Apoptosis of Chondro cytes and Its Regulation in Pathogenesis of Osteoarthritis / 대한류마티스학회지

No abstract available.

Evaluation of Posterolateral Fusion Mass at Lumbosacral Junction Using Standard AP and Ferguson Radiographs / 대한척추외과학회지

PURPOSE: To evaluate the reliance of standard AP radiograph and Ferguson radiograph in assessment of instrumented lumbosacral fusion mass with interobserver and intraobserver reproducibilities. MATERIALS AND METHODS: Postoperative standard AP radiograph and Ferguson radiograph were used to evaluate the fusion mass at the lumbosacral region of 44 consecutive patients who underwent posterolateral L4-S1 or L5-S1 instrumented fusion with pedicle screws & autogenous iliac bone graft. Ferguson radiograph was performed with the x-ray beam oriented toward the cranial portion at 40degree relative to the x-ray table. All observations were performed independently by three observers, blinded to the history, diagnosis, and patient identity. The fusion mass was graded as solid, pseudarthrosis or questionable. A second review was repeated at 2 weeks after index review. Interobserver and intraobserver reproducibilities were analyzed with Fleiss'method. RESULTS: Ferguson radiographs were more reliable than standard AP radiographs in detecting the fusion mass. Kappa values with the interobserver reproducibility were higher in Ferguson radiographs than in the standard AP radiographs. Kappa values with the intraobserver reproducibility of all three observers were higher in Ferguson radiographs than in the standard AP radiographs. The questionable fusion masses in the standard AP radiographs were revealed solid or pseudarthrosis in Ferguson radiographs in 67%. CONCLUSIONS: Ferguson radiograph is a more reliable method than standard AP radiograph in evaluating instrumented posterolateral fusion mass in lumbosacral region.

Nitric Oxide Production of Rat Osteoblast Cells by Pulsed Electromagnetic Field Radiation / 대한정형외과연구학회지

Experimental study was conducted to prove the effect of pulsed electromagnetic field (PEMF) on the production of Nitric oxide (NO) from the cultured rat osteoblast-like cells. Calvarium of thirty Sprgue-Dawley rats was digested by sequential collagenase and cultured in-vitro. The osteoblast cell phenotype was confirmed by expression of osteoclacin by immunohistochemistry. PEMF was generated and applied to cultured osteoblast cells. Production of NO was measured by Greiss reaction. Ten minute exposure of PEMF to ostoeblast cell showed increased NO content at 24 and 48 hours(p<0.05). Cultures with different duration of PEMF exposure (10, 20, 30 60 minutes) demonstrated similar responses. In conclusion. this study proved that NO can be generated with PEMF which support the notion that NO can be a possible mediator of PEMF on bone metabolism.

Nitric Oxide Production of Rat Osteoblast Cells by Pulsed Electromagnetic Field Radiation / 대한정형외과연구학회지

Experimental study was conducted to prove the effect of pulsed electromagnetic field (PEMF) on the production of Nitric oxide (NO) from the cultured rat osteoblast-like cells. Calvarium of thirty Sprgue-Dawley rats was digested by sequential collagenase and cultured in-vitro. The osteoblast cell phenotype was confirmed by expression of osteoclacin by immunohistochemistry. PEMF was generated and applied to cultured osteoblast cells. Production of NO was measured by Greiss reaction. Ten minute exposure of PEMF to ostoeblast cell showed increased NO content at 24 and 48 hours(p<0.05). Cultures with different duration of PEMF exposure (10, 20, 30 60 minutes) demonstrated similar responses. In conclusion. this study proved that NO can be generated with PEMF which support the notion that NO can be a possible mediator of PEMF on bone metabolism.

Change of the Effect of TGF-beta1 on Physeal Chondrocytes According to Culture Methods in Vitro / 대한정형외과학회잡지

PURPOSE: We intended to check the growth rates and phenotypic markers of chondrocytes in the dedifferentiated cells cultivated in various conditions in order to establish the ideal culture system for implantation. MATERIALS AND METHODS: Culturing rabbit chondrocytes from proximal tibia, we checked the phenotypes at first, second, and third week. Then we cultured the chondrocytes in different circumstances such as monolayer or three dimensional gel in the presence or abscence of TGF-B1, and checked the growth rates and phenotypic markers. RESULTS: There was no difference in growth rates and mRNA level of type I, type II collagen and aggrecan between the cells cultured in monolayer and three dimensional gel of collagen. However, the responses of the cells to TGF-B1, were quite different between these two groups. In monolayer culture, the expression of type I collagen was depressed by TGF-B1 while the growth rate was markedly increased. Oppositely in three dimensional culture, the mRNA level of type I collagen was markedly increased and the growth rate was completely suppressed by TGF-B1. The expression of type II collagen could be detected only in TGF-B1-treated cells cultured in three dimensional gel for 4 or more days. The mRNA level of aggrecan was also increased by TGF-B1, in the cells cultured in three dimensional gel. CONCLUSIONS: These results suggest that the number of chondrocytes can be efficiently expanded by culturing the cells in monolayer and the phenotypes of chondrocyte can be restored by culturing the cells in three dimensional gel containing TGF-B1. The application of semi-solid gel containing differentiated chondrocytes in physeal implantation should be further evaluated

Prediction of Risk Factors in Hip Fractures from Simple Radiographic Measurements of the Proximal Femur / 대한정형외과학회잡지

PURPOSE: To investigate whether simple measurements made on conventional pelvis plain film could predict hip fractures independently of bone mineral density. MATERIALS AND METHODS: The authors analyzed the simple radiographs and dual x-ray absorptiometry scan of women over the age of 60 years who had sustained a neck fracture (n=40), trochanteric fracture (n=40) and non-fracture volunteers (n=40). RESULTS: In an age-adjusted univariate logistic regression model, the most reliable risk factor of hip fracture in bone mass was bone mineral density of the femoral neck. In the measurements of bone architecture, the most important risk factor was Singh index and in bone geometric measurements, it was hip axis length. There were no statistical differences in the measurements between neck fractures and trochanteric fractures. In a multivariate model, these three variables were shown to be significant improvements in the assessment of hip fracture risks. CONCLUSIONS: The authors concluded that simple measurements of proximal femoral geometry made on pelvic radiographs could predict hip fracture as well as bone density of the hip.

Effect of Intermittent Administration of Parathyroid Hormone on Fracture Healing in Ovariectomized Rats / 대한정형외과학회잡지

PURPOSE: This study was designed to compare fracture healing in normal and ovariectomized rat, and to evaluate the effect of intermittent administration of parathyroid hormone on fracture healing in osteopenic animal model, MATERIALS AND METHODS: Four-months-old mature female Sprague-Dawley rats were randomly elivided into 5 groups. Group I underwent a sham operation, and others (Group II-V) were ovariectomized. At three months after ovariectomy or sham operation, standardized bilateral transverse tibial fractures were created and intramedullary nailings with Kirschner wire were performed. The rats were then treated with daily subcutaneous injection of placebo in Groups I and II, 17beta-estradiol in Group III, low doses of recombinant human PTH (1-84) in Group IV, and high doses of recombinant human PTH (1-84) in Group V for 4 weeks. At day 30 of post-fracture the animals were sacrificed and fracture healing was assessed with histologic/histomorphometric analysis and three-point bending mechanical testing. RESULTS: On histologic/histomorphometric evaluation of sham operation group, the fracture callus mainly consisted of dense trabecular bone. On the other hand, Groups II and III seemed to have much looser cancellous network, abundant in fibrous marrow. In parathyroid hormone-treated g roups, external callus consisted of more dense trabecular, woven bone than that of Groups II or III, and especially the high doses of parathyroid hormone-treated group was comparable to the sham operation group in terms of per cent trabecular bone volume (Group I>V>IV>III=II, PIV>III=II, PIV=III=II, PIV=II=III, P<0.05). CONCLUSIONS: On the basis of this study, it may be concluded that fracture healing is delayed in the ovariectomy-induced osteopenic rat model. Our experiment also showed dose-related stimulation of parathyroid hormone in the strength of fracture, and that antiresorptive agents such as estrogen had no effect. Further study is needed in large animal model, and attention should be focused on systemic/long-term effect of parathyroid hormone and its relationship with local growth factors in fracture healing.

Risk factor for osteoporotic vertebral fractures in korean postmenopausal women / 대한내과학회지

BACKGROUND: Osteoporotic fracture is an important cause of disability in elderly women, and vertebral fractures are the most common of aU osteoporotic fractures. To prevent osteoporotic vertebral fracture, risk factor identification is necessary, therefore, we examined the relationship between the well-known risk factors for osteoporosis or falls and vertebral fracture. METHODS: A total 105 Korean women aged 50-76 and had postmenopausal osteoparosis were enrolled in this study. We examined the factors attributing to develop the osteoporotic vertebral fractures through comparing the arthropometric data, past and family histories of fractures, amount of exer#cise, risk factors for falls, biochemical markers, and bone mineral densities. RESULTS: 41 had one or more vertebral fractures and 64 had no vertebral fracture. Compared to women without vertebral fracture, women with vertebral fractures were older, smaller and showed higher waist-hip ratio and larger degree of kyphosis. History of previous fractures had a significant correlation with vertebral fractures and spending a few hours daily on the feet was a risk factor for osteoporotic vertebral fractures. Women who had no vertebral fracture had greater muscle mass of leg, walked faster, and tolerated more time in tandem position than who had any osteoporotic. vertebral fracture. Compared to the non-fractured group, serum albumin level was lower in the fractured group, and urine deoxypyridinoline/creatinine ratio, the bone resorption marker, was greater in the fractured group as predicted. Women without any fracture had greater bone mineral density of femoral neck and lumbar vertebrae. In Logistic regression analysis, waist-hip ratio, history of previous fractures, degree of kyphosis, and thigh circumference were the risk factors for the osteoporotic vertebral fracture. CONCLUSION: It could be possible to prevent osteoporotic vertebral fractures by efforts to identify and reduce the risk factors. But prospective studies should be performed regatding social and traditional characteristics of Korea.

Correlation of the Bone Mineral Density with Morphometric Dimensions and Characteristics of Osteoporotic Vertebral Fracture / 대한정형외과학회잡지

This study was aimed (1) to evaluate osteoporotic vertehral fracture using normal morphometric dimensions in the Korean women (2) to test the relative importance of vertebral morphometry and fracture characteristics in predicting lumbar spine hone mineral density (3) to study clinical significance of the patients of 2 standard deviation to 3 standard deviation morphometric value. Normal morphometric data was ohtained from 60 heolthy women and 100 women with osteoporotic vertebral fracture defined by normal morphometry were evaluated. Fracture identification by 3SD cut off value was almost similar with that of qualitative method. Fracture identification by 2SD cut off value showed an increased number of fractures on the mid thoracic and thoracolumbar junction. Distrihution of the osteoporotic vertehral fracture showed double peaks on mid thoracic and thoracolumbar junction. Bone mineral density of third lumhar spine (LSBMD) in the multiple fracture group was significantly decreased from that of the single tracture group(p0.05). Comparing LSBMD of 3SD, 2SD-3SD fracture group and controls, the 3SD fracture group showed lowest value (P<0.01). But LSBMD of 2SD-3SD fracture group showed no difference with that of controls. Fracture threshold was 0.847gm/cm2 in 90th percentile. The correlation of LSBMD with the sum of normalized height of vertebral bodies, the sum of the deformity ratio of the vertebral body and spinal deformity index were all statistically insignificant.

Autologous Vs Allogenic Chondrocytes Transplantation for Full Thickness Chondral Defects in Rabbit's Patella / 대한정형외과학회잡지

Biologic resurfacing of the damaged joints is an area of great interest and clinical promise because of the limited potential ofdamaged articular cartilage healing. Several methods such as spongiolization. joint dehridement and ahrasion of suhchondral hone. perichondral grafts, and osteochondral grafts have heen used to repair cartilage defects, but the results were not satisfactory. Rccently autologous chondrocyle transplantation with a pcrioslcal patch was paid an altention for its advantage , the regeneration with hyalin cartilage. But it have many disadvantages such as too expensive cost. second staged operation, and technically difficult to isolatc chondrocytes from a small volume of donor site, so we performed that a definecl cartilaee delect in the ribbit patella was treated with transplanta1ion of in virto expanded allogenic chondrocvtes and then compared with an autologous chondrocytes transplantation. Adult rabbits were used to transplant autogenously and allogenously and allogenically harvested and in vitro cultured chondrocytes into patellar chondral lesions that had been made previously 3x 3mmin size , extending down to the calcified zone. Chondrocytes were isolated in the femoral condyle of the opposite knee or othe rabbit knee. And then enzymatic digestion ( collagenase A and DNase I ) was performed for 5 hours room temperature in a spinner bottle and cells were seeded in a 25cm2 culture flask in Dulheccos modified essential medium (DMEM), supplemented with l0% fetal hovine serum (FBS). The culture medium was changed twice weekly. After 14 days of culture, the cells were isolated hy irypsinization and transplanted into previously made chondral defects with an autogenous periosteal patch taken from the medial aspect of tibia. Healing ol' the defects was assessed by gross examination, immunohistochemical stain, and light microscope with hematoxylin-eosin stain at 8, 16, and 24 weeks. Allogenic and autologous chondrocytes transplantation significantly increased the amount of newly tormed repair tissue compared to that found in control knees in which the Jesion was solely covered hy a periosteal patch. The repair tissue, however, had a tendency of incomplete bonding to adjacent cartilage. This study shows that allogenic and autologous articular chondrocytes that have heen expanded for 2 weeks in vitro can stimulate the healing phase of chondral lesion. There is no signilicant diffcrence hetween allogenic and autologous chondrocytes transplantation.

Anatomic Variations and Magnetic Resonance Imaging of the Lateral Ankle Ligaments / 대한해부학회지

The lateral ankle ligaments consisted of the anterior talofibular, posterior talofibular and calcaneofibular ligaments. This study was to investigate the dimensions and anatomic variations of these ligaments and correlate with MR images. Sixty seven ankles of Korean adults were used. Among these 37 ankles were only disseted and 30 ankles were dissected after getting MR images. The anterior talofibular ligament consisted of two bands in 72.4%. The length and thickness of this ligament were 20.9mm and 1.8mm, respectively. The widths were 7.0 mm in the upper band and 4.7 mm in the lower band. The talofibular ligament appeared as a hypointense thick band or several lines in MR images. This ligament was observed in 100% of the axial MR sections and 82.8% of the coronal sections. The posterior talofibular ligament showed single thick band in 53.2% while others showed as two bands. The length, width, thickness and the angle between the horizontal plane and the posterior talofibular ligament were 21.8 mm, 7.3 mm, 3.4 mm and 22.6degrees, respectively. In coronal MR images this ligament appeared as a hypointense and heterogeneous thick band between the lateral malleolus and the talus. All anterior and posterior talofibular ligaments were observed in axial MR images with at least one same MR plane showing the two ligaments together. The length, width and thickness of the calcaneofibular ligament were 25.3 mm, 5.2 mm and 2.3 mm, respectively. It was composed of two bands in 8.5%. The angles to the coronal and sagittal planes and this ligament were 20.7degrees(range 5degrees~60degrees) and 27.0degrees(range 7degrees~50degrees), respectively. The calcaneofibular ligament was seen as a hypointense short line or dot depending on the cut plane. It was observed in 72.4% of the axial MR images and in 75.9% of the coronal images but was better imaged in the coronal planes.

Risk Factors for Failed Healing in Amputation for Vacscular Obstructive Diseases in Lower Extremity / 대한정형외과학회잡지

We examined the factors which may serve as predictors of success or failure of amputation in lower extremity for vascular obstructive diseases in 52 consecutive patients who were treated at the Department of Orthopaedic Surgery and Yonsei Cardiovascular Center from January 1st, 1990 to December 31st, 1994. The minimum follow up period was 10 months. The population was divided into two groups, group of success of primary amputation and group of failure. The results were as follows, male and female ratio was 42:10 and the average age was 57.5 years old. Among total 52 cases, there were 22 cases of arteriosclerosis obliterans, 15 cases of Buerger's diseases, 12 cases of vasculitis, 3 cases of acute arterial embolism. Complications after primary amputation included 9 cases of superficial wound infections, 7 cases of marginal wound necroses. Sixteen cases belonged to the group in which reamputation were performed because of intractable poor wound healing. Preoperative value of hemoglobin, hematocrit, serum albumin and serum creatinine which had been generally known as prognostic factors in wound healing were not related to the necessity of reamputation (Multivariate Regression Test, P>0.05). And also age, blood pressure and smoking history and level of amputation didn't show any difference between two groups but existence of lower extremity infection and uncontrolled diabetes mellitus were related to the prognosis of reamputation (Multivariate Regression Test, P<0.05).

Effect of Calcium and Activated Vitamin D ( 1- hydroxyvitamin-D ) on Bone Mineral Density in Osteoporosis / 대한정형외과학회잡지

Forty-five elderly female osteoporotics were given daily dose of 750 mg of calcium and 1.0 microgram of activated vitamin D (1-a hydroxyvitamin D) orally for 24 months to evaluated the effect of drugs on bone mineral density. Bone mineral density was evaluated and repeated every 6 months for 2 years. Average bone mineral density (L (2)-L (4)) and T score were 0.773 (SD 0.120) and -2.90 (SD 0.97) before treatment, and increased to 0.808 (SD 0.121) and -2.59 (SD 0.97) after 24 months of therapy, respectively (p<0.01). During treatment, complications including hypercalcemia, hypercalciuria, or renal stone were not observed, and indicators of renal function were normal. Therefore the activated vitamin D treatment in osteoporosis is effective in diminishing normal decline of bone mineral density, especially in areas with low calcium and vitamin D intake, such as South Korea.

The Early Development of The Human Knee Joint / 대한정형외과학회잡지

As the arthroscopic surgery of the knee joint has taken rapid strides recently, the knowledge of the structure and deveIopment of the joint are getting needed more and more. An embryological study about the development of the human knee joint was carried out using a total of 23 knees of human embryos. Serial sections of 23 embryos aged 5-8 postovulatory weeks (12-31 mm C.R.) and 3-dimensional reconstruction were examined. The embryos have been staged according to Carnegie's 'developmental stages'. The femur, tibia and fibula had begun to undergo chondrification by stage 18. The patella had commenced chondrification at stages 23. As the mesenchymal model began to chondrify, concomitant changes occurred in the region of the presumptive knee joint to create the interzone (stage 19-20). The following structures became condensed successively: patellar tendon (18-19), lateral collateral ligament and popliteus tendon (19-20), cruciate ligaments (20-22), meniscus (21-22). In summary, the differentiation from a generalized cellular blastema to a joint resembling the adult in form and arrangement occurred in only a relatively few days. By the end of the embryonic period proper (stage 23, 8 postovulatory weeks), all the elements of the knee joint were present in a form and arrangement closely resembling those of the adult. It seems that the embryological studies are more required to clarify the structures having many variants such as synovial plica, meniscus, and the development of the joint cavity through this study.

The Relationship between the Fracutures of the Hip and the Bone Mineral Density over Fifty years / 대한정형외과학회잡지

Osteoporosis has been described as the most common disease in the old age group. As the bone mineral density decreases, the skeleton becomes more prone to fracture. Hip fractures occur late in life following substantial reduction in skeletal mass. So the incidence of hip fracture is increasing due to prolongation of average life span. The bone density of femoral neck, Ward triangle, and trochanteric region were measured by dual energy x-ray absorptiometry (DEXA) in 15 patients with femoral neck fractures and in 58 patients with intertrochanteric fractures to evaluate the relationship between bone mineral density (BMD) value and fracture type. The results were as follows 1. In femoral neck fracture group, the mean BMD value was 0.59+/-0.02 g/cm2 in femoral neck, 0.38+/-0.08 g/cm2 in Ward triangle and 0.48+/-0.09 g/cm2 in trochanteric region. In intertrochanteric fracture group, the mean BMD value was 0.57+/-0.09 g/cm2 in femoral neck, 0.39+/-0.10 g/cm2 in Ward triangle, and 0.47+/-0.13 g/cm2 in trochanteric region. 2. In femoral neck fracture group, the fracture threshold value was 0.75 g/cm 2 in femoral neck, 0.60 g/cm2 in Ward triangle and 0.67 g/cm2 in trochanteric region. In intertrochanteric fracture group, the fracture threshold value was 0.63 g/cm2 in femoral neck, 0.51 g/cm2 in Ward triangle, and 0.57 g/cm2 in trochanteric region. In conclusion, there was no statistical relationship in BMD value between neck fracture and intertrochanter fracture group, and no statistical relationship between BMD value and each fracture type in femoral neck and intertrochanter fracture. The type of hip fracture may be related to the degree of trauma rather than the value of the BMD.

Transforming growth factor-beta 1 responsiveness of human articular chondrocytes in vitro: normal versus osteoarthritis

The transforming growth factor-beta 1 was known as having the most important influence on chondrocytes among various growth factors, being abundant in articular chondrocytes and osteocytes. We performed in vitro monolayer cultures of human articular chondrocytes from normal and osteoarthritic patients and studied the transforming growth factor-beta 1 responsiveness of those chondrocytes. The cell-growth curve indicated that the primary osteoarthritic chondrocyte culture with transforming growth factor-beta 1 showed a more rapid growth pattern than normal chondrocytes with or without TGF-beta 1 and osteoarthritic chondrocytes without TGF-beta 1. The osteoarthritic group showed a sharp decline in growth pattern with subsequent culture. The shape of osteoarthritic chondrocytes was bigger and more bizarre compared to those of normal chondrocytes. With subsequent culture, this change became prominent. The transforming growth factor-beta 1 increased the [3H]-TdR uptake in each group. The phenotypes of chondrocytes were more clearly expressed in the normal group. The chondrocytes lost their phenotype (production of collagen type II) following subculture in each group. The transforming growth factor-beta 1 could not inhibit or delay the dedifferentiation process (loss of phenotype).

Arthroscopic transglenoid Bankart suture repair with modifications of Caspari's technique

Recent advances in arthroscopic surgery have given new options for dealing with anterior glenohumeral instability with less morbidity than the open procedure. The early literature discussing arthroscopic Bankart suture repair is favorable, however limited long-term follow-up studies have yet to prove its success. This study reports our experience with arthroscopic transglenoid Bankart suture repair with a minimum 2-year follow-up. Arthroscopic transglenoid Bankart repair was performed in 23 cases of anterior shoulder instability with some modifications of Caspari's suture technique. First, the suture material was #1 PDS and the number of sutures was 4 or 5. Second, the insertion site of the guide pin was moved to 1 o'clock on the right shoulder and to 11 o'clock on the left shoulder to prevent slippage of the guide pin. With this technique, we obtained 87% satisfactory results analyzed by the Rowe functional grading system. There was no suprascapular or axillary nerve injury. Two patients had redislocations and one patient had recurrent subluxation. Five patients complained of suture-knot irritation problems.

Tuberculous Osteomyelitis of the Long Bones / 대한정형외과학회잡지

The incidence of the tuberculous osteomyelitis of bone and joint has been decreasing due to improvements in nutrition and medical treatment. However the resurgence of tuberculosis is observed with more frequency as an opportunistic infection. In Korea the incidence of the tuberculosis has been decreasing with rapid economic development, but it is still one of the common pathological conditions involving bone and joint. Tuberculos osteomyelitis confined only to the long bones without involving joints is very rare. The accurate diagnosis of the turberculos osteomyelitis of long bone is difficult, because of the low incidence, long duration and nonspecific radiological findings. We reviewed retrospectively a total of 521 consecutive bone and joint tuberculosis from March 1985 to December 1994. Thirty-eight cases were involved only long bones without inflicting joints. The mean duration of follow up was 16 months. The disease was most frequent in the third decade. Femur(45%) and metaphysic(79%) were the most commonly involved site of the tuberculous osteomyelitis of the long bone. Significant delay in the diagnosis and the initation of the treatment would have been avoided if the biopsy had been performed early. It was looked like that longer symptom duration, higher ESR, associated with pulmonary tuberculosis and inappropriate treatment resulted in recurrence. But when compared with primarily cured cases, these factors did not affect the recurrence statistically. In conclusion, the better results and prevention of the recurrence were observed in cases with early diagnosis, complete removal of the lesion and continuous antituberculous medication.

Salmonella Typhi Osteomyelitis in a Non-sickle Cell Patient: Three Cases Report / 대한정형외과학회잡지

Salmonella osteomyelitis is uncommon and it often develops in patients with sickle cell anemia and other hemoglobinopathy. Especially, osteomyelitis caused Salmonella typhi in a nonsickle cell patients is a very rare event. We report three cases with review of literature.

The Effects of Bone Graft in the Treatment of Osteoporotic Unstable Intertrochanteric Fracture of the Femur / 대한정형외과학회잡지

There are many problems in the treatment of intertrochanteric fracture of the femur in elderly patients due to poor bone quality and unstable pattern of the fracture. In the internal fixation of intertrochanteric fracture, it is known that the important prognostic factors include the accuracy of anatomic reduction, the stability of reduction, and the proper positioning if the lag screw. However, in elderly patients, the loss of reduction frequently occur as a postoperative complication in spite of the adequate anatomic reduction. In general, the bone graft increases initial stability of the fracture and promotes bone healing. So authors tried a prospective study using plain films to determine the effects of bone graft in the treatment of osteoporotic unstable intertrochanteric fracture of the femur with large bone defect in the posteromedial cortex. The study population included 35 patients who had been treated at the Department of Orthopaedic Surgery, Yonsei University College of Medicine from Mar. 1990 and to Feb. 1994. The results were as follows. 1. Among 35 patients, there are 22 cases of anatomically reduced (6 cases of bone graft group and 16 cases of non-bone graft group) and 13 cases of nonanatomically reduced (5 cases of bone graft group and 8 cases of non-bone graft group). 2. The average sliding length was 5.7mm in antomically reduced (5.0mm in bone graft group and 6.1mm in non-bone graft group) and 7.9mm in nonanatomically reduced (6.0mm in bone graft group and 9.6mm in non-bone graft group). 3. The loss of reduction during follow-up period was found in 6 cases in anatomically reduced (27.3%), 1 case in bone graft group (16.7%) and 5 cases in non-bone graft group (31.2%), and 6 cases (75%) in nonanatomically reduced without bone graft. In conclusion, additional bone graft in the treatment of osteoporotic unstable intertrochanteric fracture of the femur decreased postoperative complications such as the varus and posterior angular deformity. Therefore, we recommend selective bone graft in the treatment of osteoporotic unstable intertrochanteric fracture of the femur with large bone defect in the posteromedial cortex.