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Femoral Neck Stress Fracture

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541. Quantitative magnetic resonance imaging in the calcaneus and femur of women with varying degrees of osteopenia and vertebral deformity status. (Abstract)

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

542. 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

543. 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.

544. 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

545. 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

546. 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

547. 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

548. 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

549. Calcium phosphate crystal distribution in the superficial zone of human femoral head articular cartilage. Full Text available with Trip Pro

Calcium phosphate crystal distribution in the superficial zone of human femoral head articular cartilage. The distribution of cuboid crystals in articular cartilage was examined by image analysis of electron micrographs. The specimens were considered to be functionally normal articular cartilage from femoral heads resected either because of femoral neck fracture or tumour in the distal femur. The study was restricted to the superficial region between 0 and 50 microns depth. Crystals were (...) mechanical stress.

1992 Journal of anatomy

550. A randomized trial of sodium fluoride (60 mg) +/- estrogen in postmenopausal osteoporotic vertebral fractures: increased vertebral fractures and peripheral bone loss with sodium fluoride; concurrent estrogen prevents peripheral loss, but not vertebral fra (Abstract)

-treated groups. Complete nonvertebral fractures did not occur in the two +E groups; there were no differences between groups F CaD and CaD. Baseline BMD (spine and femoral neck) was related to incident vertebral fractures in the control groups (no NaF), but not in the two NaF groups. Our results and a literature review indicate that fluoride salts, if used, should be at low dosage, with pretreatment and co-treatment with a bone resorption inhibitor. (...) . Peripheral bone loss occurred at most sites in the F CaD group at 27 months: tibia/fibula shaft -7.3% (p = 0.005); femoral shaft -7.1% (p = 0.004); distal forearm -4.0% (p=0.004); total hip -4.1% (p = 0.003); and femoral neck -3.5% (p = 0.006). No significant loss occurred in group FE CaD. Differences between the two NaF groups were greatest at the total hip at 27 months but were not significant [p < 0.05; in view of the multiple bone mineral density (BMD) sites, an alpha of 0.01 was employed to denote

2002 Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA Controlled trial quality: uncertain

551. Proximal femoral bone mineral density after resurfacing total hip arthroplasty and after standard stem-type cementless total hip arthroplasty, both having similar neck preservation and the same articulation type. (Abstract)

Proximal femoral bone mineral density after resurfacing total hip arthroplasty and after standard stem-type cementless total hip arthroplasty, both having similar neck preservation and the same articulation type. To examine whether the Freeman cementless total hip arthroplasty (THA), with femoral neck preservation and a large metal head, can prevent stress shielding in a manner similar to resurfacing THA, we compared femoral bone mineral density (BMD) change in 10 resurfacing THA patients (...) , although it may prevent some major complications after resurfacing THA such as neck fracture and avascular necrosis of the femoral head.

2007 Journal of Arthroplasty

552. New QCT analysis approach shows the importance of fall orientation on femoral neck strength. (Abstract)

New QCT analysis approach shows the importance of fall orientation on femoral neck strength. The influence of fall orientation on femur strength has important implications for understanding hip fracture risk. A new image analysis technique showed that the strength of the femoral neck in 37 males varied significantly along the neck axis and that bending strength varied by a factor of up to 2.8 for different loading directions.Osteoporosis is associated with decreased BMD and increased hip (...) fracture risk, but it is unclear whether specific osteoporotic changes in the proximal femur lead to a more vulnerable overall structure. Nonhomogeneous beam theory, which is used to determine the mechanical response of composite structures to applied loads, can be used along with QCT to estimate the resistance of the femoral neck to axial forces and bending moments.The bending moment [My(theta)] sufficient to induce yielding within femoral neck sections was estimated for a range of bending

2005 Journal of Bone and Mineral Research

553. Femoral neck trabecular microstructure in ovariectomized ewes treated with calcitonin: MRI microscopic evaluation. Full Text available with Trip Pro

improved all the Tb structural parameters to the Sham level (p < 0.0001 approximately p = 0.0281), whereas 50 IU significantly increased the Tb number and the mean length of the Tb branches. BV/TV explained 74% of the variation of compressive stress of the trabecular cylinder cores of the femoral neck. Combining all structural parameters in a multivariate regression analysis significantly improved the explanation to 84%, and adding BMD further improved the predictive ability of the model to 92%. We (...) conclude that OVX induces deterioration of the MRI-derived Tb microstructure in the femoral neck of ewes. sCT treatment prevents OVX-induced changes. The femoral neck microarchitecture significantly correlates with its biomechanical properties. Combining microstructural parameters with BMD further improves the prediction of bone biomechanical properties. The effects of sCT on OVX ewes may help explain reduced fracture risk in postmenopausal osteoporotic women treated with sCT.

2005 Journal of Bone and Mineral Research

554. Subchondral fatigue fracture of the femoral head in military recruits. (Abstract)

Subchondral fatigue fracture of the femoral head in military recruits. Subchondral stress fracture of the femoral head is a rare condition that usually occurs as an insufficiency fracture in people with poor bone quality. We evaluated the clinical characteristics of subchondral fatigue fractures of the femoral head that occurred in young, healthy military recruits.Between January 1998 and November 2001, seven subchondral fatigue fractures of the femoral head were treated in five patients (...) , and all of them showed increased radionuclide uptake in the femoral head. In all affected hips, magnetic resonance images demonstrated a localized or diffuse bone-marrow-edema pattern in the femoral head and/or neck. A subchondral fracture line (a magnetic resonance crescent sign) was identified in all hips. In the patients who did not have collapse of the femoral head, the pain decreased gradually and disappeared completely within six months, with correspondingly improved findings on sequential

2004 The Journal of Bone and Joint Surgery. American Volume

555. Femoral Fractures

Guidelines. You may find the article more useful, or one of our other . In this article In This Article Femoral Fractures In this article Fractures of the femur are common. They may affect the neck, shaft or distal (supracondylar) femur. They include: Fractures of the femoral neck - far more common in the elderly. Fractures of the femoral shaft and supracondylar fractures - usually caused by violent trauma and most often occur in adolescents and young adults. Femoral stress fractures - partial-thickness (...) fractures, most commonly affecting the femoral neck. They are chronic overuse injuries and tend to be seen in those who take part in physical activity. They may progress to full fractures. They are covered more fully in the separate article. Hip fractures A hip fracture means a fracture of the proximal femur (proximal to 5 cm below the lesser trochanter). Hip fractures are the most common reason for admission to an orthopaedic trauma ward. [ ] Intracapsular fractures Involve the femoral neck between

2008 Mentor

556. Management and return to play of stress fractures. (Abstract)

. High-risk stress fractures occur in the superolateral femoral neck, anterior tibial shaft, tarsal navicular, proximal fifth metatarsal, and talar neck. Low-risk stress fractures occur in the lateral malleolus, calcaneus, 2nd through 4th metatarsals, and the femoral shaft.The undertreatment of high-risk stress fractures can lead to catastrophic bone failure and/or prolonged loss of playing time. Overtreatment of low-risk stress fractures can result in unnecessary deconditioning and unneeded loss (...) Management and return to play of stress fractures. The purpose of this article is to provide the clinician an evidence/experience-based algorithm for the management of stress fractures.Medline search of peer reviewed publications regarding stress fracture etiology, classification, treatment, and natural history.The algorithm was developed from a review of retrospective case series, a few evidence-based papers, and the clinical experience of 4 sports medicine team physicians with a combined

2005 Clinical Journal of Sport Medicine

557. Relation between age, femoral neck cortical stability, and hip fracture risk. (Abstract)

to transmit much mechanical load to this region. We aimed to measure whether elastic instability increases greatly with age since it might trigger hip fracture in a sideways fall.We measured with computed tomography the distribution of bone in the mid-femoral neck of 77 proximal femurs from people who died suddenly aged 20-95 years. We then calculated the critical stress, from the geometric properties and density of the cortical zone most highly loaded in a sideways fall, as a threshold for elastic (...) Relation between age, femoral neck cortical stability, and hip fracture risk. Hip fracture risk rises 100 to 1000-fold over 60 years of ageing. Loss of resistance to bending is not a major feature of normal ageing of the femoral neck. Another cause of fragility is local buckling or elastic instability. Bones adapt to their local experience of mechanical loading. The suggestion that bipedalism allows thinning of the underloaded superolateral femoral neck cortex arises from the failure of walking

2005 Lancet

558. Exercise and oral contraceptive use suppress the normal age-related increase in bone mass and strength of the femoral neck in women 18-31 years of age. (Abstract)

Exercise and oral contraceptive use suppress the normal age-related increase in bone mass and strength of the femoral neck in women 18-31 years of age. Women who exercise during their second and third decades may increase their peak bone mass and lower their eventual risk for postmenopausal fracture. However, the effects of exercise in younger women can be modulated by the use of oral contraceptives, which may prevent the normal accretion of bone mass that would otherwise occur. We hypothesized (...) sessions/week of aerobic and nonaerobic exercises, and continued for 2 years. Each 6 months, the femoral neck of each subject was scanned using a Lunar dual-energy X-ray absorptiometry (DEXA) scanner, and bone mineral content, density and geometric information were used to calculate estimated stresses and bending rigidity at the hip. Percent changes from baseline were analyzed using two-way analysis of variance (ANOVA) at 6, 12, 18, and 24 months. Women who neither exercised nor took oral

2000 Bone Controlled trial quality: uncertain

559. Stress fractures of the femoral shaft in women's college lacrosse: a report of seven cases and a review of the literature. Full Text available with Trip Pro

Stress fractures of the femoral shaft in women's college lacrosse: a report of seven cases and a review of the literature. Stress fractures do not often occur in the shaft of the femur. They are more common in the femoral neck, the tibial shaft, the metatarsals, and other bones of the foot. In female athletes, stress fractures classically afflict the distance runner, the ballerina, the gymnast, and the figure skater.To describe the clinical presentation, diagnosis, treatment, and outcome (...) of seven college female lacrosse players with femoral shaft stress fractures, and review the literature.The unusual results of this study support the principle that clinical suspicion should be high when treating any female athlete regardless of the sport. In this case series, an abrupt change in the quality of the running surface during the competitive training season was the only underlying common thread among the athletes.The findings suggest that risk factors for the female athlete are variable

2005 British Journal of Sports Medicine

560. Stress fracture of the femoral neck as a complication of total knee arthroplasty. (Abstract)

Stress fracture of the femoral neck as a complication of total knee arthroplasty. Stress fracture of the hip is a rare complication of total knee arthroplasty that occurs most often in patients in whom a significant deformity of the knee has been corrected, particularly those with poor mobility before surgery. We report 4 cases of ipsilateral fracture of the femoral neck after total knee arthroplasty.

2005 Journal of Arthroplasty

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