Nonanatomical reduction of displaced subcapital femoral fractures (Gotfried reduction).

The purpose of this presentation is to describe the Gotfried (nonanatomical) reduction technique of unstable subcapital femoral fractures. In addition, to report, retrospectively, on the radiological outcomes of displaced subcapital femoral fractures reduced with the Gotfried reduction method. The technique involves creation of a positive buttress between the proximal and distal fracture parts to prevent future reduction deterioration once fracture line bone resorption takes place as well as reduction in valgus. Presented are unstable Garden 3/4 cases, 4 cases stabilized with the Physiological Hip Nail, and 1 with the PC.C.P plate. No radiological signs of fracture redisplacement, nonunion, or AVN were detected at a follow-up minimum of 12 months. Results of this technique are encouraging. Larger scale and multiple studies are needed to confirm the value of this new reduction method.

The effect of hindlimb immobilization on acid phosphatase, metalloproteinases and nuclear factor-kappaB in muscles of young and old rats.

Age-associated muscle wasting (sarcopenia of old age) is a major problem in elderly people, however, the mechanisms of muscle proteolysis in aging remain obscure and enigmatic. Possible reasons for loss of skeletal muscle mass with aging may be attributed to multiple and complex proteolytic systems. The purpose of the present study was to explore the kinetics of activation of extracellular hydrolytic and proteolytic systems in muscles of hindlimbs immobilized by external fixation of 24-month-old female Wistar rats, in comparison with those of 6-month-old rats. Results show that elevated acid phosphatase activities (lysosomal hydrolytic enzyme activated mainly in macrophages) in immobilized limb muscles of young animals, differ from old animals. In young rats external fixation resulted in significantly elevated acid phosphatase activities (50-55%; p<0.05) after 4 weeks of immobilization, whereas in old animals similar increases were observed already during the first and second weeks of immobilization. The extracellular proteolytic enzymes, matrix metalloproteinases (MMP-2 and -9), were also differentially activated in old animals compared to young animals. In young animals, as shown in previous studies, both MMP-2 and -9 activities were elevated significantly in immobilized muscles. In this study of old animals, only MMP-2 activity was detected, with no significant elevation in the immobilized muscles of old animals. In addition, the levels of the transcription factor Nuclear Factor-kappaB (NF-kappaB) in nuclear extracts of old rat muscles, as detected by ELISA, showed a biphasic pattern after immobilization, suggesting that NF-kappaB could be activated by different processes in the atrophy process, at least in the old age. In conclusion, it seems that the kinetics of activation of extracellular hydrolytic and proteolytic systems differ in muscles of old animals compared to young animals.

Clinical spectrum of asymptomatic femoral neck abnormal uptake on bone scintigraphy.

UNLABELLED: The purpose of this study was to assess the clinical spectrum of asymptomatic abnormal focal uptake of (99m)Tc-methylene diphosphonate (MDP) in the femoral neck. METHODS: Fifteen consecutive patients with asymptomatic abnormal focal uptake of (99m)Tc-MDP in the femoral neck were evaluated. Two patients had bilateral abnormal focal uptake. The patient's history, clinical findings, and plain hip radiograph were obtained in all cases. Scintigraphic, radiographic and clinical findings were correlated. RESULTS: Eight of 17 (47%) femoral necks showed a definite herniation pit on radiography, 6 patients (35%) had normal radiographic findings, 1 patient had a bone island, 1 patient had a bone island and a herniation pit, and 1 patient had a subtle lesion suggestive of a herniation pit on radiography. All patients remained asymptomatic for at least a 10-mo follow-up period. CONCLUSION: A herniation pit is the most common finding among asymptomatic abnormal femoral neck focal uptake. This condition should be distinguished from a wide variety of disorders associated with increased focal abnormal uptake of (99m)Tc-MDP in the femoral neck.