Intertrochanteric Region Research Articles

Anesthetic management of a known case of pemphigus vulgaris with diabetes mellitus posted for surgery

80 yr old diabetic female known case of pemphigus vulgaris, got admitted to our hospital with relapse of fresh lesions. During her hospital stay she fell down in the washroom and developed fracture in inter-trochanteric region of left femur for which surgery was planned. She had pancytopenia, low hemoglobin level, low platelet count and deranged blood sugar levels. After optimization she was planned for surgery under spinal anesthesia. Special care was taken during transfer, positioning, placement of intravenous lines and monitors. She was premedicated with intravenous steroids. Part was painted gently with chlorhexidine & spinal anesthesia was administered using hyperbaric bupivacaine with a 26 gauge Quincke’s needle taking care not to puncture the blisters and papules. Pressure points were adequately padded. Intra-operative hemodynamics were stable. Post-operatively, care was taken for the existing lesions along with special care to prevent the development of fresh lesions.

Bone response to eccentric versus concentric cycling in adolescents with obesity

ObjectivesBecause adolescents with obesity are susceptible to bone fragility during weight loss (WL), we evaluated the impact of eccentric (ECC) versus classical concentric (CON) training at the same oxygen consumption (V˙O2) on bone density, geometry and strength. MethodsThirty five adolescents were included into 2 training (CON and ECC cycling) and a control (CTR, without training) groups. Anthropometry, dual-energy X-ray absorptiometry, hip structural analysis and quantitative bone ultrasound were assessed before and after the 12-week intervention. ResultsThe trainings promoted significant improvements in body mass index, total fat (FM) and lean mass (LM), with better improvements for FM and LM in the ECC group (p < 0.05). Leg LM percentage increased only in the ECC group (p < 0.05). Total body bone mineral content and density increased in both training groups (p < 0.001) with significant time x group interactions only between ECC and CTR (p < 0.05). Buckling ratio at the intertrochanteric region and femoral shaft increased only in CTR and CON groups (p < 0.05). Speeds of sounds at the calcaneum increased only in ECC group (p < 0.01). ConclusionsBone fragility, from a compromised relationship between density, geometry and strength, might be prevented with the ECC modality.

Hip Structural Analysis Reveals Impaired Hip Geometry in Girls With Type 1 Diabetes.

Among patients with type 1 diabetes (T1D), the risk of hip fracture is up to 6-fold greater than that of the general population. However, the cause of this skeletal fragility remains poorly understood. To assess differences in hip geometry and imaging-based estimates of bone strength between youth with and without T1D using dual-energy x-ray absorptiometry (DXA)-based hip structural analysis. Cross-sectional comparison. Girls ages 10 to 16 years, including n = 62 with T1D and n = 61 controls. The groups had similar age, bone age, pubertal stage, height, lean mass, and physical activity. Bone mineral density at the femoral neck and total hip did not differ in univariate comparisons but was lower at the femoral neck in T1D after adjusting for bone age, height, and lean mass. Subjects with T1D had significantly lower cross-sectional area, cross-sectional moment of inertia, section modulus, and cortical thickness at the narrow neck, with deficits of 5.7% to 10.3%. Cross-sectional area was also lower at the intertrochanteric region in girls with T1D. Among those T1D subjects with HbA1c greater than the cohort median of 8.5%, deficits in hip geometry and strength estimates were more pronounced. DXA-based hip structural analysis revealed that girls with T1D have unfavorable geometry and lower estimates of bone strength at the hip, which may contribute to skeletal fragility and excess hip fracture risk in adulthood. Higher average glycemia may exacerbate effects of T1D on hip geometry.

Comparison of hip subregion bone mineral density to the type of proximal femur fracture.

To compare the BMD of the femoral neck region and the intertrochanteric region between the femoral neck fracture group and the intertrochanteric fracture group. We did a retrospective review of radiographs of the proximal femoral fractures in patients registered from 2010 to 2017. A total of 329 patients were classified into the femoral neck fracture group (group A, n = 162) and the femur intertrochanteric fracture group (group B, n = 167). We did intergroup comparisons of age, sex, BMI (body mass index), and bone mineral density (BMD) of the neck and intertrochanteric region, adjusting for age. We did multiple logistic regression analysis among these parameters. The BMD of the femoral neck and intertrochanteric was statistically significantly different between the two groups (p < 0.001), and the BMD of the femur intertrochanteric was also significantly different between the two groups (p < 0.001). BMD of both regions in the intertrochanteric fracture group was lower than that of the femoral neck fracture group. In linear regression analysis, the beta values of the intertrochanteric fracture group were about twice as high as those of the femoral neck fracture group. In linear regression analysis, the beta values of the intertrochanteric fracture group were about twice as high as those of the femoral neck fracture group.

Impact of sleeve gastrectomy on hip structural analysis in adolescents and young adults with obesity

Sleeve gastrectomy (SG), the most commonly performed metabolic and bariatric surgery, is associated with reductions in areal bone mineral density at multiple sites, and changes in bone structure at the distal radius and tibia without reductions in strength estimates at these peripheral sites. Data are lacking regarding effects on hip strength estimates. To evaluate effects of SG on measures of hip structural analysis in adolescents and young adults over 12 months using dual-energy x-ray absorptiometry. Translational and Clinical Research Center. We enrolled 48 youth 14- to 22-years old with moderate-to-severe obesity; 24 underwent SG and 24 controls were followed without surgery (18 females, 6 males in each group). Hip structure was assessed using dual-energy x-ray absorptiometry at baseline and 12 months. Analyses are adjusted for age, sex, race, and the baseline bone measure. The SG group lost 25.9% weight versus .3% in controls. Compared with controls, SG had reductions in narrow neck, intertrochanteric and femoral shaft bone mineral density Z-scores (P ≤ .012). Furthermore, SG had greater reductions in narrow neck and intertrochanteric region (but not femoral shaft) cross-sectional area, cortical thickness, cross-sectional moment of inertia and section modulus, and increases in buckling ratio (P ≤ .039). Differences were attenuated after adjusting for 12-month body mass index change. At 12 months, differences were minimal after adjusting for age, sex, race, and weight. Over 12 months, SG had negative effects at the narrow neck and intertrochanteric regions of the hip, but not the femoral shaft. Reduced body mass index may compensate for these deleterious effects on bone.

Third Place Award: Reconstruction of metastatic bone loss of the proximal femur and acetabulum: A literature review

Background: Improved rates of long-term survival in cancer patients has led to an increasing prevalence of metastatic disease, notably to osseous structures. The proximal femur and acetabulum are vital weight-bearing surfaces of the lower extremity and common regions of metastatic spread. There are many reconstructive options that depend on several factors including the location of the lesion, type of lesion, and the prognosis of the patient. Methods: An extensive literature review was conducted searching Pubmed.gov with the key words metastatic, proximal femur, acetabulum, reconstruction, and fixation. This identified pathologic characteristics for various metastatic processes, anatomic considerations for the proximal femur, and periacetabular metastatic lesions. This also identified treatment-sensitive tumors compared to treatment-resistant conditions. Reconstruction was usually recommended specifically considering renal, lung, and gastrointestinal carcinomas as well as previously irradiated bone where healing was unlikely. In addition, this study provides a technique guide for implementation of a proximal femoral prosthetic replacement (PFR). Results: The management of femoral head or neck lesions are frequently managed by hemiarthroplasty with overall reasonable outcomes. In intertrochanteric or subtrochanteric regions, there have been high failure rates of intramedullary fixation, and 2-year reoperation rate of up to 35% was reported with conversion to endoprosthesis. In comparison to an 85% implant survival in intramedullary constructions, there was a 100% 5-year survival in endoprosthesis reconstruction. Periacetabular lesions that do not impact structural stability can be managed with palliative measures. Those patients experiencing significant pain with contained defects may be managed with cement augmentation. Support of the columns may be required with fixation into the ilium, and those with extensive disease may require en bloc internal hemipelvectomy. Conclusions: Management of lesions of the proximal femur and acetabulum can be managed with a variety of treatment constructions. The utilization of PFR is increasingly more common especially in the setting of destructive metastatic lesions in the proximal femur as soft-tissue repairs improve ambulatory function. Additionally, the survivorship of endoprosthesis is greater than intramedullary fixation and is recommended for reconstruction for individuals with an expected survivorship greater than 7 mo. Lesions within the periacetabular region that are refractory to nonoperative management may benefit anywhere on the spectrum from intralesional cementation to en bloc hemipelvectomy depending the primary tumor type and degree of osseous involvement. Level of Evidence: Level IV.

OR32-05 Lower Oxytocin Levels Are Associated with Lower Bone Mineral Density and Less Favorable Hip Geometry in Hypopituitary Men

Introduction: Hypopituitary patients are at risk for bone loss. Oxytocin (OT) and vasopressin (VP) are hypothalamic-posterior pituitary hormones with opposing actions on bone (anabolic and catabolic, respectively). Whether OT and/or VP contribute to impaired bone homeostasis in hypopituitarism is unknown. Hypothesis: We hypothesized that lower plasma OT and higher VP levels would be associated with lower bone mineral density (BMD) and less favorable hip geometry and estimated strength in men with hypopituitarism. Design: We performed a cross-sectional study of 37 men with hypopituitarism ages 20–60 (mean±SEM 45.8±1.9) years: 20 with anterior pituitary deficiencies only (APD) and 17 with central diabetes insipidus (CDI; marker of posterior pituitary dysfunction), of similar age, body mass index and number of adenohypophyseal deficiencies, on stable hormone replacement. Main outcome measures were fasting plasma OT and VP levels, and dual X-ray absorptiometry-derived BMD (lumbar spine, total hip, femoral neck, distal radius and subtotal body) and hip structural analysis (HSA; cortical thickness, section modulus, and buckling ratio at narrow neck, intertrochanteric region and femoral shaft). All analyses were adjusted for multiple comparisons using Holm-Bonferroni correction. Results: Mean BMD Z-scores were lower at all sites and all HSA parameters at the intertrochanteric region as well as cortical thickness at the femoral shaft were less favorable in those participants who had fasting OT levels below the median than in those with higher levels (P≤0.022). There were no differences in any bone variables at any skeletal site in those with fasting VP levels below vs. above the median (P≥0.232). Lower fasting OT levels were positively associated with (1) lower BMD Z-scores at the lumbar spine, femoral neck, total hip and subtotal body (P≤0.02) and (2) less favorable hip geometry and strength variables (lower cortical thickness, lower section modulus and higher buckling ratio) at the intertrochanteric region in CDI (P≤0.018), but not APD participants (P≥0.458 and P≥0.429, respectively). The associations between OT and bone variables remained significant after adjusting for key determinants of BMD including lean body mass and IGF-1 levels. There were no relationships between plasma VP levels and bone variables in CDI or ADP groups (P≥0.173). Conclusions: OT, but not VP levels, are positively associated with BMD at multiple sites as well as favorable hip geometry and estimated strength in men with hypopituitarism and CDI. Future studies will be important to determine whether OT could be used therapeutically to optimize bone health in patients with hypopituitarism.

Non-union of Intertrochanteric Fracture Right Femur with Limb Shortening

Nonunion of intertrochanteric fracture is uncommon because there are excellent blood supply and good cancellous bone in the intertrochanteric region of the femur. A diagnosis of primary intertrochanteric nonunion is made when at least 15 weeks after the fracture there is radiological evidence of a fracture line, with either no callus (atrophic) or with callus that does not bridge the fracture site (hypertrophic). The patient was subsequently treated successfully with an open reduction procedure. Open reduction and internal fixation with right DHS (Dynamic Hip Screw) with 8 screw holes plate inserted first and then 6 screws inserted under the guidance of Image Intensifier (C Arm). We would like to report a case of right intertrochanteric fracture with non-union. A 60 years old patient presented with the history of pain in the right hip, off and on for many years after the operation. The pain was associated with stiffness of the right hip joint. This case is selected for reporting because it’s a relatively rare incidence.

The impact of protein diet on bone density in people with/without chronic kidney disease: An analysis of the National Health and Nutrition Examination Survey database.

High protein diet is essential for the healthy state of bones. Low protein diet is often recommended to patients with chronic kidney disease (CKD). Risk factors for femoral neck fractures are clear, but trochanteric and intertrochanteric fractures may have different risk factors. In this study, we determined the association between bone density at different femoral areas and a number of protein diets in patients with and without CKD. We extracted information from the database of the National Health and Nutrition Examination Survey (NHANES), 2005-2010. We have basic variables, metabolic diseases, and bone density of different femoral areas and separated them according to different protein diets (<0.8g/kg/day, 0.8-1.0g/kg/day, 1.0-1.2g/kg/day, and ≥1.2g/kg/day). The differences of differential femoral areas were analyzed according to different protein intakes in subjects with and without CKD. A total 12,812 subjects were analyzed. Among all four subgroups of protein diets, we found statistically significant differences over bone mineral density (BMD) or T scores (p<0.0001) among all femoral areas. For total femoral BMD and T scores, the higher the protein intake, and the higher the bone BMD and T scores were noticed (p<0.0001). We found similar relationship in the trochanter and intertrochanteric bone areas, but not in the femoral neck area. For the femoral BMD, higher protein diets led to higher BMD in the femoral neck, trochanter, intertrochanteric, and total femoral areas (p=0.032, 0.0036, 0.008, and 0.0039, respectively). Such increased BMD benefits of higher protein diet were not found in CKD patients. Higher protein diets led to higher femoral BMD only in subjects without CKD. CKD patients did not benefit in developing higher femoral BMD and those with Low protein diet did not reduce their femoral BMD. CKD was found to be a risk factor for low BMD in the intertrochanteric bone region.

Lower Oxytocin Levels Are Associated with Lower Bone Mineral Density and Less Favorable Hip Geometry in Hypopituitary Men

Introduction: Hypopituitary patients are at risk for bone loss. Hypothalamic-posterior pituitary hormones oxytocin and vasopressin are anabolic and catabolic, respectively, to the skeleton. Patients with hypopituitarism may be at risk for oxytocin deficiency. Whether oxytocin and/or vasopressin contribute to impaired bone homeostasis in hypopituitarism is unknown. Objectives: To determine the relationship between plasma oxytocin and vasopressin levels and bone characteristics (bone mineral density [BMD] and hip structural analysis [HSA]) in patients who have anterior pituitary deficiencies only (APD group) or with central diabetes insipidus (CDI group). Methods: This is a cross-sectional study. Subjects included 37 men (17 CDI and 20 APD), aged 20–60 years. Main outcome measures were fasting plasma oxytocin and vasopressin levels, and BMD and HSA using dual X-ray absorptiometry. Results: Mean BMD and HSA variables did not differ between the CDI and APD groups. Mean BMD Z-scores at most sites were lower in those participants who had fasting oxytocin levels below, rather than above, the median. There were positive associations between fasting oxytocin levels and (1) BMD Z-scores at the spine, femoral neck, total hip, and subtotal body and (2) favorable hip geometry and strength variables at the intertrochanteric region in CDI, but not APD, participants. No associations between vasopressin levels and bone variables were observed in the CDI or ADP groups. Conclusions: This study provides evidence for a relationship between oxytocin levels and BMD and estimated hip geometry and strength in hypopituitarism with CDI. Future studies will be important to determine whether oxytocin could be used therapeutically to optimize bone health in patients with hypopituitarism.

Determination of bone mass and hip axis length of contralateral side in patients with hip fracture

Introduction: The currently accepted definition of osteoporosis as follows: A progressive systemic skeletal disease characterized by a low bone mass and microarchitectural deterioration of bone tissue leading to an increase in bone fragility and a susceptibility to fractures. BMD compared with age and sex matched controls (Z-scores) or with young adult sex matched controls (T-scores). Hip axis length (HAL) is the dimension along the femoral neck axis from the base of greater trochanter through the femoral head and the acetabulum to the inner pelvic brim, and it is one of the strongest predictors of fracture risk. Material and method: Twenty five patients with hip fracture of which 14 patients had intertrochantric fracture and 11 had neck femur fracture were included in our study. Bone mineral density of contralateral hip at neck, trochanteric region, Ward’s triangle, upper shaft and total BMD were assessed. Hip axis length was calculated automatically by the machine. All the parameters were analyzed and compared for statistical reporting of results. Summary and Conclusion: We conclude that the patients with hip fractures have significantly lower bone mass in proximal femur, femoral neck region and intertrochanteric region. The mean hip axis length of patients with femoral neck fractures (10.25 ± 0.73 cm) is more than patients with intertrochanteric fractures (9.76 ± 0.80 cm).

Treatment strategy for elderly patients with the isolated greater trochanteric fracture.

Background:The objective of this study was to evaluate the risk of femur intertrochanteric fracture associated with femur trochanter major fractures in patients over 65 years of age with magnetic resonance examination for better diagnosis and treatment.Methods:Thirty-one patients who had incomplete femur intertrochanteric fracture diagnosed were included in the study. Patients were classified according to the length of the fracture line crossing the intertrochanteric border. Fracture patterns were described on magnetic resonance imaging coronal views. Group A, pattern 1, greater trochanteric fracture extends to intertrochanteric region with both cortices; Group B, pattern 2, fracture has characteristics of pattern 1 fracture including diametaphysis fracture line; Group C, pattern 3, greater trochanteric fracture only has extending superolateral cortex fracture line of intertrochanteric region; and Group D, pattern 4, fracture has characteristics of pattern 1 fracture and including superior extension to the baso-cervical line. Surgical treatment with dynamic hip screw was applied to all patients with intertrochanteric extension after magnetic resonance examination.Results:This study included 16 women (80.3 ± 6.7 years) and 15 men (76.9 ± 10.94 years). Group A had 11 patients, group B had 8 patients, group C had 6 patients, and group D had 6 patients. Ambulation was initially prescribed for these patients 1 day after the surgery. The average surgery durations of the A, B, C, and D patterns were 44.54 ± 7.56, 49.37 ± 12.65, 49.16 ± 3.76, and 44.16 ± 5.84 min, respectively. No statistically significant differences were observed among the four patterns (P = 0.404).Conclusion:Surgical treatment of the greater trochanteric fracture which is considered an indicator of occult intertrochanteric fracture is a good choice for the treatment because of the procedure safety and early mobilization after the surgery

Differences in geometric strength at the contralateral hip between men with hip fracture and non-fractured comparators.

Older men sustain excess bone mineral density (BMD) declines after hip fracture; however, BMD provides no information on mechanical structure and strength. The aim was to assess whether changes in hip bone geometry in older men after hip fracture differ than that expected with aging. Two cohorts were used: Baltimore Hip Studies 7th cohort (BHS-7) and Baltimore Men's Osteoporosis Study (MOST). The sample (N=170) included older Caucasian men with hip fracture that were propensity score matched (1:1) to community-dwelling non-fractured comparators. Hip Structural Analysis (HSA) calculated aerial BMD and metrics of bone structural strength: cross-sectional bone area (CSA), cortical outer diameter (OD), section modulus (SM), and centroid position (CP). Mixed-effect models estimated changes in HSA parameters and adjusted robust regression models evaluated between-cohort differences in annual percent change at the narrow neck (NN), intertrochanteric (IT), and femoral shaft (FS). Hip fracture was associated with statistically greater declines in NN CSA (β=-2.818; 95% CI: -3.300%, -2.336%), SM (β=-1.896%; 95% CI: -2.711%, -1.080%) and CP (β = -0.884%; 95% CI: -0.889%, -0.880%) and significantly larger increases in NN OD (β=0.187%; 95% CI: 0.185%, 0.190%). Differences in IT HSA parameters were like the NN but larger in magnitude, while there were favorable changes in FS geometry where fragility fractures are rare. Findings indicate there are declines in bone structure and strength at the NN and IT regions of the proximal femur in older men during hip fracture recovery that far exceed what occurs during normal aging.

Proximal femur fat fraction variation in healthy subjects using chemical shift-encoding based MRI

The objective of this study was to describe the normal variation of bone marrow fat content in the proximal femur considering the influence of side, age, sex and body mass index using fat fraction MRI. From September 2012 to July 2016, the MRI of 131 patients (258 hips) considered to have a normal MRI appearance were retrospectively evaluated. Patient records were searched to allow calculation of the body mass index (BMI). Water-fat based chemical shift MRI was available for all patients included. Proton density fat fraction maps were calculated, and measurements were performed in the femoral epiphysis, intertrochanteric region, and greater trochanter. The influence of patient age, sex, hip side and BMI on fat fraction values was assessed. Fat fraction was significantly different in the different locations evaluated (P = 0.0001). Patient sex and age significantly influenced fat fraction values in all regions evaluated (P < 0.02) with the exception of the epiphysis for sex (p = 0.07). In all locations, PDFF values were higher in men compared to women (3.3%, 4.4% and 13.1% higher in the epiphysis, greater trochanter and intertrochanteric region respectively). The intertrochanteric region presented the lowest fat fraction values with the highest variation compared to the greater trochanter and the epiphysis. BMI only influenced fat fraction values in the intertrochanteric region of females over 42 years old (P = 0.014). The interobserver variability of the measurements performed was considered to be excellent (ICC = 0.968). In conclusion, patient sex, age, and measurement location significantly influenced fat fraction values indicating that specific standards of reference are needed depending on these factors.

Treatment of basicervical femoral neck fractures with proximal femoral nail antirotation.

ObjectiveA basicervical femoral neck fracture, which is located at the junction between the femoral neck and intertrochanteric region, is a rare type of fracture. The treatment effects for this type of fracture vary. The present retrospective study was performed to evaluate the clinical and radiological outcomes of proximal femoral nail antirotation and illustrate its effect on improving the clinical prognosis of basicervical femoral neck fractures.MethodsFourteen patients with two-part basicervical fractures underwent treatment with proximal femoral nail antirotation.ResultsThe treatment exhibited a good effect on decreasing complications such as femoral neck shortening and screw protrusion. Improvements were also noted in the Harris hip score and other clinical prognostic factors. The patients were satisfied with the prognosis, although not all of them returned to their preinjury level of occupation or daily activities.ConclusionThis research provides clinical data to support the treatment of basicervical femoral neck fractures with proximal femoral nail antirotation and contributes to our understanding of treatment selection in the clinical setting. Selection of the optimal fixation method and subsequent conservative rehabilitation plan will benefit patients with basicervical femoral neck fractures.

Surgical management of basicervical fracture neck of femur with dynamic hip screw and derotation screw: a prospective study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Basicervical region of femur is that part of femur which is intermediate between neck and intertrochanteric region. Fracture in this region carry substantially higher chances of failure due to greater fracture angle and are rotationally unstable. If treated inadequately they carry very high chances of fracture non-union and theoretically risk of osteonecrosis. The objective of the study was to analyse functional outcome of basicervical fracture neck of femur fixation with dynamic hip screw and de-rotation screw in a tertiary care hospital.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 35 cases of basicervical fracture neck of femur admitted in Chigatteri General Hospital and Bapuji Hospital affiliated to JJM Medical College Davangere, in the period of October 2015 to October 2018. Functional outcome was assessed according to Modified Harris Hip Score after one year of follow up.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The fracture union was found in 100% cases, average time period for fracture union was 12.28±3.71 weeks (11-15 weeks range). The results according to Modified Harris hip score were excellent in 70%, good in 11.4%. good in 5.7% and poor in 2.8% at the end of one year. The correlation analysis with Pearson’s correlation coefficient (r) was 0.74 which show a highly positive correlation between the union of basicervical fracture neck of femur with dynamic hip screw and derotation screw.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; With the study of 35 cases of basicervical fracture neck femur we conclude that these are a unique type of fractures mid-way between neck and intertrochanteric fractures with rotational and axial instability, and also risk of osteonecrosis. DHS allows for controlled collapse of the fracture for uneventful healing, and de-rotation screw gives rotational stability. &lt;/p&gt;

Association Between Urinary Triclosan With Bone Mass Density and Osteoporosis in US Adult Women, 2005‒2010.

Laboratory studies have demonstrated that triclosan (TCS) can cause significant interstitial collagen accumulation and an increase in trabecular bone. However, little is known about the relationship between TCS exposure and human bone health. We used 2005 to 2010 National Health and Nutrition Examination Survey data to examine the association between urinary TCS concentration and bone mineral density (BMD) and osteoporosis in US adult women aged ≥20 years. After inclusion and exclusion, 1848 women were analyzed. After adjustment for other covariates, we observed significant associations between tertile 3 of TCS concentration and lower BMD in regions of the total femur (β = -0.016; 95% CI = -0.032, -0.000), intertrochanteric region (β = -0.022; 95% CI = -0.042, -0.002), and lumbar spine (β = -0.014; 95% CI = -0.029, 0.001), respectively, relative to tertile 1. Compared with women at tertile 1, those at tertile 3 were more likely to have increased prevalence of osteoporosis in the intertrochanteric region (OR = 2.464; 95% CI = 1.190, 5.105). This epidemiological study investigated the association between urinary TCS concentration and BMD and osteoporosis in US adult women. We found urinary TCS concentration was negatively associated with BMD and was positively associated with the prevalence of osteoporosis. The evidence was stronger in postmenopausal women than in premenopausal women. Future prospective studies are needed to validate these findings.

Biomechanical analysis of the placement of fixation lag screw in different intertrochanteric hip fracture angles

The common surgical method for fracture fixation in the femoral neck and intertrochanteric region is the implantation a dynamic lag screw into the femoral head. However, failure rates of this fixation are high due to a cut-out of the lag screw from the femoral head. It is unclear if the lag screw positions will affect the stabilisation of the intertrochanteric fracture with different fracture angles. This study aimed to examine the influence of lag screw placement in the fixation of hip fractures with different fracture angles in healthy and osteoporotic femurs using three-dimensional finite element analysis. Two screw positions at the centre and inferior–posterior (IP) of the femoral head with three fracture angles (30°, 45°, 60°) were studied. The results showed that varying fracture angles and the onset of disease (osteoporosis) have influenced the optimal placement of the lag screw. The lag screw in the IP position in the healthy femur with 30° and 45° fracture angles and osteoporotic femur with 30° fracture angle induced lower periprosthetic bone strains. For a healthy femur with 60° fracture angle and osteoporotic bone with 45° and 60° fracture angles, a centralised placement of the lag screw in the femoral neck was preferred.

Does isolated greater trochanter implication affect hip abducent strength and functions in intertrochanteric fracture?

BackgroundA fracture in the isolated greater trochanter is an infrequent type of femoral intertrochanteric fracture. The gluteus medius and gluteus minimus are abducent muscle groups with attachments located on the greater trochanter. Thus, a fracture of the greater trochanter could cause avulsion injury of these attachment points and eventually affect the abducent function of the hip joint and cause chronic pain. Despite these prospects, the impact of a greater trochanter fracture on abducent strength and hip joint function have yet to be investigated.MethodsPatients who were diagnosed with an isolated greater trochanter fracture (via computed tomography scan and X-ray) and underwent conservative treatment from June 2013 to October 2016 were included in the present study. Magnetic resonance imaging (MRI) was used to verify the morbidity of recessive fractures. Patients’ Harris Hip Scores were determined at 3 months, 6 months, and 12 months and the abducent strength and range of motion of the hip joint on the injured side were analyzed and compared to those on the healthy side.ResultAmong 32 patients, there were 7 individuals diagnosed with isolated greater trochanter fractures by MRI, and 25 individuals whose fractures were found to have extended into the intertrochanteric region, wherein the recessive intertrochanteric region fractures had no relationship with patients’ age, gender, or weight. After 12 months of conservative treatment, 7 patients still complained of pain in the hip joint. The average Harris Hip Score was 87.84 ± 4.83, and the abducent range of the hip joint on the injured side (42.02 ± 13.93°) was not significantly different from that of the healthy side (46.24 ± 7.93°). The abducent strength of the hip joint of the injured side was 121.32 ± 41.06 N which was significantly lower than that of healthy side (137.44 ± 42.21 N).ConclusionResults from this investigation suggest that an isolated greater trochanter fracture attenuates the abducent strength of the hip joint, which may be related to injuries of the ligaments and muscles around the greater trochanter. The surgical skills and methods of addressing isolated greater trochanter fractures merit further investigation.

Lower Bone Mineral Density is Associated with Intertrochanteric Hip Fracture.

A better understanding of how bone mineral density and vitamin D levels are associated with femoral neck and intertrochanteric hip fractures may help inform healthcare providers. We asked: 1) In patients age ≥ 55 years, is there a difference in quantitative ultrasound of the heel (QUS) t-score between patients with fractures of the femoral neck and those with fractures of the intertrochanteric region, accounting for other factors 2) In patients age ≥ 55 years, is there a difference in vitamin D level between those with fractures of the femoral neck and those with fractures of the intertrochanteric region, accounting for other factors? 3) Is there an association between vitamin D level and QUS t-score? In this retrospective cohort study, 1,030 patients were identified using CPT codes for fixation of hip fractures between December 2010 and September 2013. Patients ≥ 55 years of age who underwent operative management for a hip fracture following a fall from standing height were included. Three orthopaedic surgeons categorized fracture type using patient radiographs. Upon hospital admission, QUS t-scores and vitamin D levels were determined. Descriptive statistics, bivariate analyses and multivariable regression were performed. Accounting for potential confounders, patients with lower QUS t-scores were more likely to have intertrochanteric femur fractures than femoral neck fractures. In a bivariate analysis, there was no association between vitamin D level and either fracture type. There was no association between vitamin D level and bone mineral density. Patients with lower bone density that fracture their hips are more likely to fracture in the intertrochanteric region than the femoral neck, but vitamin D levels are unrelated. Awareness of this association emphasizes the importance of bone mineral density screening to assist with intertrochanteric hip fracture prevention. III.