Changes in the bone tissue lipids in persons with steroid- and alcohol-induced osteonecrosis.

The lipids associated with osteonecrotic bone have a higher cholesterol content than those associated with normal (nondiseased) or osteoarthritic bone. A study of 18 osteonecrotic femoral heads showed elevated total lipids in the affected superolateral regions of the osteonecrotic bone as compared with both the unaffected inferomedial regions and the superolateral regions of nondiseased femoral heads. Cholesterol content was elevated in both the affected and unaffected regions of the osteonecrotic bones when contrasted with the cholesterol contents of control bones. Greatest elevations were noted for those persons with histories of combined steroid use and alcohol abuse. Seven controls and four osteoarthritic femoral heads had lower total lipid and cholesterol contents. The bone cholesterol content was correlated (r = 0.82) with the proportion of the tissue that was necrotic. The elevated cholesterol content in the necrotic tissues may contribute to cell death by altering membrane metabolism.

Simultaneous fractures of both femoral necks: review of the literature and report of two cases.

Simultaneous fracture of both femoral necks is extremely rare. Delay in diagnosis may be avoided by noting the association of these fractures with two conditions: violent skeletal trauma and major motor seizures. Treatment of two patients is reported in addition to a review of seven cases previously reported. The author's experience indicates that accurate reduction and percutaneous Knowles pinning provide adequate fixation and permit early weight-bearing.

Recurrent dislocation of the shoulder after age fifty.

Recurrent dislocation of the shoulder is infrequent in patients over the age of 50. In a small group of 6 patients with an average age of 64 years and multiple recurrences, 4 subsequently were treated by anterior capsulorraphy (Bankart). There was an unusual degree of loose jointedness in all 6 cases. When compared with a group of patients under the age of 30 with recurrent dislocation of the shoulder, the older group was functionally rated 19.4 out of a possible score of 25 points, compared with a rating of 10.8 in the younger group. In the older population, recurrent dislocation may become a problem if the patient is loose-jointed. Immobilization for 3 to 4 weeks may not be helpful in this group of patients. Anterior capsulorraphy is as successful as in younger patients and is not followed by unusual joint stiffness.

Posterior fracture-dislocation of the IV metacarpal hamate articulation: case report.

Posterior fracture-dislocation of the metacarpal hamate articulation is rare. A single case managed with splint immobilization and early finger motion is reported. The early functional results utilizing this method are excellent.

Identification of calcium oxalate deposits in bone by electron diffraction.

Oxalosis involving bone secondary to prolonged chronic renal failure and long-term dialysis occurred in a living patient. The cystalline deposit in the small fragment of bone was identified by electron diffraction.

Serum protein analysis following implantation of methyl methacrylate in rats.

Thirty-six Sprague-Dawley white rats were implanted with methyl methacrylate and bone wax in a 1:1 ratio. At periods of 1, 3, 5, 7, 10 and 14 days-post-implantation arterial blood samples were drawn and the serum protein separated electrophoretically. A significant depression in the alpha 1 and alpha 2 fractions of the methacrylate animals was demonstrated as was a significant increase in the beta fraction of the 3 day group. There was a sustained depression of the alpha 1 fraction in the methacrylate animals in a 3 day and a 5 day time period. It is not felt, however, that this is indicative of a mechanism for the diverse phenomena that have been described secondary to implantation of methyl methacrylate.