Introduction: Reversed oblique subtrochanteric fractures are unstable and pose a surgical challenge. Fixation with Dynamic Hip Screw is prone to collapse with medial displacement and high rate of non or mal union. The use of Proximal Femoral Nails may result in non anatomical reduction which delays union and impedes rehabilitation. PCCP is a percutaneous plate originally designed for fixation of intertrochanteric fractures. However, the plate supports the greater trochanter and can prevent collapse of subtrochanteric fractures and rigidly secure the femoral neck. This study summarized our experience in fixating reversed oblique subtrochanteric fracture with the PCCP technique.

Patients and Methods: Between January 2005 and March 2006 26 patients who sustained reversed oblique subtrochanteric fractures (AO-31A3) were consecutively treated with PCCP. Two patients died and were excluded from this study. Patients’ age ranged between 58 and 93 (average 86, median 80). Follow-up was between 6 to 20 months (average 12). All patients were operated on a standard fracture table with the use of posterior reduction device. An attempt to reduce the fracture was done in each case prior to the surgical incision. In the majority of cases the shaft was displaced medially to the greater trochanter. The PCCP plate was introduced percutaneously and the medially displaced shaft was pulled to the plate using the reduction clamp. The rest of the procedure was done according to the regular technique of the PCCP. All patients were instructed to refrain from weight bearing for six weeks after the surgery and then resume full weigh bearing. Follow-up was in the out patient clinic 6 weeks, 3 months and one year after the surgery.

Results: Time of surgery varied between 35 to 75 minutes. There were no patients who were planned to undergo this procedure and were diverted to a different modality of fixation. All the procedures were done percutaneously. Anatomic or near anatomic reduction was achieved in all cases. All patients resumed full weigh bearing six weeks after the surgery. All but one fracture united. The patient whose fracture did not unite was blind and fell a few times during rehabilitation and eventually suffered from pull-out of the plate from the femur with breakage of the shaft screws. She underwent revision surgery with bone graft and the fracture united. Follow-up radiograms showed that the reduction was maintained in all but three patients. Medial displacement of 8–15 mm occurred in 3 patients. There were no infections.

Conclusions: While there is an ongoing debate among “nailers” vs. “platers” for the fixation of femoral neck fractures, PCCP combines the theoretical advantages of both percutaneous technique and absolute stability. In this study this biological system was found to be a reliable solution for the challenging fixation of reversed oblique (AO-31A3) subtrochanteric fractures, with high union rate, fast recovery and low complication rate.

Introduction: When subjected to strain or strain rates are higher than usual, the bone remodels to repair microdamage and to strengthen itself. During the initial resorption phase of remodeling, the bone is transitorily weakened and microdamage can accumulate leading to stress fracture.

Methods: To determine whether short –term suppression of bone turnover using bisphosphonates can prevent the initial loss of bone during the remodeling response to high bone strain and strain rates and potentially prevent stress fractures, we conducted a randomized, double blind, placebo-controlled trial of 324 new infantry recruits known to be at high risk for stress fracture. Recruits were given a loading dose of 30 mg of residronate or placebo daily for 10 doses during the first two weeks of basic training and then a once a week maintenance dose for following 12 weeks. Recruits were monitored by biweekly orthopedic examinations during 15 weeks of basic training for stress fractures. Bone scans for suspected tibial and femoral stress fractures and radiographs for suspected metatarsal stress fractures were used to verify stress fracture occurrence.

Results: By the intension to treat analysis and per protocol analysis, there was no statistically significant difference in the tibial, femoral, metatarsal, or total stress fracture incidence between the treatment group and the placebo.

Discussion: We conclude that prophylactic treatment with residronate in a training population at high risk for stress fracture using a maintenance dosage for the treatment of osteoporosis does not lower stress fracture risk.

Objective: The objective of this study was to compare the influence of different hyperthemic processes (autoclave and microwave oven) on the morphologic and thermodynamic properties of collagen.

Summary and Background Data: The current thinking regarding the treatment of human bone tumors is a radical excision, attempting to preserve the function of the limb. An acceptable method for limb preservation is reimplantation of the affected bone after the debridement of gross tumor tissue and sterilization by means of autoclave. This hyperthermic processing technique provides a perfectly sized graft, but it is associated with a decline in the mechanical and biological properties of the bone. A previous study demonstrated that sterilization using a microwave kills all viable cells with a minimal decrease in the mechanical and biological properties of the bone. Possible explanation of this phenomenon is preservation of matrix protein such as collagen. The current study’s goal was to investigate the effect of different hyperthermic treatments on native collagen.

Materials and Methods: In this study we used Heilistat-absorbable collagen sponge (American biomaterials corporation, Plainsboro, NJ 08536). This collagen was divided into three study groups. The first group was processed in the autoclave, the second in a microwave oven and the third which served as the control group received no thermal treatment. The thermodynamic properties of these three groups were checked by Differential Scanning Calorimetry (DSC) and Thermo-Gravimetric Analysis (TGA). The morphological structure was examined by Scanning Electron Microscope (SEM), Phillips. Accelerating Voltage 30 KV.

Results: Thermodynamic properties: The peak temperature and the amount of energy invested showed similar results in the control group and in the microwave group, and differed from the results of the group treated by autoclave. The graphs of TGA, which represent the weight decrease as a function of heating, were also similar in the microwave group and the control group.

The morphological structure of the collagen, namely, the architectural structure of the material and single fibers, as shown by the SEM in various magnifications (100, 1200, 2500 and 5000), was much more similar when comparing between the control group and the microwave group than in the autoclave processed group.

Conclusion: Hyperthermic treatment using a microwave oven has minimal effect, if any, on the native collagen of bone, causing only minimal damage to the morphological and thermodynamic properties of bone. This observation may explain the biological superiority of the microwave treatment over autoclave treatment of bone.