Introduction. The proximal femur fracture in children is rare. Furthermore osteoporotic fracture associated with bone tumor make it difficult to decide the proper management method. The treatment plan should include both the treatment of the fracture and management of the condition responsible for the fracture. However, the reported literatures are rare and vary. Hypothesis. We identified the results of treatment associated with pathologic fracture of proximal femur in children. Material and Method. We retrospectively reviewed 56 patients who had fracture associated with benign bone femur between May 25th, 1995 and Jan. 14th, 2012. The patients’ mean age was 11.7(2–20) years old and follow-up duration was 55.3(5–132) months. Results. Fifty-six children with pathologic proximal femur fracture due to benign tumor were treated by various methods. Surgery consisted with combination of curettage, graft and internal fixation. We had 13(23%) complication. 6(11%) of them was related with fracture and 7(12%) of them was related with tumor. In six, malunion and shortening due to varus deformity developed after follow-up. In seven, recurrence was treated by curettage and internal fixation. There is no case of nonunion. Discussion and Conclusion. To manage the osteoporotic fracture of proximal femur in children, a thorough understanding of the risks associated with it is essential for decision making of increasing successful results

Background. Though less common than in females, osteoporosis and osteoporosis-related fractures are not uncommon in males. Our primary objectives were (1) to compare the rates of osteoporosis and osteopenia in adult Brazilian males versus females, 55 years old and over and presenting for bone mineral densitometry (BMD); and (2) to compare males and females as to past osteoporosis screening and management. Methods. From our clinic population, we prospectively surveyed 343 males and 493 females, all at least 55 years of age, who had presented for BMD testing, to identify baseline demographic and clinical characteristics; risk factors for osteoporosis and osteoporotic fractures; overall osteoporosis and 10-year fracture risk; and evidence of prior assessment for and/or management/prevention of osteoporosis. Final osteoporosis risk was determined using the results of BMD testing and the FRAX® tool. Gender comparisons were performed using Pearson 2 analysis for nominal and ordinal variables, Student's t-tests for normally-distributed continuous variables, and Mann-Whitney U tests for non-normally-distributed continuous variables, with all tests 2-tailed and p=0.05 set as the threshold for statistical significance. Binary logistic regression was performed to identify predictors of prior hormonal treatment and BMD. Results. There were no differences in the rates of prior fracture, spinal fracture or long-bone fracture between the sexes, though women were more likely to have osteoporosis of the spine and femur, and had higher estimated risks of future osteoporotic fracture (all p < 0.001). Women also were significantly more likely to have received treatment for their osteoporosis (7.9 vs. 3.1%, p=0.004) and to have had prior BMD testing (80.7 vs. 16.2%, p < 0.001). Ten-year probabilities of hip fracture were 4.8% in males and 5.2% in females; and for a major osteoporotic fracture 5.6% and 24.3%., respectively (both p < 0.001). Age, gender and spinal osteoporosis predicted prior hormonal treatment; but gender was the only predictor of prior BMD, with males 95% less likely to have undergone prior testing than females. Conclusions. Despite similar past fracture rates, and lower but still appreciable future fracture risk, far fewer males than females had received prior screening or management of their osteoporosis

Introduction. In elderly patients, the incidence of a second fracture in the contralateral hip within 2 years of a femoral neck fracture (FNF), ranges from 7 to 12%. Hypothesis. We want to evaluate the safety and efficacy of the Prevention Nail System (PNS), a titanium screw with a hydroxyapatite-coated thread, developed to prevent contralateral FNFs in severe osteoporotic patients. Materials and methods. From September 2008 to May 2012, 80 osteoporotic FNF patients (Tscore<;−2.5) were recruited. Patients received standard care for the fractured hip and were randomized to receive either the PNS (Group A), or nothing (Group B) in the contralateral hip. DXA, CT and X-rays of the reinforced hip were scheduled at 3, 12 and 24 months postoperative. Results. Average follow-up was 26 months. Twenty-one patients reported secondary falls. Group A: 13 patients with 9 osteoporotic fractures (3 contralateral subtrochanteric); Group B: 6 patients with a second osteoporotic fracture (3 contralateral FNF). CT scans showed no radiolucencies or PNS loosenings. Discussion and Conclusion. In Group A the hip fractures had a spiroid rime beginning from the lateral cortical entry hole; FNFs were fixed with the PNS plate. The secondary fracture occurred, in Group A patients, within a month of hospital discharge; this could be due to the implantation device drill which is wider than the body of the screw. PNS is well tolerated but subtrochanteric fractures may occur in case of difficult insertion of the device

The augmentation of fixation with bone cement is increasingly being used in the treatment of severe osteoporotic fractures. We investigated the influence of bone quality on the mechanics of augmentation of plate fixation in a distal femoral fracture model (AO 33 A3 type). Eight osteoporotic and eight non-osteoporotic femoral models were randomly assigned to either an augmented or a non-augmented group. Fixation was performed using a locking compression plate. In the augmented group additionally 1 ml of bone cement was injected into the screw hole before insertion of the screw. Biomechanical testing was performed in axial sinusoidal loading. Augmentation significantly reduced the cut-out distance in the osteoporotic models by about 67% (non-augmented mean 0.30 mm (. sd. 0.08) vs augmented 0.13 mm (. sd. 0.06); p = 0.017). There was no statistical reduction in this distance following augmentation in the non-osteoporotic models (non-augmented mean 0.15 mm (. sd. 0.02) vs augmented 0.15 mm (. sd. 0.07); p = 0.915). In the osteoporotic models, augmentation significantly increased stability (p = 0.017). Cite this article: Bone Joint J 2013;95-B:1406–9

We investigated a new intramedullary locking nail that allows the distal interlocking screws to be locked to the nail. We compared fixation using this new implant with fixation using either a conventional nail or a locking plate in a laboratory simulation of an osteoporotic fracture of the distal femur. A total of 15 human cadaver femora were used to simulate an AO 33-A3 fracture pattern. Paired specimens compared fixation using either a locking or non-locking retrograde nail, and using either a locking retrograde nail or a locking plate. The constructs underwent cyclical loading to simulate single-leg stance up to 125 000 cycles. Axial and torsional stiffness and displacement, cycles to failure and modes of failure were recorded for each specimen. When compared with locking plate constructs, locking nail constructs had significantly longer mean fatigue life (75 800 cycles (. sd. 33 900) vs 12 800 cycles (. sd. 6100); p = 0.007) and mean axial stiffness (220 N/mm (. sd. 80) vs 70 N/mm (. sd. 18); p = 0.005), but lower mean torsional stiffness (2.5 Nm/° (. sd. 0.9) vs 5.1 Nm/° (. sd. 1.5); p = 0.008). In addition, in the nail group the mode of failure was either cut-out of the distal screws or breakage of nails, and in the locking plate group breakage of the plate was always the mode of failure. Locking nail constructs had significantly longer mean fatigue life than non-locking nail constructs (78 900 cycles (. sd. 25 600) vs 52 400 cycles (. sd. 22 500); p = 0.04). The new locking retrograde femoral nail showed better stiffness and fatigue life than locking plates, and superior fatigue life to non-locking nails, which may be advantageous in elderly patients. Cite this article: Bone Joint J 2014;96-B:114–21

Our aim in this pilot study was to evaluate the fixation of, the bone remodelling around, and the clinical outcome after surgery of a new, uncemented, fully hydroxyapatite-coated, collared and tapered femoral component, designed specifically for elderly patients with a fracture of the femoral neck. We enrolled 50 patients, of at least 70 years of age, with an acute displaced fracture of the femoral neck in this prospective single-series study. They received a total hip replacement using the new component and were followed up regularly for two years. Fixation was evaluated by radiostereometric analysis and bone remodelling by dual-energy x-ray absorptiometry. Hip function and the health-related quality of life were assessed using the Harris hip score and the EuroQol-5D. Up to six weeks post-operatively there was a mean subsidence of 0.2 mm (−2.1 to +0.5) and a retroversion of a mean of 1.2° (−8.2° to +1.5°). No component migrated after three months. The patients had a continuous loss of peri-prosthetic bone which amounted to a mean of 16% (−49% to +10%) at two years. The mean Harris hip score was 82 (51 to 100) after two years. The two-year results from this pilot study indicate that this new, uncemented femoral component can be used for elderly patients with osteoporotic fractures of the femoral neck

Introduction. Locking plates have been especially useful in the treatment of osteoporotic fractures. This study aimed to investigate the role of locking plate in femoral fractures in patients with osteogenesis imperfecta. Material & Methods. 6 male patients with osteogenesis imperfecta were operated for femoral fractures using locking compression plate. Their age ranged between 4 and 14 years. They were kept non weight bearing till the fracture united. Results. 5 patients out of 6 patients had refracture, as soon as they started walking. All 5 patients were reoperated using intramedullary titanium elastic nails. All of them united later on and were walking full weight bearing at the end of one year. Conclusion. Our study indicates that locking plates should not be used in the treatment of fractures in patients with osteogenesis imperfecta

Introduction. Femur neck fractures (NOF) in the young could result in mal-union, non-union and avascular necrosis of the femoral head. Osteosynthesis is the standard of management in NOFs in young patient above complications sometimes end in Arthroplasty. The aim of our study is to identify predictors of NOF failures in the young population. Method. A retrospective study conducted in a single center. Patients with NOF fractures below the age of <50y excluding pathological and osteoporotic fractures were assessed in the period from 2005–2008. The mean follow-up was 22 months (6–40). Fractures were classified according to Gardens classification. Our Aim was to identify causative factors for fixation failures. Analysis was done using SPSS 17.0. Results. Within the 4 year period we identified 41 NOF fractures, 24 (75%) fractures were displaced. 7 (25%) out of the displaced fractures went in to failure and required arthroplasty. 3 (42%) went in to avascular necrosis and 2(28.5%) went in to screw cut out and non unions. All failures were primarily fixed with cancellous screws. We identified Male sex (p=0.03), Pre-operative delay of >25h (p=0.04), Chronic alcohol intake (p=0.02) and intra operative time >107min (p=0.001) as the main predictors of NOF failures in the young. Conclusion. Early surgical intervention within 25h, restricting the operation time to less than 107min would reduce the failure rates. We would recommend arthroplasty for patients who are chronic alcoholics

Patients most at risk of osteoporosis are post-menopausal women. However, for many such women, presentation of osteoporosis is only made following their first fragility fracture. Often in the UK, osteoporosis investigation occurs following discharge, and any subsequent secondary prevention starts in the community. This may result in patients with osteoporosis not being investigated or not receiving correct prophylactic treatment. 143 post-menopausal women (av. age 77.7 years) starting secondary osteoporosis prophylaxis following fragility fractures requiring operative intervention were included in this retrospective study. Osteoporosis was defined by DEXA scan using the WHO criteria (122 hip fractures and 21 wrist fractures), following the UK's national guidelines for osteoporosis prophylaxis. Treatment was started following discussion and explanation of treatment with each patient, and either commenced by the surgical team during the acute hospital admission with the fracture, or in an out-patient setting within 6 weeks of the fracture by an orthopaedic specialist nurse. To check compliance, either the patient themselves or the patients' family physician was contacted. Results showed that 120 of the women (83.9%, 102 hip fractures, and 18 wrist fractures) were still compliant with secondary osteoporosis prophylaxis at an average follow-up of 200 days (5 hip fractures lost to follow-up, 0 wrist fractures). 12 women with hip fractures died (0 wrist fractures), and 6 women stopped taking their prophylaxis (3 hip fractures, 3 wrist fractures): 4 for medical reasons, and 2 for unknown reasons. No women sustained further fractures. Few studies have previously investigated compliance of osteoporosis secondary prevention, and our results compare favorably. We therefore recommend the prompt commencement of secondary prevention treatment by the orthopaedic surgical team following osteoporotic fractures

Introduction. Several clinical and radiological studies have confirmed the benefits of using Volar Locking Plates (VLPs) to treat unstable distal radius fractures. The “theoretical” advantage of VLPs compared to standard plate fixation is that VLPs, through their design, intrinsically provide angular stability for most fracture configurations including comminuted fractures and, quite possibly, osteoporotic fractures. However few studies have compared the clinical results of patients of different ages who have been treated using VLPs. Aim. The aim of this study was to compare the clinical outcomes of VLP fixation of displaced distal radius in younger (<59 yrs) and older (>60yrs) patients. Patients & Methods. We reviewed 78 consecutive patients who had undergone ORIF of their displaced distal radial fractures using a VLP. All patients were reviewed at predetermined time points by an independent observer and the findings at 6 months are presented. In addition to documenting the standard demographics for each patient and classifying the fractures using the OTA/AO system, wrist function was assessed using Range of Movement (ROM), Grip strength (GS), the Modified Gartland & Werley score (MGWS), the Patient Rated Wrist Evaluation (PRWE), the Quick DASH scores, and overall scores of wrist Pain and Function using Visual Analogue Scores (VAS). Results. 43 patients were under 60 years of age and 35 patients were 60 years or over. The proportion of extra-articular to intra-articular fractures were similar for both age groups. There was little difference in terms of patient perception of Pain and Function, or ROM, MGWS (7.2 versus 6.9), PRWE (24 versus 23.6) and quick DASH scores (17.3 versus 19.1) between the two groups at 6 months. The younger group did have significantly better grip strength, but when compared as a percentage of the uninjured wrist, the results were also similar (83% vs 80%). Conclusions. VLPs are a suitable option for fixing distal radial fractures in older patients (>60yrs) and the clinical results appear to be just as good as they are in younger patients

BACKGROUND CONTEXT. Osteoporosis causes decreased bone mineral density, which predisposes to fragility fractures. Low-energy vertebral compression fractures are the most common type of osteoporotic fragility fracture. Prior studies have shown that only one-quarter of patients diagnosed with an osteoporotic fracture are referred or treated for osteoporosis. PURPOSE. To identify the rate of recurrent fractures after vertebroplasty and after the conservative treatment for patients aged 50 years and older who sustained low impact vertebral compressions fractures over a 6-month period. STUDY DESIGNED/SETTING. Prospective study. PATIENT SAMPLE. The sample included patients 50 years or older who had a low-energy vertebral compression fracture. The patients were divided into two groups: first group (n=24) - patients teated by vertebroplasty and the second group (n=34) - patients treated conservatory. There was no significant difference among the groups in terms of the vertebral levels or BMD. METHODS. Patients records were reviewed for fracture recurrence and in the same time we examined medical records for osteoporotic medication prescriptions, refferals to endocrinology and to dual-energy X-ray absorptiometry (DEXA) scans. RESULTS. Confounding factors of age at the procedure, sex and chronic steroids use were considered and found to have no statistically significant difference between the two groups and between those with fracture recurrence and those without fracture recurrence. Four vertebroplasty procedure resulted in a recurrent fracture within the first 6 months. In the patient group treated conservatory 8 patients sustained recurrent fractures. Patients with recurrent vertebral fracture didn't receive active osteoporosis treatment. Within 6 months after the fracture only 21% of patients were receiving active osteoporosis treatment. CONCLUSIONS. The incidence of recurrent fracture after vertebroplasty or after conservative treatment is substantial but have no statistically significant difference between the two groups. We consider that the recurrence rate is not related with the surgical intervention but is the result of natural history of the patient's osteoporosis because the patients do not understand the importance of initiating active therapeutic intervention for osteoporosis recommended by physicians

Introduction. The most common treatment options for fixation of osteoporotic distal femur fractures are retrograde nails and locking plates. There are proponents of more elastic titanium plates as well as more rigid steel plates; No clear superiority of one over the other has been established. We aimed to evaluate the mechanical differences between stainless steel and titanium locking plates in the fixation of distal femur fractures in osteoporotic bone. We hypothesized that due to its higher elasticity titanium locking plates can absorb more energy and are therefore less likely to “cut” into the bone compared to stainless steel locking plates resulting in improved metaphyseal osteoporotic fracture fixation. Methods. We used eight matched pairs of osteoporotic fresh-frozen human cadaveric femurs (age >70 years, all female). Within each pair we randomized one femur to be fitted with a Less Invasive Stabilization System (LISS-Titanium locking plate) and one with a Distal Locking Condylar Plate (DLCP-Stainless steel locking plate). A fracture model simulating an AO 33-A3 fracture was created (extraarticular comminuted fracture) and specimens were subsequently subjected to step-wise cyclic axial loading to failure. We used an advanced three dimensional tracking system (Polhemus Fastrak) to monitor the movement of the distal fragment relative to the real time distal plate position allowing us to evaluate distal implant cut-out. Results. During cyclic testing, seven of the eight pairs of matched femurs, the DLCP failed before the LISS plate (p=0.03). All constructs were able to withstand cyclical loading up to 800N. The overall plastic deformation as measured by the displacement of the Instron crosshead experienced by the titanium plate constructs was significantly lower compared to the stainless steel plate construct: The plastic deformation of the LISS plates was 39% lower compared to the Locking Condylar plates after cycle testing at 400 Newtons and 70% lower at 800N. Furthermore during the 800N cycle testing the LISS plating system showed a significantly lower rate of plastic deformation not only for the entire bone-implant construct, but also between the plate and the distal fragment than the locking condylar plate (=less distal implant cut-out). Conclusions. The use of a more advanced three dimensional tracking system, fresh-frozen osteoporotic matched human specimen and the ability to test all constructs to failure allowed us a more thorough comparison of titanium versus stainless steel implants compared to previous studies. The titanium locking plates provided an overall superior fixation of osteoporotic distal femur fractures with less distal implant cut-out, a better elastic recoil, and a slower rate of residual plastic deformation

BACKGROUND. As life expectancy in the population rises, osteoporotic fractures are seen most frequently in the vertebral column. Percutaneous kyphoplasty is increasingly used for pain reduction and stabilization in these patients, but the efficacy, cost-effectiveness, and safety of the procedure remain uncertain. OBJECTIVE. To clarify whether kyphoplasty has additional value compared with optimum pain treatment in patients with acute vertebral fractures. MATERIALS & METHODS. From January 2004 to June 2009, 122 patients (31 males and 91 females), from 56 to 85 years old (mean age 68.5) were treated for 165 osteoporotic vertebral fractures of the thoracic or lumbar spine (minimum 15% height loss; level of fracture at Th5 or lower; bone oedema on MRI), with back pain for 6 weeks or less, and a visual analogue scale (VAS) score of 5 or more. Twelve patients (15 fractures) were lost at follow-up period and excluded. Patients were randomly allocated to percutaneous kyphoplasty (75 patients) or conservative treatment by computer-generated randomization codes. All fractures were analyzed for improvement in sagittal alignment (Cobb angle, kyphotic angle, sagittal index, vertebral height); and pain relief at 1, 6, 12, 24 months, as measured by VAS score. RESULTS. Percutaneous kyphoplasty resulted in direct and greater pain relief than did conservative treatment; difference in mean VAS score between baseline and 1 month was −6,5 after kyphoplasty and −2.4 after conservative treatment, and between baseline and 1 year was −7.2 after kyphoplasty and −3.8 after conservative treatment. No serious complications or adverse events were reported. Apart from the pain, the patient's ability to ambulate independently and without difficulty, and the need for medications improved significantly (P < 0.001) after kyphoplasty. Vertebral height significantly increased at all postoperative intervals, with 10% height increases in 88% of fractures, in kyphoplasty group at 2 years. There were no severe kyphoplasty-related complications, such as neurological defects, cement leakage or narrowing of the spinal canal whereas additional fractures occurred at the adjacent vertebrae at a rate of 10%. 35% of patients treated conservatively, had limitations in everyday activities the first 6 months, whereas additional fractures occurred at the adjacent vertebrae at a rate of 14%. CONCLUSION. In patients with acute osteoporotic vertebral compression fractures and persistent pain, balloon kyphoplasty is effective and safe. Pain relief after kyphoplasty is immediate, is sustained for at least 2 years, and is significantly greater than that achieved with conservative treatment, at an acceptable cost

Introduction. The calcium-PTH-vitamin D-axis has long been highlighted for its effects on bone status and much interest has been given to how this relates to the risk of sustaining an osteoporotic fracture. Little attention has on the other hand been given to how disturbances in this axis, as for example secondary hyperparathyroidism (SHPT), relate to mortality among hip fracture patients. We therefore wanted to determine if SHPT could predict mortality in this group of patients. Methods. The study included 562 hip fracture patients (HF) (age 70 years) admitted to a Danish university hospital. Each hip fracture patient was exactly matched according to age and sex with two controls randomly chosen from a control population of approximately 248000 subjects. The control group (Con) (n=1124) consists of subjects who have had PTH, total calcium (Ca) and 25OH-vitamin D (VitD) measured at the General Practitioners Laboratory of Copenhagen after referral from their general practitioner. Of the HF's 462 had a Ca measurement, 440 had a PTH measurement and 439 had a VitD measurement. Basic characteristics (values for age, Ca, PTH and VitD are mean (SD)): Sex (females/males) (%): 73.8/26.2. Age (years): 82.9 (5.7). Ca (mmol/l): Con 2.34 (0.13), HF 2.27 (0.13), p<0.0001 (chi-square). PTH (pmol/l): Con 6.4 (5.8), HF 6.6 (5.4), p=0.4 (chi-square). VitD (nmol/l): Con 53.3 (30.1), HF 49.3 (29.6), p=0.02 (chi-square). Results. General 1-year mortality (dead/total): Con-female 9.2% (76/830), Con-male 17.7% (52/294), HF-female 24.6% (102/415), HF-male 33.3% (49/147), p<0.0001 (log rank). Prevalence of SHPT defined by PTH>7.1 pmol/l and VitD<50 nmol/l: Con 18%, HF 20%, p=0.2 (chi-square). SHPT and related 1-year mortality (dead/total): Con-nonSHPT 9.7% (89/922), Con-SHPT 19.3% (39/202), HF-nonSHPT 22.7% (78/343), HF-SHPT 34.9% (30/86), p<0.0001 (log rank). Discussion. Our study clearly shows that SHPT is a significant predictor of mortality in both hip fracture patients and the control group as mortality is significantly higher among subjects suffering from SHPT. The effect of SHPT on mortality appears early on among the hip fracture patients after which the mortality parallels the other groups. In accordance with the literature, we found that the general 1-year mortality among hip fracture patients is significantly increased compared to an age- and sex-matched control group. The fact that the prevalence of SHPT is not significantly higher among the hip fracture patients than in the control group in our study is a bit surprising but might be due to a higher degree of awareness of vitamin D deficiency among elderly patients at risk of hip fractures and a higher level of vitamin D supplementation in this group

Aims

To compare operative and nonoperative treatment for displaced distal radius fractures in patients aged over 65 years.

Aims

Complex displaced osteoporotic acetabular fractures in the elderly are associated with high levels of morbidity and mortality. Surgical options include either open reduction and internal fixation alone, or combined with total hip arthroplasty (THA). There remains a cohort of severely comorbid patients who are deemed unfit for extensive surgical reconstruction and are treated conservatively. We describe the results of a coned hemipelvis reconstruction and THA inserted via a posterior approach to the hip as the primary treatment for this severely high-risk cohort.

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The aim of this study was to explore whether time to surgery affects functional outcome in displaced proximal humeral fractures

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Bone health assessment and the prescription of medication for secondary fracture prevention have become an integral part of the acute management of patients with hip fracture. However, there is little evidence regarding compliance with prescription guidelines and subsequent adherence to medication in this patient group.

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The aim of this study was to evaluate the clinical and radiological outcomes of locking plate fixation, with and without an associated fibular strut allograft, for the treatment of displaced proximal humeral fractures in elderly osteoporotic patients.

Aims

The aim of this study was to evaluate the outcomes of a salvage procedure using a 95° angled blade plate for failed osteosynthesis of atypical subtrochanteric femoral fractures associated with the long-term use of bisphosphonates. These were compared with those for failed osteosynthesis of subtrochanteric fractures not associated with bisphosphonate treatment.