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Femoral Neck Stress Fracture

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521. Males have larger skeletal size and bone mass than females, despite comparable body size. (Abstract)

at the femoral neck and total femur (p < 0.02). Geometric variables of the hip including neck diameter and neck-axis length were also greater in males (p < 0.02). There was greater cross-sectional moment of inertia, safety factor, and fall index in males (all p < 0.02). Males had greater tibial BMC, volumetric BMD, and cortical area and thickness compared with females (p < 0.01), with both greater periosteal circumference (p = 0.011) and smaller endosteal circumference (p = 0.058). Statistically controlling (...) to greater cortical thickness in the tibia. We conclude that differences in bone mass and geometry confer greater skeletal integrity in males, which may contribute to the lower incidence of stress and osteoporotic fractures in males.

2005 Journal of Bone and Mineral Research

522. Differential diagnosis of pain around the hip joint. (Abstract)

, including: iliopsoas tendonitis, "internal" snapping hip, "external" snapping hip, iliotibial band and greater trochanteric bursitis, and gluteal tendon injury. Finally, we discuss extra-articular causes of hip pain that are often managed nonoperatively or in an open fashion: femoral neck stress fracture, adductor strain, piriformis syndrome, sacroiliac joint pain, athletic pubalgia, "sports hernia," "Gilmore's groin," and osteitis pubis.

2008 Arthroscopy

523. Knee Pain

. Other causes of knee pain, including: Children and adolescents: referred pain from the hip - eg, , and . Adults: trauma - (anterior cruciate, medial collateral, lateral collateral); ; inflammatory arthropathy ( , ); referred pain from the hip (eg, fracture of the neck of the femur) or . Older adults: , , . Any age: . Management The management will depend on the underlying cause. However, conservative treatment is usually effective and most patients will not require surgical intervention. Management (...) : 10.1002/14651858.CD008402.pub2. ; Patellar taping for patellofemoral pain syndrome in adults. Cochrane Database Syst Rev. 2012 Apr 184:CD006717. doi: 10.1002/14651858.CD006717.pub2. ; Evidence Based Conservative Management of Patello-femoral Syndrome. Arch Bone Jt Surg. 2014 Mar2(1):4-6. Epub 2014 Mar 15. ; Take your shoes off to reduce patellofemoral joint stress during running. Br J Sports Med. 2014 Mar48(6):425-8. doi: 10.1136/bjsports-2013-092160. Epub 2013 Jul 13. ; Patellofemoral pain: an update

2008 Mentor

524. Chondromalacia Patellae

. Other causes of knee pain, including: Children and adolescents: referred pain from the hip - eg, , and . Adults: trauma - (anterior cruciate, medial collateral, lateral collateral); ; inflammatory arthropathy ( , ); referred pain from the hip (eg, fracture of the neck of the femur) or . Older adults: , , . Any age: . Management The management will depend on the underlying cause. However, conservative treatment is usually effective and most patients will not require surgical intervention. Management (...) : 10.1002/14651858.CD008402.pub2. ; Patellar taping for patellofemoral pain syndrome in adults. Cochrane Database Syst Rev. 2012 Apr 184:CD006717. doi: 10.1002/14651858.CD006717.pub2. ; Evidence Based Conservative Management of Patello-femoral Syndrome. Arch Bone Jt Surg. 2014 Mar2(1):4-6. Epub 2014 Mar 15. ; Take your shoes off to reduce patellofemoral joint stress during running. Br J Sports Med. 2014 Mar48(6):425-8. doi: 10.1136/bjsports-2013-092160. Epub 2013 Jul 13. ; Patellofemoral pain: an update

2008 Mentor

525. Painful Hips In Children Full Text available with Trip Pro

, such as endurance running. Children present with activity-related hip, groin or thigh pain that can be reproduced by asking them to hop. Fractures can be diagnosed by technetium bone scan or MRI. Femoral neck stress fractures sometimes require surgical stabilisation. Snapping hip syndrome refers to sounds or sensations of snapping or clicking with hip flexion and extension. There can be some pain. An internal snapping hip is due to movement of the iliopsoas tendon over the iliopectineal eminence, lesser (...) stress fracture. Common causes of hip pain in children Transient synovitis and septic arthritis are the most common causes of hip pain in young children. Hip pain may be caused by conditions unique to the growing skeleton, including Perthes' disease, slipped capital femoral epiphysis (SCFE) and apophyseal avulsion fractures of the pelvis. The relative likelihood of the different causes of hip pain varies with age [ ] . The most common and significant causes of hip pain in children are: Transient

2008 Mentor

526. Orbital Swellings

about any change in colour perception. Mention of things looking 'washed out' (especially red objects) may be the first warning that the optic nerve is stressed and potentially compromised. This is not a good symptom - see 'Referral', below. Very rarely, enophthalmos might be misconstrued as orbital swelling if it is subtle. P ain: this important symptom may arise from inflammation, infection, acute pressure changes (such as haemorrhage) and bony or neural invasion. It may also be referred from (...) fractures (although a blowout fracture is easily missed); however, beyond that, CT remains the first-line imaging modality for orbital disease. Contrast is helpful particularly where malignancy is suspected (but cannot be used in patients with iodine allergy, dehydration, cardiac failure, hyperthyroidism and renal impairment). MRI scanning tends to be used for diseases at the orbitocranial junction (eg, optic sheath tumours). Ultrasound can be helpful in assessing vascular lesions (using Doppler flow

2008 Mentor

527. Gait Abnormalities in Children

, and periodicity (acute onset and persistent pain/limp suggest trauma or serious causes such as infection). Unwitnessed trauma is common in very young children. Toddler's fracture needs to be considered in apparently well but non-weight-bearing young children. Put non-accidental injury (NAI) through your diagnostic sieve. Overuse injuries (stress fractures, avulsion fractures) may be subacute or acute and are more common in active children. Gait disturbance (antalgic limp) and stiffness are more common in JIA (...) be undertaken. Differential diagnosis Splinters, blisters or tired muscles are common causes. More serious problems include: Developmental - eg, , . Trauma - eg, fracture, non-accidental injury, puncture wound, slipped femoral epiphyses. Infections - eg, , , synovitis (viral, bacterial or atypical - ). - eg, . Neoplasia - eg, . Inflammatory - eg, . Non-painful chronic limping may be indicative of a developmental problem, such as developmental dysplasia of the hip, or of a neuromuscular problem

2008 Mentor

528. Once Weekly Parathyroid Hormone for Osteoporosis

that fractures occur after only modest levels of mechanical stress that would not harm normal bone. Fractures of the hip, spine, and wrists are most typical, though fractures of the ribs, pelvis, and humerus also occur. Research has shown that hip fractures cause a 10% to 20% increase in mortality, and the cost of all osteoporotic fractures is estimated to be $6.14 billion in health care costs and lost earnings per year. The most common form of osteoporosis is postmenopausal osteoporosis. A reduction in bone (...) Femoral neck T-score below -2 AND lumbar spine T-score below -2.5 OR femoral neck T-score below -2.5 AND T-scores of both total hip and lumbar spine below -2 Contacts and Locations Go to Information from the National Library of Medicine To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor. Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00065637 Locations Layout table for location

2003 Clinical Trials

529. Randomized Trial Of Exemestane Versus Continued Tamoxifen In Postmenopausal Women With Early Breast Cancer

points for each group, respectively. Percent Change From Baseline in Femoral Neck and Femoral Wards Bone Mineral Density (BMD) at 6, 12 and 24 Months On-treatment and 24 Months Post-treatment: Bone Metabolism Sub-study [ Time Frame: Baseline, 6, 12, 24 months after randomization (on-treatment), 24 months post-treatment ] BMD measurements for femoral neck (FN) and femoral wards (FW) were performed using dual energy X-ray absorptiometry (DXA) for participants who entered the bone-metabolism sub-study (...) With Fracture: Bone Metabolism Sub-study [ Time Frame: Baseline up to 24 months post-treatment ] Change From Baseline in Treatment Outcome Index (TOI) at 3, 6, 9, 12, 18, 24, 30, 36, 48 and 60 Months: QoL Sub-study [ Time Frame: Baseline, 3, 6, 9, 12, 18, 24, 30, 36, 48, 60 months after randomization ] The TOI was defined as the sum of 23 items based on following Functional Assessment of Cancer Therapy - Breast version [FACT-B] subscales: Physical well-being (7 items), Functional well-being (7 items

2002 Clinical Trials

530. Anisotropy of osteoporotic cancellous bone. (Abstract)

Anisotropy of osteoporotic cancellous bone. To investigate the mechanism underlying femoral neck fracture, it is necessary to determine the various mechanical properties, including the bone strength, of the primary compressive group. We investigated the mechanical anisotrophy of the primary compressive group by comparing differences in its mechanical properties, depending on the loading direction. Twenty-three femoral heads of 20 female and 3 male patients with femoral neck fracture were (...) studied. The mean age of these patients was 79.9 years (range, 63-98 years). A total of 82 cubic specimens (6.5 mm in length) were obtained (one to six specimens from each femoral head). The specimens obtained from each femoral head were randomly assigned into two groups: parallel and perpendicular. The parallel group included 43 specimens, and the perpendicular group included 39 specimens. A compressive load was applied either parallel or perpendicular to the primary compressive group

1999 Bone Controlled trial quality: uncertain

531. Bone Mineral Density in Women With Major Depression

Disorder. We have found statistically and clinically significant reductions in bone mineral density (BMD) in a group of 24 depressed but otherwise healthy pre-menopausal women, as compared to 24 healthy, closely matched controls. The difference was significant at several trabecular bone sites (e.g., 13.6% at the femoral neck, 13.6% at the Ward's triangle, and 10.8% at the trochanter). Epidemiological studies indicate that losses in trabecular bone mineral density of these magnitudes are associated (...) total body adiposity and lean body mass. Condition or disease Healthy Involutional Depression Osteoporosis Detailed Description: Osteoporosis is a condition that is underdiagnosed and undertreated, and often goes unnoticed until a fragility fracture occurs after many years of progressive loss of bone quality. Risk factors for osteoporosis include glucocorticoid excess and a pro-inflammatory state, both of which we and others have observed in a substantial proportion of patients with Major Depressive

1999 Clinical Trials

532. Osteoarthritis of the hip: the patient behind the disease. Full Text available with Trip Pro

with OA of the hip; (2) patients with acute femoral neck fracture; (3) healthy controls. OA of the hip was rare in patients with femoral neck fracture; conversely, patients with coxarthrosis did not have the low values for bone density seen in the fracture group. There were significant differences in somatotype in the 2 patient groups; 94% of those with OA were endomorphic mesomorphs. Polyarticular OA occurred with the same prevalence in the 2 groups of women, but among males there was a significantly (...) greater involvement of knees and hands in the OA group than in the fracture group. The highest incidence of joint calcification was found in the fracture group and the lowest in the OA group. It was concluded that patients with OA of the hip form a definable subset of the general population. Within this group the appearances of hip OA are determined by 3 interacting factors: mechanical stress, cartilage degeneration, and bone response.

1982 Annals of the Rheumatic Diseases

533. Quantitative magnetic resonance imaging in the calcaneus and femur of women with varying degrees of osteopenia and vertebral deformity status. Full Text available with Trip Pro

highly positively correlated (r2 = 0.61 +/- 0.11) but the correlation of region-of-interest (ROI) means for different calcaneal sites among patients was weaker (r2 = 0.34; p < 0.0001). The strongest discriminator of vertebral deformity was R2* of the calcaneus, which was lower in the fracture group, consistent with lower trabecular density. Among the calcaneal sites examined, the subtalar region, a location characterized by dense nearly horizontal trabeculae that transmit the stresses imparted (...) as the average of all pixels in the calcaneus, was a strong discriminator as well (p < 0.005). On the other hand, calcaneal BVF was only marginally discriminating (p = 0.05). Among the BMD sites examined, the lumbar spine (average L1-L4) was significant (p = 0.005, 66% diagnostic accuracy), as was the femoral neck (p = 0.01). The data suggest the calcaneus to be suited as a surrogate site to assess vertebral osteoporosis and that R2* is sensitive to alterations in bone quality not captured by density.

2002 Journal of Bone and Mineral Research

534. Factors affecting bone loss in female endurance athletes: a two-year follow-up study. (Abstract)

Factors affecting bone loss in female endurance athletes: a two-year follow-up study. Low bone mass leading to stress fractures is a well-known and yet unsolved problem among female athletes.To quantify the rate of bone loss in healthy female athletes and investigate the effects of estrogen and vitamin K supplementation on bone loss.Prospective cohort study.We classified 115 female endurance athletes into amenorrheic, eumenorrheic, or estrogen-supplemented groups and randomized them to receive (...) either placebo or vitamin K(1). The bone mineral densities of the subjects' femoral neck and lumbar spine were measured at baseline and after 2 years.Bone mineral density in the lumbar spine remained constant, but bone density in the femoral neck had decreased significantly after 2 years in all three subgroups. The decrease was higher in amenorrheic (-6.5% +/- 4.0%) than in eumenorrheic (-3.2% +/- 4.1%) and estrogen-supplemented athletes (-3.9% +/- 3.1%). Supplementation with vitamin K did not affect

2003 American Journal of Sports Medicine Controlled trial quality: uncertain

535. Magnetic resonance imaging: a cost-effective alternative to bone scintigraphy in the evaluation of patients with suspected hip fractures

patient awaiting RBS (but who had not yet had it performed) suffered a fall on her second day in hospital which resulted in a displaced femoral neck fracture requiring surgical intervention with a hemiarthroplasty. Clinical conclusions Using MRI instead of bone scanning shortens the time to diagnosis in patients with suspected hip fractures in institutions performing delayed RBS. Measure of benefits used in the economic analysis No summary benefit measure was identified in the economic analysis (...) in the interpretation of the study results due to the retrospective nature of the study design, the small sample size, and the lack of sensitivity analysis and statistical analysis of the costs. The issue of generalisability was partly addressed by stressing that the study cost results may not be generalisable to other medical settings with different patient population, different prevalence of patients with fractures requiring surgery, different costs of imaging modalities, different cost per LOS, and different

1998 NHS Economic Evaluation Database.

536. Role of Surgical Position on Interface Stress and Initial Bone Remodeling Stimulus around Hip Resurfacing Arthroplasty. (Abstract)

Role of Surgical Position on Interface Stress and Initial Bone Remodeling Stimulus around Hip Resurfacing Arthroplasty. Valgus alignment of femoral resurfacing components has been advocated to reduce proximal femur loading and thus minimize the risk for femoral neck fractures. However, such reduction in loading may exacerbate undesirable stress shielding. This study examined the effect of extreme implant orientations (+/-15 degrees ) and stem canal overreaming on initial bone remodeling (...) stimulus using finite element models. The changes in implant-cement interface stresses due to implant alignment were also evaluated. The valgus model showed increased initial bone resorption stimulus, which extended distally and peripherally around the femoral neck. The peak implant-cement interface shear stress for the varus model was 10.9 MPa, exceeding the interface shear strength. Overreaming of the stem canal eliminated distal tip loading, but proximal stress shielding was still unavoidable

2008 Journal of Arthroplasty

537. Raloxifene enhances material-level mechanical properties of femoral cortical and trabecular bone. Full Text available with Trip Pro

. Skeletally mature female beagles (n = 12 per group) were treated daily for 1 yr with oral doses of vehicle or raloxifene (0.50 mg/kg d). Trabecular bone mechanical properties were measured at the femoral neck using reduced platen compression, a method that allows the trabecular bone to be tested without coring specimens. Cortical bone properties were assessed on prismatic beam specimens machined from the femoral diaphysis using both monotonic and dynamic (cyclic relaxation) four-point bending tests (...) Raloxifene enhances material-level mechanical properties of femoral cortical and trabecular bone. We have previously documented that raloxifene enhances the mechanical properties of dog vertebrae independent of changes in bone mass, suggesting a positive effect of raloxifene on material-level mechanical properties. The goal of this study was to determine the separate effects of raloxifene on the material-level mechanical properties of trabecular and cortical bone from the femur of beagle dogs

2007 Endocrinology

538. Nonunion of fractures of the subtrochanteric region of the femur. (Abstract)

no or minimal pain. All were ambulatory. There were no intraoperative complications. There was one postoperative complication (4%), an adynamic ileus that was treated medically. Revision internal fixation and selected bone grafting for subtrochanteric nonunion led to a high rate of fracture union and functional improvement. Intramedullary devices with fixation into the femoral head and neck and fixed angled devices were effective in achieving stable fixation of the proximal bony fragment. (...) Nonunion of fractures of the subtrochanteric region of the femur. There are no large clinical series to guide the clinician treating a subtrochanteric nonunion. Deformity, bone loss from previous hardware, and the high stresses in the subtrochanteric region all pose challenges to achieving successful bony union with reoperation. The purpose of this study was to retrospectively review a consecutive series of patients treated with reoperation using contemporary techniques for subtrochanteric

2004 Clinical Orthopaedics and Related Research

539. Periprosthetic fractures after total knee arthroplasty. (Abstract)

Periprosthetic fractures after total knee arthroplasty. Fractures around total knee arthroplasties are challenging clinical problems and include the following: stress fractures of the pelvis and femoral neck, supracondylar femur fractures, fractures of the proximal tibial metaphysis and diaphysis, and patellar fractures. Treatment focuses on restoration of the patient's prefracture functional status. The etiology of supracondylar femur fractures is multifactorial and treatment includes (...) immobilization, retrograde intramedullary nailing, open reduction and internal fixation, and revision arthroplasty. The "Less Invasive Stabilization System" plate has recently been added to the list of viable fixation options. Tibial metaphyseal and diaphyseal fractures are less common and usually treated with revision arthroplasty. In the absence of maltracking or component loosening, vertical patellar fractures often respond to immobilization. Disruption of the extensor mechanism may require cerclage

2005 Journal of Arthroplasty

540. Use of DXA-Based Structural Engineering Models of the Proximal Femur to Discriminate Hip Fracture. Full Text available with Trip Pro

Use of DXA-Based Structural Engineering Models of the Proximal Femur to Discriminate Hip Fracture. Several DXA-based structural engineering models (SEMs) of the proximal femur have been developed to estimate stress caused by sideway falls. Their usefulness in discriminating hip fracture has not yet been established and we therefore evaluated these models. The hip DXA scans of 51 postmenopausal women with hip fracture (30 femoral neck, 17 trochanteric, and 4 unspecified) and 153 age-, height (...) -, and weight-matched controls were reanalyzed using a special version of Hologic's software that produced a pixel-by-pixel BMD map. For each map, a curved-beam, a curved composite-beam, and a finite element model were generated to calculate stress within the bone when falling sideways. An index of fracture risk (IFR) was defined over the femoral neck, trochanter, and total hip as the stress divided by the yield stress at each pixel and averaged over the regions of interest. Hip structure analysis (HSA

2008 Journal of Bone and Mineral Research

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