Oxidative Stress and Osteoporosis.

➤: Oxidative stress has been implicated as a causative factor in many disease states, possibly including the diminished bone mineral density in osteoporosis. ➤: Understanding the effects of oxidative stress on the development of osteoporosis may lead to further research improving preventative and therapeutic measures that can combat this important contributor to morbidity and mortality worldwide. ➤: A diet rich in whole plant foods with high antioxidant content along with antioxidant-preserving lifestyle changes may improve bone mineral density and reduce the risk of fragility-related fractures. While it is not explicitly clear if antioxidant activity is the effector of this change, the current evidence supports this possibility. ➤: Supplementation with isolated antioxidants may also provide some osteoprotective benefits, but whole plant food-derived antioxidants potentially have more overall benefits. Larger-scale clinical trials are needed to give credence to definitive clinical recommendations.

Morel-lavalée lesions treated with debridement and meticulous dead space closure: surgical technique.

Morel-Lavalée lesions (M-L lesion) can be successfully treated with debridement and meticulous dead space closure on an acute or delayed basis. The technique is simple, reproducible, and involves only one trip to the operating room in all but the open infected lesions. Our series of 24 Morel-Lavalée lesions in 22 patients resulted in no infections or recurrence of fluid collection. Two patients had superficial skin loss treated by local wound management.

Posterior bicondylar tibial plateau fractures.

OBJECTIVE: To present a case series of patients with posterior bicondylar tibial plateau fractures treated by direct fracture exposure and fixation through dual incisions. DESIGN: Retrospective clinical study. SETTING: Level 1 trauma centers. PATIENTS/PARTICIPANTS: Eight patients were identified that had posterior bicondylar tibial plateau fractures. Two patients had depressed posterolateral tibial plateau fractures with contained defects and did not have direct fracture exposure. One patient died of medical problems leaving 5 patients who underwent direct fracture exposure, reduction, and fixation. INTERVENTION: Posteromedial followed by posterolateral open reduction and internal fixation of posterior bicondylar tibial plateau fractures. RESULTS: At 6 to 24 months follow-up (mean 13 months), all patients returned to near full activities, each with aching after prolonged standing (8-hour shift). Range of motion averaged 2 degrees to 121 degrees of flexion. Three of 5 returned to manual labor jobs; the others were not employed at the time of injury. CONCLUSIONS: Posterior bicondylar tibial plateau fractures have a high association with lateral meniscal pathology and can be associated with anterior cruciate ligament injury. Reduction of the posterior plateau condyles is easiest with the knee in full extension. Flexion contractures can be a problem, and patients should be encouraged to regain/maintain knee extension. The dual-incision approach to these challenging fractures can result in good to excellent knee function for these patients.