A retrospective comparison of total versus partial cross-bone resection in surgical management of congenital cleft hand.

This study aimed to compare clinical and radiographical results of total or partial resection of the cross-bone in the management of children with cleft hand. Nine children with 10 cleft hands who underwent resection of the cross-bone were retrospectively identified and divided into two groups based on type of resection: Group T (total resection) including 5 children (5 affected hands; 3 boys; mean age = 3.5 (range, 2-5) years), and Group P (partial resection) including 4 children (5 affected hands; 3 boys; mean age = 3.2 (range, 2-5) years). Mean follow-up was 68 (range, 60-85) months in group T and 47 (range, 40-60) months in group P. To assess clinical status, postoperative cosmetic satisfaction was evaluated by asking the parents, and cosmetic appearance was rated using a visual analogue scale (VAS) at the follow-up. In the radiographical evaluation, change in cleft divergence following reconstruction was assessed as the metacarpal divergence angle between the index and the ring finger metacarpals. Overall, cosmetic satisfaction was rated "very satisfied" or "satisfied" in 7 of the 10 hands, and functional satisfaction as "very satisfied" or "satisfied" in all. Mean postoperative cosmetic aspect on VAS was 6.4 (range, 5-8) in group T, and 6.2 (range, 4-8) in group P (p = 0.99). Mean metacarpal divergence angle significantly decreased from 42.2° (range, 35-52°) and 40.2° (range, 36-46°) preoperatively to 21.2° (range, 15-35°) and 19.8° (range = 12-31°) at 3-year follow-up in groups T and P, respectively (p < 0.001 for each group). Both total and partial cross-bone resection provided satisfactory clinical and radiographical medium-term results for of children with cleft hand.

Risedronate therapy for neurofibromatosis Type 1-related low bone mass: a stitch in time saves nine.

Neurofibromatosis Type 1 (NF1) is a common hereditary disease characterized by disorders regarding the skin, neural, and skeletal systems. Osteoporosis is one of the skeletal manifestations of NF1, which is associated with increased fracture risk. The management of NF1-related low bone mass has been less studied in the literature. We present a 19-year-old patient with severe low bone mass complicating NF1. The patient received 1-year course of 35 mg risedronate sodium once per week along with a daily regimen of 1200 mg calcium and 800 IU vitamin D. Significant improvement with regard to the Z-scores and bone mineral density values was achieved. Besides, rapid favourable biochemical response was obtained. The patient experienced 24·4 and 15·0% improvements in bone mineral density at the lumbar site and hip, respectively, at the first year of therapy. No adverse effect was observed. Since increased bone turnover is the primary contributor of osteoporosis in NF1, antiresorptive agents such as bisphosphonates can be considered for treatment. Despite the lack of consensus on the treatment of osteoporosis in NF1, risedronate may hold a promise as a potential therapy for osteoporosis complicating NF1. This is the first report of risedronate therapy in a case with NF1-associated low bone mass in the literature.

Osteopenia and osteoporosis in postmenopausal women. Assessment by radiogrammetric measurement.

PURPOSE: To compare the ability of the medial cortical thickness ratio to the width of the second metacarpal bone at the midshaft (MCR) in discriminating patients as normal, osteopenic or osteoporotic. MATERIAL AND METHODS: MCR was calculated from radiographs of 120 postmenopausal women. By dual-energy X-ray absorptiometry, the mineral density was measured in the lumbar spine, the wrist and the femoral neck. Patients were grouped in accordance with the diagnostic criteria of WHO on the basis of t-scores. MCR values were compared with t-scores and the ability of the MCR technique in discriminating the patient groups was evaluated. RESULTS: Analysis of radiogrammetric data revealed significant differences in MCR value between the 3 groups. The MCR was lower in patients with osteoporosis and osteopenia compared with the normal group. The mean value of MCR was also slightly lower in patients with osteoporosis than in those with osteopenia. Accuracy assessment (ROC analysis) of MCR in the discrimination of patients with osteoporosis showed that test accuracy was acceptable, but less accurate than spinal, wrist and femoral neck t-scores. Compared with t-scores, this test was found to fairly discriminate those with and without osteopenia. CONCLUSION: The MCR method can discriminate patients as osteoporotic or normal. However, it seems that the MCR method should not be used for decisions concerning treatment of osteoporosis because of its low accuracy and thereby a risk for misclassification.

Vitamin D status and bone mineral density of veiled and unveiled Turkish women.

The aim of the study is to compare vitamin D status and bone mineral density (BMD) in veiled and unveiled healthy Turkish women of reproductive age. Thirty young to middle-aged volunteer veiled women and 30 age-matched control subjects with western clothing habits were enrolled in the study. The two groups had similar dietary habits, body mass index (BMI) distribution, and gestational history. Physical and laboratory examinations were performed to rule out any disease that could affect bone metabolism. Serum 25-hydroxyvitamin D (25-OHD) levels were measured, and BMD of the spine and hip were investigated by dual energy x-ray absorptiometry (DEXA). The mean age of dressing the veil was 15.7 +/- 6.13 years, and 66.7% of the veiled women claimed that they were not ever exposed to direct sunlight, as they were leading an indoor life. Compared with the control group, veiled women were less educated and physically less active (p < 0.001 and p < 0.05, respectively). 25-OHD levels were positively correlated with exposure to sunlight and negatively correlated with the duration of being veiled. None of the veiled women had vitamin D insufficiency, but their mean 25-OHD concentration (33.1 +/- 16 ng/ml) was significantly lower than that of controls (53.9 +/- 27.3 ng/ml) (p < or = 0.001), and serum alkaline phosphatase (ALP) levels were higher (p < 0.01). Differences in the absolute BMD values at the spine and hip were not statistically significant, but the mean Z value at the lumbar spine was significantly lower in the veiled subjects (p < 0.05). Veiled women have low 25-OHD status, and vitamin D supplementation should strictly be advised to these women for the prevention of osteomalacia and osteoporosis.