• The Journal of Korean Orthopaedic Ultrasound Society
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• v.4 no.1
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• pp.38-41
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• 2011

After closed reduction and internal fixation with proximal femoral nail for intertrochanteric fracture, some patients complained lateral hip pain. We report two cases of lateral hip pain due to tendinopathy confirmed by ultrasonography.

• Journal of the Korean Orthopaedic Association
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• v.55 no.3
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• pp.237-243
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• 2020

Purpose: This study examined the effects of the postoperative administration of parathyroid hormone (PTH) on fracture healing in intertrochanteric fractures accompanied by osteoporosis in elderly females. Materials and Methods: Female patients aged 65 years and more who underwent surgery after a diagnosis of intertrochanteric fractures and osteoporosis during the period from July 2013 to December 2017 were included as subjects. The subjects were divided into two groups: PTH-treated group and non-PTH-treated group. The formation time of the first callus, timing of the bridging callus, and time of bony union for both groups were evaluated. Results: In the PTH-treated group, the mean time of the first callus formation, average time of bridging callus, and the average time of bony union were 32, 58, 83 days, respectively, which were significantly shorter than that of the untreated group. Conclusion: PTH, a treatment for osteoporosis, promotes callus formation and the healing process. Therefore it will be helpful in intertrochanteric fractures accompanied by osteoporosis in elderly females.

• Journal of the Korean Orthopaedic Association
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• v.55 no.6
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• pp.503-510
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• 2020

Purpose: Bipolar hemiarthroplasty is used as an alternative to open reduction and internal fixation for unstable intertrochanteric fractures in elderly patients. Recent advances in medical systems and technologies have resulted in increased survival rates after intertrochanteric fractures of the femur, requiring selection of the appropriate femoral stems considering the mid- to long-term duration of survival. Hemiarthroplasty was performed for unstable intertrochanteric fractures using a double tapered quadrilateral femoral stem (C2 stem), and the clinical and radiological results were evaluated as a five-year follow-up post-surgery. Materials and Methods: From January 2004 to December 2013, 43 patients (43 hips) who underwent hemiarthroplasty with a C2 stem were enrolled in this study. Their mean age was 78.6 years (range, 70-84 years), and the mean follow-up period was 85.4 months (range, 60-96 months). During the follow-up period, clinical parameters, such as the changes in pain, walking ability, and functional status, were examined. Radiologically, changes in the proximal femur, such as osteoporosis and bone resorption of cortical bone, were noted. Complications that occurred during the follow-up period, such as dislocation and prosthetic features, were also reviewed. Results: Initially, the pain was relieved postoperatively, but it increased four years after surgery. The walking ability was reduced by two steps in nine patients after 60 months, and the Harris hip score was reduced significantly postoperatively after two to three years. Radiologically, cortical osteoporosis occurred in 14 patients. Five patients developed cortical bone resorption. Four of them showed nonunion of the trochanteric fracture fragments, and three of them suffered reverse oblique fractures. Conclusion: Careful selection considering the general health condition and remaining lifespan of the patient would be necessary for primary hip hemiarthroplasty using a 3C type cementless femoral stem for unstable intertrochanteric fractures in elderly patients with osteoporosis.

• Journal of the Korean Orthopaedic Association
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• v.56 no.4
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• pp.334-340
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• 2021

Purpose: This study analyzed the bone mineral densities of the lumbar vertebrae and femurs of patients with ankle fractures to determine the correlation between ankle fractures and osteoporosis. Materials and Methods: From April 2002 to July 2014, one hundred consecutive ankle fracture patients with bone mineral density tests performed within post-traumatic one year were enrolled. The patients were divided into three age groups according to their age at the time of injury (group 1: <50, group 2: 50-69, group 3: ≥70). The types of ankle fractures were classified into unimalleolar, bimalleolar and trimalleolar fractures. The bone mineral density was analyzed using the T score, Z score, absolute value (g/cm²) of the lumbar spine (L1-L4), femur neck, femur intertrochanter, and total femur. Results: There were 3.2 times more females with ankle fractures than males, and the prevalence of osteoporosis according to age group was 0% in the group under 50 years, 24.2% in the 50 to 69-year-old group, and 15% in the group over 70 years. Osteoporosis was found in 30% of patients with a trimalleolar fracture in the 50 to 69-year-old group. In all patient groups, a lower age indicated a higher frequency of unimalleolar fractures. The relationship between the bone mineral density and the type of fracture is that the frequency of trimalleolar fracture increased with decreasing T score of the lumbar vertebrae and the absolute value of bone mineral density (g/cm²) and the Z score of the femur neck, but there were no other indicators. Conclusion: Among the 100 patients with ankle fractures, females were more common than males, because osteoporosis was less severe in males. The incidence of unimalleolar fracture was higher than that of trimalleolar fracture. On the other hand, the correlation between the ankle fractures and the bone mineral density of the femur and lumbar spine was not significant.

• Journal of the Korean Orthopaedic Association
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• v.56 no.1
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• pp.51-60
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• 2021

Purpose: Radiocarpal dislocation (RCD), which is caused by high-energy trauma, often involves radial styloid fractures and short radiolunate ligament (SRLL) injuries. Although SRLL injuries may occur as a simple rupture at the attachment site of radius, it may occur with a relatively large avulsed-fragment in the volar rim of the lunate facet of the radius. This study aimed to differentiate the injury type of SRLL and assess the differences in the treatment results depending on the treatment methods that have been applied in RCD with radial styloid fractures. Materials and Methods: Eighteen patients managed surgically with RCD were enrolled in this study. The patients were classified as Group 1 and Group 2 by using the Dumontier method. In this study, Group 2 was subdivided into 2A (purely ligamentous or small avulsion fracture of the volar rim of lunate facet) and 2B (large avulsed-fragment enough to internal fixation) according to the injury type of SRLL. Groups 2A and 2B were treated with direct repair and screw fixation, respectively. Pain, range of motion of the wrist joint, grip strength, and complications on final radiographs were examined. The outcomes were evaluated using patient-rated wrist evaluation (PRWE), and modified Mayo wrist score (MMWS). Results: All patients were Group 2 (six and twelve patients in 2A and 2B, respectively). The mean flexion to extension arch recovered 79%,and the mean grip strength was 72.9% of the uninjured side. Group 2A showed better recovery in extension, flexion and pronation than Group 2B, but there was no difference in radial deviation, ulnar deviation, supination, grip strength and pain. No differences in the PRWE and MMWS were observed between two groups. Complications included traumatic arthritis in seven patients and residual instability in five patients. Conclusion: When the SRLL was injured, the involvement of a large avulsion fracture on the anterior plane of the radiolunate did not affect the test results. On the other hand, it should be observed cautiously because avulsion fractures tend to disturb the joint's reduction through rotation or displacement. In addition, anatomical reduction and sturdy internal fixation are important for restoring the function of the SRLL.

• The Journal of the Korean bone and joint tumor society
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• v.11 no.2
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• pp.175-182
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• 2005

Purpose: Bone tumor occurred in femur frequently involve proximal intertrochanteric region or distal metaphyseal region. Sometimes, the pathologic fracture can happen according to the size of tumor due to the substantial biomechanical stresses. Therefore, the prognosis can be improved biomechanically by the angled blade plate considering the anatomic configuration after the excision of tumor. Materials and Methods: Between October 1991 and April 2005, there were a total of 16 patients(17 cases) who were treated by the excision of tumor and internal fixation with the angled blade plate for bone tumor occurred in femur. After the excision of tumor, we filled the cavity by bone graft in 11 cases and bone cement in 6 cases. The internal fixation was used by angled blade plate in all cases. Result: The average follow-up time was 55.5 months(6-144 months) in 16 patients(17 cases). No metal failure occurred after the operation. Reoperation was performed in 4 cases due to tumor recurrence, and the internal fixation was firm until that. Conclusion: The angled blade plate can prevent the fracture until grafted bone incorporated to host bone, and protect fragile connection between cement and host bone.

• Journal of Biomedical Engineering Research
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• v.24 no.5
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• pp.401-410
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• 2003

This study investigates the biomechanical efficacies of various cement augmentation techniques with or without pressurization for varying degrees of osteoporotic femur. For this study, a biomechanical analysis using a finite element method (FEM) was undertaken to evaluate surgical procedures, Simulated models include the non-cemented(i.e., hip screw only, Type I), the cement-augmented(Type II), and the cemented augmented with pressurization(Type III) models. To simulate the fracture plane and other interfacial regions, 3-D contact elements were used with appropriate friction coefficients. Material properties of the cancellous bone were varied to accommodate varying degrees of osteoporosis(Singh indices, II∼V). For each model. the following items were analyzed to investigate the effect surgical procedures in relation to osteoporosis of varying degrees : (a) von Mises stress distribution within the femoral head in terms of volumetric percentages. (b) Peak von Mises stress(PVMS) within the femoral head and the surgical constructs. (c) Maximum von Mises strain(MVMS) within the femoral head, (d) micromotions at the fracture plane and at the interfacial region between surgical construct and surrounding bone. Type III showed the lowest PVMS and MVMS at the cancellous bone near the bone-construct interface regardless of bone densities. an indication of its least likelihood of construct loosening due to failure of the host bone. Particularly, its efficacy was more prominent when the bone density level was low. Micromotions at the interfacial surgical construct was lowest in Type III. followed by Type I and Type II. They were about 15-20% of other types. which suggested that pressurization was most effective in limiting the interfacial motion. Our results demonstrated the cement augmentation with hip screw could be more effective when used with pressurization technique for the treatment of intertrochanteric fractures. For patients with low bone density. its effectiveness can be more pronounced in limiting construct loosening and promoting bone union.

• Journal of Trauma and Injury
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• v.23 no.1
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• pp.1-5
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• 2010

Purpose: To investigate the results of treatment of reverse oblique trochanteric fractures with compression hip screw. Methods: We reviewed the results of 12 cases of reverse oblique trochanteric fracture treated with compression hip screw from January 2000 to December 2006 which could be followed up for more than 1 year. The mean follow up period was 26 months (15~40). The mean age was 48 years old. Injury mechanism was composed of 6 cases of traffic accident and 6 cases of fall down. 8 persons were man. We investigated the union time, degree of neck-shaft angle change, amount of sliding of compression hip screw, complications, functional and clinical results. Results: 10 cases were united and the mean union time were 5 months (3~8). The mean neck-shaft angle change was 3.5 degrees (0~12). The amount of sliding of compression hip screw was 8.9 mm (2~24). There were six coxa vara, six leg due to coxa vara shortening, two nonunion, and one superficial infection. Unsatisfactory results of Jensen's social function score and Parker and Palmer's mobility score were studied. Conclusion: The results of treatment of reverse oblique trochanteric fractures with compression hip screw were relatively unsatisfied.

• Journal of Oral Medicine and Pain
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• v.21 no.2
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• pp.279-291
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• 1996

저수준레에저요법에 대해서는 지난 10여년간 의학계 및 치과계에서 임상적으로 사용하여 좋은 결과가 있다고 많은 보고가 발표되고 있다. 특히 치근의 골결손에 관한 연구에서는 전기요법, 초음파요법, 전자장요법 등 뿐만아니라 저수준레이저를 사용하여 골절부내 Callus형성이 촉진되었음을 보고하고 새로운 치료법의 하나가 될 수 있음을 제안한 바도 있다. 본 연구에서는 칼륨비소를 다이오드로 사용한 저수준레이저조사가 골결손의 치유에 어떠한 영향을 미치는지 확인하고자 골모세포의 알칼리성 인산분해효소의 활성화와 석회화결절의 형성을 평가함으로 골모세포의 기능을 조사코저하였다. 실험은 첫째, 9개군으로 나누어 레이저 조사기간에 따른 알칼리성 인산분해효소의 활성화를 조사하였고, 둘째, 이를 근거로 9일간 계속 매일 1회 1.3 J/cm2의 레이저를 조사한 후 펄스의 종류별 차이를 비교하였으며, 세째,레이저펄스별 석회차 결절의 형성 정도를 광학현미경으로 관찰하여 비교분석하였다. 결과, 7일 계속 레이저를 조사한 경우 다른 군에 비해 서서히 ALP의 활성이 증가하였으나 유의한 차이는 없었으며. 따라서 9일동안 레이저를 계속 조사한 경우에는 전체 에너지량이 5.895 J/cm2 인 펄스13과 15가 뚜렷하게 유의한 증가를 보여주었다. 그러나 석회화결절의 형성은 전체 에너지량이 2.546 J/cm2 인 펄스11에서 가장 많았다. 결론적으로 골형성이나 알칼리성 인산분해효소의 활성을 촉진하는 데에는 적절한 레이저 조사조건이 필요하나, 알칼리성 인산분해효소의 활성을 촉진한 펄스와 석회화결절의 형성을 촉진하는 펄스가 서로 다르게 나타난 것은 골형성을 촉진하는 여러요인 들이 저수준레이저에 자극받았을 가능성이 높음을 보여준다 이러한 결과들로 보아 저수준레이저는 골모세포의 기능을 자극하여 골결손의 치유를 개선하는 데 도움될 것이라 사료된다.다. 각 백서의 양측 창상중 하나는 1,3,5,7일 마다 각 실험의 방법에 따라 레이저를 조사하고 실험동물의 다른 창상은 대조군으로서 사용하였다. 모든 창상의 면적은 실험 1,3,5,7 일째에 일정한 거리에서 사진촬영하여 면적계를 이용, 측정한 후 통계적인 의의를 조사하였다. 본 연구의 결과는 저수준레이저는 특정 조건하에서 S. aureus의 증식을 촉진하였다. 그러나 S. aureus에 감염된 창상을 저수준레이저로 조사시 치유가 촉진되었다. 중앙 조사법고 주변조사법에 의한 창상치유효과는 통계적인 의의가 보이지 않았다. 따라서 결론적으로 S. aureus 에 감염된 창상에 직접 또는 간접적이든 pulse의 종류에 관계없이 조사하는 경우 치유효과가 나타나는 것은 정사주위 조직의 LLLI 자극효과가 염증의 확산을 억제한다고 말할수 있다.4/1$0^{\circ}C$에서는 Shoa-Nan-Tsan과 Lenkwang이 가장 높았으며 백앙벼는 3 온도 조건 모두에서 활성이 낮았다. 발아소요일수와 amylase 활성과는 유의적인 정의 상관관계를 보였다., 다다조, 미국의 건답직파재배 품종 등이었으며 우리 나라 육성종들은 모두 지중에서 신장이 멈추어 제1본엽이 지중에서 추출하였으며, Scm파종심에서 불완전엽이 지면을 뚫고 나오는 품종은 Chinsura Boro뿐이었고 Nato, Labelle, Weld Pally, Italliconaverneco 등도 지면 가까이 까지 신장하였다. 6. 50% 출아일수는 제2절간장을 제외 한 모든 유아 형질의 신장도와 유의한 부의 상관을 보였는데 가장 높은 상관을 보인 것은 중배축장＋제1절간장＋불완전옆장이었으며, 다음이 불완전엽장이 었다. 7. 출아율은 중배축장+제1절간장＋불완전엽장, 중배축장＋초엽 장과 모든 파종심에서 높은 정의 상관을 보여 제1본엽의 추출 위치가 높을수록

• Journal of the Korean Orthopaedic Association
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• v.54 no.6
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• pp.519-527
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• 2019

Purpose: To evaluate the treatment result in polyostotic fibrous dysplasia classified according to the involvement of the femoral head. Materials and Methods: Twenty-three patients from March 1987 to March 2014 were reviewed retrospectively. Patients with no involvement of the physeal scar in the femoral head were classified as Type I, and those with involvement of the physeal scar were classified as Type II. A plain radiograph was used to measure the femoral neck shaft angle, articulo-trochanteric distance (ATD), and anterior bowing through the lateral view. A teleoroentgenogram of the lower limb was used to measure the leg length discrepancy and lower extremity mechanical axis. The pre- and postoperative femoral neck-shaft angle and ATD were compared to assess the degree of correction of the deformity. Results: Among a total of 46 cases (23 patients), 28 cases (23 patients) had lesions in the proximal femur. Type I were 16/28 cases (15/23 patients) and Type II were 12/28 cases (9/23 patients). The preoperative proximal femoral neck-shaft angle was 116.8° in Type I and 95.3° in Type II. The ATD was 12.08 mm in Type I and -5.54 mm in Type II. The deformity correction showed significant improvement immediately after surgery, the deformity correction was lost in Type II (neck shaft angle Type I: 133.8°-130.8°, Type II: 128.6°-116.9°, and ATD Type I: 17.66-15.72 mm, Type II: 7.44-4.16 mm). The extent of anterior bowing was 12.74° in Type I and 20.19° in Type II. The mean differences of 12 mm between the 9 patients who showed a leg length discrepancy and the lower extremity mechanical axis showed 4 cases of lateral deviation and 7 cases of medial deviation. Conclusion: In polyostotic fibrous dysplasia, when the femur head is involved, the femur neck shaft angle, ATD, and anterior bowing of the femur had more deformity, and the postoperative correction of deformity was lost, suggesting that the involvement of the femoral head was an important factor in the prognosis of the disease.