혈청 표지자 분석을 통한 근위 대퇴 골절 형태 예측

권병택,권석현 대한골다공증학회 2015 Osteoporosis and Sarcopenia Vol.13 No.1

Purpose: To analyze serum markers in proximal femur fracture patients, which are known to be accompanied with osteophorosis or metabolic diseases, and consider it as predictive factor and to study how it affects on the fracture form. Materials and Methods: Vit. D3 known as serum marker of Vit. D, 25(OH)D, and 1,25(OH)2D of 152 patients from April, 2013 to March, 2014 who visited our hospital and diagnosed as proximal femur fracture(Femur neck fracture 73, Intertrochanteric fracture 79) were analyzed. Also, serum calcium level corrected by serum protein, phosphate, creatinine, alkaline phosphatase, estradiol, IGF-1, and PTH were compared and analyzed. Results: Femur neck fracture group showed significantly low value of D3, 25(OH)D, and 1,25(OH)2D (P-value<0.05) as the values were 37.72±7.21 pg/mL, 27.05±8.43 ng/mL, 25.05±6.78 pg/mL in femur neck fracture group, and 40.36±6.97 pg/mL, 29.54±9.12 ng/mL, 28.87±7.43 pg/mL in intertrochanteric fracture group respectively. The number of patients who were diagnosed as hypovitaminosis D. due to serum 25(OH)D value lower than 30ng/ml were significantly high in femur neck fracture group as the numbers were 56 in femur neck fracture, and 44 in intertrochanteric fracture. Serum calcium level corrected by serum protein, phosphate, creatinine, alkaline phosphatase, estradiol, IGF-1 and PTH level showed no significant difference between two groups. Conclusion: Serum 25(OH)D level was decreased in proximal femur fracture patiens, and was lower as the patient was older and BMD was lower. Therefore it is thought that proximal femur fracture is affected by vitamin D metabolism.

Outcomes of Combined Neck and Trochanter Fractures of the Femur Treated with Cephallomedullary Nail in Elderly

Hyunseung Yoo,조영호,Seong Mun Hwang 대한고관절학회 2019 Hip and Pelvis Vol.31 No.4

Purpose: Proximal femur fractures are classified into intracapsular neck fractures and extracapsular trochanteric fractures, and several related treatment recommendations in elderly patients have already been introduced. Importantly, we have observed cases of combined intra and extracapsular fractures (i.e., ipsilateral neck and trochanter fractures). The purpose of this study is to report the outcomes of combined neck and trochanter fractures of the femur treated with cephalomedullary nail (CMN) in elderly patients. Materials and Methods: From January 2010 to December 2014, 410 patients with proximal femoral fractures were fixed using CMN; among this group, 37 patients with combined neck and trochanter fractures were identified. Two of these patients died fewer than three months after injury and another two did not return for follow-up. Thirty-three patients were included and reviewed retrospectively in this study. Results: All patients were injured by simple fall. Bone union was obtained in 28 of 33 patients. Of the five patients who failed treatment, three experienced implant penetration through head (cut-through and cut-out), one had breakage of CMN and the last one had a loosening of internal fixation device with persistent non-union at final follow-up. The former four patients underwent hip replacement surgery and the latter refused surgery because he had low demand in daily life and many medical problems. Conclusion: Eighty-five percent of elderly patients with combined neck and trochanter fractures of the femur treated with CMN achieved bone union; these complex fractures require more accurate reduction than usual extra-articular intertrochanteric fractures.

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.

Learning Curve of Internal Fixation for Nondisplaced Femoral Neck Fractures: A Cumulative Sum Analysis

이영균,문경호,김진우,하용찬,이명호,구경회 대한정형외과학회 2018 Clinics in Orthopedic Surgery Vol.10 No.1

Background: The purpose of this study was to determine whether there is a learning curve for internal fixation for nondisplaced femoral neck fractures using the cumulative sum (CUSUM) technique. We applied the CUSUM technique in monitoring performance of a single surgeon in internal fixation for nondisplaced femoral neck fractures. Methods: Fifty consecutive patients who underwent internal fixation for nondisplaced femoral neck fractures were evaluated retrospectively. Loss of fixation within 6 months postoperatively was considered as failure of treatment. Patients were stratified into the early experience group (cases 1 to 25) and the late experience group (cases 26 to 50). The CUSUM method was used to analyze the learning curve. Results: There was no failure of treatment during study period. The operation time became shorter with experience. Using the CUSUM analysis to plot the learning curve, there was no significant learning curve observed for multiple pinning for nondisplaced femoral neck fractures. Conclusions: The CUSUM analysis revealed there was no obvious learning curve to become proficient at internal fixation for nondisplaced femoral neck fractures, if technical principles were followed during the procedure.

대퇴골 경부 골절과 동반된 Pertrochanteric fracture의 치료

김원유,한창환,최우성,지종훈,문창윤,김진영 대한골절학회 2002 대한골절학회지 Vol.15 No.3

목 적 : 대퇴골 경부 골절과 동반된 전자부 골절(pertrochanteric fracture)의 정확한 진단을 환기시키기고 이러한 경우 시행한 인공 골두 치환술의 예비적 임상결과를 보고하는데 있다. 재료 및 방법 : 대퇴 경부 골절의 동반이 의심되는 7예를 대상으로 하였으며 평균 골밀도는-4.25, Singh index는 평균 3.28이었다.모든 예에서 수술전 CT 단층 촬영술을 시행하였으며 CT소견상 대퇴골 경부 골절이 동반되었다고 판단시 양극성 인공 골두 치환술을 시행하였고 수술시 채취한 대최 골두 표본에서 골절 양상을 확인하고 사진 촬영하여 기록하였다. 수술 후 임상결과의 판정은 Postel의 임상경과 grade를 이용하여 시행하였으며 수상전의 보행상태와 비교하여 이의 회복이 가능한 시점에 주안점을 두어 조사하였다. 결 과 : 모든 예에서 수술 전 단순 방사선 및 CT 소견과 합당한 전자부 골절의 소견을 보였다. 수술 후 평균 13개월(6~19개월)에 전 례에서 양호이상의 소견을 보였으며 모든 환자에서 수상 전과 비슷한 정도로의 운동량의 회복을 보였다. 결 론 : 이러한 골절의 정확한 진단을 위하여는 골다공증이 동반된 분쇄상이 심한 대퇴부 전자부 골절에서는 CT촬영 및 정확한 판독이 필요하고 부수적으로 일단 이러한 골절이 발견 시는 조기 인공 골두치환술도 좋은 치료법이라고 생각된다. Objectives : To establish the precise diagnosis of a comminuted pertrochanteric fracture with femoral neck fracture in a senile osteoporotic patient and report of a preliminary clinical results of early bipolar hemiarthroplasty. Material & Methods : Consecutive seven cases of comminuted pertrochanteric fractures who were suspicious to have combination with femoral neck fracture were evaluated. All cases had routine radiographs and CT scans of proximal femur and performed with bipolar hemiarthroplasties. Observation of the retrieved femoral head to evaluate a fracture and recorded with photograph. Postoperative evaluation was done with Daubine & Postel clinical grading with medical recording and personal telephone. The clinical evaluation was focused on the recovery for preinjured walking distance. Results : All patients were proved to have combination with pertrochanteric fractures and femoral neck fractures. In addition, all patients were recovered to more than good in clinical grading and pre-injured walking distance. Conclusion : To make a precise diagnosis of pertrochanteric fractures with femoral neck fracture it is recommended to perform the CT scan with prompt reading of the simple radiographs in suspicious case. An early bipolar hemiarthroplasty was also recommended to treat this kind of senile difficult fracture.

55세이상의 환자에서 대퇴경부골절의 치료시 인공관절 성형술과 다발성 핀 고정술의 결과

고한석,김덕원,송재국,하정구 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.3

Object : Femoral neck fracture has high incidence rate in old age patients because of the length of mean life and increased activity. The rate of femoral neck fracture increases every year. The purpose of this study was to analyze results of multiple pinning and prosthetic replacement in femoral neck fracture. Materials and Methods : We evaluated 66 patients who had been operated femoral neck fractures between May 1994 and April 1997. We analyzed results of Harris hip scores, hip function test of Jesse, mean op, time, blood loss, admission days, and complications. Results : Group Ⅰ(multiple pinning) were 31 cases, Group Ⅱ(arthroplasty) were 35 cases. Operation time of Group Ⅰ was 52 minutes, Group Ⅱ was 109 minutes. Blood loss of Group Ⅰ was 22cc, Group Ⅱ was 983cc. Admission days of Group Ⅰ was 9.8 days, Group Ⅱ was 24.1 days. Harris hip scores of Group Ⅰ was 86.5, Group Ⅱ was 73.3. Complications of Group Ⅰ were nonunion(3 cases), avascular necrosis(1 case), Group Ⅱ were infection(1 case), dislocation(5 cases), expire(1 case). Conclusions : Multiple pinning is lower expensive technique and has lower complication rate. We can operate multiple pinning in mild displaced femoral neck fracture in old patients. By national standardization and monitoring of femur neck fracture If overuse of arthroplasty was reduced, we can come true national health cost reduction.

동측 대퇴 경부 및 간부 골절의 치료

김정렬,이형석,박명식,유희철,양두현 대한골절학회 2003 대한골절학회지 Vol.16 No.3

목적: 동측 대퇴골 경부 및 간부 골절의 치료 결과를 분석해 보고, 효과적인 치료 방법을 알아보고자 하였다. 대상 및 방법: 1992년 1월부터 1999년 1월까지 동측 대퇴골 경부 및 간부 골절 치료 후 2년 이상 추시 가능한 17예를 대상으로 하였다. 각 예에 대한 치료 방법에 따른 골유합 시기, 합병증 및 치료 결과를 분석하였고, 기능적 결과는 고관절은 Iowa 판정법을 이용하였고, 대퇴부에 대해서는 Swiontkowski 분류법에 의해 판정하였다. 결과: 대퇴 경부 골절은 전예에서 골유합을 얻었으며, 평균 골유합 기간은 12주였다. 대퇴 간부 골절은 1예에서 불유합이 있었으며, 불유합 1예를 제외하면 평균 28.5주에 골유합을 얻었다. 대퇴 간부 골절에서 각 치료법간의 골유합 시기는 통계학적 의의는 없었다(p>0.05). 합병증으로는 대퇴 간부 골절에서 단축 1예, 불유합 1예가 있었다. 기능적 결과는 Iowa 고관절 판정법상 우수 9예, 양호 8예였으며, Swiontkowski 분류법상 우수 9예, 양호 6예, 보통 1예, 불량 1예였다. 결론: 동측 대퇴골 경부 및 간부 골절의 치료에 있어 합병증을 줄이고 치료 결과를 향상시키기 위해서는 대퇴 경부 골절의 조기 진단이 중요하고, 대퇴 경부로 가는 혈행 손상을 줄이기 위해 조기 수술과 정확한 해부학적 정복을 시행하여야 하며, 간부 골절에 대해서는 가장 적합한 고정물의 선택이 중요하리라 사료된다. Purpose: To analyse the result of the treatment of ipsilateral fermoral neck and shaft fractures and to consider effective method of the treatment. Materials and Methods: Seventeen patients with ipsilateral femoral neck and shaft fractures were treated from January 1992 to January 1999 and followed up more than 2 years. Radiologic bony union between each treatment method, complication were analysed. The functional results assessed with Iowa hip rating system and Swiontkowski system. Result: In femoral neck fractures, bony union was obtained in all cases, average 12 weeks. In femoral shaft fractures, bony union was obtained in all but one caes. There was no statistical association bony union time between each treatment method (p>0.05). By Iowa hip rating system, nine hip had an excellent result; eight, a good result. According to rating system of Swiontkowski , the result was excellent in nine, good in six, fair in one, and poor in one. Conclusion: We concluded that early diagnosis of all injuries was needed. To avoid further vascular damage of femoral head, early anatomical reduction of the femoral neck fracture should be performed. And then, shaft fracture was fixed with implants which were most appropriate for that combination of fractures.

Internal Fixation of Pauwels Type-3 Undisplacedincomplete Insufficiency Femoral Neck Fractures with Cephalomedullary Nails

Joo-Hyoun Song,Jongmin Kim,Seungbae Oh 대한고관절학회 2020 Hip and Pelvis Vol.32 No.2

Femoral neck stress fractures are rare and when treating are difficult to achieve favorable outcomes. This study characterizes outcomes associated with the use of cephalomedullary nails for fixation of Pauwels type-3 vertical femoral neck undisplaced-incomplete insufficiency fractures. Four consecutive patients with a Pauwels type-3 vertical femoral neck tensile insufficiency fracture from 2016 to 2018 were reviewed. Magnetic resonance imaging data revealed tensile visible fracture lines and hip-joint effusions with a high shear angle. For all patients, bone mineral density and vitamin D levels were low; vitamin D therapy was initiated immediately. Surgical procedures were conducted with cephalomedullary nails (Gamma 3 locking nail system; Stryker) under general anesthesia. A cephalomedullary nail appears to be a safe and effective alternative to the use of multiple parallel screws or a sliding hip screw for fixation of vertical femoral neck stress fractures (level of evidence: Level V).

Comparative Study for Osteosynthesis of Femoral Neck Fractures: Cannulated Screws versus Femoral Neck System

Youngho Cho,Jaeuk Shin,Sangwoo Kim 대한고관절학회 2023 Hip and Pelvis Vol.35 No.1

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.

대퇴 경부 불안정 골절을 위한 Femoral Neck System과 추가적 유관 나사 고정술의 컴퓨터를 이용한 재현 및 임상적 적용을 위한 생체역학적 특징

김주영 ( Ju-yeong Kim¸ ) 대한골절학회 2023 대한골절학회지 Vol.36 No.1

목적: Pauwels III형 대퇴 경부 불안정 골절의 고정에 사용되는 FNS와 추가 유관 나사를 고정했을 때의 비교 결과를 컴퓨터 시뮬레이션을 바탕으로 평가하고, 임상 적용을 위한 생체 역학적 특징을 살펴보고자 하였다. 대상 및 방법: 3 0구 사체의 대퇴골 단층 촬영된 이미지를 Mimics^®로 옮겨 3차원 모델을 만들었다. 불안정 대퇴 경부 골절에 가상으로 고정할 수 있도록 FNS의 3차원 스캔을 수행했고, 추가 고정에 사용되는 유관 나사는 Ansys에서 모델을 만들어 사용했다. 이 모델들에 대해 가상으로 생리학적 부하를 주어 생체역학적 특성을 분석하였다. 결과: 뼈에 작용한 최대 응력의 수치는 F NS에서 380.14 MPa, FNS+7.0 mm 전산 유관 나사에서 297.87 MPa이었다. FNS에 작용한 최대 VMS 수치는 FNS에서 786.83 MPa, FNS+7.0 mm 전산 유관 나사에서 435.62 MPa이었다. 최대 전변형 수치는 FNS에서 10.0420 mm, FNS+7.0 mm 전산 유관 나사에서 9.2769 mm였다. 결론: 불안정 대퇴골두 경부 골절에 있어서 FNS에 해부학적인 공간 및 생체역학적 특성을 고려해 보았을 때, 7.0 mm 크기의 1개의 전산 유관 나사를 FNS 전상부에 고정하였을 때 의미 있는 생체역학적 안정성을 보였다. Purpose: To identify the biomechanical features for clinical applications through a computational simulation of the fixation of the Femoral Neck System (FNS) with additional cannulated screws for a Pauwels type III femoral neck fractures. Materials and Methods: Thirty cadaveric femurs underwent computed tomography, and the images were transferred to the Mimics^® program, resulting in three-dimensional proximal femur models. A three-dimensional scan of the FNS and 6.5 mm and 7.0 mm cannulated screws was performed to enable computerized virtual fixation of FNS with additional cannulated screws for unstable femoral neck fractures. Furthermore, the cannulated screw used for additional fixation was modeled and used as a cylinder within the Ansys program. The biomechanical characteristics of these models were investigated by applying a physiological load virtually. Results: The maximum von Mises stress value at bone was 380.14 MPa in FNS and 297.87 MPa in FNS+7.0 mm full-thread cannulated screw. The maximum von Mises stress value at FNS was 786.83 MPa in FNS and 435.62 MPa in FNS+7.0 mm full-thread cannulated screw. The FNS group showed the highest maximum von Mises stress values at bone and FNS. For total deformation, the maximum deformation value was 10.0420 mm in FNS and 9.2769 mm in FNS+7.0 mm full-thread cannulated screws. The FNS group represented the highest maximum deformation compared to the other groups. Conclusion: Considering the anatomical spatiality and biomechanical characteristics of the FNS in unstable femoral neck fractures, when one 7.0 mm full thread cannulated screw was also fixed to the anterosuperior portion of the FNS, significant biomechanical stability was demonstrated.