Management of osteoporosis in patients with hip fractures

Experimental analysis of the quality of an implant embedded in the bone based on its mechanical parameters

BACKGROUND/OBJECTIVE

We present a description of an experiment in which the parameters describing the quality of the mandrel embedding an implant into a bone were determined. A method was developed that allows, from outside a living organism, the strength of the mandrel of the implant in the bone tissue to be determined. Using the proposed technique, we investigated how the mechanical properties of the bone affect the quality of the implant mandrel embedding in the bone tissue.

MATERIALS AND METHODS

As part of the research work, we conducted 15 compression tests on previously prepared samples that reflected an uncemented endoprosthesis embedding in the proximal base of a femur bone.

RESULTS

The results of the research showed that the load applied is dispersed between the mandrel and the bone tissue. The mechanical stability of the embedding affects the mechanical properties of the bone. The experiment revealed the nature of the mechanical stability of the embedding in relation to the increasing contact surface area.

CONCLUSIONS

We observed a non-linear nature of dependences of bone density as the main parameter describing the properties of bone relative to the extent of loosening expressed in the form of the slip surface of the mandrel relative to the bone. The mechanical stability of the embedding is crucial in the initial phase of the implant healing because it eliminates the loosening of the mandrel embedding. It provides a guarantee that the specific geometry of the treated motion apparatus part will be preserved and lowers the risk of inflammatory conditions during the treatment process.

Evaluation of the Measurement Properties of Four Performance Outcome Measures in Patients with Elective Hip Replacements, Elective Knee Replacements, or Hip Fractures

OBJECTIVES

To evaluate the measurement properties of four performance outcome (PerfO) measures (timed up and go, four-step stair climb, long stair climb, and repeated chair stand) in three patient populations(elective total hip replacement [eTHR], elective total knee replacement [eTKR], and hip fracture [HF]).

METHODS

A cross-sectional and longitudinal design was used to assess the PerfO measurement properties using the US Food and Drug Administration guidance for industry around patient-reported outcome measures to support labeling claims. Patient-reported outcome measures and patient- and clinician-reported global concept items were completed along with four PerfO measures at visit 1 and two follow-up visits. Measurement properties assessed included reliability, construct validity, ability to detect change, and estimates of meaningful change.

RESULTS

A total of 280 patients (100 eTHR, 105 eTKR, and 75 HF) were recruited, with most (n = 276) providing data at visit 1. Most of the patients were female (64%) and retired (64%), and had at least one comorbidity (91%). Inter-rater and test-retest reliability ranged from good to excellent (0.73 ≤ intraclass correlation coefficient ≤ 0.95) for each PerfO measure. Known-groups validity was demonstrated for all PerfO measures, with those reporting less pain better physical functioning and those who did not use an assistive device having quicker mean completion times. Construct validity and ability to detect change were demonstrated and estimates of meaningful change derived.

CONCLUSIONS

This study found the measurement properties of four PerfO measures in samples of patients with eTHR, eTKR, and HF to be supported for consideration of future use, and provided estimates for interpretation of change.

A complex proximal femoral fracture

We present the case of a 39-year-old sportswoman who was involved in a motorcycle accident in 2012. She sustained a complex proximal femoral fracture that involved the neck and trochanteric region. We decided to preserve the natural bone stock and repair the fractures, adopting skeletal traction in the first stage and then implanting an intramedullary nail. Twenty months later the fracture was healed clinically and radiologically and the patient was able to walk and run without pain.

Failure to treat osteoporosis and the risk of subsequent fractures in elderly patients with previous hip fracture: a five-year retrospective study

BACKGROUND AND AIMS

Considering the results of cost-effective analyses, the National Osteoporosis Foundation recommends osteoporosis treatment for patients with previous hip fracture. The aim of this study was to examine the application of adequate treatment for osteoporosis among patients who have had a hip fracture. We also evaluated the rate of subsequent fractures after five years.

METHODS

We conducted a retrospective data study, with a follow-up at five years after discharge, in a tertiary teaching hospital with orthopedic services and all medical specialities. Treatment for osteoporosis and subsequent fracture rates were evaluated in 114 patients with hip fracture. Functional status was assessed using the Barthel Index (BI). We also evaluated the rate of subsequent fractures after five years.

RESULTS

Twenty-five patients (22%) had a new fracture at some moment during the follow-up. Six percent at discharge and 12% at five years of follow-up were receiving adequate treatment for osteoporosis. After five years of follow-up, a decline in their BI persisted in 72% of the 43 surviving patients.

CONCLUSIONS

Few patients were receiving adequate treatment for osteoporosis after hip fracture. Their fracture rates and functional decline were important.

Acute and long-term management of patients with vertebral fractures

Symptomatic vertebral fractures are associated with significant morbidity, excess mortality and health and social service expenditure. Up to 20% of patients with an incident vertebral fracture experience a further vertebral fracture within one year. It is therefore important that vertebral fractures are detected early, and treatment considered as soon as possible. Only a third of vertebral fractures come to medical attention, where they typically present with acute back pain, but other presentations include loss of height and increasing kyphosis. Spine X-rays should then be performed to confirm the diagnosis and exclude other pathology. Bone density measurements are not essential before starting treatment for osteoporosis in patients with low-trauma vertebral fractures, but may be useful to confirm osteoporosis when there is uncertainty about previous trauma. They may also aid in selecting the most appropriate therapy and monitoring response to treatment. Up to 30% of women and 55% of men with symptomatic vertebral crush fractures have underlying secondary osteoporosis, where treatment may lead to large increases in bone density. These conditions should therefore be sought by medical history, physical examination and appropriate investigations. The management of patients with acute vertebral fractures should include measures to reduce pain and improve mobility, as well as starting treatment for osteoporosis. Treatments have now been shown in randomized controlled trials to improve bone density and reduce the incidence of vertebral and non-vertebral fractures in patients with osteoporosis. Choice of treatment will depend on the underlying causes of bone loss, efficacy in any particular situation, cost, patient preference and the potential non-skeletal advantages and disadvantages.