Bone remodelling suppressants like the bisphosphonates reduce bone loss and slow progression of structural decay. As remodelling removes damaged bone, when remodelling suppression is protracted, bone quality may be compromised predisposing to microdamage accumulation and atypical femoral fractures. The aim of this study was to determine whether teriparatide therapy assists in fracture healing and improves bone quality in patients with bisphosphonate associated atypical femoral fractures. A prospective study was conducted involving 14 consecutive patients presenting during 2 years with atypical femoral fracture. All patients were offered teriparatide therapy unless contraindicated. Age and sex matched control subjects without fragility fractures or anti-resorptive treatment were recruited. High resolution peripheral micro-computed tomography (HRpQCT) scans of the distal radius and distal tibia were analysed for their cortical bone tissue mineralisation density using new software (StrAx1.0, StrAxCorp, Australia) at baseline and 6 months after teriparatide. Administration of 20 μg of teriparatide subcutaneously daily for 6 months to 5 of the 14 patients was associated with 2-3 fold increase in bone remodelling markers (p=0.01) and fracture healing. At the distal radius, the proportion of less densely mineralised bone increased by 29.5% (p=0.01), and the proportion of older, more densely mineralised bone decreased by 16.2% (p=0.03). Similar observations were made at the distal tibia. Of the nine patients managed conservatively or surgically, seven had poor fracture healing with ongoing pain, one sustained a contralateral atypical fracture and one had fracture union after 1 year. Teriparatide may assist in healing of atypical fractures and restoration of bone quality.

Background Three‐dimensional (3D) printing has seen increasing interest in surgery, where it improves the visualization of difficult anatomy in complex cases. This literature review investigates the benefits and limitations of 3D printed models in preoperative planning in the field of orthopaedic surgery. Methods A literature search was performed using the Ovid platform on the Embase and MEDLINE databases using the terms ‘3D printing’, ‘Orthopaedics’ and ‘Surgical Planning’. Studies using 3D printed models as a part of preoperative planning were included. All others were excluded. Data regarding the metrics used to assess the benefit of the use of 3D models, surgical outcome, and surgeon or patient opinion on the technology were extracted. Results A total of 41 studies resulted. Eight (19.5%) were case–control studies, the remainder were case reports or case series. Assessment of benefit was mostly subjective, although the case–control studies included objective metrics such as operation time, intraoperative blood loss and intraoperative fluoroscopy time. The use of 3D printing technology showed subjective benefit for both patient and surgeon as well as indicating clinically significant improvements in intraoperative metrics. Conclusion Despite the current absence of large scale trials, 3D printing has clear benefits in preoperative planning, particularly when utilized in complex cases. A streamlined workflow for case selection, in‐house model creation and preoperative rehearsals is still required to be developed before the process is ready for routine use. Evidence supports an improvement in intraoperative metrics and patient engagement but data to support improved clinical outcome is lacking.

WP review of doctor-prepared prescriptions reduced the proportion of patients who were supplied oxycodone but not the amount supplied/patient. Having a pharmacist assist with prescribing reduced the amount of oxycodone supplied.