Skeletal health in men with chronic lung disease: rates of testing, treatment, and fractures.

UNLABELLED: To advance our understanding of the burden of fractures among men, we studied a group of men at high risk for low bone strength due to lung disease. We found high rates of fractures but low rates of bone density testing that could predict fracture before it occurs. INTRODUCTION: To advance understanding of the burden of fragility fractures and attention to bone health among men with chronic obstructive lung disease (COPD), we quantified rates of fragility fracture, bone density testing, and anti-resorptive treatment and calculated the number needed to screen (NNS) to prevent one hip fracture in a cohort of men with COPD. METHODS: Veterans Administration (VA) and VA-Medicare administrative data permitted a retrospective cohort study of 87,360 men aged 50 and older, newly diagnosed with COPD between 1999 and 2003. Logistic regression models including patient characteristics, morbidities, and medication use assessed the effect of covariates on fracture and probability of testing or treatment. RESULTS: Mean age was 66.8. Hip and wrist fracture rates were 3.99 and 1.31 per 1,000 person years, respectively. Mean follow-up was 2.67 years; 4.4% underwent bone densitometry; 2.8% filled anti-resorptive prescriptions. Age, white race/ethnicity, more COPD exacerbations, barbiturate use, and anti-Parkinson's drug use were significantly associated with fracture. Age, and systemic corticosteroids were most significantly associated with testing or treatment. Based on published adherence and treatment effects, the cohort's calculated NNS to prevent one hip fracture is 432. CONCLUSIONS: Fracture rate was high and testing and treatment uncommon. The NNS of 432 to prevent one hip fracture is smaller than 731, the NNS for women aged 65-69 for whom universal screening is recommended. Attention to the bone health of this population is warranted. Future research must determine how testing and treatment impact overall quality of life and mortality of men with COPD.

Digital pulley reconstruction with expanded polytetrafluoroethylene (PTFE) membrane at the time of tenorrhaphy in an experimental animal model.

Digital pulley reconstruction with a synthetic material, PTFE membrane, was compared with suture repair of the native A3 pulley at the time of tenorrhaphy in the chicken model. The surgically treated foot was immobilized in flexion for either 28 or 35 days and then allowed full ambulation for periods of up to 42 days postoperatively. At sacrifice digits underwent range-of-motion testing, and the pulley and tenorrhaphy sites were explored. No disruptions were noted in the reconstructed PTFE pulleys. The number of tenorrhaphy disruptions was similar between the PTFE pulley group (11%) and the suture repair of the native pulley group (14%). No decrease in range of motion was demonstrated in the PTFE pulley digits, and no deleterious effect of increasing immobilization time (35 days versus 28 days) was noted. The results indicate that this synthetic pulley did not interfere with normal tendon healing processes. PTFE membrane may prove to be a promising reconstructive alternative when the native pulley is irreparably damaged.

Development of a synthetic replacement for flexor tendon pulleys using expanded polytetrafluoroethylene membrane.

Reconstruction or replacement of the damaged pulley is a difficult surgical problem because of the need to find suitable biological material, the bulkiness of the repair, and adhesion formation between the pulley and flexor tendons. Therefore, a method was developed to reconstruct the fibro-osseous pulleys with polytetrafluoroethylene (PTFE) membrane. Twenty White Leghorn chickens had the A3 pulley of the long digit excised; this was followed by a standard injury to the flexor profundus tendon. The A3 pulley was then reconstructed with PTFE membrane. In the opposite foot, the A3 pulley was transected laterally, the tendon injured in the same manner, and the native pulley sutured. Seven control chickens had a PTFE pulley reconstruction without tendon injury in one foot and the opposite foot did not undergo surgery. At postoperative days 0, 21, and 35, the animals were killed to evaluate the effectiveness of the PTFE pulleys. Flexor tendon function was assessed by determining the active range of motion of the digit. There was no significant difference between the PTFE pulleys and suture repair of the native pulleys at postoperative days 21 and 35. This indicates that the PTFE pulleys were capable of preventing tendon bow-stringing and did not significantly impair tendon gliding. The breaking strength of the PTFE pulley was less than that of the normal A3 pulleys, but it was sufficient to allow immediate mobilization of the digits postoperatively without fear of pulley rupture. The synthetic PTFE pulley appears to have the potential to function as an effective immediate replacement for the fibro-osseous pulleys.