• The Journal of the Korea Contents Association
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• v.12 no.12
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• pp.335-344
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• 2012

Osteoporosis is increasing in Korea as it becomes an aging society with the rapid economic growth and the development of medical technology. Osteoporosis also develops due to chemo and radiation therapy of cancer which also increases owing to Westernized diet. Osteoporosis is caused by reduced bone density, has close relationship with the change of geometry of proximal femur, which is a factor of hip fracture risk. The purpose of this study was the analysis of the correlations of osteoporosis and the change of geometry of proximal femur, which was observed according to T-score variance. The 350 male and female patients are chosen from D hospital in Busan, who were classified by age, sex and T-score values (normal, osteopenia, and osteo porosis). The results show that the age and gender have significant difference in the incidence of osteoporosis; the disease classification according to T-score value has significant difference in the geometry of the proximal femur such as Cortical ratio calcar, Cortical ratio shaft, Hip/shaft Angle, Strength index, Section modulus, CSMI, and CSA, and is highly correlated with the incidence of osteoporosis. Therefore, the findings of this research is that the change of the geometry of the proximal femur could be used as an indicator in the diagnosis of osteoporosis, could enhance the accuracy of the diagnosis in the future, and could be used as a clinical predictive factors through the analysis of the correlations of T-score variance and the geometry changes of the proximal femur.

• Journal of Veterinary Clinics
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• v.31 no.6
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• pp.523-526
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• 2014

Three dogs were admitted for repair of bone fracture. Case 1 (Maltese, 1.8 kg, intact female, 5-month-old) and case 2 (poodle, 3.0 kg, intact female, 6-month-old) had non-weight bearing lameness in the left pelvic limb, and case 3 (mixed, 3.3 kg, intact female, age unknown) had non-weight-bearing lameness in the left thoracic limb. On orthopedic examination, there was pain, crepitus, palpable instability and substantial soft tissue swelling on the affected side. No neurological deficits were identified. Radiographs revealed left proximal metaphyseal tibial and fibular fractures in cases 1 and 2, and left proximal metaphyseal radial and ulnar fractures in case 3. All cases had closed long-bone fractures with short juxta-articular fracture segments. Under fluoroscopic guidance, proper placement of the ring fixation elements was confirmed during surgery. Two or three rings were used to stabilize fractures with traditional circular external skeletal fixators (CESF). Postoperative radiographs showed acceptable alignment and apposition of the previously identified fracture. Time to radiographic union ranged from 5 to 14 weeks and there were no signs of implant failure or pin tract infection. Functional outcomes were excellent in all cases. CESF can be successfully used to reduce short juxta-articular fractures in which bone plates or external skeletal fixation cannot be applied.

• The Journal of the Korean bone and joint tumor society
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• v.13 no.1
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• pp.48-54
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• 2007

Purpose: To evaluate clinical results of the tumor prosthetic replacement for pathologic fracture of the proximal femur with extensive bony destruction due to metastatic bone tumors. Materials and Methods: From 2005 October to 2006 October, resection of proximal femur and tumor prosthesis replacement was performed for metastatic bone tumors extensively involving trochanteric area in 6 patients. The mean age of overall patients was 61(range, 48~77). Mean clinical follow up was 10.5 months (range, 6~16). Primary tumor consisted with multiple myeloma in 2 patients, lung cancer in 1, breast cancer in 1, transitional cell carcinoma of the renal pelvis in 1, unknown origin in 1 patient. $MUTARS^{(R)}$ proximal femur (Implantcast, Munster, Germany) were used in all cases. The functional evaluation in the lower extremities was performed with Musculoskeletal Tumor Society 1993 scores. The degree of pain relief after surgical treatment was assessed with Visual Analogue Scale (VAS). Results: At the final follow up, all of the patients survived. The mean lower extremities functional score of Musculoskeletal Tumor Society 1993 was 17.8(59.3%)(range, 12~25). VAS was improved to 2.5 from 8.5 after the surgical treatment. Ambulation was encouraged as soon as possible and mean duration after surgery for ambulation was 7.3(range, 3~16) days. Post-operatively, there was no surgical infection, periprosthetic fracture or loosening. Dislocation occurred in one out of six cases. Conclusion: Resection of proximal femur and tumor prosthesis replacement for metastatic bone tumors around proximal femur extensively involving trochanteric area seems to be safe procedure in view of post-operative complication, and effective for functional restoration as well as pain relief. Thus, it is accordant to the treatment principle of the metastatic bone tumors.

• Journal of Yeungnam Medical Science
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• v.4 no.2
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• pp.131-138
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• 1987

In 1814, Giovanni Battista Monteggia first described two cases of fracture of proximal third of ulna with a dislocation of radial head, and this combined injury is now known as the Monteggia fracture. Despite its rarity, the importance of early recognition of dislocated radial head and correct treatment bas been emphasized. Eight cases of Monteggia fracture were studied from March, 1984 to June, 1987. The results are as follows 1. Male patients were six and female were two. 2. The frequent cause of injury was fall down in four cases. 3. Bado type I accounted for 50%, type II for 12.5% and type III for 37.5%. 4. The level of ulna fracture was above upper one third of ulna in seven. 5. The common direction of dislocated radial head was anterior. 6. Two children and two adults were managed by closed reduction. Four ulna fractures in adult were treated by open reduction and internal fixation using a semitubular plate. 7. The results (by Bruce et al. criteria) were 3 excellent, 2 good, 1 fair and 2 poor.

• Clinics in Shoulder and Elbow
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• v.22 no.2
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• pp.87-92
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• 2019

Background: This study was conducted to compare the radiological and clinical outcomes of internal fixation using a Polarus humeral nail for treatment of a humeral shaft fracture according to fracture types. Methods: From 43 patients, 13 were excluded and 30 patients were included. The 30 patients were divided into 2 groups: 15 in group I (Orthopaedic Trauma Association/Arbeitsgemeinschaft $f{\ddot{u}}r$ Osteosynthesefragen classification type A and B) and 15 in group II (type C). The mean age was 63.1 years (range, 20-87 years), and mean follow-up period was 2.3 years (range, 1.0-6.1 years). The causes of injuries were as follows: 12, traffic accidents; 14, simple slips; 2, simple falls; 2, contusions after lower energy trauma. Radiological and clinical evaluations were performed. Results: Radiological union was confirmed by plain anteroposterior and lateral radiographs on average of 5.0 months in group I, and 8.4 months in group II, respectively. Differences between the two groups were statistically significant (p<0.01). The clinical union value was 1.6 in group I, and 2.0 months in group II, but these values did not differ significantly (p=0.441). The mean Korean shoulder scoring system scores were 89.7 and 90.6, which did not differ significantly (p=0.352). Conclusions: Intramedullary nailing using the Polarus humeral nail is considered to be a good treatment modality for all types of humeral shaft fractures. Additionally, the Polarus humeral nail can be an optimal choice for the treatment of complex type fractures such as segmental or comminuted humeral shaft fractures.

• Proceedings of the KOSOMBE Conference
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• v.1997 no.11
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• pp.263-266
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• 1997

Three dimensional numerical model based on the finite element method(FEM) were developed to predict the mechanical behavior of hip implants. The purpose of this study is to investigate the stress distribution of two types of cementless total hip replacement femoral component -a straight stem and a curved stem, and to compare their effect on the stress shielding between two types by three dimensional finite element method. The authors analyzed von Mises stress in the cortex & stem and compared the stress between the straight and the curved stem. In comparison of stresses between two different design of femoral stem, there was 25% more decrease of stress in straight stem than curved stem in the medial cortex at proximal region. The straight stem had consistently much lower stresses than the curved stem throughout the whole medial cortex with maximum 70% reduction of stress. However, there was little change in stress between nature and 2 implanted femur throughout the lateral cortex. Stress of femoral stem was much higher in the straight stem than the curved stem up to 60%. The straight stem had more chance of stress shielding and a risk of fatigue fracture of the stem compared with the curved stem in noncement hip arthroplasty. In design of femoral stem still we have to consider to develop design to distribute more even stress on the proximal medial cortex.

• Journal of the Korean Orthopaedic Association
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• v.56 no.3
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• pp.215-223
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• 2021

Purpose: Distal radius fractures in youth are treated conservatively in most cases, but there are some cases of redisplacement in the follow-up period after cast immobilization, even after complete reduction. This study examined the risk factors of redisplacement in reduced unstable distal radius fractures. Materials and Methods: From February 2011 to June 2018, 44 unstable distal radius fractures were managed with a closed reduction and cast immobilization. The patients were aged between 6 and 14 years. The cases of redisplacement were analyzed with the fracture characteristics (fracture obliquity, fracture level ratio, ulnar fracture combined), cast qualities (gap index, cast index, 3 point index, and radius-2nd metacarpal angle) and host factors (age, sex). Results: The mean angulation in the union was 9.2° (0°-32.8°). In the categorical grouping 29 cases were within 10° angulation, and 15 cases were more than 10°. No significant differences in the factors of the cast indices or host factors were noted. The meaningful factor was the fracture level calculated by the relative width of the fracture site divided by the sum of width of diaphysis and epiphysis (p=0.001) and combined ulnar fracture (p=0.019). Conclusion: Unstable distal radius fractures should be treated with more stubborn guidelines lest the fracture loses its anatomical alignment. In particular, in patients with less remodeling power, operative treatment would secure a better result if the fracture occurs in a more proximal location.

• Molecules and Cells
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• v.23 no.2
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• pp.246-251
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• 2007

Osteoporosis is a common metabolic bone disease characterized by low bone mineral density (BMD) with an increased risk of fracture. Low bone mass results from an imbalance between bone formation by osteoblasts and bone resorption by osteoclasts. Microphthalmia-associated transcription factor (MITF) plays a critical role in osteoclast development and thus is an important candidate gene affecting bone turnover and BMD. In order to investigate the genetic effects of MITF variations on osteoporosis, we directly sequenced the MITF gene in 24 Koreans, and identified fifteen sequence variants. Two polymorphisms (+227719C > T and +228953A > G) were selected based on their allele frequencies, and then genotyped in a larger number of postmenopausal women (n = 560). Areal BMD ($g/cm^2$) of the anterior-posterior lumbar spine and the non-dominant proximal femur was measured by dual-energy X-ray absorptiometry. We found that the MITF + 227719C > T polymorphism was significantly associated with low BMD of the trochanter (p = 0.005-0.006) and total femur (p = 0.02-0.03) (codominant and dominant models), while there was no association with BMD of the lumbar spine. The MITF+228953A > G polymorphism was also associated with low BMD of the femoral shaft (p = 0.05) in the recessive model. Haplotype analysis showed that haplotype 3 of the MITF gene (MITF-ht3) was associated with low BMD of the trochanter (p = 0.03-0.05) and total femur (p = 0.05) (dominant and codominant models). Our results suggest that MITF variants may play a role in the decreased BMD of the proximal femur in postmenopausal women.

• Clinics in Shoulder and Elbow
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• v.22 no.1
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• pp.29-36
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• 2019

Background: The execution of fibular allograft augmentation in unstable proximal humerus fractures (PHFs) was technically demanding. In this study, the authors evaluated the clinical and radiographic outcomes after tricortical iliac allograft (TIA) augmentation in PHFs. Methods: We retrospectively assessed 38 PHF patients treated with locking-plate fixation and TIA augmentation. Insertion of a TIA was indicated when an unstable PHF showed a large cavitary defect and poor medial column support after open reduction, regardless of the presence of medial cortical comminution in preoperative images. Radiographic imaging parameters (humeral head height, HHH; humeral neck-shaft angle, HNSA; head mediolateral offset, HMLO; and status of the union), Constant score, and range of motion were evaluated. Patients were grouped according to whether the medial column support after open reduction was poor or not (groups A and B, respectively); clinical outcomes were compared for all parameters. Results: All fractures healed radiologically (average duration to complete union, 5.8 months). At final evaluation, the average Constant score was 73 points and the mean active forward flexion was $148^{\circ}$. Based on the Paavolainen assessment method, 33 patients had good results and 5 patients showed fair results. The mean loss of reduction was 1.32 mm in HHH and 5.02% in HMLO. None of the parameters evaluated showed a statistically significant difference between the two groups (poor and not poor medial column support). Conclusions: In unstable PHFs, TIA augmentation can provide good clinical and radiological results when there are poor medial column support and a large cavitary defect after open reduction.

• Archives of Plastic Surgery
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• v.48 no.1
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• pp.98-106
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• 2021

Background Hand fractures can be treated using various operative or nonoperative methods. When an operative technique utilizing fixation is performed, early postoperative mobilization has been advocated. We implemented a protocol involving controlled active exercise in the early postoperative period and analyzed the outcomes. Methods Patients who were diagnosed with proximal phalangeal or metacarpal fractures of the second to fifth digits were included (n=37). Minimally invasive open reduction and internal fixation procedures were performed. At 3 weeks postoperatively, controlled active exercise was initiated, with stress applied against the direction of axial loading. The exercise involved pain-free active traction in three positions (supination, neutral, and pronation) between 3 and 5 weeks postoperatively. Postoperative radiographs and range of motion (ROM) in the interphalangeal and metacarpophalangeal joints were analyzed. Results Significant improvements in ROM were found between 6 and 12 weeks for both proximal phalangeal and metacarpal fractures (P<0.05). At 12 weeks, 26 patients achieved a total ROM of more than 230° in the affected finger. Postoperative radiographic images demonstrated union of the affected proximal phalangeal and metacarpal bones at a 20-week postoperative follow-up. Conclusions Minimally invasive open reduction and internal fixation minimized periosteal and peritendinous dissection in hand fractures. Controlled active exercise utilizing pain-free active traction in three different positions resulted in early functional exercise with an acceptable ROM.