Bone mineral density changes in male patients with chronic obstructive pulmonary disease: clinical and biochemical variables in correlation with glucocorticoids use

Recent studies have shown that osteoporosis and vertebral fractures are quite common in postmenopausal women with chronic obstructive pulmonary disease [COPD]. Few data are available in correlation between bone mass density [BMD] and men with COPD. This study was designed to investigate the prevalence of osteoporosis in men with COPD, with special regards to the role of glucocorticoids [GCs] use in these patients. We aimed to determine factors that influence bone metabolism and the clinical variables of this group of patients. We also tried to answer the arising question: should COPD patients be routinely evaluated for BMD? The study included 56 male patients with documented COPD for at least two years, their age ranged 24-66 years. Subjects were divided into 3 groups: group 1. Consisted of 18 patients, who were oral GCs users, group 2. consisted of 18 patients who were inhaled GCs users and group 3 consisted of 20 patients, never GCs users [this group was considered as the control group]. All subjects underwent measurement of BMD pulmonary function tests [PFTs] and a number of biochemical markers of bone metabolism. The associations between BMD Pulm. Function tests GCs use biochemical markers and clinical variables were analyzed. Of all 56 patients with COPD, the prevalence of osteopenia and osteoporosis as defined by WHO criteria was 26.8% and 21.4% at the lumber spine, 30.4% and 23.2% at total hip. 35.7% and 28.5% at femoral neck and 32.1% and 28.8% for total body respectively. Patients included group 1 had the lowest BMD at any site [p<0.0001]. group 2 patients had over all bone mass loss, that was indistinguishable from those who were receiving oral GCs. Group 3 patients had less bone mass reduction than the other two groups. Of the clinical and biochemical markers measured N-telopeptide was significantly correlated with bone mass [P<0.01], but there was no correlation with other markers. The lowest mean of FEVI [Forced Expiratory Volume in one second] was observed in group 1 patients. BMI [Body Mass Index] was weakly correlated with bone mass in the 3 studied groups. Bone mass loss is a common problem in male patients with COPD, while the use of oral GCs increases the frequency of osteoporosis, inhaled GCs therapy offered to protection from bone loss. COPD patients who had never treated with GCs had also a substantial risk for osteoporosis. We advocate early screening and preventive intervention

Ligament reconstruction and tendon interposition in the treatment of thumb basal joint arthritis

Osteoarthritis of the thumb basal joint is a relatively common condition and could be quite disabling. Surgical procedures which restore a painless and mobile joint result in a gratifying outcome both to the patient and surgeon. Fourteen patients with 16 thumbs suffering from thumb basal joint arthritis underwent ligament reconstruction and tendon interposition during the period from September 2002 to March 2005. Eleven patients were females and 3 were males. Their ages ranged from 46 to 68 years [average 52 years]. The patients were selected to perform that procedure after failure of the non-surgical treatment to relieve their symptoms and after careful clinical and radiological evaluation. The lateral half of the flexor carpi radials tendon was used for volar ligament reconstruction and interposition arthroplasty. The follow up period ranged from 12 to 34 months [average 17 months]. The average total Buck-Gramcko score was 49 points [excellent outcome]. In eleven cases the scores were above 48 points [good results], and in one case the score was 36 points [fair results]. One patient had temporary paresthesias in the distribution of the superficial sensory ranch of radial nerve. Reflex sympathetic dystrophy occurred in another patient. Ligament reconstruction with tendon interposition has the advantage of relieving the pain, restoring thumb motion and strength with relatively few complications

Upper tibial coronal plane - oblique osteotomy for deformity correction in Blount's disease

Correction of tibia vara deformity entails correction of varus and internal rotation deformities. In small children, the use of internal fixation is not desirable to avoid physeal violation; also, external fixator may not be applicable. Then, the osteotomy should be inherently stable, corrects all elements of deformity and allows post-operative adjustments of position. Oblique osteotomy has been described to perform varus derotation of the proximal femur and to correct varus internal rotation of the tibia in Blount's disease. The present study included 16 children. In ten patients the deformity was bilateral and it was unilateral in the other six patients, with a total of 26 tibiae. The youngest child was three years old and the oldest was 12 years old. The procedure included coronal plane oblique osteotomy starting distal to the tibial tubercle and runs up to the posterior tibial metaphysis just distal to the epiphyseal plate. A single fixation screw was used for limited internal fixation in the sagittal plane to allow post-operative position correction by cast wedging. All osteotomies healed within 12 weeks. The deformities were corrected with ten degrees of over-correction of varus deformity. In two patients post-operative weakness of extensor hallucis longus occurred which resolved within one week. Upper tibial oblique osteotomy in the coronal plane has the advantages of correction of all deformity elements with minimal internal fixation, at the same time allows post-operative adjustments which are desirable in small children