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Osteoporosis is a thinning of the bone that leads to fracture with minimum force. It affects postmenopausal women and elderly of both genders. Bone Mineral Density (BMD) is one of the parameters related to bone strength. For measuring BMD Dual Energy X-ray absorptiometry (DXA) is currently considered as the “gold standard”. Osteoporosis is evaluated in postmenopausal women using low-cost digital hip radiograph in comparison with DXA as a gold standard. (i) To evaluate the morphometry of proximal femur using digital radiograph in the diagnosing osteoporosis in Indian women. (ii) To evaluate the morphometry of metacarpal using digital radiograph in the diagnosing osteoporosis in Indian women. (iii) To calculate the energy at neck, head, and trochanter of the proximal femur using image processing technique of anisotropic Morlet wavelet transform. By using The Anisotropic filter proximal femur is enhanced then the feature is extracted using Morlet wavelet transform. A free medical screening camp for osteoporosis was conducted at SRM Medical College and Research Institute. A total number of 50 (n = 50) Indian women, 18 healthy premenopausal women (n = 18, 36.3 ± 8.7 years) and 32 postmenopausal women (n = 32, 58 ± 9.1 years) whose age ranged from 20 to 85 years were included.

Objectives: To compare the results of a simulated fall on the greater trochanter in the proximal portion of a synthetic femur before and after femoral reinforcement with tricalcium phosphate bone cement (TP) and polymethyl methacrylate (PMMA), using finite element analysis (FEA). Methods: Using two synthetic proximal femurs, a FEA simulating a fall on the greater trochanter was performed, using the Bi-directional Evolutionary Structural Optimization (BESO) program. For this analysis, the femurs were filled with TP and PMMA after perforations were created in the trochanteric region and neck. The results were compared with the strength values obtained from testing the control specimen, a synthetic bone without reinforcement. Results: FEA showed a value of 600 N prior to reinforcement. After cementing with PMMA, the load increased by 57.5% (945 N), and by 53% (920 N) after cementing with TP. Conclusion: Synthetic femurs gained resistance to fracture-causing forces in a simulated fall on the trochanter after bone reinforcement with PMMA and TP. Level of Evidence III; Experimental study. RESUMO Objetivos: Avaliar, com o método de elementos finitos (EF), os resultados obtidos com a simulação de queda sobre o trocanter maior, usando a porção proximal de um fêmur sintético, com a finalidade de comparar os valores obtidos antes e após técnica de reforço femoral com cimento de fosfato tricálcico (FT) e polimetilmetacrilato (PMMA). Métodos: Utilizando dois fêmures proximais sintéticos, foi realizada a análise de elementos finitos, simulando queda sobre o trocanter maior com o programa Bi-directional Evolutionary Structural Optimization (BESO). Para essa análise, os fêmures foram preenchidos, após a realização de pertuitos na região trocantérica e no colo, com FT e PMMA e os resultados foram comparados com a força obtida na análise do corpo de prova controle, osso sintético sem preenchimento. Resultados: Comparando a análise de elementos finitos antes do reforço femoral, obteve-se o valor de 600 N. Depois da cimentação com PMMA, foi observado um aumento na carga máxima da ordem de 57,5% (945 N) e de 53% (920 N) com o FT. Conclusão: Os fêmures sintéticos ganharam resistência aos fatores causadores de fratura em queda simulada sobre o trocanter depois do reforço ósseo com PMMA e cimento de FT. Nível de Evidência III; Estudo experimental.

Mathis, SL, and Caputo, JL. Resistance training is associated with higher lumbar spine and hip bone mineral density in competitive male cyclists. J Strength Cond Res 32(1): 274-279, 2018-In contrast to other athletic activities, competitive cycling is associated with low areal bone mineral density (BMD). This investigation evaluated training and dietary factors associated with BMD in a sample of competitive male cyclists. Lumbar spine, total hip, femoral neck, and femoral trochanter BMD were measured with dual X-ray absorptiometry in 40 cyclists at the start of a cycling season. Participants reported weekly hours of cycling and weight training, years of competitive cycling experience, and completed a 1-day dietary recall to allow estimation of dietary calcium intake. Multivariable linear regression analyses revealed that weight training was associated with higher BMD of the lumbar spine (β = 0.001, t = 2.88, p = 0.01), hip (β = 0.002, t = 4.95, p < 0.001), femoral neck (β = 0.002, t = 5.31, p < 0.001), and femoral trochanter (β = 0.002, t = 4.31, p < 0.001). No other factor was a predictor of preseason BMD in this sample. These data emphasize the need for competitive male cyclists to participate in weight training to maintain or increase bone mass of the lumbar spine and hip.

Background: Perthes disease is a condition in which a self-limiting avascular event affects the capital epiphysis of the femur with a very variable course. It has been shown frequently, however, that there is a group of patients who definitely benefit from containment, either surgical or nonsurgical, better with surgical. We studied midterm to long term outcome of closed wedge varus derotation osteotomy (VDRO) with trochanteric apophysiodesis in Perthes disease. Materials and Methods:. 88 children with mean age of 7.9 ± 2 years, belonging to Herring's lateral pillar Groups B and C treated with VDRO with trochanteric apophysiodesis were included in this study. Radiological evaluation was done using Mose's index, the epiphyseal quotient, the articulotrochanteric distance and center edge angle of Wiberg. Results: Containment was achieved in all patients on postoperative radiographs. At a mean followup of 12 years, good results were obtained in 66, fair in 19, and poor in 3 patients using Catterall's postoperative classification. Conclusions: VDRO is an effective containment method of femoral head for patients belonging to the Herring's Group B and also effective in many patients belonging to Herring's Group C. It is a good procedure to attain containment in children

The synthesis of trochanteric fractures has evolved considerably since the use of the Staca nail-plate in 1964. This implant, despite its age, remains a solid and reliable material for the synthesis of this type of fracture. Objective: To evaluate the anatomo-clinical and functional results of Staca nail-plate osteosynthesis of trochanteric fractures at the Regional University Hospital of Ouahigouya in Burkina Faso. Methods: We performed a retrospective study of 52 trochanteric fractures treated by Staca nail-plate in the regional university hospital of Ouahigouya between June 2007 and June 2017. There were 10 women and 42 men with a mean age of 61 years (range 17 years to 89 years). Ten stable type I and II of Ender classification fractures and 42 unstable fractures were recorded, including four pseudarthrosis and six vicious calluses. The anterolateral approach was used in all cases. In the absence of an image intensifier, we performed an arthrotomy to identify the femoral neck and set up a guide pin. Results: The reduction was satisfactory with stable synthesis in 39 cases. At last follow-up, consolidation was effective in all patients, except one. Two cases of acetabular protrusion were noted, requiring early removal of equipment. Fifty-one patients were autonomous. The overall results were considered satisfactory. Conclusion: The Staca nail-plate remains a means of solid osteosynthesis. Although it is no longer relevant in industrialized countries, it provides comparable results to new implants for the osteosynthesis of trochanteric fractures. Because of its low cost, its abandonment is not justified in low-income countries.

Segmental femoral neck fracture (a combination of subcapital and intertrochanteric femoral fracture) is rare.1-16 We present a rare case of a 72 year old morbidly obese patient with an ipsilateral displaced fracture of intracapsular and Intertrochanteric femoral neck fracture. Keywords: Segmental Femoral neck fracture, Neck and trochanter fracture.

This retrospective study was conducted to investigate the correlation between kinetic gait parameters and femoral bone mineral density (BMD) in elderly subjects aged 50 years and older that could walk independently. Four hundred and twenty-six subjects (158 men and 258 women; mean age 68.7 years, standard deviation (SD) 7.9 years) were included in the study. BMDs (g/cm2) of the femoral neck, trochanter, shaft, and total proximal femur were collected. Kinetic data including maximum hip power and hip power-time integral was obtained from a three-dimensional gait analysis with self-selected walking speed. Correlation between BMDs of proximal femur and gait kinetic data was analyzed. Multiple regression analysis was also performed to identify factors significantly associated with BMD. Correlation between BMD and hip kinetic data was not prominent in elderly men. In women, BMD was significantly correlated with hip kinetic data. Hip power-time integral showed greater correlation with BMD than maximum hip power during gait in elderly women. Age (p

Short-stem hip arthroplasty (SHA) was designed to preserve bone stock and provide an improved load transfer. To gain more evidence regarding the load transfer, this review analysed the periprosthetic bone remodelling of SHA in comparison to standard hip arthroplasty (THA). PubMed and ScienceDirect were screened to extract dual-energy X-ray absorptiometry (DXA) studies evaluating the periprosthetic bone remodelling of SHA and two proven THA designs. From the studies included, the postoperative change in periprosthetic bone mineral density (BMD) after one year and the trend over two years was determined. Fifteen studies with four SHAs (CFP, Metha, Nanos, Fitmore) and two THAs (CLS and Bicontact) designs were included. All SHA and THA stems revealed an initial decrease at the calcar and major trochanter (Gruen 1 and 7) with the Metha, Nanos and Fitmore showing a smaller and more balanced remodelling compared to THA. The pattern after one year and the trend over two years argue for a methaphyseal anchorage of the Metha and Nanos, whereas the Fitmore and CFP seem to anchor metha-diaphyseal. Clearly different pattern of bone remodelling were observed between all four SHAs. Periprosthetic bone remodelling is also present in SHA, with the main bone reduction observed proximally. However, certain SHA stems show a more balanced remodelling compared to THA, arguing for a favourable load transfer. Also, the femoral length where bone remodelling occurs is clearly shorter in SHA. As distinctively different pattern between the SHA designs were observed, they should not be judged as a single implant group.

Finite element model can estimate bone strength better than BMD. This study used such a model to determine its association with hip fracture risk and found that the strength estimate provided limited improvement over the hip BMDs in predicting femoral neck (FN) fracture risk only. Bone fractures occur only when it is loaded beyond its ultimate strength. The goal of this study was to determine the association of femoral strength, as estimated by finite element (FE) analysis of DXA scans, with incident hip fracture as a single condition or with femoral neck (FN) and trochanter (TR) fractures separately in older men. This prospective case-cohort study included 91 FN and 64 TR fracture cases and a random sample of 500 men (14 had a hip fracture) from the Osteoporotic Fractures in Men study during a mean ± SD follow-up of 7.7 ± 2.2 years. We analysed the baseline DXA scans of the hip using a validated plane-stress, linear-elastic FE model of the proximal femur and estimated the femoral strength during a sideways fall. The estimated strength was significantly (P

Dietary fiber may increase calcium absorption, but its role in bone mineralization is unclear. Furthermore, the health effect of dietary fiber may be different between sexes. We examined the association between dietary fiber (total fiber and fiber from cereal, fruits, vegetables, nuts, and legumes) and bone loss at the femoral neck, trochanter, and lumbar spine (L2 to L4 ) in older men and women. In the Framingham Offspring Study, at baseline (1996-2001), diet was assessed using the Willett food-frequency questionnaire, and bone mineral density (BMD) was measured using dual-energy X-ray absorptiometry. Follow-up BMD was measured in 2001-2005 and 2005-2008 among 792 men (mean age 58.1 years; BMI 28.6 kg/m2 ) and 1065 women (mean age 57.3 years; BMI 27.2 kg/m2 ). We used sex-specific generalized estimating equations in multivariable regressions to estimate the difference (β) of annualized BMD change in percent (%ΔBMD) at each skeletal site per 5 g/d increase in dietary fiber. We further estimated the adjusted mean for bone loss (annualized %ΔBMD) among participants in each higher quartile (Q2, Q3, or Q4) compared with those in the lowest quartile (Q1) of fiber intake. Higher dietary total fiber (β = 0.06, p = 0.003) and fruit fiber (β = 0.10, p = 0.008) was protective against bone loss at the femoral neck in men but not in women. When examined in quartiles, men in Q2-Q4 of total fiber had significantly less bone loss at the femoral neck versus those in Q1 (all p < 0.04). For women, we did not observe associations with hip bone loss, although fiber from vegetables appeared to be protective against spine bone loss in women but not men. There were no associations with cereal fiber or nut and legume fiber and bone loss in men or women. Our findings suggest that higher dietary fiber may modestly reduce bone loss in men at the hip. © 2017 American Society for Bone and Mineral Research.

Objectives To evaluate the incidence and risk factors of pressure ulcers (PU) in adult patients admitted to intensive care units (ICUs), as well as the outcome (including ICU and hospital mortality) of these patients. Methods Epidemiological cohort multicenter prospective study, evaluating patients admitted for a period of 31 days (June 01 to July 01, 2015) until hospital discharge. Epidemiological and clinical data were collected daily until ICU discharge, as was the incidence of PU, either new or present on admission. Setting 10 general adult ICUs. Results We evaluated 332 patients, 52.1% male, mean age 63.1 years. The most common cause of admission was medical diseases (50.3%), and the mean APACHE II score was 14.9. A total of 45 patients (13.6%) had PU; the most common sites were sacral, calcaneal, ears, and trochanter. The incidence of PU was related to predictive factors, such as the Braden Scale and length of lack of nutrition. The presence of PU was strongly related to unfavorable outcomes, such as Mechanical Ventilation (MV) duration and ICU and hospital mortality. Conclusions PU incidence is related to severity of the patient’s condition and predicted by Braden Scale score. The presence of PU is also related to adverse outcomes, such as MV duration and ICU and hospital mortality. It was also shown that patients with PU have a higher incidence of medical complications, such as acute renal failure, pneumonia, and the need for vasoactive drugs.

Abductor deficiency after total hip arthroplasty is a rare and challenging problem facing reconstructive surgeons today. The etiologies are vast. Herein, we review the relevant anatomy of the abductor mechanism, as well as the course and potential sites of injury for the superior gluteal nerve. The diagnosis can be challenging, but a focus on history and physical examination is the most important diagnostic tool. Supplemental modalities include plain radiographs, arthrography, ultrasound, electromyography, and magnetic resonance imaging. A variety of treatments exists for symptomatic abductor deficiency. We review potential modalities ranging from soft tissue transfers, trochanter fixation and osteotomy with a slide, as well as potential revision components.

Background A nationwide survey of hip fractures by the Japanese Orthopaedic Association (JOA) from 1998 to 2008 found a drastic increase in incidence. The aims of this study were to elucidate the status of hip fractures from 2009 to 2014 and to survey the causes for delayed surgery. Methods A tally of all hip fractures that occurred in patients from 2009 to 2014 was conducted in hospitals authorized by the JOA or in clinics with inpatient facilities of the Japanese Clinical Orthopaedic Association (JCOA). A survey of the causes for delay in surgery was conducted at 849 sites and 526 sites participated. Results A total of 488,759 hip fractures were registered. Increases in incidence from 2009 to 2014 were prominent in the 90–94-year-old age group among women and the 85–89-year-old age group among men. More trochanteric fractures than neck fractures occurred; however, the neck/trochanter ratio increased over time. The mean duration of preoperative hospital stay was 4.8 and 4.5 days, and the mean duration of hospitalization was 40.5 and 36.8 days in 2009 and 2014, respectively. There were significant differences between patients who waited for surgery up to 3 days and those who waited longer than 3 days in date of hospitalization, fracture type, comorbidities, anticoagulant use, surgical procedure, type of physician who administered anesthesia, type of anesthesia, and operating room schedule. Physicians in charge of each patient who waited for surgery for more than 3 days most frequently cited difficulties in securing operating rooms as the cause for delayed surgery. Conclusion A drastic increase occurred in the number of patients with hip fractures with time in Japan. One problem in the treatment of hip fractures is the long waiting time from hospitalization to surgery resulting from difficulties in securing operating rooms.

Background Hip arthroplasty in unstable trochanteric fracture warrants quick recovery with little risk of mechanical failure, avoids the risk associated with internal fixation, and enables the patient to maintain a good level of function immediately after surgery. Aim The aim of this study is to evaluate the clinical and functional outcomes of cemented bipolar prosthesis in unstable intertrochanteric fractures in the elderly. Patients and methods Twenty-four patients with unstable type of intertrochanteric fracture according to Association Osteosynthesis Classification were treated with hemiarthroplasty (cemented bipolar prosthesis) and reconstruction of trochanter. The average age of the patients was 79 years. We evaluated postoperative complications, mortality rate, functional outcome using the Harris hip score, time to return to preinjury level of activity, and radiological signs of healing and loosening or migration of implant. The range of period of follow-up was 2–5 years (mean: 3.5 years). Results Mobilization and full weight-bearing was started immediately within 1 week of surgery. The dislocation rate in our study was zero. Deep infection and loosening of the implant was not observed in any of the cases. The mean Harris hip score improved progressively with time of follow-up. The mean score was 45.30 on the third day. The final average Harris hip score at the last follow-up was 81.90. Limb length discrepancy was observed in seven patients and average shortening was 1.3 cm (range: 0.5–1.8 cm). Conclusion Hip arthroplasty in mobile and psychologically stable elderly patients with unstable intertrochanteric fracture is a valuable treatment option.

Background: CT scan evaluation of the morphology of trochanteric & subtrochanteric fractures helps in the selection of appropriate implant for fixation of proximal femoral fractures, resulting in better surgical outcome. Materials and methods: CT scan evaluation done in 64 cases of intertrochanteric and subtrochanteric fractures since April 2012 to March2014. The fracture morphology of these fractures analyzed regarding stable or unstable fracture, integrity of posteromedial part of trochanter, severe comminution of lateral cortex of trochanter, quality of the bone based on their trabecular pattern, and fracture line extending into the subtrochanteric area. Dynamic hip screw, proximal femoral nailing, proximal femoral locking plate and cemented hemiarthroplasty were selected according to fracture morphology. Results compared with previous 60 surgically treated cases of trochanter & subtrochanteric fractures done based on the xray morphology of the fractures, for the period before April 2012. Results: 2 cases of implant penetration into the joint, 11 cases of hip screw cut out, 9 cases of varus angulations, 4 cases of implant failure with nonunion occurred of the 60 cases done with only x ray evaluation, study done from September 2008 to March 2012. After 2 years of follow up only 4 cases of nonunion occurred after implant selection for surgical treatment of intertrochanteric and subtrochanteric fractures based on CT scan evaluation. Conclusion: CT scan evaluation provides good method of choosing an implant in surgical management of trochanteric and subtrochanteric fractures.

Background. Several randomized trials demonstrated aromatase inhibitors (AI) superiority in terms of disease-free survival compared to tamoxifen treatment for postmenopausal hormone receptor-positive breast cancer (BC) patients. Anyway AI toxicity profile due to estrogen suppression is a concern. Pivotal trials demonstrated a significant bone mineral density (BMD) loss due to AI, with a consistent risk of fractures, thus impacting on patients' quality of life. Bisphosphonates represent an effective treatment in postmenopausal osteoporosis fractures prevention. Several studies demonstrated that upfront bisphosphonates therapy prevents bone loss in postmenopausal women receiving adjuvant AI for early-stage BC. However an adequate patients selection for adjuvant bisphosphonates treatment during AI endocrine therapy is still a challenge. We present the final results of the BONADIUV trial, a single-blind, randomized, placebo-controlled phase 2 study designed to evaluate the impact of ibandronate treatment on BMD in osteopenic women taking AI. Methods. Between January 2011 and May 2014, 561 patients underwent a baseline BMD assessment before starting AI as planned adjuvant treatment. Overall 171 osteopenic patients (lumbar spine [LS] and/or trochanter -1< T-score Results. A total of 171 patients were randomized in the study. Overall 27 patients (15.8%) withdrew the protocol (17 ibandronate vs 10 placebo arm): the final analysis was performed on 144 patients (72 patients per arm). P-value from Wilcoxon test showed no significant difference between arms at baseline both for LS (p=0.94) and trochanter (p=0.83). At 2-year, osteopenic patients treated with ibandronate gained +18.7% and +15.5% at the LS and trochanter BMD, respectively. Patients treated with placebo lost -13.3% at the LS, and gained +2.9% at the trochanter. Trochanter p-value from covariance analysis showed a mean BMD change significantly in favor of ibandronate arm at 1-year (p=0.012), and borderline at 2-year (p=0.087). Concerning LS, the mean BMD change was significantly in favor of ibandronate arm both at 1-year (p=0.002) and 2-year (p Conclusions. Final results of our study showed that treatment with ibandronate, as compared to placebo, improved BMD change in osteopenic women treated with adjuvant AI, and consistently protected patients' bone loss. Citation Format: Livi L, Saieva C, Desideri I, Scotti V, De Luca Cardillo C, Carta G, Cecchini S, Orzalesi L, Sanchez LJ, Casella D, Bernini M, Nori J, Bianchi S, De Feo ML, Meattini I. A single-blind, randomized, placebo-controlled phase II study to evaluate the impact of oral ibandronate on bone mineral density in osteopenic breast cancer patients receiving adjuvant aromatase inhibitors: Final results of the single-center BONADIUV trial [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-09-12.

Dual-Mobility-Pfannen (DMP) werden sowohl bei Primar- als auch bei Revisionsoperationen zunehmend eingesetzt, um das Luxationsrisiko zu minimieren. So konnten verschiedene Studien Uberlebensraten von DMP bis zu 100 % bei einer durchschnittlichen Dislokationsrate von weniger als 1,5 % nach Primarimplantation bei einer Follow-up-Zeit von 10 Jahren belegen. Fur Prothesenwechseloperationen wurden Uberlebensraten von bis zu 99 % mit Dislokationsraten zwischen 0 und 10 % nach einer durchschnittlichen Follow-up-Zeit von 5 Jahren beschrieben. Der vorliegende Beitrag soll einen Uberblick liefern uber die technischen Grundlagen inklusive des Funktionsprinzips von Dual-Mobility-Pfannen. Weiter sollen Indikationen und spezifische Komplikationen dieses Pfannensystems anhand der aktuellen Datenlage aufgezeigt werden.

Objective: to assess current approaches to hip joint (HJ) ar­throplasty with high dysplastic dislocation and to evaluate out­comes. Methods: we studied the literature on the problem of to­tal hip arthroplasty under conditions of dysplastic coxarthrosis (DC) Crowe III–IV type classification and results of treatment in 322 patients (126 (39.1 %) — DC type III, 4 (4.4 %) — IV), wth domestic arthroplasty modular system with two types of ta­pered legs and two «dysplastic» with a square profile. Results: the main problem of hip joint arthroplasty in patients with DC Crowe III–IV type — selection of the optimal method of the femo­ral head construction, setting the cup on implant bed in the acetabulum (AC), prevention of cardiovascular and neurological complications. The method of low intertrochanteric osteotomy, femoral neck used in 126 cases (90 %) during the arthroplasty and length of limb offset from 2.8 to 4.5 cm without complica­tions. In 11 patients cup set to AC into true bed after osteotomy T. Paavilainen. In 3 cases subtrochanteric osteotomy performed with partial resection of the bone segment from 4 to 5 cm. Posi­tive results were obtained in 94.6 % of patients. Conclusions: in patients with DC III–IV type for Srowe when shortening the limb to 4 cm, treatment can be performed on the level or over minor trochanter intertrochanteric osteotomy, the release AC zone and immobilization of the proximal femur that saves its metaphysis and HJ muscular balance. In the case of complete dislocation of the femoral head with dysplastic genesis and shortening of the limbs over than 4 cm we recommend shorten­ing osteotomy together with the restoration of anatomic center of rotation of the head implant, ie setting the cup to the anatomic bed of AC combined with bone grafting defect in AC and use inserts 10o and 20o shed for prevent dislocation of the implant.

Background: Trochanteric osteotomy still has an important role in hip arthroplasty in cases of (1) preexisting developmental hip dysplasia with superior subluxation, (2) revision arthroplasty, specifically with acetabular component revision in the face of well-fixed femoral component, and (3) recurrent dislocation without component loosening or malalignment, in treatment of complicated trochanteric fixation in osteoporotic bone and nonunions may be difficult. This study reports the clinical outcomes of trochanteric fixation following total hip arthroplasty (THA) utilizing a hook plate construct in a cohort of ten patients. Materials and Methods: The Arbeitsgemeinschaft für Osteosynthesefragen (AO) articulated hook plate was used in nine cases of established approach related nonunion following THA and in one case of osteopenic bone during primary THA. All ten patients returned for interviews and clinical examination. The average time for clinical followup was 35 months (range 5–48 months). The mean age of the study cohort was 65 years (range 56–74 years). Time to union and incidence of postoperative complications were assessed. Results: Union occurred in all ten cases at an average of 3.3 months postoperatively. One patient developed symptomatic trochanteric bursitis and required plate removal. Another patient developed a superficial infection which was successfully treated with local wound debridement and antibiotics. A third patient developed a symptomatic neuroma at the site of the iliac crest bone harvest and was successfully treated with excision of the neuroma. No catastrophic implant failures occurred. Conclusions: The articulated design of the plate allows for ease in application and functional construct stability. The articulated hook plate is an option for fixation of osteopenic bone fragments and established nonunions of the greater trochanter.

Introduction The objectives of this study were to evaluate the correlation between bone attenuation around the shoulder joint assessed on conventional computed tomography (CT) and bone mineral density (BMD) based on dual-energy X-ray absorptiometry (DEXA) of the central skeleton and the correlation between the bone quality around the shoulder joint and the severity of the fracture pattern of the proximal humerus. Materials and methods A total of 200 patients with proximal humeral fracture who underwent preoperative 3-dimensional shoulder CT as well as DEXA within 3 months of the CT examination were included. Fracture types were divided into simple and comminuted fracture based on the Neer classification. After reliability testing, bone attenuation of the glenoid, three portions of the humeral head, and metaphysis was measured by placing a circular region of interest on the center of each bony region on CT images. Partial correlation analysis was used to assess the correlation between the bone quality around the shoulder joint on CT and the BMD on the central skeleton after adjusting for age and body mass index. Partial correlations between fracture classification and CT/DEXA results were also evaluated. Results Bone attenuation measurements of the glenoid and humeral head showed good to excellent reliability (intraclass correlation coefficient, 0.623–0.998). Bone attenuation of the central portion of the humeral head on CT showed a significant correlation with the BMD of L1, L4, the femoral neck, and femoral trochanter (correlation coefficient, 0.269–0.431). Bone attenuation of other areas showed a lower correlation with BMD by DEXA. As the level of the Neer classification increased from a 2 to 4-part fracture, bone attenuation of the central humeral head decreased significantly (r = −0.150, p = 0.034). However, the BMD on DEXA was not a predictive factor for comminuted fracture of the proximal humerus. Conclusions DEXA examination of the central skeleton may not reflect the bone quality of the proximal humerus and severity of proximal humeral fracture. Direct assessment of the bone quality of the proximal humerus is recommended to determine the osteoporotic nature of the fracture.

Introduction Fractures caused by osteoporosis are prevalent among elderly females, which reduce quality of life significantly. This study aimed at comparing cost-effectiveness of Zoledronic acid in preventing and treating post-menopause osteoporosis as compared with routine medical treatment. Methods This cost-effectiveness study was carried out retrospectively from the Ministry of Health and insurance organizations perspective. Costs were evaluated based on the cost estimation of a sample of patients. Outcomes were obtained from a systematic review. The Cost-Effectiveness Ratio (CER) and incremental cost-effectiveness ratio (ICER) for outcome of femoral neck Bone Mineral Density (BMD), hip trochanter BMD, total hip BMD and lumbar spine BMD and cost-benefit of consuming Zoledronic Acid were calculated for fracture outcome obtained from reviewing hospital records. Results The results and the ICER calculated for study outcomes indicated that one percent increase of BMD on femoral neck BMD requires further cost of $386. One percent increase of BMD on hip trochanter BMD requires further cost of $264. One percent increase of BMD on total hip BMD requires further cost of $388, one percent increase of BMD on lumbar spine BMD requires further cost of $347. The Cost Benefit Analysis (CBA) calculated for vertebral and hip fracture, non-vertebral fracture, any clinical fracture, and morphometric fracture for a 36-month period were about 0.82, 0.57, and 1.06, respectively. Vertebral and hip fractures, and non-vertebral fractures or any clinical fracture for a 12-month period were calculated as 1.14 and 0.64, respectively. In other words, Zoledronic acid consumption approach is a cheaper and better approach based on an economic assessment, and it can be considered as a dominant approach. Conclusion According to the cost-effectiveness of zoledronic acid in the prevention and treatment of osteoporosis in women, despite the costs, it is recommended that insurance coverage for the drug should be considered in the period after menopause and the benefits of this drug. This can reduce the costs imposed on the patients and also it can reduce the economic burden on the community, particularly as a result of the fracture.

The diagnosis of pseudoaneurysm of the deep femoral artery as a late complication after orthopaedic surgery is uncommon. The causes of the injury of the artery may be due to the intervention technique itself (mainly the orthopaedic materials or the use of clips), and less frequently by fragments displaced by the trochanter. A case of pseudoaneurysm of the deep femoral artery by a less displaced trochanter fragment is presented in this article, showing how the different professionals interacted, and with the intervention of specialists in angioradiology to resolve it.

BackgroundLimb length discrepancy (LLD) is one of the main cause of dissatisfaction after total hip arthroplasty (THA). The teardrop-lesser trochanter method can accurately predict and analyze LLD for healthy people. However, for patients with preoperative LLD, no method for predicting postoperative LLD is currently available, and these patients are highly susceptible to more severe LLD after THA. Accordingly, this study proposed a calculation method to predict postoperative limb length for these patients.MethodsEighty patients who underwent THA between May 2016 and October 2018 due to unilateral developmental dysplasia of the hip (DDH) were evaluated. Relevant parameters were measured from radiographs of full-length lower limbs, e.g. the distance between the rotation center of the hip and the midpoint of the tibial plafond and the distance between the point which was marked at the same height as the lesser trochanter on the anatomical long axis of the femur and the midpoint of the tibial plafond. Then, a mathematical model was established by simplifying the structure from the hip to the ankle. The relationship between the placement position of the prosthesis and the LLD value was calculated by Law of Sines and Iterative Calculation.ResultsThe preoperatively predicted LLD values and the postoperatively measured LLD values were compared, yielding a mean absolute difference of 3.7 (range, 0.1 to 8.6) mm. The intraclass correlation coefficient (ICC) of the two parameters exhibited strong reliability (ICC = 0.911, 95%CI, 0.795 to 0.955). The Bland-Altman plot also showed good conformity between the two parameters.ConclusionsThe proposed calculation method effectively predicted the postoperative LLD using preoperative parameters. Despite the complexity of the method, it can go a long way towards reducing the occurrence of severe postoperative LLD in DDH-THA.

Extinct sloths represent a wide range of morphological, locomotor, and body size variation. Researchers have examined femoral neck angle in two dimensions to hypothesize locomotor behaviors in this group; however, this measure does not account for femoral neck anteversion. Here, we present a new method for quantifying femoral neck anteversion angle, in addition to femoral neck angle, to capture the 3D position of the femoral head/neck. Femora of extant (n = 21; Bradypus and Choloepus) and extinct (n = 49; Acratocnus, Megalocnus, Neocnus, and Parocnus) sloths were surface scanned and their surface models used to calculate three angles of femoral neck anteversion and femoral neck angle. Femoral neck anteversion was calculated as the angle between the femoral neck axis and the geometric axis of the femoral condyles (GA), the 35% cross section axis, and a trochanter axis. Femoral neck angle was calculated as the angle between the femoral neck and shaft axes. Genera were compared using ANOVAs with post hoc multiple comparisons for each angle. Femoral neck angle and femoral neck anteversion relative to the cross section were also analyzed. Significant differences among genera exist for all angles, (p < .001) but not all angles separate all genera. Femoral neck and anteversion angles typically yield different results, demonstrating the utility of analyzing both angles. The GA and cross section angles are highly correlated in sloths, with the exception of comparisons among Megalocnus, Parocnus, and Neocnus, suggesting morphological variation in the distal femur. While this method was applied to sloths, it has broad applicability to mammalian groups.

Osteoporosis and fractures are important public health issues that impose serious burdens on patients. Patients with systemic sclerosis (SSc) have low bone mineral density (BMD) and increased risk for fracture. We aimed to explore the association between SSc and BMD and fracture risk.For this meta-analysis, we analyzed data from articles that reported mean differences in BMD or fracture risk between patients with SSc and controls. We undertook a systematic literature search of the PubMed, Web of Science, and Cochrane Library databases. The pooled weighted mean difference (WMD) was used to estimate the mean difference in BMD between patients with SSc and controls. Pooled odds ratios (ORs; with 95% confidence intervals [95% CIs]) were used to assess the association between SSc and fracture risk.Analysis of the results from 18 studies showed that patients with SSc had significantly lower BMD than controls in the following categories: whole body (WMD - 0.07, 95% CI - 0.1 to - 0.04, p 0.00001), lumbar spine (WMD - 0.08, 95% CI - 0.11 to - 0.05, p 0.00001), femoral neck (WMD: -0.28, 95% CI: -0.46 to -0.10, p=0.002), total hip (WMD - 0.10, 95% CI - 0.14 to - 0.06, p 0.00001), and femoral trochanter (WMD - 0.06, 95% CI - 0.09 to - 0.03, p 0.0001). Moreover, patients with SSc had an increased risk of vertebral fracture (OR 10.38, 95% CI 1.19 to 90.58, p = 0.03). We did not find a significant difference in the risk of osteoporotic fracture between patients with SSc and controls (OR = 2.24, 95% CI 0.58 to 8.59, p = 0.24).Patients with SSc have a significant reduction in bone mass, and these patients have an increased risk of vertebral fracture. The early monitoring of BMD in patients with SSc is recommended for the prevention of osteoporosis and fracture.Key points• SSc patients have a significant low BMD• SSc patients also have an increased risk of vertebral fracture.

Objective: To verify the association of the practice of mechanical restraint with pressure injury (PI) in hospitalized patients. Method: A cross-sectional study of 111 patients from medical, surgical and intensive care units at a public hospital in the state of Rio de Janeiro, Brazil. To analyze the association between variables, the [odds ratio (OR)] was adopted. Results: It were found 57 patients in mechanical restraint (51.4%). In the group of patients contained, the occurrence of PI was estimated in 43.9% and in the group of patients not contained in 5.6%. The chance of the contained patient to present PI was 13 times higher than in patients not contained. The location of the injury was more frequently in the sacral region, classified as stage 2 (21.1%) and stage 3 (12.3%), followed by trochanter (15.8%) and calcaneus (10.5%). Conclusion: It is recommended the adoption of nursing practices of suppression or reduction of the time in the use of mechanical restraint, adopting educational measures and prevention of PI.

Background: Recent studies suggested an inverse association between exposures to perfluoroalkyl substances (PFASs) and bone mineral density (BMD). Whether exposures to PFASs are also associated with changes in BMD has not been examined. Methods: Five major PFASs (perfluorooctanesulfonic acid, PFOS; perfluorooctanoic acid, PFOA; perfluorohexanesulfonic acid, PFHxS; perfluorononanoic acid, PFNA; perfluorodecanoic acid, PFDA) and BMD (g/cm2) at six bone sites (spine, total hip, femoral neck, hip intertrochanteric area, hip trochanter, and hip Ward's triangle area) were measured at baseline among 294 participants in the POUNDS-LOST study, a weight-loss trial, of whom a total of 175 participants had BMD measured at both baseline and year 2. Linear regression was used to model the differences or changes in BMD for each SD increment of PFAS concentrations. In a secondary analysis, interactions between PFASs and baseline body mass index (BMI), as well as a BMI-related genetic risk score (GRS) derived from 97 BMI-predicting SNPs were examined in relation to changes in BMD. Results: At baseline, both PFOS and PFOA were significantly associated with lower BMD at several sites. For each SD increase of PFOS, the βs (95% CIs) for BMD were −0.020(-0.037, −0.003) for spine, −0.013(-0.026, 0.001) for total hip, −0.014(-0.028, 0.000) for femoral neck, and −0.013(-0.026, 0.000) for hip trochanter. For PFOA, the corresponding figures were −0.021(-0.038, −0.004) for spine, −0.015(-0.029, −0.001) for total hip, and −0.015(-0.029, −0.002) for femoral neck. After adjusting for baseline covariates and 2-year weight change, higher baseline plasma concentrations of PFOS, PFNA, and PFDA were associated with greater reduction in BMD in the hip; the βs (95% CIs) were −0.005(-0.009, −0.001), −0.006(-0.010, −0.001), and −0.005(-0.009, −0.001), respectively. Similar associations were found in hip intertrochanteric area for all PFASs except PFHxS, with βs ranging from −0.006 for PFOA to −0.008 for PFOS and PFNA. Participants with a higher GRS tended to have less PFAS-related BMD decline in total hip (Pinteraction = 0.005) and the hip intertrochanteric area (Pinteraction = 0.021). There were similar PFAS-related BMD changes by baseline BMI levels, although the interactions did not achieve statistical significance. Conclusions: This study demonstrated that higher plasma PFAS concentrations were not only associated with a lower BMD at baseline, but also a faster BMD loss in a weight-loss trial setting. Genetic predisposition to larger body size may somewhat attenuate the deleterious effects of PFASs on BMD. Further exploration of the possible impact of PFAS exposures on bone density is warranted.

Introduction The item 'hip pain' is widely used in questionnaires related to Spondyloarthritis and/or Ankylosing spondylitis (AS), either in clinics with patients being physically present or remotely, as the hip joint is known to affect AS in particular. Patients in clinics often claim to have hip pain. However, by stating "hip" they are referring to variable structures located in the hip region not necessarily related to hip joint itself. Objective To assess which structure(s) patients mean when referring to hip pain. Methods A diagram used as a proforma for patients to indicate the site of 'hip pain' following a detailed history and examination was used. Radiological imaging was utilised for those patients with multiple sites or clinically unclear causes of "hip" pain. Results From 54 patients 7 different anatomical sites described which were: Trochanter, (27.2%), hip joint (20.8%), iliac crests (anterior superior [6.9%], posterior superior [8.3%], and anterior inferior [4.1%]), lumbar spine (8.3%), sacroiliac joint (6.9%). More than 1 sites in the same patient: (17.5%). Diagnoses were: Trochanteric bursitis (27%), osteoarthritis of hip and spine, (25%), enthesitis (22%), sacroiliitis (6.7%), synovitis (5%), fibromyalgia (3.4%), and hip dislocation (1.6%). More than 1 diagnosis in same patient: 9.3%. Conclusion 'hip pain' as an item used in questionnaires must be interpreted with caution.

Context Osteoporosis is characterized by low bone mineral density (BMD) and has been thought to only be a major health concern for postmenopausal women. However, osteoporosis and its risk factors have been greatly understudied in the middle-aged and male populations. Objective To assess the likelihood of low BMD and its association with related risk factors in early–middle-aged (defined in this study as 35-50 years) men and women. Methods Eligible men and women completed a questionnaire assessing calcium intake, hours per week of exercise, and other related risk factors associated with osteoporosis and osteopenia. The primary outcome variable, BMD, was attained using dual-energy x-ray absorptiometry scans taken at the femoral neck, trochanter, intertrochanteric crest, total femur, and lumbar spine. Results Of the 173 participants in this study, 23 men (28%) and 24 women (26%) had osteopenia at the femoral neck. In men, there was a significant and negative correlation between exercise and femoral neck BMD (r=−0.296, P=.01). In women, correlation analyses showed significant positive correlations between exercise and BMD of the trochanter (r=0.329, P=.003), intertrochanteric crest (r=0.285, P=.01), total femur (r=0.30, P=.01), and lumbar spine (r=0.29, P=.01). Conclusions Osteopenia was found in more than 25% of both male and female participants, which suggests that more osteoporosis screening and prevention programs need to be targeted to persons in the studied age group because osteopenia can lead to osteoporosis.

The effects of the seat tube angle and crank arm length on metabolic responses, neuromuscular activation, and lower extremity joint kinematics were investigated during bicycling with a relatively lower seat height usually used for daily life.Eleven young males performed bicycling on ergometer with various seat tube angles (60°, 65°, and 70°) and crank arm lengths (127, 140, 152, and 165 mm). Oxygen consumption was measured with electromyography of the knee extensor muscle, and hip, knee, and ankle joint angles. The seat height was set as the shorter than subject's trochanter height, because this study simulates pedaling a bicycle in daily life on public roads.Significantly higher oxygen consumption was noted with a 70° of seat tube angle on comparison with a 65° of seat tube angle (p 0.05). There were no significant effects of the crank arm length on oxygen consumption (p 0.05).From these results, the present study suggests that a shallower seat angle could help to decrease the physiological burden during bicycling with a relatively lower seat height.

Background: To compare bone density accrual and markers of bone geometry and formation between female adolescents engaged and not engaged in artistic gymnastics (AGs). Methods: This was a 12-month longitudinal study involving 20 female adolescents, including 10 controls and 10 gymnasts (AGs) aged 11 to 16 years. At baseline, the gymnasts had a minimum of 12 months of practice, and the controls reported no participation in any organized sport. Bone mineral density (BMD) was measured in the lower limbs, upper limbs, spine, and whole body. In addition, BMD and geometrical properties of the femur were assessed. As a bone formation marker, osteocalcin level was measured. Results: Femoral aspects were increased in the gymnasts by 19% (P= 0.009), 14% (P= 0.047), and 10% (P= 0.046) in the Ward’s triangle, trochanter, and the overall bone, respectively, than in the control girls. Geometrical parameters, bone accrual, and osteocalcin levels were similar in both groups. The weekly training load explained 30.8% of all bone gains on the lower limbs and affected the density on parts of the femur. Conclusions: The gymnasts, after a 12-month follow-up, demonstrated a higher BMD in the Ward’s triangle and whole femur than the controls, as well as an improvement in femur density. These changes were mainly due to the weekly training load. Lastly, the gymnasts had significant bone accrual (after 12 months) in the upper limbs, lower limbs, and whole body.

The immature stages of Casignetus MacLeay, 1819 (Coleoptera: Lucanidae: Lucaninae: Casignetini) are revised with the description of third instars of males and female of C. humboldti (Gyllenhal, 1817), and C. spixi (Perty, 1830), and female of C. lindei (Boileau, 1899). Pupae of both sexes of C. humboldti, and female of C. lindei are also described for the first time. Casignetus larvae can be recognized by the form of the pars stridens, formed by a slightly arched, longitudinal row of robust, and sclerotized teeth, and by the fusion of the femur and trochanter in prothoracic and mesothoracic legs. Additionally, new characters are proposed for Casignetus species: frontal sutures curvature; epicranial setae; epipharynx and hypopharynx setae; and number and shape of stridulatory teeth.

The Mediterranean diet (MD) has been associated with an improvement in health and an increase in longevity. Certain components of a MD can play a role in the prevention of osteoporosis and/or hip fracture. We investigated the association between the degree of adherence to a MD and bone mineral density (BMD) measured in several bone areas in a population of Spanish premenopausal women. We analyzed 442 premenopausal women aged 42.73 &plusmn, 6.67 years. Bone measurements were obtained using quantitative bone ultrasound (QUS) for the phalanx, dual energy X-ray absorptiometry (DXA) for the lumbar spine, Ward&rsquo, s triangle, trochanter, and hip, and peripheral quantitative computed tomography (pQCT) for the non-dominant distal forearm. MD adherence was evaluated with MedDietScore. Amplitude-dependent speed of sound (Ad-SOS), BMD, and volumetric bone mineral density (vBMD) (total, trabecular, and cortical bone density) were positively associated with higher adherence to the MD (p &lt, 0.05). Adherence to the MD was significantly associated with QUS, BMD, and vBMD in multiple regression analysis, QUS: Ad-SOS (m/s) &beta, = 0.099 (p = 0.030), BMD (g/cm2): femur neck &beta, = 0.114 (p = 0.010) and Ward&rsquo, s triangle &beta, = 0.125 (p = 0.006), vBMD (mg/cm3): total density &beta, = 0.119 (p = 0.036), trabecular density &beta, = 0.120 (p = 0.035), and cortical density &beta, = 0.122 (p = 0.032). We conclude that the adherence to the MD was positively associated with better bone mass in Spanish premenopausal women.

Transplantation of adipose tissue is used for cosmetic as well as for reconstructive purposes. The methods of harvesting, processing, and transplantation vary in practice. Grafts are harvested almost exclusively using special extraction needles. Smaller fat particles are harvested using fine needles with small diameters of lateral openings and again transplanted using thin injection needles. There is a proven relationship between the diameter of the fat particles and that of the perforations in the extraction needle. The adipose tissue can be harvested from different regions of the body, mostly from the buttocks or the trochanter region and also possibly from the inner sides of the upper thigh or the knee region. Just a few hours postoperatively, the beginning of the neovascularization becomes evident. A certain loss in volume is generally experienced. Finally, the risks and complications of transplantation of autologous adipose tissue are discussed.

Posterior dislocation of hip is commonly associated with acetabular lip fractures. Involvement of neck, trochanter or intertrochanteric region is uncommon. Very few cases of posterior hip dislocation with ipsilateral intertrochanteric fracture in the absence of head or acetabular fracture have been reported in the literature. We report such a case in a 19yr male treated with open reduction and internal fixation with sliding hip screw with good functional and radiological outcome at 1 year. Being an extremely rare form of injury, such an injury pattern does not exist in present classification systems. There is a need to revise the existing classification systems and formulate a protocol for the management of the same. Such fractures may also be associated with a sharp calcar spike of the proximal fragment impinging femoral vessels and branches. Attempt at closed reduction without adequate anatomical orientation of the spike can lead to hazardous vascular consequences.