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Femoral Neck Stress Fracture

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501. Femoral Neck Trabecular Bone: Loss with Ageing and Role in Preventing Fracture. Full Text available with Trip Pro

or buckling resistance was increased by the trabecular bone supporting the most stressed cortical sector in each femoral neck. We repeated these measurements and calculations in an age- and sex-matched series of femoral necks donated by women who had suffered intracapsular hip fracture and controls, using histological measurements of cortical thickness to improve accuracy. With normal aging, trabecular BMD declined asymmetrically, fastest in the supero-lateral one-half (in antero-posterior projection (...) Femoral Neck Trabecular Bone: Loss with Ageing and Role in Preventing Fracture. Hip fracture risk rises 100- to 1000-fold over six decades of age, but only a minor part of this increase is explained by declining BMD. A potentially independent cause of fragility is cortical thinning predisposing to local crushing, in which bone tissue's material disintegrates at the microscopic level when compressed beyond its capacity to maintain integrity. Elastic instability or buckling of a much thinned

2009 Journal of Bone and Mineral Research

502. Bone Stress Injuries Are Common in Female Military Trainees: A Preliminary Study. Full Text available with Trip Pro

symptoms. Asymptomatic, low-grade bone stress injuries of the femoral and tibial shaft are common in female recruits undergoing heavy physical training. Because these injuries seem to remain constant or even disappear despite continued heavy physical activity, we do not recommend routine screening of asymptomatic trainees. As some bone stress fractures may have severe consequences (eg, in the femoral neck), symptomatic bone stress injuries should be examined and treated. (...) Bone Stress Injuries Are Common in Female Military Trainees: A Preliminary Study. Although bone stress injuries are common in male military trainees, it is not known how common they are in female trainees. It also is unclear whether asymptomatic bone stress injuries heal if intensive training is continued. We prospectively followed 10 female trainees of a military Reserve Officer Course. The subjects underwent clinical and MRI examinations of the pelvis, thighs, and lower legs at the beginning

2009 Clinical Orthopaedics and Related Research

503. Spontaneous bilateral femoral neck fractures associated with a low serum level of vitamin D in a young adult. (Abstract)

Spontaneous bilateral femoral neck fractures associated with a low serum level of vitamin D in a young adult. Bilateral femoral neck fracture is an extremely rare injury in young adults. We report a young adult with bilateral femoral neck fracture after minimal stress. The current case did not demonstrate any abnormality on laboratory data, except for a low serum level of vitamin D(3). Although, in our case, the patient underwent bilateral femoral head arthroplasty, early diagnosis could have (...) been helpful to avoid further displacement of the fracture and surgical treatment.

2009 Journal of Arthroplasty

504. Acetabular Retroversion in Military Recruits with Femoral Neck Stress Fractures. Full Text available with Trip Pro

Acetabular Retroversion in Military Recruits with Femoral Neck Stress Fractures. Acetabular retroversion (AR) alters load distribution across the hip and is more prevalent in pathologic conditions involving the hip. We hypothesized the abnormal orientation and mechanical changes may predispose certain individuals to stress injuries of the femoral neck. We retrospectively reviewed the anteroposterior (AP) pelvic radiographs of 54 patients (108 hips) treated for a femoral neck stress fracture (...) (FNSF) and compared these radiographs with those for a control group of patients with normal pelvic radiographs. We determined presence of a crossover sign (COS), femoral neck abnormalities, and neck shaft angle. The prevalence of a positive COS was greater in patients with stress fractures than in the control subjects (31 of 54 [57%] versus 17 of 54 [31%], respectively) and higher than for control subjects reported in the literature. Thirteen patients had radiographic changes of the femoral neck

2009 Clinical Orthopaedics and Related Research

505. Orthogeriatric Care

for rapid definitive treatment of older people with trauma so that these patients could walk immediately. This group also stressed the need for team care, full and open communication with the patient and family and utilised the principles of geriatric assessment [1]. Recently the British Geriatrics Society has published a framework document on Orthogeriatric Services. The outcomes of fracture in older people have been shown to be much better when there is close collaboration between departments (...) , fewer orthopaedic complications and less need for major re-operations [11]. As surgical techniques improved, the opportunity for immediate postoperative weight-bearing was realised. This applies to both intra- and extracapsular fractures. The need for appropriate surgical technique has been stressed [12]. In the 1970s and 1980s the concepts of early mobilisation, home rehabilitation and support services after hip fracture were recognised as an alternative to the transfer of patients

2004 Australian and New Zealand Society for Geriatric Medicine

506. Cost-effectiveness of alendronate therapy for osteopenic postmenopausal women

, or proximal fibula), post-hip and vertebral fracture, and death. The cycle length was 6 months and the time horizon was lifetime. Women in the no fracture state could develop a distal forearm, hip, clinical vertebral, radiographic vertebral, or other fracture, at which time transition to that post-fracture state occurred. Different combinations of starting age (55, 65 and 75 years) and femoral neck T-score (-1.5, -2.0 and -2.4) were considered. The model incorporated an increased relative risk (...) . For women taking alendronate, the relative risk for incident vertebral fractures (over placebo) was 0.54 for those with a femoral neck T-score of -2.0 to -2.4, and 0.82 for those with a T-score of -1.5. The relative risk for non-vertebral fractures was 1.0. The mortality associated with acute hip fracture was 1.375 times that of the base rate. Quality of life values were as follows: no fracture state, 0.84; post-distal forearm fracture, 0.82 in the first year, then 0.839; post-other fracture, 0.753

2005 NHS Economic Evaluation Database.

507. Effect of weighted exercises on bone mineral density in post menopausal women: a systematic review

bone metabolism except oestrogen. The participants included in the review were aged from 40 to 75 years (where stated). A number of studies included women on hormone replacement therapy (HRT). Outcomes assessed in the review Studies that assessed change in BMD using a dual-energy X-ray absorptiometry (DXA) scan were eligible for inclusion. Commonly reported sites of DXA scans used in the reported studies included lumbar spine, femoral neck and trochanter. How were decisions on the relevance (...) a week and lasted from 45 to 70 minutes each session (8 studies). There was an increase in BMD when weights equalling 80% of maximal back extensor strength were used (1 study). A site-specific positive effect of exercise on BMD was found in the femoral trochanter (6 studies), and an increase or maintenance in BMD reported at the femoral neck (5 studies). A positive exercise effect was reported at Ward’s triangle (3 studies) and on BMD in the lumbar spine (4 studies). A positive exercise effect

2007 DARE.

508. Vertebral assessment with dexa (Update)

study investigating the ability of quantitative ultrasonometry (QUS) of the Calcaneus (heel) and DXA to predict morphometric fractures in the vertebrae of post- menopausal women, found that QUS and DXA could equally discriminate between women with and without vertebral fractures. This study included 764 women with non-traumatic vertebral fractures and 770 normal control women. DXA was used to determine BMD at several sites in each subject (total body, lumbar spine, total femur, femoral neck (...) with osteoporosis and also the best correlation with prevalent vertebral fracture in the population studied (Arabi et al 2007)(diagnostic evidence level IV). 1 When quantitative ultrasound and DXA are used to measure bone strength they can both give a prediction of when the bone will fail under mechanical stress. Whether DXA is useful in all patient subgroups and what variability can be expected for the same patient in multiple scans was addressed in a study published in 2006. The study reported that sampling

2007 Australia and New Zealand Horizon Scanning Network

509. Tackling inequalities through the social determinants of health: Building the evidence base

neighbourhoods, depression and anxiety reduced significantly post-intervention.[6, 7] Another similar study found physical health improvements and reductions in alcohol abuse.[8] Mental health benefits of the voucher offers for adults and for female youth were also “substantial” in the recent study of MTO by Kling et al.(2007) .[9] The authors suggest that these mental health gains result from the reduction in stress associated with moving to neighbourhoods with lower rates of random violence. The benefits (...) examined the Berlin model (discussions of how to cope with work-related stress). Only the Dusseldorf health circle met our inclusion criteria for interventions (five studies were included). No study examined the effects on health inequalities. In terms of general health effects, the results were mixed. The controlled study of three separate health circles found that general sickness absence and sickness absence due to low back pain increased in both the intervention and control group. The four

2007 Public Health Research Consortium

510. Osteoporosis Prevention, Diagnosis, and Therapy

at the spine predicts spine fracture better than measures at other sites. 17 49,896 Osteoporosis 3/6/01, 10:14 AM 18 Newer measures of bone strength, such as ultrasound, have been introduced. Recent prospective studies using quanti­ tative ultrasound (QUS) of the heel have predicted hip frac­ ture and all nonvertebral fractures nearly as well as DXA at the femoral neck. QUS and DXA at the femoral neck provide independent information about fracture risk, and both of these tests predict hip fracture risk (...) osteopenia in some individuals. The osteoporosis of cystic fibrosis is also related to the frequent need for corticosteroids as well as to other undefined factors. Hypogonadal states, characterized clinically by delayed menarche, oligomenorrhea, or amenorrhea, are relatively common in adolescent girls and young women. Settings in which these occur include strenuous athletic training, emotional stress, and low body weight. Failure to achieve peak bone mass, bone loss, and increased fracture rates have

2000 NIH Consensus Statements

511. Interest of a prescreening questionnaire to reduce the cost of bone densitometry

was carried out at the Department of Epidemiology and Public Health of the University of Liege. No follow-up was conducted. The outcome measurement was based on complete medical records. BMD measurements, using dual-energy X-ray absorptiometry (DXA) technology, were performed at three sites (total hip, femoral neck and lumbar spine). BMD values were expressed as T-scores. A T-score of at least -1 indicated a normal individual, a score of -1 to greater than -2.5 indicated an osteopenic person, while (...) years); (4) natural or surgical menopause after the age of 45 years with at least two additional risk factors (such as no hormonal substitution treatment, family history of osteoporosis, BMI less than <25 kg/m2); (5) primary or secondary hypogonadism; (6) history of traumatic fractures; (7) fortuitous discovery of osteopenia by radiogram; (8) history of long-term immobilisation; (9) diseases affecting the skeleton; and (10) long-term use of medications affecting the skeleton. Factors 1 to 4 were

2002 NHS Economic Evaluation Database.

513. I have a 36 year old lady who developed severe hip pain in pregnancy, which may be acute avascular necrosis. The patient wants to know what is the prognosis and what treatment options are available?

for femoral head AVN have considerable variation, but certain generalizations can safely be slated. Namely, the clinical results of core decompression alone deteriorate with more advanced lesions. The addition of cancellous bone grafting appears to slightly enhance clinical outcomes if subchondral fracture is present. The addition of demineralized bone matrix to core decompression confers little (if any) clinical response, while the effects of bone morphogenic protein remain uncertain. The supplemental (...) implementation of electrical stimulation with core decompression has provided disappointing results. Low-frequency pulsed electric and magnetic fields (PEMF) may offer more promise, but clinical results thus far are inconclusive. The placement of a structural graft through a core tract into the femoral head generally yields disappointing results. However, grafts placed into the femoral neck or directly into the femoral head are more promising. Free vascularized fibular grafting significantly alters disease

2005 TRIP Answers

514. A Comparison of Two Different Surgical Techniques for Total Hip Resurfacing

anterolateral trochanteric osteotomy: Less bone resection, less complicated revision surgery. Reduced stress shielding of the femur. Lower incidence of hip dislocations. Walking function improved by change in mobilisation regime and operative technique. Risk of femoral neck fracture is reduced by preoperative measurement of bone density. Risk of avascular necrosis of the femoral head is reduced with the anterolateral approach preserving femoral head blood supply and preventing later failure of the implant (...) Intervention/treatment Experimental: 1 This arm utilizes the anterolateral approach using the ReCap® Total Hip Resurfacing System. Procedure: Anterolateral approach The anterolateral approach is performed with the patient positioned on the side. The blood supply to the femoral neck from the medial circumflex artery is regarded preserved by this surgical method. Device: ReCap Total Hip Resurfacing This arm utilizes the anterolateral approach using the ReCap® Total Hip Resurfacing System. Active Comparator

2008 Clinical Trials

515. Case reports: transient osteoporosis of the hip: an atypical case. Full Text available with Trip Pro

may be limited by concerns for the fetus. This includes regional migratory osteoporosis, inflammatory arthritis, septic arthritis, avascular necrosis, stress fracture of the femoral neck, synovial disorders, and neoplasia. We report the typical results and management of transient osteoporosis as a reminder of this uncommon, but impressive condition.

2006 Clinical Orthopaedics and Related Research

516. Failure mechanisms of total hip resurfacing: implications for the present. (Abstract)

prostheses implanted between 1977 and 1981. Forty-one of 62 joints had failed, representing a failure rate of 66%. The time to failure averaged 9.7 years with a range of 6 months to 21.5 years. There were 23 femoral failures (37%). Eleven were caused by femoral fracture, and 12 were caused by femoral loosening. All late femoral failures (greater than 10 years postoperatively) showed narrowing of the femoral neck secondary to stress shielding. There were 18 acetabular failures (29%) with 10 failing (...) secondary to polyethylene wear and eight failing secondary to acetabular loosening. Failure of the Indiana conservative hip prosthesis continues over time related to femoral and acetabular failure mechanisms. These data should be considered in the context of growing enthusiasm for resurfacing with new bearing surfaces and cementless fixation.

2006 Clinical Orthopaedics and Related Research

517. Surgical variables affect the mechanics of a hip resurfacing system. (Abstract)

. Our data indicate the local stresses and strains associated with implant loosening and neck fracture were reduced by placing the implant in a valgus orientation and covering reamed cancellous bone, but unloading of the femoral head, found for all variables examined, may lead to adverse bone remodeling. (...) Surgical variables affect the mechanics of a hip resurfacing system. Recent clinical studies have linked failure to surgical variables of stemmed hip resurfacing systems. We used finite element analysis to investigate the effects of implant position, stem orientation, and extent of fixation both on the local stresses and strains associated with implant loosening, neck fracture, and stem fracture, as well as on the load transfer distribution in the bone-implant system. The range of peak stress

2006 Clinical Orthopaedics and Related Research

518. Metal-on-Metal Hip Resurfacing: A Skeptic's View. (Abstract)

conventional hip arthroplasty. Early complications and revision for femoral neck fractures are more likely with resurfacing. Blood and urine metal ion levels, capsular lymphocytic aggregation, and hypersensitivity are concerns with metal-on-metal articulation. Metal-on-metal hip resurfacing should only be used by a limited number of hip surgeons. The risks and complications of metal-on-metal hip resurfacing outweigh any possible advantages. (...) stress shielding with a diaphyseal component. More acetabular bone may be removed with resurfacing, negating its "conservative" premise. One computer simulation suggested the range of hip motion might be considerably less with resurfacing compared with conventional hip arthroplasty. There are a very limited number of patients for whom hip resurfacing is truly indicated, and the femoral head may be unsuitable for resurfacing in 40% of selected patients. Resurfacing is technically more difficult than

2007 Clinical Orthopaedics and Related Research

519. Bone remodeling around the Cambridge cup: a DEXA study of 50 hips over 2 years. Full Text available with Trip Pro

presented with displaced, subcapital, fractures of the neck of the femur. Regions of interest (ROI) were defined according to De Lee and Charnley. BMD during follow-up was compared with immediate postoperative values for the affected limb.The mean precision error (CV%) was 1.01%, 2.26% and 1.12%, for ROI I, II and III respectively. The mean change in BMD, for both cups, was analyzed. There was no significant difference between the BMD changes induced with the HA- and non-HA-coated cups.After an initial (...) Bone remodeling around the Cambridge cup: a DEXA study of 50 hips over 2 years. In a prospective 2-year study we have used dual-energy X-ray absorptiometry to measure periprosthetic bone mineral density (BMD) following implantation of a novel, "physiological", acetabular component designed using composite materials.The acetabular components were implanted in hydroxyapatite (HA) and HA-removed options. They were implanted in conjunction with a cemented femoral component in 50 female patients who

2006 Acta Orthopaedica

520. Fragile external phenotype of modern human proximal femur in comparison with medieval bone. (Abstract)

was evaluated. Using direct measurements of external bone dimensions and geometric properties, we estimated the fall-induced stress as an index of hip fragility.Within approximately 1000 years, the femoral axis length has become substantially longer (analysis of covariance, body height adjusted, p < 0.001), whereas the neck circumference has not increased. The macroanatomy was found similar between the contemporary adult and elderly groups. In hip fracture cases, however, the femoral axis length was further (...) Fragile external phenotype of modern human proximal femur in comparison with medieval bone. Proximal femur macroanatomy of 118 medieval and 67 contemporary adults, 84 contemporary elderly, and 48 contemporary hip fracture cases was evaluated. Within approximately 1000 years, the femoral neck axis has become longer, and its cross-section has become proportionally smaller and more oval in shape. These changes in the present external phenotype alone account for approximately 50% higher fall

2007 Journal of Bone and Mineral Research

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