Mechanical evaluation of bone samples following alendronate therapy in healthy male dogs.

Alendronate and other bisphosphonates are clinically efficacious in treating postmenopausal osteoporosis, Paget's disease and hypercalcemia associated with malignancy. Because bisphosphonates are being considered for use in younger patients with joint replacements to prevent osteolysis, and for stress fracture prophylaxis in military recruits, it is important to know how bisphosphonate therapy affects healthy bone. We sought to determine whether bones from healthy male dogs exhibit alterations in structural or mechanical properties following alendronate treatment for 23 weeks. We tested trabecular tissue samples in compression and determined tissue ash density. We tested whole long bones in bending and torsion. For trabecular samples, we evaluated trabecular modulus, strength, and density. For whole bone specimens, we compared structural stiffness and ultimate load. We found no significant differences in any measure, between canines treated with alendronate for 23 weeks and controls, although we found consistent trends toward higher properties in the treated group. Correlation analysis revealed significant relationships between stiffness and strength measures for each mechanical test. Our results indicate bisphosphonate treatment in healthy canines does not weaken the properties of bone. The trends indicate a slight positive overall effect of alendronate treatment on the mechanical properties of healthy canine bone.

From clinical pathways to CPOE: challenges and opportunities in standardization and computerization of postoperative orders for total joint replacement.

Clinical pathways, or caremaps, have become key tools for hospitals to streamline patient care. They are most applicable in situations where a high degree of predictability regarding treatment and/or diagnostic intervention is expected. Perceived advantages include cost savings, more uniform nursing care, and improved patient satisfaction. Total joint replacement is an ideal indication for implementation of clinical pathways. At the authors' institution, despite the adoption of a clinical pathway for these procedures, postoperative orders continue to be handwritten DE NOVO adding variability that may be detrimental to patient safety. This article describes the authoring and implementation of a computerized order process for the care of postoperative total joints patients using a multidisciplinary approach.

Anticardiolipin antibody associated arterial thrombosis following fibula fracture.

A case is described of a 20-year-old college student in whom open reduction and internal fixation of a Weber B fibula fracture was complicated by arterial thrombosis and gangrene of the foot. The patient subsequently required a below-knee amputation. A hypercoagulability workup revealed the presence of an anticardiolipin antibody. Although this is an extremely unusual complication, young female patients with a positive personal or family history of early thrombotic events, such as DVT, multiple pregnancy loss, or early myocardial infarction, should be viewed as being at increased risk. Additional risk factors such as oral contraceptive use, should be sought during the initial history.