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Osteoporosis is the most common disease of the musculoskeletal system in old age. Therefore, research on osteoporosis risk factors is actively being conducted. However, whether socioeconomic inequality is associated with the prevalence and diagnosis experience of osteoporosis remains largely unexplored. This study aims to investigate whether socioeconomic inequality can be a risk factor for osteoporosis in postmenopausal women. Cross-sectional data of 1,477 postmenopausal women aged over 50 obtained from the Korea National Health and Nutrition Examination Survey V-2 were analyzed. Univariate analyses were performed to calculate the prevalence of osteoporosis and the rate of osteoporosis diagnosis experience according to the risk factor categories. Multivariate logistic regression analysis was performed to identify the independent variables’ associations with osteoporosis prevalence and diagnosis experience. The prevalence of osteoporosis was 34.8%, while the diagnosis experience rate was 22.1%. The higher the age, the higher the probability of osteoporosis presence and diagnosis experience. The lowest household income level was associated with a 1.63 times higher risk of osteoporosis. On the contrary, this factor was not significant for diagnosis experience. These results were similar for the 50–59 and 60–69 age groups. Among postmenopausal women, those who are older and have low socioeconomic levels are at a high risk of developing osteoporosis. Moreover, the lower the socioeconomic level, the lower the awareness of osteoporosis. Therefore, there is a need to develop more proactive preventive measures in postmenopausal women with low socioeconomic levels.

Objectives To investigate the clinical and radiologic predictors of postoperative recurrent septic arthritis of the shoulder (SAS) using multivariable analysis. Methods Forty-three patients (mean age, 65 years; 24 women) who underwent surgery for SAS between January 2011 and October 2019 were retrospectively enrolled. An orthopedic surgeon assessed clinical (age, sex, comorbidity, duration from symptom onset to MR imaging and surgery, surgical method, antibiotic usage), laboratory (serum white blood cell [WBC] count, C-reactive protein [CRP] level, synovial cell count), and surgical findings (culture/biopsy results). Two musculoskeletal radiologists evaluated MR imaging findings (bone marrow [reactive bone marrow edema, osteomyelitis, osteochondral erosion] and soft tissue [synovitis, bursitis, muscle edema, abscess] abnormalities). Recurrent SAS was evaluated at ≥ 12 months postoperatively. Univariable and multivariable analyses were performed to determine the best predictor of recurrent SAS. Results The overall recurrent SAS rate was 33% (14/43). On univariable analysis, mean age (without recurrence vs. recurrence: 68 vs. 59 years, p  = .04), mean duration from symptom onset to surgery (18 vs. 25 days, p  = .02), serum WBC count (12,000 vs. 9,000 cells/mL 3 , p  = .04), CRP level (13 vs. 6 mg/L, p  = .01), and osteomyelitis on MR imaging ( p  < .01 for both readers) significantly differed between patients with and without recurrence; on multivariable analysis, only osteomyelitis on MR imaging was significantly associated with recurrent SAS for both readers ( p  = .02 and .01 for each reader respectively). The inter-reader agreement was good ( κ  = .62–1.0) for all MR imaging findings, except for muscle edema (fair, κ  = .37). Conclusion Osteomyelitis on MR imaging was the best predictor of recurrent SAS. Key Points • Osteomyelitis on preoperative MR imaging was the best predictor associated with recurrent septic arthritis of the shoulder on multivariable analysis including clinical, laboratory, and MR findings. • In multivariable analyses focused on each bone marrow abnormality, with adjustment for clinical and laboratory parameters, the presence of reactive bone marrow edema and osteochondral erosion on MR imaging showed no significant association with recurrent septic arthritis of the shoulder.

Subtalar arthrodesis (SA) is a widely used salvage procedure for posttraumatic subtalar arthritis (PSA), but its underlying healing mechanisms remain poorly understood. The immune system plays a critical role in the union process after arthrodesis; however, the systemic osteoimmunological response has not been clearly defined. In this study, we investigated immune cell dynamics in patients who underwent SA using single‐cell RNA sequencing (scRNA‐seq). Peripheral blood mononuclear cells (PBMCs) were collected before surgery and 3 months after the operation. The degree of bone fusion was assessed using computed tomography (CT) scans at 3 months, and patients were categorised into early union (EU) and delayed union (DU) groups. scRNA‐seq analysis was performed to examine immune cell composition, gene expression and functional pathways. Monocytes in the EU group showed enhanced antigen processing and presentation, whereas those in the DU group demonstrated increased phagocytic activity. NK cells in the DU group exhibited stronger cytotoxicity through Fc‐gamma receptor signalling and antibody‐dependent cellular cytotoxicity (ADCC) pathways, while NK cells in the EU group showed higher chemokine and cytokine activity. These immune differences persisted postoperatively, suggesting that variations in the systemic immune environment may influence bone healing outcomes. Our findings emphasise the important roles of monocytes and NK cells in bone union and suggest that immunomodulatory approaches could help improve bone repair.

PurposeTo evaluate the potential of locking compression plate with intramedullary fibular allograft in managing proximal humeral fractures with an unstable medial column.MethodsBetween March 2007 and March 2015, we retrospectively analyzed 63 patients who underwent locking plate fixation for proximal humeral fracture with an unstable medial column. All patients were assigned into group 1 (patients treated with locking plate) and group 2 (patients treated with locking plate with intramedullary fibular allograft). Groups 1 and 2 were composed of 29 and 34 patients, respectively. We analyzed bone union, the neck–shaft angle, the Constant score, the range of motion, and complications.ResultsThe mean average bone union time of the patients was 13.9 weeks in group 1 and 11.3 weeks in group 2. The average Constant score was 67.4 in group 1 and 73.6 in group 2 (p < 0.05). The mean preoperative NSA, postoperative NSA, and NSA at the last follow-up were 104.4°, 125.8°, and 115.8°, respectively, in group 1, and 109.0°, 130.3°, and 127.1°, respectively, in group 2. The mean forward flexion, abduction, external rotation, and internal rotation were 109.0°, 48.2°, 34.0°, and L5, respectively, in group 1, and 127.5°, 118.2°, 38.7°, and L1, respectively, in group 2. In group 1, avascular necrosis occurred in one patient and screw cutout in two patients. In group 2, screw cutout occurred in one patient.ConclusionIn patients aged over 65 years with proximal humeral fractures, an unstable medial column was associated with poor clinical results owing to varus collapse. To prevent this, an intramedullary fibular allograft was used, and radiologic and clinical results were better with this approach than with a locking plate alone. Therefore, locking plate fixation using a fibular allograft is one of the possible treatments for patients with an unstable medial column.

With the aging society, musculoskeletal degenerative diseases are becoming a burden on society, and rotator cuff disease is one of these degenerative diseases. The purpose of this study was to examine the incidence of shoulder osteoarthritis and the etiologic factors of rotator cuff disease in the Korean elderly population. A total of 102 patients performing ultrasonography were recruited, and their demographic factors were analyzed. As functional factors, visual analog scale and the peak torque of external and internal rotators of the shoulder using an isokinetic dynamometer were measured. As an anatomical factor, the acromiohumeral distance in the plain radiograph of the glenohumeral anterior-posterior view was used. There were more female patients (65.7%) than male patients (34.3%). The age range with the highest number of respondents was 50–59 years old. The mean visual analogue score was 4.09 (Min 1 to Max 9). Age and dominant hand side factors appear to be the crucial etiologic factors of the presence and severity of rotator cuff disease. The lower net value of the external rotator strength is weakly related to the presence of rotator cuff disease after adjusting for age, and this is the only modifiable factor in the study.

This study aimed to identify the risk factors for non-traumatic rotator cuff tears in Korean adult patients who underwent surgical treatment, focusing on socioeconomic factors. A retrospective study was conducted with 659 patients who were diagnosed with a full rotator cuff tear and underwent surgical treatment. The outcome variable was the rotator cuff tear size (mm), as indicated by preoperative magnetic resonance imaging. Socioeconomic variables included occupation, education level, insurance type, and residential area. Univariate analyses were used to evaluate the relation between tear size and independent variables, and multivariate regression was used to estimate the effects of socioeconomic factors on tear size after adjusting for other variables. Significant differences were found in mean tear size according to age, occupation, residence area, and symptom duration (p < 0.05) in multivariate regression analysis. Rural residents had a 2.12 mm larger tear size than urban residents. Compared to National Health Insurance patients, the tear size of Medicaid beneficiaries was significantly larger (6.79 mm) in urban areas. The larger the rotator cuff tear, the greater the risk of retear and poor shoulder function. Therefore, policy efforts are required to expand access to medical care for the vulnerable.

Background and Objectives: Few studies have investigated the socioeconomic factors associated with retear after rotator cuff repair. This study aimed to identify the risk factors, including socioeconomic factors, for rotator cuff retear in patients who underwent arthroscopic rotator cuff repair. Materials and Methods: This retrospective study included 723 patients diagnosed with full-thickness rotator cuff tears who underwent arthroscopic rotator cuff repair from March 2010 to March 2021. The outcome variable was rotator cuff retear observed on postoperative magnetic resonance imaging or ultrasonography. Sex, age, obesity, diabetes, symptom duration, and tear size were the independent variables. Socioeconomic variables included occupation, educational level, type of medical insurance, and area of residence. We compared patients with and without retear and estimated the effects of the independent factors on retear risk. Results: The mean age of the patients, symptom duration, and tear size were 62.4 ± 8.0 years, 1.8 ± 1.7 years, and 21.8 ± 12.5 mm, respectively. The age, type of medical insurance, diabetes, tear size, and symptom duration differed significantly between patients with and without retearing (p < 0.05). Age, occupation, type of medical insurance, diabetes, initial tear size, and symptom duration significantly affected the risk of retear. Patients who performed manual labor had a significantly higher retear rate (p = 0.005; OR, 1.95; 95% CI, 1.23–3.11). The highest retear risk was seen in patients with Medicaid insurance (p < 0.001; OR, 4.34; 95% CI, 2.09–9.02). Conclusions: Age, initial tear size, and symptom duration significantly affect retear risk after arthroscopic rotator cuff repair. Occupation and type of medical insurance were also risk factors for retear. Socioeconomically vulnerable patients may be at a greater risk of retear. Proactive efforts are required to expand early access to medical care.

Background: Arthroscopic superior capsular reconstruction (ASCR) has recently been introduced as an alternative treatment for patients with massive irreparable rotator cuff tears. However, the results of ASCR are still limited, and little information about retear after ASCR or subsequent treatment has been reported. Purpose: To investigate the retear rate of patients who underwent ASCR and to analyze the clinical outcomes of treatments performed for a retear. Study Design: Case-control study; Level of evidence, 3. Methods: This was a retrospective analysis of prospectively collected data from 42 patients (46 shoulders) who underwent ASCR between March 2015 and April 2018. All patients were divided into 2 groups: those with no retear (30 shoulders) and those with retear (16 shoulders). Pre- and postoperative clinical and radiological results were compared between the 2 groups. The retear pattern and treatment outcomes of the retear group were analyzed. Results: The overall incidence of retear was 35% (16/46). No difference was found in preoperative demographic or clinical data between the 2 groups. Preoperative magnetic resonance imaging data showed a significant between-group difference in the preoperative Goutallier grade of the subscapularis (1.5 ± 1.1 in the no-retear group vs 2.5 ± 1.3 in the retear group; P = .016). In the retear group, there were 10 cases of lateral side tears, 3 cases of midsubstance tears, 2 cases of medial side tears, and 1 case of medial and lateral tears. Reoperation was performed in 8 patients who had lateral insertion tear. Conclusion: Overall, clinical scores improved after ASCR in patients with massive irreparable rotator cuff tears. However, 35% (16/46) of the patients showed retear, and lateral side retear occurred in 68% (11/16). The clinical outcome of the patients with preoperative subscapularis atrophy or postoperative lateral side retears was worse, and reoperation was often required. Therefore, it is important that the lateral side be firmly fixed during the ASCR procedure.

Patients with osteoporosis are asymptomatic and are at risk for fractures. Therefore, early detection and interventions are important. We found that a population with a low socioeconomic status living in rural areas was reported to have a high osteoporosis prevalence but a relatively low diagnosis rate. Research on the disparity of osteoporosis prevalence and treatment from the socioeconomic perspective was conducted. This study aimed to investigate the influence of residence area and basic livelihood conditions on osteoporosis prevalence and diagnosis in postmenopausal women aged over 50 years. The cross-sectional data of 1477 postmenopausal women aged over 50 years obtained from the Korea National Health and Nutrition Examination Survey V-2 were analyzed. Univariate analyses were performed to calculate the prevalence and diagnosis rate according to risk factor categories. A multivariate logistic regression analysis was performed to identify the influence of residence area and basic livelihood conditions after controlling for other factors. The osteoporosis prevalence in basic livelihood beneficiaries (53.7%) and rural area residents (41.9%) was higher than that in non-beneficiaries (33.1%) and urban area residents (31.8%). There was no significant difference in the diagnosis rates in relation to the basic livelihood conditions or residence areas. The adjusted odds ratio for the prevalence among the beneficiaries living in rural areas was 2.08 (95% confidence interval: 1.06–4.10). However, the odds ratio for diagnosis was not significantly different. Earlier screening examination policies for osteoporosis in postmenopausal women with a low socioeconomic status living in rural areas are needed.

Background/Objectives: Fluoroscopy has been widely adopted in interventional pulmonology, as it facilitates real-time visualization of the bronchoscope, endobronchial ultrasound, and biopsy tools during procedures. The purpose of this study was to evaluate the effectiveness of radiation shields in minimizing scattered X-ray dose to the bronchoscopist in a phantom study and to determine the dose of scattered X-ray dose to medical staff with radiation shields in clinical application. Methods: An anthropomorphic torso phantom was positioned on the fluoroscopic table between the C-arm X-ray tube and the image detector to mimic bronchoscopic operations. Upper and lower body lead shields were used to examine the effectiveness of radiation shielding. Scatter radiation rates were assessed at a first operator location using real-time dosimeters with and without protective devices. In clinical application, the scattered X-ray dose of the first operator and main assistant was measured using wearable radiation dosimeters during 20 procedures. Results: In the phantom study, scattered radiation without shielding was 266.34 ± 8.86 μSv/h (glabella), 483.90 ± 8.01 μSv/h (upper thorax), 143.97 ± 8.20 μSv/h (hypogastrium), and 7.22 ± 0.28 μSv/h (ankle). The combination of upper and lower body lead shields reduced the scattered X-ray dose by 98.7%, 98.3%, 66.2%, and 79.9% at these levels, respectively. In clinical application, mean scattered X-ray dose rates were 0.14 ± 0.05 μSv/procedure (eye), 0.46 ± 0.51 μSv/procedure (chest), 0.67 ± 0.50 μSv/procedure (hypogastrium), and 1.57 ± 2.84 μSv/procedure (assistant’s wrist). Conclusions: The combination of radiation shields significantly reduced the scattered X-ray dose at the operator site in the phantom study. The scattered X-ray dose to medical staff during bronchoscopy can be kept at a low level with the aid of a shielding system.