Atypical femur fracture during bisphosphonate drug holiday: a case series

Recent studies have noted an increased risk of low energy subtrochanteric and femoral shaft fractures termed "atypical femur fractures" (AFFs) associated with long-term bisphosphonate use. As such, many clinicians have begun recommending a "drug holiday" to reduce the risks associated with long-term bisphosphonate use. We present two cases of AFFs occurring during a 4-year or greater drug holiday following long-term bisphosphonate use. These findings highlight the need to reevaluate optimal bisphosphonate therapy duration, dosage, as well as initiation and duration of a drug holiday with continued monitoring in the prevention of AFFs.

Mechanical stimulation of dorsal root ganglia induces increased production of substance P: a mechanism for pain following nerve root compromise?

The undecapeptide, substance P, is known to be synthesized in cell bodies of dorsal root ganglia. This neuropeptide is also known to modulate sensory, nociceptive transmission postsynaptically on dorsal horn interneurons. In the animal model used in the current study, experimental mechanical stimulation of dorsal root ganglia and nerve roots increased the amounts of substance P, as well as substance P immunoreactivity in cell bodies of the dorsal root ganglia and in the substantia gelatinosa of the spinal dorsal horn that the cell bodies innervated. These results were determined by using both immunohistochemistry and radioimmunoassay. This study suggests that substance P may modulate nociception when lumbar nerve roots are stimulated mechanically.

External fixation of complex carpal dislocations: a preliminary report

In ten cases of complex carpal fracture dislocations an external fixator between the radius and the second or third metacarpals was used as an adjunct to open reduction and internal fixation. The external fixator facilitates reduction, ligamentous repair, and internal fixation of the carpal bones. Furthermore, continuous postoperative distraction of the wrist maintains a stable reduction of the carpus permitting cast free after treatment and early active motion of the neighboring joints. This method is particularly useful for carpal stabilization when combined injuries of the same extremity coexist.