• Journal of Trauma and Injury
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• 제25권1호
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• pp.25-27
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• 2012

A 30-year-old, male truck driver had a traffic accident and visited a hospital due to left hip pain. The patient's femoral head was fractured, and he was treated conservatively. For 14 years afterwards, he walked without a limp, had no pain, and drove his truck. He was involved in another traffic accident and experienced a comminuted fracture of the left distal femur 14 years after the initial injury. Although he was symptom-free, while being treated by open reduction and internal fixation for the distal femur fracture, he was concerned about the status of his left femoral head. Pelvis radiographs and reconstructed CT images were done, and they showed a spur change around the femoral head which had a dense sclerotic band within and revealed a slight depression of subchondral bone of the medial portion of the femoral head. The diagnosis was a Pipkin type-II fracture of the femoral head.

• Journal of Korean Neurosurgical Society
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• 제67권2호
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• pp.137-145
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• 2024

In adult spinal deformity (ASD) surgery, mechanical failure (MF) has been a significant concern for spine surgeons as well as patients. Despite earnest endeavors to prevent MF, the absence of a definitive consensus persists, owing to the intricate interplay of multifarious factors associated with this complication. Previous approaches centered around global spinal alignment have yielded limited success in entirely forestalling MF. These methodologies, albeit valuable, exhibited limitations by neglecting to encompass global balance and compensatory mechanisms within their purview. In response to this concern, an in-depth comprehension of global balance and compensatory mechanisms emerges as imperative. In this discourse, the center of gravity and the gravity line are gaining attention in recent investigations pertaining to global balance. This narrative review aims to provide an overview of the global balance and a comprehensive understanding of related concepts and knowledge. Moreover, it delves into the clinical ramifications of the contemporary optimal correction paradigm to furnish an encompassing understanding of global balance and the current optimal correction strategies within the context of ASD surgery. By doing so, it endeavors to furnish spine surgeons with a guiding compass, enriching their decision-making process as they navigate the intricate terrain of ASD surgical interventions.

• Hip & pelvis
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• 제35권1호
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• pp.47-53
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• 2023

Purpose: The purpose of this study is to compare the radiological results of fixation using the femoral neck system (FNS) and cannulated screw (CS) for treatment of femoral neck fractures. Materials and Methods: A retrospective study of patients with femoral neck fractures who underwent internal fixation and had follow-up of more than six months from 2010 to 2020 was conducted. A total of 87 patients were enrolled in the study. The FNS group included 20 patients and the CS group included 67 patients. Classification of fractures was performed according to Garden and Pauwels classification. Operation time, intraoperative blood loss, sliding distance of the implant, lateral soft tissue irritation caused by implants, and complications were evaluated. Results: The mean operation time was 40.30 minutes in the FNS group and 46.84 minutes in the CS group. The mean intraoperative bleeding volume was 51.25 mL in the FNS group and 72.16 mL in the CS group. Bone union was achieved in 18 patients in the FNS group (90.0%) and in 61 patients in the CS group (91.0%). The mean sliding distance of the implant was 4.06 mm in the FNS group and 3.92 mm in the CS group. No patients in the FNS group and 12 patients in the CS group complained of soft tissue irritation. Conclusion: A shorter operative time, less intraoperative bleeding, and less irritation of soft tissue were observed in the FNS group. FNS could be an alternative to CS for fixation of femoral neck fractures.

• 한국전문물리치료학회지
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• 제23권1호
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• pp.20-30
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• 2016

Background: Total knee arthroplasty (TKA) recovers the alignment of the knee joint, but fails to automatically restore the alignment and function of the hip and ankle joints. It may affect the alignment and stability of the knee joint, therefore therapeutic intervention in hip and ankle joint is necessary for the rehabilitation process after TKA. Objects: The aim of this study was to comparison of the effects of the two exercise methods on the coronal plane alignment after TKA. This study conducted an experiment by dividing subjects into a lower extremity isometric co-contraction group (LEIC) and a quadriceps isolated isometric contraction (QIIC) group. Methods: A total of 37 subjects were randomly assigned to the LEIC ($n_1$=19) or the QIIC ($n_2$=18). Exercise was applied to five times per week for three weeks, starting on the eighth day after surgery. Range of motion exercises were performed as a common intervention and then each group performed quadriceps isometric contraction exercises with 10 sets of 5 repetitions. Radiological imaging was performed prior to surgery, one month and six months after surgery. In addition, the hip-knee-ankle angle (HKA) and tibiotalar angle (TTA) were measured. Results: The HKA was close to neutral in the LEIC rather than the QIIC (p<.05). The LEIC showed varus and the QIIC exhibited valgus TTA (p<.05). In a comparison of HKA and TTA over time, there was no significant change in either group (p>.05). According to the comparison of the TTA before surgery, the LEIC showed significant changes in the varus direction (p<.05), while there was no significant change in the QIIC (p>.05). Conclusion: The LEIC method triggered changes in the TTA and brought the HKA close to the neutral. Thus, LEIC is more effective than QIIC in creating stability in the coronal plane alignment of the knee and ankle joints after TKA.

• 대한정형외과스포츠의학회지
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• 제1권1호
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• pp.15-20
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• 2002

목적: 스포츠손상에의한비구순파열환자에서진단및치료에대해고찰해보고자하였다. 대상및방법: 1995년3월부터2000년1월까지스포츠손상후발생한고관절통으로본원에내원한환자에서비구순파열로진단된15예를대상으로하였다. 원인별로달리기5예, 격투기3예, 에어로빅3예, 수영2예, 등산1예, 자전거 1예등이었다. 남자가6명, 여자가9명이었고, 나이는 평균41세였다. 모든 환자는6개월간격으로 추시하였고, 보존적 치료를 시행한 경우최소2년 이상 투약 및 증세관찰을 하였고, 관절경적 수술을 시행한6예에서 수술 전, 수술 후 6개월과 12개월에 Harris Hip Score (이하HHS)를측정하였고, JOA pain scoring system에의해결과를평가하였다. 결과: 보존적치료를 시행한9예에서 HHS는 평균 15점 향상되었고, 그중 4예는 1단계의 통증 지수 향상이 있었는데, 이들 모두Czerny 분류상type IA였다. 관절경적수술을 시행한6예에서수술후 HHS는 32점향상되었고, 6예모두에서2단계이상의통증지수향상이관찰되었다.결론: 스포츠손상환자에서급,만성고관절통을호소하는경우비구순파열은반드시감별진단되어야하며, 이학적검사상의심이될경우자기공명관절조영술을이용한진단이유용할것으로사료된다. 확진이된경우관절경을이용한파열된비구순의변연절제술이효과적인치료방법으로생각된다.

• Structural Engineering and Mechanics
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• 제91권3호
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• pp.251-262
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• 2024

Numerical modeling using the finite element method (FEM) offers crucial insights into the mechanical behavior of prostheses, including stress and strain distribution, load transfer, and stress intensity factors. Analyzing cracking in PMMA surgical cement (polymethylmethacrylate) for total hip prostheses (THP) is essential for understanding the loosening phenomenon, as the rupture of orthopedic cement is a primary cause. By understanding various failure mechanisms, significant advancements in cemented total prostheses can be achieved. This study performed a numerical analysis using a 3D FEM model to evaluate stress levels in different THP models, aiming to model damage in the orthopedic cement used in total hip arthroplasty. Utilizing ABAQUS software, FEM, and XFEM, the damage in three types of THPs-Charnley (CMK3), Osteal (BM3), and THOMPSON was modeled under stumbling loading conditions. XFEM allowed for the consideration of crack propagation between the cement and bone, while the GEARING criterion employed a user-defined field subroutine to model damage parameters. The study's findings can contribute to improving implant fixation techniques and preventing postoperative complications in orthopedic surgery.

• 대한골관절종양학회지
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• 제3권1호
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• pp.18-25
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• 1997

Prosthetic replacement is one of the most common methods of reconstruction after resection of malignant tumor around the knee. Gait analysis provides a relative objective data about the gait function of patients with prosthesis. The purpose of this study was to compare the gait pattern of the patients who underwent limb salvage surgery with prosthesis for distal femur and that of patients with prosthesis for proximal tibia. This study included ten patients (4 males, 6 females, mean age 22.7 years, range 14-36) who underwent a wide resection and Kotz hinged modular reconstruction prosthesis replacement and six normal adult(Control). The site of bone tumor was the distal femur (Group 1) in six patients and proximal tibia (Group 2) in 4 patients. The follow-up period ranged from 15 to 82 months (mean : 33 months). The evaluation consisted of clinical assessment, radiographic assessment, gait analysis using VICON 370 Motion Analysis System. The gait analysis included the linear parameters such as, walking velocity, cadence, step length, stride length, stance time, swing time, single support and double support time and the three-dimensional kinematics (joint rotation angle, velocity of joint rotation) of ankle, knee, hip and pelvis in sagittal, coronal and transverse plane. For the kinetic evaluation, the moment of force (unit: Nm/kg) and power (unit: Watt/kg) of ankle, knee and hip joint in sagittal, coronal and transverse plane. In the linear parameters, cadence, velocity, step time and single support were decreased in both group 1 and group 2 compared with control. Double support decreased in group 2 compared with control significantly(p<.05). In contrast to our hypothesis, there was no significant difference between group 1 and group 2. In Kinematics, we observed significant difference (p<.05) of decreased knee flexion in loading response (G2

• 한국임상수의학회지
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• 제31권2호
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• pp.125-128
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• 2014

38 kg, 7년령의 골든리트리버가 대퇴관절 탈구증으로 의뢰되었다. 신체검사에서는 왼쪽 뒷다리를 신전시킬 때 통증과 염발음이 확인되었다. 방사선 검사를 통해 왼쪽 대퇴관절 탈구증 및 경도의 퇴행성 골변화가 관찰되었다. 치료로서 TightRope$^{(R)}$를 이용한 최소침습 관절경적 정복을 하였으나, 수술 후 한달이 지나 재탈구가 발생하였다. 이에 대해 무시멘트형 대퇴관절 전치환술을 실시하였다. 수술 후 10개월 경과된 결과, 환자는 정상적으로 앉기, 서기, 보행을 보였으며, 특이한 파행없이 편안하게 뛸 수 있었다. 수술한 뒷다리의 허벅지둘레는 반대쪽 다리의 그것에 비해 108.6%였다. 이 증례를 통해 대퇴관절 전치환술은 대퇴관절 정복이 실패하여 재탈구된 개의 대퇴관절 탈구 치료에 효과적인 수술법이 될 수 있다.

• 대한정형도수물리치료학회지
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• 제16권1호
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• pp.1-8
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• 2010

Purpose : This study aimed to examine the relationships among five clinical measures for functional alignment of the lower extremity. Methods : Thirty healthy subjects (15 males and 15 females) were recruited for the study. The five clinical measures of functional alignment of the lower extremity included navicular drop, quadriceps angle, internal rotation of hip, and anterior and lateral pelvic tilt angles. The level of navicular drop was calculated by the difference between the height of the navicular bone in the sitting (non-weight bearing) and standing (weight bearing) positions. The quadriceps angle and internal rotation of hip were measured using a standard goniometer with photographic markers while the subjects were lying in a prone position on a table with their knee at $90^{\circ}$ flexion. Anterior and lateral pelvic tilt angles were determined using a inclinometer. Results : Correlation and a simple linear regression analysis were used to assess relationships between the clinical measures. There were significant correlations between navicular drop and quadriceps angle (p<.05), between navicular drop and internal rotation of hip (p<.05), and between quadriceps angle and internal rotation of hip (p<.01). In simple linear regression analysis, the navicular drop appeared to be a factor affecting the quadriceps angle and internal rotation of hip (p<.05). The findings suggest that navicular drop has a great impact on lower extremity alignment. Conclusion : This study might help us to examine lower extremity function and clarify its role as a potential injury risk factor.

• Hip & pelvis
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• 제36권1호
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• pp.12-25
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• 2024

Protrusio acetabuli, or abnormal protrusion of the femoral head into the acetabulum, requires performance of a total hip arthroplasty (THA) for which various reconstruction techniques and outcomes have been described. The aim of this systematic review is to provide a comprehensive analysis of the current evidence, evaluate treatment efficacy, compare surgical techniques, and identify topics for future research along with improving evidence-based decision-making, improving patient outcomes in the management of this condition. A thorough systematic review of the PubMed, Embase, Cochrane Library databases, and Scopus library was conducted, and articles describing techniques of THA for treatment of protrusion acetabuli were extracted. The initial search generated 751 results. After exclusion, 18 articles were included. Of these, eight were prospective studies and 10 were retrospective. Surgery was performed on 783 hips with a mean age of 60 years; 80% of females who mostly had inflammatory arthritis were followed up for 8.86 years (range, 2-15.4 years). Good outcomes have been achieved with THA using uncemented cups with bone graft; however, no conclusion could be drawn with regard to the femoral side. It can be concluded that the concept of restoration of the anatomical hip center of rotation is paramount for good outcome and better survival of the implant is important when using uncemented cups with a bone graft. In addition, screw augmentation for fixation is not recommended unless absolutely necessary. The most common complications were aseptic loosening and heterotopic ossification. While the former required revision, conservative management was administered for the latter.