up radiographs and CT scans. Bone attenuation was measured by placing a circular region of interest around the ankle joint on the preoperative CT image. The postimplant removal outcomes were assessed using 2 functional questionnaires, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale and Foot and Ankle Outcome Score (FAOS). Significant factors related to the AOFAS ankle-hindfoot scale scores and FAOS were identified through univariate analysis using age, sex, radiographic measurements, and CT findings as explanatory variables, followed by multiple regression analysis. On multiple regression analysis, the total FAOS was independently related to the AO classification (p?=?.003) and Lauge-Hansen classification (p?=?.003). The total AOFAS ankle-hindfoot scale score was related to articular incongruity (p?=?.044). The early clinical outcomes after ankle fracture surgery were affected by involvement of the ankle joint fracture rather than the lateral malleolus fracture height. Female sex and the presence of postoperative articular incongruity correlated with inferior early clinical outcomes.     

Pre-emptive Treatment of HCV after Living Donor Liver Transplantation with Direct-Acting Antiviral Agents

Background

Hepatitis C virus (HCV) universally recurs after liver transplantation (LT). Although the introduction of direct-acting antiviral agents (DAAs) has revolutionized the treatment of HCV infection, no optimal treatment for HCV recurrence after LT has been developed.

Methods

This study retrospectively evaluated the efficacy of DAAs as a pre-emptive treatment for recurrent HCV infection after living donor liver transplantation (LDLT). From January 2010 to December 2016, 70 patients received pegylated interferon (PegIFN) and 35 patients were treated with DAA-based regimens to treat recurrent HCV after LDLT. All antiviral treatments were pre-emptive.

Results

Genotype 1b was the most common HCV type (61.9%). Twenty-two recipients in the DAA group were treated with ledipasvir/sofosbuvir, nine received daclatasvir plus asunaprevir, three received sofosbuvir, and one received sofosbuvir plus daclatasvir. All 35 patients (100%) in the DAA group achieved a sustained virologic response (SVR), a percentage significantly higher than that (71.4%) in the PegIFN group (p?<?0.001). In the PegIFN group, the 1-, 3-, and 5-year graft survival rates were 85.7, 73.9, and 70.7%, respectively, whereas those in the DAA group were 100, 100, and 100%, respectively (p?=?0.008).

Conclusion

DAA-based regimens are an effective treatment for HCV recurrence after LDLT, resulting in an improved SVR and better graft survival than PegIFN.

     

Comparison of postoperative pain control methods after bony surgery in the foot and ankle

Background

We performed a prospective study to evaluate and compare the effectiveness of postoperative pain control methods after bone surgery in the foot and ankle.

Interleukin 6 gene polymorphism in patients with degenerative lumbar scoliosis: a cohort study

Purpose

Low bone mass and a female gender increase susceptibility to the development of degenerative lumbar scoliosis (DLS), which suggests the potential involvement of an osteoporosis-related gene in the pathogenesis of DLS. In the present study, the authors studied the relations between polymorphisms of interleukin 6 (IL-6) gene and DLS in a patient cohort.

Methods

In 184 patients with a diagnosis of DLS, the authors determined the presence of the -597 G/A, -572 G/C, and -174 G/C polymorphisms, measured bone mineral densities at the lumbar spine (LSBMD) and femoral neck (FNBMD), assessed radiological findings including lumbar scoliosis and lateral listhesis, investigated biochemical markers of bone turnover, and compared these results obtained with those of 220 healthy normal controls.

Results

Genotype frequencies in the DLS patients and controls revealed a significant difference for the IL6-572 G/C polymorphism (P = 0.0168). Mean LSBMD was lower in DLS patients than in controls, but no significant difference was found between these two groups with respect to FNBMD, biochemical markers, or radiological findings. A significant association was found between the IL6-572 G/C polymorphism and LSBMD. LSBMD in DLS with the CC genotype was found to be significantly higher than in DLS with the GC (P < 0.05) or GG (P < 0.05) genotypes.

Conclusion

The results of this study suggest that the IL6-572 G/C polymorphism influences LSBMD in Korean DLS patients and the prevalence of the disease.