Frequency of CYP3A4, CYP3A5, CYP2C9, and CYP2C19 variant alleles in patients receiving clopidogrel that experience repeat acute coronary syndrome.

The presence of cytochrome P450 (CYP) variant alleles may reduce the activation of the prodrug clopidogrel to its active state. This research evaluated the frequency of variant alleles in the genes coding for CYP3A4, CYP3A5, CYP2C9, and CYP2C19 enzymes in patients on clopidogrel therapy and experiencing repeat acute coronary syndrome (ACS) compared to a control group with a matching ethnic composition. Real-time polymerase chain reaction was used for allelic discrimination. Complete data were obtained for 92 patients enrolled over a 3-month period. There were no significant differences in the presence of the examined CYP3A4, CYP3A5, CYP2C9, or CYP2C19 variant alleles between the two groups. The present data indicate that patients currently receiving clopidogrel therapy who present with repeat ACS do not have higher frequency of the examined variant alleles compared to a control group.

Comparison of Herbert and Acutrak screws in the treatment of scaphoid non-union and delayed union.

A retrospective analysis was performed on patients who had undergone surgery for delayed union or non-union of a scaphoid fracture. This was conducted to investigate if there was a difference in outcome between patients treated with the Acutrak screw or the Herbert screw. Twenty two cases were treated with a Herbert screw and 23 with an Acutrak screw. The patient demographics, aetiology of injury and fracture types were similar between the two groups. There was no significant difference in union rate or time to union for fractures treated with the Herbert screw or the Acutrak screw. There appears to be no difference in outcome for cases of scaphoid fracture delayed union and non-union treated with either the Herbert screw or the Acutrak screw.

Internal fixation of proximal humeral fractures.

We discuss the appropriate assessment and treatment options available for proximal humeral fractures. Important factors to consider are the fracture pattern, the bone quality and any co-morbidities. These are common injuries and are increasing in incidence due to an ageing population. The management of displaced 3- and 4-part fractures remains controversial. The ideal is anatomic reduction and stable internal fixation of the fractures especially the tuberosities to allow early mobilisation. The recent introduction of fixed angle locking plates allows stable fixation even in markedly osteoporotic bone. The early results are encouraging however there are presently no randomised trials comparing these devices to conservative treatment, conventional plating or hemiarthroplasty.

Dislocated Thompson hemiarthroplasty--the management of the recurrent dislocator.

Dislocation of a Thompson hemiarthroplasty of the hip is a serious complication with a high mortality rate. Previous papers have focused on surgical techniques to try and prevent dislocation. There is little in the literature on how to manage a patient after a dislocation. Patients with a dislocated Thompson hemiarthroplasty over a 5-year period from 1997 to March 2002 were analysed. Attempts were made to identify factors which may contribute to redislocation. Our strategies for preventing redislocation were evaluated. Of the 612 patients who received a Thompson hemiarthroplasty 23 patients (4%) dislocated. The average number of dislocations per patient was 2.4. Thirteen patients (57%) redislocated their prosthesis. Ten patients (43%) dislocated at least twice. Seven patients (30%) had either a total hip replacement, Girdlestone's procedure or the hip was left dislocated. Out of 15 patients fitted with an abduction brace 8 (60%) redislocated. Out of 8 patients treated with traction 6 (75%) redislocated. The 6-month mortality for patients suffering a dislocation was 7/23 (30%). If the prosthesis dislocates twice, the hip should be deemed unstable and consideration should be given to a revision procedure. Abduction braces and traction are ineffective in this condition and should be abandoned.