Objective The objective of this study was to identify deficiencies in initiating anti-osteoporotic treatment following a fragility femoral fracture. Methods All patients ≥55 years of age treated for a fragility femoral fracture between June 2012 and May 2017 were enrolled. Medications at discharge and at 90 days and 1 year of follow up were analyzed. Patients were classified into 4 groups: Group I did not receive any treatment for osteoporosis; Group II received only calcium and vitamin D3; Group III received an anabolic agent, calcium, and vitamin D3; and Group IV received bisphosphonates, calcium, and vitamin D3. Results A total of 167 patients with an average age of 65.81±12.55 years were included. There were 88 (52.7%) males and 79 (47.3%) females. At discharge, 107 patients (64.1%) were not prescribed optimal treatment for osteoporosis, and this reduced to 55 (32.9%) at the 90-day follow up. At 1 year, the number of patients receiving suboptimal treatment was further reduced to 25.74%. Conclusions Although the number of patients with fragility fractures receiving insufficient treatment was lower in the present study than in previous reports, increased efforts and coordinated treatment plans initiated by a fracture liaison service should be of high priority.
Background Finite element analysis has suggested that stemless implants may theoretically decrease stress shielding. The purpose of this study was to assess the radiographic proximal humeral bone adaptations seen following stemless anatomic total shoulder arthroplasty. Methods A retrospective review of 152 prospectively followed stemless total shoulder arthroplasty utilizing a single implant design was performed. Anteroposterior and lateral radiographs were reviewed at standard time points. Stress shielding was graded as mild, moderate, and severe. The effect of stress shielding on clinical and functional outcomes was assessed. Also, the influence of subscapularis management on the occurrence of stress shielding was determined. Results At 2 years postoperatively, stress shielding was noted in 61 (41%) shoulders. A total of 11 (7%) shoulders demonstrated severe stress shielding with 6 occurring along the medial calcar. There was one instance of greater tuberosity resorption. At the final follow-up, no humeral implants were radiographically loose or migrated. There was no statistically significant difference in clinical and functional outcomes between shoulders with and without stress shielding. Patients undergoing a lesser tuberosity osteotomy had lower rates of stress shielding, which was statistically significant ( p = 0.021) Discussion Stress shielding does occur at higher rates than anticipated following stemless total shoulder arthroplasty, but was not associated with implant migration or failure at 2 years follow-up. Level of evidence IV, Case series.
Background and objective: Meniscus retention after injuries important for long-term effective functioning of the knee joint and injured meniscus usually require surgical repair. This preliminary study was conducted to determine if injection of Bone Marrow Derived Chondrocytes (BMDC) will regenerate the injured meniscus.Patients and methods: In 15 patients, twenty CC of Bone marrow was aspirated under aseptic technique under local anesthesia and sedation and in vitro chondrocyte was expanded from the mesenchymal stem cells. After three weeks of bone marrow aspiration 5 million chondrocytes were injected in the effected knee joint. Patients were followed up in the clinics and data collected of pain and range of movements. At 3 months the knee joint was assessed by clinical examination and a magnetic resonance imaging was done and pre and post injection MRI was evaluated by the musculo-skeletal radiologist who was blinded of the MRI scans.Results: Fourteen patients were in the study group which could be analyzed. The mean age of patients was 36.4±5.1 years. There were complaints of any side effects of the Bone marrow aspirated neither site nor the site of injection in the knee. The average pain score pre-injection was 6.36.3±1.25 compared to 90 days post injection was 1.4±0.51 (P<0.0001). The range of movements Flexion improved from 90.4±10.13 to 116±5.16 (P <0.001). Post injection MRI showed the healing of the all the meniscus with good thickness.
Conclusion:Our study shows that BMDC injection in the knee joint showed great potential to heal the injured meniscus. This calls for further randomized control studies.
Surgical resection of the fibula is commonly done for either to obtain structural bone graft or to respect the fibula if involved by bone tumor. The vascular anatomy around the popliteal fossa is complex and has to be studied prior to any attempt of surgical resection. We present a case of 11 years old female patient who was diagnosed as a Ewing’s sarcoma of the fibula and her pre-operative CT angiography showed a vascular anomaly of Peronea magna artery. Following adjuvant chemotherapy, the patient was treated by wide local resection and the surgical procedure has to be modified in order to save the dominant peroneal artery the vascularity of the limb.
A modified approach is to place a mandibular 0.017" Â 0.025" flexible nickel-titanium archwire in the immediate presurgical period. Kobayashi ligatures may be placed on the brackets to facilitate intraoperative bimaxillary fixation. The splint is removed towards the end of the surgical procedure and the occlusion is checked for a solid three-point landing. Light bilateral box elastics are placed intraoperatively or directly after surgery, which will begin active extrusion immediately (Figs 1 and 2). DISCUSSION This modified technique reduces both treatment time and patient discomfort.
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