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Treatment of Chronic Osteomyelitis of Femur and Reconstruction with Fibular Osteocutaneous Free Flap (대퇴골 만성골수염의 치료 및 비골 유리골피판술을 이용한 재건)

  • Baik, Eui Hwan;Ahn, Hee Chang;Choi, Seung Suk;Jo, Dong In;Hwang, Kun Sung;Chung, Ung Seu
    • Archives of Plastic Surgery
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    • v.33 no.5
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    • pp.637-642
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    • 2006
  • Purpose: Incidence of chronic osteomyelitis in femur is lower than that of tibia due to abundantsurrounding soft tissue like muscles and subcutaneous fat. However, if the femur is infected, surgical approach would be very difficult because of surrounding soft tissue and bony defects would be getting larger due to the late detection. Chronic osteomyelitis of femur is an intractable disease with frequent recurrence and remained bone instability in spite of multiple classical operations. Methods: From August 1998 to October 2005, we had 7 cases of fibular osteocutaneous free flap to reconstruct the femur. Those were followed-up for 23 months. All 7 cases were male. 4 cases were in midshaft and the others are distal part of femur. Results: The 7 cases that had not been healed in spite of average 9.1 times previous operations were reconstructed successfully without the recurrence of chronic osteomyelitis. Continuous rehabilitation therapy and brace were very helpful for the ambulation. It took 5.6 months for complete union of bone, and 9.8 months for the ambulation. Conclusion: After wide resection, reconstruction of the femur using fibular osteocutaneous free flap guaranteed bone stability and prevented recurrence of osteomyelitis through rich blood supplying fibula and muscle. Double barrel graft of fibula would be needed in case of the sufficient strength and thickness of femur. We report the successful results of reconstruction of femur with fibular osteocutaneous free flap for chronic osteomyelitis of femur.

Femur Fractures in Parkinsonism: Analysis of a National Sample Cohort in South Korea

  • An, Soo Jeong;Lee, Seung-Hwan;Lee, Seo-Young;Kwon, Jae-Woo;Lee, Seung-Joon;Kim, Young-Ju
    • Journal of clinical neurology
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    • v.13 no.4
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    • pp.380-386
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    • 2017
  • Background and Purpose Falling with a femur fracture is a serious event that negatively affects the quality of life of elderly individuals as well as patients with parkinsonism. This study investigated the association between parkinsonism and femur fracture and compared the risk of femur fracture between subjects with and without parkinsonism. Methods This study examined a population-based matched cohort constructed using the National Sample Cohort data set, which comprises approximately one million subscribers to medical insurance and aid in South Korea. Subjects with parkinsonism during 2003-2013 were identified as the exposed group, and up to five individuals matched for age, sex, and index years were identified as the controls for each parkinsonism subject. The risk of femur fracture for parkinsonism was evaluated using Cox regression. Results The incidence of femur fracture according to age, sex, and body mass index varied significantly between subjects with parkinsonism and controls (p<0.001). The presence of parkinsonism was associated with a higher risk of femur fractures for males [hazard ratio (HR)=2.85, 95% confidence interval [CI]=1.87-4.34], subjects younger than 65 years (HR=2.89, 95% CI=1.64-5.11), and underweight subjects (HR=3.90, 95% CI=1.82-8.35). The adjusted HR for femur fracture with parkinsonism was highest within 2 years of the disease diagnosis (HR=3.10, 95% CI=2.12-4.53). Conclusions Our study found that the presence of parkinsonism is more strongly related to femur fracture in males, and increases the influence of traditional risk factors on femur fracture. It is necessary to consider how factors associated with the amount of ambulatory activity-even in an early diagnosed state-can play an important role in femur fracture in subjects with parkinsonism.

The Influence of Impact Angle on Hip Fracture in Fallings

  • Choi, Jae-Bong
    • International Journal of Safety
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    • v.4 no.1
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    • pp.1-7
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    • 2005
  • The direction of the applied load and displacement rate on the femur during falls may be an important factors in the etiology of hip fractures. Nonetheless, previous studies did not consider these two factors simultaneously for falling condition. Therefore, in the present study, an impact test system is developed to simulate the falling condition and the influence of impact angle on the deformation pattern changes of proximal femur is investigated. The results showed that a slight variation in impact angle quite affects deformation pattern of the proximal femur. Along with bone mineral density and trabaecular morphology, the impact angle can be another important factor affecting the structural capacity of the proximal femur.

Nutrient intake and Bone Minaral Density in Korean Premenopausal Women (폐경전 40대 한국 여성들의 영양 섭취 상태와 골밀도와의 관계)

  • 이종호;최미숙;백인경;문수재;임승길;안광진;이현철;송영득;허갑범
    • Journal of Nutrition and Health
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    • v.25 no.2
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    • pp.140-149
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    • 1992
  • It was hypothesized that variations within the range of usual calcium(Ca) and sodium(Na) intakes of Korean influence bone mineral density(BMD) in healthy premenopausal women The relationship of nutrient intake urinary excretion physical activity and circulating IGF-1 level with spine({{{{ { L}_{2 } }}}}-{{{{ { L}_{4 } }}}}) and femur BMD was determined in 47 normal premenpausal women. There was a positive relationship between BMD of the lumbar spine and body weight. The BMD of femoral neck was positively correlated with Ca and protein intakes from animal source and circulating IGF-1 level. There was a negative relationship between femur BMD and both Na intake and urinary excretion. The complex interrelations between femur BMD regression analysis, From this analysis. Ca intake from animal origin was the only significnat Premenopausal women of femur BMD. In the basis of femur BMD three groups were divided Premenopausal women of femur BMD$\leq$0.84g/cm2 showed depressed Ca intake of animal origin in later and early life and enhanced urinary Na excretion compared to women of femur study suggests that dietary Ca is a major constituent affecting femur BMD because of a decrease in net Ca absorption and an increase in urinary Ca loss.

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Clinical and Radiological Comparison of Femur and Fibular Allografts for the Treatment of Cervical Degenerative Disc Diseases

  • Oh, Hyeong-Seok;Shim, Chan Shik;Kim, Jin-Sung;Lee, Sang-Ho
    • Journal of Korean Neurosurgical Society
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    • v.53 no.1
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    • pp.6-12
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    • 2013
  • Objective : This consecutive retrospective study was designed to analyze and to compare the efficacy and outcomes of anterior cervical discectomy and fusion (ACDF) using a fibular and femur allograft with anterior cervical plating. Methods : A total of 88 consecutive patients suffering from cervical degenerative disc disease (DDD) who were treated with ACDF from September 2007 to August 2010 were enrolled in this study. Thirty-seven patients (58 segments) underwent anterior interbody fusion with a femur allograft, and 51 patients (64 segments) were treated with a fibular allograft. The mean follow-up period was 16.0 (range, 12-25) months in the femur group and 19.5 (range, 14-39) months in the fibular group. Cage fracture and breakage, subsidence rate, fusion rate, segmental angle and height and disc height were assessed by using radiography. Clinical outcomes were assessed using a visual analog scale and neck disability index. Results : At 12 months postoperatively, cage fracture and breakage had occurred in 3.4% (2/58) and 7.4% (4/58) of the patients in the femur group, respectively, and 21.9% (14/64) and 31.3% (20/64) of the patients in the fibular group, respectively (p<0.05). Subsidence was noted in 43.1% (25/58) of the femur group and in 50.5% (32/64) of the fibular group. No difference in improvements in the clinical outcome between the two groups was observed. Conclusion : The femur allograft showed good results in subsidence and radiologic parameters, and sustained the original cage shape more effectively than the fibular allograft. The present study suggests that the femur allograft may be a good choice as a fusion substitute for the treatment of cervical DDD.

Design and stress analysis of femur bone implant with composite plates

  • Ramakrishna, S.;Pavani, B.
    • Biomaterials and Biomechanics in Bioengineering
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    • v.5 no.1
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    • pp.37-50
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    • 2020
  • Development of lightweight implant plates are important to reduce the stress shielding effect for a prosthesis of femur bone fractures. Stainless steel (SS-316L) is a widely used material for making implants. Stress shielding effect and other issues arise due to the difference in mechanical properties of stainless steel when compared with bone. To overcome these issues, composite materials seem to be a better alternative solution. The comparison is made between two biocompatible composite materials, namely Ti-hydroxyapatite and Ti-polypropylene. "Titanium (Ti)" is fiber material while "hydroxyapatite" and "polypropylene" are matrix materials. These two composites have Young's modulus closer to the bone than stainless steel. Besides the variety of bones, present paper constrained to femur bone analysis only. Being heaviest and longest, the femur is the most likely to fail among all bone failures in human. Modelling of the femur bone, screws, implant and assembly was carried out using CATIA and static analysis was carried out using ANSYS. The femur bone assembly was analyzed for forces during daily activities. Ti-hydroxyapatite and Ti-polypropylene composite implants induced more stress in composite implant plate, results less stress induced in bone leading to a reduction in shielding effect than stainless steel implant plate thus ensuring safety and quick healing for the patient.

Bone Mineral Bensity and Bone Turnover Markers in Patients with Femur Fracture Who Visited the Emergency Department (응급센터를 내원한 대퇴골 골절 환자에서 골밀도와 생화학적 표지자들의 의의)

  • Lee, Kyoung Mi;Han, Seung Baik;Kim, Jun Sig;Baek, Kwang Je;Hong, Seong Bin;Moon, Kyoung Ho;Kang, Joon Soon;Yoon, Seung-Hwan
    • Journal of Trauma and Injury
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    • v.18 no.2
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    • pp.87-93
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    • 2005
  • Background: The most frequent fracture seen at the emergency department (ED) in the elderly is a femur fracture whereas they do not know the degree of osteoporosis. We analyzed the degree of osteoporosis in patients with femur fractures and compared patients with only femur fractures (FX) to patients with femur and vertebral fractures (VX) by examining the clinical features, the bone mineral density (BMD), and biochemical markers. Methods: From January 2004 to December 2004, we enrolled prospectively 30 femur fracture patients who visited the ED. The bone mineral densities of the lumbar spine and the femur were examined. Total calcium, phosphate, alkaline phosphatase, osteocalcin, and serum C-terminal telopeptide (s-CTx) were measured. The patients with femur fractures were divided into two subgroups according to the presence of vertebral fracture. Results: All BMDs of the FX group showed osteoporosis. The s-CTx levels were higher than normal. The patients in the FX with VX were older than those in the FX only group, and had lower BMDs. There were no significant differences in markers between the subgroups, but the incidence of trochanteric fractures was higher in FX with VX group than in the FX only group. Conclusion: Femur fractures in the elderly were associated with osteoporosis. In our study, despite a considerable difference in BMD between patients with femur fractures and those with femur fractures combined with vertebral fractures, there was no difference in biochemical markers on bone formation nor in the those of bone resorption. We will further investigate the biochemical markers and BMD in the population of osteoporotic fractures. So those indicators should be helpful for planning treatment and for prevention of FX in the elderly.

Effects of Gagamdokhwalgisang-Tang(GD;加減獨活奇生湯) on the Morphometric Changes of Femur and the Factors Related with Bone Metabolism in Ovariectomized Rats (가감독활지생탕(加減獨活奇生湯)이 난소적출 흰쥐 대퇴골의 형태계측학적 변화 및 골대사 관련인자에 미치는 영향)

  • Moon, Hyon-Ju;Lim, Eun-Mee
    • The Journal of Korean Obstetrics and Gynecology
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    • v.19 no.1
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    • pp.47-68
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    • 2006
  • Purpose : This study was carried out to investigate the effects of Gagamdokhwalgisang-Tang on the morphometric changes of femur, and on the hormones and cytokines associated with bone metabolism in overiectomized rats. Methods : Twenty-four female Sprague-Dawley rats were divided into sham operated group(normal) ovariectomized group(control), and treated with extract of GD group(treated). Each group was evaluated the changes of body weight at 0, 3, 6, 8 weeks after ovariectomy. Morphometric analysis(femur weight, femur/body weight ratio, femur ash weight femur ash/body weight ratio cross sectional area of compact bone and concellous bone of femur) and histopathological examination were performed at 8 weeks after ovariectomy. Estrogen, Alkaline Phosphatase(ALP) and cytokine(Tumor necrosis $factor-{\alpha}$, $Interleukin-l{\beta}$, Inerleukin-6) assay were performed at 8 weeks after ovariectomy. Results : 1. The body weight of control and treated group was significantly increased(p<<0.001) compared with the normal group at 8 weeks. 2. The femur weight and femur/body weight ratio of treated group were significantly increased(p<<0.05, p<<0.01) compared with the control group at 8 weeks. 3. The femur ash weight showed no significantly different changes, but femur ash/body weight ratio of treated group was significantly increased(p<<0.05) compared with the control group at 8 weeks. 4. In the cross sectional area of cancellous bone of femoral body, the treated group was significantly increased(p<<0.001) compared with the control group at 8 weeks. 5. The serum estrogen level of treated group showed no significantly different changes compared with the control group at 8 weeks. 6. The serum ALP activity of treated group was significantly decreased(p<<0.01) compared with the control group at 8 weeks. 7. The serum Tumor necrosis $factor-{\alpha}(TNF-{\alpha})$ level of treated group was significantly decreased(p<<0.05) compared with the control group at 8 weeks. 8. The serum $Interleukin-l{\beta}(IL-1{\beta})$ level of treated group was significantly decreased(n<<0.001) compared with the control group at 8 weeks. 9. The serum Interleukin-6(IL-6) level of treated group was significantly decreased(P<<0.01)compared with the control group at 8 weeks. Conclusion : These results indicate that GD inhibits bone resorption in ovariectomized rats. And the major inhibitory mechanism may be related to the inhibitory effects of GD on the secretion of $TNF-{\alpha}$, $IL-1{\beta}$ and IL-6 in the pathogenesis of osteoporosis in estrogen deficient rats.

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An Experimental Study of Radiographic Density of Alveolar Bone and Cortical Thickness of Mandible by Osteoporosis (골다공증에 따른 치조골 방사선사진농도와 하악하연두께의 변화에 대한 연구)

  • Lee Byeong-Do
    • Imaging Science in Dentistry
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    • v.30 no.4
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    • pp.235-242
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    • 2000
  • Purpose: To evaluate the effect of the systemic osteoporosis on radiographic density of alveolar bone and cortical thickness of mandible. Materials and Methods: The bone mineral density values of lumbar and femur were measured by dual-energy X-ray absorptiometry and T scores of lumbar, femur were obtained respectively. Radiographic densities of alveolar bones and panorama mandibular index (PMI, represents as cortical thickness) were analysed statistically according to age and T score variables. Results: The radiographic density of alveolar bone of maxillary molar showed significant difference by age and femur T group. That of mandibular molar showed significant difference between femur T group. Panorama mandibular index showed significant difference between age groups. Conclusion: The radiographic density of alvealar bones was more dependent on age and femur T than lumbar T. Cortical thickness of mandible was correlated with increasing age.

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