Low psoas major muscle area as a risk factor for contralateral hip fracture following intertrochanteric fracture.

OBJECTIVE: This study aimed to investigate the relationship between the psoas major muscle area as a risk factor and subsequent contralateral hip fractures in patients with initial intertrochanteric fractures. METHODS: Of 136 treated for intertrochanteric fractures, 104 female patients had computed tomography done to assess their fractures at initial stage and had been followed up for more than 2 years. These patients were then divided into 2 groups: i.e. those who had a contralateral hip fracture (CF) (n=16) and those who did not (NF) (n=88) groups. We mainly assessed the relationship between the corrected psoas major muscle area (CPMA) at initial fracture and the occurrence of contralateral hip fracture. RESULTS: The CF group had significantly lower CPMA than the NF group (p=0.001). There was positive correlation between the CPMA and the period from the initial to the contralateral hip fracture in the CF group. The CPMA cutoff value of 480.98 mm2/m2, was showed sensitivity of 63.6% and specificity of 87.5% in receiver operating characteristic curve analysis for all patients. CONCLUSIONS: The lower CPMA was associated with the contralateral hip fracture within 2 years from initial intertrochanteric fracture. The low CPMA would be a risk factor for contralateral hip fracture.

ADAPT system is a dramatic advance in computer-assisted surgery for femoral trochanteric fractures.

INTRODUCTION: In recent years, computer-assisted surgery has made it possible to undergo surgery with a high degree of precision. This study aimed to investigate the usefulness of computer-assisted surgery for femoral trochanteric fractures using the ADAPT (ADAptive Positioning Technology) system. METHODS: A total of forty patients with femoral trochanteric fracture underwent intramedullary nailing for fracture fixation: in twenty patients, the ADAPT system (ADAPT group), and in the other twenty, it was not used (control group). The operative time, intraoperative fluoroscopy time, tip apex distance (TAD), and tip to head surface distance (TSD) were measured and compared between the two groups to assess the efficiency and accuracy of the surgery. RESULTS: The operative time was significantly shorter (P < 0.05), intraoperative fluoroscopy time was significantly reduced (P < 0.01), and implant placement was significantly better in the ADAPT group (P < 0.01). CONCLUSION: Navigation systems have been developed to improve the efficiency of surgery. The ADAPT system was considered a very useful device for intramedullary nailing of femoral trochanteric fractures, as it reduced the intraoperative fluoroscopy time and improved the accuracy of implant placement, also reducing the operative time.

Anti-interleukin-6 receptor antibody reduces neuropathic pain following spinal cord injury in mice.

The present study reports the beneficial effects of an anti-mouse interleukin-6 (IL-6) receptor antibody (MR16-1) on neuropathic pain in mice with spinal cord injury (SCI). Following laminectomy, contusion SCI models were produced using an Infinite Horizon (IH)-impactor. MR16-1 was continuously injected for 14 days using Alzet osmotic pumps. A mouse IL-6 ELISA kit was then used to analyze IL-6 levels in the spinal cord tissue between 12 and 72 h after injury. Motor and sensory functions were evaluated each week using the Basso Mouse Scale (BMS), plantar von Frey and thermal threshold tests. Histological examinations were performed 42 days after SCI. Between 24 and 72 h after SCI, the expression levels of IL-6 were significantly decreased in the MR16-1 treated group. Six weeks after surgery, the BMS score of the MR16-1-treated group indicated significant recovery of neurological functions. MR16-1-treated mice in the SCI group exhibited lower paw withdrawal thresholds in the plantar von Frey and thermal tests, which were used to evaluate allodynia. MR16-1 treatment significantly increased the area of Luxol fast blue-stained tissue, representing spared myelin sheaths. These results indicate that the continuous inhibition of IL-6 signaling by MR16-1 between the early and sub-acute phases following SCI leads to neurological recovery and the suppression of hyperalgesia and allodynia. Overall, our data suggest that the inhibition of severe inflammation may be a promising neuroprotective approach to limit secondary injury following SCI and that an anti-IL-6 receptor antibody may have clinical potential for the treatment of SCI.