Fracture recurrence in hip fracture with menopausal hormone therapy versus risedronate: a clinical trial.

OBJECTIVES: An open-label, randomized trial was conducted to examine the effects of risedronate versus menopausal hormone therapy (MHT) in postmenopausal women with recent hip fracture. METHODS: Among 1165 eligible women, 281 were recruited and randomly assigned to receive oral risedronate (35 mg/week) or percutaneous estradiol gel (1.5 mg/day) plus oral micronized progesterone (100 mg/day) for 4 years. The primary end point was recurrent fracture and the secondary end points were mortality and bone mineral density (BMD). RESULTS: Kaplan-Meier analyses showed no significant differences in fracture recurrence and mortality between the two groups. The incidence of any new fracture per 100 person-years (PY) was 8.63 in the risedronate group and 12.86 in the MHT group (p = 0.180); that of clinical fracture was 4.75 and 6.99, respectively (p = 0.265); and that of asymptomatic vertebral fracture was 4.87 and 5.58, respectively (p = 0.764). The respective incidence of death per 100 PY was 3.58 and 4.40 (p = 0.503). BMD increased comparably at the lumbar spine in both groups. BMD at the total hip did not change in the risedronate group, but increased significantly by 2.8% in the MHT group. CONCLUSIONS: MHT might not differ from risedronate in the prevention of secondary fractures and death among postmenopausal women with recent hip fracture.

Incidence, risk factors, and fracture healing of atypical femoral fractures: a multicenter case-control study.

The incidence of atypical femoral fractures (AFFs) was 2.95% among 6644 hip and femoral fractures. Independent risk factors included the use of bisphosphonates (BPs), osteopenia or osteoporosis, rheumatoid arthritis, increased femoral curvatures, and thicker femoral cortices. Patients with AFFs and BP treatment were more likely to have problematic healing than those with typical femoral fractures (TFFs) and no BP treatment. INTRODUCTION: To determine the incidence and risk factors of atypical femoral fractures (AFFs), we performed a multicenter case-control study. We also investigated the effects of bisphosphonates (BPs) on AFF healing. METHODS: We retrospectively reviewed the medical records and radiographs of 6644 hip and femoral fractures of patients from eight tertiary referral hospitals. All the radiographs were reviewed to distinguish AFFs from TFFs. Univariate and multivariate logistic regression analyses were performed to identify risk factors, and interaction analyses were used to investigate the effects of BPs on fracture healing. RESULTS: The incidence of AFFs among 6644 hip and femoral fractures was 2.95% (90 subtrochanter and 106 femoral shaft fractures). All patients were females with a mean age of 72 years, and 75.5% were exposed to BPs for an average duration of 5.2 years (range, 1-17 years). The use of BPs was significantly associated with AFFs (p < 0.001, odds ratio = 25.65; 95% confidence interval = 10.74-61.28). Other independent risk factors for AFFs included osteopenia or osteoporosis, rheumatoid arthritis, increased anterior and lateral femoral curvatures, and thicker lateral femoral cortex at the shaft level. Interaction analyses showed that patients with AFFs using BPs had a significantly higher risk of problematic fracture healing than those with TFFs and no BP treatment. CONCLUSIONS: The incidence of AFFs among 6644 hip and femoral fractures was 2.95%. Osteopenia or osteoporosis, use of BPs, rheumatoid arthritis, increased anterior and lateral femoral curvatures, and thicker lateral femoral cortex were independent risk factors for the development of AFFs. Patients with AFFs and BP treatment were more likely to have problematic fracture healing than those with TFFs and no BP treatment.

Mechanoreceptors distribution in the human medial collateral ligament of the elbow.

BACKGROUND: The human elbow maintains its stability mainly through its bony structure. Stability is enhanced by ligamentous structures. To allow the ligamento-muscular reflex, which protects against strain and stress, mechanoreceptors are embedded in the ligament. This report describes the existence and the distribution of the elbow medial collateral ligaments (MCLs) mechanoreceptors. HYPOTHESIS: The bony attachment site has the highest density of mechanoreceptors, and the anterior part has the highest density of mechanoreceptors. MATERIALS AND METHODS: Eight MCLs of elbow from fresh frozen cadavers were used. The MCLs were harvested deep to the periosteum from the medial epicondyle to the ulna. The fan-shaped ligaments were divided into six regions of interest (ROI) and stained with modified gold chloride stain. Specimens were evaluated under a light microscope. Golgi, Ruffini, and Pacinian corpuscles were found in every specimen. The number and the distribution of each mechanoreceptor in each ROI were recorded. The density of each mechanoreceptor was calculated in regards to its volume. RESULTS: Golgi, Ruffini, and Pacinian corpuscles were seen in the ligament with small nerve fibers. Ruffini corpuscles had the highest median density of all three corpuscles. The median corpuscle density was higher in the anterior than in the posterior part and higher in the bony attachment than in the mid-substance site except for Golgi corpuscle. CONCLUSION: The three typical types of mechanoreceptors were identified in human MCL with the anterior part and bony attachment as the dominant distribution site. LEVEL OF EVIDENCE: Basic Science Study.

Factors affecting peri-implant fracture following locking plate for osteoporotic distal femur fractures.

INTRODUCTION: The purpose of this study is to evaluate the outcomes and to analyze the risk factors for the occurrence of peri-implant fracture after treatment of osteoporotic distal femoral fractures using a locking plate. HYPOTHESIS: Risk factors affecting peri-implant fracture exist after locking plate fixation in osteoporotic distal femur fracture. MATERIALS AND METHODS: Eighty-nine cases (88 patients) with osteoporotic distal femoral fractures were evaluated between January 2006 and January 2014. The cohort included 13 men and 76 women with a mean age of 70.4 (50-91). Mean duration of follow-up was 47.9 months (12 to 106). All patients with distal femoral fracture were treated with a locking compression plate. Bone mineralized densitometry measurement was obtained from all patients. Risk factors including sex, age, rheumatoid arthritis (RA), taking of bisphosphonate, primary or periprosthetic fracture after total knee arthroplasty (TKA), open or closed fracture, types of the most proximal screw (locking/cortical), and number of proximal screws were analyzed. Complication, union, time to union, and range of motion of knee were also evaluated. RESULTS: All patients had osteoporosis with the mean BMD of -3.16 (-2.5∼-5.4). The mean range of motion of knee was 126 degrees (90-145). Eighty-four cases (94.4%) showed union, the mean time to union was 14 weeks (10-42). Peri-implant fractures occurred in four patients (4.5%) after bone union at mean 37.5 months (14-62) postoperatively. Eight patients had angular deformities of over 5 degrees. Nonunion was observed in 5 cases and superficial wound infection in 2 cases. There were eight patients with RA, two of whom had suffered a peri-implant fracture. In statistical analysis, rheumatoid arthritis or periprosthetic fracture in TKA patients was a risk factor for peri-implant fracture (P=0.039, 0.019, respectively), and other factors showed no statistical differences. CONCLUSIONS: Treatment using a locking plate showed favorable outcomes in osteoporotic distal femoral fractures. However, peri-implant fracture could occur in patients with RA or periprosthetic fracture after TKA. Therefore, cautious consideration is required for management of osteoporotic distal femur fracture in patients with RA or periprosthetic fracture after TKA. Analysis of more cases will be needed in order to achieve conclusive results. LEVEL OF EVIDENCE: Therapeutic study, level IV (retrospective study). See the Guidelines for Authors for a complete description of levels of evidence.

Re-revision of failed revision Total Hip Arthroplasty acetabular components.

While revision of total hip arthroplasty (THA) is being performed with increasing frequency, outcomes of repeated revisions have been rarely reported in the literature. The purpose of this study was to report mid-term outcomes of re-revision of failed revision THA acetabular components. We performed at least two revisions of the failed acetabular component in 57 patients (57 hips) between August 1996 and April 2008. Of these, 15 patients with infection were excluded and one died before 4-year evaluation. The final study cohort consisted of 41 patients (41 hips) with a mean age of 55.5 years (range, 37 to 82). Preoperative acetabular bone defects was classified as Paprosky Type IIA in 4 hips, Type IIB in 6, Type IIC in 9, Type IIIA in 16, and Type IIIB in 6. The mean duration of follow-up was 7.2 years (range, 4 to 15). Mean Harris hip score improved 45 points preoperatively to 83 points postoperatively. Six hips (14.6%) required additional revision procedure: 3 for aseptic loosening, 2 for deep infection, and 1 for recurrent instability. Complications included 2 dislocations and 1 peroneal nerve palsy. Kaplan-Meier survivorship with an end point of reoperation for any reason was 88.5% (95% CI, 78.0% to 100%) at 7.2 years. For aseptic loosening of the acetabular component, the survival was 91.8% (95% CI, 80.8% to 100%) at 7.2 years. Rerevision with contemporary uncemented cup or antiprotrusio cage for failed revision THA acetabular components showed encouraging mid-term outcomes for this technically challenging condition.

Breast cancer screening: How knowledgeable are female staff of a public university?

Breast cancer is the most common cancer among women worldwide and in Malaysia. It has better cure rate if detected early. However, the practice of breast cancer screening in Malaysia is still low. The objective of this study is to determine the knowledge and its associated factors as well as sources of information on breast cancer and breast cancer screening among female staff in a public university in Malaysia. Materials and Methods: This was a cross sectional study conducted in 2005 involving 394 female staff including academic and non-academic staff, which was selected by cluster sampling. A self-administered questionnaire on socioeconomic characteristics and family history of breast cancer was used for data collection. Chi-square Test and Fisher’s Exact Test was used for testing an association using SPSS 12.0. Results: The response rate was 84.3%. Only 50.9% had high knowledge on breast cancer and breast cancer screening and this was significantly associated with occupational status, monthly family income and educational level (p<0.05). The usual source of information was mass media (92.2%) while the most preferred source is the health team (71.4%). Conclusion: As mass media was a major source of information, all types of mass media could efficiently be utilized to disseminate knowledge by presenting specific programmes associated with breast cancer and breast cancer screening.

The type 1 equilibrative nucleoside transporter regulates anxiety-like behavior in mice.

Activation of adenosine receptors in the brain reduces anxiety-like behavior in animals and humans. Because nucleoside transporters regulate adenosine levels, we used mice lacking the type 1 equilibrative nucleoside transporter (ENT1) to investigate whether ENT1 contributes to anxiety-like behavior. The ENT1 null mice spent more time in the center of an open field compared with wild-type littermates. In the elevated plus maze, ENT1 null mice entered more frequently into and spent more time exploring the open arms. The ENT1 null mice also spent more time exploring the light side of a light-dark box compared with wild-type mice. Microinjection of an ENT1-specific antagonist, nitrobenzylthioinosine (nitrobenzylmercaptopurine riboside), into the amygdala of C57BL/6J mice reduced anxiety-like behavior in the open field and elevated plus maze. These findings show that amygdala ENT1 modulates anxiety-like behavior. The ENT1 may be a drug target for the treatment of anxiety disorders.