There is still debate over the limits of age and bone stock quality of patients on whom to use an un-cemented straight stem coated with hydroxyapatite (HA). We studied a group of 244 patients with a displaced intracapsular fracture of the femoral neck who underwent cementless hemiarthroplasty or total hip arthroplasty. 143 patients were reviewed at the two-year follow up. A fully HA-coated stem for intracapsular hip fracture results in a satisfactory return to pre-injury mobility and a low complications rate. The advantage reported in the literature of a low mortality rate with use of an un-cemented implant in elderly patients was shown to be greater still on finding an immediate primary stability and rapid osteointegration of the implant.
Vitamin D exerts extra-skeletal actions, given the presence in many different tissues of its nuclear receptors controlling transcription of genes related to autoimmune diseases and its endocrine effects mainly affecting calcium metabolism. Many papers have highlighted its ability to reduce infections and to modulate innate and adaptive cellular immunity, with an inverse correlation between the incidence of airway infections and serum vitamin D levels. During the COVID-19 epidemic, not only the elderly confined to the home, with no physical activity, minimal sun exposure and physiological reduction of the UV-radiation induced activation of vitamin D, but also people suffering from fragility fractures, often with comorbidities and treatments with bone-loss side effects (primarily steroids), as well as people in environments at high risk (such as patients and staff in hospitals), should take vitamin D supplements as an important step in the prevention of infections and their spread. In any case, randomised studies should be conducted on large populations to give value to this therapeutic strategy, given the lack of unequivocal of not univocal data on the immune supportive role of vitamin D, on the dose to be administered and blood levels to be achieved.
Phenylketonuria is a congenital inborn error of metabolism of phenylalanine hydroxylase. Characteristic arthrosis called ochronotic arthropathy is localized at main joints. The Authors present two cases of ochronotic arthropathy. Clinical and radiological features are described.
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