Can Alarming Improve Compliance with Weekly Bisphosphonate in Patients with Osteoporosis?

노재휘,이영균,하용찬,김정현,서유성,구경회 대한골대사학회 2016 대한골대사학회지 Vol.23 No.2

Background: Although bisphosphonate is effective for the prevention and treatment of osteoporosis, poor medication compliance is a key-limiting factor. We determined whether alarm clock could improve compliance with weekly bisphosphonate in patients with osteoporosis, by comparing with age- and gender-matched control group. Methods: Fifty patients with osteoporosis were recruited and participated in alarm clock group. Patients were asked to take orally weekly risedronate for 1 year, and received alarm clock to inform the time of taking oral bisphosphonate weekly. Using the propensity score matching with age and gender, 50 patients were identified from patients with osteoporosis medication. We compared the compliance with bisphosphonate using medication possession ratio (MPR) between two groups. Results: Although there was no significant difference of baseline characteristics between both groups, the mean MPR (0.80±0.33) of alarm clock group was higher than that (0.56±0.34) of control group (P<0.001). Conclusions: Alarming could improve the compliance with weekly oral bisphosphonate in patients with osteoporosis.

Revision Arthroplasty Using a MUTARS® Prosthesis in Comminuted Periprosthetic Fracture of the Distal Femur

노재휘,최형석,김정현,권세원,박종석,서유성 연세대학교의과대학 2016 Yonsei medical journal Vol.57 No.6

Periprosthetic fractures after total knee arthroplasty (TKA) are gradually increasing, reflecting extended lifespan, osteoporosis, and the increasing proportion of the elderly during the past decade. Supracondylar periprosthetic femoral fracture is a potential complication after TKA. Generally, open reduction and internal fixation are the conventional option for periprosthetic fracture after TKA. However, the presence of severe comminution with component loosening can cause failure of internal fixation. Althoughthe current concept for periprosthetic fracture is open reduction and internal fixation, we introduce an unusual case of revision arthroplasty using a MUTARS® prosthesis for a comminuted periprosthetic fracture in the distal femur after TKA, with technical tips.

Examination of the Pronator Quadratus Muscle during Hardware Removal Procedures after Volar Plating for Distal Radius Fractures

노재휘,공현식,송철호,이성명,이영호,백구현 대한정형외과학회 2014 Clinics in Orthopedic Surgery Vol.6 No.3

Background: It is not clear whether the pronator quadratus (PQ) muscle actually heals and provides a meaningful pronation force after volar plating for distal radius fractures (DRFs). We aimed to determine whether the length of the PQ muscle, which is dissected and then repaired during volar plating for a DRF, affects the forearm rotation strength and clinical outcomes. Methods: We examined 41 patients who requested hardware removal after volar plating. We measured the isokinetic forearm rotation strength and clinical outcomes including grip strength, wrist range of motion, and disabilities of the arm, shoulder and hand (DASH) scores at 6 months after fracture fixation. During the hardware removal surgery, which was performed at an average of 9 months (range, 8.3 to 11.5 months) after fracture fixation, we measured the PQ muscle length. Results: The average PQ muscle length was 68% of the normal muscle length, and no significant relationship was found between the PQ muscle length and the outcomes including isokinetic forearm rotation strength, grip strength, wrist range of motion, and DASH scores. Conclusions: This study demonstrates that the length of the healed PQ muscle does not affect isokinetic forearm rotation strength and clinical outcomes after volar plating for DRFs. The results of this study support our current practice of loose repair of the PQ that is performed by most of the surgeons to prevent tendon irritation over the plate, and suggest that tight repair of the PQ is not necessary for achieving improved forearm function

Ceramic Head Fracture in Ceramic-on-Polyethylene Total Hip Arthroplasty

노재휘,박종석,송의섭,김우종,서유성 연세대학교의과대학 2013 Yonsei medical journal Vol.54 No.6

Revision rates of total hip arthroplasty have decreased after introducing total hip arthroplasty (THA) using ceramic component, since ceramic components could reduce components wear and osteolysis. The fracture of a ceramic component is a rare but potentially serious event. Thus, ceramic on polyethylene articulation is gradually spotlighted to reduce ceramic component fracture. There are a few recent reports of ceramic head fracture with polyethylene liner. Herein, we describe a case of a ceramic head component fracture with polyethylene liner. The fractured ceramic head was 28 mm short neck with conventional polyethylene liner. We treated the patient by total revision arthroplasty using 4th generation ceramic on ceramic components.

투석을 시행하는 만성 신부전 환자의 인공 고관절 치환술 시 합병증에 대한 분석

노재휘(Jae-Hwi Nho),최형석(Hyung-Suk Choi),박강희(Kang-Hee Park),박종석(Jong-Seok Park),서유성(You-Sung Suh) 대한정형외과학회 2011 대한정형외과학회지 Vol.46 No.3

목적: 투석을 시행받는 만성 신부전 환자에 대한 수술적 치료는 결과 및 예후가 일반 환자군에 비해 불량하여, 인공 고관절 치환술을 시행받은 만성 신부전 환자의 수술과 관련된 합병증에 대한 결과적 차이를 분석하고자 하였다. 대상 및 방법: 투석 중인 만성신부전 환자에서 양극성 반치환술이나 고관절 전치환술을 시행한 38명의 환자, 총 40예를 대상으로 합병증의 종류와 빈도 및 연령, 성별, 투석 기간, 당뇨 합병 여부에 따라 환자군을 분류하여, 술 후 1년 내 수술과 관련된 합병증에 대해 분석하였다. 결과: 술 후 1년 내 총 15예에서 정형외과적 혹은 내과적 합병증이 발생하였고(37.5%), 사망은 전체 8예(20%)였다. 성별 및 투석 기간에 따른 분류에서는 합병증 발생 및 사망률에 있어 통계학적으로 유의한 차이점은 발견할 수 없었으나, 연령(p=0.014) 및 당뇨(p=0.026) 합병 여부에 따른 분류에서는 합병증 발생에 있어서 유의한 차이점을 발견할 수 있었다. 결론: 투석을 시행하는 만성 신부전 환자에서 시행한 인공 고관절 전치환술은 다양한 합병증이 발생할 수 있으며, 특히 고령 환자 및 당뇨가 동반된 경우 보다 세심하고 철저한 수술 전 치료 계획 및 술 후 관리를 통해 합병증을 줄이려는 노력이 필요하다. Purpose: In general, the results and prognosis of surgical treatment in dialysis patients are poor compared to patients with normal kidney function. This study analyzes the complications in chronic renal failure patients who underwent primary hip arthroplasty for hip fractures and arthropathy. Orthopaedic complications and medical complications were analyzed for a consequential difference. Materials and Methods: Between 2003 and 2008, 38 dialysis patients (40 cases) with chronic renal failure were enrolled with 24 cases of bipolar hemiarthroplasty and 16 cases of total hip arthroplasty. Types and rates of orthopaedic and medical complications were investigated. Patients were classified according to age, gender, duration of dialysis and diabetes mellitus status. Complications were analyzed for each group. Results: Complications occurred in 15 patients (overall complication rate: 37.5%). Eight patients were died within 1 year (mortality: 20%). Gender and duration of dialysis were not correlated to number of complications. However, there were significant differences according to age (p=0.014) and having diabetes (p=0.026). With regard to mortality, there was no significant difference according to the above classification. Conclusion: Patients on hemodialysis have a high risk of complications after primary hip arthroplasty, especially in elderly patients and diabetic patients. Therefore, we require a full disclosure before recommending hip arthroplasty surgery in dialysis patients, and close postoperative care in patients undergoing dialysis.

Clinical and Radiologic Outcomes among Bipolar Hemiarthroplasty, Compression Hip Screw and Proximal Femur Nail Antirotation in Treating Comminuted Intertrochanteric Fractures

서유성,노재휘,김성민,홍시전,최형석,박종석 대한고관절학회 2015 Hip and Pelvis Vol.27 No.1

Purpose: In comminuted intertrochanteric fractures, various operative options have been introduced. The purpose of this study was to determine whether there were differences in clinical and radiologic outcomes among bipolar hemiarthroplasty (BH), compression hip screw (CHS) and proximal femur nail antirotation (PFNA) in treating comminuted intertrochanteric fractures (AO/OTA classification, A2 [22, 23])Materials and Methods: We retrospectively evaluated total 150 patients (BH, 50; CHS, 50; PFNA, 50) who were operated due to intertrochanteric fractures from March 2010 to December 2012 and were older than 65 years at the time of surgery. We compared these three groups for radiologic and clinical outcomes at 12 months postoperatively, including Harris Hip Score, mobility (Koval stage), visual analogue scale and radiologic limb length discrepancy (shortening). Results: There was no statistical significance among three groups in clinical outcomes including Harris Hip Score, mobility (Koval stage), visual analogue scale. However, there was significant differences in radiologic limb discrepancy in plain radiographs at 12 months postoperatively (radiologic shortening: BH, 2.3 mm; CHS, 5.1 mm; PFNA, 3.0 mm; P=0.000). Conclusion: There were no clinical differences among BH, PFNA, and CHS in this study. However, notable limb length shortening could be originated during fracture healing in osteosynthesis, compared to arthroplasty (BH<PFNA<CHS).

Reduction Loss after Extension Block Kirschner Wire Fixation for Treatment of Bony Mallet Finger

김병성,노재휘,정기진,윤건희,박은석,박성용 대한수부외과학회 2018 대한수부외과학회지 Vol.23 No.4

Purpose: We investigated occurrence of reduction loss after extension block (EB) Kirschner wire fixation or additional interfragmentary fixation (AIF) and clinical results including extension lag of the distal interphalangeal joint for treating bony mallet finger. Methods: Forty-six patients were included with a mean follow-up of 28 months (range, 12-54 months). Twenty-seven patients were treated with EB K-wire fixation (Group A) while 19 patients were treated with AIF (Group B). We checked radiologic factors, such as amount of articular involvement, volar subluxation, mallet fragment angle, reduction loss, range of motion including extension lag, and functional outcomes using Crawford’s criteria. Results: Reduction loss occurred in eight patients (17%). Differences in mean extension lag, age, preoperative volar subluxation and mallet fragment angle between patients with reduction loss and those with reduction maintaining were significant. However, there were no significant differences in gender, hand dominance, amount of articular involvement, AIF, or further flexion between reduction loss and reduction maintaining. As for patterns of displacement, there was a sig-nificant relationship between gap or step-off and extension lag. Using Crawford’s evaluation criteria, functional outcomes were excellent in 31, good in 10, fair in 3, and poor in 2 patients. Conclusion: Reduction loss should be careful in older age, smaller mallet fragment angle and preoperative volar subluxation.

Incidence of Osteoporotic Refractures Following Proximal Humerus Fractures in Adults Aged 50 Years and Older in Korea

정형석,노재휘,하용찬,장선미,김하영,유준일,박상민,이영균 대한골대사학회 2019 대한골대사학회지 Vol.26 No.2

Background: The purpose of this study was to investigate the incidence and characteristics of osteoporotic refractures after proximal humerus fracture in Korean adults aged above 50 years. Methods: Patients aged 50 years or older with initial proximal humerus fractures reported in 2012 were enrolled and followed up until 2016 using the Korean National Health Insurance data. Based on the last claim date, the refractures were classified as osteoporotic fractures including spine, hip, distal radius, and humerus 6 months after the index fracture involving the proximal humerus. Each osteoprotic fracture was identified using specific International Classification of Diseases, 10th Revision codes and site-specific physician claims for procedures. Results: A total of 5,587 first-time fractures involving proximal humerus were reported in 2012. Among them, a total of 1,018 osteoporotic refractures occured between 2012 and 2016. The total cumulative incidence of osteoporotic refractures was 4.85% (271/5,587) at 1 year, 9.61% (537/5,587) at 2 years, 14.21% (794/5,587) at 3 years, and 18.22% (1,018/5,587) at 4 years. In terms of site by year, the incidence of associated refractures was as follows: spine, 48.62% (495/1,018); hip, 25.83% (263/1,018); wrist 18.57% (189/1,018); and humerus 6.97% (71/1,018) during all the follow-up periods. Conclusions: Our study showed that the cumulative incidence of osteoporotic refractures following proximal humerus fractures in the elderly population has been increasing over the years. Given that osteoporotic refractures are associated with an increased mortality risk, a public health strategy to prevent the refracture after proximal humerus fracture in the elderly is imperative.

정형외과 수술의 무수혈적 환자혈액관리 프로토콜

서유성,이정재,노재휘,정하란,이원석,장병웅,김용범,천동일,최성우,이재철,최형석 대한수혈학회 2019 大韓輸血學會誌 Vol.30 No.1

We developed a new blood management protocol that allows patients to not undergo transfusion during major orthopaedic surgery. Here, we report the safety of or our protocol. The preoperative pharmacological protocol consisted of the administration of 40 g of recombinant erythropoietin subcutaneously and 100 mg of iron supplements intravenously. During the operation, reinfusion of drainage blood using a cell saver and plasma expander was used. The cell saver device passed the collected blood through a filter, which washed the blood, removing the hemolyzed cells and other impurities. Intravenous tranexamic acid 1 g is given just before the operation, except high-risk patients for venous thromboembolism. Postoperatively, recombinant erythropoietin and iron supplements were administered in the same manner with the preoperative protocol and continued until a hemoglobin level reached 10 g/dL.

Dorsal Translation of Ulnar Head after the Arthroscopic Wafer Procedure for Ulnar Impaction Syndrome

윤건희,정기진,노재휘,조휘제,김병성 대한수부외과학회 2019 대한수부외과학회지 Vol.24 No.4

Purpose: The purpose of this study was to evaluate the results of the arthroscopic wafer procedure (AWP) for ulnar im-paction syndrome (UIS) and identify preoperative factors and degree of distal radioulnar joint (DRUJ) translation that could assist in predicting outcomes. Methods: We retrospectively reviewed the medical records of 9 patients (11 wrists) who underwent AWP for UIS. Among these, 5 cases were converted to secondary ulnar shortening osteotomy and were categorized to group A and the remaining 6 cases were categorized to group B. The ulnar variance (UV), radioulnar ratio (RUR) by computed tomog-raphy or magnetic resonance imaging (MRI), MRI evidence of mechanical impaction in the ulnar or lunate, grip power, Disability of Shoulder, Arm and Hand (DASH) score, and Mayo wrist score were examined before and after AWP. Results: The MRI evidence did not differ significantly between groups A and B (p>0.05). The average UV and RUR changed from 1.6±0.7 mm and 0.68±0.17 before AWP to –1.5±0.9 mm and 0.54±0.10 after AWP, respectively. The differ-ence between the preoperative RUR (0.65) and postoperative RUR in group B (0.49) was significant (p=0.027, Pearson correlation coefficient=0.862). The grip strength, DASH score, and Mayo wrist score improved from 77.1%, 47.6, and 69.1 to 85.2%, 16.8, and 85.5, respectively. Conclusion: If patients have persisting pain and DRUJ dorsal translation is not reduced after wafer procedure, secondary ulnar shortening osteotom may be required.