• Hip & pelvis
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• 제34권2호
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• pp.79-86
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• 2022

Purpose: The purpose of this study was to determine whether the direct anterior approach (DAA) can be applied to hemiarthroplasty for treatment of unstable femoral intertrochanteric fractures in elderly patients. Materials and Methods: We conducted a retrospective review of 34 cases (34 patients) who underwent bipolar hemiarthroplasty using a DAA from February 2019 to April 2020. The mean age of the patients was 82.68 years (range, 67-95 years). A cementless distal fixation hip system was used in all cases. Operation time, total amount of blood loss, intraoperative and postoperative fractures, infections, and reoperations were measured. The patients performed weight-bearing walking as tolerated immediately after surgery. Measurement of migration of the greater trochanter (GT) and progressive subsidence of the femoral stem was performed using follow-up radiographs. Results: The mean operative time was 83.50 minutes (range, 60-120 minutes). The mean amount of bleeding was 263.53 mL (range, 112-464 mL). Walking started a mean of 3.03 days (range, 3-4 days) after surgery. There was no case of progressive migration of the GT more than 5 mm even though it was not fixed. There were no cases of infection, dislocation, or reoperation. Conclusion: Bipolar hemiarthroplasty using the DAA for treatment of unstable femoral intertrochanteric fractures could be considered a useful option that provides many advantages in elderly patients.

• Hip & pelvis
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• 제30권4호
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• pp.269-275
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• 2018

Purpose: The purpose of this study is to describe a method of inserting cement in the femoral head before fixation with dynamic hip screw to prevent screw cut out due to osteoporosis and to evaluate its clinical outcome in these patients. Materials and Methods: In this prospective study, 30 patients aged 60 years and older with intertrochanteric fracture were included. Bone mineral density was measured. After reaming of the femoral head and neck with a triple reamer and polymethyl methacrylate, bone cement was introduced into the femoral head using a customized nozzle and a barrel fitted on a cement gun. A Richard screw was inserted and the plate was fixed over the femoral shaft. Patients were mobilized and clinical outcomes were rated using the Salvati and Wilson's scoring system. Results: More patients included in this study were between 66 and 70 years old than any other age group. The most common fracture according to the Orthopaedic Trauma Association classification was type 31A2.2 (46.7%). The T-score was found to be $-2.506{\pm}0.22$ (mean${\pm}$standard deviation); all patients were within the range of -2.0 to -2.8. The duration of radiological union was $13.67{\pm}1.77$ weeks. Salvati and Wilson's scoring at 12 months of follow up was $30.96{\pm}4.97$. The majority of patients were able to perform their normal routine activities; none experienced implant failure or screw cut out. Conclusion: Bone cement augmentation may effectively prevent osteoporosis-related hardware complications like screw cut out in elderly patients experiencing intertrochanteric fractures.

• 대한정형외과학회지
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• 제55권3호
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• pp.193-199
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• 2020

골수강 내 금속정(골수정)은 1988년부터 대퇴골 전자간 골절을 치료하는 데 사용되어 왔다. 골수정은 활강고나사와 같은 골수강 외 고정 장치에 비하여 기계적 이점이 있으나 대퇴 전자간 골절 Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) 31-A1 및 31-A2 골절 치료에 활강고나사보다 유리한 고정 기구인지에 대해서는 논란이 계속되고 있다. 지난 30년 동안 여러 시행 착오가 극복되었고 새로운 유형의 대퇴 골수정이 개발되어 임상에서 사용되고 있다. 새로 개발된 골수정은 삽입 과정이 쉬워지고 지연나사를 사용한 대퇴 골두의 고정 능력이 향상되어 왔다. 그러나 고정 실패율은 여전히 정형외과 의사의 수술 술기에 달려 있다고 할 수 있다. 이 종설에서 우리는 골수정을 이용하여 대퇴 전자간 골절을 치료하는 동안 내측 지지대 복원의 중요성에 대해 초점을 맞추고 그 기본 원칙에 대하여 논의해 보고자 한다.

• Hip & pelvis
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• 제30권4호
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• pp.254-259
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• 2018

Purpose: Internal fixation using compression hip screws (CHS) and traction tables placing patients in the supine position is a gold standard option for treating intertrochanteric fractures; however, at our institution, we approach this treatment with patients in a lateral decubitus position. Here, the results of 100 consecutive elderly (i.e., ${\geq}45$ years of age) patients who underwent internal fixation with CHS in lateral decubitus position are analyzed. Materials and Methods: Between March 2009 and May 2011, 100 consecutive elderly patients who underwent internal fixation with CHS for femoral intertrochanteric fracture were retrospectively reviewed. Clinical outcomes (i.e., Koval score, Harris hip score [HHS]) and radiographic outcomes (i.e., bone union time, amount of sliding of lag screw, tip-apex distance [TAD]) were evaluated. Results: Clinical assessments revealed that the average postoperative Koval score decreased from 1.4 to 2.6 (range, 0-5; P<0.05); HHS was 85 (range, 72-90); and mean bone union time was 5.0 (range, 2.0-8.2) months. Radiographic assessments revealed that anteroposterior average TAD was 6.95 (range, 1.27-14.63) mm; lateral average TAD was 7.26 (range, 1.20-18.43) mm; total average TAD was 14.21 (range, 2.47-28.66) mm; average lag screw sliding was 4.63 (range, 0-44.81) mm; and average angulation was varus $0.72^{\circ}$(range, $-7.6^{\circ}-12.7^{\circ}$). There were no cases of screw tip migration or nonunion, however, there were four cases of excessive screw sliding and six cases of varus angulation at more than $5^{\circ}$. Conclusion: CHS fixation in lateral decubitus position provides favorable clinical and radiological outcomes. This technique is advisable for regular CHS fixation of intertrochanteric fractures.

• Investigative Magnetic Resonance Imaging
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• 제21권3호
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• pp.177-182
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• 2017

Schwannomas are benign nerve sheath tumors that are typically located in soft tissue. Occasionally, schwannomas involve osseous structures. These intraosseous schwannomas are generally benign neoplasms that account for less than 0.2% of primary bone tumors. Schwannomas are very rarely observed in long bones. We present a case of a schwannoma affecting the proximal femur with a coincident subchondral fracture of the femoral head. A 38-year-old-male presented with left hip pain without deteriorating locomotor function. Plain film radiographs displayed a lobulating contoured lesion within the intertrochanteric portion of the femur. The magnetic resonance imaging (MRI) scans showed a tumor occupying the intertrochanteric region. Diffuse bone marrow edema, especially in the subchondral and head portions of the femur that was possibly due to the subchondral insufficiency fracture was also noted. The lesion was surgically excised and bone grafting was performed. Histologically, there was diffuse infiltrative growth of the elongated, wavy, and tapered cells with collagen fibers, which are findings that are characteristic of intraosseous schwannoma. Although very rare, intraosseous schwannoma should be included in the differential diagnosis of radiographically benign-appearing, non-aggressive lesions arising in the femur. The concomitant subchondral fracture of the femoral head confounded the correct diagnosis of intraosseous schwannoma in this case.

• 대한정형외과학회지
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• 제52권1호
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• pp.25-32
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• 2017

목적: 고령 환자에서 발생한 불안정성 대퇴골 전자간부 골절의 치료 시 골수강내 금속정의 길이에 따른 방사선적, 임상적 치료 결과를 비교 분석하고자 한다. 대상 및 방법: 2009년 8월부터 2014년 12월까지 방사선 영상상 AO/OTA 분류 31-A2 대퇴골 전자간부 골절로 진단되어 골수강 내 금속정을 이용한 내고정을 시행한 뒤 최소 1년 이상 추시가 가능하였던 65세 이상의 환자 139예를 대상으로 후향적 대조군 연구를 시행하였다. 대상군을 짧은 골수정(I군)과 긴 골수정(II군)을 사용한 군으로 분류하였으며 각각 106예, 33예로 조사되었다. 방사선적인 평가로 골절의 정복 정도, 골유합까지의 기간, 합병증 발생을 조사하였으며 수술 전 혈색소, 수술 시간, 수술 중 출혈량, 수혈 유무, 입원 기간 및 최종 추시 시 Charnley 고관절 점수를 통한 임상적 평가를 시행하였다. 결과: 수술 후 단순 방사선 검사상 전 예에서 good 또는 acceptable한 정복 상태를 얻었다. 골유합까지 평균 4.8개월이 걸렸으며 두 군 간의 차이는 없었다. II군(57.87분)이 I군(45.65분)보다 수술 시간이 길었던 것으로 확인되었다(p=0.003). 수술 중 출혈량의 경우 II군(288.78 ml)이 I군(209.90 ml)보다 많은 것으로 확인되었다(p=0.046). 최종 추시 시 임상적 결과는 두 군 모두 만족스러웠다. 결론: 고령의 환자에서 발생한 후내측 골편을 동반한 불안정성 대퇴골 전자간부 골절의 치료 시 골절 부위의 정복을 잘 시행한 경우 긴 골수정과 짧은 골수정 모두 만족스러운 방사선적, 임상적 결과를 보였다.

• Hip & pelvis
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• 제35권3호
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• pp.175-182
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• 2023

Purpose: This study aims to compare patients in whom fixation failure occurred via cut-out (CO) or cut-through (CT) in order to determine patient factors and radiographic parameters that may be predictive of each mechanism. Materials and Methods: This retrospective cohort study includes 18 patients with intertrochanteric (IT) hip fractures (AO/OTA classification 31A1.3) who underwent treatment using a single lag screw design intramedullary nail in whom fixation failure occurred within one year. All patients were reviewed for demographics and radiographic parameters including tip-to-apex distance (TAD), posteromedial calcar continuity, neck-shaft angle, lateral wall thickness, and others. Patients were grouped into cohorts based on the mechanism of failure, either lag screw CO or CT, and a comparison was performed. Results: No differences in demographics, injury details, fracture classifications, or radiographic parameters were observed between CO/CT cohorts. Of note, a similar rate of post-reduction TAD>25 mm (P=0.936) was observed between groups. A higher rate of DEXA (dual energy X-ray absorptiometry) confirmed osteoporosis (25.0% vs. 60.0%) was observed in the CT group, but without significance. Conclusion: The mechanism of CT failure during intramedullary nail fixation of an IT fracture did not show an association with clinical data including patient demographics, reduction accuracy, or radiographic parameters. As reported in previous biomechanical studies, the main predictive factor for patients in whom early failure might occur via the CT effect mechanism may be related to bone quality; however, conduct of larger studies will be required in order to determine whether there is a difference in bone quality.

• Journal of Trauma and Injury
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• 제26권3호
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• pp.125-130
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• 2013

Purpose: This study was undertaken in order to identify the characteristics of patients diagnosed with occult an hip fracture after hip trauma. Methods: We retrospectively reviewed the medical records and radiology reports of all patients who underwent hip skeletal computed tomography (CT) for suspected hip fractures but had normal initial X-rays after hip trauma between August 2006 and January 2012. The variables evaluated included age, gender, body mass index (BMI), accident mechanism, previous fracture, independence, late presentation, ability to bear weight, pain on passive rotation, tenderness of the groin area, diagnosis and treatment. Patients were divided into two groups, with hip fracture (occult hip fracture group) and without hip fracture (no fracture group) to evaluate the characteristics associated with an occult hip fracture. Results: The patients, a total of 139, had a mean age of 58.3 years and included 72 male patients(51.8%). The occult hip fracture group included 43 patients(30.9%). Of those 43, 21 patients(48.8%) had intertrochanteric or trochanteric fractures, 8 patients(18.6%) had femur neck fractures and 14 patients(32.6%) had acetabular fractures. Of the 43, 15 patients(34.9%) needed operative treatment. Age was higher in the occult hip fracture group than it was in the no fracture group($64.4{\pm}19.1$ years vs. $55.5{\pm}23.6$ years, p=0.021). A previous fracture was associated with the presence of a new fracture (p=0.014; OR=3.971, 95% CI=1.314-11.997). Conclusion: Further evaluation of patients who are older or have history of fractures is prudent, even though the initial X-rays are normal.

• 대한정형외과학회지
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• 제55권3호
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• pp.237-243
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• 2020

목적: 고령 여성에서 대퇴부에 발생한 골다공증과 동반된 전자간 골절에서 수술 후에 부갑상선 호르몬 제제 투여 후 골절 치유에 대한 영향을 알아보고자 하였다. 대상 및 방법: 2013년 7월부터 2017년 12월까지 대퇴부 전자간 골절 및 골다공증을 진단 받은 후 수술을 시행한 65세 이상의 여자 환자에서 부갑상선 호르몬 제제를 투여한 군과 투여하지 않은 군을 대상으로 최초 가골의 형성 시기, 가골교로의 진행 시기 및 골유합 진행 시기를 조사하였다. 결과: 부갑상선 호르몬 투여군에서 최초 가골의 형성은 평균 32일, 가골교로의 진행은 평균 58일, 골유합이 된 시기는 평균 83일로 투약을 하지 않은 군에 비하여 통계적으로 의미 있게 기간이 단축된 소견을 보였다. 결론: 골다공증 치료제인 부갑상선 호르몬 제제는 고령의 여성에서 골다공증이 동반된 전자간 골절에서 가골의 형성 및 치유 과정을 촉진시킨다. 따라서 수술 후 이의 투여가 도움이 될 거라 생각된다.

• Journal of Yeungnam Medical Science
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• 제40권2호
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• pp.212-217
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• 2023

We report a case of transient osteoporosis of the hip with a femoral neck fracture found during follow-up. A 53-year-old man presented with left hip pain without trauma. The pain did not improve after 2 weeks and he was brought to our hospital by ambulance. Magnetic resonance imaging (MRI) of the left hip joint showed diffuse edema in the bone marrow, which was identified by low signal intensity on T1-weighted images, high signal intensity on T2-weighted images, and increased signal intensity on short tau inversion recovery. This edema extended from the femoral head and neck to the intertrochanteric area. He was diagnosed with transient osteoporosis of the left hip. Rest gradually improved his pain; however, 3 weeks later, his left hip pain worsened without trauma. X-ray, computed tomography, and MRI results of the hip joint demonstrated a left femoral neck fracture, and osteosynthesis was performed. Differential diagnoses included avascular necrosis of the femoral head, infection, complex regional pain syndrome, rheumatoid arthritis, leukemia, and other cancers. Transient osteoporosis of the hip generally has a good prognosis with spontaneous remission within a few months to 1 year. However, a sufficient length of follow-up from condition onset to full recovery is necessary to avoid all probable complications such as fractures.