Adjuvant Teriparatide Therapy for Surgical Treatment of Femoral Fractures; Does It Work? / 대한고관절학회지

PURPOSE: Atypical femoral fracture (AFF), periprosthetic femoral fracture (PPFF) and femoral nonunion (FNU) are recalcitrant challenges for orthopedic surgeons. Teriparatide (TPTD) had been demonstrated to have anabolic effects on bone in various studies. We postulated that adjuvant TPTD after operation would enhance biologic stimulation for bone formation. We investigated (1) whether the adjuvant TPTD could achieve satisfactory union rate of surgically challenging cases such as displaced AFF, PPFF and FNU; (2) whether the adjuvant TPTD could promote development of abundant callus after surgical fixation; (3) whether the adjuvant TPTD had medically serious adverse effects. MATERIALS AND METHODS: Thirteen patients who agreed to off label use of TPTD in combination of operation were included in this retrospective case series. Median patients' age was 68.7 years, and there were three male and ten female patients. Their diagnoses were nonunion in six patients and acute fracture in seven. Medical records and radiographic images were reviewed. RESULTS: Twelve of thirteen fractures were united both clinically and radiologically within a year after adjuvant TPTD. Union completed radiologically median 5.4 months and clinically 5.7 months after the medication, respectively. Callus appeared abundantly showing median 1.4 of fracture healing response postoperatively. There was no serious adverse reaction of medication other than itching, muscle cramp, or nausea. CONCLUSION: Even appropriate surgical treatment is a mainstay of treatment for AFF, PPFF, and FNU, the current report suggested that adjuvant TPTD combined with stable fixation results in satisfactory outcome for the challenging fractures of femur.

Changes of Functional Outcomes According to the Degree of Completeness of Spinal Cord Injury

OBJECTIVE: To evaluate whether an initial complete impairment of spinal cord injury (SCI) contributes to the functional outcome prediction, we analyzed the relationship between the degree of complete impairment according to the American Spinal Injury Association impairment scale (AIS), the posterior tibial nerve somatosensory evoked potential (PTSEP) and the changes of functional indices. METHODS: Sixty subjects with SCI were studied who received rehabilitative management for over 2 months. The degree of completeness on basis of the initial AIS and PTSEP were evaluated at the beginning of rehabilitation. Following treatment, several functional indices, such as walking index for spinal cord injury version II (WISCI II), spinal cord independence measure version III (SCIM III), Berg Balance Scale (BBS), and Modified Barthel Index (MBI), were evaluated until the index score reached a plateau value. RESULTS: The recovery efficiency of WISCI and BBS revealed a statistically significant difference between complete and incomplete impairments of initial AIS and PTSEP. The SCIM and MBI based analysis did not reveal any significant differences in terms of the degree of AIS and PTSEP completeness. CONCLUSION: AIS and PTSEP were highly effective to evaluate the prognosis in post-acute phase SCI patients. BBS and WISCI might be better parameters than other functional indices for activities of daily living to predict the recovery of the walking ability in post-acute SCI.

The Significance of the Berg Balance Scale as a Parameter of Walking Outcome in Post-acute Spinal Cord Injured Patients

OBJECTIVE: To evaluate the correlation between the K-BBS (Korean version of Berg balance scale), a tool for assessing balance, with the WISCI (walking index for spinal cord injury), and SCIM (spinal cord independence measure) in patients with post-acute spinal cord injuries. In addition, the difference in the K-BBS, WISCI, SCIM according to the degree of severity of the SEP (somatosensory evoked potential) findings of the posterior tibial nerve was analyzed in these patients. METHOD: Thirty patients with post-acute spinal cord injuries were assessed with the K-BBS, WISCI, and SCIM every other week until discharge. A posterior tibial SEP study was recorded at the beginning of rehabilitation. Delayed latency or small amplitude in the SEP on one or both sides was regarded as the mild group, and non-evoked SEP on both sides was regarded as the severe group. Improvement in walking was based on the change in the scores from admission to discharge. The statistical analysis included the non-parametric Spearman rank correlation and t-test; p<0.05 RESULTS: The assessment scales showed a high correlation between the K-BBS, WISCI, and SCIM (p<0.05). The relationship between the K-BBS and WISCI was specifically strong (r=0.936). Moreover, there was a significant difference in the scores of the K-BBS, WISCI, and SCIM according to the severity of the SEP (p<0.05). CONCLUSION: The findings of a statistical correlation of the K-BBS and the posterior tibial SEP with the WISCI and SCIM provides strong support for their use as outcome measures.

Relationship of Diabetic Polyneuropathy Severity with Various Balance Parameters

OBJECTIVE: To compare the balance parameters, the diabetes mellitus (DM) composite score representing the severity of diabetic polyneuropathy, and the neuropathy impairment score-lower limb (NIS-LL). METHOD: Thirty patients with DM were studied. Subjects were evaluated with nerve conduction study in upper and lower extremities, DM composite score, and NIS-LL, various balance parameters such as plantar pressure difference of both sides and unipedal standing time. The subjects who could not stand without support by any reasons were excluded. RESULTS: NIS-LL showed strong correlation with DM composite score (r(s)=0.683) and unipedal standing time (r(s)=0.663) (p0.05). CONCLUSION: NIS-LL was considered to have clinical usefulness in the evaluation of balance problems related to DM.