Bone Fractures In Patients Research Articles

Proton pump inhibitor use and bone fractures in patients with chronic kidney disease.

Patients with chronic kidney disease (CKD) are at high risk for bone fractures, which are associated with high morbidity and mortality. Proton pump inhibitors (PPI) have been linked to an increased risk for fractures in the general population as well as in patients with need for hemodialysis, but studies in patients with CKD are currently missing. We performed a population-based observational case-control study exploring a sample of patients with CKD derived from the IQVIATM Disease Analyzer database. Patients with and without fractures were matched using the 1:1 nearest neighbor propensity score matching method. To investigate the association between PPI use and fractures, multivariable logistic regression analyses were performed adjusting for confounding factors. In total, 6076 patients with and 6076 patients without fractures were matched and subsequently available for analyses. In the total cohort, PPI use was associated with an increased risk for fractures (OR 1.68; 95% CI 1.55-1.83). This association was noted for nearly all types of fractures. The strongest association between PPI use and fractures was found in patients below the age of 60 with a PPI prescription for longer than two years (OR 6.85, 95% CI 1.85-25.38). The same was true, when analyzing cumulative PPI doses. Here, patients below the age of 60 with a cumulative PPI dose above 16000mg (highest quartile) had the highest risk for fractures (OR 4.62, 95% CI 1.87-11.44). There was no difference between men or women regarding the association between PPI use and fractures. This study provides evidence that PPI use is associated with fractures in patients with CKD. Deprescription of PPI in patients without an indication for treatment could be a modifiable risk factor to reduce fracture risk in this high-risk group.

JUSTIFICATION OF THE COMPLEX TREATMENT OF PURULOUS COMPLICATIONS OF FOOT INJURIES IN PATIENTS WITH DIABETES MELLITUS

In recent years, despite the development of modern methods of diagnosis and treatment of foot injuries in patients with diabetes mellitus, there has been an increase in the number of purulent-necrotic complications with a significant percentage of generalization of the infection. Due to potentially "catastrophic" wound healing, uncontrolled, irrational use of antibiotics, lack of regular blood glucose control, implementation of long and complex surgical interventions leads to the development of complications, including infection. The aim of the study. To substantiate the expediency of using a complex treatment scheme for purulent complications of foot bone fractures in patients with diabetes. Materials and methods. The results of treatment of 25 diabetic patients with foot injuries complicated by a purulent process were analyzed. In order to restore homeostasis disorders, patients received a complex of medical measures, including surgical treatment, infusion therapy, immunotherapy, antibiotic therapy. Patients were under the constant control of an endocrinologist. The results. As a result of complex treatment of patients, the inflammatory process was stopped in 21 (84%) patients, however, in 1 (4%) patient with stage 3 diabetic foot syndrome and in 3 (12%) patients with stage 4 according to the F.W.Wagner classification, the inflammatory process spread on the shin, therefore amputation was performed in this patients. The use of the developed treatment tactics, which included drainage of the wound with the removal of destroyed bone fragments, fixators (pins, screws, plates) in the maximum possible volume is the most effective method of surgical treatment of patients with this form of inflammation and allows you to save the foot, avoid the progression of purulent process and repeated surgical intervention.

Osteoporosis and bone fractures in patients with celiac disease: A nationwide cohort study.

Celiac disease (CD) is an autoimmune disease caused by an abnormal immune response triggered by ingestion of gluten. Treatment of CD is a lifelong gluten-free diet. Both diagnosed and undiagnosed CD has been found to be associated with reduced bone mineral density, which can lead to an increased risk of fractures. We therefore aimed to investigate the association of CD and the risk of fractures and osteoporosis in Denmark in a nationwide registry-based study. We identified all patients with CD (ICD-10 code K90.0) between 2000 and 2018 and included those with at least two contacts with a CD diagnosis. In total, 9397 CD patients and 93,964 randomly selected age- and sex-matched (1:10) references from the general population were identified. The overall hazard ratio (HR) of developing osteoporosis in CD patients compared with matches was 5.39 (95% confidence interval (CI): 4.89, 5.95), however when excluding events of osteoporosis occurring within 12months from the date of diagnosis the overall HR was reduced to 3.87 (95% CI: 3.44, 4.33). The HR for major osteoporotic fractures was 1.37 (95% CI: 1.25, 1.51) and for any fractures 1.27 (95% CI: 1.18, 1.36). For osteoporosis, major osteoporotic fractures, and any fracture prior to diagnosis of CD the odds ratios comparing CD patients with matches were 4.32 (95% CI: 3.64, 4.68), 1.29 (95% CI: 1.21, 1.37) and 1.34 (95% CI: 1.27, 1.41), respectively. Thus, this study showed an increased risk of osteoporosis and bone fractures among individuals with CD, both before and after diagnosis of CD. These results underline that the risk of osteoporosis should be considered in the clinical management of patients with CD and that early diagnosis and treatment could be important.

GENESIS OF TRAUMA IN PATIENTS WITH LONG BONE FRACTURES COMPLICATED UNDER COVID-19

Traumatology is one of the branches of medicine that cannot suspend its activities, despite the danger of the COVID-19 epidemic. Treatment of skeletal bone fractures in patients with COVID-19, given the novelty of this problem, is one of the most difficult tasks of modern traumatology and orthopaedics. Bone fractures against the background of COVID-19 are characterized not only by high mortality and disability, but also by unpredictable progression. The aim of our study was to study the impact of the mechanism of occurrence and traumatogenesis of long bone fractures in patients with COVID-19. To carry out the research tasks, we formed a retrospective study array, which consisted of 289 cases of skeletal bone fractures, which were treated at the "Kyiv City Clinical Hospital of Emergency Medical Care" from March 2020 to February 2021. The main mechanism of injury in patients with skeletal bone fractures against COVID-19 was a fall from a height, which was observed 1.5 times more often than in the pre-war period. There was a 10% reduction in high-energy injury mechanisms such as falls from height and direct impact during the epidemic period, and an almost 10% increase in low-energy compression injury mechanisms. Among the patients of the main group, the combination of lighter mechanisms of injury such as falling and compression was more often detected, in contrast to the patients of the control group, where more high-energy mechanisms of trauma from a fall and a direct blow prevailed. During the COVID-19 epidemic, domestic injuries as a cause of fractures increased sharply and the specific gravity of road accidents decreased sharply, which is associated with epidemic restrictions. During the period of the COVID-19 epidemic, industrial injuries significantly decreased, while criminal and combined injuries remained at the same level as before the epidemic.

Predictors of Middle Meningeal Artery-Related Vascular Diseases Associated with Blunt Head Trauma

Traumatic middle meningeal artery (MMA)-middle meningeal vein (MMV) fistula (MMA-MMV fistula) and MMA pseudoaneurysm are the 2 main MMA-related vascular diseases occurring after blunt head trauma. These are rare but known causes of delayed intracranial hemorrhage. This study investigated predictors that may aid in the diagnosis of these diseases. In our department, screening digital subtraction angiography (DSA) is performed for patients with blunt head trauma accompanied by intracranial hemorrhage and skull or facial bone fracture. This study included 87 patients who underwent screening DSA without craniotomy from January 2019 to June 2023. The patients' clinical characteristics were retrospectively collected from the database. Statistical analysis was performed to examine the associations of various evaluation items with MMA-related vascular diseases. The first DSA examination revealed 34 MMA-MMV fistulas and 1 MMA pseudoaneurysm. The second follow-up DSA examination revealed 13 MMA-MMV fistulas and four MMA pseudoaneurysms. Temporal/parietal bone fracture (odds ratio, 5.33; P=0.0005; 95% confidence interval, 1.95-14.60) was significantly associated with MMA-related vascular diseases. Endovascular treatments were performed in 9 patients. All procedures were successfully completed without complications; no delayed bleeding was observed. Temporal/parietal bone fracture in patients with blunt head trauma is a likely predictor of MMA-related vascular diseases. When initial head computed tomography reveals this pathology, we recommend careful imaging follow-up (e.g., DSA) and treatment as needed, while considering the possibility of MMA-related vascular diseases.

Reduced Bone Regeneration in Rats With Type 2 Diabetes Mellitus as a Result of Impaired Stromal Cell and Osteoblast Function-A Computer Modeling Study.

Bone has the fascinating ability to self-regenerate. However, under certain conditions, such as type 2 diabetes mellitus (T2DM), this ability is impaired. T2DM is a chronic metabolic disease known by the presence of elevated blood glucose levels that is associated with reduced bone regeneration capability, high fracture risk, and eventual non-union risk after a fracture. Several mechanical and biological factors relevant to bone regeneration have been shown to be affected in a diabetic environment. However, whether impaired bone regeneration in T2DM can be explained due to mechanical or biological alterations remains unknown. To elucidate the relevance of either one, the aim of this study was to investigate the relative contribution of T2DM-related alterations on either cellular activity or mechanical stimuli driving bone regeneration. A previously validated in silico computer modeling approach that was capable of explaining bone regeneration in uneventful conditions of healing was further developed to investigate bone regeneration in T2DM. Aspects analyzed included the presence of mesenchymal stromal cells (MSCs), cellular migration, proliferation, differentiation, apoptosis, and cellular mechanosensitivity. To further verify the computer model findings against in vivo data, an experimental setup was replicated, in which regeneration was compared in healthy and diabetic after a rat femur bone osteotomy stabilized with plate fixation. We found that mechanical alterations had little effect on the reduced bone regeneration in T2DM and that alterations in MSC proliferation, MSC migration, and osteoblast differentiation had the highest effect. In silico predictions of regenerated bone in T2DM matched qualitatively and quantitatively those from ex vivo μCT at 12 weeks post-surgery when reduced cellular activities reported in previous in vitro and in vivo studies were included in the model. The presented findings here could have clinical implications in the treatment of bone fractures in patients with T2DM. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

272P Primary prevention of bone fractures in patients (pts) with hormone receptor (HR)+ early breast cancer (EBC) during adjuvant hormonal therapy (HT): The predict & prevent project (P&P)

272P Primary prevention of bone fractures in patients (pts) with hormone receptor (HR)+ early breast cancer (EBC) during adjuvant hormonal therapy (HT): The predict & prevent project (P&P)

Survival analysis in nonagenarian patients with non-hip lower limb fractures.

The United Kingdom has an aging population with nearly 1 in 5 being over the age of 65, and over 0.5 million over the age of 90. The treatment of acute fractures of the lower limb in the nonagenarian cohort of patients poses a technical challenge to orthopaedic surgeons. To report the fracture incidence, survival outcomes of treating acute non-hip lower limb fractures in nonagenarians in Major Trauma Centre. Thirty Lower limb long bone fractures in patients of age from 90 to 99 years were identified during 12-mo at a Level 1 trauma centre from a computerized database. A retrospective evaluation performed for fracture incidence, treatment, length of hospital duration and mortality at 30-d, 1-year and 2-year. Thirty fractures (28 patients) were identified, twenty-four fractures were treated with surgery (mean age 93 years SD ± 2.59) and 6 managed conservatively (mean age 94 years SD ± 2.07). The mean length of the hospital stay was 18.2 d for both groups. The 30-d, 1-year and 2-year mortality risks were 1/23, 6/23 and 9/23 (4%, 26% and 39%) in the surgery group and 0/5, 1/5 and 2/5 (0%, 20% and 40%) in the conservative group, with no evidence for a difference between the two groups at any time point. Nonagenarians in the surgical group had similar length of hospital stay and mortality risks as those treated conservatively. Patients with fewer comorbidities and admitted from their own home were offered surgery.

#3048 INDOXYL SULFATE INHIBITS OSTEOGENESIS OF BONE MARROW DERIVED MESENCHYMAL STEM CELLS THROUGH AHR/HES1/BMP2 PATHWAY

Abstract Background and Aims There is a high global burden of chronic kidney disease (CKD). The increased risk of bone fracture in patients with CKD suggests that CKD-associated factors, such as uremic toxins, might be the cause. Recent studies demonstrated that low turnover osteodystrophy and bone formation defect develop in early CKD, which indicates that uremic toxins, particularly in relatively low concentrations, can potentially be a cause. Thus far, studies about defected osteogenesis adopted high concentrations of uremic toxins (for example, indoxyl sulfate (ISx) >100 μM). Furthermore, the pathology is not yet fully investigated. Uremic toxin induced aryl hydrocarbon receptor (AHR) has been linked to bone formation defect, however, the mechanisms are incompletely understood. AHR inhibit osteogenesis during early processes of differentiation of early cells (stem cells), but whether uremic toxins induced AHR to affect stem cell in osteogenesis lineage has yet to be studied. The present study aims to clarify whether ISx at concentrations approximate to average in CKD patients (20 μM in free form) affect osteogenesis of bone marrow-derived mesenchymal stem cells (BMSCs), and further survey the underline signal transduction of AHR-induced defected osteogenesis. Method Mineralization of D1 cells (mouse BMSCs) was evaluated by alizarin red S staining (ARS). The mRNA expressions and protein levels of osteogenic markers including Runx2, BMP2, ALP, and osteocalcin were determined by quantitative real-time polymerase chain reaction (RT-PCR) and western blotting. AHR translocation into the nucleus was evaluated by an immunofluorescence confocal microscope. Reporter gene assays were adopted to study the transcriptional regulation of Runx2 and BMP2. Results ISx at concentrations ≤50 μM significantly downregulated mineralization of BMSCs with the most influence in the early stage of osteogenesis. ISx decreased the mRNA expressions and protein levels of osteogenic markers Runx2, BMP2, ALP, and osteocalcin. ISx of 50 μM induced AHR translocation into the nucleus and upregulated AHR target genes CYP1a1 and CYP1b1. The ISx-induced mineralization defects of BMSCs were counteracted by AHR antagonist CH223191, while downregulated gene expressions of osteogenic markers were recovered by AHR antagonist and knockdown (KD) of AHR. In mechanistic studies, ISx upregulated mRNA levels of hairy and enhancer of split (HES1), which is a primary target of NOTCH signaling. Although there were no significant differences in expressions of Notch1∼4, the upregulated Hes1 was attenuated by the antagonist and KD of AHR, which indicated that Hes1 was directly regulated by AHR. We identified putative binding sites of transcription repressor Hes1 in the promoter area of BMP2 and Runx2. Following experimental treatment of ISx, expression levels of BMP2 and Runx2 monitored by reporter assays were downregulated, which indicated that Hes1 plays as a transcription repressor to downregulated BMP2 and Runx2. Conclusion ISx under clinically relevant concentrations attenuated mineralization of BMSCs, particularly in the early stage of osteogenesis. ISx-induced AHR upregulated Hes1, which inhibited expressions of not only Runx2, but also BMP2, which has not been published before. A study of the underline signal transduction pathways relevant to the AHR genomic control system may provide potential therapy for low bone formation in early CKD.

Etiology and Epidemiology of Nasal Bone Fractures in Patients Referred to the Otorhinolaryngology Section, 2019.

Introduction One of the most observed diseases in the otorhinolaryngology emergency, compared with the other facial fractures, is related to nasal bone fractures (NBFs). The peak of incidence is seen in the age group ranging from 11 to 30 years old. Objective The present evaluation was devoted to the etiology and epidemiological study of NBFs. Methods In the present cross-sectional study, 376 patients with NBF were evaluated. The necessary information such as gender, age, education, job, causes of NBF, and clinical symptoms of patients have been recorded on the checklist. Results The study revealed that 76.9% of the patients were male and 23.1% were female; 37.5% of all patients were self-employed, and most of them were from urban areas. Traffic accident (26.6%) and falling (25.5%) were the main reasons for NBF. The most common clinical symptoms for NBF were tenderness (96%; n = 361), nasal swelling (90.4%; n = 340), and deformity (89.4%; n = 336). Conclusion The results showed that the incidence of NBFs in young men without higher education level and self-employed were high which can be related to the traffic accidents and fights. Also, falls, beatings and accidental hit are the most common causes of NBFs among women. Therefore, to decrease the incidence of otorhinolaryngology trauma, training about the general life skill and providing awareness about using personal safety equipment and measures should be increased at the future.

A case series on post-traumatic facial nerve palsy

Road traffic accidents accounts a for substantial proportion of traumatic facial nerve injuries. Facial nerve paralysis causes considerable facial disfigurement and emotional distress to the patient. It can cause detrimental effect on both voluntary and involuntary actions of facial muscles. Importantly, it can interrupt normal daily functions such as eating and drinking. Therefore, early identification and surgical intervention are of prime importance in the management of traumatic facial nerve palsies, which is described below in this case series. The goal is to find out type of temporal bone fractures in patients with traumatic facial nerve palsy, to find out the common site of facial nerve injury in patients with traumatic facial nerve palsy, and to assess the surgical outcomes in patients who underwent facial nerve decompression. Case series of five patients who are admitted in ENT Wards in Rajiv Gandhi Government General hospital with traumatic facial nerve palsy were included in this study. Thorough history taking, otoscopic examination, audiological evaluation, radiological Imaging (HRCT temporal bone), topodiagnostic tests, and nerve conduction studies were done in all the five cases. All five patients presented with either grade 3/grade 4 facial palsy according to House–Brackmann’s grading system. HRCT temporal bone showed a fracture line in all the five cases. Electroneuronography showed more than 90% degeneration in all the cases. All the patients underwent facial nerve decompression followed by a course of oral steroids and post-operative physiotherapy. All five cases showed remarkable improvement in facial palsy after surgery with leveling up to House–Brackmann grade 2 and grade 1, early identification of facial nerve palsy due to trauma and prompt management by surgical intervention plays a important role in the management of facial nerve palsy.

P341 Fracture risk in middle-age and older patients with inflammatory bowel disease: A Korean nationwide population-based cohort study

Abstract Background Fracture risks and associated factors in middle-age and older Asian populations with inflammatory bowel disease are poorly understood. We investigated fracture risk and the effects of comorbidities and lifestyle habits on the risk of developing fractures in middle-age and older Korean patients with inflammatory bowel disease. Methods We conducted a nationwide population-based cohort study using data from the National Health Insurance Corporation Database. We included patients aged over 40 years with inflammatory bowel disease who received the National Screening Program. We compared patients with age- and sex-matched controls. The incidence of fractures, including vertebral, hip, and other sites was determined using claims data. Results The risk of total fractures and vertebral fractures was significantly higher in the inflammatory bowel disease group [adjusted hazard ratio=1.31, 95% confidence interval=1.16–1.48; adjusted hazard ratio=1.59, 95% confidence interval=1.33–1.92, respectively]. Obesity, diabetes, hypertension, and lack of exercise were associated with an increased risk of fracture in patients with ulcerative colitis. In contrast, risk tended to increase regardless of comorbidities and lifestyle habits in patients with Crohn’s disease. Conclusion The risk of bone fracture, especially vertebral fracture, is high in middle-age and older Korean patients with inflammatory bowel disease. Obesity, diabetes, hypertension, and lack of exercise are risk factors for bone fracture in patients with ulcerative colitis. These findings may be helpful for clinicians to educate patients with inflammatory bowel disease on bone health and raise awareness of bone fractures in patients with ulcerative colitis who have specific risk factors.

Fracture Risk in Middle-Aged and Older Patients With Inflammatory Bowel Disease: A Korean Nationwide Population-Based Cohort Study.

Fracture risks and associated factors are poorly understood in middle-aged and older Asian populations with inflammatory bowel disease (IBD). Therefore, we investigated fracture risk and the effects of comorbidities and lifestyle habits on the risk of developing fractures in middle-aged and older Korean patients with IBD. We conducted a nationwide population-based cohort study using data from the National Health Insurance Corporation Database. Patients with IBD who underwent the National Screening Program and were over 40 years of age were included in the study. We compared patients with age- and sex-matched controls. The incidence of fractures, including vertebral, hip, and other sites, was determined using claims data. The risk of total fractures and vertebral fractures was significantly higher in the IBD group (adjusted hazard ratio [HR], 1.31, 95% confidence interval [CI], 1.16-1.48; adjusted HR, 1.59, 95% CI, 1.33-1.92, respectively). Obesity, diabetes, hypertension, and lack of exercise were associated with increased fracture risk in patients with ulcerative colitis (UC). In contrast, the risk increases in patients with Crohn's disease regardless of comorbidities and lifestyle preferences. The risk of bone fracture, especially vertebral fracture, is high in middle-aged and older Korean patients with IBD. Obesity, diabetes, hypertension, and lack of exercise are all risk factors associated with bone fractures in patients with UC. These findings are helpful for clinicians to educate patients with IBD on bone health and raise awareness of bone fractures in patients with UC who have specific risk factors.

Age-Related Characteristics of Mineral and Bone Metabolism in Patients with Chronic Kidney Disease Stage 5D on Hemodialysis

Summary Abnormalities in mineral and bone metabolism are a risk factor for increased cardiovascular and all-cause mortality and bone fractures in patients with chronic kidney disease stage 5D (CKD 5D). This single-center study aimed to investigate the age-related features of mineral and bone disorders in patients with CKD 5D on haemodialysis treatment and analyse the therapy provided. The biochemical parameters of mineral and bone metabolism and the ongoing therapy were studied in 90 patients undergoing hemodialysis treatment, of whom 44 (48.9%) were aged <65 years and 46 (51.1%) were aged ≥65 years. Serum phosphate, 25(OH) vit.D, parathyroid hormone, and serum albumin were significantly lower in patients aged ≥65 years compared with patients aged <65 years. There was a significant negative correlation between these parameters and age. We found no significant differences in therapy between the two age groups. A significant proportion of the patients aged ≥65 years had serum calcium and parathyroid hormone values below the lower desirable limit, while most of those aged <65 years had hyperphosphatemia and parathyroid hormone ≥600 pg/ml. Mineral and bone metabolism in CKD stage 5D patients on hemodialysis showed age-dependent patterns. Knowing them is crucial for optimal treatment.

Avascular Necrosis and Minimal Trauma Bone Fractures in Patients with Dyskeratosis Congenita

Introduction: Dyskeratosis congenita (DC) and related telomere biology disorders (TBD) result from germline variants in genes required for telomere maintenance. DC is traditionally characterized by a triad of nail dysplasia, oral leukoplakia, and reticular skin pigmentation. Significant complications include bone marrow failure (BMF), pulmonary fibrosis, liver disease, and hematologic and solid organ malignancies. Previous reports described avascular necrosis (AVN) of the femoral head or humerus in DC/TBD. However, these findings were limited to a few individual case reports. Herein, we present a study of AVN and minimal trauma fractures (MTF) in a large cohort of patients with DC/TBD. Methods: We reviewed medical records of all patients with a confirmed diagnosis of DC/TBD enrolled in the IRB-approved Inherited Bone Marrow Failure Syndromes study (NCT00027274) between 2002 - 2019 for the history of AVN and/or MTF. Data were compiled on DC/TBD characteristics, treatments, as well as body mass index (BMI), lipid profile, bone mineral density (BMD), and 25-hydroxyvitamin D (25[OH]D) levels. We used stratified random sampling to match DC/TBD patients with AVN and/or MTF by age, gender, inheritance pattern and genotype with a control group of DC/TBD patients with no AVN/MTF. Distributional variance was assessed for all t-tests and two-sided p values <0.05 were considered significant. Statistical analysis was carried out using RStudio (Ver 1.4.1106). Results: Forty-two of 233 patients (18%) with DC/TBDs experienced at least one AVN and/or MTF at a median age of 21.9 years (range 4 to 58.7); 15/42 were females (Table 1). Twenty-three patients had AVN alone, 6 had MTF alone, and 13 developed both AVN and MTF (Figure 1). The median age at first AVN was 24.1 years (range 6.3 - 58.7) and at first MTF 13.6 years (range 4 - 44.3). AVN was more common in patients with autosomal recessive/X-linked recessive (AR/XLR)/TINF2 DC (n=20, 21.3%) and developed at a younger age (median 18.8 years, range 6.3 - 47.8) than in patients with autosomal dominant (AD) disease (12.5%; median age 29.9 years, range 11.1 - 58.7); p=0.013. MTF occurred almost exclusively in patients with AR/XLR/TINF2 DC (n=17, 19%) compared with AD DC/TBD (n=1, .9%); p<.0001. There were 68 AVN events in 36 patients (median 2 events/patient, range 1 - 5). The most frequent sites were femoral heads (33/36) followed by humeral heads (5/36) and knees (3/36); 22/33 had bilateral femoral head AVN (Figure 1). Twenty-two of 26 patients with severe BMF received androgen/steroids within 5 years of AVN and 8 received hematopoietic cell transplantation (HCT). Compared with the matched control group, significantly more DC patients with AVN had severe BMF and received androgen/corticosteroids (p<0.02). Importantly, 12/36 DC/TBD patients (33%) developed AVN without prior HCT, corticosteroid, or androgen treatment. 24/36 patients received treatment for AVN, including total hip arthroplasty (n=15) and core decompression (n=5) or other medical intervention (n=4). Median time from diagnosis with AVN to treatment was 0.81 years (range 0.03 - 2.7). We identified 38 MTF events in 19 DC patients; the most frequent fracture site was the femoral diaphysis (11 events in 8 patients) (Figure 1). Fractures occurred spontaneously or during routine activities such as entering a vehicle, running in the playground, or low-impact dancing as per patient reports. Seventeen patients (89%) with MTF had severe BMF, 12 (63%) had received HCT (7 had taken androgens/steroids). Compared with matched controls, significantly more DC patients with MTF had received HCT (p=0.02). Other factors such as BMD, elevated cholesterol, overweight/obesity, and 25[OH]D levels were not significantly associated with AVN or MTF in our cohort. Conclusions: AVN and MTF are highly prevalent in patients with DC/TBDs. AVN developed across the entire DC/TBD spectrum but was significantly associated with severe BMF and AR/XLR/TINF2 DC. MTFs occurred almost exclusively in young patients with severe disease indicated by AR/XLR/TINF2 mode of inheritance. Improved screening and effective clinical management of symptoms for patients at higher risk of developing AVN/MTF is needed. Furthermore, these findings signal the need for future research exploring the mechanism underlying AVN and MTF in patients with DC/TBDs. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Effectiveness of Pharmacological Interventions Versus Placebo or No Treatment for Osteoporosis in Patients With CKD Stages 3-5D: Editorial Summary of a Cochrane Review

Osteoporosis is an important comorbidity in patients with chronic kidney disease (CKD). Compared with individuals who do not have CKD, the prevalence of osteoporosis and the risk of fractures is higher in individuals with CKD.1,2 Major bone fractures in patients with CKD are a global health care burden and are often associated with high rates of hospitalization, death, and high health care–associated costs.3,4

Computed tomography in the assessment of pelvic bone fractures in patients with combined injuries

To date, mortality from a complex pelvic injury remains high. It is noted that the total mortality from pelvic injury is 4.7 %. It is recognized that diagnostic imaging plays a leading role in the treatment of pelvic fractures, and image quality helps to reduce the morbidity and mortality of patients with injuries. The aim of the study was to evaluate the role of CT with three-dimensional reconstruction in the diagnosis of pelvic bone fractures. Material and methods. During the 36-month period, 76 patients of both sexes (54 (71.0 %) men and 22 (29.0 %) women) were examined. The Young-Burgess classification system was used to assess the nature of pelvic fractures. A spiral computed tomograph Aquilion 16 Model TSX-101A (Toshiba, Japan) was used. All patients are scanned in a supine position with no movement during the examination. The scan was started from the top of the iliac crest and continued through the level of the sciatic tubercles. The thickness of the cut and the step of the tomography is 10 mm, the table feed is 15 mm per tube revolution, the pitch is 1.5:1, the scanning time is 20–30 seconds. Results. The average age of the patients was 35.2 ± 1.77 years. The largest share was road injuries – 86.9 %: road accidents – 30.3 %, collisions with a pedestrian – 32.9 %, motorcycle and bicycle accidents – 23.7 %, falling from a height – 13.1 % of patients. Pelvic organ radiography diagnosed a sacral fracture in 33 (43.4 %) patients. Anteroposterior compression (AS) was recorded in 9.2 % of cases, of which AS-I in 7.89 %, AS-II – 1.31 %. Lateral compression was observed in 73.68 % of cases: LC-I – 57.89 %, LC-II – 10.53 %, LC-III – 5.26 %. Vertical shift and mixed mechanical injury were detected in 7.89 and in 7.89 % of cases, respectively. The unclassified fracture was detected in 1.31 % of cases. Pelvic ring fractures were associated with sacral fractures (69 (90.8 %) patients) and with acetabular fractures (63 (82.9 %) cases), in 6 (7.9 %) patients – not associated. Conclusions. In combined injuries, lateral compression injuries of the pelvis were more common, which, in comparison with traditional radiographs, were statistically significantly recognized on CT images (p &lt; 0.001), which confirmed the fact that pelvic fractures are more common in lateral compression injuries than in anteroposterior injuries. For a complete assessment of the pelvic ring, in addition to the pelvic view, a CT scan of the lateral part of the sacrum is required.

X-ray Radiography of Bone Fractures Associated With Road Traffic Accidents RTA

One of the leading causes of bone fractures are Road Traffice Accidents (RTAs), they are perhaps the most prevalent causes of mortality in individuals. Objective: To investigate the prevalence and types of bone fractures in patients who have been involved in a road traffic collisions in the city of Gujranwala, Pakistan. Methods: It was a cross-sectional analysis at the orthopedic department of the DHQ/Teaching Hospital in Gujranwala, all patients with RTA-related fractures who underwent x-rays were included after written informed consent. The study included a total of 100 patients, all of which had suffered fractures as a result of traffic incidents from January 13th, 2022 to April 13th, 2022, the research was completed in three months. The obtained data were entered and analyzed by utilizing IBM SPSS Statistics 26.0. Results: There were 35 females and 65 males in the study, and according to the age distribution, 34% of those aged 26 to 35 years had a higher risk of fracture. Femur 37.7%, tibia 21.3%, fibula 16.4%, radius 2.5%, ankle joint 1.6%, humerus 6.6%, knee joint 2.5%, elbow joint 4.9%, and thumb and spine 0.8% are among the bones that have been fractured. Moreover, no incidents of skull fractures were recorded. Conclusion: Bone fractures are much more common in men than in women. In road traffic accidents, the most common bone fracture is the femur, which occurs most frequently in people who ride motorbikes or cycles, whereas, the transverse bone fracture is the most prevalent type of bone fracture.

Detecting bone lesions in the emergency room with medical infrared thermography

IntroductionLow- to high-energy impact trauma may cause from small fissures up to extended bone losses, which can be classified as closed or opened injuries (when they are visible at a naked eye).ObjectiveThe aim of this study was to investigate the feasibility of clinical diagnosis of bone trauma through medical infrared thermography, in a hospital emergency room.MethodsForty-five patients with suspected diagnosis of bone fracture were evaluated by means of medical infrared images, and the data correlated with the gold standard radiographic images, in the anteroposterior, lateral, and oblique views, at the orthopedic emergency department. The control group consisted of thermal images of the contralateral reference limb of the volunteers themselves. Data were acquired with a medical grade infrared camera in the regions of interest (ROIs) of leg, hand, forearm, clavicle, foot, and ankle.ResultsIn all patients evaluated with a diagnosis of bone fracture, the mean temperature of the affected limb showed a positive difference greater than 0.9 °C (towards the contralateral), indicating the exact location of the bone trauma according, while the areas diagnosed with reduced blood supply, showed a mean temperature with a negative variation.ConclusionClinical evaluation using infrared imaging indicates a high applicability potential as a tool to support quick diagnosis of bone fractures in patients with acute orthopedic trauma in an emergency medical setting. The thermal results showed important physiological data related to vascularization of the bone fracture and areas adjacent to the trauma well correlated to radiographic examinations.

"Sarcopenia and risk of osteoporosis, falls and bone fractures in patients with chronic kidney disease: A systematic review".

BackgroundChronic kidney disease [CKD] has been suggested to increase the risk of osteoporosis, sarcopenia, falls, and fractures. The aim of this systematic review was to explore the occurrence of osteoporosis, falls, and fractures in patients with sarcopenia and CKD, and to explore the possible association between sarcopenia and osteoporosis, falls, and fractures in patients with CKD.MethodsThis systematic review was conducted according to the PRISMA guideline. The protocol was registered at PROSPERO. The systematic literature search was conducted in Pubmed [1966 to present] and EMBASE [1974 to present] on December 4, 2020. We searched for articles on CKD and sarcopenia, and then we selected them with outcomes such as osteoporosis, falls, and bone fractures. The risk of bias was assessed with the Newcastle-Ottawa Scale.ResultsFive studies were eligible and included. No studies reported the occurrence of osteoporosis, falls, and bone fractures in patients with CKD and sarcopenia. Sarcopenia had a significant association with low bone mineral density [BMD] and osteoporosis in patients with CKD. The risk of bias assessed with the Newcastle-Ottawa Scale varied from 3–7 stars [median of 7]. Due to the included studies’ heterogeneity, a meta-analysis could not be conducted.ConclusionThe occurrence of osteoporosis, falls, and bone fractures in patients with sarcopenia and CKD could not be assessed from the included studies, but an association between sarcopenia and decreased BMD/osteoporosis in patients with CKD was found. The potential mechanistic link between sarcopenia and osteoporosis in CKD needs to be investigated in future studies.