The prevalence of osteoporosis and incidence of osteoporotic fractures is increasing gradually as life expectancy is prolonged and the aged population increases. Osteoporotic hip fractures (femoral neck fractures and femoral intertrochanteric fractures) have high mortality because the patients with these fractures are elderly and have several comorbidities. Thorough preparation and a multidisciplinary approach in the preoperative period are critical, and early surgery is recommended. There are also several principles to treat osteoporotic hip fractures and prevent fixation failures. Many studies have suggested various treatment methods for femoral neck fractures and femoral intertrochanteric fractures. Functional recovery treatment is essential based on the patient’s health and activity levels. Finally, aggressive management of osteoporosis and the prevention of falling is needed to treat osteoporotic hip fractures successfully.
Purpose This study compared the 3-month treatment effects of teriparatide and percutaneous vertebroplasty for acute osteoporotic vertebral compression fractures. Materials and Methods A retrospective study was conducted on 76 patients diagnosed with acute osteoporotic vertebral compression fractures from January 1, 2020 to December 31, 2022. The patients were divided into the teriparatide group and the percutaneous vertebroplasty+alendronate group. The visual analog scale (VAS), Oswestry disability index (ODI), and height of the vertebrae anterior wall were measured before treatment and at 1 and 3 months after treatment. Results Of the 76 patients, 42 were treated with teriparatide, and 34 were treated with percutaneous vertebroplasty. The symptoms improved in both groups, with a decrease in the VAS and ODI scores at 1 and 3 months after treatment, respectively. On the other hand, there was no significant difference in the VAS, ODI score, and anterior vertebral body height between the two groups before treatment and at 1 and 3 months after treatment. Conclusion In the treatment of acute osteoporotic vertebral compression fractures, conservative treatment using teriparatide showed similar short-term (3 months) treatment results to percutaneous vertebroplasty in terms of improvement in back pain and function and degree of reduction in anterior vertebral body height.
The incidence of fragility fractures of the pelvis (FFP) has increased significantly due to the aging popu-lation and improved diagnostic modalities. The evaluation and treatment of these patients differ from that of high-energy pelvic ring injuries typically seen in younger patients. Therefore, it is important to classify the FFP by patterns of the classification system to standardize optimal treatment criteria and appropriate treatment strategy. However, some cases are not classifiable according to the FFP classifi-cation. A newly proposed classification that can be verified by comparing existing FFP classifications is needed to overcome the weak points. Non-operative treatment is usually considered first and should focus on early mobilization. Operative fixation should focus on stabilizing the minimally invasive pelvic ring than the reduction of fractures to facilitate early mobilization and avoid complications that can arise from comorbidities associated with immobility.
Purpose Osteoporosis causes various fixation failures in patients with intertrochanteric fractures. This study aimed to investigate the effect of a demineralized bone matrix (DBM) for cancellous or cortical bone defects on internal fixation in older osteoporotic patients with intertrochanteric fractures. Materials and Methods Among patients with intertrochanteric fractures who underwent surgical treatment from January 2016 to December 2021 at a facility, 171 patients were AO/OTA type 31-A1 and type 2 fractures which are considered relatively stable. The patients were grouped based on DBM use (Group A: DBM use, Group B: DBM non-use), and their clinical and radiology results were analyzed retrospectively. The patients were then subdivided into Group A-a and -b after removing factors that could cause treatment failures, such as the reduction status and location of the helical blade, and then further subdivided (Group A-a-1/2/3/4 and Group B-b-1/2/3/4) according to cancellous or cortical bone defects that could accompany intertrochanteric fractures. The time to full weight-bearing (FWB) and Harris hip score (HSS) 3 months after surgery in these subgroups were investigated. Results There was no significant difference in the clinical radiology results and complications between Group A and Group B. However, the time to FWB (p<0.001) and HSS (p=0.029) were significantly superior in Group A. In Group A-a with DBM use, after removing the risk factors for intertrochanteric fracture failure, the time to FWB (p=0.055) was close to the significance level, and HSS (p=0.036) was significantly superior. In Group A-a-1 (cancellous defect only) and Group A-a-3 (cancellous and cortical defect), the time to FWB (p=0.088, 0.052) was close to the significance level, and the HSS (p=0.039, 0.018) was significantly superior when DBM was used. Conclusion In patients with intertrochanteric fractures of AO/OTA type 31-A2.3 or less, if stable reduction and firm fixation are achieved, selective DBM use may help early recovery after surgery.
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.
With the discovery of screlostin as a pivotal player in bone metabolism, a novel medication targeting sclerostin has been introduced. Romosozumab, a humanized anti-sclerostin monoclonal antibody, is a unique approach to the treatment of osteoporosis that inhibits sclerostin, a key regulator that has the dual properties of promoting bone formation and inhibiting bone resorption. Romosozumab has been shown to be superior to conventional agents, in increasing bone mineral density and preventing osteoporotic fractures. Romosozumab may also be effective in the management of treatment-resistant osteoporosis and in the prevention of osteoporotic fractures in the very high risk population. However, further studies are necessary as there is insufficient data on its clinical efficacy and safety.
Citations
Citations to this article as recorded by
The 2024 Guidelines for Osteoporosis - Korean Society of Menopause: Part II Dong Ock Lee, Yeon Hee Hong, Moon Kyoung Cho, Young Sik Choi, Sungwook Chun, Youn-Jee Chung, Seung Hwa Hong, Kyu Ri Hwang, Jinju Kim, Hoon Kim, Dong-Yun Lee, Sa Ra Lee, Hyun-Tae Park, Seok Kyo Seo, Jung-Ho Shin, Jae Yen Song, Kyong Wook Yi, Haerin Paik, J Journal of Menopausal Medicine.2024; 30(2): 55. CrossRef
Denosumab, a fully human monoclonal antibody to the receptor activator of nuclear factor-kappa B ligand, was introduced and used as an anti-osteoporotic agent. Denosumab prevents bone resorption by inhibiting the differentiation and action of osteoclasts, resulting in an increase of bone mineral density and broad-spectrum anti-fracture efficacy. Clinical studies, including FREEDOM (Fracture Reduction Evaluation of Denosumab in Osteoporosis Every Six Months) and its extension up to 10 years, FREEDOM Extension, demonstrated its long-term efficacy and safety in postmenopausal osteoporosis. In addition, the efficacy and safety of denosumab were confirmed in male osteoporosis and glucocorticoid- induced osteoporosis. Therefore, recent clinical guidelines recommend denosumab as an initial treatment. This review summarizes the mechanism of action, pharmacological characteristics, efficacy, and safety issue of denosumab.
Fragile fractures, also known as osteoporosis fractures, insufficiency fractures, and senile fractures are a significant problem encountered by orthopedic surgeons. Calcium and vitamin D are essential for maintaining bone health and deficiencies in calcium and vitamin D are major risk factors for the development of osteoporosis. Sufficient amounts of calcium are also required for fracture-callus mineralization. Hence, compromised bone repair that is frequently observed in osteoporotic patients might be attributed to calcium and vitamin D deficiencies. Consequently, calcium and vitamin D supplementation represents a potential strategy for treating compromised fracture healing in osteoporotic patients.
There is some clinical evidence of the positive effect of supplementation in fracture healing and posttraumatic bone turnover, but research in this area is ongoing. Calcium and vitamin D should be the primary treatment of choice in osteopenic patients with an insufficiency of calcium and vitamin D and for the prevention of secondary osteoporotic fractures. Calcium and vitamin D can also be used as addition to other primary osteoporotic medications such as antiresorptive or bone-forming agents. The role of calcium and vitamin D in fracture healing and the therapeutic potential of calcium and vitamin D supplementation is summarized in this context.
Atypical fractures associated with prolonged bisphosphonate (BP) therapy rarely occur outside the femur, and the diagnostic criteria, appropriate treatment principles, and fixation methods for atypical ulnar fractures have not been established. The authors experienced the use of internal fixation with a metal plate and a new internal fixation method with an intramedullary nail in the treatment of an atypical ulnar fracture in a patient who had been on BP therapy for 10 to 20 years. This paper reports findings along with a review of the relevant literature.
Citations
Citations to this article as recorded by
Treatment of Atypical Ulnar Fracture Associated with Bisphosphonate Therapy: A Case Report Dong-Soo Kim, Ji-Kang Park, Eui-Sung Choi, Ho-Seung Jeong, Seok-Hyun Hong, Byung-Hyun Ahn Journal of the Korean Fracture Society.2020; 33(2): 101. CrossRef
PURPOSE The purpose of this study was to investigate the radiologic and serologic factors related to postoperative union using intramedullary (IM) internal fixation in atypical femoral fractures (AFF), which are closely related to bisphosphonates (BPs) for osteoporosis. MATERIALS AND METHODS From February 2008 to December 2016, 65 patients (71 cases) who had undergone IM nail fixation after diagnosis of AFF were enrolled in this study. Patients were divided into group A, who experienced union within 6 months and group B, who did not experience union within 6 months. They were evaluated for duration of BPs use, radiologic factors and serological factors. RESULTS The mean duration of BPs use was 6.17 years in group A and 8.24 years in group B (p=0.039). In the subtrochanteric area, there were 14 cases (27.5%) in group A and 14 cases (70.0%) in group B. In the femoral shaft, there were 37 cases (72.5%) in group A and 6 cases (30.0%) in group B (p=0.001). On the preoperative, the flexion in the coronal plane was 5.9° (2.1°–9.2°) in group A and 8.0° (3.1°–12.1°) in group B (p=0.041). On the postoperative, conversion to valgus was 15 cases (29.4%), 8 cases (40.0%); conversion to neutral was 34 cases (66.7%) and 8 cases (40.0%); conversion to varus was 2 cases (3.9%) and 4 cases (20.0%), each (p=0.037). The fracture site gap was 1.5 mm (0–2.9 mm) on the front side and 1.2 mm (0–2.2 mm) on lateral side and 2.2 mm (0.9–4.7 mm) and 1.9 mm (0.5–3.5 mm), each (p=0.042, p=0.049). Among serological factors, there was no significant difference between the two groups. CONCLUSION Factors adversely affecting the union should be recognized before surgery, such as longterm BPs use or a severe degree of bending of the femur in the coronal plane. During surgery, proper reduction and spacing of the fracture site on the coronal plane should allow adequate reduction of the anterior and posterior surfaces. Obtaining anatomic reduction would be most beneficial for union, but if that is not possible, obtaining congenital valgus rather than varus on the coronal plane may be helpful for union.
Citations
Citations to this article as recorded by
Subtrochanteric Fracture Reduction during Intramedullary Nailing: Technical Note Gyu Min Kong Journal of the Korean Fracture Society.2019; 32(2): 107. CrossRef
The prevention and treatment of fragility fractures is evolving continuously. Adequate fracture care should involve treating the fracture itself as well as the underlying bone disease. Although effective treatments of osteoporosis are available, a large proportion of patients with fragility fractures are not prescribed anti-osteoporotic medications after their injury. Recent advances in diagnostic tools and medications allow for a more effective and comprehensive treatment of fragility fractures.
Citations
Citations to this article as recorded by
Risk Factors for Falls or Fractures in Stroke Patients: An Analysis of 2020 Patient Sample Data Miso Lee, Mikyung Moon The Korean Journal of Rehabilitation Nursing.2024; 27(1): 58. CrossRef
Synthesis of Niobium η-Carbide Nb3(Fe,Al)3C by Mechanical Alloying in a Liquid Organic Medium M. A. Eryomina, S. F. Lomayeva Журнал физической химии.2023; 97(5): 680. CrossRef
The Effect of Denosumab in Elderly Patients Regarding Bone Density and Fracture Risk Sung-Hyun Yoon, Karam Kim, Ki-Choul Kim Journal of Bone Metabolism.2023; 30(3): 275. CrossRef
Trends of Nursing Research on Accidental Falls: A Topic Modeling Analysis Yeji Seo, Kyunghee Kim, Ji-Su Kim International Journal of Environmental Research and Public Health.2021; 18(8): 3963. CrossRef
Review on Korean Herbal Medicine Complex Prescriptions and Single Herbal Medicines for Osteoporosis : Focused on Domestic Research Published Since 2013 Jung Min Lee, Nam Hoon Kim, Eun-Jung Lee Journal of Physiology & Pathology in Korean Medicine.2021; 35(3): 87. CrossRef
Recently, atypical femoral fractures (AFFs) have been found in patients who were prescribed bisphosphonate to prevent osteoporotic fractures. Although the occurrence of AFF is rare, there are some concerns, such as a higher risk of delayed or non-union of AFF. This paper reviews the treatment of AFF and suggests some considerations during surgery.
Citations
Citations to this article as recorded by
How to Improve Fracture Healing in Atypical Femoral Fractures Sang-Jin Jeong, Chan-Woo Park, Seung-Jae Lim Journal of the Korean Orthopaedic Association.2024; 59(1): 9. CrossRef
Atypical Femoral Fracture Occurring at a Proximal Screw Insertion Site after Plate Removal in a Distal Femoral Fracture Jin Woo Jin, Sung Jin Shin, Jong Min Jeon Journal of the Korean Orthopaedic Association.2024; 59(4): 314. CrossRef
Position Statement: Atypical Femoral Fracture from the Korean Society for Bone and Mineral Research in 2023 Jae-Hwi Nho, Byung-Woong Jang, Dong Woo Lee, Jae-Hyun Kim, Tae Kang Lim, Soo Min Cha, Dong-Kyo Seo, Yong-Geun Park, Dong-Geun Kang, Young-Kyun Lee, Yong-Chan Ha Journal of Bone Metabolism.2023; 30(3): 209. CrossRef
This paper reviews previous studies on the treatment of osteoporotic vertebral compression fractures in elderly patients to determine what factors should be considered for successful treatment. In osteoporotic vertebral compression fractures, the primary treatment is conservative treatments. Other treatments include osteoporosis treatment, pain control, orthosis, and physical therapy. Recently, percutaneous catheterization or balloon plasty is performed for rapid pain recovery and early ambulation. Percutaneous catheterization or balloon posterior plasty is effective in reducing pain and improving the activity ability. Surgical treatment should be considered in cases of nonunion or osteonecrosis, dent, deformation, and spinal cord compression after conservative treatment has failed. In surgical treatment, posterior spinal fixation and vertebroplasty are more advantageous in terms of the amount of bleeding, operation time compared to the anterior approach, but the most appropriate method should be selected through the patient's condition and understanding of each surgical method.
Citations
Citations to this article as recorded by
Effects of Herbal Medicines on Bone Mineral Density Score in Osteoporosis or Osteopenia: Study Protocol for a Systematic Review and Meta-Analysis Su Min Hong, Eun Jung Lee Journal of Korean Medicine Rehabilitation.2021; 31(2): 49. CrossRef
Spinal Stability Evaluation According to the Change in the Spinal Fixation Segment Based on Finite Element Analysis
Cheol-Jeong Kim, Seung Min Son, Jin-Young Heo, Chi-Seung Lee Journal of the Computational Structural Engineering Institute of Korea.2020; 33(3): 145. CrossRef
PURPOSE The purpose of this study was to investigate the radiological and epidemiological characteristics, as well as the clinical course of pelvic insufficiency fractures in the elderly population. MATERIALS AND METHODS At a Haeundae Paik Hospital, we retrospectively reviewed patients with pelvic insufficiency fractures between March 2010 and May 2017. The demographic data of patients were analyzed, and bone mineral density and bone turnover markers were evaluated to estimate the metabolic status of the bone. The radiological characteristics were evaluated by comparing the simple x-ray images with the computed tomography images, and the types of fractures were classified via computed tomography images. For clinical course evaluation, we investigated comorbid complications, and compared the walking ability scale before and 6 months after the fracture. RESULTS A total of 42 patients were included, with an average age of 76.5 years. All were female except one case. In 5 cases where the initial medical examination was from another institution, the fracture was not found in 3 cases. All cases received conservative treatment. After the diagnosis of pelvic bone fracture using a simple x-ray imaging, additional fractures were found in 81.0% of the study population using a computed tomography. Initiation of gait occurred at an average of 2.8 weeks, and every case except 1 (97.6%) fully recovered their gait ability. CONCLUSION We concluded that there was a limitation with diagnosing pelvic insufficiency fracture using only a simple x-ray imaging technique. In general, cases in this study showed conservative treatment yielded favorable clinical outcome with relatively less critical complications.
Although several publications have reported delayed or non-union, there is a consensus that the standard treatment for atypical femoral fracture (AFF) is an intramedullary nailing. However, no case of tensile insufficiency fracture of femoral neck associated with intramedullary nailing in patients with AFF have been reported. Here, we report an 82-year-old woman with tensile type of insufficiency fracture of the femoral neck after intramedullary nailing for the treatment of AFF.
Some proximal humeral fractures in elderly patients are accompanied by medial metaphyseal comminution and quality of the bone is so poor that head preserving osteosynthesis seems to be amenable. In cases of medial metaphyseal comminution, lateral locking compression plate (LCP) fixation also has a tendency to become a matter of screw cut out or loss of fixation. The author reports on successful treatment of two osteoporotic proximal humeral fractures combined with medial meta-physeal comminution, with application of additional direct medial supporting plate fixation. Medial plate fixations were added when the fractures were still unstable after the conventional lateral LCP fixation and anterior circumflex humeral arteries had been ruptured before. The fixations were stable enough to start exercise immediately after surgery. The inclinations of the humeral neck were not changed until the last follow-up and clinical results were satisfactory without humeral head osteonecrosis which was a concern.
Citations
Citations to this article as recorded by
Dual-Plate Fixation for Proximal Humerus Fractures With Unstable Medial Column in Patients With Osteoporosis Hyun-Gyu Seok, Sam-Guk Park Journal of Orthopaedic Trauma.2023; 37(10): e387. CrossRef
The plate fixation strategy of complex proximal humeral fractures Qi Sun, Xiaoming Wu, Lei Wang, Ming Cai International Orthopaedics.2020; 44(9): 1785. CrossRef
Biomechanical evaluation of a novel dualplate fixation method for proximal humeral fractures without medial support Yu He, Yaoshen Zhang, Yan Wang, Dongsheng Zhou, Fu Wang Journal of Orthopaedic Surgery and Research.2017;[Epub] CrossRef
PURPOSE With the increase in the old age population, proximal humerus fractures have been increasing recently. However, complications after operative treatment, such as fixation failure, are common because of osteoporosis. We treated proximal humerus fractures in patients with osteoporosis conservatively, and evaluated the radiographic and functional results by analyzing the factors affecting the results. MATERIALS AND METHODS Nineteen out of 30 cases for whom the clinical follow-up was over 1 year were included in this retrospective study. There were 17 females and 2 males, and the mean age was 73.2 years. The causes were slip from a short height (18 cases) and a minor car accident (1 case). We evaluated the union period, nonunion, malunion and the Constant score and analyzed several factors affecting the functional result, such as age, fracture pattern, and malunion. RESULTS Seventeen cases (89.5%) obtained union within 12.8 weeks on average. Neck-shaft angle was 125.3degrees on average, with seven cases of malunion. The Constant score was 84.1 on average, and there were excellent scores in 11 cases, good scores in 4 cases, and fair scores in 2 cases. Fracture pattern, neck-shaft angle, or malunion did not affect the functional outcome, and elderly patients showed poorer shoulder function. CONCLUSION Proximal humeral fractures with osteoporosis may achieve a high rate of bony union when treated with conservative methods. Despite the common occurrence of malunion, a satisfactory functional outcome may be expected.
PURPOSE To determine the influence of osteoporosis on the results of percutaneous K-wire fixation for distal radius fractures. MATERIALS AND METHODS Between March 2007 and February 2011, Fifty seven patients who underwent fixative surgery with K-wires after closed reduction and those available for follow-up for at least 6 months were reviewed. They were divided into the two groups of T score -3 or more (group 1) and T score less than -3 (group 2). These groups were compared by the range of motion of the wrist and Disabilities of the Arm, Shoulder and Hand (DASH) score. Radiologic evaluations consisting of radial length, radial inclination and volar tilt were compared. In group 1 with 34 cases, the average age was 65.4 years (50 to 78 years) and T score was -1.97 (-0.1 to -2.93). In group 2 with 23 cases, the average age was 74 years (54 to 89 years) and T score was -4.11 (-3.1 to -6.97). RESULTS There was no statistical difference between group 1 and group 2 in terms of range of motion, DASH score and radiologic evaluations. CONCLUSION In the case of no volar side cortical comminution, percutaneous K-wire fixation can be applied for the treatment of distal radius fracture with osteoporosis.
PURPOSE The aim of the present study was to evaluate the degree of serum vitamin D deficiency in patients with osteoporotic spinal compression fracture and correlation of serum vitamin D level with several variables. MATERIALS AND METHODS The medical records of 134 patients with osteoporotic spinal compression fracture, diagnosed at our hospital between October 2008 and June 2011, were reviewed. Serum 25(OH)vitamin D3 was used to evaluate the status of vitamin D level. Serum 25(OH)vitamin D3 level was compared and analyzed according to sex, the number of fractured vertebral body, living environment, and the season of injury. The correlation between vitamin D level and age, bone mineral density, and bone turnover marker were evaluated. RESULTS In the serum 25(OH)vitamin D3, 87 patients (65%) associated with osteoporotic spinal compression fracture had an insufficient level. Vitamin D level was the lowest in winter, the highest in summer, and significantly higher in the living home than nursing home. Vitamin D level was negatively correlated with age (r=-0.201, p=0.02) and positively correlated with bone mineral density (r=0.217, p=0.012). CONCLUSION Evaluation of vitamin D level in osteoporotic vertebral compression fracture patients may be helpful in planning the treatment of the patients. For insufficient vitamin D level, the adequate sun exposure and supplement of vitamin D may be used.
Citations
Citations to this article as recorded by
Vitamin D Status according to the Diseases in Hospitalized Rehabilitation Patients: Single Center Study Hanbit Ko, Jin Hee Nam, Soo-kyung Bok Brain & Neurorehabilitation.2019;[Epub] CrossRef
PURPOSE To assess the effectiveness of optimal treatment of proximal humeral fractures and humeral shaft fractures in elderly patients with osteoporosis using the Polarus nail. MATERIALS AND METHODS Twenty-three patients with proximal humeral and humeral shaft fractures in elderly osteoporosis patients were treated using the Polarus intramedullary nail. Nine patients had proximal humeral fracture, 10 had humeral shaft fracture and 4 had the proximal humeral frac-ture extended diaphyseally. Radiological outcomes included the bone-union and the degree of re-sidual deformity. The residual deformities of the proximal humerus were assessed by the neck-shaft angle and the shaft angulation. Clinical outcome was assessed with the American Shoulder and Elbow Surgeons (ASES) score. RESULTS All cases had bony union and the mean union period was 16.5 weeks. The average neck/shaft alignment at the time of bone union was 135degrees and varus deformities of neck-shaft angle was not seen in all patients. Varus shaft angulation was seen in 5 patients. The mean ASES score after surgery was 86.7 points. CONCLUSION The Polarus intramedullary nail is effective for the treatment of proximal humeral and humeral shaft fractures in elderly patients with osteoporosis because it not only enables early postoperative mobilization, but also obtains bone-union without avascular necrosis and nonunion.
PURPOSE To evaluate the effectiveness of magnetic resonance imaging (MRI) for the diagnosis and usefulness of vertebroplasty in osteoporotic occult vertebral fractures. MATERIALS AND METHODS Of 472 osteoporotic vertebral fractures treated from May 2003 to July 2009, 45 patients were diagnosed with occult osteoporotic vertebral fracture. Their medical charts and radiographs were reviewed. The degree of vertebral body collapse was graded by a semiquantitative method. In order to increase the reliability, interpretation was based on radiographic diagnoses from 3 orthopedic surgeons. Vertebroplasty was performed at 31 of the 45 patients, for whom conservative treatment failed. Pre-operatively and post-operatively, pain was evaluated using a visual analog scale (VAS). RESULTS We observed 55 occult fractures in 45 patients. Forty vertebrae (72.7%) among the 55 vertebrae were just adjacent to an old vertebral fracture with deformation of the vertebral body. The rediagnosis rate of occult fracture attempted without MRI was only 21.8%. The average pre-operative VAS score of 8.07 (6~9) was improved to 2.43 after surgery and showed no delayed vertebral body collapse. CONCLUSION Gadolinium enhancement of MRI is critical to the diagnosis of occult vertebral fractures, which are 9% of whole osteoporotic vertebral fractures. Seventy-two point seven percent of occult vertebral fractures were just adjacent to an old vertebral fracture with collapse of the vertebral body. This means that if vertebroplasty is performed without thorough MRI examination, it may fail.
PURPOSE The Purpose of the study is to know patients' compliance of drug treatment of osteoporosis after operation of fracture and to compare of accompanying fractures between patients who diagnosed with osteoporosis itself and had the drug treatment of osteoporosis after surgery of periarticular fracture of hip. MATERIALS AND METHODS In experimental group, consecutive 60 patients who had fracture of femoral neck and trochanter. And in control group, 61 patients diagnosed osteoporosis with drug treatment within the same period in orthopedic department from July 2006 to July 2007. The average age is 73.8 (+/-6.7) year in experimental group, and 66.6 (+/-7.46) year in control group. Both groups had at least a year follow-up with drug treatment and had BMD again at least a year later. RESULTS BMD test in experimental group showed -3.05 (+/-1.35) preoperatively and -2.74 (+/-1.50) in last follow-up. BMD test in control group showed -3.55 (+/-0.52) in initial administration and -3.10 (+/-0.87) in last follow-up. The results showed a significant improvement in statistical analysis (p=0.0002, p<0.0001). CONCLUSION The compliance of drug treatment of osteoporosis after operation of periarticular fracture of hip is the same as in patients' diagnosed osteoporosis.
Citations
Citations to this article as recorded by
Does the Time of Postoperative Bisphosphonate Administration Affect the Bone Union in Osteoporotic Intertrochanteric Fracture of Femur? Yoon Je Cho, Young Soo Chun, Kee Hyung Rhyu, Joon Soon Kang, Gwang Young Jung, Jun Hee Lee Hip & Pelvis.2015; 27(4): 258. CrossRef
Sequential Hip Fractures in Elderly Osteoporotic Patients Soojae Yim, Yuseok Seo, Sanghyok Lee, Joonghyun Ahn Hip & Pelvis.2012; 24(4): 309. CrossRef
PURPOSE To compare the functional and radiological outcomes of volar plating to that of external fixation for treating unstable osteoporotic distal radius fracture. MATERIALS AND METHODS From March 2006 to March 2008, 36 patients with osteoporosis over 60-year old were selected for this study. They were divided into two groups; group I (open reduction and internal fixation with volar fixed angle plate) and group II (closed reduction and external fixation). Clinical outcomes and radiologic outcomes were evaluated. RESULTS There was no statistical difference between group I and group II in range of motion and DASH score, BMD score. However, the grip strength and PRWE score were found to be higher in group II (p<0.05). In radiologic evaluation, group I showed higher radial inclination, volar tilting angle (p<0.05). CONCLUSION Internal fixation using Volar-fixed Angle Plate seems to give more stable fixation for distal articular fragments compared to external fixation. it could allow early postoperative exercise and could result in low incidence of postoperative complication such as pin track infections and joint stiffness. Therefore, the internal fixation could be more desirable treatment method to manage unstable distal radius fracture.
Citations
Citations to this article as recorded by
Functional Outcomes of Percutaneous K-Wire Fixation for Distal Radius Fractures with or without Osteoporosis Ki-Chan An, Gyu-Min Kong, Jang-Seok Choi, Hi-Chul Gwak, Joo-Yong Kim, Sung-Yub Jin Journal of the Korean Fracture Society.2013; 26(4): 248. CrossRef
PURPOSE To find out the relationship between the initial Magnetic Resonance Image (MRI) findings and the progression of vertebra collapse when treated with Jewett brace in osteoporotic stable thoracolumbar fractures. MATERIALS AND METHODS We divided 38 cases of 37 patients of thoracolumbar osteoporotic stable thoracolumbar fractures who were treated with Jewett brace into two groups. One group was composed of those body collapse progressed more than 10% compared with the initial state, and the other group less than 10%. We analyzed the relationships between the progression of collapse and the superior endplate fractures, the fracture line extending to posterior cortex, the size of bone marrow edema, the signal intensity on T1 and T2 weighted MR images, the presence of paravertebral hematoma, and the degree of posterior extensor muscle atrophy using MR images. RESULTS The body collapse was more likely to progress when there was superior endplate fracture, when it showed larger size of bone marrow edema on T1 weighted image, and transverse low signal on T2 weighted image. But extending of fracture line to posterior cortex, presence of paravertebral hematoma, and degree of posterior extensor muscle atrophy did not show any statistical correlations to progression of collapse. CONCLUSION The body collapse is more likely to progress when there was superior endplate fracture, larger low signal on T1 weighted image and low signal on T2 weighted image at initial MRI treated with Jewett brace.
Citations
Citations to this article as recorded by
The Factors between the Progression of the Compression Rate and Magnetic Resonance Imaging Findings in Osteoporotic Vertebral Fracture Patients Treated with Teriparatide Taebyeong Kang, Seung-Pyo Suh, Jeongwoon Han, Byungjun Kang, Changhyun Park Journal of the Korean Orthopaedic Association.2023; 58(5): 392. CrossRef
Statistical Analysis on Hospitalized Patients with Thoracolumbar Compression Fracture at Single Korean Medicine Hospital: Retrospective Review Hyun jin Jang, So jeong Kim, Min Ju Kim, Hyeon Kyu Choi, Pil Je Park, Kang Yeon soo, Jeong Kyo Jeong, Ju Hyun Jeon, Young Il Kim Journal of Korean Medicine.2023; 44(2): 149. CrossRef
The Influence of Initial Magnetic Resonance Imaging Findings on the Compression Rate of Thoracolumbar Osteoporotic Vertebral Compression Fracture Seok-Ha Hwang, Seung-Pyo Suh, Young-Kyun Woo, Ho-Seung Jeon, Ho-Won Jeong Journal of the Korean Orthopaedic Association.2018; 53(4): 341. CrossRef
The Relationship between the Progression of Kyphosis in Stable Thoracolumbar Fractures and Magnetic Resonance Imaging Findings Deuk Soo Jun, Won Ju Shin, Byoung Keun An, Je Won Paik, Min Ho Park Asian Spine Journal.2015; 9(2): 170. CrossRef
PURPOSE To perform comparative analysis between the results of internal fixation and hemiarthroplasty in unstable intertrochanteric fracture of osteoporotic bone. MATERIALS AND METHODS From February 2003 to February 2006, 36 patients treated surgically for unstable intertrochanteric fractures were evaluated. The patient's age was older than 70 year old; the T-score of preoperative bone mineral density (BMD) was lower than -3.0; they were followed up for more than 1 year. The patient were divided into two groups. One group was treated with dynamic hip screw or proximal femoral nail (Group A, 23 cases), and the other group was treated with bipolar hemiarthroplasty (Group B, 13 cases). The two groups were compared in terms of hip joint function using Clawson classification and radiologically. RESULTS Nonunion and fixation failure happened in 6 cases (26%) of gruop A. However, all patients in group B showed stable maintenance of implant. Recovery of hip joint function was found in 13 cases (43%) of group A, whereas 12 cases (93%) of group B recovered. CONCLUSION Nonunion and failure of fixation happened more frequently in internal fixation than bipolar hemiarthroplasty, and the postoperative hip joint function was better in bipolar hemiarthroplasty than internal fixation. Therefore, bipolar hemiarthroplasty might be better operative treatment for unstable intertrochanteric fracture of osteoporotic bone.
Citations
Citations to this article as recorded by
The Stability Score of the Intramedullary Nailed Intertrochanteric Fractures: Stability of Nailed Fracture and Postoperative Patient Mobilization Sung-Rak Lee, Seong-Tae Kim, Min Geun Yoon, Myung-Sang Moon, Jee-Hyun Heo Clinics in Orthopedic Surgery.2013; 5(1): 10. CrossRef
Analysis of the Factors Involved in Failed Fixation in Elderly Intertrochanteric Femoral Fracture Joon Soon Kang, Ryuh Sup Kim, Bom Soo Kim, Young Tae Kim, Seung Hyun Hong Journal of the Korean Fracture Society.2012; 25(4): 263. CrossRef
Results of Osteoporotic Treatment Drug after Periarticular Fracture of Hip Soo Jae Yim, Young Koo Lee, Cheong Kwan Kim, Hyun Seok Song, Hee Kyung Kang Journal of the Korean Fracture Society.2010; 23(2): 167. CrossRef
PURPOSE To compare outcomes of humeral shaft fractures fixed with locking compression plate and those fixed with dynamic compression plate in elderly patients. MATERIALS AND METHODS Nineteen consecutive elderly patients with a fracture of the humeral diaphysis were evaluated retrospectively. Ten patients had been fixed with LC-DCP, and nine had been fixed with LCP. Radiological and clinical results were compared and comparison of implants was done. RESULTS Loosening of the plate occurred in one case each from the LCP group and the LC-DCP group. The rest of the patients achieved union uneventfully without any complications. Union rate, clinical score and hardware were not significantly different between the two groups. One patient who developed loosening in the LC DCP underwent reoperation whereas one patient with loosening in the LCP was successfully managed conservatively. CONCLUSION Principle of fracture fixation was more important than plate selection in humeral shaft fracture of elderly patient.
Citations
Citations to this article as recorded by
Plate osteosynthesis of fractures of the shaft of the humerus: comparison of limited contact dynamic compression plates and locking compression plates Ashutosh Kumar Singh, Nidhi Narsaria, R. R. Seth, S. Garg Journal of Orthopaedics and Traumatology.2014; 15(2): 117. CrossRef
Clinical and Radiographical Follow-up for Residual Displacement of Fracture Fragments after Interlocking Intramedullary Nailing in Humeral Shaft Fractures Jae-Kwang Yum, Dong-Ju Lim, Eui-Yub Jung, Su-Een Sohn The Journal of the Korean Shoulder and Elbow Society.2013; 16(2): 107. CrossRef
PURPOSE Clinical and radiologic results of femur intertrochanteric fractures treated with ITST nail in elderly patients with osteoporosis were analysized to evaluate the efficacy and complication of ITST nailing. MATERIALS AND METHODS 32 patients who were treated with ITST nail due to femur intertrochanteric fracture and were followed up for more than 1 year were analysed. According to Evans classification, 11 cases were stable fractures and 21 cases were unstable fractures. Clinically, ambulatory function was compared and radiologically, BMD of healthy leg was checked with analysis of postoperative bone union and complication. RESULTS In ambulatory function comparison before and after the operation, there were 9 cases of good, 17 cases of moderate and 6 cases of poor. Considering social activity after the operation, 7 cases showed normal ambulation, 9 cases showed ambulatory with one cane, 5 cases showed two cane ambulation and 11 cases showed dependent ambulation. In radiologic evaluation, T-score of ward triangle in healthy femoral neck showed BMD of -3.12. In 20 cases, bone union was observed within 3 months. The patients with low BMD result had poor outcome. There were 2 cases of intraoperative proximal femur fracture, 3 cases of nonunion and 4 cases of death within 1 year. CONCLUSION In elderly patients with intertrochanteric fracture, ITST nailing is relatively efficient treatment. However, in pateint with severe osteoporosis (T-score<-3.0) and unstable fracture pattern, arthroplasty should be considered due to relatively high complicaton rate.
Citations
Citations to this article as recorded by
The PFNA Nail for Pertrochanteric Fracture of the Femur without Fracture Table Jeoung Ho Kim, Sang Hong Lee, Kwang Chul Lee, Sung Won Cho Journal of the Korean Fracture Society.2011; 24(3): 217. CrossRef
Results of Osteoporotic Treatment Drug after Periarticular Fracture of Hip Soo Jae Yim, Young Koo Lee, Cheong Kwan Kim, Hyun Seok Song, Hee Kyung Kang Journal of the Korean Fracture Society.2010; 23(2): 167. CrossRef
PURPOSE To evaluate the usefulness of internal fixation with modified Steinmann pins and tension band wiring technique in comminuted proximal humeral fracture with osteoporosis and the correlations among bone mineral density, age, Neer's score and period of union. MATERIALS AND METHODS Twelve cases of comminuted proximal humeral fracture with osteoporosis were surgically treated with modified Steinmann pins and tension band technique, and followed up for an average 20.8 months (range, 6~39 months). Average age was 73.6 years old (range, 59~85 years old). Results were assessed using Neer's evaluation criteria. RESULTS Excellent results were noted in eight cases and satisfactory results in four cases. Radiological union was obtained in all cases. Two cases showed impingement syndrome of the proximal portions of Steinmann pins, which were managed by early removal of the metal. One case developed operative wound infection, which were managed by antibiotics therapy, irrigation and secondary closure. CONCLUSION Internal fixation using modified Steinmann pins and tension band wiring technique for proximal humeral fracture, with osteoporosis, makes complete union of fracture, minimizes risk of complications, and enables early rehabilitation by rendering relatively rigid fixation.
PURPOSE We are to find the method to objectify postoperative prognosis, analyzing the factors confluencing the result of kyphoplasty in osteoporotic vertebral compression fracture (OVCF). MATERIALS AND METHODS Our study included 50 patients (55 vertebral bodies) who have undergone kyphoplasty from Sep. 2004 until Oct. 2005. We divided in the group according to bone mineral density (BMD), compression rate, recovery rate and cement leakage. We verified the significance of each group, using independent t-test, and ANOVA test among observers. RESULTS We performed kyphoplasty on 55 vertebral bodies, 12 cases with more than 0.4 g/cm2 in BMD (mean: 0.53 g/cm2) and their mean preoperative compression rate (CR), immediate postoperative recovery rate (RR-IPO), and recovery rate after 6 months (RR-6M) was each 30.58%, 12.35%P, 9.93%P. 15 cases under 0.4 g/cm2 (mean 0.31 g/cm2), and their CR, RR-IPO and RR-6M was 26.73%, 11.77%P, 5.26%P respectively. The p-value was 0.004. Another studies according to CR, RR-IPO and leakage of cement revealed the better results in the cases of the lower CR, the smaller reduction and abscecnce of cement leakage, but statistically insignificant (p=0.309, 0.069, 0.356). CONCLUSION Preoperative BMD was most important factor that confluencing postoperative radiological result in OVCF. Other factors were also thought to be confluencing factors, but statistically insignificant..
Citations
Citations to this article as recorded by
Cement Leakage into Disc after Kyphoplasty: Does It Increases the Risk of New Adjacent Vertebral Fractures? Hoon-Sang Sohn, Seong-Kee Shin, Eun-Seok Seo, Kang-Seob Chang Journal of the Korean Fracture Society.2011; 24(4): 361. CrossRef
PURPOSE To evaluate retrospectively the results regarding pain relief, complication after percutaneous vertebroplasty, for an osteoporotic compression fractures. MATERIALS AND METHODS 260 patients (male 55, female 260, mean age 69.4 years old) treated by percutaneous vertebroplasty in Dankook University Hospital from July 1997 to July 2004 were reviewed. We performed percutaneous vertebroplasty and observed the degree of pain relief using pain scale pre-/postoperation. we evaluate the complication by plain radiographs and computed tomography, ABGA and chest X-ray. we evaluate pain relief and complication for 1 week by follow-up plain radiographs.
we recommended BMD follow-up per 1 year and osteoporosis medication at least 2 years. A clinical result was evaluated as excellent, good, fair, poor and visual analogue scale (VAS 0~10) for 1 year. We prefaced a statistical analysis by T-test using SPSS (version 11.0) correlating 1 week and 1 years effects. RESULTS 73 (28.3%) of the patients were evaluated as excellent: 123 (45.5%), as good: 45 (17.8%), as fair; and 23 (8.5%), as poor, show 73.8% over good in 1 week. 76 (29.3%) of the patients were evaluated as excellent; 120 (44.3%), as good; 43 (16.8%), as fair; and 25 (9.6%), as poor in 1 year, show 73.6% over good result. 1 week follow-up and 1 year follow-up show similar results. 1 patient had death (hemothorax), 4 patients had arrhythmia, 15 patients (21 vertebrae) had fracture around vertebroplasty. CONCLUSION Percutaneous vertebroplasty using PMMA is valuable method in the treatment of osteoporotic compression fracture, providing immediately pain relief, long term pain relief, prevention of complication originated from long term traction and bed rest, unwearing brace and early ambulation.
Citations
Citations to this article as recorded by
Comparison of Outcomes of Conservative Treatment, Early Vertebroplasty, and Delayed Vertebroplasty in Patients with Osteoporotic Vertebral Compression Fractures Se-Hyuk Im, Young-Joon Ahn, Bo-Kyu Yang, Seung-Rim Yi, Ye-Hyun Lee, Ji-Eun Kwon, Jong-Min Kim Journal of Korean Society of Spine Surgery.2016; 23(3): 139. CrossRef
Large Pulmonary Embolus after Percutaneous Vertebroplasty - A Case Report - Sang Ho Moon, Soo Won Lee, Byoung Ho Suh, Sung Hwan Kim Journal of Korean Society of Spine Surgery.2009; 16(1): 46. CrossRef
Risk Factors of New Compression Fractures in Adjacent Vertebrae after Percutaneous Vertebroplasty Myung-Ho Kim, Sang-Hyuk Min, Suk-Ha Jeon Journal of the Korean Fracture Society.2007; 20(3): 260. CrossRef