1.Regional CT value in prediction of proximal femoral fracture.
Bin CHEN ; Shi-Ping ZOU ; Yue-Hui WANG ; Yu ZHOU ; Wen-Zhong CHEN ; Ai-Guo WANG ; Wen-Teng SI
China Journal of Orthopaedics and Traumatology 2023;36(12):1142-1146
OBJECTIVE:
To investigate CT values of cancellous bone in femoral neck in adults over 60 years with proximal femoral fractures.
METHODS:
From January 2020 to December 2020, a retrospective analysis was performed on 280 subjects aged 60 years or older who underwent bilateral hip CT examination, including 85 males and 195 females, 120 on the left side and 160 on the right side, aged 75 (66, 82) years old. One hundred thirty-six patients with proximal femoral fractures were included in study group and 144 patients without fractures were included in control group. GEOptima CT was used to scan and reconstruct horizontal, coronal and sagittal layers of proximal femur. CT values of cancellous bone in femoral neck were measured and compared between two groups. The relationship between CT values of cancellous bone of femoral neck and proximal femoral fracture was analyzed statistically.
RESULTS:
In terms of age, fracture group aged 79(73.3, 85.0) years old, non-fracture group aged 69.5 (64.0, 78.8) years old, and had significant difference in age between two groups (P<0.05). In terms of CT value, regional CT value in fracture group was 8.62(-3.62, 27.15) HU, which was lower than that in non-fracture group 34.31(-5.93, 71.74) HU(P<0.05). CT value on coronal view in fracture group was -8.48(-30.96, 17.46) HU, which was lower than that in non-fracture group 40.49(5.55, 80.71) HU (P<0.05). CT value on sagittal view in fracture group was -31.28(-54.91, -5.11) HU, which was lower than that in non-fracture group 7.74(-20.12, 44.54) HU (P<0.05). CT values on horizontal view in fracture group was 0.17(-23.13, 24.60) HU, which was lower than that in non-fracture group 46.40(10.42, 85.18) HU(P<0.05). The mean regional CT values among three planes in the fracture group were lower than those in the non-fracture group. Logistic regression analysis showed coronal CT value was influencing factors of proximal femoral fracture, and it could be written into regression equations that predict probability of fracture.
CONCLUSION
In adults aged over 60 years old, CT values of cancellous bone of femoral neck decreased with increasing age. The smaller CT value of cancellous bone of femoral neck, the greater risk of proximal femoral fracture.
Male
;
Adult
;
Female
;
Humans
;
Middle Aged
;
Aged
;
Aged, 80 and over
;
Proximal Femoral Fractures
;
Retrospective Studies
;
Femur Neck
;
Hip Fractures/surgery*
;
Tomography, X-Ray Computed
;
Bone Density
2.Pathologic Femoral Neck Fracture Due to Fanconi Syndrome Induced by Adefovir Dipivoxil Therapy for Hepatitis B.
Yoon Suk LEE ; Byung Kook KIM ; Ho Jae LEE ; Jinmyoung DAN
Clinics in Orthopedic Surgery 2016;8(2):232-236
In Fanconi syndrome, hypophosphatemic osteomalacia is caused by proximal renal tubule dysfunction which leads to impaired reabsorption of amino acids, glucose, urate, and phosphate. We present a rare case of a 43-year-old Korean male who was found to have insufficiency stress fracture of the femoral neck secondary to osteomalacia due to Fanconi syndrome. He had been receiving low-dose adefovir dipivoxil (ADV, 10 mg/day) for the treatment of chronic hepatitis B virus infection for 7 years and he subsequently developed severe hypophosphatemia and proximal renal tubule dysfunction. The incomplete femoral neck fracture was fixed with multiple cannulated screws to prevent further displacement of the initial fracture. After cessation of ADV and correction of hypophosphatemia with oral phosphorus supplementation, the patient's clinical symptoms, such as bone pain, muscle weakness, and laboratory findings improved.
Adult
;
Amino Acids
;
Fanconi Syndrome*
;
Femoral Neck Fractures*
;
Femur Neck*
;
Fractures, Spontaneous
;
Fractures, Stress
;
Glucose
;
Hepatitis B*
;
Hepatitis B, Chronic
;
Hepatitis*
;
Humans
;
Hypophosphatemia
;
Kidney Tubules, Proximal
;
Male
;
Myalgia
;
Osteomalacia
;
Phosphorus
;
Uric Acid
3.Pathologic Femoral Neck Fracture Due to Fanconi Syndrome Induced by Adefovir Dipivoxil Therapy for Hepatitis B.
Yoon Suk LEE ; Byung Kook KIM ; Ho Jae LEE ; Jinmyoung DAN
Clinics in Orthopedic Surgery 2016;8(2):232-236
In Fanconi syndrome, hypophosphatemic osteomalacia is caused by proximal renal tubule dysfunction which leads to impaired reabsorption of amino acids, glucose, urate, and phosphate. We present a rare case of a 43-year-old Korean male who was found to have insufficiency stress fracture of the femoral neck secondary to osteomalacia due to Fanconi syndrome. He had been receiving low-dose adefovir dipivoxil (ADV, 10 mg/day) for the treatment of chronic hepatitis B virus infection for 7 years and he subsequently developed severe hypophosphatemia and proximal renal tubule dysfunction. The incomplete femoral neck fracture was fixed with multiple cannulated screws to prevent further displacement of the initial fracture. After cessation of ADV and correction of hypophosphatemia with oral phosphorus supplementation, the patient's clinical symptoms, such as bone pain, muscle weakness, and laboratory findings improved.
Adult
;
Amino Acids
;
Fanconi Syndrome*
;
Femoral Neck Fractures*
;
Femur Neck*
;
Fractures, Spontaneous
;
Fractures, Stress
;
Glucose
;
Hepatitis B*
;
Hepatitis B, Chronic
;
Hepatitis*
;
Humans
;
Hypophosphatemia
;
Kidney Tubules, Proximal
;
Male
;
Myalgia
;
Osteomalacia
;
Phosphorus
;
Uric Acid
4.Adefovir-induced Fanconi syndrome associated with osteomalacia.
Samel PARK ; Woo Il KIM ; Dai Hyun CHO ; Yeo Joo KIM ; Hong Soo KIM ; Ji Hee KIM ; Seung Kuy CHA ; Kyu Sang PARK ; Ji Hye LEE ; Sang Mi LEE ; Eun Young LEE
Clinical and Molecular Hepatology 2018;24(3):339-344
Fanconi syndrome is a dysfunction of the proximal renal tubules that results in impaired reabsorption and increased urinary loss of phosphate and other solutes. The pathophysiology of drug-induced Fanconi syndrome is unclear. Here we report the case of a 36-year-old woman who presented with pain in multiple bones and proteinuria. She had a 7-year history of taking adefovir at 10 mg/day for chronic hepatitis B. Three years previously she had received surgery for a nontraumatic right femur neck fracture, after which she continued to complain of pain in multiple bones, and proteinuria, glycosuria, and phosphaturia were noted. The findings of a light-microscope examination of a renal biopsy sample were normal, but mitochondrial damage of the proximal tubules was evident in electron microscopy. Western blot analysis revealed that the level of serum fibroblast growth factor 23 (FGF23) was lower than in normal controls. After 2 months of treatment, hypophosphatemia and proximal tubular dysfunction were reversed, and serum FGF23 had normalized. This case suggests that direct mitochondrial damage in proximal tubules can cause drug-induced Fanconi syndrome associated with osteomalacia.
Adult
;
Biopsy
;
Blotting, Western
;
Fanconi Syndrome*
;
Female
;
Femoral Neck Fractures
;
Fibroblast Growth Factors
;
Glycosuria
;
Hepatitis B, Chronic
;
Humans
;
Hypophosphatemia
;
Hypophosphatemia, Familial
;
Kidney Tubules, Proximal
;
Microscopy, Electron
;
Mitochondria
;
Osteomalacia*
;
Proteinuria