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Survival and Functional Outcomes after Hip Fracture among Nursing Home Residents
조홍만,이규정,민웅배,최용석,이현석,문형진,심혜영,이대건,유미정 대한의학회 2016 Journal of Korean medical science Vol.31 No.1
Following the implementation of a long-term care insurance system for the elderly in Korea, many nursing homes have been established and many more patients than ever before have been living at nursing homes. Despite the fact that this is a high-risk group vulnerable to hip fractures, no study has yet been conducted in Korea on hip fracture incidence rates and prognoses among patients residing at nursing homes. We recently studied 46 cases of hip fracture in nursing homes; more specifically, we investigated the most common conditions under which fractures occur, and examined the degree of recovery of ambulatory ability and the mortality within 1 yr. Among those who had survived after 1 yr, the number of non-functional ambulators increased from 8 hips before hip fracture to 19 hips at final post-fracture follow-up. These individuals showed poor recovery of ambulatory ability, and the number who died within one year was 11 (23.9%), a rate not significantly different from that among community-dwelling individuals. It was evident that hip-joint-fracture nursing home residents survived for similar periods of time as did those dwelling in the community, though under much more uncomfortable conditions. The main highlight of this report is that it is the first from Korea on nursing home residents’ ambulatory recovery and one-year mortality after hip fracture. The authors believe that, beginning with the present study, the government should collect and evaluate the number of hips fractured at nursing facilities in order to formulate criteria that will help to enable all patients to select safer and better-quality nursing facilities for themselves or their family members.
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박봉주,조홍만,민웅배 대한고관절학회 2015 Hip and Pelvis Vol.27 No.3
Purpose: People with dementia have poor mobility and discharge outcomes following hip fractures. The purpose of this study was to evaluate the clinical and radiological results of internal fixation of undisplaced femur neck fractures (Garden types 1 and 2) by proximal femoral nail antirotation (PFNA) in dementia patients. Materials and Methods: We studied retrospectively 19 patients with undisplaced femur neck fracture. All patients were over 70 years of age, walked independently with a cane or crutches and suffered moderate-tosevere dementia. Patients were treated with PFNA and followed-up for more than 2 years. Revision, loss of fixation, complications, and walking ability outcomes were measured. Results: In walking-ability evaluation, patients showed an average decrease of just 0.2 points at the final followup. Walking ability was evaluated from before injury to 4 weeks after surgery and decreased by less than 0.5 points. Radiological bone union was achieved in 17 cases; the average time to bone union was 4.14 months (range, 2.5-7 months). Complications included non-union in two cases and femoral head avascular necrosis in one case of non-union. Conclusion: We found that for patients with osteoporotic bone tissues in their femoral heads or patients (e.g.,those suffering dementia) for whom cooperating with medical workers for postoperative walking control or rehabilitation exercises is difficult, implanting a mechanically stable spiral blade for fixation of femoral neck fractures could facilitate walking after surgery.
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Giant Wart as a Cutaneous Horn on the Dorsum of the Hand
조홍만,이규정,민웅배,최용석 대한수부외과학회 2016 대한수부외과학회지 Vol.21 No.2
A 81-year-old female presented with a giant cutaneous horn (1.5×2×4 cm sized) over the right hand, rapid growth recent 6 months. Cutaneous horn was excised and split thickness skin graft of the defect was done under regional anesthesia. Histopathology showed overlying a wart. In the current study, we report the case of a patient with giant wart as a giant cutaneous horn in a dorsal side of hand.
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박봉주,조홍만,민웅배 대한고관절학회 2015 Hip and Pelvis Vol.27 No.3
Purpose: To compare the clinical and radiological results between internal fixation using the proximal femoral nail system and bipolar hemiarthroplasty (BHA) in reverse oblique intertrochanteric hip fractures in elderly patients. Materials and Methods: From January 2005 to July 2012, we reviewed the medical records of 53 patients who had been treated surgically for reverse oblique intertrochanteric fracture and had been followed-up on for a minimum of two years. All patients were ≥70 years of age, and divided into two groups for retrospective evaluation. One group was treated with internal fixation using the proximal femoral nail system (31 cases), and the other group was treated with BHA (22 cases). Results: Early ambulation postoperatively and less pain at postoperative three month were significantly superior in the BHA group. However, by 24 months postoperatively, the internal fixation group exhibited higher Harris scores and correspondingly less pain than the BHA group. There were no significant differences in union rate, duration of hospitalization or lateral wall fracture healing between the two groups. Four patients in the internal fixation group underwent reoperation. Conclusion: In the treatment of intertrochanteric fracture of the reverse oblique type, open reduction and internal fixation should be considered to be the better choice for patients with good health and bone quality. However, in cases of severe comminition of fracture and poor bone quality, BHA is an alternative offering advantages including early ambulation, less pain at early stages, and a lower risk of reoperation.
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김주오(Ju-Oh Kim),안기용(Ki-Yong An),박봉주(Bong-Ju Park),민웅배(Woongbae Min) 대한정형외과학회 2016 대한정형외과학회지 Vol.51 No.2
통풍은 제1 중족 족지 관절에서 많이 발생하며 족근 관절 및 후족부에서 발생하기도 한다. 통풍성 슬관절염은 흔보히고 되지만, 본 증례와 같이 양측성 슬와 낭종 내 통풍 결절은 드물다. 저자들은 양측성 슬와 낭종 내 통풍 결절을 진단하고 낭종 절제술을 시행한 증례를 문헌 고찰과 함께 보고하고자 한다. Gout often occurs in the first metatarsophalyngeal joint, and also in the ankle joint and posterior foot. Knee joint gouty arthritis is commonly reported, but gouty tophi in bilateral popliteal cysts, such as this case, are rare. We report on a case treated by cystectomy of gouty tophi in bilateral popliteal cysts and review.
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