장기간 비스포스포네이트 복용 환자에서동시에 발생한 양측성 대퇴 경부 부전 골절 - 증례 보고 -

신성기,류형곤,신대원,한범수 대한골절학회 2022 대한골절학회지 Vol.35 No.3

Bisphosphonate is used widely for osteoporosis management. On the other hand, some studies have reported that prolonged use of bisphosphonate without a proper resting period can cause insufficiency fracture and, in rare cases, fractures on the femur neck. This paper reports a case of an elderly patient who suffered bilateral femur neck insufficiency fractures induced by non-stopped long-term bisphosphonate therapy. The patient complained of pain in her buttocks at the first visit. During the admission period, inguinal area pain newly developed. Both a femur neck insufficiency fracture was observed on the hip radiographic image. Hip pinning and postoperative parathyroid hormone treatment were performed. The patient was discharged without specific complications and reported improvement in symptoms on the last follow-up. Several authors have reported one-sided femoral neck insufficiency fractures due to bisphosphonate use, but the present case is uncommon in that it occurred simultaneously in both femur necks. In addition, in the case of bilateral femur fractures, the walking ability after surgery is lower than that of one-sided fracture cases, so active rehabilitation is necessary. 비스포스포네이트는 대표적인 골다공증 치료 약물이다. 최근 연구 결과에 따르면, 비스포스포네이트 장기간 복용은부전 골절의 발생률을 증가시키고 드물게 대퇴 경부 골절을일으킨다. 본 증례는 장기간 비스포스포네이트를 복용한 환자에게 동시에 발생한 양측성 대퇴 경부 부전 골절 증례이다. 환자는 둔부 통증을 주소로 내원하였고 입원 중 양측 서혜부 통증이 추가 발생하여 시행한 방사선학적 검사상 양측성 대퇴 경부 부전 골절이 진단되어 양측 대퇴 경부 핀 고정술을시행하였으며, 술 후 부갑상선 호르몬 제제를 투여하였다. 퇴원 후 추시 결과 증상 호전되었다. 장기간 비스포스포네이트복용 환자의 편측성 대퇴 경부 부전 골절 증례는 보고된 바있으나, 본 증례는 양측성으로 동시에 발생하였다는 점에서흔하지 않은 증례이며, 편측성 골절 환자보다 추후 보행능력등이 저하될 가능성이 크므로 적극적인 재활이 필요하다.

Development of a Femur Neck Bone Mineral Density Measuring Device for Accurate Examination

Man-Seok Han,Sun-youl Seo,Yong-Kyun Kim,Min-Cheol Jeon,Hyun-kuk Lee,Se-Jong Yoo 한국자기학회 2016 Journal of Magnetics Vol.21 No.2

In bone density examinations, a change in the measured BMD occurs owing to the differences between the measured areas. To address this problem, we aimed to develop a new auxiliary device that could be rotated by 15o by fixing the ankle to the distal femur neck. Dual energy X-ray absorptiometry (DXA) of BMD examinations were performed once a year, but 10 patients were examined over three sessions to analyze the area for measuring the femur neck BMD. The goal of this test was to determine the device’s reliability, and the results were expressed in terms of the standard deviation of measurements. After performing bone density measurements using the new auxiliary device on 10 normal patients, with three measurements for each patient, the obtained standard deviation was 0.03. The standard deviation of the measured BMD was 0.19 when using the currently existing auxiliary device, while the standard deviation of the measured BMD was 0.03 when using the new auxiliary device. By using the new auxiliary device, the standard deviation could be reduced by ~80%. Accurate rotation of the femur neck was possible in all examinations, and the standard deviation of BMD measurements could be reduced by up to 80% compared with the measurements performed using the currently existing auxiliary device. We hope that this advantageous new design can be used as a standard auxiliary device for measuring the femur neck BMD.

Insufficiency Fracture of Ipsilateral Femur Neck in Patient Treated with Long Term Bisphosphonate Treatment - A Case Report -

김도훈,이의철,강석권 대한골대사학회 2012 대한골대사학회지 Vol.19 No.2

Bisphosphonate is notable for the treatment of osteoporosis in the world. But recently if Bisphosphonate is taken for a long time, it causes an insufficiency fracture by suppression of bone turn-over and it is reported rarely on femur neck. Here we report a case of insufficiency fracture on ipsilateral femur neck in woman treated with long term Bisphosphonate therapy.

파라메트릭 형상모델을 이용한 근위 대퇴골의 경부 골절 영향 해석

이호상(Ho-Sang Lee),박병건(Byoung-Keon Park),채제욱(Je-Wook Chae),김재정(Jay-Jung Kim) 한국비파괴검사학회 2011 한국비파괴검사학회지 Vol.31 No.5

대퇴골 근위부의 기하학적 형상은 대퇴골 경부 골절과 중요한 상관관계를 가지고 있는 것으로 보고되고 있다. 기존의 연구에서는 인장실험법과 유한요소해석법을 이용하여 상관관계를 분석해왔다. 그러나 이 방법들은 인체의 미리 정의된 대퇴골 형상을 변경할 수 없고, 다수의 시험편들을 확보하기 어렵기 때문에 다양한 시험편과 모델을 적용할 수 없다는 한계가 있다. 따라서 본 연구에서는 대퇴골 골절 해석에 폭넓게 사용할 수 있도록 매개변수로 기하학적 형상 변형이 가능한 대퇴골 모델을 이용하여 대퇴골 골절과 형상매개변수의 관계를 분석하였다. 이 관계를 분석하기 위하여 4가지 주요 매개변수(대퇴골두 직경, 대퇴경부직경, 대퇴경두간 길이, 대퇴경간각)를 이용하여 다양한 해석 모델을 생성하여 유한요소해석을 수행하였다. 이 후 대퇴골두에서의 반력(reaction force)과 경부에서의 응력 분포(stress distribution)를 분석함으로써 유한요소해석을 수행하였고, 대퇴경부 직경이 대퇴골 경부 골절에 가장 큰 영향을 미치고 대퇴골두 직경이 가장 작은 영향을 미치는 결과가 나타났다. It has been reported that the femoral morphology has a major correlation to femoral neck fractures(FNF). Previous studies to analyze these correlations have relied on mechanical testing and finite element methods. However, these methods have not been widely applied to various femur samples and models. It is because of the availability of the samples from both patients and cadavers, and also of the geometric limitations in changing the shape of the models. In this study we analyzed femoral neck fractures using a parameterized femoral model that could provide flexibility in changing the geometry of the model for the wide applications of FNF analysis. With the parameterization a variety of models could be generated by changing four major dimensions: femoral head diameter(FHD), femoral neck diameter(FND), femoral neck length(FNL), and neck-shaft angle(NSA). We have performed FEA on the models to compute the stress distributions and reaction forces, and compare them with the data previously generated from mechanical testing. The analysis results indicate that the FND is significantly related with the FNF and the FHD is not significantly related with the FNF.

DR을 이용한 비 외상 환자의 대퇴 경부 측방향 검사 시 최적의 X-선 입사각도 및 환자자세

조민규(Ming-Gyu Jo),오왕균(Wang-Kyun Oh) 대한영상의학기술학회 2016 대한영상의학기술학회 논문지 Vol.2016 No.1

목 적 : 대퇴 경부 손상 환자의 측방향 검사 시 종전의 CR-cassette를 이용한 Hip trans lateral view로 검사할 경우 검사시간과 재검사율의 증가와 Image quality 저하의 문제점이 있었다. 이을 보완하기 위해 DR system을 활용하여 최적의 X-선 입사각도와 환자자세를 연구하여 대체 가능한 검사방법을 찾기 위해 본 연구를 시작하게 되었다. 대상 및 방법 : 연구는 80명의 환자 및 지원자를 대상으로 실시하였다. 실험에 사용한 장비는 Philips사의 digital diagnost를 사용하여 FFD=110cm, X-선 입사 각도는 머리쪽으로 15°에서 10°간격으로 각각 25°, 35°, 45°로 나누어 실험을 실시하였다. 자세는 lateral 상태에서 검사 반대측 무릎을 직각으로 flexion 하여 반대쪽 앞으로 넘겨 검사측 hip joint와 중복을 피하고 검사측하지는 각각 0°, 15°, 30°씩 internal rotation 시켜 실험을 진행 하였다. 실험 결과 얻은 영상은 본원 정형외과 전문의 2명에게 blind test를 통한 5점 척도로 비교 분석하였다. 또한 종전의 CR을 이용한 검사법과 DR을 활용한 검사법의 검사시간 차이를 분석하였고, 검사를 진행하는 방사선사의 만족도를 비교해 보았다. 검사시간 측정은 환자가 검사대에 바로 누운자세에서 시작하여 image confirm 까지 평균시간을 측정하였다. 결 과 : 검사측 하지는 15°내선하고 X-선 입사각도는 머리쪽으로 30°~35°로 하여 검사를 실시했을 때 femoral neck의 왜곡 정도가 기존의 IP를 사용한 검사법과 큰 차이가 나지 않았으며, DR을 활용하여 CASSETTE를 사용했을 때의 화질저하를 개선할 수 있었다. 또한 기존의 CR system에서 IP의 영상을 변환하기까지 검사 시간이 평균 2분 50초인 반면 DR을 활용했을 경우 검사시간을 약 50초대로 크게 단축시킬 수 있었다. 결 론 : Hip joint에 trauma가 없는 환자를 대상으로 Hip trans lateral 검사시 DR을 활용 한다면 환자자세의 안정성과 검사자의 만족도가 향상되었다. 검사시간 단축으로 환자 적체를 해소하여 원활한 검사진행을 할 수 있었다. 재검사율 감소로 인한 방사선피폭을 줄일 수 있었으며, 화질향상 효과를 통하여 임상의의 만족도를 높일 수 있으리라 기대한다. Purpose : In the case of the examination on the lateral side of a patient with damaged femoral neck, hip trans lateral view using conventional CRcassette increases examination time and reexamination rate, and lowers image quality. To solve the problem, this study used DR system to analyze the optimal incident angle of X-ray and patient posture and tried to find an alternative examination method. Materials and Methods : The study subjects were 80 patients and applicants. The equipment used for test was digital diagnost of Philips. Test conditions were FFD=110cm; incident angle of X-ray started at 15°to the head, and then was respectively set to 25°, 35°, and 45°at an interval of 10°. In regard to patient posture, in the lateral side, the other one of the knee to be examined had flexion at a right angle, and then was stretched over to the opposite side in order to avoid overlapping of hip joint to be examined; the lower limb to be examined had internal rotation, respectively by 0°, 15°, and 30°. The test images were applied to blind test of two orthopedists in this hospital, and were compared in the scale of 5 points. In addition, the examination methods using conventional CR and DR were compared in terms of examination time and radiologists satisfaction with examination method. The examination time measurement began when a patient lay down on examination table and ended when image was confirmed. Result : For test, the lower limb to be examined was extended 15°, and the incident angle of X-ray was set to 30°-35°toward the head. In regard to femoral neck distortion, the method using DR had no big difference from the examination method using exiting IP, and improved the lowering image quality which occurred in CASSETTE based examination method. Regarding examination time up to IP image conversion, the examination method using conventional CR system had 2 minutes and 50 seconds on average, whereas the method using DR greatly shortened to around 50 seconds. Conclusion : When DR was used for patients without hip joint trauma in hip trans lateral examination, stability of patient posture and examiner satisfaction were greatly improved. By shortening examination time, it was possible to solve the problem of patients long wait and make examination smoothly. In addition, by reducing re-examination rate, the method helped to reduce radiation exposure. With the effect of image quality improvement, it is expected that the method will improve clinicians satisfaction.

Arthroscopic treatment of intraosseous ganglion-induced femoroacetabular impingement in the femoral neck: a case report

Byung Hoon Lee,Yong-Chan Ha,Sae Hyun Kang,Jin-Kyu Lim 대한정형외과 스포츠의학회 2017 Arthroscopy and Orthopedic Sports Medicine Vol.4 No.2

Intraosseous ganglion is rarely associated with clinical symptoms because instances of extraosseous extensions are rare; the periosteum and the cortex of the bone represent a substantial physical barrier for intraosseous extensions of soft tissue lesions to intrude into bone. However, we observed a case of a symptomatic intraosseous ganglion located in the articular capsule of the hip in the inferomedial femoral neck. A 21-year-old woman complained of persistent mild pain and discomfort in the left groin for 18 months. Further, she complained about involuntary movements such as external rotation of the hip during full flexion and adduction and inability to kneel down, as well as discomfort during exercise such as yoga. Radiography and computed tomography implied the presence of an intraosseous ganglion in the inferomedial femoral neck. Using an image intensifier, we excised the lesion arthroscopically. The patient’s symptoms resolved immediately after surgery. This report describes a case of femoroacetabular impingement caused by an intraosseous ganglion in the femoral neck and evaluates the advantages of arthroscopic procedures for the surgical management of this lesion.

대퇴골 경부 골절의 내고정 방법에 따른 치료 결과의 비교 분석

황성관 ( Sung Kwan Hwang ),유호영 ( Ho Young Ryu ) 대한고관절학회 2008 Hip and Pelvis Vol.20 No.4

목적: 대퇴골 경부 골절에서 압박고 나사와 다발성 유관 나사를 이용한 내고정술 후 안정성, 합병증, 기능 회복 등의 치료 결과를 비교 분석하기 위함이다. 대상 및 방법: 2000년 10월부터 2007년 01월까지 대퇴부 경부 골절 진단 하에 다발성 유관 나사를 이용하여 내고정술을 시행 받은 76명과 압박고 나사를 이용한 내고정술을 시행받은 50명을 대상으로 임상적, 방사선학적 분석을 시행하였다. 예후에 영향을 미치는 요소로서 연령 및 성별, 골절의 원인, 수술시간, 총 실혈량, 손상부터 수술까지의 시간 등을 분석하고, 기능적 회복 정도는 FIMTM 점수를 사용하였으며, 수술 전 방사선 사진상 Garden 분류법에 의한 전위정도, Singh씨 지수, 후방 피질골 분쇄 유무, 수술 후 방사선 사진상 골유합 정도와 함께 합병증의 발생 유무를 관찰하였다. 결과: 연령 및 성별 분포, 손상부터 수술까지의 시간, 골절의 원인 등은 두 군간에 통계학적으로 유의한 차이가 없었으며, 골절의 전위 정도, 술 후 골절 정복의 정확성 및 나사못의 위치, FIM(TM) 점수를 이용한 기능적 회복 정도, 합병증에서는 두 집단간에 통계학적인 차이는 없었으나, 수술시간 및 총실혈량에서는 다발성 유관 나사 고정군에서 통계학적으로 유의하게 낮게 나타났다. 결론: 대퇴골 경부 골절 수술시 출혈량 및 수술시간 단축을 위해서는 다발성 유관나사 고정법이 더 유용할 것으로 사료된다. Purpose: We wanted to compare the stability, the complications and the patients` functional recovery after undergoing internal fixation with dynamic hip screws or cannulated hip screws for treating fracture of the femoral neck. Materials and Methods: Out of one hundred twenty six patients who had fracture of the femoral neck, seventy six patients were treated with cannulated screws and fifty patients were treated with dynamic hip screws from October 2000 to January 2007. The clinical information included the age and gender distribution, the operation time, the total blood loss, the interval from injury to operation, the etiology of the fractures and the functional outcome. The preoperative X-ray information included the fracture type by the Garden stage, the Singh index and the posterior cortex comminution. The postoperative information included the quality of reduction and the pin and screw position. The Garden alignment index, evidence of union, the FIM(TM) score, the complications and the failure rate. Results: No statistical difference was noted between the two fixation methods regarding the gender, the initial fracture displacement, the postoperative reduction or the position of the fixation device, the functional outcome using FIM(TM) score and the complication. Yet the cannulated screw fixation group showed a significantly shorter operation time and less total blood loss (P<0.05). Conclusion: To decrease the operation time and blood loss, cannulated screw fixation is considered to be the more useful fixation method for treating fracture of the femoral neck.

Atraumatic Bilateral Fracture of the Femoral Neck in Young Male Patient with Suspected Osteomalacia

윤병호,권민수 대한골대사학회 2017 대한골대사학회지 Vol.24 No.3

In this report, we describe the case of a healthy 37-year-old male patient without a history of disease, who developed atraumatic bilateral fracture of the femoral neck. Radiological and blood investigations revealed osteopenia and severe vitamin D deficiency (7.42 ng/mL), respectively, but patient had no apparent risk factors for insufficiency fracture. Bilateral osteosynthesis was obtained using cannulated screws and laboratory findings improved after vitamin D supplementation. This case highlights the effect of vitamin D deficiency on demineralization in a young male patient.

긴 주대를 포함한 슬관절 치환물을 가진 환자에서의 고관절 반치환술

이성락 ( Sung Rak Lee ),이봉진 ( Bong Jin Lee ),김성태 ( Seong Tae Kim ),박권희 ( Kwon Hee Park ) 대한고관절학회 2009 Hip and Pelvis Vol.21 No.3

대퇴 경부 골절은 노인에게서 흔히 발생하는 골절로 합병증 및 치료 방법은 이미 자세히알려져 있다. 최근 슬관절의 인공관절술이 많이 시행되면서 그에 따른 합병증의 병발로 재치환술도 흔해졌으며 긴 주대(Long stem)를 사용한 슬관절 치환술의 빈도도 증가하고 있다. 본 증례에서는 긴 주대를 사용한 슬관절 재치환술을 받은 환자에서 발생한 대퇴 경부 골절을 주대를 제거하지 않고 modular segment를 이용한 고관절 반치환술로 2년 추시 상 좋은 결과를 얻었기에 보고하는 바이다. Femoral neck fractures frequently occur in elderly patients and the treatment strategies for this are well documented. Revision knee arthroplasty using a long intra-medullary stem has recently been increasingly used for treating complications such as infection, aseptic loosening or instability. The current case had a femoral neck fracture with a well-fixed, long stem knee prosthesis, which reached to near the lesser trochanter of the femur. The authors performed the surgery using impaction of the modular hip segment; its inner diameter was fit to the outer diameter of the femoral stem of the knee prosthesis. At two years postoperative follow-up, the result was excellent without loosening or osteolysis.

Pathological Fracture of Femoral Neck Leading to a Diagnosis of Wilson’s Disease: A Case Report and Review of Literature

Nishit Bhatnagar,Purushotham Lingaiah,Jeetendra Singh Lodhi,Yugal Karkhur 대한골대사학회 2017 대한골대사학회지 Vol.24 No.2

Wilson’s disease (WD) is a rare inherited disorder of copper metabolism. It chiefly has hepatic, neurological and ophthalmic manifestations. Although osteoporosis, rickets and early arthritis are common features of WD, they are under-recognized. Musculoskeletal manifestations very rarely lead to diagnosis of the disease. Here we present a case of a 12-years-old girl who presented with a 3-months-old pathological fracture of neck of femur. WD was diagnosed on investigating the cause of the pathological fracture, which was managed by performing a conventional McMurray’s intertrochanteric osteotomy. At 6 months follow up, fracture had united and patient was able to ambulate with support. WD can be a rare cause of pathological fracture. A high index of suspicion must be maintained in patients of pathological fracture presenting with associated neuropsychiatric or hepatic manifestations.