Effects of Teriparatide on Treatment Outcomes in Osteoporotic Hip and Pelvic Bone Fractures: Meta-analysis and Systematic Review of Randomized Controlled Trials

문남훈,Jae Hoon Jang,신원철,Seok Jin Jung 대한고관절학회 2020 Hip and Pelvis Vol.32 No.4

The primary objective of this study was to evaluate randomized controlled trials (RCTs) that have reported the effects of teriparatide on bone-healing in osteoporotic hip and pelvic bone fractures to determine the efficacy of teriparatide in lowering the rate of treatment failure. A total of 2,809 studies were identified using a comprehensive literature search (MEDLINE [n=1,061], Embase [n=1,395], and Cochrane Library n=353]). Five RCTs were included in the final analysis. Treatment failure rates at the last follow-up of osteoporotic hip and pelvic bone fractures between the teriparatide and control groups was the primary outcome. Treatment failure was defined as non-union, varus collapse of the proximal fragment, perforation of the lag screw, and any revision in cases due to mechanical failure of the implant during the follow-up period. The number of treatment failures in the teriparatide and placebo groups were 11.0% (n=20 out of 181) and 17.6% (n=36 out of 205), respectively. Although the rate of treatment failure in the teriparatide group was lower than that in the control group, this difference was not significant (odds ratio, 0.81 [95% confidence interval, 0.42-1.53]; P=0.16; I2=42%). This metaanalysis did not identify any significant differences in the rate of treatment failure between the teriparatide and control groups at final follow-up. Based on these results, we believe that there is a lack of evidence to confirm efficacy of teriparatide in reducing treatment failures in osteoporotic hip and pelvic bone fractures.

An Uncommon Case of Bilateral Pathologic Hip Fractures: Antiviral Drug-induced Osteomalacia in a Patient with Hepatitis B

문남훈,신원철,도민욱,조형준,서근택 대한고관절학회 2018 Hip and Pelvis Vol.30 No.2

The long-term use of adefovir and tenofovir–antiviral medications commonly used to treat chronic hepatitis B–can be associated with proximal renal tubular dysfunction resulting in significant hypophosphatemic osteomalacia. However, there have been few reports about pathological fractures requiring surgical stabilization in cases of antiviral drug-induced hypophosphatemic osteomalacia. We present the case of a 51-year-old man who sustained bilateral pathological hip fractures associated with antiviral drug-induced hypophosphatemic osteomalacia. To treat a lamivudine-resistant hepatitis-B viral infection, the patient received adefovir for 7 years followed by tenofovir for the subsequent 3 years. He had suffered from polyarthralgia and generalized weakness for 2 years prior to presentation at our clinic. Misdiagnosis and inadequate management of his condition accelerated weakness of the bone matrix and ultimately induced pathological fractures. The patient was managed via cementless total hip arthroplasty on the left hip and internal fixation on the right hip. This case highlights that orthopaedic surgeons should consider the possibility of hypophosphatemic osteomalacia if patients receiving antiviral drugs complain of polyarthralgia and generalized weakness.

Romosozumab: 새로운 골다공증 치료제

문남훈 ( Nam Hoon Moon ),신원철 ( Won Chul Shin ),장재훈 ( Jae Hoon Jan ) 대한골절학회 2021 대한골절학회지 Vol.34 No.4

과도한 골형성을 보이는 유전 질환의 병인에 대한 연구를 통해 골대사에 sclerostin이 중요한 역할을 한다는 것이 밝혀진 후, 이를 이용한 새로운 골다공증 치료제가 제시되었다. 로모소주맙은 인간화 항-sclerostin 단클론 항체로 골대사에 중요한 조절 인자인 sclerostin을 억제하여 골형성 촉진, 골흡수 억제 등 이중 작용 기전을 가지는 새로운 골다공증 치료제이다. 로모소주맙은 기존 골다공증 치료제의 단점을 보완하고, 이들에 비해 골밀도 증가, 골절 예방에서 우수한 효과를 가진다고 현재까지 보고되고 있다. 또한 지속적인 치료에도 반응하지 않는 골다공증, 초고위험군에서의 치료에서도 좋은 결과를 보일 것으로 기대되고 있다. 그러나 아직 임상 효과, 부작용 등에 대한 결과가 충분하지 않은 실정으로 이에 대한 지속적인 추가 연구가 필요할 것으로 생각된다. 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.

거상형 폴리에틸렌 삽입물의 교환 및 방향전환술로 치료한 인공고관절 전치환술 후 전방 아탈구 -증례 보고-

문남훈 ( Nam Hoon Moon ),신원철 ( Won Chul Shin ),서근택 ( Kuen Tak Suh ) 대한고관절학회 2013 Hip and Pelvis Vol.25 No.4

뇌경색에 의해 우측 무력감이 있는 62세 여자 환자에서 발생한 우측 고관절 골관절염에 대하여 거상형 폴리에틸렌 삽입물을 이용한 인공고관절 전치환술을 시행하였다. 술 후 2년 경 두번째 뇌경색에 의해 우측 무력감이 심해지면서 재발성 전방 불안정성이 발생하였다. 이에 대하여 저자들은 거상형 폴리에틸렌 삽입물의 교환 및 방향전환술을 시행한 후 성공적인 결과를 보였기에 문헌 고찰과 함께 보고하는 바이다. Total hip arthroplasty for osteoarthritis of the right hip was performed in a 62-year-old female patient with rightside weakness due to cerebral infarction. Because the second cerebral infarction aggravated right-side weakness, recurrent anterior subluxation occurred two years after surgery. We report on a case of recurrent anterior subluxation of total hip arthroplasty, which was treated successfully by exchange and reorientation of an elevated-rim polyethylene, and discuss studies reporting on recurrent subluxation after total hip arthroplasty and its treatment.

고관절 골절 수술에서 수술 전 Enoxaparin 혈전 예방 요법 대 수술 후 Enoxaparin 혈전 예방 요법

문남훈(Nam Hoon Moon),장재훈(Jae-Hoon Jang),박진섭(Jin Sup Park),박기영(Ki Young Park),박용건(Young Gun Park) 대한정형외과학회 2016 대한정형외과학회지 Vol.51 No.5

목적: 고관절 골절 환자에서 정맥혈전색전증의 예방을 위해 수술 전 및 수술 후 시작한 enoxaparin 투여방법의 안전성과 유효성을 비교 분석하고자 한다. 대상 및 방법: 2009년 3월부터 2014년 3월까지 부산대학교병원에서 고관절 골절로 내원하였던 629명의 환자 중 연구 포함기준을 만족시키는 총 414명(65.8%)을 대상으로 하였다. 156명은 enoxaparin 40 ㎎을 수술 후 48시간부터 피하주사로 시작하였고(A군), 258명은 enoxaparin 40 ㎎을 수술 전부터 피하주사로 시작하였다(B군). 양 군에서 정맥혈전색전증의 발생 빈도와 입원 기간 중 출혈 위험성을 비교 분석하였다. 결과: 증상을 동반하는 정맥혈전색전증은 A군에서 7.1% (11명), B군에서 5.4% (14명)이었으며, 두 군 간의 유의한 차이는 없었다. 증상을 동반하는 심부정맥혈전증과 폐색전증의 발생 역시 두 군 간의 유의한 차이는 없었으나, A군 중 2예는 폐색전증으로 인하여 사망하였고, B군 중 1예는 폐출혈로 사망하였다. 주요 출혈 및 입원 기간 중 사망 빈도는 두 군 간에 유의한 차이가 없었다. 결론: 혈전색전증의 위험인자를 동반하는 고령의 고관절 골절 환자에서는 수술 전부터 시작하는 약물 예방 요법을 고려해 볼 수 있다. Purpose: The purpose of this study was to evaluate the safety and efficacy of pre- and postoperative initiation of enoxaparin in treatment of hip fracture. Materials and Methods: In this study, we enrolled 629 consecutive patients with hip fracture who Pusan National University Hospital between March 2009 and March 2014. Of these patients, 414 patients (65.8%) met the final inclusion criteria. Enoxaparin was administered subcutaneously at 40 mg once daily starting 48 hours after surgery in 156 patients (group A), and immediately after admission in 258 patients (group B). The incidence of symptomatic venous thromboembolism (VTE) and risk of bleeding during hospitalization period were compared between groups. Results: The incidence of symptomatic VTE during the hospitalization period was 7.1% (11 patients) in group A and 5.4% (14 patients) in group B. No significant difference in the rate of symptomatic VTE was found between the groups (unadjusted odds ratio [OR], 0.756; 95% confidence interval [CI], 0.334–1.710; adjusted OR, 0.554; 95% CI, 0.212–1.449). The incidence of symptomatic deep-vein thrombosis and pulmonary embolism (including fatal and non-fatal) did not significantly differ between groups. However, fatal pulmonary thromboembolism developed in two cases in group A and one patient expired postoperatively due to pulmonary hemorrhage in group B. Major bleeding and all-cause death did not differ between groups. Conclusion: Preoperative starting chemical thromboprophylaxis may be considered in the elderly patients with hip fracture who have risk factors for venous thromboembolism.

대퇴골 비전형 골절에서 골수강내 금속정을 이용한 내고정 후 발생한 대퇴 경부 부전 골절 - 증례 보고 -

문남훈 ( Nam Hoon Moon ),장재훈 ( Jae Hoon Jang ),황태혁 ( Tae Hyuk Hwang ),박기영 ( Ki Young Park ) 대한골절학회 2016 대한골절학회지 Vol.29 No.4

대퇴골 비전형 골절(atypical femoral fracture)의 수술적 치료에 있어 골수강내 금속정 내고정술은 표준 치료방법으로 받아들 여지고 있다. 몇몇 보고들을 통해서 대퇴골 비전형 골절에서 골수강내 금속정 삽입술 후 발생하는 합병증들을 보고하고 있지만, 현재까지 인장형 대퇴 경부 부전 골절(tensile type of insufficiency fracture of femoral neck)에 대한 보고는 없다. 저자들은 82세 여자 환자에서 장기간 비스포스포네이트계 약제를 사용한 후 발생한 대퇴골 비전형 골절에서 골수강내 금속정 삽입술 시행 후 발생한 인장형 대퇴 경부 부전 골절 1예를 경험하였기에 관련 문헌 고찰과 함께 보고하고자 한다. 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.

Arthroscopic Management of Intraarticular Screw Perforation after Surgical Treatment of an Acetabular Posterior Wall Fracture: A Case Report

장재훈,문남훈,박기영 대한고관절학회 2018 Hip and Pelvis Vol.30 No.1

Although surgical techniques for treating acetabular fracture are evolving, the use of periacetabular screws is common, and their placement in acetabular surgery is still technically demanding. For instance, intraarticular screw perforation is a serious complication that may occur during surgical treatment of an acetabular fracture. Here, we describe the case of a 50-year-old female who experienced an intraarticular screw perforation after surgical treatment of a posterior acetabular wall fracture. Removal of the perforated screw was performed arthroscopically based on its ability to offer minimally invasive access to the hip joint. One year after removal of the screw, no radiological signs of osteoarthritic changes were observed. The patient regained normal ambulation without limitations to range of motion or hip pain. To our knowledge, this is the first report on the use of arthroscopy to treat intraarticular screw perforation after surgical treatment of an acetabular fracture.

Primary Intraosseus Xanthoma Involving the Proximal Femur in a Normolipidemic Patient: A Case Report

신원철,문남훈,서근택 대한고관절학회 2016 Hip and Pelvis Vol.28 No.3

We report the case of a 25-year-old woman presenting with left hip pain. A lesion was found in the proximal femoral metaphysis. Benign bone tumor, such as intraosseous lipoma or liposclerosing myxofibrous tumor, was suspected based on simple radiographs and magnetic resonance images. Curettage of the lesion and bone grafting was performed. Histologic findings reflected primary intraosseous xanthoma of the proximal femur. Laboratory tests revealed the patient to be normolipidemic, while immunoelectrophoretic fractionation of lipoproteins revealed normal values for alpha, pre-beta, beta, and chylomicrons. At the one-year follow-up, there was no evidence of local recurrence. This is the first reported case of primary intraosseous xanthoma of the proximal femur in a normolipidemic patient.

항생제를 섞은 시멘트 삽입물을 이용한 단계적 인공관절 재치환술로 치료한 견관절 세균성 관절염

천상진,문남훈,김휘택,서정탁 대한견주관절의학회 2008 대한견주관절학회 학술대회논문집 Vol.2008 No.5

수직 불안정 골반환 손상에서 S1, S2 나사못을이용한 후방 고정술의 수술 결과

여광희,문남훈,안재민,정재윤,장재훈 대한골절학회 2018 대한골절학회지 Vol.31 No.1

Purpose: Iliosacral screw fixation is an effective and less invasive method that is used widely for the definitive treatment of unstable pelvic ring injuries. On the other hand, fixation failures after iliosacral screw fixation have been reported in vertically unstable pelvic ring injuries. This study examined the surgical outcomes of posterior pelvic fixation using S1 and S2 screws in vertically unstable pelvic ring injuries. Materials and Methods: Between January 2011 and April 2016, 17 patients with vertically unstable pelvic ring injuries who met the minimum 1 year follow-up criteria were treated with internal fixation using posterior pelvic S1 and S2 screws. Their mean age was 43.9 years. According to the AO/OTA classification, 10 patients had C1, 6 had C2, and 1 had C3 injuries. Surgical treatments of single or multiple steps, where necessary, were performed by two surgeons. The clinical and radiologic outcomes were assessed retrospectively using radiographs and medical records. Results: Overall, 16 patients had bone healing without screw loosening; however, one patient could not maintain anterior pelvic fixation because of an open fracture and deep infection in the anterior pelvic ring. Of five patients who complained of neurological symptoms after injury, three had partially recovered from their neurological deficit. At the last follow-up, the clinical outcomes according to the Majeed score were excellent in 5, good in 6, fair in 4, and poor in 2 patients. The postoperative radiologic outcomes by Matta and Tornetta’s method were excellent in 5, good in 8, and fair in 4 patients. Malposition of the S2 screw was identified in one case. The mean time to union was 14.6 weeks after surgery. Conclusion: S1 and S2 screw fixation can be an effective treatment option for posterior pelvic stabilization in vertically unstable pelvic ring injuries when considering the surgical outcomes, such as screw loosening and loss of reduction.