25-hydroxyvitamin D levels in the early healing of osteoporotic hip fracture and their relationship with clinical outcome.

INTRODUCTION: Introduction: vitamin D is involved in recovery after an osteoporotic hip fracture (OHF). Previous studies have reported decreased serum vitamin D levels during fracture healing. Objectives: our aim was to evaluate: a) serum 25-hydroxyvitamin D3 (25OHD3) levels in patients with OHF at hospital admission and 8 days post-admission, and b) the relationship between 25OHD levels and clinical outcomes. Methods: a prospective study including 66 patients aged over 65 years hospitalized for OHF. We gathered data on baseline demographic characteristics, medical history, Mini Mental State (MMS) assessment, Activities of Daily Living (ADL) results, nutritional assessment, and type of fracture and surgery. Laboratory results were collected on bone biomarkers, albumin, 25OHD3, and IL6. Clinical outcomes included length of stay, complications, and mortality. In the statistical analysis, a t-test was used for continuous variables and a chi-square test for qualitative variables. Linear regression models were used for the multivariate analysis, adjusted for covariates. Results: our study population had low serum vitamin D levels at admission, with a mean [(standard error of the mean (SEM)] of 12.04 (1.03) ng/mL. Both 25OHD3 and interleukin 6 (IL-6) levels significantly declined (p < 0.001) during the early post-fracture phase. A greater decline in 25OHD3 levels was significantly associated with longer hospital stay (p = 0.042, multivariate analysis). Serum 25OHD3 levels were also associated with cognitive status as assessed using the MMS exam. Conclusions: 25OHD3 levels were reduced in OHF patients at admission, and significantly decreased during the first 8 days post-admission. 25OHD3 levels were associated with MMS-assessed cognitive status. A greater decline in serum 25OHD3 was associated with a longer hospital stay.

INTRODUCCIÓN: Introducción: la vitamina D se ha relacionado con la recuperación tras la fractura osteoporótica de cadera (FOC). Estudios previos muestran un descenso de los niveles de vitamina D en la fase precoz tras la fractura. Objetivos: evaluar: a) los niveles séricos de 25-hidroxivitamina D3 (25OHD3) al ingreso y a los 8 días del ingreso en hospitalizados por FOC; b) la relación de los niveles de 25OHD3 con los resultados clínicos, así como con el nivel cognitivo y funcional. Métodos: estudio prospectivo de 66 pacientes (> 65 años) ingresados por FOC. Se estudiaron las características demográficas, los antecedentes personales, la valoración nutricional, el test Mini Mental State (MMS), el cuestionario Activities of Daily Living (ADL), el tipo de fractura y de cirugía, y parámetros bioquímicos del metabolismo óseo, la 25OHD3, la albúmina y la interleuquina 6. Como resultados clínicos se analizaron: estancia hospitalaria, complicaciones y mortalidad durante el ingreso. El análisis estadístico consistió en: a) prueba de la t para las variables continuas y χ2 para las cualitativas; b) análisis multivariable utilizando modelos de regresión lineal ajustados según el análisis de la covarianza. Resultados: la población estudiada muestra niveles bajos de 25OHD3 al ingreso: media [± error estándar de la media (EEM)] = 12,04 (1,03) ng/mL. Durante el ingreso, 25OHD3 e interleuquina 6 decrecen significativamente (p < 0,001). El descenso de 25OHD3 se asocia con la estancia hospitalaria (p = 0,042 en análisis multivariable). Los valores disminuidos de 25OHD3 se asocian a un bajo nivel cognitivo (p = 0,042). Conclusiones: los pacientes ingresados por fractura osteoporótica de cadera tienen niveles bajos de 25OHD3 que decrecen significativamente tras 8 días de ingreso. El descenso de 25OHD3 se asocia significativamente a la estancia hospitalaria. Los niveles disminuidos de 25OHD3 se asocian a un peor estado cognitivo evaluado mediante el MMS.

Is the fracture pattern in periprosthetic fractures around the knee related with the anterior femoral notch?

INTRODUCTION: Periprosthetic fractures around the knee (PPF) are a devastating complication of total knee arthroplasty (TKA). Anterior femoral notching during TKA is considered a risk factor for PPF. The aim of this paper is to determine if an anterior femoral notch after total knee arthroplasty may affect the fracture pattern when a PPF appears postoperatively. MATERIAL AND METHODS: 50 patients diagnosed in our centre of a PPF from January 2010 to December 2013 were retrospectively enrolled. 100 patients who underwent a total knee arthroplasty without fracture were randomly obtained as a control group. Evidence of the notch was searched in both groups in postoperative X-rays. In the PPF group, distance from the shield of the femoral component to the most distal (d) and proximal (D) point of the fracture were measured. RESULTS: Two different groups were obtained: 1) d = 0 (33 out of 50 patients); the fracture is supposed to be related with the notch as it's a theoretically weaker area. 2) d > 0 (17 out of 50 patients); the fracture pattern has no relationship with the notch. Prevalence of patients suffering a fracture in the shield of the prosthesis (d = 0), was similar in both patients with notch (66,7%) and without it (68%). CONCLUSIONS: In conclusion, fracture pattern is not related with the existence of a femoral notch in the clinical setting.

Is obesity related with periprosthetic fractures around the knee?

PURPOSE: Periprosthetic fracture (PPF) is a devastating complication following primary total knee arthroplasty. Obesity is currently considered a risk factor for many complications in orthopaedics, but there is no evidence in literature about the relationship between obesity and PPF around the knee. The objective of this study was to determine whether obesity is associated with a higher incidence of PPF. METHODS: All patients diagnosed of a PPF around the knee from January 2010 to December 2013 were enrolled. Forty-nine PPF (47 women and 2 men) were included, and a total of 97 patients (80 women and 17 men) were randomly obtained as a control group. Body mass index (BMI) was obtained in both groups and classified as <25 (normal), overweight (25-29.9), obese (30-34.9), very obese (35-39.9), or morbid obesity (≥40). Both groups, were also divided into subpopulations depending on the age as follows: <70, 70-75, 75-80 and ≥80. Statistical analysis was performed to determine any difference in BMI ≥30 kg/m² distribution between groups. RESULTS: In the PPF group 61.22 % of the patients had a BMI over 30 kg/m² and likewise 62.88 % of the patients in the control group. No association was found between obesity and a higher risk of PPF (p < 0.05). CONCLUSION: As a conclusion, obesity (BMI ≥30 kg/m²) does not have any clinical relationship with the appearance of a periprosthetic fracture around the knee (p < 0.05).

Elaboración de un índice objetivo de selección de pacientes subsidiarios de prótesis articular de rodilla / Total knee prosthesis. Development of an objective selection tool for patients

No disponible

Microwave diathermy for treating nonspecific chronic neck pain: a randomized controlled trial.

BACKGROUND CONTEXT: Although the use of deep heat therapy is widespread, there is scant literature available on its effectiveness in treating back or neck pain. PURPOSE: The purpose of this study was to determine the efficacy of microwave diathermy to treat nonspecific chronic neck pain. DESIGN: The study was designed as a double-blind, randomized controlled trial. PATIENT SAMPLE: The patient sample consisted of 149 patients with nonspecific chronic neck pain in a hospital of the Andalusian Public Health Care System, Spain OUTCOME MEASURES: The study outcome measures are as follows: at baseline, pain intensity (using a visual analogue scale), disability (Neck Disability Index), and health-related quality of life (36-item short form health survey [SF-36]); at 3 weeks, baseline measures and patients' perceived overall outcome and satisfaction with the treatment; and at 6 months, 3-week measures, therapeutic co-interventions, and adherence to exercises. METHODS: Patients were allocated randomly to three groups. The first group received continuous microwave diathermy, the second group was administered pulsed microwaves, and the third group (the control group) received unplugged microwaves. All three groups received the same general treatment: range of motion, isometric exercises, and transcutaneous electrical nerve stimulation. RESULTS: The three groups had reduced pain and disability, and improvement was seen in some dimensions of the SF-36. However, there were no differences found in any of the parameters measured among the three therapeutic groups. CONCLUSIONS: Microwave diathermy does not provide additional benefit to a treatment regimen of chronic neck pain that already involves other treatment approaches.

Validation of the Spanish version of the Neck Disability Index.

STUDY DESIGN: Observational prospective study. OBJECTIVE: Validate the Spanish version of the Neck Disability Index (NDI). SUMMARY OF BACKGROUND DATA: The NDI is the most widely used neck pain scale in the largest number of populations and has been validated most often against multiple measurements of function, pain, and clinical signs and symptoms. METHODS: The Spanish version of the NDI was administered 2 or 3 times to 175 individuals with neck pain (including those requesting or not requesting specific healthcare at a given time and those with acute and subacute/chronic nonspecific or post-traumatic neck pain). After establishing the factorial structure by extracting the main components, the internal consistency was assessed with the Cronbach alpha method, the test-retest reliability was assessed with the Bland-Altman plot and the intraclass correlation coefficient methods, and the validity was established by calculating Pearson correlation coefficient with pain visual analogue scale values and with Northwick Park Neck Pain Questionnaire (Spanish version) values. Sensitivity to change was estimated while comparing the mean difference between the first application of the NDI score and the one after the treatment in the patients who improved, felt the same, or worsened. RESULTS: A single factor explained 51.6% of the variance, the Cronbach alpha score was 0.89, the intraclass correlation coefficient was 0.98, the Pearson correlation coefficient with pain visual analogue scale was r = 0.65 and with Northwick Park Neck Pain Questionnaire was r = 0.89. In the subgroup of 147 subjects in whom the sensitivity to change was studied, those who reported an improvement in neck pain showed a decrease in the NDI score of 8.20, those who felt the same showed a decrease of 0.23, and those who felt worse showed an increase of 5.55. CONCLUSION: This first Spanish version of the Neck Disability Index is reliable, valid, and sensitive to change.

[Validation of a Spanish version of the Neck Disability Index]. / Validación de una versión española del Indice de Discapacidad Cervical.

BACKGROUND AND OBJECTIVE: The Neck Disability Index (NDI) is the most used scale for neck pain and disability. There is no validated Spanish version so far. This prospective study's objective was to evaluate a Spanish version's comprehension and metrics characteristics. MATERIAL AND METHOD: The Spanish version of the NDI was obtained by the "translation-backward translation" method. This version and the pain visual analogue scale were both administered 2 times to 48 patients with nonnespecific or posttraumatic neck pain. RESULTS: 16% had comprehension troubles. The cultural level had no influence on it. Items more commonly called into question were the IX (neck pain and sleeping) and the VII (neck pain and working). The scales were fulfilled in 6 min 08 s (54 s) by those with middle-high cultural level, and in 7 min 59 s (1 min 26 s) by those with low one (p < 0.001). As shown by factor analysis, our NDI version is a one-dimension scale. Internal consistence was very good (Cronbach alpha of 0.937 at the first time and 0.944 at the second one). An optimal test-retest reliability was settled by intraclass correlation coefficient (0.978) and by Bland-Altman plot. For the construct validity, correlation with the pain visual analogue Scale was 0.643 (p < 0.01) at first time, and 0.743 (p < 0.01) at second one. This was the only metric characteristic where the cultural level had any influence. CONCLUSIONS: On reformulation of some items, our NDI Spanish version's feasibility will allow its use for future definitive validation.

Validación de una versión española del Índice de Discapacidad Cervical / Validation of a spanish version of the neck disability index

Fundamento y objetivo: El Índice de Discapacidad Cervical (IDC) es la escala más usada en dolor y discapacidad cervicales. No existe una versión española validada. El objeto de este estudio prospectivo ha sido valorar la comprensión de una versión española y sus propiedades métricas. Material y método: Se aplicó en 2 ocasiones, junto con la escala visual analógica del dolor, una versión española del IDC, obtenida mediante traducción-retrotraducción, a 48 personas con cervicalgia inespecífica o postraumática. Resultados: El 16% tuvo dudas en la comprensión, sin que en ello influyera el nivel cultural. Las preguntas más cuestionadas fueron la IX (dolor cervical y sueño) y la VII (dolor cervical y trabajo). El tiempo medio (desviación estándar) de cumplimentación fue de 6 min y 08 s (54 s) en los pacientes de nivel cultural medio-alto, y de 7 min y 59 s (1 min y 26 s) en los de nivel bajo (p < 0,001). El análisis factorial determinó la unidimensionalidad de la escala. La consistencia interna fue excelente (alfa de Cronbach de 0,937 en la primera aplicación y de 0,944 en la segunda). La fiabilidad test-retest fue óptima de acuerdo con el coeficiente de correlación intraclase (0,978) y con el gráfico de Bland-Altman. La validez de la escala vino definida por una correlación con la escala visual analógica de 0,643 (p < 0,01) en la primera aplicación y de 0,743 (p < 0,01) en la segunda. Ésta fue la única propiedad en la que influyó el nivel cultural. Conclusiones: Nuestra versión española del IDC es útil para un futuro estudio de validación definitiva previa reformulación de algunas preguntas

Background and objective: The Neck Disability Index (NDI) is the most used scale for neck pain and disability. There is no validated Spanish version so far. This prospective study's objective was to evaluate a Spanish version's comprehension and metrics characteristics. Material and method: The Spanish version of the NDI was obtained by the «translation-backward translation» method. This version and the pain visual analogue scale were both administered 2 times to 48 patients with nonnespecific or posttraumatic neck pain. Results: 16% had comprehension troubles. The cultural level had no influence on it. Items more commonly called into question were the IX (neck pain and sleeping) and the VII (neck pain and working). The scales were fulfilled in 6 min 08 s (54 s) by those with middle-high cultural level, and in 7 min 59 s (1 min 26 s) by those with low one (p < 0.001). As shown by factor analysis, our NDI version is a one-dimension scale. Internal consistence was very good (Cronbach alpha of 0.937 at the first time and 0.944 at the second one). An optimal test-retest reliability was settled by intraclass correlation coefficient (0.978) and by Bland-Altman plot. For the construct validity, correlation with the pain visual analogue Scale was 0.643 (p < 0.01) at first time, and 0.743 (p < 0.01) at second one. This was the only metric characteristic where the cultural level had any influence. Conclusions: On reformulation of some items, our NDI Spanish version's feasibility will allow its use for future definitive validation