Transforming growth factor-ß3 relation with osteoporosis and osteoporotic fractures.

BACKGROUND: The high socioeconomic impact of osteoporosis and osteoporotic fracture is due to their high mortality, morbidity, and disease-related costs. Nowadays, bone mineral density (BMD) is a comparatively expensive way to diagnose and follow up patients with osteoporosis. Transforming growth factor-ß3 (TGF-ß3) is a protein categorized into cytokines. Some previous in vitro studies showed TGF-ß3 effects on osteocytes and bone formation. Therefore, we conducted this study to find if there is any significant relationship between TGF-ß3 and BMD results. MATERIALS AND METHODS: This was an analytical cross-sectional study conducted in 2017. We included individuals who had been referred from their physicians to undergo BMD dual-energy X-ray absorptiometry. Blood samples were taken from 150 participants for measuring TGF-ß3 with ELISA method. RESULTS: The mean ± standard deviation of TGF-ß3 serum level was 79 ± 30.8 pg/ml (minimum 41 pg/ml and maximum 210 pg/ml). There was a statistically significant and direct proportional relationship between TGF-ß3 and T-score as a marker for the diagnosis and follow-up of osteoporosis and osteoporotic fracture (P = 0.001) (Pearson's correlation = +0.95). CONCLUSION: There was a significant relationship between TGF-ß3 serum level and BMD. TGF-ß3 serum level may be used as a marker for the diagnosis and follow-up of osteoporosis and osteoporotic fracture.

Studying the effects of primary arthroplasty on post-treatment results among elderly patients with pertrochanteric fracture.

Various therapeutic methods are available to treat patients with intertrochantric fracture, which is usually caused by falling down. This complication is usually observed among the elderly, particularly old women. The choice of the proper therapeutic method depends on many factors including patient's condition, type of fracture, and the amount of movement. Hip arthroplasty is one of these therapeutic methods, which have certain advantages and disadvantages. Immediate resumption of walking with the ability of weight toleration and absence of complications such as aseptic necrosis are some advantages of this method. Sixtyeight elderly patients with pertrochanteric fracture who had resorted to Iranian Army's hospitals and had undergone arthroplasty. These cases were examined with due comparison with historical and external controls. Variables such a type of operation, age, post-operation pain, the pace of resuming walking ability, embolism, surgical site infection, bedsore and DVT were studied and compared against standard operation. The results achieved through assessment of variables showed a significant difference with standard operation in terms of variables such as post-operative movement ability, pain scale in various times, surgical complications, embolism, surgical site infection, bedsore, and DVT. Post-operative pain within the first 3 months following it are some complications with not much attention is paid to them, but they are important complications which can cause many negative and influential effects on patients. Arthroplasty is more expensive than standard operation and the patient may initially feel more pain.

Clinical results of using the proximal humeral internal locking system plate for internal fixation of displaced proximal humeral fractures.

Proximal humerus fractures are accounting for 4-5% of all fractures with increasing incidence. Proximal Humeral Internal Locking System (PHILOS) plate is a new plate which permits early mobility and lowers the risk of complications. The aim of this study was to evaluate the functional outcome and the complication rate after using this plate. Between 2006-2008, 37 patients with displaced 2-, 3-, and 4-part fractures of the proximal humerus underwent surgery using PHILOS plate. The mean range of follow-up was 12 months. Twenty patients were aged 60 years and younger, and 17 were aged older than 60 years. The average American Shoulder and Elbow Surgeons (ASES) score at the final follow-up was 77.62. According to Michener and colleagues classification, 5.4% of patients had an excellent outcome, 72.9% were minimally functionally limited, 16.2% were moderately functionally limited, and 5.4% were maximally functionally limited. The average ASES score between patients 60 years and older and those 60 years and younger was not different significantly. One patient developed avascular necrosis of the humeral head, 2 patients developed an infection, and no patients developed a nonunion. Fixation with PHILOS plate can be considered a good method with high union rates for this kind of fracture, especially in the older population with osteoporotic bone.

Total hip arthroplasty in advanced osteonecrosis: the short-term results by metal-on-metal hip resurfacing.

BACKGROUND: Characteristically, osteonecrosis affects younger patients who typically refer to the orthopedic surgeon for the first time in the third to fifth decades of life, in the late stages of the disease. Femoral metal-on-metal hip resurfacing is as an alternative to conventional total hip arthroplasty in treating osteoarthritis of the hip. Since there are already many reports regarding the successful outcome of resurfacing in advanced osteoarthritis, the purpose of this study was to analyze the clinical outcomes of this procedure in patients with osteonecrosis of the femoral head and to compare them with a matched group of patients with osteoarthritis. MATERIAL/METHODS: This retrospective cohort study evaluated a consecutive series of 52 patients with end-stage osteonecrosis (28 patients) and osteoarthritis (24 patients) of the femoral head, managed by metal-on-metal hip resurfacing in a referral orthopedic center from Feb 2002 to May 2007. Pain, function and deformity were evaluated with the use of the Harris hip score after the operation. Patients were clinically followed for a mean of 41 months. RESULTS: The patients in the osteoarthritis group had a significantly higher mean age than those in the osteonecrosis group (47.88 ± 12.6 vs 30.86 ± 7.5, p=0.003). The clinical outcomes were similar for both groups. There was no significant difference in mean Harris hip score (p=0.347) and hip joint range of motion (p=0.346) between osteonecrosis and osteoarthritis groups after surgery. CONCLUSIONS: On the basis of these initial findings, we recommend MOM resurfacing as a viable treatment option for patients with advanced stages of osteonecrosis.