Monitoring for Deep Wound Infection after Thoracolumbar Surgery Significance of Suction Drainage Tip Culture for Early Detection of Postoperative Deep Wound Infection / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVES: To evaluate the usefulness of postoperative suction drainage tip cultures as a method of predicting the development of deep wound infections after thoracolumbar surgery using pedicle screws. SUMMARY OF LITERATURE REVIEW: The primary diagnostic elements of post-operative spinal infections are a high degree of clinical suspicion by the surgeon combined with aspiration and culture of the suspected infection sites. MATERIALS AND METHODS: We analyzed the results of cultures on postoperative suction drainage tips from a total of 471 thoracolumbar surgery cases. We calculated the sensitivity, specificity, and predictive value and investigated the isolated pathogens. In addition, we performed quantitative analyses of serum C-reactive protein using Turbidimetry. RESULTS: The post-operative infection rate was 4.0%. The most common isolated pathogen of the true positive cases was staphylococcus aureus, which was found in 3 cases (methicillin-resistant staphylococcus aureus in 2 cases); and that of the false positive cases was coagulase-negative staphylococcus in 5 cases. The sensitivity of the suction drainage tip culture was 52.6%, the specificity was 96.3%, the positive predictive value was 37.0%, and the negative predictive value was 98.0%. In cases of C-reactive protein, true positive and false negative cases followed the same course, where the CRP decreased slowly for the first week but remained elevated persistently at the 14th postoperative day. CONCLUSIONS: Culture of the suction drainage tips could not predict the development of postoperative deep wound infections, but it had more significance in the exclusion of deep wound infections. We concluded that careful observation for other signs of deep wound infections are necessary when a clinically significant pathogens are isolated.

Monitoring Method for Deep Infection after TKA: Significance of Intraoperative Synovial Fluid Culture and Postoperative Suction Drainage Tip Culture / 대한정형외과학회잡지

PURPOSE: The aim of this study was to evaluate the usefulness of the intra-operative synovial fluid culture and post-operative suction drainage tip culture as a method for predicting the development of a deep infection after primary TKA. MATERIALS AND METHODS: Between July 1998 and July 2002, 324 primary total knee arthroplasty procedures were performed and aerobic and anaerobic bacterial cultures for intra-operative synovial fluid and post-operative suction drainage tip were obtained. The results of culture of intra-operative synovial fluid and post-operative suction drainage tip of total 324 primary TKA cases were analyzed. The sensitivity, specificity and predictive value were calculated. positive culture rate for osteoarthritis was compared with rheumatoid arthritis and the results of a single TKA was compared with both simultaneous TKA. RESULTS: 14 out of 324 knees showed a positive intra-operative synovial fluid culture and 10 cases showed a positive post-operative suction drainage tip culture. Only 1 case out of the 4 deep infection cases showed a positive on suction drainage tip culture with S. aureus being isolated. The specificity of the intra-operative synovial culture was 95.6% and the negative predictive value was 98.7%. The sensitivity of the post-operative suction drainage tip culture was 25%, the specificity was 97%, the positive predictive value was 10% and the negative predictive value was 99%. The positive culture rate was similar in the osteoarthritis and rheumatoid arthritis cases (respectively p=0.4717, p=0.6550). However, the culture positive rate between single and both simultaneous TKA was numerically different, approximately 2 times (3.2% vs 6.31% for intra-operative synovial culture and 4.0% vs 9.47% for post-operative suction drainage tip culture) but it was not statistically significant (respectively p=0.311, p=0.1051). CONCLUSION: In primary TKA, a culture of intra-operative synovial fluid and post-operative suction drainage tip cannot predict a postoperative deep wound infection. It is recommended that careful observation for other signs of a deep infection be examined when a clinically significant true pathogen isisolated.

Treatment of Osteoporotic Unstable Intertrochanteric Fractures: Comparative Study between using Dynamic Hip Screw and Additional Trochanter Stabilizing Plate / 대한정형외과학회잡지

PURPOSE: To compare the effectiveness of a trochanter stabilizing plate with a dynamic hip screw, with using a dynamic hip screw only in the treatment of an unstable intertrochanteric fracture of elderly patients. MATERIALS AND METHODS: From January 2000 to December 2004, 70 patients, who were treated surgically for unstable intertrochanteric fractures, were evaluated. The patient s age were above 65 years and the T-score 0.05), but the postoperative functional loss of the hip joint was significantly lower in the group 2 (p<0.05), who required additional surgery due to reduction loss or metal failure. CONCLUSION: Although it is a relatively simple technique, the use of DHS with TSP is more effective for the buttress effect on proximal fragment and additional fixation of great trochanter than just DHS only. It decreases the excessive slippage of the lag screw, lateral displacement of the greater trochanter and postoperative functional loss of the hip joint. Therefore, it may be a useful treatment for unstable or comminuted intertrochanteric fractures in elderly patients with osteoporosis.

Surgical Treatment of the Acute Acromioclavicular Joint Dislocation Using a Wolter Plate / 대한정형외과학회잡지

PURPOSE: To introduce the surgical technique of acute acromioclavicular joint dislocation using a Wolter plate and to evaluate its efficacy after surgical treatment. MATERIALS AND METHODS: Twenty-six patients who underwent surgical treatment of the acute acromioclavicular joint dislocation using a Wolter plate and who were followed up minimally for one year were reviewed. We analyzed the clinical results of pain, function, range of motion and radiologic reduction state of the acromioclavicular joint. RESULTS: All cases showed satisfactory results. By clinical evaluation, twelve cases (46%) were excellent and fourteen cases (54%) were good. By radiologic evaluation, twenty cases (77%) were excellent and six cases (23%) were good. By postoperative X-ray, vertical displacement of the clavicle was restored in all cases. No complications such as infection, loosening of screws, plate failure or redislocation after removal of the plate occurred. CONCLUSION: Acromioclavicular joint reconstruction using a Wolter plate is believed to be a useful method, which minimizes injury of the joint articular surface and provides enough stability for postoperative rehabilitation.

A Proposal for Classification of Children's Ankle Fracture / 대한정형외과학회잡지

PURPOSE: The purpose was to propose a new classification of children's ankle fracture and to evaluate the therapeutic and prognostic efficacy. MATERIALS AND METHODS: The new classification is based on the number of fractured structures among three anatomical landmarks (articular surface, growth plate of the distal tibia and the growth plate of the distal fibula). Type I: one of the landmarks is fractured. Type II: two are fractured. Type III: all three are fractured. Type IV: crushing injury of either growth plate or the articular surface of the distal tibia. Type V: Intra-articular triplane fracture of the distal tibia. We analysed the final results obtained using the modified Weber protocol. RESULTS: Of the thirty-five cases, we classified twenty-one as Type I, (excellent 17, good 4); three as Type II, (excellent 2, good 1); four as Type III, (excellent 2, good 2); two as Type IV, (fair 2); and five as Type V, (excellent 3, good 2). CONCLUSION: Most children's ankle fractures are classified using the proposed classification. However, the number of patients and the follow up period were not enough to generalize the proposed method. In the future, a more prospective, systemic study will be needed.

LPS Induced Osteonecrosis of the Femoral Head in Rabbits / 대한정형외과연구학회지

No Abstract Available.

Efficacy of Bone SPECT for Diagnosis of Meniscal tear / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the efficacy of bone SPECT for the diagnosis of meniscal tear. MATERIALS AND METHODS: 63 cases that had undergone bone SPECT were evaluated for sensitivity and specificity by comparing arthroscopy and MRI findings. RESULTS: Bone SPECT showed a sensitivity of 93.8% and a specificty of 71% for medial meniscus and a sensitivity of 85.7% and a specificty of 87.8% for lateral meniscus tear. MRI was performed on 21 cases simultaneously, and agreement was obtained on the presence or absence, and on the nature of the pathology with bone SPECT in 15 cases (71.4%). CONCLUSION: Bone SPECT is believed to be an effective and economic way of screening for meniscal tear prior to arthroscopy, in suspected cases of meniscal tear.

External Fixation Of Lower Limb Fractures In Children / 대한정형외과학회잡지

PURPOSE: To evaluate the results and the usefulness of the external fixator for the treatment of the lower limb fractures in children. MATERIALS AND METHODS: We used 22 children fractures of lower limb treated with external fixator. There were 14 isolated femur or tibia fractures, 2 both femur and tibia fractures, 1 bilateral tibial fractures, 5 fractures associated with others, and were 10 open and 16 closed fracture. We assessed the axial alignment and leg-length discrepancy, and the range of motion of the joints and complications. RESULTS: The average union and fixation time were 8.1 and 9.5 weeks. Average of 2.4 degrees of varus or valgus and 3.8 degrees of anterior or posterior angulation were obtained. At follow-up, the range of LLD was -1.3 to +1.5cm. CONCLUSION: External fixator in lower limb fractures of children is useful to open fractures, multiple fractures, and unstable fractures to minimize complications.

Treatment of Tibial Medial Bone Defect in Primary TKA

There are several rnethods to correct the tibial bony defect including resection, cement filling, autograft or allograft and metal augmentation. The purpose of this study is to find the adequate treatment method of tibia bony defect through analysis of the result with above methods. From Sep. 1993 to Dec. 1997, the authors analyzed 93 cases of tibial medial bony defect corrected by overresection of lateral condyle, allograft and metal wedge or block among 358 cases of primary total knee arthroplasty(TKA) operated at Asan Medical Center. All cases were devided into four groups according to the treatment method; group A(31 cases) with overresection of lateral condyle, group B(37 cases) with metal wedge, group C(21 cases) with metal block and group D(4 cases) with allograft. The mean follow up period was 23.6 months(12 56 months). The results were as follows, 1. There were no definite statistical difference between group A, B, C and D in HSS knee score, ROM, correction of deformity. But in group D, there is one case of loss of the correction. 2. Loosening of the implant was not noted, but 17 cases of mild bony resorption was found just beneath the implant. It was particularly prominent in group B(9 cases) than group A(5 cases) and C(3 cases). 3. Among 4 cases of allograft, one has developed collapse of allograft. 4. 3 cases of deep infection developed only in group C, which were followed by revision TKA. Although further follow up study should be carried out, we concluded that resection of lateral tibial condyle, allograft, metal augmentation is a good substitute to the correction of the tibial bony defect in primary TKA.

Percutaneous Iliosacral Screw Fixation in Unstable Pelvic Ring Injury / 대한정형외과학회잡지

PURPOSE: To evaluate and analyse the operative results of percutaneous iliosacral screw fixation in displaced posterior pelvic ring injuries. MATERIALS AND METHODS: Fourteen consecutive patients with displaced posterior pelvic ring injuries (August 1995-June 1998) treated by percutaneous iliosacral screw fixation were reviewed. We analysed the pattern of fracture, associated injury and method of operation including patient's position, complication and functional result. RESULTS: Seventeen iliosacral screws under fluoroscopic guidance were applied in fourteen patients. During the operations various positions of patients were possible, and all cases were treated with closed reduction and percutaneous iliosacral screw fixation except in one case (open reduction and percutaneous screw fixation). Fixation of associated anterior pelvic ring injury was undertakes in eight cases. Screw-related neurovascular injury and other complications such as breakage, loosening, misplacement and redisplacement, nonunion and screw site infection during follow-up period were not found. Satisfactory clinical and radiologic results were achieved during follow-up period except in one case (limping due to leg length discrepancy, malreduction) in this study. CONCLUSION: Precise understanding of iliosacral anatomy and its variants, proper patient positioning and appropriate intraoperative interpretation of fluoroscopic iliosacral image are mandatory. We believe percutaneous iliosacral screw fixation is a useful addition to treatment options for unstable posterior pelvic ring injury.

Measurement of Proximal Humerus in Korean Adult Skeleton / 대한정형외과학회잡지

PURPOSE: To obtain basic anatomical data of proximal humerus of Korean adult skeleton. MATERIALS AND METHODS: Fifty-two dry humeri of Korean adults were measured with a caliper and goniometer. Measured parameters were retroversion, angle of the bicipital groove, bicipital groove-shaft angle, neck-shaft angle, diameters of the humeral head, dimension of the greater tuberosity, distance between humeral head and greater tuberosity, and length of the humerus. All of the eight parameters were measured twice. The correlations between retroversion and diameters of the humeral head, retroversion and length of the humerus, retroversion and angle of the bicipital groove, diameters of the humeral head and length of the humerus were analyzed by student t-test using SAS system. RESULTS: Retroversion was 34.2 degree with high individual variation, ranging from 17.0 degree to 50.0 degree. The angle of the bicipital groove was 36.2 (22.0-54.0) degree. The bicipital groove-shaft angle was 7.4 (1.0- 16.0) degree. The neck-shaft angle was 136.3 (120.0-150.0) degree. The superior-inferior diameter of the humeral head was 43.3 (35.5-52.0) mm, and anterior-posterior diameter was 39.9 (33.5-46.0) mm. The dimension of the greater tuberosity was 29.8 (19.0-46.0) mm, and the distance between humeral head and greater tuberosity was 7.9 (4.5-12.0) mm. The length of the humerus was 303.7 (265.0-388.0) mm. There was significant correlation between the head diameters, the retroversion, and the length, but no correlation between the retroversion and the angle of the bicipital groove. CONCLUSIONS: It is suggested that high individual variation of retroversion should be considered in case of arthroplasty. The humeral head was elliptical in shape. The mean narrow diameter of the humeral head was about 40 mm. The greater tuberosity was about 30 mm in dimension, and located 8 mm inferior to the humeral head. The bicipital groove was not a reliable reference in determining retroversion.

Treatment of Hallux Valgus with a Proximal Metatarsal Osteotomy and Distal Soft: Tissue Procedure / 대한정형외과학회잡지

The deformity of hallux valgus is associated with three hasic prohlems: a prominent rnedial eminence, contracted soft-tissue structures on the lateral side of the great toe, and an altered intermetatarsal angle between the first and second metatarsal. We retrospectively have reviewed the results for thirty-one patients(47 feet) in whom a hallux vaigus deformity had heen conected with the release of the distal soft tissues, excision of the medial eminence, plication of the medial part of the capsule, and proximal crescentic osteotomy of the first metatarsal. The patients were followed for an average of twenty months(range, twelve to twenty-eight months). There were nine cases with mild defoimity, twenty-nine cases with moderate deformity, nine cases with severe deformity. The preoperative hallux valgus angle averaged 38.1 degrees, and the immediate postoperative angle averaged 6.7 degrees. The preoperative intermetatarsal angle averaged 17.1 degrees, and the immediate postoperative angle, 7.6 degrees. At the latest follow-up, the hallux valgus angle averaged 19.3 degrees, the intermetatarsal angle averaged 9.9 degrees. We found that the more the deformity, the lesser the congruency. 74.5% of the patients were satisfied with the result of the procedure. They stated that, eiven the same circumstances, they would have the operation again. The most common complication was recurrence of the nallux valgus, which occurred in nine feet(five patients). The other complications included pain under a fibular sesamoid in one foot, severe hypoesthesia on the medial aspect ot the big toe in one foot, and superficial wound infection in one foot.

Gait Analysis of Patients with Unilateral Hip Lesion Treated with Total Hip Arthroplasty / 대한정형외과학회잡지

Total hip replacement arthroplasty ( THA ) is a useful treatment method in the patients with avascular necrosis ( AVN ) or degenerative arthritis ( DA ) to relieve pain and recovery of function. Beside pain relief , patients want improvement in gait pattern , which is related with Jeg length discrepancy, range of motion, and muscle power. It could be difficult to analyse the cause of limp accuratelv by the clini-cal observation. Therefore gait analysis will he a good tool for the identification of the factors related to the recovery of patients after the operation. This study was undertaken in an attempt to evaluate the gait characteristics of 16 patients with unilateral hip disease treated with THA. We compared the outcome of qualitative and quantitative analysis of gait and also compared with those of 14 healthy person. The results were as followed : 1. The patients showed short single support time on their painful limb prior to THA , but postoperatively , it was increased to near normal (p<0.05). 2. Preoperatively, the range of hip flexion of the sound side was increased more than those of the normal control and the painful limh. After the THA, it returned to the near normal (p<0.05~). The hip extension of the painful limh uas increased postoperatively (P<0.05) but still it was lower than normai subject. The hip ahduction and internal roiation of sound side was also increased to near normal after THA. In conclusion, great improvement ot the gait characteristics in patients with hip disease after THA was found and this gait improvement can he analyzed quantitatively hy gait analysis.

Bone SPECT, Simple Radiography , and Operative Findings in Osteoarthritic Knee with or without Anterior Cruciate Ligament Injury / 대한정형외과학회잡지

In so-called primary osteoarthritic knees, there may be secondary osteoarthritis due to the instability from chronic cruciate ligament and/or meniscal tear. The purpose of this study is to compare the findings of bone single-photon emission computed tomography(SPECT) and those of simple radiography in osteoarthritic knees which we consider as primary on the status of anterior cruciate ligament(ACL). We reviewed the preoperative bone SPECT and simple radiography of forty-three osteoarthritic knees in 23 patients who underwent total knee arthroplasty between 1995 and l996. We divided the cases into two groups on the status of ACL: thirty intact ACLs(Group I), thirteen insufficient ACLs(Group II). Meniscal tear and/or ACL insufficiency were found in 38 of 43 knees, As regards with presence of osteophytes and sclerotic changes on simple radiograph, there was no significant differences between group I and II. Joint space narrowing was more prominent and diffuse in group I(medial 29, lateral 24) than group II(medial 7, lateral 6). Bone SPECT showed diffuse uptake in group I(medial 30, lateral 23), but less uptake on the lateral compartment(medial 13, lateral 3) in group II. In ACL-intact osteoarthritic knees, joint space narrowing on simple radiograph and hot uptake on bone SPECT were more prominent and diffuse than in ACL-insufficient knees. Clinical relevance is still uncertain and further investigation is needed.

Home Treatment of Rotator Cuff Disease / 대한정형외과학회잡지

We treated 617 patients who were diagnosed as rotator cuff disease at the Department of Orthopaedic Surgery, Asan Medical Center in Korea between March, 1995 and December, 1996. We evaluated 175 cases who were followed up over five months and were treated according to our home treatment protocol. Average follow-up period was eleven months(range, five to eighteen months). We educated every patient who were not suspected of having full thickness tear of the rotator cuff based on clinical and MRI findings. According to patients condition, we treated them with both stretching and strengthening exercise or strengthening exercise only. This physician-directed home treatment was occasionally supported by the use of NSAID in case severe pain. Patients did stretching and strengthening exercise in 93(53%)cases, and strengthening exercise initially in 82(47%)cases. One hundred and forty five(83%) cases had satisfactory results. Home treatment of the rotator cuff disease is effective, convenient and not dangerous. We recommend this physiciandirected home treatment for primary management of almost all the patient with rotator cuff disease except full thickness tear of the rotator cuff tendon.

Effects of Parathyroid Hormone and Insulin on Proliferation in Osteogenic Sarcoma UMR-106-01 Cells / 대한정형외과학회잡지

Parathyroid hormone(PTH), a major bone hormone, inhihits DNA and collagen syntheses in osteohlast-like cells in vitro, but increase the proliferation of osteoblast in vivo as secn in hyperparathyroidism. On the other hand, insulin is known to increase DNA and collagen syntheses and modify the effects of PTH in osteoblast-like cells. We have examined the effects of PTH and insulin in rat osteosarcoma UMR-l06-01 cells and whether PTH plays a role in the insulin-mediated bone formation. When 1 nM PTH and 10 nM insulin were administered to VMR-l06-01 ceils, the rates of DNA synthesis were 124% and 136% of the untreated control, respectively. When the two hormones were administered serially by exposing to 1 nM PTH for 7 days followed by 10 nM insulin lor 24h, the largest increase was observed. The protein synthesis was also increased remarkahly when the two hormones were aclministered serially: the[3H]-leucine incorporation rates, compared to the control group, were 75% and l62% with PTH ancl insulin administration, respectively, but the rate was 297% with the serial administration of the two. The collaeen synthesis, as measured by the (3H)-proline incorporation rates were 60% and l64% with PTH and insulin administration, respectively, but 351% with serial administration, again showing a dramatic effect. These results showed that 1 nM PTH decreased DNA and collagen syntheses in UMR-l06-01 cells after both a 24h and a more prolonged exposure. Similar exposures to insulin tended to increase the syntheses. The comhination of PTH and insulin tended to increase the syntheses. hut not beyond the effect of insulin alone. However, the sequential administration of PTH and insulin markedly increases ihose rales relative to the simultaneous adminstration of these two hormones. Thus, it is possihle that sequential stimulation of PTH and insulin in hone matrix exerts an synergistic effect on hone formation in vivo.

Rotator Cuff Repair Without Bony Trough / 대한정형외과학회잡지

Surgical repair has been widely accepted for full thickness tear of the rotator cuff. In traditional method, hony trough on the greater tuberosity of the humerus has heen used for tendon to hone suture. Recently, there have been some suggestions that hony trough would not he essential for repairing the rotator cuff. Purpose of this study was to investigate the clinical result of rotator cuff repair without bony trough. We evaIuated the clinical results of 23 operative repairs of the full-thickness tear of the rotator cuff, using modified ASES scoring system, at an average of l4 months postoperatively. For these cases, all the tendon to hone sutures were done without makin bony trough. There were 3 cases of small tear. 14 case of medium tear, 1 case of large tear and 5 cases of massive tear. Mini-open repairs with arthroscopic acromioplaslies were used for 9 cases with small or medium sized tear. Open acromioplasties and repairs were done for 14 cases. Nine cases were rated excellent (39%), and twelve cases showed good results (52%). Two cases showed fair results (9%). Averagc increase of score was 40 (ranee, 18 to 78). There were no complications or deteriorations of function. No patient needed additional surgery. Repair without hony trough is more simple and easier than the traditional method making bony trough. There would he possibility of less tension to the tendons and preserving more natural course of tendons. The authors believe that this method provides larger contact surface between the tendon and hone. The repairing method without hony trough is considered to he a safe and efficient method for the full thickness tear of the rotator cuff. This technique can he useful not only for ordinary open repair, but also for mini-open repair.

Functional Knee Braces for Control of Hyperextension

The functional knee hrace has been used to provide or to assist knee stahility in the anterior cruciate ligament (ACL) deficient knee, Nowadays, it is more indicated in the postoperative care of ACL injury to protect the reconstructed or repaired ligament, but eontroversies still exist regarding the effectiveness and the selection of an appropriate model. For successful application, it must restrict the knee motion within the range of certain arc, especially hyperextension, during weight bearing together with convenience and comfort.. The six commercial functional knee braces, which were introduced in Korea, were ehecked to detect the angle discrepancy between angle of brace and knee joint motion. The purpose of this study was to guide correct application of the functional knee brace in preventing hyperextension of the knee joint. Each brace was grouped into small, medium and large by size, and fixed with the arc of motion 30 to 90. The brace was applied to 3 healthy volunteers whose size was just fit mth the brace size small, rnedium and large, respectively. True lateral X-ray of the knee joint was taken in active flexion and extension state under the fluoroscopic control and measured the lateral intershaft angle of femur and tibia. Average angle discrepancy between the brace and the intershaft ang]e of femur and tibia in active extension was 22 and 3 in acTive flexion. In active extension at 30, angle discrepancy of Denzo brace was the large:st recording 26, that of Sentry hrace was the smallest recording 17. In active flexion at 90', angle discrcyancy of Sentry hrace was the largest recording 13, that of ACL brace (custom made modified Sentry brace) was the smallest recording 2. There was no statistically significant difference of the angle discrepancy among each size of brace. This study suggests that, at least 20 of angle discrepancy must be considered in appling the knee brace for prevention of hyperextension of the knee joint and careful selection of the brace, which may be affected by the design of hrace and the soft tissue compliance, is mandatory.

Early Results of Percutaneous Ilioscral Screw Fixation in Unstable Posterior Pelvic Ring Injury / 대한정형외과학회잡지

In the past two decades, open reduction and internal fixation has been the preferred treatment of posterior pelvic ring disruption with instability. Despite of rigid fixation, it can induce bleeding, wound infection, wound necrosis and prolong operation time in the patient with combined injuries. To compensate for these disadvantages, we have implemented closed reduction and percutaneous iliosacral fixation under fluoroscopy in reducible posterior pelvic ring disruption. In spite of anatomical risk during screw insertion, the percutaneous iliosacral screw technique after closed reduction of the posterior pelvic ring disruption minimally violates the soft tissue envelope and reduces both the operative blood loss and infection rate. We are reporting the early results of our 6 patients treated between Aug. 1995 to Aug. 1996. The operation time was shorter than open reduction and internal fixation. There was no significant bleeding, wound infection and nerve injury by screws.

Effects of RGD Protein on the Bone Resorptive Activity of Osteoclast / 대한정형외과학회잡지

Osteoclasts resorb bone by the hydrogen ions and proteolytic enzymes in the localize environment under the ruffled border. Before releasing hydrogen ion and enzymes, osteoclast should attach to bone surface very tightly and make a room to release enzymes and hydrogen ion in the center. Specialized attachment molecule in the cell membrane, such as integrin, is associated with specific noncollagenous protein in the matrix, which has specific amino acid sequence (Arginine-Glycine- Aspartic acid sequence). We may speculate that osteoclast action would be decreased if the integrin is blocked by antibody or RGD protein. In this study, the osteoclasts were cultured on the coverslip or bone slice with or without RGD protein in the culture medium, and numbers of growing giant cells were much less in group with RGD protein. The number resorption pits, formed on mineralized bone slice, was also lower in the group adding RGD protein in the medium. And we made a conclusion that the osteoclastic bone resorption was inhibited by soluble RGD protein.