No abstract

Bisphosphonates are widely used for treatment of postmenopausal osteoporosis. Although short-term safety and efficacy of these drugs have been investigated and documented, an increasing number of recent reports draw attention to the possible correlation between longterm alendronate therapy and the occurrence of insufficiency fractures in the proximal femur owing to what is known as severely suppressed bone turnover. We describe two femoral insufficiency fractures in two women receiving long-term alendronate therapy. The first woman sustained a periprosthetic fracture at the tip of the femoral stem whereas the other woman had a fracture in the subtrochanteric region. We analyze the characteristics and natural course of these two unique fractures, and emphasize the importance of being aware of the possible correlation between long-term alendronate therapy and insufficiency femoral fractures.

The Neer and AO fracture classifications for fractures of the proximal humerus have shown poor reproducibility based on plain radiography. We wanted to investigate whether the addition of 3-dimensional (3D) reconstructions would increase the reproducibility of classification. 7 observers independently classified 24 fractures of the proximal humerus using both plain radiographs, CT and 3D and the classification was repeated 2 months later. There was a moderate interobserver agreement when using the Neer classification, but only a fair agreement with the AO classification. The Neer system had a mean kappa value of 0.44 and the AO had a value of 0.32 for the first assessment. In the second assessment, the mean kappa values were 0.49 and 0.34, respectively. Intraobserver reproducibility was fair to substantial agreement for Neer (kappa range 0.27-0.73) and for AO (kappa range 0.29-0.74). In conclusion, the addition of CT and 3D to plain radiographs did not improve the reproducibility of the classifications of Neer and AO of the proximal humerus.

Measurement of leg length discrepancy is an important part in planning a successful total hip arthroplasty (THA). Many clinical and radiological methods with variable degrees of accuracy have been advocated to carry out this measurement. We studied the accuracy of a commonly used clinical method by comparing it to a well-known and reliable radiological method. A total of 139 patients aged 44-89 (mean: 67.5 years) scheduled to undergo THA were examined for clinical and radiological leg length discrepancy measurements before and after the operation by the same observers. There was a poor correlation between the clinical and radiological methods preoperatively [r =0.21, intra-class correlation coefficient (ICC)=0.33]. The correlation was better postoperatively (r =0.45, ICC=0.62). The clinical method used is not recommended for leg length discrepancy measurement preoperatively. Caution should even be taken when using this method postoperatively. The authors recommend using the radiological method when measuring leg length discrepancy as a part of planning for THA.Résumé Objectif: La mesure de l'inégalité de longueur est une part importante de la planification des prothèses totales de hanche. De nombreuses méthodes cliniques et radiologiques ont été utilisées pour permettre de telles mesures. Nous avons voulu étudier une méthode clinique habituelle comparée à une méthode radiologique fiable. Patients et méthode: 139 patients âgés de 44 à 89 ans (en moyenne 67,5 ans) devant bénéficier d'une prothèse totale de hanche ont été examinés sur le plan clinique et radiologique avec mesure de l'inégalité de longueur avant et après l'intervention chirurgicale par les mêmes observateurs. Résultats: il y a peu de corrélations entre les méthodes cliniques et radiologiques pré-opératoires (r =0.21, ICC=0.33). La corrélation est bien meilleure en post-opératoire (r =0.45, ICC=0.62). En conclusion, la méthode clinique n'est pas recommandée en pré-opératoire, elle doit être utilisée avec méfiance. En post-opératoire il est recommandé d'utiliser une méthode radiologique afin de mesurer l'inégalité de longueur des membres inférieurs. Celle-ci doit faire partie du planning d'une prothèse totale de hanche.

Despite the excellent interobserver reliability and intraobserver reproducibility of LLD measurement on radiographs, clinicians should be aware of its limited accuracy when compared to CT-scanogram.