Improving adherence to and persistence with oral therapy of osteoporosis.

UNLABELLED: Osteoporosis treatment has low adherence and persistence. This study evaluated if greater patient involvement could improve them. At 12 months, only 114 out of 344 participants were "fully adherent and persistent" (all drug doses taken throughout the study). Only frequency of drug administration had a significant influence on adherence. INTRODUCTION: Osteoporosis affects millions of individuals worldwide. There are now several effective drugs, but adherence to and persistence with treatment are low. This 12-month multicenter, prospective, randomized study evaluated the efficacy of two different methods aimed at improving adherence and persistence through greater patient involvement, compared with standard clinical practice. METHODS: Three hundred thirty-four post-menopausal women, receiving an oral prescription for osteoporosis for the first time, were recruited and randomized into three groups: group 1 (controls, managed according to standard clinical practice) and groups 2 and 3 (managed with greater patient and caregiver involvement and special reinforcements: group 2, instructed to use several different "reminders"; group 3, same "reminders" as group 2, plus regular phone calls from and meetings at the referring Center). All enrolled women had two visits (baseline and 12 months). RESULTS: Of 334 enrolled women, 247 (74%) started the prescribed therapy. Of those who started, 219 (88.7%) persisted in therapy for at least 10 months. At final evaluation, only 114 women were considered as "fully adherent and persistent" (all doses taken throughout the 12 months). There were no significant differences regarding "full adherence" among the three randomized groups. The frequency of drug administration had a significant influence: weekly administration had a >5-fold higher adherence and monthly administration an 8-fold higher adherence (p < 0.0001) than daily administration. CONCLUSIONS: The special effort of devising and providing additional reminders did not prove effective. Additional interventions during the follow-up, including costly interventions such as phone calls and educational meetings, did not provide significant advantages.

Bone integration of new stemless hip implants (proxima vs. nanos). A DXA study: preliminary results.

The development of short femoral prostheses has the advantage to preserve bone and soft tissues, restore hip geometry, permit mini-invasive techniques and allow quickly return to an active life, but very few studies described bone reaction to these new designed prostheses. The aim of the present study was to evaluate the osseointegration of two different partial neck retained stemless hip prosthesis at one year after surgery, measured by the changes of periprosthetic bone mineral density (BMD) in 5 regions of interest (ROIs) using a dual-energy X ray absorptiometry (DXA) device. The signs of stress-shielding were evaluated by standard radiographs. Thirty-two uncemented primary total hip arthroplasty (THA) patients allocated into 2 groups were evaluated. In the first group (n=19) a Proxima (De-Puy-J&J) hip stem was implanted. In the second group (n=12) a Nanos (Smith & Nephew) hip stem was used. We found that both the implants preserve metaphyseal bone stock and increase periprosthetic BMD. In Nanos prostheses a significant higher BMD values were observed in region of interest (ROI) 3 and 4 (p<0.05). No differences were found in ROIs 1, 2, and 5. Proxima stem seem to produce a physiological strain distribution in the femur. No signs of stress-shielding were present in both the implants. In conclusion, this preliminary DXA analysis showed a physiological integration of both the stems that reproduces the biomechanical stress of proximal femur. New designed short stem implants showed optimal osseointegration after one year, and therefore appears an excellent alternative to traditional long stem hip prostheses.

[Results 37 years after insertion of an acrylic implant for scaphoid pseudoarthrosis]. / Résultat 37 ans après la pose d'un implant acrylique pour traitement d'une pseudarthrose du scaphoïde.

Prosthetic treatment by means of a scaphoid implant was described by Swanson in 1970. The authors report the long-term results of pseudoarthrosis of the scaphoid treated by an acrylic implant at the Rizzoli Orthopaedic Institute in Bologna in 1956. Only one other similar case of long-term treatment by an artificial Vitallium (r) prosthesis was found in the literature.

Surgical treatment of Allman type III acromio-clavicular dislocation. A long-term follow-up study.

The authors report the results of a long-term follow-up study of surgical treatment of Allman type III acromio-clavicular dislocation. Despite numerous publications regarding the validity of closed treatment, the authors believe, in accordance with the anatomo functional and pathological knowledge, that open treatment is justified not only in young people but in older ones too. Among the different techniques, the authors prefer acromio-clavicular fixation with threaded wires because the operation time is short and the functional results are good with the lowest number of complications.

Isolated palmar dislocation of the trapezoid.

A rare example of an isolated palmar dislocation of the trapezoid bone is described. Treatment by open reduction and fixation with a Kirschner wire gave a satisfactory result.

Bifid median nerve as a cause of carpal tunnel syndrome. Report of one case.

The authors describe a case of bifid median nerve at the wrist resulting in carpal tunnel syndrome, and they emphasize the rarity of this occurrence. In this case, the disorder is accompanied by agenesis of the thenar eminence and bony malformation of the radial column of the wrist.

[External fixators in the treatment of fractures and fractures/luxations of the pelvis]. / I fissatori esterni nel trattamento delle fratture e fratture/lussazioni del bacino.

Combined fractures of the two pelvic arches and severe disjunction of the pubic symphysis are acute lesions which are difficult to treat; in order to avoid poor functional results, the use of external fixatives have now become a routine orthopedic surgical practice. Two cases are reported to illustrate the large numbers of patients treated by the Orthopedic and Traumatological Division of the Ospedale Civile in Alessandria.

[Review of 64 cases of hallux valgus surgically treated with the Keller-Lévière technique]. / Revisione di 64 casi di alluce valgo operati con la tecnica di Keller-Lélièvre.

Sixty four cases of hallux valgus treated using the Keller-Lélièvre technique during the period from January 1982 to December 1987 are examined. The results achieved reveal the validity and limits of this surgical technique. Having established the prescriptions of the technique, it still represents the simplest and safest method for treating this affection in adult/old-aged patients.

[A case of a fracture of the clavicle associated with an acromio-clavicular luxation]. / Su un caso di frattura di clavicola associata a lussazione acromion-claveare.

The study reports a rate case of a girl with associated clavicular fracture and acromioclavicular dislocation following a care accident. The pathogenetic mechanism may be attributed to a trauma on the medial shoulder stump which having fractured the clavicle then provoked the acromioclavicular dislocation by continued pressure on that point. It is important to observe that the patient fully recovered, virtually without therapy.

[A case of paralytic syndrome of the upper limb caused by tourniquet]. / Su un caso di sindrome paralitica all'arto superiore da laccio emostatico.

A case of paralytic syndrome of an upper limb in a healthy young man following the application of a tourniquet, accidentally inflated to a pressure of more than 200 mmHg during an operation, is described in which motility was fully recovered after 3 months. The importance of checking equipment periodically is stressed.

[Our experience in the use of Thompson's endoprosthesis in medial fractures of the femur neck]. / La nostra esperienza nell'uso dell'endoprotesi di Thompson nelle fratture mediali di collo di femore.

The study reports the results of a study of a random sample of 40 patients with medial fractures of the collum femoris in whom the caput femoris was substituted by Thompson's cemented prosthesis, taken from a series of 189 operations performed between 1981 and 1987. In conclusion, Thompson's prosthesis is demonstrated to be still valid in patients over 75 years old.

[Treatment of subcutaneous rupture of the extensor pollicis longus tendon]. / Sul trattamento delle rotture sottocutanee del tendine estensore lungo del pollice.

The authors present the results of 13 cases operated for subcutaneous rupture of the extensor pollicis longus. Transferral of the extensor indicis proprius was employed in 12 cases and tenodesis involving the extensor pollicis brevis was performed in 1. Results are best when abduction and retropulsion of the thumb are restored. Testing of the correct tension of the transferral procedure is emphasized.