• Archives of Reconstructive Microsurgery
• /
• v.25 no.2
• /
• pp.72-74
• /
• 2016

The keystone flap is a fascia-based island flap with two conjoined V-Y flaps. Here, we report a case of successful treatment of a trochanter pressure sore patient with the traditional keystone flap. A 50-year-old male patient visited our department with a $3{\times}5cm$ pressure sore (grade III) to the left of the greater trochanter that was covered with eschar. Debridement was done and the defect size increased to $5{\times}8cm$ in an elliptical shape. Doppler ultrasound was then used to locate the inferior gluteal artery perforator near the wound. The keystone flap was designed to the medial side. The perforator based keystone island flap covered the defect without resistance. The site remained clean, and no dehiscence, infection, hematoma, or seroma developed. In general, greater trochanter pressure sores are covered with a perforator based propeller flap or fascia lata flap. However, these flaps have the risk of pedicle kinking and require a large operation site. For the first time, we successfully applied the keystone flap to treat a greater trochanter pressure sore patient. Our design was also favorable with the relaxation skin tension lines. We conclude that the keystone flap including a perforator is a reliable option to reconstruct trochanteric pressure sores.

• KSII Transactions on Internet and Information Systems (TIIS)
• /
• v.11 no.12
• /
• pp.6054-6068
• /
• 2017

In this paper, we defined the relative cross-sectional area of forearm cortical bone and investigated its correlation with hip bone mineral density values of total femur, femoral neck, femoral trochanter, femoral inter-trochanter and femoral ward's triangle, respectively. Based on the correlations, we established a linear transformation between the relative cross-sectional area of forearm cortical bone and each hip bone BMD. We obtained forearm images using CBCT and hip bone BMDs using dual-energy X-ray absorptiometry (DXA) for 28 subjects. We also investigated the optimal forearm region to provide the strongest correlation coefficient. We used the optimized forearm region to establish each linear transformation to estimate BMD values for total femur, femoral neck, femoral trochanter, femoral inter-trochanter and femoral ward's triangle from the relative cross-sectional area of forearm cortical bone, respectively. We observed the strong correlations with total femur (r=0.889), femoral neck (r=0.924), femoral trochanter (r=0.821), femoral inter-trochanter (r=0.867) and femoral ward's triangle (r=0.895), respectively. The strongest correlation was observed in the forearm mid-shaft regions. Our results suggest that the hip bone BMD values can be simply estimated from forearm CBCT images in a convenient sitting position without X-ray exposure on a hip including genital organs, and may be useful for screening osteoporosis.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.22 no.1
• /
• pp.86-91
• /
• 2000

Autogenous bone graft is the useful technique for management of various bone defect in oral and maxillofacial surgery. The most common site for bone graft harvest is the anterior iliac crest. There is usually considerable cancellous bone graft available and it can be obtained with minimal morbidity. However, complications noted in iliac crest grafts include prolonged postoperative pain, hematoma and fracture, gluteal muscle weakness. Occasionally, when large amounts of bone graft are needed and previous harvest procedure had used, iliac bone harvest may be not adequate. Like the iliac crest, the greater trochanter has abundant cancellous bone and is readily accessible with acceptable morbidity. The purpose of this study was to assess the availability of cancellous bone graft from the greater trochanter, compare the quantity with that available from the anterior iliac crest, investigate anatomical hazards, and make recommendations for consistent harvest.

• The Korean Journal of Nuclear Medicine Technology
• /
• v.27 no.2
• /
• pp.81-82
• /
• 2023

A 55-year-old female patient, referred by the endocrine metabolism department, was recommended for orthopedic surgery because a lesion was found in the proximal femur in the bone mineral densitometry (BMD). Pelvis AP and frog-leg images performed by the orthopedic department found an intraosseous mass (more likely a benign tumor) in the greater trochanter of the left femur. However, she did not need special treatment and decided to keep observing. The role of a radiologic technologist is important in BMD and it provides significant assistance in the treatment of patients.

• Journal of Nutrition and Health
• /
• v.32 no.1
• /
• pp.50-63
• /
• 1999

This study was conducted with 20 female gymnasts and 23 age-matched controls to examine the relationship of diet, menstrual function and bone mineral density (BMD). The results obtained are summarized as follows : Energy intake of gymnasts was 968.9$\pm$421.4kcal, and energy expenditure was 2091.4$\pm$361kcal showing negative energy balance(-1,122.5$\pm$534.6kcal). The average intakes of calcium, iron, vitamin A, thiamin, riboflavin and niacin did not meet the Recommended Dietary Allowances for their age groups. Mean age at menarche in gymnasts is 15.8$\pm$1.2 years compared with 11.8$\pm$2.8 years in age-matched controls. The profile of estradiol, progesterone, and luteinizing hormone was lower than age-matched controls but not significant. Athletic amenorrheic gymnasts(n=12) have the menstrual irregularity(n=10) and amenorrhea(n=2). A number of variables as such nutritional deficiency in diet, negative energy blasnce and hypogonadotropic hormonal status were included. The bone mineral density (BMD) of female gymnasts were significantly higher than controls for the lumbar neck(p<0.001), trochanter(p<0.01), and Ward's triangle(p<0.001), but there were no significant differences for the lumbar spine and forearm. The lumbar spine BMD had a positive correlation with age and lean body weight. The femoral neck BMD was significantly associated with age, group and lean body mass. The trochanter BMD had significant relationship with group, body mass index, energy expenditure and follicular stimulating hormone. Ward's triangle BMD were related to body mass index and follicular stimulating hormone. The significant association was deterced between forearm BMD and age and lean body weight. The major finding of this investigation is that the BMD of gymnasts were higher than age-matched controls despite the fact that gymnasts as a group had inadequate dietary calcium and a higher propensity to have an interruption of their menstrual cycle. These data indicate that grymnsts involved in sports producing significant impact loading on the skeleton had greater femoral neck, trochanter and Ward's triangle bone density than age-matched controls.

• Journal of radiological science and technology
• /
• v.23 no.2
• /
• pp.13-19
• /
• 2000

There were some controversies about direct cause of hip fracture. We attempted to look at 40 osteoporotic proximal femur fractures in women over 50 years between March in 1999 and Febuary in 2000. The bone density of the fracture group and the healthy 85 control group was measured by Dual Energy X-ray absorptiometry(DEXA). The result was compared using age matched paired T test. The results were as follows ; 1. The femoral neck fractures were 14 cases and the trochanteric fractures were 26 cases. Mean age at a fracture was 67.1 years in neck fracture group and 76.5 years in trochanteric fracture. 2. In the control group, the bone density of both side of the proximal femur was measured and it showed statistically no difference between both sides in same person. 3. The bone density of neck, Ward's triangle, trochanter(P<0.05) and lumbar spine(P<0.001) was significantly reduced in the proximal femoral fracture group comparing with the control group. 4. The bone density of neck, Ward's triangle, trochanter(P<0.05) was significantly reduced in the proximal femoral neck fracture group comparing with the control group, but there was no statistical difference in lumbar spine comparing with the control group. 5. The bone density of neck, Ward's triangle, trochanter and lumbar spine(P<0.001) was significantly reduced in the proximal femoral neck fracture group comparing with the control group. We concluded that the bone mineral densities(BMD) of proximal femur and lumbar spine had decreased in hip fractures but that the bone mineral density and T-score % of the proximal femur were statistically lower than that of the lumbar spine. We suggest that measuring the bone mineral density of the proximal femur may reflect the weakness of the proximal femur more precisely than measuring the bone mineral density of the lumbar spine.

• Imaging Science in Dentistry
• /
• v.36 no.2
• /
• pp.95-101
• /
• 2006

Purpose : Bony strength is dependent on bone mass and bony structure. So this study was designed to investigate the relationship between the bone mass and bony trabecular characteristics. Subjects and Methods : Study subjects were 51 females (average age 68.6 years) and 20 males (average age 66.4 years). Bone mineral density (BMD, $grams/cm^2$) of proximal femur was measured by a dual energy X-ray absorptiometry (DEXA). Regions of interest (ROIs) were selected from the digitized radiographs of proximal femur. A customized computer program processed morphologic operations (MO) of ROIs. 44 skeletal variables of MO were calculated from ROIs on the Ward's triangle and greater trochanter of femur. WHO BMD classes were predicted by MO variables of the same ROI. Classification and Regression Tree analysis was used for calculating weighted kappa values, sensitivity and specificity of MO. Results : The discriminating factors of morphologic operation were branch point, branch point [per cm sq]. Age also played important role in distinguishing osteoporotic classes. The sensitivity of MO at Ward's triangle and Greater Trochanter was 91.8%, 65.6%, respectively. The specificity of MO was 100% at Ward's triangle and Greater Trochanter. Conclusion : Bony trabecular characteristics obtained using radiological bone morphometric analysis seem to be related to bone mass.

• Journal of muscle and joint health
• /
• v.7 no.1
• /
• pp.89-101
• /
• 2000

This study was carried out to compare the bone mineral density and risk factors of osteoporosis between normal and rheumatoid arthritis in postmenopausal women. Sixty-eight postmenopausal patients with rheumatoid arthritis(RA) were compared with 124 postmenopausal normal women. Data were collected from october, 1998 to April, 1999 at Dong-a university hospital in Pusan. From all subjects, individual characteristics such as age, body weight, height, age of menarche, duration of menopause, gravity, parity, and breast feeding period and factors of life style such as milk consumption, exercise, alcohol intake, cigarette smoking, coffee consumption were identified as influencing factors of osteoporosis by questionnaire. From RA patients, health assessment score, Ritchie articular index, erythrocyte sedimentation rate, C-reactive protein and steroid dosage were measured by rheumatologist on measuring bone mineral density. Bone mineral density was measured at the Lumbar spine, femoral neck, femur Ward's triangle, and femur trochanter using dual x-ray absorptiometry. The data was analyzed by using a frequency, t-test, Chi-square, ANCOVA with SPSS PC program. The results could be summarized as follows : 1) There was a significant difference in age and breast feeding period between RA patients and normal women. 2) RA patients took less calcium in the past and practiced less regular exercise in past and present than normal women. 3) There was no difference in lumbar bone mineral density between RA patients and normal women. 4) There was a significant difference in femur Ward's triangle and femur trochanter between RA patients and normal women after adjustment for age and breast feeding period. 5) The prevalence of osteoporosis of all subjects was the highest in femur Ward's triangle. In summary, our findings suggest that the bone mineral densities of femur Ward's triangle and trochanter in postmenopausal women with RA is significantly lower than normal women. Also the exercise participation rate of postmenopausal women with RA is lower than normal women. For the further study, we recommend to develop exercise program that improve the bone mineral density in femur Ward's triangle and trochanter and to test the effect of that exercise program.

• Journal of the Korean Society of Clothing and Textiles
• /
• v.46 no.3
• /
• pp.454-463
• /
• 2022

This study aims to provide basic size data for the development of a hip dislocation prevention garment for cerebral palsy (CP) children and useful information for the design of garment products for CP children through identifying differences in body shape between CP and non-CP children and reviewing the tibial-stature prediction formulas of previous studies. Forty-seven Korean children with CP aged 2 to 14 years were measured for body size from October 2019 to August 2020. Body measurements of 18 sites, including greater trochanter length, which is an important site for a hip dislocation prevention garment, were collected and analyzed. Data of non-CP children were taken from same age of Size Korea and compared. Tibial-stature prediction formulas suggested in four previous studies were also reviewed. CP children had significantly lower stature as well as circumferential dimensions when compared to non-CP children. Greater trochanter length is difficult to predict through other body dimensions. Thus, direct measurement is required. Of the general key dimensions used in the clothing industry, only hip circumference could explain the body shape of CP children. Tibial-stature prediction formulas cannot always but tend to largely predict the actual stature of CP children.

• Korean Journal of Clinical Pharmacy
• /
• v.18 no.2
• /
• pp.114-119
• /
• 2008

Alendronate is a bisphosphonate that selectively inhibits osteoclast-mediated bone resorption. Dosing convenience is an important element for the enhancement of patient compliance and the effective management of osteoporosis. The purpose of this study was to compare the effectiveness and compliance among alendronate pharmaceutical products (oral once-weekly alendronate 70 mg, daily alendronate 10 mg, and once-weekly alendronate 70 mg with Vitamin $D_3$ 2800 IU) in terms of the change in bone mineral density (BMD), biochemical markers, and compliance estimates. A retrospective chart review was conducted in patients with osteoporosis who received alendronate 70 mg (Group 1), alendronate 10 mg (Group 2), or alendronate 70 mg with Vitamin D3 2800 IU (Group 3) at the endocrinology department of a hospital in Korea from Jan. 1, 1998 to Mar. 31, 2008. The primary endpoints were the increases in spine antero-posterior BMD T-score and femur trochanter BMD T-score, and the compliance of alendronate products. Secondary endpoints included changes in bone turnover-related biochemical markers including bone-specific alkaline phosphatase, urinary N-terminal telopeptides (NTX) and osteocalcin, and in serum vitamin $D_3$ concentration. There was no statistical difference in the BMD increase among the three alendronate products; spine BMD T-score increased by $0.49{\pm}0.52$, $0.39{\pm}0.48$ and $0.50{\pm}0.41$, and femur trochanter BMD T-score by $0.29{\pm}0.42$, $0.21{\pm}0.53$ and $0.24{\pm}0.22$ in Group 1, 2 and 3, respectively. With respect to the increases in femur trochanter BMD T-score and the decreases in NTX and osteocalcin, 70 mg once-weekly group was remarkably superior to 10 mg daily group (p < 0.05) The compliance of 70 mg once-weekly group was significantly higher than that of 10 mg daily treatment group (p < 0.001). In conclusion, all three alendronate treatment groups were equivalent in effectiveness, and the compliance of 70 mg once-weekly group was better than that of 10 mg daily treatment group.