Weekly Teriparatide for Delayed Unions of Atypical Subtrochanteric Femur Fractures.

INTRODUCTION: The occurrence of atypical femur fractures (AFFs) in patients on prolonged bisphosphonate treatment has been gaining medical attention, but the use of pharmacotherapy for these fractures has not been explored in detail. The authors describe a case of AFFs successfully treated with once-weekly administration of 56.5 µg teriparatide (TPTD). CASE PRESENTATION: The patient was a 74-year-old female patient who had been taking alendronate for approximately 6 years and who suffered with a fall while walking. X-rays revealed a subtrochanteric right femur fracture. The contralateral femur showed cortical thickening and a transverse radiolucent fracture line. Based on these specific features, the patient was diagnosed with AFF. The patient underwent osteosynthesis with intramedullary nailing for the right fracture. Alendronate treatment was discontinued. Low-intensity pulsed ultrasonography therapy did not affect the healing of the fracture with delayed union, even after 3 months of application. Prophylactic osteosynthesis was performed for the subtrochanteric left femur. Bone tissue collected from the left fracture site during surgery showed severe suppression of bone turnover. Union of bilateral femurs was achieved after 3 months of a once-weekly administration of TPTD. CONCLUSION: Once-weekly TPTD treatment is shown to be beneficial for improving the healing of AFFs showing delayed union.

Enlargement of cervical spinal cord correlates with improvement of motor function in upper extremities after laminoplasty for cervical myelopathy.

OBJECTIVE: The correlation between postoperative spinal cord enlargement at the most compressive disc level and clinical outcome is controversial. The relationship between spinal cord enlargement at neurologically symptomatic disc level and clinical recovery has not been explored. The purpose of this study was to clarify the relationship between postoperative spinal cord enlargement at neurologically symptomatic disc level and neurologic outcome. METHODS: We studied 55 consecutive patients between 1995 and 2002. All patients underwent preoperative neurologic examination to determine the neurologically symptomatic disc level of the spinal cord and computed tomographic myelography twice before and 4 weeks after laminoplasty. The cross-sectional areas of both spinal cord and dural sac from C3/4 to C7/T1 disc levels were measured on computed tomographic myelography images. The Japanese Orthopedic Association scoring system was used for clinical evaluation before and 1 year after surgery. RESULTS: Total score improved significantly from 10.2+/-2.8 (SD) to 13.0+/-3.0 after operation. Motor and sensory function scores of upper and lower extremities also improved significantly. The enlargement of spinal cord area at the neurologically symptomatic disc level correlated significantly with improvement in motor function scores of upper extremities (rs=0.421 P=0.0052). However, there were no significant relationships between the enlargement of the spinal cord at the most compressive disc level or that at the dural sac and any categories of Japanese Orthopedic Association scoring system. CONCLUSION: Postsurgical enlargement of the cervical spinal cord at the neurologically symptomatic disc level at 4 weeks postoperatively correlated with recovery of motor function of the upper extremities at 1 year.

Clinical results of the new cervico-thoracic orthosis 'Neck-Chest brace'

The efficacy of a new cervico-thoracic Neck-Chest brace (N-C brace) prepared for post- operative patients of cervical canal expansive laminoplasty was assessed. The orthosis is light in weight (300 g) and easy to fit. The effect of the orthosis to restrict the neck motion was studied in 10 normal young males by using lateral view radiographs in extension and flexion positions. The average range of the neck motion for the N-C brace was 24.4% of the values obtained without the orthosis. The restriction of the motion was significantly better than that without orthosis. Then, the clinical efficacy of the N-C brace was assessed in 40 patients of cervical spondylotic myelopathy who underwent expansive laminoplasty. Alignment changes of the postoperative cervical spine was found only in 10% of the patients who had a straight and kyphotic curvature pattern in the cervical spine before operation. The cervical alignments in the other 90% of patients were not changed post-operatively. These data clearly demonstrated that the N-C brace effectively controls the neck motion and is recommended for patients who have a lordotic curvature pattern in the cervical spine to prevent the post-surgical changes in the alignment after expansive laminoplasty.