Atypical Femoral Fracture Combined with Osteonecrosis of Jaw During Osteoporosis Treatment with Bisphosphonate

원유건,임준렬,김영환,송형근,양규현 대한골대사학회 2014 대한골대사학회지 Vol.21 No.2

Bisphosphonate, a potent anti-resorptive agent, is generally accepted as a safe, effective,well tolerated treatment for postmenopausal osteoporosis. Atypical femoral fracture(AFF) and bisphosphonate related osteonecrosis of jaw (BRONJ) are the increasing mor-bidities in patients treated with long term bisphosphonate. Pathogenic mechanisms ofAFF and BRONJ are not fully identified and not identical. We report a case of BRONJ fol-lowed by AFF and its nonunion in a 67-year-old woman patient receiving an oralbisphosphonate during 7 years for the treatment of osteoporosis.

Failed Extensor Indicis Proprius Tendon Transfer for Extensor Pollicis Longus Tendon Rupture after Distal Radial Fracture

원유건,허윤무,이정범,김태균,이재익 대한수부외과학회 2015 대한수부외과학회지 Vol.20 No.1

Open reduction and internal fixation using volar plating for the treatment of distal radial fractures (DRFs) is becoming an increasingly popular method. Tenosynovitis of extensor tendons causes delayed extensor pollicis longus (EPL) tendon rupture which known as complication following screw penetration of the dorsal cortex after volar plating for DRFs. As the reconstructive procedure for a closed ruptured EPL tendon in minimal displaced DRF, extensor indicis proprius (EIP) transfer is widely used. However, tendon injuries of the fourth compartment, which includes the extensor digitorum communis or EIP, can be caused by screw irritation after volar plating for DRFs. We encountered a rare case of failed EIP tendon transfer for delayed EPL tendon rupture after volar plating for a DRF. Because the EIP tendon can also be damaged by screw penetration, care must be taken to use EIP tendon for treatment of delayed EPL rupture after volar plating for DRFs.

A Rare Extradural Spinal Meningioma with Nocturnal Chest Pain - A Case Report -

원유건,김상범,장민구,민영기,Andreas Gutzeit,Fabio Casari,Oliver Nic Hausmann 대한척추외과학회 2019 대한척추외과학회지 Vol.26 No.3

Study Design: Case report. Objectives: To report a rare case of a spinal extradural meningioma in a patient with longstanding nonspecific thoracic nocturnal pain Summary of Literature Review: Meningioma is a frequent intradural extramedullary tumor that is associated with pain, sensory/motor deficits, and sphincter weakness. Spinal meningiomas most commonly occur in the thoracic spine, although they can also be found at other locations. Materials and Methods: A 65-year-old woman first visited the cardiac and gastrointestinal departments of our institution due to chest pain 2 years previously. No explanation for the complaint could be found in the heart or other organs. On a computed tomography scan of the thorax, a spinal mass was found a few months before the diagnosis. On magnetic resonance imaging, an extramedullary and extradural mass was observed at T7/8. Results: We performed surgery and found an extradural spinal meningioma upon the histological diagnosis. Postoperatively, the patient could adequately move both legs and feet and the nocturnal chest pain disappeared after surgery without any complications. Conclusions: Awareness of the rarity and nonspecific symptoms of extradural spinal meningiomas will be beneficial for their accurate diagnosis and proper treatment. Key Words: Extradural space, Thoracic pain, Iatrogenic dural injury, Spinal meningioma, Spine tumors

The Efficacy of Low Molecular Weight Heparin for the Prevention of Venous Thromboembolism after Hip Fracture Surgery in Korean Patients

원유건,김광균,원예연 연세대학교의과대학 2016 Yonsei medical journal Vol.57 No.5

Purpose: The aim of this study was to investigate the efficacy of low-molecular-weight heparin (LMWH) for the prevention of venousthromboembolism in Korean patients who underwent hip fracture surgery (HFS). Materials and Methods: Prospectively, a total 181 cases were classified into the LMWH user group (116 cases) and LMWH non-user group (65 cases). Each group was sub-classified according to fracture types as follows: 81 cases of intertrochanteric fracture (group A: 49, group B: 32) and 100 cases of neck fracture (group C: 67, group D: 33). We compared the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) according to LMWH use. Results: Of the 181 cases, four DVTs were found in the LMWH user groups (1 in group A, and 3 in group C). One case of PE was found in LMWH non-user group D. The incidences of DVT and PE showed no statistically significant differences between the LMWH user and non-user groups (p=0.298 and 0.359, respectively). In subgroup analysis, no statistically significant differences were found between groups A and B and between groups C and D. Conclusion: The administration of LMWH was not effective in the prevention of venous thromboembolism and PE in the Korean patients who underwent HFS.

Comparison of the Chemical Composition of Subchondral Trabecular Bone of Medial Femoral Condyle between with Advanced Osteoarthritis and without Osteoarthritis

김광균,원유건,김태균,백명현,채재원 대한골대사학회 2015 대한골대사학회지 Vol.22 No.3

Background: The purpose of this study is to investigate differences of chemical composition between subchondral bone in advanced osteoarthritic (OA) and non-OA distal femur. Methods: Twenty femurs were harvested, respectively. The subchondral trabeculae were obtained from the middle of medial articular surface of distal femurs. A 10 mm diameter cylindrical saw was used to harvest. Raman spectroscopy, a non-destructive technique, was employed to determine the chemical information of the trabecular bones in the human distal femurs. Results: The maximum intensity of the phosphate peak was 2,376.51±954.6 for the non-OA group and 1,936.3±831.75 for the OA group. The maximum intensity of the phosphate peak observed between the two groups was significantly different (P=0.017). The maximum intensity of the amide I peak were 474.17± 253.42 for the nonOA group and 261.91±205.61 for the OA group. The maximum intensity of the amide I peak were significantly different between the two groups (P=0.042). Also, among other chemical and matrix components (Hydroxyproline,Carbonate, Amide IIIdisordered;ordered, and CH2), the spectrums showed similar significant differences in the intensity (P=0.027, P=0.014, P=0.012; P=0.038, P=0.029). Area integration were performed to determine disorder in collagen’s secondary structure via amide III (alpha helix/random coil). The value of the alpha helix to random coil band area are significantly different (P=0.021) and result showing that there was a trend toward higher collagen maturity for the nonosteoarthritic bone specimens. Conclusions: The result suggested that OA may affect the chemical compositions of trabecular bone, and such distinctive chemical information may be.

주상골 골절에 대한 관혈적 배측 접근법을 이용한무두 자가압박 나사 고정술

강호정,원유건,권지원,고일현,최윤락 대한수부외과학회 2013 대한수부외과학회지 Vol.18 No.3

Purpose: We present the clinical and radiological results of open reduction and internal fixation for scaphoid fracture with retrograde headless screw fixation via dorsal approach. Methods: This study carried out a survey targeting 15 patients who have a retrograde headless screw fixation on nonunion of scaphoid fracture without previous operation, 2 patients who have a retrograde headless screw fixation on nonunion of scaphoid fracture with previous operation and 8 patients who have a trans-scaphoid perilunate dislocation. We figured out a mechanism of injury, and clinical symptom, radiologic findings. The surgery was done with open dorsal approach which is retrograde headless screw fixation internally, with or without bone graft. We analyzed the result by Maudsley method, in terms of bone union, duration for union, radiologic finding, clinical outcomes. Results: After surgery, 22 of 25 patients had union result on fracture and other 3 patients had nonunion result. It took 12 weeks to achieve bone union on average. Based on radiograhs, we had one case of partial avascular necrosis of proximal fragment without clinical symptoms. We had one case of each scaphoid nonunion without previous operation, with operation and trans-scaphoid perilunate dislocation had arthritic change and non-symptomatic nonunion result. In terms of clinical outcome, 22 patients showed satisfactory results and 3 patients had slight limitation of range of motion. Conclusion: Retrograde headless screw fixation with or without bone graft for the treatment of scaphoid fracture is recommendable. 목적: 저자들은 주상골 골절 치료에 있어 무두 나사를 수배측 접근술로 주상골의 근위에서 원위 방향으로 역방향 내고정을 실시하였으며 결과를 알아보고자 한다. 방법: 주상골 골절 후 불유합 15예, 주상골 골절 내고정 후 발생한 불유합으로 재수술을 시행한 2예 및 주상골 경유 월상골 주위 탈구로 수술한 8예의 환자를 대상으로 손상 원인, 임상적 증상, 방사선학적 양상 등을 조사하였다. 수술은 수배측 도달법을 이용하여 근위부에서 원위부 방향으로 무두 나사로 내고정하였다. 수술 후 방사선학적 결과 및 임상적 결과를 Maudsley와 Chen기준으로 평가하였다. 결과: 급성 및 불유합 주상골 골절 25예 중 총 22예에서는 유합을 얻었다. 임상적 평가에서는 88%에서 우수 및 양호,12%에서 보통 및 불만족의 결과를 얻었다. 결론: 주상골 불유합과 주상 골절 및 월상골 주위 탈구 치료에 있어 수배측 도달술로 접근하여 주상골의 무두 나사로 내고정 시행하는 것은 추천할 만한 치료법으로 생각된다.

Osteochondral Autograft from the Ipsilateral Femoral Head by Surgical Dislocation for Treatment of Femoral Head Fracture Dislocation: A Case Report

이기수,원유건,김상범,김선중,양규현 연세대학교의과대학 2016 Yonsei medical journal Vol.57 No.6

As anatomical reduction of the articular surface of femoral head fractures and restoration of damaged cartilage are essential for good long-term results, many treatment options have been suggested, including fixation of the fracture using various surgical exposuresand implants, as well as arthroscopic irrigation and debridement, bone marrow stimulating techniques, osteochondral allograft, autograft, and autogenous chondrocyte implantation. We report a case of osteochondral autograft harvested from its own femoral articular surface through surgical hip dislocation. The osteochondral graft was harvested from the inferior non-weight-bearing articular surface and grafted to the osteochondral defect. One year later, the clinical and radiological results were good, without the collapse of the femoral head or arthritic change. This procedure introduced in our case is considered convenientand able to lessen surgical time without morbidity of the donor site associated with the harvest.

시상면 균형과 관련된 골반지표의 방사선학적 특성

김상범,이기수,원유건,전준범,황철목,홍창화 대한척추외과학회 2016 대한척추외과학회지 Vol.23 No.3

연구 계획: 척추 변형의 치료 시 골반지표의 방사선학적 특성에 대한 고찰. 목적: 이 문헌은 척추의 시상 정렬, 골반 지표, 정렬을 측정하는 방법을 평가하고, 이 지표들 사이의 관계를 연구하여 척추의 변형을 이해하고자 한다. 선행문헌의 요약: 척추와 골반의 시상면상 주요 지표들을 파악하고 서로의 상관관계를 아는 것은 여러 가지 척추 질환의 진단과 치료에 있어서 매우 중요하다. 대상 및 방법: 문헌 고찰결과: 골반 및 척추의 지표들은 상호간에 밀접한 상관관계의 양상을 보이므로 시상면 균형을 분석하는데 척추 지표뿐만 아니라 골반 지표를 계측하는 것은 필수적이다. 퇴행성 변화는 정상 척추의 만곡을 손상시킬 가능성이 있고, 이는 시상 부정정렬을 일으키게 된다. 시상 균형의 분석은 척추의 질환을 이해 하는데 중요한 요소이다. 또한, 수술적 치료의 결과는 방사선학적 척추-골반 지표와 이들의 변형의 관계를 이해함으로써 잘 판단 할 수 있다. 결론: 시상 정렬과 균형 그리고 보상기전의 관계를 인지하기 위한 척추와 골반 지표의 이해는 척추 변형의 본질과 이를 치료하는데 있어 포괄적인 개념을제공 한다. Study design: A literature review on the radiologic findings of pelvic parameters for treatment of spinal deformity. Objectives: This review examines sagittal spine alignment, pelvic parameters, and methods for assessing alignment, and examines the relationships among all of these parameters to understand spinal deformity. Summary of Literature Review: Understanding the main pelvic and sagittal spinal parameters and recognizing their correlation is imperative in the diagnosis and treatment of various spinal disorders. Materials and Methods: Review of the literature. Results: As spinal and pelvic parameters tend to have a strong correlation, it is essential to measure not only spinal parameters but also pelvic parameters in analyzing sagittal balance. Degenerative changes have the potential to greatly disrupt the normal curvature of the spine, leading to sagittal malalignment. Analysis of sagittal balance is crucial to optimizing the management of spinal diseases. Improvement in surgical outcomes may be achieved through better understanding of radiographic spino-pelvic parameters and their association with deformity. Conclusions: Understanding spinal and pelvic parameters raises awareness of the relationship among alignment and balance, the soft tissue envelope, and compensatory mechanisms, which will, in turn, provide a more comprehensive understanding of the nature of spinal deformity and the modalities with which it is treated.

소복재정맥에서 발생한 혈전을 동반한 여러 개의 정맥류

강찬,송재황,원유건,Tan Eric W.,이기수 대한족부족관절학회 2024 대한족부족관절학회지 Vol.28 No.1

Several types of soft tissue masses occur in the lower extremities. A mass associated with blood vessels is often difficult to diagnose. A 15-year-old male patient visited the author’s hospital with discomfort and edema in his right calf that had persisted for six months. A physical examination showed no palpable mass other than mild edema. Three masses were found during the ultrasound scan along the small saphenous vein. The masses had a cyst-like appearance and were filled with thrombus. In duplex ultrasound, vascular reflux was represented inside the masses. During surgery, it was suspected that vascular deformation occurred in the small saphenous vein, and simple ligation and resection treatments were performed. The patient was finally diagnosed with venous aneurysms accompanied by thrombosis based on the histology tests. The symptoms disappeared after surgery, and there were no recurrences or unusual findings at the follow-up one year later. Venous aneurysms occurring in the superficial veins of the lower extremities are rarely reported, but treat- ment and diagnosis are important. This paper reports a case of an aneurysm on the small saphenous vein.

측면 요추간 고정술 이후 발생한 척추체 골절 발생한 두 환자 - 증례 보고 -

이기수,김상범,원유건,이재신,안재성,강찬 대한척추외과학회 2018 대한척추외과학회지 Vol.25 No.1

Study Design: Although the frequency of the oblique lumbar interbody fusion (OLIF) procedure has increased in recent years, reports on its complications remain rare. We report 2 cases of vertebral fracture after OLIF. Objectives: We aimed to report 2 cases of coronal vertebral fracture after an OLIF procedure in non-osteoporotic patients without significant trauma, and to review the complications of OLIF. Summary of Literature Review: There is a growing but limited literature describing early postoperative complications after OLIF. Materials and Methods: Patient 1 was an obese woman who underwent 2-level OLIF with posterior instrumentation procedures and subsequently experienced 2-level coronal plane fractures. Patient 2 was an elderly man who underwent 3-level OLIF without posterior instrumentation and experienced 1 coronal vertebral fracture. We report vertebral body fracture as a complication of OLIF through these 2 cases. Results: Patient 1 was treated nonsurgically after the fractures. The fractures healed uneventfully. However, patient 2 underwent posterior instrumented fusion and had a solid bridging bone above and below the fracture. Factors potentially contributing to these fractures are discussed. Conclusions: OLIF is an effective procedure for several spinal diseases. However, fracture can occur after OLIF even in non-osteoporotic patients. Factors such as intraoperative end-plate breach, subsidence, cage rolling, and inadequate posterior instrumentation could contribute to the development of fractures after oblique interbody fusion. 연구 계획: 최근 측면 척추체간 유합술의 빈도가 증가하고 있으나 합병증에 대한 문헌적 고찰은 적은 현실이다. 이에 측면 척추체간 유합술 후 발생한 척추체 골절에 대하여 보고하고자 한다. 목적: 골다공증이 없는 환자에서 측면 척추체간 유합술 시행 후 저명한 외상 없이 발생한 척추체 골절 두 예 보고 및 이와 관련된 합병증을 고찰 하고자한다. 선행문헌의 요약: 측면 척추체간 유합술 시행 후 발생한 합병증에 대한 보고가 적은 현실이다. 대상 및 방법: 첫 번째 환자는 두 레벨 측면 척추체간 유합술 및 후방 고정술을 받은 비만의 여성으로 수술 후 척추체 두 레벨에서 골절 소견이 발생하였다. 두 번째 고령의 남성은 후방 고정술 없이 세 레벨의 측면 척추체간 유합술 시행 후 한 레벨의 척추체 골절 소견이 발생하여 보고하고자 한다. 결과: 첫 번째 환자는 비수술적 치료로 잘 치유되었다. 그러나, 두 번째 환자는 후방 고정술을 추가적으로 시행 후 치유 되었다. 이러한 골절 유발 요인에는 골다공증 이외에 다른 요인이 있을 수 있으며 이에 대하여 고찰 하여 보았다. 결론: 측면 척추체간 유합술은 여러 척추 질환에서 효과적인 수술법으로 보고 되고 있다. 그러나, 골다공증이 없는 환자에서도 측면 척추체간 유합술 후척추체 골절이 발생할 수 있다. 수술 중 척추판 골절, 침강, 케이지 구름과 적절하지 못한 후방 고정물 등의 원인에 의하여 척추체 골절이 유발 될 수 있다. 약칭 제목: 측면 척추체간 유합술 후 발생한 척추체 골절