Bilateral Femur Research Articles

The Effects of Signaling-Selective Parathyroid Hormone Analogs on Osteoporotic Osteocyte Apoptosis

Objectives: To compare the effects of signaling-selective parathyroid hormone analogs [G1, R19]hPTH(1–28) [GR(1–28)] and [G1, R19]hPTH(1–34) [GR(1–34)] on osteoporotic osteocyte apoptosis, and to explore the mechanism of the anti-osteoporotic difference. Methods: The osteoporosis model was established in eighty adult female C57BL/6 mice aged 12 weeks. The mice were subcutaneously administered with GR(1–28) and GR(1–34) 5 days per week for 8 weeks. Bilateral femur samples were collected at 4 and 8 weeks, and micro-computed tomography (CT), H&E staining and immunohistochemical staining analyses were performed. Results: From micro-CT analysis, GR(1–34) increased proximal femoral bone mineral density (BMD) and relative bone volume (BV/TV), which was higher than GR(1–28) did. In addition, more trabecular number (Tb.N), thinner trabecular thickness (Tb.Th) and wider trabecular separation (Tb.Sp) were measured at week 8 using GR(1–34). From H&E and immunohistochemical staining, a stronger apoptosis inhibition was induced by GR(1–34) with more Bcl-2 secretion but less Bax expression, as opposed to GR(1–28). Conclusions: GR(1–34) shows better anti-osteoporotic effects than GR(1–28), which appears to be attributed to the activation of the PLC-independent PKC signaling pathway triggered by the former, inhibiting osteocyte apoptosis through up-regulation of Bcl-2 and down-regulation of Bax to increase bone mass and improving trabecular bone microstructure to enhance bone quality by reducing trabecular number, increasing trabecular thickness and trabecular space.

Bilateral femur fractures are associated with concomitant femoral neck fracture.

The purpose of this study is to determine the rate of femoral neck fractures in patients who have sustained bilateral femur fractures compared to unilateral femur fractures. A retrospective review of an institutional trauma database was completed at a single level 1 trauma academic medical center. All patients treated for a femur fracture between May 1, 2018 and December 31, 2020 were included. Twenty-one patients sustained bilateral femur fractures (11%) and 166 sustained unilateral femur fractures. Fifteen associated ipsilateral femoral neck fractures were identified. Eight of the 15 (53%) associated femoral neck fractures were observed in patients who sustained bilateral femur fractures. Eight of the 21 patients with bilateral femur fractures, 42 fractures in total, had an associated ipsilateral femoral neck fracture (38% of patients; 19% of fractures, respectively), while only seven of the 166 patients (4%) with a unilateral femur fracture had an associated femoral neck fracture (p < 0.001). Of the 208 femur fractures, 19 (9%) were open fractures. Ten of the 21 patients with bilateral femur fractures, 42 fractures in total, were identified to have an open femur fracture (48% of patients, 24% of fractures), while only nine of the 166 (5%) unilateral femur fractures were open (p < 0.001). Our results demonstrate an association between bilateral femur fractures, open femur fractures, and associated femoral neck fractures. Surgeons treating these injuries should maintain a high index of suspicion for associated ipsilateral proximal.

Two new patients with focal dermal hypoplasia: A novel PORCN variant and insights on the diagnostic considerations.

Mutations in the PORCN gene cause an X-linked dominant condition; focal dermal hypoplasia (FDH), characterized by atrophic skin, pigmented skin lesions in addition to several ocular and skeletal malformations. FDH is rare with around 275 cases reported so far from diverse ethnic groups. Herein, we provide a report of two new patients with FDH from Egypt. In addition to the typical clinical manifestations of the disease, infrequently reported clinical findings in the form of broad metaphysis, bilateral short broad femurs, and dermal sinus over the sacrum were seen in Patient 1 and partial fusion of labia majora, ventral hernia, and bladder extrophy were present in Patient 2. Two heterozygous protein-truncating PORCN mutations were identified in our patients, a known nonsense c.370C>T p.(Arg124Ter) and a novel frameshift c.375delG p.(Ala126HisfsTer3). Segregation analyses confirmed that the two mutations were "de novo" and not inherited from any of the parents. Our study expands the clinical and mutational spectrum of focal dermal hypoplasia and emphasizes the importance of investigating the different body systems and organs for the early management of patients.

Insufficiency Fracture of Simultaneously Bilateral Femur Neck in Patient Treated with Long-Term Bisphosphonate Treatment: A Case Report

Insufficiency Fracture of Simultaneously Bilateral Femur Neck in Patient Treated with Long-Term Bisphosphonate Treatment: A Case Report

Primary malignant multiple osteogenic sarcomas: a rare clinical image.

We present the case of a 12-year- old male patient, who came to the emergency department with a complaint of pain in bilateral knee joints, pain in bilateral lower legs, multiple swelling over the bilateral knee joint and in the leg region, difficulty in walking, stiffness in the bilateral knee joint since he was one year. There is no medical significant history regarding the disease condition. On physical examination, the swelling was in the region of the metaphysic of the distal end of the bilateral femur and proximal end of the bilateral tibia, skin over the swelling was shiny with tenderness and margins were irregular, on the biopsy and X-ray findings patient was diagnosed as primary malignant multiple osteogenic sarcomas. The patient was referred to the dermatology department for further management.

Transcutaneous osseointegration for amputees with short residual bone: Is there increased risk for complications? – A pilot study

Aims: Transcutaneous osseointegration for amputees (TOFA) provides improved mobility and quality of life for most patients versus a traditional socket prosthesis. One uncertainty regarding TOFA is whether a minimum residual bone length is necessary to achieve solid fixation. This study evaluated the relationship between residual bone length and occurrence of post-TOFA complications requiring operative intervention. Patients and Methods: A retrospective review of our osseointegration registry was performed. Inclusion criterion was index osseointegration at least 12 months prior. Chart review included demographics and whether additional surgery occurred to manage noninfected loosening, periprosthetic fracture, and infection. Occurrence rates were compared using binary logistic regression analysis and by stratifying implants as <140 versus ≥140 mm. Results: Sixty segments were included (58 patients and 2 bilateral femur amputees). The implant length averaged 129.4 ± 31.1 (48–200) mm. No noninfected loosening occurred. Six patients (10%) had infection-related post-TOFA operation, at lengths ranging from 130 to 160 mm (representing the central 60% of implant lengths): five were debridement with implant retention and one other was removed. No implants below 130 mm (n = 19, 32%) required debridement or removal. Three patients (5%) had periprosthetic fracture (all femurs), at lengths ranging from 140 to 160 mm (the central 55% of implant lengths); no implants below 140 mm (n = 22, 37%) had periprosthetic fracture. Regression identified no association between length and noninfected loosening (P = 1.000), periprosthetic fracture (P = 0.999), or infection (P = 0.124). Dichotomized <140 versus ≥140 mm rates of complication were as follows: noninfected loosening (0/22 = 0% vs. 0/38 = 0%, P = 1.000), fracture (3/38 = 7.9% vs. 0/22 = 0%, P = 0.292), and infection (5/38 = 13.2% vs. 1/22 = 4.5%, P = 0.400). Conclusion: Residual bone length does not appear to be associated with post-TOFA reoperation to address noninfected loosening, periprosthetic fracture, or infection. The "minimum necessary" length of bone to achieve stable transcutaneous osseointegration capable of supporting full body weight remains uncertain.

複合的指標に基づく重症外傷患者選別基準とアンダートリアージの低下(Composite criteria for identification of severely injured patients and decreased undertriage)

要旨【目的】重症外傷の病院前選別ではアンダートリアージの減少が予後改善に寄与するとされているが，本邦では病院前の重症外傷選定基準に関する研究は少ない。そこで，受傷機転と生理学的・解剖学的所見による複合的基準が重症外傷のアンダートリアージ減少に関連しているか検証した。【対象】2016年10月からの2年間に横浜市指定4区で発生した外傷患者を対象に，後ろ向き観察研究を行った。現場から搬送され入院あるいは外来死亡した症例の中で，来院時心肺停止を除外し解析を行った。研究期間前半はショックを伴う頸胸腹損傷・両側大腿骨骨折を重症外傷と判定し（基準A），後半は高リスク受傷機転および生理学的・解剖学的異常所見を複合的に用いて判定した（基準B）。基準を満たさず搬送され重症外傷と診断された症例をアンダートリアージとし，各基準のアンダートリアージ率を比較した。【結果】539例の対象症例のうち，基準A運用期間は281例，基準B運用期間は258例であった。年齢や重症度は両期間とも相似していたが，緊急手術は基準B運用期間で多かった。アンダートリアージ率は，基準Aで27.6%，基準Bで18.1%であり，基準Bで有意に低かった（p=0.04）。【結語】外傷患者の搬送プロトコールにおいて，受傷機転，生理学的所見，および解剖学的所見を複合的に用いた重症患者選別基準がアンダートリアージの減少につながることが示唆された。

A Rare and Fatal Case of Cutaneous T-Cell Lymphoma (CTCL)

Introduction: Cutaneous T-Cell Lymphoma (CTCL) is a form of Non-Hodgkin Lymphoma involving T-cell neoplasms mainly concentrated in the skin. Primary Cutaneous Peripheral T-Cell Lymphoma is Not Otherwise Specified (PTL-NOS) is the rarest case of CTCL disease.Case Presentation: A female, 35 years old, complained of a lump on her face. In the last 3 months, the lump felt soft, contained a liquid that, when it ruptures, secretes Blood, and the crusty scar will blacken and easily bleed with pain. Physical examination of pale conjunctiva on the face, neck, chest, abdomen, back, and legs obtained nodules with a chewy consistency with erythema appearance in varying size. Some nodules that appear were covered in blackish crustae. The right lung has a decrease in the sound of breath, accompanied by swelling in both limbs. The conclusion of bilateral femur skin biopsy impresses cutaneous T lymphoma cells. Within three months, cancer developed into lesions spread almost throughout the body, and due to the rapid and progressive nature of cancer, its diagnosis developed into PTL-NOS.Conclusions: Patients with PTL-NOS may come with solitary nodules such as red tumors in any area of the body. However, most often, patients come with symptoms of multifocal or diffuse scattered nodules. In enforcing the diagnosis, it takes a high level of suspicion, and multiple rebiopsies are necessary to enforce the diagnosis of CTCL.

890 Bilateral Acetabular Fractures Induced by An Epilepticseizure In a Paediatric Patient: A Unique Case Andits Management

Abstract Bilateral acetabular fractures following epileptic seizures are a rare but known occurrence in adults, with an 18.5% mortality rate. These fractures occurring post epileptic seizures have not been previously documented in children. We report a case of a 13-year-old boy who presented to hospital via ambulance following two violent generalised tonic–clonic seizures in a postictal state, metabolically acidotic and a low haemoglobin. Acute abdomen was suspected, and the patient underwent a CT scan which showed bilateral acetabular fractures with central dislocations of both femoral heads and free fluid in the abdomen. The patient underwent initial damage control intervention with insertion of bilateral distal femur skeletal traction. Definitive fixation of the acetabular fractures occurred 1 week later with an open reduction internal fixation with novel supra- pectineal plates using a Pfannenstiel incision. We use this report to increase awareness of significant pelvic injuries in paediatric patients post epileptic seizures.

Image based quantification of the proximal femur shape deformities in 3D by using the contralateral healthy shape structure: A preliminary study

As a result of the several hip joint disorders seen on the hip joint components, shape deformities occur in the morphological structure of the proximal femurs and femoral heads. Quantification of the shape deformities in related hip joint components is a crucial task since it may provide assistive information to clinical experts and surgeons in clinical treatment, assessment and prognosis processes. In this article, a preliminary study handling the 3D shape deformity quantification of the abnormal proximal femurs is presented. The shape deformity of the abnormal proximal femurs in bilateral hip joint images are quantified directly by using the morphological structure of the contralateral healthy proximal femurs without a need for a statistical shape model. For this purpose, segmentation maps of the bilateral proximal femurs are registered in 3D by performing a rigid transform method, and the regions outside the intersection volume are quantified as the shape deformities. To evaluate the proposed study, a total of 13 bilateral hip magnetic resonance imaging (MRI) sequences of 13 patients with Legg-Calve-Perthes disease (LCPD) were used. The deformity ratios observed in experiments are quite promising and consistent with the Waldenstrom classification system stages of the LCPD. The shape deformity ratios of the pathological proximal femurs in 3D were quantified as 18.02% (±04.84), 26.41% (±07.54), 31.21% (±11.07), and 36.84% (±09.33), respectively for the Initial, Fragmentation, Reossification, and Remodelling stages of LCPD in this preliminary study.

Single-Stage Versus 2-Stage Bilateral Intramedullary Nail Fixation in Patients With Bilateral Femur Fractures: A Multicenter Retrospective Review.

To evaluate rates of complications in patients with bilateral femur fractures treated with intramedullary nailing (IMN) during either 1 single procedure or 2 separate procedures. A multicenter retrospective review of patients sustaining bilateral femur fractures, treated with IMN in single or 2-stage procedure, from 1998 to 2018 was performed at 10 Level-1 trauma centers. Ten Level-1 trauma centers. Two hundred forty-six patients with bilateral femur fractures. Intramedullary nailing. Incidence of complications. A total of 246 patients were included, with 188 single-stage and 58 two-stage patients. Gender, age, injury severity score, abbreviated injury score, secondary injuries, Glasgow coma scale, and proportion of open fractures were similar between both groups. Acute respiratory distress syndrome (ARDS) occurred at higher rates in the 2-stage group (13.8% vs. 5.9%; P value = 0.05). When further adjusted for age, gender, injury severity score, abbreviated injury score, Glasgow coma scale, and admission lactate, the single-stage group had a 78% reduced risk for ARDS. In-hospital mortality was higher in the single-stage cohort (2.7% compared with 0%), although this did not meet statistical significance (P = 0.22). This is the largest multicenter study to date evaluating the outcomes between single- and 2-stage IMN fixation for bilateral femoral shaft fractures. Single-stage bilateral femur IMN may decrease rates of ARDS in polytrauma patients who are able to undergo simultaneous definitive fixation. However, a future prospective study with standardized protocols in place will be required to discern whether single- versus 2-stage fixation has an effect on mortality and to identify those individuals at risk. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Fracture morphology and biomechanical characteristics of Pauwels III femoral neck fractures in young adults

BackgroundPauwels classification, which categorizes types of femoral neck fractures, cannot fully reflect the three-dimensional characteristics of this injury. The purpose of our study was to determine the morphological characteristics of Pauwels III fractures through computed tomography image analysis and summarize the relevant biomechanical characteristics of different morphological fractures. MethodsWe retrospectively reviewed a total of 209 patients diagnosed with Pauwels type III femoral neck fractures. Fracture reduction was simulated based on mirror symmetry of the bilateral femur by Mimics. The fracture angle was measured and subtypes were defined. Biomechanical characteristics were compared by finite element analysis and validated using a biomechanical experiment, which was performed on a cadaveric sample. ResultsPauwels III femoral neck fractures can be divided into three subtypes: anterior, posterior, and classical. The proportion of three subtypes was 28.71%, 67.46%, and 3.82%, respectively. The anterior subtype showed the lowest axial stiffness but highest implant and bone stress. High stress distributions was concentrated on the screw-bone interface and screw-plate connections. ConclusionsBiomechanical differences across the three subtypes of Pauwels III femoral neck fractures could increase our understanding of the biomechanical characteristics that underlie the Pauwels type III femoral neck fractures (such as, three-dimensional morphology and the stress distribution of bone and implant) that have been associated with high failure rates.

Reversing Rivaroxaban Anticoagulation as Part of a Multimodal Hemostatic Intervention in a Polytrauma Animal Model.

Life-threatening bleeding requires prompt reversal of the anticoagulant effects of factor Xa inhibitors. This study investigated the effectiveness of four-factor prothrombin complex concentrate in treating trauma-related hemorrhage with rivaroxaban-anticoagulation in a pig polytrauma model. This study also tested the hypothesis that the combined use of a low dose of prothrombin complex concentrate plus tranexamic acid and fibrinogen concentrate could improve its subtherapeutic effects. Trauma (blunt liver injury and bilateral femur fractures) was induced in 48 anesthetized male pigs after 30 min of rivaroxaban infusion (1 mg/kg). Animals in the first part of the study received prothrombin complex concentrate (12.5, 25, and 50 U/kg). In the second part, animals were treated with 12.5 U/kg prothrombin complex concentrate plus tranexamic acid or plus tranexamic acid and fibrinogen concentrate. The primary endpoint was total blood loss postinjury. The secondary endpoints (panel of coagulation parameters and thrombin generation) were monitored for 240 min posttrauma or until death. The first part of the study showed that blood loss was significantly lower in the 25 U/kg prothrombin complex concentrate (1,541 ± 269 ml) and 50 U/kg prothrombin complex concentrate (1,464 ± 108 ml) compared with control (3,313 ± 634 ml), and 12.5 U/kg prothrombin complex concentrate (2,671 ± 334 ml, all P < 0.0001). In the second part of the study, blood loss was significantly less in the 12.5 U/kg prothrombin complex concentrate plus tranexamic acid and fibrinogen concentrate (1,836 ± 556 ml, P < 0.001) compared with 12.5 U/kg prothrombin complex concentrate plus tranexamic acid (2,910 ± 856 ml), and there were no early deaths in the 25 U/kg prothrombin complex concentrate, 50 U/kg prothrombin complex concentrate, and 12.5 U/kg prothrombin complex concentrate plus tranexamic acid and fibrinogen concentrate groups. Histopathologic analyses postmortem showed no adverse events. Prothrombin complex concentrate effectively reduced blood loss, restored hemostasis, and balanced thrombin generation. A multimodal hemostatic approach using tranexamic acid plus fibrinogen concentrate enhanced the effect of low doses of prothrombin complex concentrate, potentially reducing the prothrombin complex concentrate doses required for effective bleeding control.

外科的介入が遅延し，入院後に多発膿瘍を合併した化膿性胸鎖関節炎の1例(Delayed surgical intervention after admission caused whole body multiple abscesses in the patients with septic arthritis of the sternoclavicular joint: a case report)

要旨化膿性胸鎖関節炎は，胸鎖関節周囲の軟部組織に膿瘍形成を来す疾患で，主に整形外科で扱われるが，敗血症性ショックで救命救急センターに搬入される症例は稀である。今回，外科的介入を含めた集学的治療が必要であった化膿性胸鎖関節炎の1例を経験したので報告する。症例は既往歴にコントロール不良の糖尿病がある49歳の男性。1週間前より左鎖骨痛，その2日後に右肩痛が出現し，徐々に痛みの増悪と意識障害を来し，前医にて敗血症性ショックとなり当院へ救急搬送された。CTでは頸部から胸骨にかけて小さな膿瘍形成を認めた。保存的加療で全身状態の改善が得られ，第9病日には一般病棟へ転床した。その後，炎症反応の再燃があり，第16病日の造影CTで，膿瘍は縦隔に進展し，左前腕部，左膝部，両側大腿骨周囲に膿瘍の形成を認めた。抗菌薬投与に加えて胸腔鏡補助下縦隔ドレナージ術および多発膿瘍に対して開窓術を行い，炎症所見は改善し，第69病日にリハビリ目的に転院となった。頸部領域の膿瘍で胸鎖関節周囲が関与している場合は本疾患を鑑別に挙げ，MRIも踏まえた関節炎・骨髄炎の有無について早期に診断を行い，常に外科的介入を念頭に置いたうえで遅延なく的確に行うことが重要である。

Hypophosphatemic osteomalacia in neck femur fracture: Case series

Background: In adult acquired hypophosphatemic osteomalacia is generally associated with Biochemical abnormalities. Aims and Objective: To study Hypophosphatemic Osteomalacia in Neck femur fracture : A case series of 10 patients. Methodology: This was a cross-sectional study carried out in the department of Orthopedics from Aug 2015 to August 2016 in the patients who complained of Bilateral Hip (Groin) Pain and inability to walk were; Clinical, Radiological and all laboratory investigations whenever required were done and patients which were having final diagnosis of hypophosphatemic Osteomalacia in Neck femur fracture were included into the study during the study period. All details of the patients like age, sex and clinical features were noted. The data analysis was done by Excel software for windows 10. Result: In our study we have seen that the majority of the patients were in the age group of 60-70(40%), followed by 50-60 (20%), >70 (20%), 40-50 (10%), 30-40 (10%). The majority of the patients were Female (60%) and Males were 40%. The most common clinical features were Bilateral Hip (Groin) Pain (100%), Inability to walk (90%), Bilateral femur fracture (X-ray) in 30%, Unilateral femur fracture (X-ray ) in that Left was predominant i.e. 50% and Right were 20%. In the laboratory findings the all parameters were apparently normal except high Serum ALP level, low Serum Phosphorus level. Treatment and Outcome: Patient were treated conservatively they advised bed rest and supplementation of Tab. Endocal Forte OD, Protocol Supplement 2tsp with milk BD Adophos Sachet in ½ glass of Water QID, Tab. Rocaltrol (2.5) QID, average Patient were walking without support in an average 2 weeks, Pain decreased and also there is improvement of haematological parameter, X-ray shows signs of healing fracture. Conclusion: Hypophosphatemic Osteomalacia is commonly missed due to nonspecific signs and symptoms, but thorough investigation of blood and radiograph required for non-traumatic hip pain. This is rare condition needs high index of suspicion. This is totally curable by conservative Methods.

Blood Loss in Rivaroxaban Anticoagulated Pigs with Severe Polytrauma Is Significantly Reduced By Early Therapy with Prothrombin Complex Concentrate

Introduction: The reversal of the anticoagulant effects of rivaroxaban in severely bleeding patients remains uncertain with conflicting evidence. In this ongoing study we assessed the ability of a four-factor prothrombin complex concentrate (PCC) to reverse rivaroxaban anticoagulation in a porcine polytrauma model.Methods: After ethical approval, rivaroxaban was infused over 30 min (1 mg/kg/h) prior to injury in anaesthetized male pigs (n=24); the sham group (n=8) received placebo. A standardized blunt liver injury and bilateral femur fractures were induced. After trauma and hemorrhagic shock, animals were resuscitated 5 min post injury with Ringer's solution and blood loss (BL) was recorded 12 min post trauma. Randomized animals (n=8/group) received a single injection of PCC (25 or 50 IU/kg), or vehicle (control). Animals were observed up to 180 min after trauma, and total BL was assessed after the observation period or animal's death. Coagulation variables included rivaroxaban plasma concentration, global coagulation assays (PT, aPTT) and thromboelastometry. For a differentiated risk assessment, thrombin generation and thrombin-antithrombin (TAT) levels, indicating the extent of coagulation activation were obtained. BL and hemodynamic variables were monitored over 3 h or until time of death. For statistical analysis, ANOVA (mean ± SD) and the log-rank test for survival were used.Results: After infusion and prior to injury rivaroxaban levels were 666 ± 88 ng/mL. In contrast to sham animals (BL: 467 ± 56 mL), BL in in all anticoagulated animals was significantly elevated 12 min post injury (BL: 810 ± 83 mL). Anticoagulation with rivaroxaban without PCC therapy resulted in a total BL of 3111 ± 479 mL with 88 % mortality (survival time: 50-180 min; p<0.05 vs PCC treated animals and sham). The application of 25 IU/kg PCC (1497 ± 292 mL) or 50 IU/kg PCC (1468 ± 107 mL) showed a significant reduction in total BL with 100% survival and no significant difference between groups. The application of PCC was associated with a dose-depended increase in peak thrombin generation (Peak height; figure 1). D-Dimer increased after trauma in sham and PCC treated animals. However, no difference in D-Dimer concentration in the PCC 25 or 50 IU/kg group was measured post injury. Clinically and macroscopically no adverse events were observed.Conclusions: This porcine model demonstrates a four-factor PCC may be a reasonable and safe intervention for rivaroxaban-treated patients with life-threatening haemorrhage, though these data need clinical confirmation. [Display omitted] DisclosuresGrottke:Boehringer Ingelheim: Research Funding; Bayer: Research Funding; CSL Behring: Research Funding; Portola: Research Funding; Boehringer Ingelheim: Consultancy; Octapharma: Research Funding.

Local administration with tauroursodeoxycholic acid could improve osseointegration of hydroxyapatite-coated titanium implants in ovariectomized rats.

Despite advances in the pathogenesis of Tauroursodeoxycholic acid (TUDCA) on bone, the understanding of the effects and mechanisms of bone osseointegration in TUDCA-associated Hydroxyapatite (HA)-coated titanium implants remains poor. Therefore, the present work was aimed to evaluate the effect of local administration with TUDCA on HA-coated titanium implants osseointegration in ovariectomized(OVX) rats and further investigation of the possible mechanism. Twelve weeks after bilateral ovariectomy, all animals were randomly divided into three groups: sham operation(Sham) group, OVX group and TUDCA group, and all the rats from Sham group and OVX group received HA implants and animals belonging to group TUDCA received TUDCA-HA implants until death at 12 weeks. The bilateral femurs of rats were harvested for evaluation. TUDCA increased new bone formation around the surface of titanium rods and push-out force other than group OVX. Histology, Micro-CT and biochemical analysis results showed systemic TUDCA showed positive effects than OVX group on bone formation in osteopenic rats, with beneficial effect on via activation OPG/RANKL pathway and BMP-2/Smad1 pathway and microarchitecture as well as by reducing protein expression of TNF-α and IFN-γ. The present study suggests that local use of TUDCA may bring benefits to the osseointegration of HA-coated titanium implants in patients with osteoporosis, and this effect may be related to the inhibition of inflammatory reaction and promotion of osteogenesis.

Comparison of novel DXA system, Shimazu SONIALVISION G4, with GE-Lunar PRODIGY.

SONIALVISION G4 (Shimadzu, Kyoto, Japan) is a fluoroscopic imaging system capable of dual-energy X-ray absorptiometry (DXA) using the additional application. However, bone mineral density (BMD) with this system is calibrated only by a phantom, and the necessity to confirm the reliability of BMD measurement in human subjects has been pointed out. This study aimed to evaluate the clinical reliability of BMD measurement using SONIALVISION G4 by comparing it with PRODIGY (GE Healthcare, Madison, WI, USA), a reference system in developing the DXA application. BMD measurements using these two DXA systems were performed on the same day at the lumbar spine and bilateral proximal femur of 130 subjects aged 22-86years. The agreement and correlation between the measurements were determined. Thirty out of the 130 subjects were scanned twice to determine the precision of the SONIALVISION G4 system. BMD was highly correlated between the two DXA systems both at the lumbar spine and proximal femur, with correlation coefficients ranging from 0.963 (left total hip) to 0.989 (left femoral neck). Differences in BMD measured by the two systems were less than 3.0%, but a small proportional bias was observed in the Bland-Altman analysis. Coefficients of variation in BMD measurement were 1.77% in the lumbar spine and 1.41-2.76% in the proximal femur. Although BMD values by SONIALVISION G4 were close to those by PRODIGY, follow-up studies should be performed using the same device because of the small difference between devices.

A case of bilateral hip and knee osteonecrosis in a patient with ankylosing spondylitis who used steroids due to immune thrombocytopenic purpura

We aim to present a case of bilateral hip and knee osteonecrosis due to steroid use in an ankylosing spondylitis (AS) patient who developed immune thrombocytopenic purpura (ITP) after the use of nonsteroidal anti-inflammatory drugs (NSAID). A 60-year-old male patient was diagnosed with AS with bilateral sacroiliitis and inflammatory low back pain on sacroiliac radiography 10 years ago. He was followed up with NSAIDs. Intravenous steroid treatment was started in the hematology clinic to the patient who had developed ITP due to NSAID usage. The patient presented to our clinic with bilateral hip pain that developed after steroid therapy. He had limited hip joint movement and bilateral destructive hip joints in pelvic radiography. Bilateral total hip arthroplasty (THA) was performed by the Orthopedics and Traumatology Department at 1-year intervals because of osteonecrosis associated with steroid use. When he presented to our clinic 3 years later with bilateral knee pain, we detected osteonecrosis in the distal segments of bilateral femurs and proximal tibial diaphysis on knee MRI. We implemented a rehabilitation program with the conservative treatment recommendation of orthopedics. Comorbidities or drug side effects should be examined more carefully while treating peripheral joint involvement in patients with AS.

Bone infarct (osteonecrosis) as late side effect of steroid in acute lymphoblastic leukemia survivor

Survivors of acute lymphoblastic leukemia (ALL), though cured of their primary disease may suffer from long-term complications such as bone infarction contributing to a major morbidity. Here, we report a very rare case of bone infarct in bilateral tibia and femur of a patient of acute lymphoblastic leukemia, post completion of maintenance chemotherapy. With this case report, we suggest that appropriate preventive measures are necessary to decrease the risk of this very rare morbidity.