Prevalence of Cam Deformity with Associated Femoroacetabular Impingement Syndrome in Hip Joint Computed Tomography of Asymptomatic Adults / 대한고관절학회지

PURPOSE: Femoroacetabular impingement (FAI) is considered an important cause of early degenerative arthritis development. Although three-dimensional (3D) imaging such as computed tomography (CT) and magnetic resonance imaging are considered precise imaging modalities for 3D morphology of FAI, they are associated with several limitations when used in out-patient clinics. The paucity of FAI morphologic data in Koreans makes it difficult to select the most effective radiographical method when screening for general orthopedic problems. We postulate that there might be an individual variation in the distribution of cam deformity in the asymptomatic Korean population. MATERIALS AND METHODS: From January 2011 to December 2015, CT images of the hips of 100 subjects without any history of hip joint ailments were evaluated. A computer program which generates 3D models from CT scans was used to provide sectional images which cross the central axis of the femoral head and neck. Alpha angles were measured in each sectional images. Alpha angles above 55° were regarded as cam deformity. RESULTS: The mean alpha angle was 43.5°, range 34.7–56.1°(3 o'clock); 51.24°, range 39.5–58.8°(2 o'clock); 52.45°, range 43.3–65.5°(1 o'clock); 44.09°, range 36.8–49.8°(12 o'clock); 40.71, range 33.5–45.8°(11 o'clock); and 39.21°, range 34.1–44.6°(10 o'clock). Alpha angle in 1 and 2 o'clock was significantly larger than other locations (P < 0.01). The prevalence of cam deformity was 18.0% and 19.0% in 1 and 2 o'clock, respectively. CONCLUSION: Cam deformity of FAI was observed in 31% of asymptomatic hips. The most common region of cam deformity was antero-superior area of femoral head-neck junction (1 and 2 o'clock).

Korean Society for Bone and Mineral Research Task Force Report: Perspectives on Intermittent High-dose Vitamin D Supplementation

An adequate supply of vitamin D is considered necessary for osteoporosis management and fracture prevention. Intermittent high-dose vitamin D supplementation is an effective and convenient way to achieve and maintain sufficient vitamin D status. However, the long-term effectiveness of supplementation for preventing falls and fractures is unclear, and some deleterious effects of such treatments have been reported. Concerning these issues, the Korean Society for Bone and Mineral Research task force team reviewed previous clinical trials and provided the following perspectives based on current evidence: 1) An adequate supply of vitamin D is necessary for preventing falls and fractures in postmenopausal women and men older than 50 years. An oral intake of 800 to 1,000 IU/day of vitamin D is generally recommended. 2) Care should be taken concerning the routine use of intermittent high-dose vitamin D, as large-scale clinical trials showed increased risk of falls or fractures after high-dose vitamin D administration. Intermittent high-dose vitamin D supplementation is recommendable only in cases of malabsorption or when oral administration is not suitable. 3) Monitoring of the serum level of 25-hydroxy-vitamin D (25[OH]D) is advisable, especially when intermittent high-dose vitamin D is used for supplementation. The task force team suggests that a serum 25(OH)D level of >20 ng/mL is generally appropriate for the prevention of osteoporosis, and that a serum 25(OH)D level of >30 ng/mL is probably helpful both for the management of osteoporosis and the prevention of fractures and falls. However, serum 25(OH)D level >50 ng/mL (this value can vary depending on the measurement method used) is unnecessary and may be undesirable. These perspectives are relevant for the management of osteoporosis, falls, or fractures. Other metabolic bone diseases or non-skeletal disorders are not within the scope of these perspectives.

Current Role and Application of Teriparatide in Fracture Healing of Osteoporotic Patients: A Systematic Review

BACKGROUND: The use of osteoanabolic agents to facilitate fracture healing has been of heightened interest to the field of orthopaedic trauma. This study aimed to evaluate the evidence of teriparatide for fracture healing and functional recovery in osteoporotic patients. METHODS: We performed a literature search in PubMed, EMBASE, Web of Science, and the Cochrane Library using terms including “Fracture” [tiab] AND “Teriparatide [tiab] OR “PTH” [tiab]. RESULTS: This systematic review included 6 randomized clinical trials, 4 well-controlled retrospective studies, and 1 retrospective post hoc subgroup analysis. Fracture location was 2 in pelvis, 3 in proximal femur, 1 in distal femur, 1 in shoulder, 2 in wrist and 2 in spine. The use of teriparatide yielded positive effects on radiographic bone healing in 6 studies, but was not associated with better radiographic outcome in 3. In terms of functional recovery, teriparatide injection was related with decrease in pain or shorter time to mobilization in 6 studies, but not related with pain numerical scale and mobility in 3. CONCLUSIONS: Our findings suggest that teriparatide provide selective advantages to fracture healing or functional recovery in the management of osteoporotic fractures. A better understanding of the role of teriparatide on osteoporotic fractures requires greater evidences from large volume prospective trials.

Bone Mineral Density and Fatty Degeneration of Thigh Muscles Measured by Computed Tomography in Hip Fracture Patients

BACKGROUND: Recently, as an independent fracture factor from Bone mineral density (BMD), muscle weakness due to the fatty degeneration of thigh muscles have been attracting attentions as causes of hip fracture. The purpose of this study is to investigate the correlation between the body composition and BMD and fatty degeneration of thigh muscles of the female patients over 65 years old with osteoporotic hip fracture. METHODS: This study was conducted with 178 female osteoporotic hip fracture patients. Total hip BMD was measured using dual energy X-ray absorptiometry. Cross-sectional area (CSA), cross-sectional muscle area (CSmA), muscle attenuation coefficient (MAC), and intramuscular adipose tissue (IMAT) of gluteus maximus, hip abductors, quadriceps and hamstring muscle were measured with computed tomography. Normalized IMAT (nIMAT) was calculated by dividing the fat area in the muscle into the size of each muscle. The correlation between each measurement is examined then the differences between the intertrochanteric fracture group and the femoral neck fracture group were analyzed. RESULTS: CSmA and MAC of quadriceps were the largest and nIMAT was the lowest. CSA and CSmA of the four muscles showed a statistically significant positive correlation with weight, height, body mass index (BMI), and BMD. MAC of 2 gluteal muscles was positively correlated with weight, BMI and BMD. nIMAT of all four muscles was positively correlation with weight and BMI but nIMAT of 2 mid-thigh muscles was positively correlation with BMD. CONCLUSIONS: Muscle size and fatty degeneration in the thigh muscles were most positively correlated with the body weight. BMD was positively correlation with CSA and CSmA of all thigh muscles, and MAC of 2 gluteal muscles and fatty degeneration of 2 mid-thigh muscles. There was no statistically significant difference in the size of the femoral muscle and the degree of fatty degeneration between the two fracture groups.

Proximal Femoral Geometry as Fracture Risk Factor in Female Patients with Osteoporotic Hip Fracture

BACKGROUND: Proximal femoral geometry may be a risk factor of osteoporotic hip fractures. However, there existed great differences among studies depending on race, sex and age of subjects. The purpose of the present study is to analyze proximal femoral geometry and bone mineral density (BMD) in the osteoporotic hip fracture patients. Furthermore, we investigated proximal femoral geometric parameters affecting fractures, and whether the geometric parameters could be an independent risk factor of fractures regardless of BMD. METHODS: This study was conducted on 197 women aged 65 years or more who were hospitalized with osteoporotic hip fracture (femur neck fractures ; 84, intertrochanteric fractures; 113). Control group included 551 women who visited to check osteoporosis. Femur BMD and proximal femoral geometry for all subjects were measured using dual energy X-ray absorptiometry (DXA), and compared between the control and fracture groups. Besides, proximal femoral geometric parameters associated with fractures were statistically analyzed. RESULTS: There were statistically significant differences in the age and weight, cross-sectional area (CSA)/length/width of the femoral neck and BMD of the proximal femur between fracture group and control group. BMD of the proximal femur in the control group was higher than in the fracture group. For the femoral neck fractures group, the odds ratio (OR) for fractures decrease in the CSA and neck length (NL) of the femur increased by 1.97 times and 1.73 times respectively, regardless of BMD. The OR for fractures increase in the femoral neck width increased by 1.53 times. In the intertrochanteric fracture group, the OR for fractures increase in the femoral neck width increased by 1.45 times regardless of BMD. CONCLUSIONS: We found that an increase of the femoral neck width could be a proximal femoral geometric parameter which plays important roles as a risk factor for fracture independently of BMD.

Bone Mineral Density Changes after Total Knee Replacement in Women Over the Age of 65

BACKGROUND: There are few reports on bone mineral density (BMD) changes of axial bones after total knee replacement (TKR) due to severe osteoarthritis (OA) of the knee joint and its results are controversial. The purpose of our study was to measure the BMD changes of hip and spine in patients receiving TKR due to severe OA and to identify clinical factors relating BMD changes. METHODS: Among 66 female patients above 65 years old who underwent TKR due to severe OA and checked preoperative BMD, 52 patients who checked 1 year follow up BMD were enrolled. We investigated the association of the BMD changes with bilaterality of operation, obesity, preoperative knee functional scores, bisphosphonate medication, and diagnosis of osteoporosis. RESULTS: We found no correlation between BMD changes and bilaterality of operation, obesity, preoperative knee functional scores and diagnosis of osteoporosis. Spine BMD increased in non-treatment and bisphosphonate treatment group but total hip BMD significantly increased in bisphosphonate treatment group. CONCLUSIONS: Bisphosphonate treatment for 1 year prevents early reduction of hip BMD just after TKR regardless osteoporosis diagnosis. We considered that the bisphosphonate medication would be beneficial to prevention of later hip fracture in elderly patient receiving TKR due to severe OA of knee joints.

Isolated Intrauterine Clavicle Fracture in an Otherwise Normal Neonate: Two Case Reports / 대한주산의학회잡지

Intrauterine clavicle fracture is a rare finding, but can occur as the result of maternal trauma, skeletal dysplasia or theoretically other metabolic/structural abnormalities, but idiopathic isolated intrauterine fracture of an otherwise normal infant, newborn without serious injury to the mother is extremely rare. The authors experienced intrauterine clavicle fracture in normal infant, newborn with no special maternal and fetal history which was only found incidentally at birth. We report two cases of idiopathic isolated intrauterine clavicle fracture with confirmation of the diagnosis by X-rays.

Cementless Total Hip Arthroplasty Using Circumferentially Porous Coated Femoral Stem: Minimum Five-Year Followup Study / 대한정형외과학회잡지

PURPOSE: The result of more than 5 year follow up after cementless total hip arthroplasty using circumferentially porous coated femoralstem was evaluated. MATERIALS AND METHODS: Eighty five patients (95 hips) were followed more than 5 years after a primary total hip arthroplasty using multilockfemoral stem, which was circumferentially porous coated at the proximal 1/3 of femoral stem. The average age at the time of operation was 48 years. The average duration of followup was 6.9 years. The Harris hip score was used for the evaluation of clinical results. The canal fit of the stem at the proximal canal and isthmus level was evaluated from the postoperative radiographs. The component stability, endosteal bone formation, radiolucent line, osteolysis and polyethylene wear were evaluated from serial followup radiographs. RESULTS: The mean Harris hip scores increased from 60.1 points preoperatively to 91.3 points at the time of the most recent followup. All hips had a press fit at both the proximal canal and isthmus level. On the lastest followup radiograph, endosteal bone formation was observed in all cases (100%). The radiolucent line around the femoral stem was observed in 92 cases (97%), mainly Gruen zones II, III, IV, V and VI. The radiolucent line was thinner than 1 mm and there was no progressive widening. The acetabular osteolysis developed in 31 cases(33%) and the femoral osteolysis in 31 cases (33%) mostly in Gruen zones I, II, and VII. There was no distal osteolysis in the femur. There was no loosening or migration of cup and stem. The mean linear wear was 1.29 (0-5.69) mm and the mean rate of linear wear was 0.18(0-0.81) mm/year. Seventeen hips (18%) were revised for the dissociation of polyethylene liner in 10 hips (11%), excessive wear in the polyethylene liner and progressive osteolysis in 6 hips (6%) and recurence of tuberculous arthritis in 1 hip (1%). CONCLUSION: Cementless total hip arthroplsty using circumferentially porous coated femoral stem showed good medium-term results clinicallyand radiologically, it is likely that circumferential porous coating in the femoral stem induces bone ingrowth and prevents distal osteolysis.

Effects of Steroid and Nonsteroidal Anti-inflammatory Drugs on Acute Wound Healing and Collagen Synthesis in Rat Skin / 대한정형외과학회잡지

PURPOSE: We studied short-term effects of steroid and anti-inflammatory drugs on collagen synthesis in rat skin. MATERIALS AND METHODS: The 18 rats were divided equally into three groups: group I; piroxicam, group II; triamcinolone, group III; saline. All drugs were given by intraperitoneal injection. Drugs were administered to rats for 4 days after dorsal skin incision. One day after operation and at 24 hour interval there after, skin tissues containing subcutaneous fat were randomly harvested. Measurement procedures were composed of three steps: the first was Masson's trichrome stain for collagen tissue identification; the second involved transporting the image to a computer and the third the analyses of the collagen area using a morphometry program. RESULTS: Statistically significant differences were found in the mean values of the relative collagen contents of the triamcinolone and saline injection groups on the third day (p<0.05). Relative collagen content of the saline injection group was greater than those of the other groups. The triamcinolone group showed the least collagen content. Collagen content of groups increased in time. CONCLUSION: Steroid had an inhibitory effect on the synthesis of collagen. Anti-inflammatory drugs also reduced the amount of collagen synthesis, but without statistical difference.