Introduction: Proton magnetic resonance spectroscopy (¹H MRS) is a powerful non-invasive technique used to identify and quantify chemical compounds. In a recent study, the early histopathologic findings of osteonecrosis showed marrow edema and hemorrhage, and the late findings were fibrous marrow transformation with new bone formation. The purpose of this study was to apply ¹H MRS to the bone marrow of osteonecrosis and bone marrow edema syndrome by measuring the amount of lipid relative to water of the femoral head and greater trochanter.

Materials and Methods: Magnetic Resonance (MR) imaging and MR spectroscopy were performed in twenty-five patients (male: female = 17:8, age = 29–69 years) who were diagnosed with osteonecrosis and bone marrow edema syndrome and compared with three normal control patients. Twenty-three cases were osteonecrosis and two were bone marrow edema syndrome. Ficat stages of osteonecrosis in the femoral heads were 1 patient with stage I, 8 patients with stage II, and 14 patients with stage III disease. Osteonecrosis developed in 14 patients with steroid therapy after kidney transplantation, in 6 alcoholics, and 3 were idiopathic. After routine hip MRI, spectroscopy was obtained from T2 weighted images by the 3-dimensional localization technique. Locations of voxels were the center of the osteonecrotic zone verified by T2-weighted MR images and from the fat marrow in the greater trochanter of femur. The values of the [Lipid/Water] ratios were calculated for all patients.

Results: The average Lipid/Water ratio of the osteonecrotic area was 3.15, those of the greater trochanter was 6.45, compared with 10.28 in the normal control group. The MRS pattern for osteonecrosis could be divided into 4 patterns: A, Lipid/Water > 10 ; B, 3 < Lipid/Water ≤ 10; C, 0.3 ≤ Lipid/Water < 3; and D, Lipid/Water ≤ 0.3. The numbers of cases for each pattern were 1 in A, 6 in B, 10 in C, and 6 in D. Interestingly, in one patient with Ficat stage I osteonecrosis diagnosed by only bone scintigraphy, ¹H MR spectroscopy revealed a much higher lipid/water peak ratio compared to the normal control group. The average Lipid/Water ratio of the bone marrow edema syndrome patients was 0.71.

Discussion: This study revealed the decreasing pattern of lipid content as osteonecrosis progresses, which correlates with histopathologic results. In bone marrow edema syndrome, a reverse pattern to the normal control group was found. Further study is needed for the change of Lipid/Water ratio in early change of osteonecrosis.

Introduction: Nonsteroidal anti-inflammatory drugs (NSAIDs) have been reported to suppress bone repair and remodeling in vivo. Our previous studies showed that NSAIDs inhibited osteoblast proliferation and induced cell death in fetal rat osteoblast cultures. However, the NSAIDs effects on the functions of human osteoblasts remain unclear. Newly developed selective cyclo-oxygenase 2 (COX-2) inhibitors, celecoxib and refecoxib, have been reported to have lower risk of gastrointestinal complications than traditional nonsteroidal anti-inflammatory drugs. A recent report showed that refecoxib decreased bone ingrowth in an animal study. However, the effects of COX-2 selective inhibitors on human osteoblasts have rarely been investigated. In this study, the effects of steroid, non-selective, and selective COX-2 inhibitors on proliferation, cell cycle kinetics, and cytotoxicity in cultured human osteoblasts were examined.

Materials and Methods: Indomethacin,ketorolac,piroxicam, and diclofenac (10⁻⁵ and 10⁻⁴M); dexamethasone (10⁻⁷ and 10⁻⁶M); Celecoxib and DFU, an analogue of rofecoxib, (10⁻⁷–10⁻⁴M) were tested for 24 or 48 hr in human osteoblast cultures.

Results: In this study, we found that a 24 hour treatment of COX-2 selective inhibitors, celecoxib and DFU, significantly inhibited proliferation, arrested cell cycle, and had cytotoxicity in cultured human osteoblasts. However, the inhibitory effect on proliferation could be reversed if these agents were withdrawn for 24 hours. Indomethacin, ketorolac, diclofenac, and piroxicam also significantly inhibited proliferation and arrested cell cycle at the G₀/G₁ phase, but had no cytotoxic effects on human osteoblasts.

Discussion: These results suggest that the COX-2 selective and non-selective NSAIDs may affect osteoblastic functions through different mechanisms.

The conventional treatment of comminuted fractures in the distal radius has been unsatisfactory. We therefore made a prospective study using the principle of ligamentotoxis and primary cancellous bone grafting as the uniform method of treatment. Ligamentotaxis was maintained by using an external fixator for three weeks only, after which a carefully monitored programme of rehabilitation was given. We have reviewed 72 consecutive distal radial fractures after a follow-up of 7 to 40 months (average 11 months). Reduction had been maintained during healing and over 80% of patients regained full range of movement in hands, wrists and forearms with strong and pain-free wrist function. Complications were infrequent and gave no real problems. We conclude that distraction, external fixation and bone grafting appears to be an excellent method of treating comminuted fractures of the distal radius.