Jung Il Lee

Aims: The aim of this nationwide population-based cohort study was to identify the risk factors associated with the development of idiopathic cubital tunnel syndrome (CuTS), and the factors which influence the requirement for surgery in these patients. Methods: We analyzed data from 43,189 patients newly diagnosed with idiopathic CuTS between January 2009 and December 2021, using the Korean National Health Insurance Service database. They were identified using diagnostic codes, procedural codes for surgery, and/or electrodiagnostic study codes. Patients with cervical radiculopathy, brachial plexopathy, polyneuropathy, previous CuTS and recent fracture, dislocation, or arthroplasty of the elbow were excluded. Age- and sex-matched controls were selected at a 1:5 ratio. Logistic regression identified risk factors for the development of CuTS, and Cox proportional hazards regression determined factors associated with surgical treatment. A false discovery rate-adjusted p-value < 0.05 was considered significant. Results: Risk factors for the development of CuTS included carpal tunnel syndrome (CTS), arthritis of the elbow, rheumatoid arthritis (RA), gout, depression, dyslipidaemia, hypertension, obesity, metabolic syndrome, diabetes, current smoking, anaemia, and hazardous alcohol drinking, in decreasing order of odds ratios. A total of 7,810 patients (18%) underwent surgery. Factors associated with surgery included CTS, arthritis of the elbow, RA, hypertension, obesity, metabolic syndrome, diabetes, current smoking, and hazardous alcohol drinking, in decreasing order of hazard ratios. Regular exercise significantly reduced the risk of both the development of CuTS and the requirement for surgery. Conclusion: In this large cohort study, we identified risk factors for the development of idiopathic CuTS and its surgical treatment, many of which parallel those for CTS. These findings may guide clinicians in risk stratification, prevention, and management of patients with idiopathic CuTS, and provide insights into the shared aetiology. Cite this article: Bone Joint J 2026;108-B(5):657–662.

The relationship between distal radioulnar joint (DRUJ) involvement and subsequent arthritis or functional outcomes remains unclear. This study evaluated associations between DRUJ articular disruption, arthritis severity, and wrist function following volar locking plate fixation. We retrospectively reviewed patients with unstable distal radius fractures who underwent volar locking plate fixation and had a minimum follow-up of 1 year. Preoperative computerized tomography scans were analyzed for DRUJ articular involvement, articular step-off, and volar or dorsal subluxation. Patients were categorized by presence or absence of DRUJ involvement; presence or absence of sigmoid notch articular step-off; and degree of DRUJ subluxation (P < .05), though functional outcomes were similar. Arthritis grades and function were comparable between patients with subluxation ≥ 10% (n = 18) and < 10% (n = 39). Sigmoid notch involvement was not associated with higher DRUJ arthritis severity or impaired function, whereas articular step-off correlated with increased arthritis grades without functional deficits. These findings suggest that while sigmoid notch involvement alone may not be a major determinant of functional outcome, careful attention to reducing articular step-off may help minimize the risk of radiographic arthritis progression.

Peripheral nerve repair is considered the gold standard treatment for complete nerve transection injuries, yet achieving satisfactory functional recovery remains challenging due to muscle atrophy during the time required for axonal regeneration. This study investigated the beneficial effects of 4-aminopyridine (4-AP), a potassium channel blocker, on neural and muscular recovery. Following complete transection of the right sciatic nerve, 40 mice underwent end-to-end nerve repair using microscopic epineural sutures and were randomly assigned to either the control or 4-AP groups immediately after surgery (n = 20 per group). The experimental animals were administered intraperitoneal injections of 200 μL normal saline or soluble 4-AP at a dose of 10 μg daily. The sciatic functional index (SFI) and nerve conduction studies were measured until 12 weeks postoperatively. Morphological analyses of nerve and muscle, and Western blotting for proteins associated with muscle atrophy were performed at 3 and 12 weeks after surgery. There were no significant differences in the SFI between the two groups. Nerve conduction study showed that 4-AP treatment increased the compound muscle action potential and decreased latency. A histomorphometric study showed that 4-AP treatment increased myelin thickness, G-ratio (axonal diameter/axoglial diameter on cross-sectioned nerve), cross-sectional area of myofibrils, and minimal Feret diameter of myofibrils. Additionally, expression levels of FoxO3 and mTORC1 were lower in the 4-AP treated mice, while myogenin expression levels showed no significant difference between the groups. 4-AP treatment promotes myelination and prevents denervation-induced muscle atrophy after neurorrhaphy. These findings suggest that 4-AP may be a promising candidate for clinical consideration as an adjuvant therapy following nerve repair for transection injuries.

김동환, et al. J Korean Fract Soc. 2024 Jul;37(3):158-168. https://doi.org/10.12671/jkfs.2024.37.3.158

Background: Previous longitudinal cohort studies have reported the conflicting results of the relationship between statin use and the development of tendinopathy disorder. It is unclear if there is a relationship between statin use, particularly the type or cumulative doses, and the development of tendinopathy disorder. Purpose: To investigate an association between statin treatment and the development of tendinopathy. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 594,130 participants were enrolled in this study in 2002 and evaluated until 2015. There were 84,102 statin users and 168,204 nonusers (controls) selected at a ratio of 1:2 using propensity score matching analysis. The types of included tendinopathy were as follows: (1) trigger finger, (2) radial styloid tenosynovitis, (3) elbow epicondylitis, (4) rotator cuff tendinopathy, and (5) Achilles tendinitis. Cox proportional hazards models with time-varying covariates were constructed to identify the association between statin use and tendinopathy development. Results: Statin treatments regardless of statin types were associated with a significantly greater risk of all types of tendinopathy development (hazard ratio, 1.435; 95% CI, 1.411-1.460) compared with no statin treatment. A trend toward risk reduction was observed according to cumulative statin doses, which was indicated by hazard ratios of 2.337 (95% CI, 2.269-2.406), 2.210 (95% CI, 2.132-2.290), and 1.1 (95% CI, 1.098-1.146) in patients with cumulative defined daily doses of 90, 91-180, and >180, respectively. Conclusion: This nationwide population-based cohort study suggests that statin use regardless of the statin type was associated with a greater risk of tendinopathy compared with that of nonusers. The risk of tendinopathy development was diluted with the increasing cumulative defined daily dose.

Objectives: With the increasing popularity of searches for medical information on YouTube, the availability of videos concerning carpal tunnel syndrome (CTS) is increasing. This study aimed to evaluate the quality and reliability of YouTube videos on CTS. Setting and participants: No participants were included. Primary and secondary outcome measures: We searched YouTube on 1 April 2021 using the keywords “carpal tunnel syndrome” and “carpal tunnel release” and evaluated the first 55 retrieved videos. We summarised the video characteristics including Video Power Index (VPI), which was designed to evaluate video popularity based on the number of likes and views. We categorised them based on source and content. Video quality and reliability were evaluated using the Journal of the American Medical Association (JAMA) benchmark criteria, the Global Quality Score (GQS) and the Carpal Tunnel Syndrome-Specific Score (CTS-ss) . Results: The mean (range: minimum–maximum) of JAMA scores, GQS and CTS-ss were 2.13 (1–4), 2.69 (1–5), and 5.0 (1–15), respectively. The most common source of video was from allied health workers, and academically sourced videos had the highest JAMA score and GQS. Three scores were significantly correlated with each other. Multiple linear regression analysis showed that a higher JAMA score was associated with a higher likes ratio, and a higher GQS was associated with a longer video running time and greater number of comments. However, a higher VPI was not associated with higher video quality or reliability represented by the three scores. Conclusions: YouTube videos on CTS have low quality and reliability. Video popularity was not significantly correlated with quality or reliability. Our findings suggest that expert groups should provide and promote high-quality video content to YouTube users and patients.

Background: Bicycles and motorcycles are a main means of transportation and leisure for individuals aged under 20 years in South Korea. We aimed to identify the epidemiology of injuries and describe and compare patterns of injury and clinical outcomes of two-wheel vehicle-related accidents in these individuals. Methods: We analysed data obtained from the National Emergency Department Information System for 401 emergency departments (EDs) from January 2016 to December 2018. We included patients aged < 20 years who experienced injuries while driving or a passenger on two-wheeled vehicles. We analysed patients with a bicycle-related injury and those with a motorcycle-related injury, and then compared two groups and performed a regression analysis for factors predicting severe trauma. Results: This study enrolled 54,342 two-wheel vehicle injury patients (37,410 bicycle and 16,932 motorcycle-related), of which, 86.8% (bicycle) and 94.9% (motorcycle) were males. External injuries were the most common. ED mortality was 9 (0.0%) for bicycles and 53 (0.3%) for motorcycles. Overall, 3,346 (8.9%) patients were hospitalised with bicycle injuries and 4,096 (24.2%) with motorcycle injuries. Among admitted patients with bicycle-related injuries, 48.7% had upper extremity injuries and among those admitted patients with motorcycle-related injuries, 76.0% had lower extremity injuries. Among hospitalised patients, the mean injury severity score (ISS) was 12.0 ± 12.6 in bicycle-related injury and 17.6 ± 15.4 in motorcycle-related injury. The number of patients with ISS ≥ 16 was 27.6% for bicycle related injuries and 45.2% for motorcycle-related injuries. The mean length of hospital stay was 191.5.8 ± 224.2 h for bicycle injury, and 359.6 ± 416.7 h for motorcycles. Hospital mortality cases were 0.2% with bicycle injury and 1.2% with motorcycle injury. Motorcycle-related injuries had more severe injury (ISS ≥ 16), with an adjusted odds ratio of 2.825 (95% confidence interval 2.610–3.059) compared to bicycle-related injuries. Conclusions: In the population aged under 20 years, two-wheel vehicle-related occurred predominantly in males. When using two-wheeled vehicles, motorcycle injuries were higher in patients aged over 14 years and were associated with higher ISS (≥ 16). Political efforts should be made to educate under 20 years of age for safe driving and to wear protective gear, including helmets to prevent severe injury.