Adiponectin restores the obesity-induced impaired immunomodulatory function of mesenchymal stromal cells via glycolytic reprogramming

Obesity has been known to negatively modulate the life-span and immunosuppressive potential of mesenchymal stromal cells (MSC). However, it remains unclear what drives the compromised potency of obese MSC. In this study, we examined the involvement of adiponectin, an adipose tissue-derived hormone, in obesity-induced impaired therapeutic function of MSC. Diet-induced obesity leads to a decrease in serum adiponectin, accompanied by impairment of survival and immunomodulatory effects of adipose-derived MSC (ADSC). Interestingly, priming with globular adiponectin (gAcrp) improved the immunomodulatory potential of obese ADSC. Similar effects were also observed in lean ADSC. In addition, gAcrp potentiated the therapeutic effectiveness of ADSC in a mouse model of DSS-induced colitis. Mechanistically, while obesity inhibited the glycolytic capacity of MSC, gAcrp treatment induced a metabolic shift toward glycolysis through activation of adiponectin receptor type 1/p38 MAPK/hypoxia inducible factor-1α axis. These findings suggest that activation of adiponectin signaling is a promising strategy for enhancing the therapeutic efficacy of MSC against immune-mediated disorders.

Effects of DA-5513 on alcohol metabolism and alcoholic fatty liver in rats / 한국실험동물학회지

Hangover is characterized by a number of unpleasant physical and mental symptoms that occur after heavy alcohol drinking. In addition, consistently excessive alcohol intake is considered as a major reason causes liver disease. The present study investigated the in vivo effects of DA-5513 (Morning care® Kang Hwang) on biological parameters relevant to hangover relief and alcoholic fatty liver. Blood alcohol and acetaldehyde concentrations were determined in rats administered a single dose of alcohol and treated with DA-5513 or commercially available hangover relief beverages (Yeomyung® and Ukon®). The effects of DA-5513 on alcoholic fatty liver were also determined in rats fed alcohol-containing Lieber-DeCarli diets for 4 weeks. Serum liver function markers (aspartate and alanine aminotransferase activities) and serum/liver lipid levels were assessed. Blood alcohol and acetaldehyde concentrations were lower in the groups treated with DA-5513 or Yeomyung®, as compared with control rats. However, Ukon® did not produce any significant effects on these parameters. Treatment with DA-5513 significantly reduced serum aspartate and alanine aminotransferase activities and markedly reduced serum cholesterol and triglyceride levels, as compared with control rats. Histological observations using Oil Red O staining found that DA-5513 delayed the development of alcoholic fatty liver by reversing hepatic fat accumulation. These findings suggest that DA-5513 could have a beneficial effect on alcohol-induced hangovers and has the potential to ameliorate alcoholic fatty liver.

Development and application of quantitative detection method for nervous necrosis virus (NNV) isolated from sevenband grouper Hyporthodus septemfasciatus

OBJECTIVE@#To develop the rapid and efficient quantitative detection tool for nervous necrosis virus isolated from sevenband grouper Hyporhodus septemfasciatus.@*METHODS@#The viral genes of the NNV (SGYeosu08) isolated from sevenband grouper were phylogenetically analyzed. In addition, novel quantitative PCR primers based on the genomic sequence of SGYeosu08 isolate were designed and compared it with the conventional bio-assay method (TCID50) using in vitro and in vivo samples.@*RESULTS@#The phylogenetic analysis of viral genes demonstrated the relationship of SGYeosu08 with members of red-spotted grouper nervous necrosis virus (RGNNV). The qNNV_R1 primer set (R1_F and R1_R) and the qNNV_R2 primer set (R2_F and R2_R) revealed 93% primer efficiency (regression: y = -0.2861x + 9.9401, R(2) = 0.9976) and the revealed 108% primer efficiency (regression: y = -0.3172x + 10.0611, R(2) = 0.9982), respectively. Its comparison with viral infectivity calculated by TCID50 method showed similar kinetic pattern at in vitro and NNV challenged fish (in vivo) samples.@*CONCLUSIONS@#Result show that this method is rapid and efficient to diagnose NNV infection compare to traditional bioassay method (TCID50).

Detection of coat protein gene of nervous necrosis virus using loop-mediated isothermal amplification

OBJECTIVE@#To establish a novel and highly specific loop-mediated isothermal amplification (LAMP) assay for the identification of nervous necrosis virus (NNV) infection.@*METHODS@#A set of synthesized primers was used to match the sequences of a specific region of the nnv gene from the National Center for Biotechnology Information database, not originating from NNV-infected fish, the efficiency and specificity of LAMP were measured dependent on the concentration of DNA polymerase and the reaction temperature and time. In addition, to determine species-specific LAMP primers, cross reactivity testing was applied to the reaction between NVV and other virus families including viral hemorrhagic septicemia virus and marine birnavirus.@*RESULTS@#The optimized LAMP reaction carried out at 64 °C for 60 min, and above 4 U Bst DNA polymerase. The sensitivity of LAMP for the detection of nnv was thus about 10 times greater than the sensitivity of polymerase chain reaction. The LAMP assay primers were specific for the detection NNV infection in Epinephelus septemfasciatus.@*CONCLUSIONS@#The development of LAMP primers based on genetic information from a public database, not virus-infected samples, may provide a very simple and convenient method to identify viral infection in aquatic organisms.

Detection of coat protein gene of nervous necrosis virus using loop-mediated isothermal amplification

Objective: To establish a novel and highly specific loop-mediated isothermal amplification (LAMP) assay for the identification of nervous necrosis virus (NNV) infection. Methods: A set of synthesized primers was used to match the sequences of a specific region of the nnv gene from the National Center for Biotechnology Information database, not originating from NNV-infected fish, the efficiency and specificity of LAMP were measured dependent on the concentration of DNA polymerase and the reaction temperature and time. In addition, to determine species-specific LAMP primers, cross reactivity testing was applied to the reaction between NVV and other virus families including viral hemorrhagic septicemia virus and marine birnavirus. Results: The optimized LAMP reaction carried out at 64 °C for 60 min, and above 4 U Bst DNA polymerase. The sensitivity of LAMP for the detection of nnv was thus about 10 times greater than the sensitivity of polymerase chain reaction. The LAMP assay primers were specific for the detection NNV infection in Epinephelus septemfasciatus. Conclusions: The development of LAMP primers based on genetic information from a public database, not virus-infected samples, may provide a very simple and convenient method to identify viral infection in aquatic organisms.

Development and application of quantitative detection method for nervous necrosis virus (NNV) isolated from sevenband grouper Hyporthodus septemfasciatus

Objective To develop the rapid and efficient quantitative detection tool for nervous necrosis virus isolated from sevenband grouper Hyporhodus septemfasciatus. Methods The viral genes of the NNV (SGYeosu08) isolated from sevenband grouper were phylogenetically analyzed. In addition, novel quantitative PCR primers based on the genomic sequence of SGYeosu08 isolate were designed and compared it with the conventional bio-assay method (TCID

Changes in Clinical Symptoms, Functions, and the Median Nerve Cross-Sectional Area at the Carpal Tunnel Inlet after Open Carpal Tunnel Release

BACKGROUND: The aim of this study was to investigate the relationship between clinical symptoms and cross-sectional area (CSA) of the median nerve at the carpal tunnel inlet before and after open carpal tunnel release (CTR). METHODS: Thirty-two patients (53 hands) that underwent open CTR for idiopathic carpal tunnel syndrome were prospectively enrolled. Median nerve CSA at the carpal tunnel inlet was measured preoperatively and at 2 and 12 weeks after CTR by high resolution ultrasonography. The Boston carpal tunnel questionnaire (BCTQ) was also completed at these times. RESULTS: BCTQ symptom (BCTQ-S) score was significantly improved at 2 weeks postoperatively, but BCTQ function (BCTQ-F) score and CSA were significantly improved at 12 weeks postoperatively. Preoperative CSA was significantly correlated with preoperative BCTQ-S and BCTQ-F scores but was not significantly correlated with postoperative BCTQ scores or postoperative changes in BCTQ scores. Postoperative median nerve CSA was not significantly correlated with postoperative BCTQ-S or BCTQ-F scores, and postoperative changes in median nerve CSA were not significantly correlated with postoperative changes in BCTQ-S or BCTQ-F scores. CONCLUSIONS: The study shows clinical symptoms resolve rapidly after open CTR, but median nerve swelling and clinical function take several months to recover. In addition, preoperative median nerve swelling might predict preoperative severities of clinical symptoms and functional disabilities. However, postoperative reductions in median nerve swelling were not found to reflect postoperative reductions in clinical symptoms or functional disabilities.

Clinical Outcome of Simple Discectomy for Recurrent Lumbar Disc Herniation

STUDY DESIGN: This is a retrospective study. OBJECTIVES: To analyze the clinical outcomes of simple discectomy in patients with recurrent lumbar disc herniation. SUMMARY OF LITERATURE REVIEW: There are two methods of studying the treatment of recurrent lumbar disc herniation. The first type of study considers fusion for the prevention of complications such as postoperative lumbar segmental instability and persistent back pain. The second type of study assumes that simple discectomy without fusion is sufficient in the surgical management of recurrent lumbar disc herniation. MATERIALS AND METHODS: Sixteen patients who underwent simple discectomy due to recurrent lumbar disc herniation were followed up over 3 years. The mean age was 52.8 years (38-68 years). The mean follow-up period was 75.4 months (36-144 months). VAS scores for back pain and radiating lower leg pain were each compared pre- and post-operatively. The Oswestry Disability Index (ODI) was used to analyze the clinical outcome. A modified MacNab's outcome was used to evaluate patient satisfaction. Subjective survey data in a Delphi checklist was reviewed to verify clinical lumbar instability. RESULTS: The mean back pain VAS score showed 87.5% improvement (p<0.001). The mean lower leg VAS score showed 89% improvement (p<0.001). The mean preoperative ODI score was 29.9, and the mean score checked at the last follow up was 3.5. It thus showed 88.3% improvement (p<0.001). Excellent or good satisfaction was reported by fourteen patients (87.5%), and clinical lumbar instability was identified in one patient (6.3%). CONCLUSIONS: Simple discectomy without fusion is one of treatment option for recurrent disc herniation without instability.

The Pharmacological Effects of Benachio-F(R) on Rat Gastrointestinal Functions

Functional dyspepsia (FD) is a prevalent idiopathic upper gastrointestinal (GI) disorder characterized by diverse symptomatology including epigastric pain or discomfort, postprandial fullness, and early satiety. Although its pathophysiological mechanisms have not yet been fully established, the available studies suggest that the etiology of FD is invariably multifactorial. Benachio-F(R) (BF) is a proprietary liquid formulation of 7 herbal extracts that has been proposed to address this multifactorial etiology using multi-drug phytotherapy. The pharmacological effects of BF, in comparison with those of two other herbal products (Whalmyungsu(R); WM and Iberogast(R); IB) were evaluated in rats. In a laparotomy-induced rat model of delayed GI transit, BF significantly accelerated the delayed gastric emptying caused by morphine, apomorphine, and cisplatin, and also significantly increased mean gastric transit, as compared to the control animals. BF markedly increased gastric accommodation in rats and produced higher gastric volume values than did the control treatment. The effects of BF were generally comparable or superior to those of WM and IB in these models. Furthermore, BF significantly stimulated biliary flow, as compared to the control treatment. These results indicated that BF might have great potential as an effective phytotherapeutic agent capable of reducing GI symptoms and increasing quality of life in FD patients.

Zanamivir Oral Delivery: Enhanced Plasma and Lung Bioavailability in Rats

The objective of this study was to enhance the oral bioavailability (BA) of zanamivir (ZMR) by increasing its intestinal permeability using permeation enhancers (PE). Four different classes of PEs (Labrasol(R), sodium cholate, sodium caprate, hydroxypropyl beta-cyclodextrin) were investigated for their ability to enhance the permeation of ZMR across Caco-2 cell monolayers. The flux and Papp of ZMR in the presence of sodium caprate (SC) was significantly higher than other PEs in comparison to control, and was selected for further investigation. All concentrations of SC (10-200 mM) demonstrated enhanced flux of ZMR in comparison to control. The highest flux (13 folds higher than control) was achieved for the formulation with highest SC concentration (200 mM). The relative BA of ZMR formulation containing SC (PO-SC) in plasma at a dose of 10 mg/kg following oral administration in rats was 317.65% in comparison to control formulation (PO-C). Besides, the AUC0-24 h of ZMR in the lungs following oral administration of PO-SC was 125.22 +/- 27.25 ng hr ml(-1) with a Cmax of 156.00 +/- 24.00 ng/ml reached at 0.50+/-0.00 h. But, there was no ZMR detected in the lungs following administration of control formulation (PO-C). The findings of this study indicated that the oral formulation PO-SC containing ZMR and SC was able to enhance the BA of ZMR in plasma to an appropriate amount that would make ZMR available in lungs at a concentration higher (>10 ng/ml) than the IC50 concentration of influenza virus (0.64-7.9 ng/ml) to exert its therapeutic effect.

Treatment of Ulnar Fractures Combined with Distal Radius Fracture / 대한정형외과학회잡지

Approximately 5-6% of distal radius fractures have a concomitant distal ulnar fracture, this incidence is more frequent in osteoporotic elderly patients. When the distal ulnar fracture is stable after fixation of the distal radius fracture, the distal ulnar fracture can be managed with cast immobilization. However, when the distal ulnar fracture shows malalignment or instability, an operative method should be used. The operative method for distal ulnar fracture includes internal fixation using a K-wire, intramedullary nail, or plates and salvage procedures including ulnar head resection or Sauve-Kapandji procedure. Approximately 50% of distal radius fractures are combined with ulnar styloid process fracture. Although approximately 50-70% of ulnar styloid process fractures result in nonunion if they are not treated by an operative method, they tend to be asymptomatic. Recent studies of distal radius fracture treated using a volar locking plate have generally reported that neither the presence nor the size of concomitant ulnar styloid fracture has an effect on clinical outcome.

Survival Analysis of Conservative Treatement in Osteoporotic Vertebral Fracture

STUDY DESIGN: Prospective study. OBJECTIVES: To define the prognostic factors by analyzing the survival rates of osteoporotic vertebral fracture treated by conservative management. SUMMARY OF THE LITERATURE REVIEW: Due to an increasing elder population, many recent studies of osteoporosis have been done; pointing out that osteoporotic vertebral fracture may produce serious complications. However, there is nothing obviously demonstrated in both the management and prognosis of the osteoporotic vertebral fracture. MATERIALS AND METHODS: Survival analysis was done for 130 patients who had undergone conservative management for a single level vertebral fracture. Univariant and multivariant survival analysis was done for age at trauma, sex, body mass index (BMI), bone mineral density (BMD), smoking, diabetic history, fracture level, fracture type, vertebral compression ratio and regional Cobb's angle. RESULTS: Survival rate for conservative management was 70.7%. Univariant analysis for survival rate revealed significantly inferior results for age over 78 (p=0.008), T score< -3.5 (p=0.047), and crush or biconcave type than wedge type (p=0.021). Only the age factor showed significance in multivariant analysis (p=0.025, Hazard ratio=2.08). CONCLUSION: Conservative management in a single level osteoporotic vertebral fracture, showed a survival rate of 70.7% and age was the most important factor in conservative management. We should notice that age of more than 78 years is at high risk for failure in conservative management of vertebral fracture.

The Availability of Autogenous Bicortical Iliac Bone Graft in Anterior Cervical Interbody Fusion

STUDY DESIGN: Retrospective study. OBJECTIVES: To demonstrate the fusion rate, degree of subsidence and donor site morbidity of anterior cervical interbody fusion with autogenous bicortical iliac bone graft and anterior cervical locking plate. SUMMARY OF THE LITERATURE REVIEW: In anterior cervical discectomy and fusion with autogenous tricortical iliac bone graft, a large percentage of patients report chronic donor site pain. MATERIALS AND METHODS: Retrospective research was done for 39 patients who underwent anterior cervical interbody fusion with autogenous bicortical iliac bone graft, from January 2006 to July 2011, with a follow up period of longer than 1 year. Fusion rates and subsidece of the graft is estimated with radiographs. Neck pain and donor site pain was estimated with visual analogue scale (VAS) and dysfunction was estimated with the neck disability index (NDI). RESULTS: A 95% of patients who underwent anterior cervical interbody fusion with autogenous bicortical iliac bone graft revealed definitive fusion with little amount of subsidence. The mean VAS score was 0.7 on the donor site and the mean NDI score was 3.8 at the final visit. There was excellent clinical outcome without complication at the donor site or the recipient site. CONCLUSIONS: Anterior cervical interbody fusion with autogenous bicortical iliac bone graft showed high fusion rates and minimal subsidence with excellent clinical outcomes. Therefore, bicortical iliac bone graft is an effective operational procedure in anterior cervical interbody fusion.

The Efficiency of Additional Fixation of the Alternative Bone Substitute in Unstable Intertrochanteric Fractures of Femur Treated with Gamma Nail

PURPOSE: To evaluate the efficiency of additional fixation of the alternative bone substitute in unstable intertrochanteric fractures treated with gamma nail and alternative bone substitute and only with gamma nail. MATERIALS AND METHODS: Radiologic comparison was done between forty-four patients of unstable intertrochanteric fracture (AO type A2.2, A2.3) during six months. The patients were divided into two groups, a group treated with gamma nail and alternative bone substitute (22 patients, group 1) and another group treated only with gamma nail (22 patients, group 2). Postoperative reduction status, Cleveland index, Tip-apex distance and complications during the follow-up period was compared. Lag screw slippage and femoral neck-shaft angle change were measured between two groups. RESULTS: No significant difference of reduction status, Cleveland index and Tip-apex distance was found. In group II, there was a 1 more case of cutting-out of the lag screw, but also there was a significant difference. Lesser change in lag screw slippage and neck-shaft angle change was investigated. CONCLUSION: As there are lesser lag screw slippage and neck-shaft angle change, alternative bone substitutes applied in unstable intertrochanteric fractures seems to be useful in maintaining reduction and preventing failure of internal fixation when proper reduction and screw insertion is performed.

Analysis of Stroke Patients with Hip Fracture

OBJECTIVE: To investigate the specific features of stroke patients with hip fracture, and the correlation of fracture occurrence with rehabilitation after stroke onset. METHOD: We retrospectively analyzed 181 stroke patients in a total of 892 patients who underwent an operation due to hip fracture. The assessment factors consists of age, the location of brain lesion, bone marrow density, body mass index, the presence of diabetes mellitus and anemia, laboratory findings of serum albumin, calcium and phosphate. We also analyzed subject's dominant hand side, experience of rehabilitation, and the duration between stroke onset and occurrence of hip fracture. RESULTS: Among 181 patients (56 male, 125 female), most common location of the brain lesion was the subcortex. About 70% of patients had osteoporosis, anemia and hypoalbuminemia. Among 34 hemiplegic patients, most of them had hip fracture on hemiplegic side (91.2%). The duration between stroke onset and occurrence of hip fracture of the patients who had experience of rehabilitation after stroke was longer than that of the patients without rehabilitation experience (p<0.05). CONCLUSION: Woman, osteoporosis, anemia and hypoalbuminemia are correlated with the hip fracture in stroke patient. The hip fracture of the stroke patient who did not have rehabilitation experience occurred earlier. The rehabilitation therapy including education for prevention of falling may be helpful to stroke patients with these factors.

Surgical Treatment of Femur Intertrochanteric and Subtrochanteric Fracture

Femur intertrochanteric and subtrochanteric fractures are extracapsular hip fractures and they show a bimodal age distribution. Most hip fractures in young patient are subtrochanteric or basicervical fractures that are caused by high energy injury. Most of the hip fractures in old patients are intertrochanteric fractures related to osteoporosis and low energy injury. For proximal hip fractures, the muscles around the hip joint make reduction difficult and the position of the lag screws affects healing of the fracture. To lower the complications of these fractures, surgeons can use an appropriate implant along with performing good reduction and good lag screw positioning. We report here on our review of femur intertrochanteric and subtrochanteric fractures, the characteristics of compression hip screws, the intramedullary devices and the technical pitfalls.

Treatment of the Unstable Intertrochanteric Fracture with Proximal Femoral Nail Antirotation: Comparison with Compression Hip Screw with Trochanteric Stabilizing Plate

PURPOSE: To evaluate the effectiveness of Proximal Femoral Nail Anti-rotation (PFNA) for the treatment of unstable intertrochanteric fracture comparing with Compression Hip Screw (CHS) with Trochanteric Stabilizing Plate (TSP). MATERIALS AND METHODS: With clinical study, 43 patients who were treated surgically for unstable intertrochanteric fractures were retrospectively evaluated. One group was treated with CHS and TSP (Group 1, 22 cases) and the other was treated with PFNA (Group 2, 21 cases). By postoperative radiograph and last follow up radiograph we measured Tip-apex distance, Cleveland index, Lag screw slippage, Neck-shaft angle change and Union time. And By retrospective medical record review, the clinical results were evaluated with the operation time, intraoperative estimated blood loss, amount of drainage, amount of transfusion, walking ability change and complication. RESULTS: There was a lower operation time, intraoperative estimated blood loss, amount of drainage, amount of transfusion, lag screw slippage and neck shaft angle change in the Group 2 than in the Group 1 (p<0.05). CONCLUSION: PFNA showed better results than CHS with TSP in operation time, estimated blood loss, amount of drainage and transfusion, lag screw slippage and neck-shaft angle change.

Effect of a Trochanter-stabilizing Plate in Unstable IntertrochantericFractures : A Clinical and Biomechanical Study

PURPOSE: To evaluate the effectiveness of a trochanter-stabilizing plate (TSP) for the treatment of unstable intertrochanteric fractures. MATERIALS AND METHODS: In the clinical aspect of the study, 48 patients who were treated surgically for unstable intertrochanteric fractures were evaluated. One group of patients was treated with CHS [spell out with 1st use] only (group 1, n=23) and the other group was treated with CHS and TSP (group 2, n=25). In the biomechanical aspect of the study, an AO type A2.2 intertrochanteric fracture was reproduced in 10 proximal femur models. Five models were reduced and fixed using CHS only (group 1) and 5 models were fixed using CHS with TSP (group 2). A load of 750 N (300 cycles) was applied using Instron. RESULTS: In the clinical aspect of the study, the extent of lag screw sliding, greater trochanter lateralization, and neckshaft angle varus change was less in group 2 than in group 1. In the biomechanical aspect of the study, the extent of lag screw sliding was less in group 2 than in group 1, but the neck-shaft angle varus change was greater in group 2 than in group 1. CONCLUSION: The use of TSP is effective for the buttress effect on the proximal fragment. It decreases the excessive sliding of the lag screw, lateral displacement of the greater trochanter, and neck-shaft angle varus change. Therefore, TSP may be a useful treatment for unstable intertrochanteric fractures.

Early Clinical Results in the Use of a Tantalum Trabecular Metal System For Osteonecrosis of the Femoral Head

PURPOSE: To evaluate the effectiveness of core decompression using a tantalum trabecular metal system for treatment of early stage osteonecrosis of the femoral head, with a minimum follow-up of 1 year and a maximum follow-up of 5 years. MATERIALS AND METHODS: Between January 2003 and August 2007, a retrospective analysis was conducted on 46 femoral heads in 36 patients (9 males and 27 females) underwent core decompression using a tantalum trabecular metal system. The mean duration of follow-up was 26 months (minimum, 1 year; maximum, 5 years). The ARCO classification system was used. The mean age of the patients was 42.9 years. The conversion to total hip arthroplasty due to aggravating hip pain was defined as a clinical failure. RESULTS: At an average of 12 months, 18 patients (21 hips) were converted to THR. No conversion to THR in occurred in stages IA or IIA. In Stage IB, one-half of the medial lesion and all of the lateral lesions were converted to THR. One of 11 medial lesions and all of the lateral lesions in stage IC were converted to THR; 2 of 3 medial lesions and all of the lateral lesions in stage IIB were converted to THR. In stage IIC, 6 of 8 lateral lesions were converted to THR, but the central lesions were not converted. All of the lateral lesions in stage IIIC were converted to THR. CONCLUSION: The higher stage of ARCO classification and the more lateral position of the lesion, the greater the failure rate of the tantalum trabecular metal system. Conversion to THR from a failed tantalum trabecular system developed within 12 months postoperatively. The tantalum trabecular metal system is a useful treatment for osteonecrosis of the femoral head with a lower stage of ARCO classification and a medial location of the lesion.

Factors Predicting Complications after Internal Fixation of Femoral Neck Fractures

PURPOSE: To evaluate the factors predicting complications after internal fixation using multiple cannulated screws in the patients with femoral neck fracture, the authors performed a comparative study of a success group and a failure group and reviewed the literature. MATERIALS AND METHODS: Sixty-eight patients with intracapsular femoral neck fractures were treated by multiple pinning from January 2000 to July 2007 and followed up more than one year. Relationships between the complications such as failure of union, collapse of femoral head due to osteonecrosis of femoral head and several affecting factors including the degree of displacement by Garden stage, state of reduction, position of screws, patient's age, time interval from injury to operation, anatomical fracture site and two weeks postoperative (99m)Tc-MDP bone scan were analyzed. RESULTS: Statistically significant factors were the degree of displacement by Garden stage (p<0.001), reduction state (p<0.001) and postoperative two weeks (99m)Tc-MDP bone scan (p<0.001). CONCLUSION: An accurate anatomical reduction is needed to decrease complications with multiple cannulated screws fixation of femoral neck fracture. Displacement of fracture by Garden stage and (99m)Tc-MDP bone scan are major factors predicting complications.