Greater trochanter of the femur (GTF) vs. proximal femoral nail anti-rotation (PFNA) for unstable intertrochanteric femoral fracture.

OBJECTIVE: We aim to compare the effects of stem type prosthesis implantation of the greater trochanter of the femur (GTF) and proximal femur nail anti-rotation (PFNA) for treatment of unstable intertrochanteric femoral fracture. PATIENTS AND METHODS: We retrospectively analyzed 108 patients with unstable intertrochanteric femoral fracture, including 61 cases who underwent GTF treatment and 47 cases who underwent PFNA treatment. We compared the operative time, blood loss, clinical healing and bone healing time, partial weight bearing and full weight bearing time, Harris hip score, rate of complications and rate of adverse reactions of implantation materials. RESULTS: Comparing the two groups in terms of operative time and blood loss, the differences were not statistically significant (p>0.05). The clinical and bone healing time in the GTF group were shorter than those in the PFNA group and the differences were statistically significant (p<0.05). The partial and full-weight bearing times in the GTF group were significantly shorter than those in the PFNA group. The Harris scores, one and six months after surgery, were higher than those in the PFNA group and by comparing the scores after 12 and 18 months, the differences were not statistically significant (p>0.05). The rate of complications and rate of adverse reactions of implantation material in the GTF group were lower than those in the PFNA group and the differences were statistically significant (p<0.05). CONCLUSIONS: GTF implantation is more advantageous in functional improvement and in reducing complications compared with PFNA for the treatment of unstable intertrochanteric femoral fracture.

Circulating periostin levels increase in association with bone density loss and healing progression during the early phase of hip fracture in Chinese older women.

The present study shows that hip fracture women had higher serum periostin (sPostn) levels. The elevation of sPostn is associated with bone density loss, yet fracture itself may even increase sPostn levels during early healing phase. INTRODUCTION: The study aims to quantify the associations of sPostn levels with bone density loss and the possible effect on the fracture healing. METHODS: This study enrolled 261 older women with osteoporotic hip fracture and 106 age-matched women without fracture serving as controls. Clinical features, bone mineral density (BMD), and bone turnover markers including sPostn level were measured after fracture within 2 days. Follow-up sPostn levels during 1 year after 2 days were available for 128 patients. RESULTS: Initial levels of sPostn after fracture were significantly higher in patients than controls. sPostn was correlated with BMD of femoral neck (r = -0.529, P < 0.001), ß-isomerized C-terminal crosslinking of type I collagen (ß-CTX) (r = 0.403, P = 0.008), and N-terminal procollagen of type I collagen (PINP) (r = 0.236, P = 0.042) in the entire cohort. After multivariate analysis, sPostn remained as an independent risk factor for femoral neck BMD, which explained 19.1% of the variance in BMD. sPostn sampled within 7 days after fracture were acutely increasing from day 2 and then decreased and maintained at slightly high levels at 360 days. The percentage changes of sPostn positively correlated with the variation in ß-CTX (r = 0.396, P = 0.002) and PINP (r = 0.180, P = 0.033) at day 7 after fracture. CONCLUSIONS: High sPostn levels were an independent predictor of femoral neck BMD in older women presenting with an acute hip fracture. Increased sPostn levels during early healing phase may imply that Postn play a role in bone repair.

Effectiveness of external fixator combined with T-plate internal fixation for the treatment of comminuted distal radius fractures.

This study compared the efficacy between external fixator combined with palmar T-plate internal fixation and simple plate internal fixation for the treatment of comminuted distal radius fractures. A total of 61 patients classified as type C according to the AO/ASIF classification underwent surgery for comminuted distal radius fractures. There were 54 and 7 cases of closed and open fractures, respectively. Moreover, 19 patients received an external fixator combined with T-plate internal fixation, and 42 received simple plate internal fixation. All patients were treated successfully during 12-month postoperative follow-up. The follow-up results show that the palmar flexion and dorsiflexion of the wrist, radial height, and palmar angle were significantly better in those treated with the external fixator combined with T-plate compared to those treated with the simple plate only (P < 0.05); however, there were no significant differences in radial-ulnar deviation, wrist range of motion, or wrist function score between groups (P > 0.05). Hence, the effectiveness of external fixator combined with T-plate internal fixation for the treatment of comminuted distal radius fractures was satisfactory. Patients sufficiently recovered wrist, forearm, and hand function. In conclusion, compared to the simple T-plate, the external fixator combined with T-plate internal fixation can reduce the possibility of the postoperative re-shifting of broken bones and keep the distraction of fractures to maintain radial height and prevent radial shortening.

Measurement of 2H2O by IR absorbance in doubly labeled H2O studies of energy expenditure.

The energy expenditure of animals in their natural surroundings can be determined by measuring the turnover in body water of isotopes of oxygen and hydrogen. We evaluated the use of infrared spectrophotometry for measuring 2H2O in small (20-microliters) water samples also labeled with 18O. For 2H2O over the enrichment range of 0.1-1 atom%, there was a linear relationship between infrared absorbance and 2H2O enrichment. 2H2O enrichments could be measured with a precision and accuracy of less than or equal to 1%, using this relationship. The presence of 18O in water samples in enrichments of up to 1 atom% had no significant effect on measurement of 2H2O by infrared absorbance. We measured the simultaneous turnover rates of 2H2O and 3H in mice and turtles also labeled with 18O. Our results validated the use of infrared absorbance in doubly labeled water measures of energy expenditure and indicated that the fractionation factors in vivo for 2H2O and 3H do not differ.