• The Journal of Korean Orthopaedic Ultrasound Society
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• v.7 no.2
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• pp.98-104
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• 2014

Purpose: To evaluate the incidence of deep vein thrombosis (DVT) before hip fracture by duplex color Doppler ultrasonography. Materials and Methods: From June 2013 to May 2014, 27 patients who had agreed to perform color Doppler ultrasonography before hip fracture surgery were evaluated for the incidence of DVT. Patients who had history of DVT were excluded. Five patients were men and 19 patients were women. The mean age was 74.3 years old (41-87). There were 15 cases of femoral neck fracture, 11 cases of intertrochanteric fractures and one case of acetabular fracture. Surgical intervention underwent within 48 hours from admission and duplex color Doppler ultrasonography was carried out at the day of admission. Results: DVT occurred in six cases (22.2%). Four cases (14.8%) occurred in proximal deep vein and two cases (7.4%) occurred in distal deep vein. The mean period of immobilization was longer in patients who had DVT. But there was no significant difference. The mean age was 79 years old (75-87) in patients who had DVT and 72 years old (65-86) in patients who had not. There was significant difference (p=0.038). Conclusion: The incidence of DVT which was diagnosed by duplex color Doppler ultrasonography before hip fracture surgery was relatively high (22.2%). So it is necessary to undergo duplex color Doppler ultrasonography more aggressively to rule out DVT before hip fracture surgery.

• Journal of Trauma and Injury
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• v.31 no.2
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• pp.103-106
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• 2018

Fat embolism refers to the presence of fat droplets within the peripheral and lung microcirculation with or without clinical sequelae. However, early diagnosis of fat embolism is very difficult because the embolism usually does not show at the computed tomography as a large fat complex within vessels. Forty-eight-year-old male with pedestrian traffic accident ransferred from a local hospital by helicopter to the regional trauma center by two flight surgeons on board. At the rendezvous point, he had suffered with dyspnea without any airway obstruction sign with 90% of oxygen saturation from pulse oximetry with giving 15 L of oxygen by a reserve bag mask. The patient was intubated at the rendezvous point. The secondary survey of the patient revealed multiple pelvic bone fracture with sacrum fracture, right femur shaft fracture and right tibia head fracture. Abdominal computed tomography was performed in 191 minutes after the injury and fat embolism with Hounsfield unit of -86 in his right common iliac vein was identified. Here is a very rare case that mass of fat embolism was shown within common iliac vein detected in computed tomography. Early detection of the fat embolus and early stabilization of the fractures are essential to the prevention of sequelae such as cerebral fat embolism.

• Journal of the Korean Orthopaedic Association
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• v.55 no.3
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• pp.193-199
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• 2020

A gamma nail has been used to treat intertrochanteric fractures since 1988. Although such cephalomedullary nails have mechanical advantages over extramedullary fixation devices, such as sliding hip screw, their beneficial effects on treating the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) 31-A1 and 31-A2 fractures are still controversial. During their 30-year history, many problems have been overcome, and new types of cephalomedullary nails have been introduced in clinical practice. New cephalomedullary nail systems facilitate nailing procedures and enhance the purchase capability of the femoral head by a lag screw. On the other hand, the failure rate still depends on the hands of the orthopedic surgeons. This review article focused on the basic principle of medial support and restoration of a medial buttress during the treatment of trochanteric fractures using a cephalomedullary nail.

• Journal of Biomedical Engineering Research
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• v.44 no.2
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• pp.139-146
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• 2023

Osteoporosis is a disease in which the risk of bone fractures increases due to a decrease in bone density caused by aging. Osteoporosis is diagnosed by measuring bone density in the total hip, femoral neck, and lumbar spine. To accurately measure bone density in the lumbar spine, the vertebral region must be segmented from the lumbar X-ray image. Deep learning-based automatic spinal segmentation methods can provide fast and precise information about the vertebral region. In this study, we used 695 lumbar spine images as training and test datasets for a deep learning segmentation model. We proposed a lumbar automatic segmentation model, CM-Net, which combines the center point of the spine and the modified U-Net network. As a result, the average Dice Similarity Coefficient(DSC) was 0.974, precision was 0.916, recall was 0.906, accuracy was 0.998, and Area under the Precision-Recall Curve (AUPRC) was 0.912. This study demonstrates a high-performance automatic segmentation model for lumbar X-ray images, which overcomes noise such as spinal fractures and implants. Furthermore, we can perform accurate measurement of bone density on lumbar X-ray images using an automatic segmentation methodology for the spine, which can prevent the risk of compression fractures at an early stage and improve the accuracy and efficiency of osteoporosis diagnosis.

• Korean Journal of Clinical Pharmacy
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• v.28 no.2
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• pp.131-137
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• 2018

Background: In South Korea, 22.3% of women ${\geq}50years$ of age and 37% of women ${\geq}70years$ of age visit the doctor to obtain treatment for osteoporosis. According to the analysis of the National Health Insurance Services claim data between 2008 and 2012, the number and incidence of hip and vertebral fractures increased during the same period. Denosumab, a newly marketed medicine in Korea, is the first RANK inhibitor. Methods: A cost-utility analysis was conducted from a societal perspective to prove the superiority of denosumab to alendronate. A Markov cohort model was used to investigate the cost-effectiveness of denosumab. A 6-month cycle length was used in the model, and all patients were individually followed up through the model, from their age at treatment initiation to their time of death or until 100 years of age. The model consisted of eight health states: well; hip fracture; vertebral fracture; wrist fracture; other osteoporotic fracture; post-hip fracture; post-vertebral fracture; and dead. All patients began in the well-health state. In this model, 5% discounted rate, two-year maximum offset time, and persistence were adopted. Results: The total lifetime costs for alendronate and denosumab were USD 5,587 and USD 6,534, respectively. The incremental cost-effectiveness ratio (ICER) for denosumab versus alendronate was USD 20,600/QALY. Given the ICER threshold in Korea, the results indicated that denosumab was remarkably superior to alendronate. Conclusion: Denosumab is a cost-effective alternative to the oral anti-osteoporotic treatment, alendronate, in South Korea.

• Clinics in Shoulder and Elbow
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• v.17 no.4
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• pp.201-204
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• 2014

Pulmonary embolism is a serious complication, which is well known in patients undergoing total hip or total knee arthroplasty or lower extremity fracture surgery. But, there are few literatures concerning pulmonary embolism after upper extremity surgery. Pulmonary embolism after minor upper extremity fracture surgery is extremely rare. We report a case of 66-year-old female patient that developed pulmonary embolism after percutaneous cannulated screw fixation for a greater tubercle fracture of the proximal humerus with literature review.

• Korean Journal of Veterinary Research
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• v.63 no.3
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• pp.29.1-29.5
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• 2023

An adult raccoon dog with extensive, deep, and contaminated wounds on the right hip and multiple fractures was rescued. The open wound was managed daily by debridement and flushing for 3 weeks. Modified active drainage was then performed, and antibiotics administered according to the antibiotic susceptibility test. After 2 weeks, the exudate disappeared and the drain was removed. After monitoring for 1 month, the animal was released in to the wild. This case shows that even if infection remains, rapid wound repair is possible if appropriate antibiotic selection through regular examination and active drainage are combined.

• Journal of the Korean Orthopaedic Association
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• v.55 no.4
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• pp.318-323
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• 2020

Purpose: To examine the relationship between total fat infiltration (TFI) rate, which quantifies the reduction of muscles around the spine and is an important factor for sarcopenia, and the factors affecting osteoporotic vertebral compression fracture. Materials and Methods: Patients treated for osteoporotic compression fractures of the lumber spine from January 2012 to December 2016 were analyzed retrospectively. Among them, this study included ninety-eight patients who were 1) diagnosed with osteoporosis with a bone mineral density (BMD) T score of less than 2.5 g/cm², 2) received vertebroplasty or kyphoplasty for lumbar fractures, 3) involved one segment of the lumbar spine, and 4) were followed-up for more than one year. The TFI rate confirmed by analyzing magnetic resonance imagings with the Image J program was studied. Based on this, the relationship between the TFI of the multifidus and erector spinae muscles and the factors of osteoporosis were analyzed. Results: The mean TFI of the multifidus and erector spinae was 14.66±10.16. The spine BMD showed a positive correlation with the hip BMD, but a negative correlation with the TFI. A positive correlation was observed between the hip BMD and body mass index. In addition, vitamin D was positively correlated with both the hip and spine BMD but negatively correlated with the TFI rate. Conclusion: Muscle growth helps treat osteoporosis, and can prevent fractures that occur frequently in osteoporosis patients. Increasing the vitamin intake can also slow the progression of muscle atrophy.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.5
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• pp.3337-3343
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• 2013

This systematic review was conducted to assess the efficacy and safety of bisphosphonates for prevention and treatment of osteopenia or osteoporosis in men with non-metastatic prostate cancer receiving androgendeprivation therapy. We searched for randomised controlled trials (RCTs) of bisphosphonates compared with placebo from Pubmed, Embase, the Cochrane Library, and ISI - Science Citation Index. Meta-analyses of prespecified outcomes (bone mineral density, fractures, and adverse events) were performed using Review Manager. Ten RCTs with a total patient population of 1,017 were identified. There was generally more improvement in bone mineral density of the lumbar spine for patients who received bisphosphonate treatment than placebo or other medical treatment at 12 months (WMD 6.02,95%CI 5.39 to 6.65). Similar effects were also observed for total hip, trochanter or femoral neck bone mineral density. However, there was no significant reduction in fractures. Fever and gastrointestinal symptoms were the most common adverse events (10.4% vs. 1.2%; 0.10% vs. 0.03%). Currently, our meta-analysis suggested that oral and intravenous bisphosphonates caused a rapid increase in spine and hip or femoral BMD in non-metastatic prostate cancer patients receiving androgen-deprivation therapy. Fever and gastrointestinal symptoms were common with the use of bisphosphonates. These short-term trials (maximum of 12 months) did not show fracture reduction. In future, more efficient performance of higher quality, more rigorous, large sample, long-term randomised controlled trials (>12 months) are needed where outcomes are detailed.

• 대한근관절건강학회:학술대회논문집
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• 1996.04a
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• pp.110-121
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• 1996

It is well defined that osteoporosis is an age related disorder and associated with decreased bone mass. It is one of the most important disease lacing the aging population because of its association with fracture of the hip, vertebrae and distal radius. The disease provoke a significant economic burden and major public health problem of an elderly. The life-time risk of hip fracture in white women is approximately 15% which is equal to the combined risk of breast, uterine, and ovarian cancer. Despite its deleterious effect on women's health, knowledge of the epidemiology of osteoporosis in Korea is only beginning. 1970 in Korea has non as the crossover period between the chronic and an Infectious diseases. As the result, the infant mortality declined and an elderly population in Korea increased significantly in the past decade, The average life expectancy of women in Korea is now about 75 years. Thus, the majority of Korean women will spend approximately one-third of their life in the postmenopause state. Therefore, better understanding of bone metabolism and fracture incidence in Korean population is a great interest for the medical community as well as for public health. Currently, no population based epidemiologic data are available to support the incidence of osteoporotic fractures in Korea. However, available data suggest that significant declining of bone mineral density (BMD [g/$cm^2$]) has been occurring in Korean women after menopause. In same population, peak BMD was observed around 33-39 years of age and continue to decline thereafter. An accelerated bone losses occur after the menopause and the average loss is approximately 13% within 15 years from the menopause. The incidence of fracture was highly correlated with an age and bone mineral density. The mean age of menopause in Korean women was 47 years and this age appears to getting younger when analyzed by the birth cohort. An earlier menopausal age and increase life expectancy place Korean women at increase risk for osteoporosis and bone fracture. Korean or Asian women are no longer protected from the risk of bone fracture. Therefore, an early prevention or intervention schemes are essential before the outbreak of osteoporosis and/or fracture occurs in Korean or Asian women.