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ObjectiveHead injuries are common injuries in E-scooter accidents which have dramatically increased in recent years. The head impact conditions and helmet performance during E-scooter accidents are barely investigated. This study aims to characterize the head-ground impact biomechanics and evaluate bicycle helmet protection in typical E-scooter falls.MethodThe finite element (FE) model of a hybrid III dummy riding an E-scooter was developed and validated. The FE model with and without a bicycle helmet was used to reproduce twenty-seven E-scooter falls caused by the collision with a curb, in which different riding speeds (10, 20, and 30 km/h), curb orientations (30, 60, and 90°), and E-scooter orientations (−15, 0, and 15°) were simulated. Head-ground impact velocities and locations were evaluated for the unhelmeted configurations while the helmet performance was evaluated with the reduction of head injury metrics.ResultsE-scooter falls always resulted in an oblique head-ground impact, with 78 % on the forehead. The mean vertical and tangential head-ground impact velocities were respectively 5.7 ± 1.5 m/s and 3.7 ± 2.0 m/s. The helmet significantly (p < 0.1) reduced the head linear acceleration, angular velocity, HIC_36, and BrIC, but not the angular acceleration. However, even with the helmet, the head injury metrics were mostly above the thresholds of severe head injuries.ConclusionTypical E-scooter falls might cause severe head injuries. The bicycle helmet was efficient to reduce head injury metrics but not to prevent severe head injuries. Future helmet standard evaluations should involve higher impact energy and the angular acceleration assessment in oblique impacts.

Title: Case study of physiotherapeutic treatment of a patient with pertrochanteric fracture Author: Dávid Daniel Supervisor: Mgr. Jana Sohrová Objectives: Main objective of this theses is to elaborate theoretical and practical information concerning pertrochanteric fracture and present physiotherapeutic interventions currently used as a treatment. Methods: The basis for writing this bachelor's thesis was continuous professional practice at the Centrum léčby pohybového aparátu. The work is divided into a general and a special part. The general part consists of the theoretical basis for the diagnosis of pertrochanteric fracture of the femur. It includes an anatomical description, kinesiology of the affected area, basic information from traumatology and subsequent rehabilitation. A special part deals with the management of therapy for a patient with a pertrochanteric fracture, input and output kinesiological analysis, case report of individual therapies and their effect. Results: A comparison of the results of the initial and final examination showed that the goals set in important physical functions were met within the therapy, but the patient is still not fully recovered. Conclusion: The set goals were met, and the work contains a general part and a special part with a complete case report of a...

Background. In relation with the COVID-19 new coronavirus infection epidemic that began in Russia in the spring of 2020, a completely new group of patients appeared: patients whose coronavirus infection was combined with the proximal femur fractures. In the course of practical work, hospital doctors had to gain experience in treating these complex patients, solve new organizational and medical tasks. The aim of the study was to evaluate the results of treatment of patients with the proximal femur fractures in combination with coronavirus infection in a «covid» hospital at the hospital stage, 30-day and 6-month terms. Materials and Methods. The retrospective study is based on the collection and generalization of data from 64 patients with the proximal femur fractures in combination with confirmed coronavirus infection who underwent inpatient treatment from 16.03.2020 to 31.05.2021. 38 (59.4%) patients had a femoral neck fracture, 26 (40.6%) had a fracture of the trochanter region. Forty (62.5%) patients underwent surgical treatment (hip replacement was performed in 23 cases, osteosynthesis was performed in 17 cases), 24 (37.5%) patients did not undergo surgery. Results. With conservative treatment, the hospital mortality rate was 41.6%, the 30-day mortality rate was 72.7%, and the 6 — month mortality rate was 95.5%. During surgical treatment, the hospital mortality rate was 5.0% (2 patients died). Early postoperative complications were detected in 5 (12.5%) patients. Thirty-one (77.5%) patients walked or stood with a walker on their own at the time of discharge; 7 (17.5%) patients could not be activated. The thirty-day mortality rate in the group of patients who underwent surgical treatment was 8.6%, and the 6-month mortality rate was 32.1%. Conclusion. Surgical treatment of patients with the proximal femur fractures in combination with coronavirus infection is much more difficult than the treatment of patients without infectious pathology. However, despite number of unresolved problems, surgical treatment of such patients is possible with good results and should be actively applied.

Fragestellung: Es gibt Hinweise, dass die Varisierung des Femurhalses in der Trochanterebene und nicht in der Femurhalsebene stattfindet. In der Hüftendoprothetik besteht bekanntlich bei varischem Kollumdiaphysenwinkel eine erschwerte Femurosteotomie durch eine beschränkte Abgrenzung zum Trochantermassiv. [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Background The prevalence of osteoporosis in patients who undergo a primary total knee arthroplasty (TKA) is increasing. Low bone mineral density (BMD) is related to unfavorable outcomes following TKA such as migration of uncemented tibial components. Postoperative blood loss in TKA is an important complication. Non-modifying predicting factors for postoperative blood loss in patients undergoing primary TKA need further elucidation. Studies on the association between BMD and blood loss after TKA are limited. We aimed to demonstrate the relationship between BMD and postoperative drainage volume following primary TKA. Methods A cross-sectional study was conducted between January 2014 and August 2020. A total of 119 primary varus osteoarthritis knees with BMD results were included in the study. Patients with secondary causes of osteoporosis were excluded. Results The median postoperative drainage volume of participants in the normal total hip BMD group and the normal trochanter BMD group was higher than that of patients in the low total hip BMD group and the low trochanter BMD group (285.0 ml vs 230.0 ml, P = 0.003; 282.5 ml vs 240.0 ml, P = 0.013, respectively). Multivariate regression analyses showed that operative time, spinal anesthesia, and normal total hip BMD status were significant predictive factors associated with increased postoperative drainage volume (P = 0.014, 0.022, and 0.013, respectively). No association was identified between the lumbar spine BMD status and postoperative drainage volume. Conclusions The relationship between BMD and postoperative blood loss in primary TKA was identified in this study. Normal total hip BMD was found to be associated with an increased postoperative drainage volume after primary TKA compared with low BMD.

PURPOSE: Low bone mineral density (BMD) and fractures are a major concern in the female population and preventative strategies are needed. Whether team sports participation may reduce age-related bone loss in elderly women is still uncertain.METHODS: One hundred and thirty healthy, non-smoking women participated in this cross-sectional study, i.e., elderly (60-80 years) team handball players (EH, n = 35), elderly untrained controls (EC, n = 35), young (18-30 years) elite football players (YF, n = 30) and young untrained controls (YC, n = 30). A whole-body and two regional dual-energy X-ray absorptiometry (DXA) scans were performed to evaluate BMD and a blood sample was collected for measurement of bone turnover markers (BTMs).RESULTS: EH had higher BMD in all regions of the lumbar spine, except for L1, compared to EC (8-10%), and higher BMD in the femoral Ward's triangle (9%) and trochanter (7%) of the left leg. Furthermore, EH had higher mean leg BMD (8%) and whole-body BMD (5%) than EC. EH and YC had similar BMD in femoral trochanter, L1-L4 and mean leg despite an age difference of ~ 40 years. YF had higher BMD in all regions of the proximal femur (18-29%) and lumbar spine (12-16%) compared to YC, as well as higher mean leg BMD (20%) and whole-body BMD (13%). Sclerostin was 14% lower in EH compared to EC. YF showed higher PINP (98%), osteocalcin (57%), and CTX (83%) compared to YC.CONCLUSION: Lifelong team handball training and elite football training are associated with superior bone mineralization and changed bone turnover in elderly and young women.

Background There is no consensus on how to best address acetabular insufficiency. Several described techniques have a high rate of loosening and most rely on fixation to intact innominate bones. They also require extensive exposure and expensive implants. We present a novel technique for acetabular insufficiency management including discontinuity and a series with mean 6.5-year follow-up. Material and Methods After exposure, a femoral neck osteotomy is made, or the femoral component is removed. Bone graft is reverse reamed into the defect, and a porous coated acetabular shell is implanted with screws for supplemental fixation. In 3-6 months, after defect healing, the femoral component is implanted. All staged total hip arthroplasties for pelvic discontinuity from 2010 to 2015 by a single provider with minimum 5-year follow-up were identified. Implant survivorship, Merle d’Aubinge, and visual analog scale scores as well as complications were recorded. Results Nine patients were identified with mean 80.8-month follow-up (62-129). Merle D’Aubinge scores improved from 5.6 (4-8) to 15.3 (14-18), and Visual analog scale scores improved from 7.2 (6-9) to 0.8 (0-2). All implants were retained, and all patients were ambulatory at the terminal follow-up. There were 2 greater trochanter fractures, one calcar fracture managed with cerclage, and one patient developed heterotopic ossification. Conclusion Staged total hip arthroplasty can be used to address pelvic discontinuity with excellent short- to mid-term outcomes. This technique allows for a more limited exposure and the use of primary hip implants. Fixation is by ingrowth and does not rely on intact pelvic architecture.

BACKGROUND The emergence on the market of non-invasive mechanisms aimed at reducing subcutaneous fat achieving a slimming effect arouses great interest in doctors and patients. Several methods for the destruction of adipocytes are today on the market. AIMS This is a pilot study on body fat reduction treatment, using a novel energy-based device for body shaping. METHODS The study is performed on 42 patients, healthy adults of both sexes, with BMI between 25 and 30 kg/m², indicated for the removal of fatty tissue deposits specifically in the following areas: flanks, abdomen, internal legs, trochanter, buttocks, and arms. A minimum of 5 to a maximum of 6 treatments were performed for each patient, with the device, every two weeks and with a follow-up of 6 weeks. Circumference reduction, side effects, and patient pain were evaluated for all patients. RESULTS A set of 42 patients were evaluated. The mean circumference reduction at 6 weeks was 2.42 ± 0.4 cm (p

Background Early containment surgery has become increasingly popular in Legg-Calve-Perthes Disease (LCPD), especially for older children. These procedures treat the proximal femur, the acetabulum, or both, and most surgeons endorse the same surgical option regardless of an individual patient's anatomy. This "one-surgery-fits-all" approach fails to consider potential variations in baseline anatomy that may make one option more sensible than another. We sought to describe hip morphology in a large series of children with newly diagnosed LCPD, hypothesizing that variation in anatomy may support the concept of anatomic-specific containment. Methods A retrospective review of a prospectively collected multicenter database was conducted for patients aged 6 to 11 at diagnosis. To assess anatomy before significant morphologic changes secondary to the disease itself, only patients in Waldenstrom stages IA/IB were included. Standard hip radiographic measurements including acetabular index, lateral center-edge angle, proximal femoral neck-shaft angle (NSA), articulotrochanteric quartiles, and extrusion index (EI) were made on printed anteroposterior pelvis radiographs. Age-specific percentiles were calculated for these measures using published norms. Significant outliers (≤10th/≥90th percentile) were reported where applicable. Results A total of 168 patients with mean age at diagnosis of 8.0±1.3 years met inclusion criteria (81.5% male). Mean acetabular index for the entire cohort was 16.8±4.1 degrees; 58 hips (34.5%) were significantly dysplastic compared with normative data. Mean lateral center-edge angle was 15.9±5.2 degrees at diagnosis; 110 (65.5%) were ≤10th percentile indicating dysplasia (by this metric). Mean NSA overall was 136.5±7.0 degrees. Fifty-one (30.4%) and 20 (11.9%) hips were significantly varus (≤10th percentile) or valgus (≥90th percentile), respectively. Thirty-five hips (20.8%) were the third articulo-trochanteric quartiles or higher suggesting a higher-riding trochanter at baseline. Mean EI was 15.5%±9.0%, while 63 patients (37.5%) had an EI ≥20%. Conclusions The present study finds significant variation in baseline anatomy in children with early-stage LCPD, including a high prevalence of coexisting acetabular dysplasia as well as high/low NSAs. These variations suggest that the "one-surgery-fits-all" approach may lack specificity for a particular patient; a potentially wiser option may be an anatomic-specific containment operation (eg, acetabular-sided osteotomy for coexisting dysplasia, varus femoral osteotomy for valgus NSA). Level of evidence Level IV.

Inter-trochanteric fracture of femur are common in geriatric population. Urbanization & sedentary life style are the primary cause of increased incidence of these fracture’s. Distribution of Inter-trochanteric femur fracture’s is limited in male population compared to female due to osteoporosis. Aim is to compare inter-trochanteric fracture’s treated with DHS (vs) PFN. We performed a narrative review to evaluate the outcome of DH (Dynamic hip) Screw (VS) PF (Proximal femoral) Nail for inter-trochanteric fracture of femur. Extensive electronic search of article’s were done in Google scholar, reference checking and PUB-MED for deciding which implant is better. Some studies’ reveal PF Nail to be better than DH Screw, while some studies’ show vice versa. Both surgeries’ are time tested, absolute & require reasonable amount of skill. Final decision depends on operative surgeon’s preference to specific technique.

Background Traumatic obturator dislocation of the hip joint associated with greater trochanter fracture is a rare injury. We used the lateral approach through the rectus abdominis to remove the femoral head dislocated into the obturator, and the posterolateral approach was used for reduction and internal fixation of the femoral greater trochanteric fracture and total hip replacement (THR). Good follow‐up results were achieved. To the best of our knowledge, this is the first report on this particular type of injury and on this approach to treating this type of injury. Case Report The patient was hospitalized due to a traffic accident that resulted in the patient experiencing swelling and deformity accompanied by limited mobility of the left hip and left knee. X‐ray examination and CT confirmed that the patient suffered from left hip obturator dislocation, greater trochanter fracture, pelvic fracture (Tile B), left acetabular fracture, right open tibiofibular comminuted fracture (Gustilo III), and posterior urethral injury. The femoral head was removed from the pelvic cavity through a pararectus approach under general anesthesia. A posterolateral approach was used for open reduction, and cable internal fixation for the left intertrochanteric fracture and uncemented THR were performed. Results The ability to work was restored 6 months after the operation. The Harris hip score, reflecting joint function, was 86 points after 2 years of follow‐up observation. Conclusion A lateral approach of rectus abdominis to remove the dislocated femoral head in the pelvis from the obturator should be selected, along with the posterolateral approach for reduction and internal fixation of the intertrochanteric fracture and THR. This case also provides a new reference for the treatment of this type of hip fracture dislocation., The femoral head was removed from the pelvic cavity through a pararectus approach under general anesthesia. A posterolateral approach for open reduction and cable internal fixation for the left intertrochanteric fracture and uncemented THR were performed.

Salvage total hip arthroplasty (THA) may be required to manage femoral neck fracture implant failures, avascular necrosis and secondary hip arthritis. Cannulated cancellous screws can become stripped or incarcerated during the initial implantation and pose hardware removal issues. We present a novel technique for safe screw removal in a 62- year-old female patient with a painful right hip. She had undergone cancellous screw fixation for a fracture of the neck of femur ten years ago. There was avascular necrosis with screw cut out leading to secondary hip arthritis necessitating THA. Intra-operatively cannulated cancellous screw along the inferior femoral neck region was incarcerated. After posterior dislocation of the head, the neck was osteotomised, and the screw threads were exposed for possible extraction. However, the thickened femoral neck region with solid cortical bone prevented the screw disengagement in either direction. The screw along the femoral trochanter region was cut with a Harrington cutter and the remaining screw disengaged with careful removal of bony spicules and controlled anticlockwise rotations, to remove the screw in around fifteen minutes. Arthroplasty could be completed uneventfully thereafter. We could remove the screw while avoiding an iatrogenic fracture along the calcar region and excessive bone loss along the screw track. The femoral canal remained uncompromised. The anticipation of a difficult implant removal with a thorough understanding of the devices and techniques, is an invaluable asset to the operating surgeon. With a simple tool and novel technique in a difficult situation, we can save on operating time and minimise complications.

Background: The incidence of fractures of the peri trochanteric fractures is increasing since the general life expectancy of the population and related osteoporosis has increased significantly during the past few decades. They are second most common fractures related to osteoporosis, by the year 2050, intertrochanteric fractures will be ones taking a major share of them. The mechanism of action of TFN is controlled collapse at the fracture site on weight bearing leading to compression at the fracture. It has been noticed complications such as implant failure, screw back-out, protrusion of implant over the tip of the greater trochanter causing impingement, the z effect involves lateral migration of inferior head screw and medial migration of superior head screw and opposite is reverse z effect. We have hereby conducted the study to evaluate the functional outcomes and complications of trochanteric femoral nail in intertrochanteric femur fractures based on clinical and radiological findings. Materials and Methods: A prospective, single blinded, randomized control trial with 43 cases, out of which 24 were males and 19 were females was conducted. The postoperative evaluation was done both clinically and radiologically. Out of the 43 cases, follow up at outpatient level at regular intervals at 6wks, 3months, and 6months for serial clinical and radiological evaluation was done. At each follow up, patients were evaluated clinically using the Modified Harris Hip Score and radiologically with appropriate X-rays. The intraoperative blood loss, duration of surgery, intra operative complications, post-operative complication, duration of hospital stay were studied.Results: Results were evaluated by modified Harris hip score in our series we had 30.2% excellent, 48.8% good, 16.3 % fair and 4.7% poor results. The nail protrusion height was >5 in 74.4% of the patient.Conclusion: Trochanteric femoral nail can be considered the most judicious and rational method of treating intertrochanteric fractures, but it we recommend a modification to the Trochanteric femoral nail that would further shorten the proximal nail end 5–10 mm for the Indian population, so as to avoid soft tissue irritation on lateral trochanter.

[Purpose] The purpose of this study was to examine the test-retest reliability and minimal detectable change (MDC) of reach distance and movement angle analyses using Image J. [Participants and Methods] Thirty-eight healthy young males performed the functional reach test (FRT) twice, and their reach movements were recorded using a digital video camera. Image J was used to combine the digital photographs taken at the start position and maximum reach and to measure each movement. The measurements recorded were the movement distance of the third metacarpal bone (reach distance), anterior-superior iliac spine, and trochanter major, and the angles recorded were the acromion-malleolus lateralis, acromion-trochanter major, and trochanter major-malleolus lateralis. The reliability of all the measurements was analyzed using intraclass correlation coefficients (ICCs), Bland-Altman plots, and MDCs. [Results] The ICCs (1, 1) were >0.80 for all the outcomes. The Bland-Altman analysis revealed no systematic bias in any outcome. The MDC of reach distance was 18.3 mm. [Conclusion] Measurement using Image J for reach distance and movement angles in the FRT showed acceptable high test-retest reliability. Measurement of the FRT and the MDC calculated in this study could be used as a reference for further research.

Annotation. The constitutional approach is a valuable tool in the hands of practicing dermatologists, which allows an individual approach to the diagnosis and treatment of patients with psoriasis. The aim of the study was to examine the differences in total, longitudinal and transverse body sizes between healthy and/or psoriatic men depending on the severity of the disease. Anthropometric examination according to Bunak was performed for 32 men of the first mature age in patients with mild and 68 men with severe psoriasis. The PASI index was used to clinically assess the severity and area of psoriatic lesions. As a control from the data bank of the research center of National Pirogov Memorial Medical University, Vinnytsya anthropometric data of 82 practically healthy men of the same age group were selected. Statistical data processing was performed in the license package “Statistica 5.5” using non-parametric methods of evaluation of the obtained results. In patients with mild and severe psoriasis compared with healthy men found: lower values – pubic height (by 3.2 % and 5.4 %) and trochanter (by 8.2 % and 7.0 %) anthropometric points, shoulder width (by 19.6 % and 19.0 %) and the width of the distal epiphysis of the shin (by 5.2 % and 4.8 %); greater values – body weight (by 20.1 % and 17.5 %), body length (by 1.7 % in mild course), body surface area (by 10.0 % and 7.8 %), height of suprasternal (by 3.0 % and 1.5 %), acromial (by 2.3 % and 1.0 %) and finger (by 6.1 % and 4.4 %) anthropometric points, width of the distal epiphysis of the shoulder (by 6.9 % and 5.7 %), forearm (by 3.3 % in mild course) and thigh (by 10.3 % and 7.1 %), mid-thoracic diameter (by 16.5 % and 16.3 %), transverse lower thoracic diameter (by 16.5 % and 15.7 %), anterior-posterior mid-thoracic diameter (by 17.7 % and 20.2 %), interspinous (by 12.2 % and 12.1 %), intercristal (by 13.4 % and 11.7 %) and intertrochanteric (by 11.3 % and 10.4 %) distances. Differences in the studied body size in patients with varying degrees of psoriasis found. Thus, in patients with mild psoriasis, compared with patients with severe psoriasis, higher values were found for: body length (by 1.6 %); heights of suprasternal (by 1.5 %), pubic (by 2.1 %) and finger (by 1.4 %) anthropometric points; width of the distal epiphysis of the forearm (by 2.3 %). Thus, pronounced differences in total, longitudinal and transverse dimensions between healthy and patients with mild and severe psoriasis were revealed by Ukrainian men of the first mature age. Between patients with varying degrees of severity of dermatosis, most differences are found only for longitudinal body size.

Background. Studies have reported that low bone mineral density (BMD) is prevalent in human immunodeficiency virus (HIV)-infected patients; however, the factors that contribute to HIV-related BMD changes are yet to be fully understood. Due to the application of dual X-ray absorptiometry (DXA) among a select group of hospitals only, the prevalence and risk factors of low BMD in HIV-infected populations have not been intensively investigated in China. Thus, the aim of our study was to investigate the prevalence of and risk factors associated with BMD changes among antiretroviral therapy (ART)-naive HIV-positive patients in China. Methods. The assessment of the prevalence of and risk factors associated with BMD changes was conducted among 156 ART-naive HIV-infected patients. Demographic and clinical data, as well as results of fasting blood tests were obtained from patients. Further, all patients underwent DXA scans to determine BMD, which was then used to classify patients with osteopenia/osteoporosis. The risk factors of reduced BMD were then evaluated using binary logistic regression. Results. Among the 156 ART-naive HIV-infected participants, osteopenia and osteoporosis were diagnosed in 48.7% (76/156) and 4.5% (7/156) of patients, respectively. The lumbar spine was most likely to have reduced BMD (49.4% [77/156]), and the proportion of osteopenia in the left hip (32.7% [51/156]) was higher than in the right hip (24.4% [38/156]). In the lumbar spine, bone loss rate in the L1 section (60.9% [95/156]) was the most significant (L2, 53.2% [83/156]; L3, 45.5% [71/156]; L4, 52.6% [82/156]). Further analysis showed that, compared with the neck (26.9% [42/156] in the left, 18.6% [29/156] in the right) and the interior (15.4% [24/156] in the left, 13.5% [21/156] in the right), the trochanter had the greatest probability of reduced BMD (46.2% [72/156] in the left, 28.8% [45/156] in the right). In the risk factor analysis, low body mass index (BMI

Background: The increased bone loss after spinal cord injury (SCI) is associated with an increase in the morbidity and mortality of fragility fractures, which can constitute a substantial cost to health care systems. Bisphosphonates (BPs) are now the principal class of medications used for osteoporosis. Objective: To demonstrate the effect of BPs on treating osteoporosis after SCI. Methods: A comprehensive search in PubMed, EMBASE, Web of Science and Cochrane Central databases was undertaken for randomized controlled trials (RCTs), exploring the effect of BPs on osteoporosis after SCI. The primary outcome measures were the BMD of different locations, serum bone turnover marker levels, serum biochemistry marker levels and adverse effect (AE) risks. The final search was performed in September 2019. Reporting was carried out according to PRISMA Guidelines. Results: Six RCTs were included. A total of 147 patients met the inclusion criteria. BPs were found to statistically prevent bone loss in the total hip, femoral neck and trochanter at the 6- and 12-month follow-up points and to increase the BMD of the lumbar spine at the 12-month follow-up time point. BPs had no clear effect on serum PINP or serum calcium levels at the 12-month follow-up time point. Conclusion: BP therapy may prevent bone loss in the lumbar spine and hip when administered early after SCI and has relatively high safety.

Objective This study was designed to establish bone mineral density (BMD) reference data of proximal femur, research the effect of age, height and weight on BMD of proximal femur, and estimate the prevalence of osteoporosis in a Chinese female population. In addition we compared the results with Lebanese and USA white women reference data. Methods Our study was conducted at one center, including 1578 Chinese women, aged 20–79years. We measured the BMD for proximal femur using dual-energy X-ray absorptiometry, and then established a reference database of proximal femur and set up regression equations of age, height and weight for BMD at proximal femur to research the effects of age, height and weight on BMD. After that, we calculated the standardized BMD and compared them with Lebanese and USA white women reference data. Results The peak BMD occurred in the age range 30–39 years for femoral neck and Ward's triangle, and 40–49 years for trochanter in Chinese women, which were later than in Lebanese and USA white women. The BMD of proximal femur in Chinese women were lower than Lebanese and USA white women in most age ranges. Weight profoundly influenced BMD in all age groups, and age and height mainly effected BMD in older age groups. The standardized prevalence of osteoporosis among Chinese women of 50–79 years old was 9.6% in femoral neck, which was higher than Lebanese but lower than USA white women. Conclusion The BMD database of proximal femur in Chinese women we established is normative and different from Lebanese and USA white women reference data, which provides more reliable information on the prevalence of osteoporosis in China.

Resumo Objetivo Avaliar, por meio de ensaio biomecânico, a carga máxima, a energia, e o deslocamento necessários para a ocorrência de fratura em modelos sintéticos de fêmures após a retirada de parafusos acanulados e a realização de técnica de reforço com polimetilmetacrilato (PMMA) em diferentes posições combinadas. Métodos Foram utilizados 25 ossos sintéticos divididos em 4 grupos: o grupo controle (GC), com 10 modelos sem perfuração, e os grupos teste (A, B e C), com 5 modelos cada. Os grupos de teste foram fixados com parafusos acanulados pela técnica de Asnis, e tiveram a síntese removida e o preenchimento de dois dos orifícios formados por técnica de reforço com PMMA. A análise biomecânica foi realizada simulando queda sobre o grande trocânter utilizando máquina servo-hidráulica. Resultados Todos os corpos de prova do GC e dos grupos A, B e C apresentaram fratura baso-cervical do colo femoral, exceto um modelo do grupo B, que apresentou fratura longitudinal. Foi utilizada uma média de 5,4 mL de PMMA no reforço dos grupos com preenchimento. Segundo a análise de variância (analysis of variance, ANOVA) e o teste de comparações múltiplas de Tukey, no nível de 5%, observou-se que o GC apresentou diferença significativa em relação aos grupos A e C nos seguintes parâmetros: carga máxima, energia até a fratura, e deslocamento. Conclusão Observou-se que os grupos A e C, quando comparados ao GC, apresentaram diferenças significativas na observação do deslocamento, da carga máxima, e da energia até a fratura.

The most common treatment for slipped capital femoral epiphysis worldwide is in situ fixation with a threaded screw. Un-threaded screws are designed to prevent slip progression without hindering residual growth of the proximal femur. This study aimed to compare growth, remodelling and long-term outcomes after fixation with un-threaded screws and a matched cohort of patients treated with a standard screw. Six patients (nine hips) treated with un-threaded screws and 16 patients (21 hips) treated with standard screws matched for age, skeletal maturity, sex and Southwick angle were recruited. Clinical records were reviewed for patient demographics, medical history and complications. Radiographs were reviewed for residual growth and time to physeal closure. Growth velocity was calculated. Absence of cam deformity signified complete remodelling. Clinical assessment was graded from excellent to poor and patient-reported outcomes were recorded. There was significantly more growth recorded in the un-threaded screw group in femoral neck length (7.6 mm, P = 0.003), articulo-lesser trochanter distance (5.3 mm, P = 0.028), pin-joint ratio (7.439%, P = 0.006) and pin-physis ratio (8.244%, P = 0.001). The probability of revision operations due to ongoing growth was higher in this group (risk ratio: 6.57, P = 0.0008). Time to physeal closure was not significantly different, but growth velocity was significantly higher in the un-threaded group. The lower probability of cam deformity was not significant. Functional and clinical results were not significantly different at average 11.2 years' follow-up. Un-threaded screws allow for significantly more growth than standard threaded screws. The un-threaded screw could not be recommended due to the higher re-operation rates, without any proven benefit.

Although bariatric surgery is associated with multiple health benefits, decreased bone mass is a known complication of the procedure. Roux-en-Y gastric bypass (RYGB) is associated with significant bone loss and increased fracture risk. However, data on the effect of sleeve gastrectomy (SG) on bone mineral changes are sparse. The impact of vitamin D and calcium levels on bone mineral density (BMD) after SG is also unknown. A retrospective chart review was performed to include patients who underwent RYGB or SG from 2014 to 2016 at a single institution. Patients were included if bone densitometry was performed preoperatively and within 2 years postoperatively. Serum 25-hydroxy vitamin D and calcium levels were collected preoperatively and at time of bone densitometry scan. BMD and T-score changes at the femoral neck, femoral trochanter, total hip, and lumbar spine were compared between RYGB and SG patients. A total of 40 patients were included. 24 (60%) of patients underwent RYGB and 16 (40%) patients underwent SG. No statistically significant difference in baseline characteristics was noted between RYGB and SG patients. All measurements, except for serum 25-hydroxy vitamin D, were significantly decreased in RYGB patients, postoperatively. All measurements, except for BMD and T-score at the lumbar spine and serum 25-hydroxy vitamin D, were significantly decreased in SG patients, postoperatively. The extent of decrease in serum 25-hydroxyvitamin D was significantly associated with decreased BMD (p = 0.049) and T-score (p = 0.032) at the lumbar spine. The extent of decrease in serum calcium was significantly associated with decreased BMD (p = 0.046) at the femoral neck. All patients were found to have decreased BMD after RYGB and SG. Surgery type was not a significant risk factor in BMD change. Despite vitamin D and calcium supplementation in all patients, a decrease in vitamin D and calcium levels were associated with a decrease in BMD. Close follow-up and treatment of vitamin D and calcium levels are warranted in all bariatric patients.

Trochanteric osteotomy is a technique that allows expanded exposure and access to the femoral canal and acetabulum for a number of indications. There has been renewed interest in variants of this technique, including the trochanteric slide osteotomy (TSO), extended trochanter osteotomy (ETO), and the transfemoral approach, for both septic and aseptic revision total hip arthroplasty (THA). Osteotomy fixation is crucial for achieving union, and wire and cable-plate systems are the most common techniques. TSO involves the creation of a greater trochanter fragment with preserved abductor attachment proximally and vastus lateralis attachment distally. This technique may be particularly useful in the setting of abductor deficiency or when augmented acetabular exposure is needed. ETO is a posterior-laterally based extensile approach that has been successfully utilized for aseptic and septic indications; most series report a greater than 90% rate of union. The transfemoral approach, as known as the Wagner osteotomy, is an extensile femoral approach and is more anterior-based than the alternate posterior-based ETO. It may be particularly useful for anterior-based approaches and anterior femoral remodelling; rates of union after this approach in most reports have been close to 100%.Cite this article: EFORT Open Rev 2020;5:477-485. DOI: 10.1302/2058-5241.5.190063

Introduction: Sclerostin is an anti-anabolic protein synthesized by osteocytes that may cause osteoporosis by inhibiting bone formation. The aim of our study was to investigate the correlation between sclerostin and bone mineral density (BMD) reduction in renal transplant recipients (RTRs) with more than 1 year after transplantation. Material and methods: This cross-sectional study was conducted on 80 patients (38 (47.5%) male/42 (52.5%) female) RTRs with a mean age of 44.68 ± 10.39 years. Patients were compared with an age and sex-matched control group of 40 healthy individuals. BMD was measured by dual-energy X-ray absorptiometry. The levels of sclerostin were determined using enzyme-linked immunosorbent assay. Results: The mean sclerostin was 3.77 ± 0.3 pg/mL in patients and 3.81 ± 0.21 pg/mL in healthy individuals. The mean T score of femoral trochanter (FT) (FT-T), femoral neck (FN) (FN-T), lumbar vertebrae (L1-4) (L1-4-T) were −0.81 ± 0.86, −1.08 ± 1.09 and −0.8 ± 1.2, respectively. The mean Z score of FT (FT-Z), FN (FN-Z), L1-4 (L1-4-Z) were −0.6 ± 0.73, −0.32 ± 0.9 and −0.54 ± 1.13, respectively. FT-Z and L1-4-Z were lower in patients than healthy subjects (p = 0.009, p = 0.021 respectively). Serum creatinine (p 3.84 pg/mL had higher FT-T (p = 0.040), FT-Z, FN-T (p = 0.018), FN-Z (p = 0.006) than those with a log10 sclerostin of ≤3.84 pg/mL. There was a significant correlation between log10 sclerostin and FN-T (r = −0.296, p = 0.009) and FN-Z (r = −0.269, p = 0.019). In linear regression analysis, high sclerostin was found to be correlated with male gender, lower FN-T and lower FN-Z independently of other risk factors. Conclusion: The levels of sclerostin can predict reduction of proximal femur BMD and development of mineral and bone disorder in RTRs. There was no difference in sclerostin levels between RTRs and healthy individuals. Resumen: Introducción: La esclerostina es una proteína con efecto antianabólico sintetizada por los osteocitos que puede causar osteoporosis al inhibir la formación de hueso. El objetivo de nuestro estudio fue investigar la correlación entre la esclerostina y la reducción de la densidad mineral ósea (DMO) en receptores de trasplante renal (RTR) más de un año después del trasplante. Materiales y métodos: Este estudio transversal se realizó en 80 pacientes (38 [47,5%] varones/42 [52,5%] mujeres) RTR con una edad media de 44,68 ± 10,39 años. Se comparó a los pacientes con un grupo de comparación emparejado por edad y sexo de 40 individuos sanos. La DMO se midió mediante absorciometría de rayos X de doble energía. Los niveles de esclerostina se determinaron utilizando un enzimoinmunoanálisis de adsorción. Resultados: El nivel medio de esclerostina fue de 3,77 ± 0,3 pg/ml en pacientes y 3,81 ± 0,21 pg/ml en individuos sanos. La puntuación T media del trocánter femoral (TF) (T-TF), del cuello femoral (CF) (T-CF), las vértebras lumbares (L1-4) (T-L1-4) fue de −0,81 ± 0,86, −1,08 ± 1,09 y −0,8 ± 1,2, respectivamente. La puntuación Z media del TF (Z-TF), CF (Z-CF), L1-4 (Z-L1-4) fue de –0,6 ± 0,73, −0,32 ± 0,9 y −0,54 ± 1,13, respectivamente. Las puntuaciones Z-TF y Z-L1-4 fueron inferiores en los pacientes que en los sujetos sanos (p = 0,009 y p = 0,021, respectivamente). Los niveles de creatinina sérica (p 3,84 pg/ml tuvieron puntuaciones T-TF (p = 0,040), Z-TF, T-CF (p = 0,018), Z-CF (p = 0,006) superiores a las de los pacientes con un log10 esclerostina ≤3,84 pg/ml. Se observó una correlación significativa entre log10 esclerostina y T-CF (r = −0,296, p = 0,009) y Z-CF (r = −0,269, p = 0,019). En el análisis de regresión lineal, se observó que los niveles elevados de esclerostina estaban correlacionados con el sexo masculino, una puntuación T-CF inferior y una puntuación Z-CF inferior independientemente de otros factores de riesgo. Conclusión: Los niveles de esclerostina pueden predecir la reducción de la DMO del fémur proximal y el desarrollo de un trastorno mineral y óseo en RTR. No se observaron diferencias en los niveles de esclerostina entre los RTR y los individuos sanos.

Background Total hip arthroplasty (THA) involving shortening osteotomy for patients with Crowe type 3 or 4 dysplasia is a challenging surgical procedure. This study aims to demonstrate that rectangular femoral component use in anatomical reconstructions with THA and transverse shortening osteotomy yields successful results without the use of bone graft or any fixation material at the osteotomy site. Methods Fifty hips from 41 patients were identified retrospectively as per study objectives. All patients were evaluated using the Harris Hip Score and Visual Analog Scale for pain. Complications were reported. Radiological evaluation criteria were then evaluated, including leg length discrepancy, degree of trochanter caudalization and stem subsidence, radiolucent and radiodense lines for both components and bone atrophy or hypertrophy around the stem according to Gruen zones, and the canal fill ratio of the stem. Results Postoperative Harris Hip Score was excellent for 68% of patients. No patient had poor results. Complication rate was 32%. One patient had nonunion (2%). The mean postoperative leg length discrepancy was 0.8(±0.6) cm. No patient had a subsidence of more than 5 mm. Radiolucent and radiodense lines were present in up to 34% of patients, and bone atrophy was present in the proximal femur in up to 96% of patients. No patient had osteolysis or loosening in neither component. Conclusion Successful clinical and radiological results can be obtained from Crowe type 3 and 4 dysplastic hips operated on with THA using a rectangular femoral component and transverse shortening osteotomy technique. The use of graft or any fixation material at the osteotomy site is not mandatory.

The aim of this study was to evaluate the relationship between the number of dislocations and anatomical parameters after bipolar hemiarthroplasty (BHA) in femoral neck fracture (FNF) treatment. A total of 240 consecutive patients (157 females, 83 males) with FNFs who were treated with BHA were evaluated retrospectively. Of these 24 patients with dislocations divided into two main groups according to the number of dislocations: Single-dislocation (Group 1, n=15) and multiple-dislocation groups (Group 2, n=9). Surgery-related and anatomical morphologic features as well as patient factors and clinical outcomes were comparatively analyzed between the groups. Pre and postoperative standard anteroposterior (AP) and lateral radiographs were used to evaluate for surgical and anatomical parameters. Harris and Modified Harris Scores were used to evaluate postoperative clinical outcomes. The mean follow-up period was 30.2±11.7 months (range, 12-56 months). Mean age was 80.1±6.4 years (range, 71-98 years). Dislocation incidence was 10.0% (24/240). Mean time to first dislocation was 2.3±1.4 months (range, 1-6 months). Mean number of dislocations was 2.1±1.0 (range, 1-4). There was significant difference in surgical factors and anatomical parameters between groups including nonoperated side offset (ON), nonoperated side femoral offset (FO), residual femoral neck length (RFNL), major trochanter upper end and femoral head center distance (TEFHCD) of nonoperated side, height of hip center (HHC) of operated and nonoperated side, femoral neck-shaft angle (FNSA) of operated side and pelvic obliqity (PO) between the groups (p0.05). Surgery-related and anatomical morphologic features were found to be effective in the number of dislocations (re-dislocation) after BHA. Patients who experienced the first-time dislocation after BHA with anatomical and surgical risk factors should be carefully monitored and more controlled physiotherapy may be recommended in terms of re-dislocation risk. [Med-Science 2020; 9(3.000): 535-40]