Ulnar Insufficiency Fractures in Patients on Prolonged Bisphosphonate Therapy: A Case Report

Atypical fractures associated with prolonged bisphosphonate (BP) therapy rarely occur outside the femur, and the diagnostic criteria, appropriate treatment principles, and fixation methods for atypical ulnar fractures have not been established. The authors experienced the use of internal fixation with a metal plate and a new internal fixation method with an intramedullary nail in the treatment of an atypical ulnar fracture in a patient who had been on BP therapy for 10 to 20 years. This paper reports findings along with a review of the relevant literature.

Role of IL-1 beta(Interleukin 1 beta) on Bone Resorption in Mouse Calvarial Bone / 대한정형외과연구학회지

PURPOSE: To determine the interactions between interleukin-1 beta(IL-1 beta) and bone cells in a fetal mouse bone model. MATERIALS AND METHODS: Fetal mouse calvarial bone cells were isolated and cultured. Alkaline phosphatase activity was measured by monitoring the release of p-nitrophenol from disodium p-nitrophenylphosphate. PGE2 was measured by radioimmunoassay and plasminogen activator activity was measured using [125 I]-fibrin coated multi-wells. The effects of systemic and local factors on bone resorption were assessed by measuring the percentage of 45 Ca release from prelabeled 19-day-old fetal mouse radii and ulnae by radioimmunoassay after 5 days culture. RESULTS: In this study, IL-1 beta stimulated cellular proliferation and the synthesis of prostaglandin E2 and plasminogen activator activity in the cultured cells in a dose-dependent manner. but alkaline phosphatase activity was decreased by IL-1 beta in a dose-dependent manner CONCLUSION: These studies support the role of IL-1 beta in the pathological modulation of bone cell metabolism, with regard to implication in the pathogenesis of osteoporosis by IL-1 beta.

Operative Treatment of Humerus Nonunion after Surgery / 대한정형외과학회잡지

PURPOSE: To analyze the cause and treatment method of humerus nonunions which were initially treated by operation. The causes of nonunion were analyzed according to the initial treatment method. We report upon treatment options. MATERIALS AND METHODS: We reviewed 15 cases of humerus nonunion, which were initially treated surgically (7 cases of dynamic compression plate, 4 of Ender nail, 3 of interlocking intramedullary nail, 1 of K-wire) from January 1992 to January 2001. RESULTS: The causes of nonunion were determined to be as follows ; inadequate internal fixation or technical failure (9 cases), postoperatively applied improper external immobilization (5 cases), inadequate choice of implant (1 case). We treated the nonunion as follows; dynamic compression plate and bone graft in 11 cases, intramedullary nailing with small plate augumentation and bone graft in two, maintenance of initial nail with small plate augumentation and bone graft in two. All cases had bone union at an average of 15.9 weeks without complications, such as osteomyelitis, radial nerve palsy, or joint stiffness. CONCLUSION: Plate fixation is considered to be superior to intramedullary fixation in the treatment of nonunion. However, cases that received interlocking intramedullary nailing can be treated easily with small plate augumentation and bone graft without initial nail removal.

The Effect of Pamidronate on Prevention of Osteoporosis in Ovariectomized Rats / 대한정형외과연구학회지

Many agents for the treatment of osteoporosis are broadly classified as inhibitors of bone resorption and stimulators of bone formation. Many pharmacological derivatives of bisphosphonates are used in the treatment of osteoporosis by inhibiting osteoclast-mediated bone resorption. Although the pamidronate, derivative of bisphosphonates, has a potent antiresorptive activity, there are only a low reports about prevention and treatment of postmenopausal osteoporosis using it. The purpose of this study is to evaluate the changes of bone metabolism and bone mass after pamidronate administration during the early period of estrogen deficiency. Ninty-five Sprague-Dawley rats (weight 233-243 g) were divided into 3 groups. Group 1(n=28) was performed sham operation. Group 2 (n=25) was both ovariectomized and intravenously injected with 0.5 cc normal saline. Group 3 (n=42) was both ovariectomized and intravenously injected with 0.1 mg/kg pamidronate. During the first 8 weeks normal saline or pamidronate was intravenously injected twice a week(q 3 day or q 4 days). After 4 weeks of observation without injection the experiental animals were sacrificed at postoperative 12 weeks. There were statistically significant decrease in the body weight and the weight of uterus in group 1 compared with group 2, 3. There was statistically significant decrease in the bone mass of the spine, proximal femur, proximal tibia in the group 2 compared with group 1, 3. The difference of bone mass between group 1 and 3 was statistically insignificant. Serum osteocalcin and PICP concentration were significantly increased in group 2 and 3 compared with group 1. But there was no statistical significance between group 2 and 3 in serum osteocalcin and PICP concentration. Serum ICTP concentration was significantly decreased in group 1 and 3 compared with group 2, but the difference between group 1 and 3 was insignificant. These results suggests that the administration of the pamidronate during the early period of estrogen deficiency can inhibit bone resorption and prevent trabecular bone loss of the spine, proximal femur and proximal tibia metabolically.

The Effect of Recombinant Human Growthn Hormone on Prevention of Osteoporosis in Ovariectomized Rat / 대한정형외과학회잡지

GH concentration in plasma decline with age. GH and GH response to GHRH are influenced by sex hormones, thereby changing around the menopause. In several aspects, features of aging resemble those of a state of GH deficiency. It has been argued the declining GH function, along with other factors, might be a causal factor in osteoporosis. The purpose of this study was to investigate that postmenopausal osteoporosis in ovariectomized rat could be prevented by rhGH. Fifty-four Sprague-Dawley rats(weight 140-200g) were devided 3 groups. Group 1(n=18) was sham operation; Group 2(n=18) was ovariectomized and received subcutaneous injection with 0.05 cc normal saline; Group 3(n=18) was ovariectomized and received subcutaneous injection with 0.2 IU rhGH. Group 2 and 3 were injected daily, 6 day per week. Each group was devided three subgroups(n=6) and were sacrificed at 6 week, 10 week, 14 week, respectively. Group 2 showed a significant increase in body weight, femur length, serum IGF-1 level, serum PICP and ICTP level at 6 weeks, 10 weeks, 14 weeks and a significant decrease in ash weight of tibia, width of bony spicules, at 14 weeks than Group 1. Group 3 demonstrated a significant increase in body weight, femur length, serum IGF-1, serum PICP and ITCP levels and a insignificant decrease in ash weight of tibia and width of bony spicules, at 6 weeks, 10 weeks, 14 weeks than Group 1. At 14 weeks, Group 3 showed a significant increase in serum IGF-1, Serum PTH, Serum PICP. From these data, we conclude that although rhGH administration leads to an activation of bone turnover and more stimulation of bone formation, it does not prevent a bone loss in ovariectomized rat.