BACKGROUND:The template method used in cementless total hip arthroplasty is influenced by many factors,so the accuracy is poor.Studies demonstrated that femoral isthmus plays an important role in total hip arthroplasty,which affect femoral prosthesis.OBJECTIVE:To discuss the effects of femoral isthmus on cementless total hip arthroplasty.METHODS:The images of 4 cadaver femoral isthmus were obtained by computer tomography.The relations between femoral component and cortical bone contact were observed on coronal slices by sawing manully.The longest and the smallest medullary canal dimensions and the cortical thickness of femoral isthmus were measured by CT films from 50 patients (55 hips) prepared forprimary total hip arthroplasty.The size of prosthesis was predicted based on the smallest medullary canal dimension of isthmus.And the conventional preoperative template was served as control.RESULTS AND CONCLUSION:There were a press fit and good contact between the femoral component and cortical bone of isthmus in 3 cadaver femoral bones.In 50 patients,the longest medullary canal dimensions of femoral isthmus were 8.2-22.4 mm(mean 14.2±3.1 ram).The smallest medullary canal dimensions of femoral isthmus were 6.1-17.9 mm[mean (10.2±2.9) mm],and the cortical thickness of femoral isthmus were 2.7-12.7 mm[mean (7.5±1.8) mm].The results of CT-isthmus measurement method predicted sizes were excellence in the 50.9% cases.There was statistically significant difference of predicted sizesbetween the excellence rate of CT-isthmus measurement method and the rate of control (P＜0.05).Particularly,the excellence rate of CT-isthmus measurement method was 63.9% in the group aged below or equal to 65 years.When the ratio of the longest medullary canal dimensions and the smallest medullary canal dimensions of femoral isthmus was large than or equal to 1.4,the excellence rate of CT-isthmus measurement method was 70%.The press fit and good contact between the femoral component and femoral isthmus plays a very important role in stabilizing of femoral prosthesis in total hip arthroplasty.The predicted sizes of femoral prosthesis depending on the medullary canal dimensions of femoral isthmus measured by CT film has better accuracy than the conventional preoperative template.

Eleven patients with small or comminuted displaced tibial avulsion fractures of posterior cruciate ligament admitted in the Department of Orthopaedics,Second Affiliated Hospital,Fujian Medical University between January 2003 and January 2008 were selected.With diameter of 4.0 mm,the length of 35 mm or 40 mm cancellous bone screw,and internal diameter of 4.0 mm spiked washer was implanted for fixation.For cases of large comminuted facture,two cancellous bone screws and spiked washer were used.Postoperatively,the limb was immobilizated in a cast plaster at a 30 degrees flexion for 2-4 weeks,followed by active exercise rehabilitation.All 11 patients were followed up with an average of 18 months(ranged 7 to 36 months).No electrolysis,corrosion reaction to metal material,or allergic response to the spiked washer were detected in patients.At 2 months,all patients achieved bony union,no fragment redisplacement,no knee laxity or instability was detected,and the affected knees regained full range of motion.The knee function was significantly improved.

Objective To observe the mortality of fragile hip fractures and evaluate the death-associated risk factors.Methods 100 men and 186 women aged 50 to 97 (mean,77.09± 10.65) years old who had fragile hip fracture over 50 years old from 2010 to 2012 were followed up,and the clinical data were retrospectively analyzed.Three months,one year and the total mortality of following time were calculated.Mortality-related risk factors were evaluated including age,gender,and surgery,duration from injury to operation,pulmonary infection,number and kind of complications.Results The 286 patients were followed up between 6 months and 42 months,with 21.42±9.88 months in average.The three month mortality was 7.69％,the patients who were followed up over one year were 231 cases,the one year mortality was 16.02％,and the total mortality of following time was 17.48％.The mortality was associated with age,gender,surgery,duration from injury to operation,number of complications,pre-injury cardiovascular disease and respiratory system diseases,and pulmonary infection.A Binary Logistic Regression analysis revealed that the independent risk factors affecting the mortality included age (OR=5.385,P=0.003),surgery (OR=21.217,P=0.000),number of complications (OR=9.038,P=0.000),pre-injury cardiovascular disease (OR=3.201,P=0.041).Conclusion The early mortality of fragile hip fractures was high and was associated with many risk factors.Age,surgery,number of complications and pre-injury cardiovascular disease were the independent risk factors affecting the mortality of fragile hip fractures.The positive treatment with complications,early surgery in condition allowed,can lower the early mortality.

Objective To investigate the correlation of incident pneumonia and serum 25-hydroxyvitamin D[25(OH)D] levels in elderly patients with fragility hip fractures.Methods 132 patients with fragility hip fractures were divided into the pneumonia group [n=43,14 males and 29 females,aged 63-97 years,a mean age of (83.8±7.1) years] and the non-pneumonia group [n=89,28 males and 61 females,aged 60-93 years,a mean age of (77.1±8.1) years].Fasting venous blood samples were taken on the second day after admission.Serum 25 (OH)D levels were measured by radioimmunoassay.Results Vitamin D deficiency was found in 90.7％ of the patients in the pneumonia group,52.8％ in the non-pneumonia group (x2=24.953,P＜0.05).The age and smoking rate were higher in the pneumonia group than in the non-pneumonia group (t=4.661,P＜ 0.05;x2 =4.459,P=0.035).Logistic regression analysis showed that serum 25(OH)D levels,age and smoking were independent impact factors for pneumonia.When serum 25(OH)D levels were less than or equal to 20 g/L,the incidence of pneumonia was increased and the risk of pneumonia was 8.66 times higher than that for patients with normal 25 (OH)D levels.Conclusions The risk of pneumonia in patients with brittle hip fractures is correlated with age,smoking and the serum 25-hydroxyvitamin D level,with the latter as a major risk factor.Patients with brittle hip fractures should be supplemented with vitamin D as early as possible in order to reduce the risk of incident of pneumonia.

BACKGROUND:StageIorIIKummel’s diseaseisusualy suggested to be treated with percutaneous vertebroplasty (PVP) orpercutaneous kyphoplasty (PKP). Stage IIIKummel’s diseasewith neurologic deficit is treated with open decompression, cement-augmented combined with internalfixation. However, surgical options for stage IIIKummel’s diseasewithdural saccompression butwithnonervous symptoms arein disputeand rarely reported. OBJECTIVE:To investigatethesurgical options of Kummel’s disease with vertebral posterior walcolapse. METHODS:Fourteen patients with Kummel’s disease with vertebral posterior wal colapse wereenroled as experimental groupandtreated with PVP or PKP based on the degree of postural reduction.Another28 patients with osteoporotic vertebral fracture as control group were treated with PKP. Thenalpatients were folowed up to observe vertebralheight, Cobb angle, visual analog scale and the Oswestry disability index. RESULTS AND CONCLUSION:After folowed up for 10 to 42 months, therestoredvertebralheight, Cobb angle, visual analog scale and Oswestry disability index were significantly improved inthetwo groups (P<0.05). Thepostoperativevertebralheight intheexperimental group was significantly higher than thatinthe control group(P< 0.05).Butno significant differencesin Cobb angle, visual analog scalescoresand Oswestry disability indexwere found between thetwo groups after operation (P> 0.05). These data suggest that based on the degree of postural reduction, individualizedPVP or PKP for Kummel’s disease with vertebral posterior wal colapsecanattain satisfactoryoutcomes.

Objective To study the changes of bone mineral density (BMD) and structural parameters of femoral neck in fragile femoral neckfracture,and to investigate the relationship between the changes and occurrence of fragile fracture of femoral neck.Methods 102 patients were divided into fracture group (n=59) and non-fracture group (n=43).There were 18 males and 41 females [[mean age (74.0±9.3) yrs,ranged 53-88 yrs] in fracture group and 16 males and 27 females [mean age (64.3±9.9)] yrs,ranged 50-82 yrs in non-fracture group.CT scan and BMD in the femoral neck were collected in all patients.The structural parameters of the femoral neck in CT scan were measured with medical image analysis software.Results BMD was lower,cortical thickness of femoral neck (FNCT) was thinner and the ratio (FNCT/FNW) of cortical thickness (FNCT) over femoral neck width (FNW) was lower in fracture group than in non-fracture group (all P＜0.001),but there were no statistically significant differences in femoral neck width (FNW) and femoral medullary cavity width (FMCW) between the two groups (both P＞0.05).The BMD of femoral neck was markedly decreased in the fracture group as compared with the non-fracture group in patients aged 50-64 yrs (P ＜0.05),and there were no statistically significant differences in the changes of the femoral neck BMD between the two groups in patients aged over 65 yrs (P＜0.05).In both of patients aged 50-64 yrs and more than 65 yrs,FNCT was thinner and ratio of FNCT/FNW was lower in the fracture group than in the non-fracture group (both P＜0.05).The patients with osteopenia and osteoporosis had thinner FNCT and lower ratio of FNCT/FNW in the fracture group than in the non-fracture group of the patients with osteopenia and osteoporosis (both P＜ 0.01).Conclusions Lower BMD and thinner cortical thickness of femoral neck are closely related to the fragile fracture of femoral neck.The phase of femoral neck BMD rapid decline is mainly in the age of 50-65 yrs,which is consistent with the risk assessment for fragile fracture in femoral neck.The decrease of cortical thickness of femoral neck on FNCT is the main factor for the decreased femoral neck strength in patients aged over 65 yrs,which is also an important factor for the fragile fracture of femoral neck in the elderly aged over 65 yrs.

BACKGROUND:The prevalence of osteoporosis is high in the patients undergoing total hip arthroplasty. Osteoporosis is associated with the survival of prostheses. Both canal flare index and bone mineral density are aged-related.
OBJECTIVE:To study the cxorrelation between canal flare index of the proximal femur and bone mineral density of femoral neck, and to pay more attention to osteoporosis.
METHODS:A retrospective study of the correlation between canal flare index of the proximal femur on pelvic radiograph and bone mineral density of femoral neck was made in 57 patients undergoing total hip arthroplasty.
RESULTS AND CONCLUSION:The canal flare index were ranged 1.8-4.8 (3.1±0.7) in 57 patients. There were 23 patients in canal flare index<3 (chimney-type medul ary cavity), 33 in canal flare index between 3 and 4.7 (normal-type medul ary cavity), and one in canal flare index>4.7 (funnel-type medul ary cavity). The age had an impact on the type of medul ary cavity. The prevalence of chimney-type medul ary cavity were significantly higher in>60 years old group than≤60 years old group, and bone mineral density of femoral neck in the group of canal flare index≥3 was significantly higher than the group of canal flare index<3. The bone mineral density of femoral neck was gradual y reduced with age, and were significantly higher in≤60 years old group than in>60 years old group [(0.751±0.235) g/cm2, (0.590±0.092) g/cm2, P=0.000]. As bone mineral density reduced, canal flare index was also decreased. Experimental findings indicate that, the bone mineral density of femoral neck is significantly correlated with canal flare index.

Objectives To study the effect of bone mineral density measurement on the diagnosis and treatment of osteoporosis in patients with fragility hip fracture.Methods A retrospective analysis was conducted on 560 cases of elderly patients with fragility hip fracture in our hospital from January 2010 to December 2012.They were divided into two groups with and without the bone mineral density measurement,and compared to study the bone turnover markers detection and osteoporosis treatment.Results Among the 80 cases with the DXA bone mineral density detection,36 cases received the bone turnover markers detection(45.0%),and the rate of osteoporosis treatment in hospital was 70.0%,while the rate of osteoporosis treatment after discharge was 57.5%.Among the 480 cases without DXA bone mineral density detection,none received bone turnover markers detection,and the rate of osteoporosis treatment in hospital was 42.1%,while the rate of osteoporosis treatment after discharge was 36.7%.Conclusions The detection rate of bone mineral density and the diagnosis and treatment rate of osteoporosis are low in patients with fragility hip fracture.DXA bone mineral density measurement is helpful to improve the detection rate of bone turnover markers and the treatment rate of osteoporosis.