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Localization of Atypical Femoral Fracture on Straight and Bowed Femurs
박영창,윤순필,양규현 대한골대사학회 2019 대한골대사학회지 Vol.26 No.2
Background: To elucidate the effect of anterolateral bowing on the fracture height of atypical femoral fractures (AFFs), we separated the AFFs into 2 groups according to the presence of anterolateral femoral bowing (straight group and bowing group) and analyzed the fracture height. The aims of this study were to evaluate the clinical and radiological features of AFFs in the straight group and bowing group, and to determine which factors were associated with the fracture height of AFFs in the total cohort and each subgroup. Methods: Ninety-nine patients with AFFs were included in this study (43 patients in the bowing group and 56 patients in the straight group). Clinical and radiological characteristics were compared between the groups. Multivariable linear regression analysis was performed to determine the effect of factors on fracture height. Results: Patients in the straight group were younger, heavier, and taller, and had a higher bone mineral density, smaller anterior and lateral bowing angles, and more proximal fracture height than those in the bowing group. Multivariable analysis showed that the presence of anterolateral bowing itself and height were associated with fracture height in the total cohort. In the subgroup analysis, the lateral bowing angle in the straight group and the estimated apex height in the bowing group were associated with fracture height. The lateral bowing angle was not significantly associated with fracture height in the total cohort and the bowing group. Conclusions: The presence of anterolateral bowing and the level of the apex of the bowed femur were important factors for the fracture height of AFFs.
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불안정성 대퇴골 전자간 골절에서 골수강외 정복(Extramedullary Reduction)의 효과: 사체를 이용한 생역학적 연구
박영창 ( Young Chang Park ),윤순필 ( Soon Phil Yoon ),양규현 ( Kyu Hyun Yang ) 대한골절학회 2018 대한골절학회지 Vol.31 No.3
목적: 본 연구는 후내측 피질골의 분쇄가 있는 불안정성 전자간 골절(AO/OTA classification 31-A2.2)에서 골절 부위 정복 형태에 따른 생역학적 특성을 신선 냉동 사체를 사용하여 실험하였다. 대상 및 방법: 총 8쌍의 신선 냉동 사체의 대퇴골을 무작위로 각각 골수강내 정복과 골수강외 정복 형태로 금속정 고정을 시행한 후 축성 압박 일회성 파괴 실험을 시행하였다. 초기 축성 강성, 최대 실패 하중 및 고정실패까지 총 흡수 에너지를 비교하였으며 고정실패 패턴을 확인하였다. 결과: 골수강외 정복은 골수강내 정복과 비교하여 평균 초기 축성 강성(422.7 N/mm vs. 332.0 N/mm, p=0.017), 최대 실패 하중(2,848.7 N vs. 1,966.5 N, p=0.012) 및 고정실 패까지 총 흡수 에너지(27,969.9 N·mm vs. 14,751.0 N·mm, p=0.012)가 각각 27.3%, 44.9%, 89.6% 높았다. 결론: 후내측 피질골 결손을 동반된 불안정성 전자간 골절에서 골수강외 정복은 골수강내 정복과 비교하여 생역학적으로 우수한 결과를 보였다. 전내측 피질골은 후내측 피질골 결손에도 불구하고 적절한 지지대가 될 수 있으며 골절 고정의 안정성을 높이는 데도 도움을 줄 수 있음을 확인하였다. Purpose: To prevent excessive sliding and subsequent fixation failures in unstable intertrochanteric fractures with posteromedial comminution, extramedullary reduction through overlapping of the anteromedial cortices of both proximal and distal fragments as a buttress has been introduced. The purpose of this study was to compare the biomechanical properties between two reduction methods-intramedullary reduction and extramedullary reduction-in treating unstable intertrochanteric fractures with posteromedial comminution (AO/OTA classification 31-A2.2). Materials and Methods: Eight pairs of frozen human cadaveric femora were used. The femora of each pair were randomly assigned to one of two groups: the intramedullary reduction group or the extra medullary reduction group. A single axial load-destruction test was conducted after cephalomedullary nailing. Axial stiffness, maximum load to failure, and energy absorbed to failure were compared be tween the two groups. Moreover, the pattern of mechanical failure was identified. Results: The mean axial stiffness in the extramedullary reduction group was 27.3% higher than that in the intramedullary reduction group (422.7 N/mm vs. 332.0 N/mm, p=0.017). Additionally, com pared with the intramedullary reduction group, the mean maximum load to failure and mean energy absorbed to failure in the extramedullary group were 44.9% and 89.6% higher, respectively (2,848.7 N vs. 1,966.5 N, p=0.012 and 27,969.9 N·mm vs. 14,751.0 N·mm, p=0.012, respectively). In the intra medullary reduction group, the mechanical failure patterns were all sliding and varus deformities. In the extramedullary reduction group, sliding and varus deformities after external rotation were noted in 3 specimens, sliding and varus deformities after internal rotation were noted in 3 specimens, and medial slippage was noted in 2 specimens. Conclusion: In unstable intertrochanteric fractures with posteromedial comminution, the biomechanical properties of extramedullary reduction are superior to those of intramedullary reduction. Anteromedial cortex could be the proper buttress, despite a comminuted posteromedial cortex. It could help enhance the stability of the bone-nail construct.
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