Trochanteric Area Research Articles

Incidence and Clinical Outcomes of Hip Fractures Involving Both the Subcapital Area and the Trochanteric or Subtrochanteric Area.

Purpose Proximal femoral fractures involving both the subcapital area and the trochanteric or subtrochanteric area have rarely been reported, but they are not uncommon. However, few studies have reported the incidence or clinical outcomes of such fractures. This study investigated such fractures. Methods In area classification, the proximal femur is divided into 4 areas by 3 boundary planes: the first plane is the center of femoral neck; the second plane is the border between femoral neck and femoral trochanter; and the third plane links the inferior borders of greater and lesser trochanters. A fracture only in the first area is classified as a Type 1 fracture; one in the first and second areas is classified as a Type 1-2 fracture. Therefore, proximal femoral fractures involving both the subcapital area and the trochanteric area are classified as Type 1-2-3, and those involving both the subcapital area and the subtrochanteric area are classified as Type 1-2-3-4. In this study, a total of 1042 femoral proximal fractures were classified by area classification, and the treatment methods and the failure rates were investigated only for Types 1-2-3 and 1-2-3-4 cases. The failure rate was defined as the incidence of internal fixator cut-out or telescoping >10 mm. Results Types 1-2-3 and 1-2-3-4 fractures accounted for 1.72%. Surgical treatment was performed for 89%. Of these, 56% underwent osteosynthesis, but the failure rate was 33%. The other patients (44%) underwent prosthetic replacement. Fracture lines of all these fractures were present along trochanteric fossa to intertrochanteric fossa in posterior aspect and just below the femoral head in anterior aspect. Conclusion Fracture involving the subcapital area to the trochanteric or subtrochanteric area was found in approximately 2%. In patients for whom prosthetic replacement was selected, good results were obtained. However, 1/3 of patients who underwent osteosynthesis had poor results.

Bacteriology and Antimicrobial Sensitivity of Isolated Bacteria from Pressure Ulcers After Spinal Cord Injury

Background: Infection is a common problem in chronically denuded skin, especially in pressure ulcers (PUs). It is one of the main reasons for delayed wound healing, in addition to morbidity and even mortality after spinal cord injury (SCI). Objectives: The current study aimed at determining the pathogenic microorganisms, as well as their antimicrobial sensitivity, isolated from active PUs in post-rehabilitated cases with SCI. Methods: The current cross sectional study was conducted from January 2015 to January 2016, on 55 outpatients with traumatic SCI and active stage II, III, and IV PUs in the Brain and Spinal Cord Injury Research Center (BASIR), Tehran, Iran. The largest PU in each case was rinsed with sterile saline and deeply sampled with sterile swabs. The cultures were bacteriologically identified and antibiogram was performed. Results: The current study population included 55 cases with a mean age of 32.7 ± 11.5 years, of which 87.3% were male. The sacral region was the most common site (n = 31; 56.4%) for PU, followed by trochanteric area (n = 9; 16.4%). The wound swab culture was positive in 51 patients (92.7%). Majority of the bacteria isolated from smaller lesions of stage II and III PUs was Escherichia coli (E. coli) (P = 0.027), while larger lesions with advanced stage were more commonly colonized with Staphylococcus epidermidis (P = 0.0378). Antimicrobial assessment of the isolated microorganisms revealed multidrug resistant E. coli and staphylococci as the prevailing organisms. Conclusions: Microorganisms invade PUs are multi-drug resistant, and their anti-microbial sensitivity patterns may be quite different from that of normal flora.

Determining weight-bearing tissue condition using peak reactive hyperemia response trend and ultrasonographic features: Implications for pressure ulcer prevention.

Frequent repositioning is important to prevent pressure ulcer (PU) development, by relieving pressure and recovering damages on skin areas induced by repetitive loading. Although repositioning is the gold standard to prevent PU, there is currently no strategy for determining tissue condition under preventive approaches. In this study, the peak reactive hyperemia (RH) trends and ultrasonographic (US) features are compared with the tissue condition under histopathological examination to determine the potential use of these features in determining the tissue condition noninvasively. Twenty-one male Sprague-Dawley rats (seven per group), with body weight of 385-485 g, were categorized into three groups and subjected to different recovery times, each with three repetitive loading cycles at skin tissues above of right trochanter area. The first, second, and third groups were subjected to short (3 minutes), moderate (10 minutes), and prolonged (40 minutes) recovery, respectively, while applying fixed loading time and pressure (10 minutes and 50 mmHg, respectively), to provide different degree of recovery and tissue conditions (tissue damage and tissue recovery). Peak RH was measured in the three cycles to determine RH trend (increasing, decreasing, and inconsistent). All rat tissues were evaluated using ultrasound at pre- and post-experiment and rated by two raters to categorize the severity of tissue changes (no, mild, moderate, and severe). The tissue condition was also evaluated using histopathological examination to distinguish between normal and abnormal tissues. Most of the samples with increasing RH trend is related to abnormal tissue (71%); while inconsistent RH trends is more related to normal tissue (82%). There is no relationship between the tissue conditions evaluated under ultrasonographic and histopathological examination. Peak RH trend over repetitive loading may serve as a new feature for determining the tissue condition that leading to pressure ulcer.

3D patient-specific finite element models of the proximal femur based on DXA towards the classification of fracture and non-fracture cases.

Osteoporotic bone fractures reduce quality of life and drastically increase mortality. Minimally irradiating imaging techniques such as dual-energy X-ray absorptiometry (DXA) allow assessment of bone loss through the use of bone mineral density (BMD) as descriptor. Yet, the accuracy of fracture risk predictions remains limited. Recently, DXA-based 3D modelling algorithms were proposed to analyse the geometry and BMD spatial distribution of the proximal femur. This study hypothesizes that such approaches can benefit from finite element (FE)-based biomechanical analyses to improve fracture risk prediction. One hundred and eleven subjects were included in this study and stratified in two groups: (a) 62 fracture cases, and (b) 49 non-fracture controls. Side fall was simulated using a static peak load that depended on patient mass and height. Local mechanical fields were calculated based on relationships between tissue stiffness and BMD. The area under the curve (AUC) of the receiver operating characteristic method evaluated the ability of calculated biomechanical descriptors to discriminate fracture and control cases. The results showed that the major principal stress was better discriminator (AUC > 0.80) than the volumetric BMD (AUC ≤ 0.70). High discrimination capacity was achieved when the analysis was performed by bone type, zone of fracture and gender/sex (AUC of 0.91 for women, trabecular bone and trochanter area), and outcomes suggested that the trabecular bone is critical for fracture discrimination. In conclusion, 3D FE models derived from DXA scans might significantly improve the prediction of hip fracture risk; providing a new insight for clinicians to use FE simulations in clinical practice for osteoporosis management.

Operative treatment of pressure ulcers using pedicled flaps

Purpose: To present the results of surgical treatment concerning pressure ulcers. Materials and methods: All patients underwent surgical treatment at the Orthopedics and Traumatology Clinic from 1997 to 2016. One operator performed the procedures. A total of 28 pressure ulcers were operated (25 patients). The clinical material consisted of 15 pressure ulcers located in the lower back area, six pressure ulcers located in the ischial area, three pressure ulcers located in the trochanteric area and four pressure ulcers located in the heel area. Results: One conducted the result evaluation based on the criteria of complications proposed by Seiler. In case of all surgically treated patients, pressure ulcers appeared after 2-5 weeks after the surgery. One patient experienced hematoma below the slide piece. One could observe seroma in case of 5 patients. In this situation, it was required to apply a local postoperative puncture. Four patients experienced marginal skin necrosis (2 of them required resection of dead skin edges in operating block conditions which were later re-stitched using “side to side” technique). During the 3-year follow-up, there was no recurrence of operated pressure ulcers. Conclusions: Deep septic pressure ulcers, according to the division introduced by Seiler, connected with bone infection require the application of muscular-skin pieces. This procedure is aimed at improving local tissue blood supply. Proper preoperative preparation of the patient, careful planning of the surgery and suitable postoperative treatment of the patient are as significant as the surgery itself.

Radiographic Analysis of Fractures of the Proximal Femur in Patients Over 50 Years Old at Hospital Universitario De Los Andes, Merida, Venezuela, 2008-2012

AIM: An observational, retrospective analysis of the XR is presented. Preoperative tests performed on patients older than 50 years of age treated surgically for fractures of the proximal femur at the University Hospital of the Andes (Merida, Venezuela). MATERIALS AND METHODS: These XRs were analyzed with reference to age, sex and fracture modality according to the AO/ASIF alphanumeric classification, which considers A the trochanter fractures and B the femoral neck ones. The mean annual frequency for the Hospital Universitario de Los Andes was estimated according to age, sex and fracture type strata. RESULTS: Between 2008 and 2012, in people over 50 years of age, 463 hip fractures were present, affecting 334 women and 129 men (2.6/1). Hip fractures are 7.3 times more frequent after age 80, compared to strata between 50 and 60 years of age. The average annual frequency is 0.12%: 0.15% for ladies and 0.09% for gentlemen. Trochanteric fractures represent 76.4% of the total and are more common in women, with a mean age of 80.4 years. About 70% of these hip fractures are considered unstable injuries. CONCLUSION: In the city of Merida (Venezuela), hip fractures affect women over 80 and more commonly in the trochanteric area with high indices of instability.

Analysis of the stress-deformed condition of models of trochanteric fractures of femoral bone of 5 type by evans after endoprosthesis

Aim of research: to develop the mathematical model of trochanteric fractures of a femur by Evans' classification and to use it for studying main directions of loading the proximal femur section at endoprosthesis with the additional fixation of fragments by needles.Materials and methods of research. For solving the set task, we developed the mathematical models of a femur with trochanteric fractures of different types by Evans' classification. We modeled trochanteric fractures of a femoral bone of 5 type by Evans, using the standard endoprosthesis, fixing separate fragments and model endoprosthesis of the offered construction.Results. The loading results were obtained. At using the endoprosthesis, the zone of maximal loads covers its neck and is 97,6 МPа on its upper surface and 118,4 МPа – on the low one. The least loaded zone is the little trochanter area, where the load value is only 1,0 МPа, and adjacent zones, where tensions don't exceed the value 10,0 МPа. The diaphyseal part of a femur is characterized with the tension values at the level from 21,1 to 23,8 МPа. At using the model system, the most tension level (88,2 МPа) is observed in the upper part of the neck. Tensions in other control points are distributed evenly and don't exceed the value 25,4 МPа by absolute values in the femoral diaphase and 17,3 МPа in the fracture zone.Conclusions. At modeling variants of endoprosthesis of the proximal section of a femur with trochanteric fractures of 5 type by Evans' classification, it was determined, that the model system at all fracture types allows to lower a tension in practically all control points of bone elements of the models essentially. Elements of metal constructions demonstrate zones of higher tensions, where they are rather higher than in the model with the endoprosthesis at the expanse of the essentially less hardness in the node of connecting the carrying pivot with the intramedullary one

Management and Treatment of Pressure Ulcers: Clinical Experience.

Objectives:Pressure ulcers are a common healthcare problem, particularly among hospitalized patients who need long-term treatment; however, preventive medicine can reduce the prevalence. A multidisciplinary approach is fundamental to providing proper care, and the general health status and cooperation of the patient determine treatment modalities. Simple methods can prevent pressure ulcers and their recurrence. The aim of this study was to share clinical experience and evaluate the approach and treatment modalities used for pressure ulcers.Methods:Fifty-two patients hospitalized with the indication of pressure ulcers were evaluated retrospectively. Age, sex, localization of the decubitus ulcer, treatment method, comorbid diseases, and any postoperative complications were analyzed.Results:Thirty-five patients were male and 17 were female. The mean age was 50.3 years. The most common accompanying disease was diabetes mellitus and the most common etiology was paraplegia. Pressure ulcers were localized on the sacral area in 45 patients, the ischial area in 23, the trochanteric area in 11 patients, and other parts of the body (scapular, lumbar) in 3 patients. Fasciocutaneous rotation flaps, myocutaneous flaps, and perforator flaps were the most used reconstruction techniques. No major complication was observed.Conclusion:The most important point with regard to pressure ulcers is prevention. Healthcare system expenses can be significantly reduced by preventing the formation of decubitus ulcers. The progression of pressure ulcers can be easily controlled if the necessary care and treatment are provided in the early period. The role of the plastic surgeon in advanced stages is to perform reconstruction in appropriate cases and to educate patients and their caregivers with the aim of preventing recurrence.

Treatment of pressure ulcers with larvae of Lucilia sericata.

This study aims to investigate the use of the Lucilia sericata larvae in patients with decubitus ulcers resistant to hyperbaric oxygen treatment, vacuum-assisted closure, surgical debridement, and other conventional therapies. A total of 36 patients (21 females, 15 males; mean age 63.7 years; range 16 to 90 years) who were admitted to our hospital for decubitus ulcers between February 2011 and July 2016 were included in our study. All patients had one or more lesions in the sacral region, trochanteric area, dorsal region, or on the heel of the foot. Nine patients had spinal cord injuries, six of them were injured during a car accident, and three of them had spinal cord injuries due to gunshot. One patient had concomitant lung cancer, one had heart failure, and two patients had a diagnosis of multiple sclerosis. Thirty three of 36 patients were admitted to the wound therapy unit within the department of emergency medicine, and three were admitted to the physical therapy and rehabilitation clinic. For each patient, Lucilia sericata maggots were applied on the lesions for 72 hours and, then, washed away. This procedure was repeated two times a week. Twenty nine patients (78.9%) had four to six sessions and seven patients (21.1%) had eight to 12 sessions. Twenty nine lesions (78.9%) were Grade 2 and 3 and were completely healed after four to eight treatment sessions, while seven lesions (21.1%) were completely cured at the end of 10 to 14 sessions. There was complete clearance of necrotic debris at the end of two sessions within the first week for 15 lesions, whereas 10 lesions (27.8%) were cured after four sessions within two weeks, seven lesions (19.4%) within five sessions after three weeks, and four lesions (11.1%) were treated at the end of seven sessions for four weeks. All the necrotic crusts over the surface of the ulcers were cleaned and bad odor of the lesions disappeared. Lucilia sericata larvae debridement is a rapid and effective treatment option for the management of chronic decubitus ulcers which are resistant to conventional therapies and other treatment modalities such as hyperbaric oxygen, vacuum-assisted closure, and surgical debridement.

Two Cases of Pressure Sore-like Ulcers on Acneiform Papules Caused by Cetuximab

Cetuximab is one of the effective chemotherapeutic agents used for the treatment of head and neck squamous cell carcinoma (HNSCC). It was approved for use and began to be used in Japan in the year 2012. The most frequent adverse effect of cetuximab is skin rash, such as acneiform papules, which results from skin fragility developing as a result of inhibition of EGFR, and occurs in over 95% of patients treated with cetuximab. It commonly arises in seborrheic areas such as the face, scalp, precordium and back, while also rarely occurring on the buttocks and trochanteric areas, which are exposed to minor pressure and shear. These papules or pustules frequently develop into pressure sore-like ulcers due to the excessively fragile skin. These adverse events have been reported only in a few cases of non-small cell lung carcinoma treated with gefitinib and erlotinib, but never in association with the use of cetuximab.

The effect of local injection of methylprednisolone acetate on the hypothalamic-pituitary-adrenal axis among patients with greater trochanteric pain syndrome.

Greater trochanteric pain syndrome (GTPS) is a common clinical entity for which the most effective treatment is local corticosteroid injection (LCI). There are no studies on the effect of LCI among patients with GTPS on the hypothalamic-pituitary-adrenal axis. The present study recruited nonselected patients diagnosed with GTPS. After consenting, participants received low dose (1μg) of adrenocorticotropin hormone (ACTH) stimulation test at 09:00. Immediately following the test, participants received a LCI of 80mg of methylprednisolone acetate at the greater trochanteric region. The ACTH stimulation test was repeated 1, 2, 4, and 6weeks following the LCI. Cortisol samples were obtained at just prior to (basal) and 30min (post-stimulation) following every ACTH stimulation test. Serum cortisol levels of <500μmol/l obtained 30min following the ACTH stimulation test were considered evidence of secondary adrenal insufficiency. The study enrolled 22 patients, 21 of whom completed participation. There were 19 female participants (~90%), and mean age of all the participants was 55.2±8.6years. Four participants showed evidence of secondary adrenal insufficiency, which was observed only at weeks 1 and 2 following the LCI. Mean serum cortisol level among these four participants 30min following the ACTH stimulation test was 354μmol/l, with a range of 268-430μmol/l. LCI of 80mg of methylprednisolone acetate in the greater trochanteric area among patients with GTPS was associated with transient secondary adrenal insufficiency in ~20% of the patients, mainly 1week following the injection.

Buttock Reconstruction in Sarcoma Surgery: An Esthetic Sigmoidplasty Closure for Large Circular Defects Using Double Opposing Skin Flaps.

Background:Large defects arising from extirpation surgery of buttock sarcomas requiring adjuvant radiotherapy are best closed with flap surgery. The traditional solutions are derived from an approach to pressure sores, which were designed for the ischial, sacral, or trochanteric areas, and have now been adapted for true buttock defects. This invariably destroys the esthetics of the buttock. We describe a novel technique of sigmoidplasty, which preserves most of the esthetic features.Methods:We report on a retrospective review of 11 consecutive buttock sarcomas managed at our institution between 2009 and 2014, focusing on those for which the described reconstruction method was used (N = 5).Results:The immediate outcome was very good. In 1 patient, partial loss of 1 of the flaps and the management thereof resulted in a minor contour deformity. In general, the buttock volume was significantly decreased but the shape was preserved. This was obtained without secondary donor defect and with minimal contour irregularity. Long-term follow-up remained pleasing, and all patients were satisfied with the outcomes.Conclusions:The described technique of buttock defect closure satisfies the oncoplastic principles of tumor surgery with the added benefit of superior esthetics. We suggest that it is a versatile adjunct to the reconstructive surgeon’s armamentarium for buttock reconstruction after sarcoma excision, particularly when the gluteal artery perforator systems are unavailable.

Pain distribution in primary care patients with hip osteoarthritis.

Hip osteoarthritis (OA) is the most common diagnosis in primary care adult patients presenting with hip pain but pain location and pain distribution in primary care patients with hip OA have been reported inadequately. To describe pain location and pain distribution in primary care patients with clinical and radiographic confirmed hip OA. Primary care patients with unilateral clinical and radiographic hip OA living on the island of Funen, Denmark were recruited from primary care to participate in a randomized clinical trial. At baseline, patients recorded pain intensity using an 11-box numeric rating scale and the distribution of hip pain using a manikin displaying three separate views: front, back and lateral. Pain drawings were analysed using a template to determine the most frequent pain locations and distribution of pain. Pain drawings were completed by 109 patients of which 108 (99%) were valid. The mean age of patients was 65 (SD 9) years and 44% were females. The mean pain intensity was 5.4 (SD 2.0). A total of 77% had marked the greater trochanter area, 53% the groin area, 42% the anterior/lateral thigh area, 38% the buttock area, 17% the knee and 15% the lower leg area. No patients marked pain exclusively in the areas of the knee, posterior thigh or lower leg. The most common pain locations of patients with hip OA presenting to primary care are the greater trochanter, groin, thigh and buttock areas. No patients recorded pain exclusively in the knee or lower leg.

Changing Pattern of Femoral Deformity During Growth in Polyostotic Fibrous Dysplasia of the Bone: An Analysis of 46 Cases.

In polyostotic fibrous dysplasia (PFD) affecting the femur, 6 types of stable femoral deformities have been identified, ranging from the mild type 1 to the most severe type 6. The purpose of our study was to identify the type of deformity present at diagnosis in children with PFD affecting the femur, and to investigate possible changes in the original type with growth. Twenty-seven children affected by either PFD or McCune-Albright syndrome, with 46 affected femurs, were consecutively observed from 1994 to 2010. Radiographs of the pelvis and femurs were taken at diagnosis, and afterward at regular intervals of 6 to 12 months depending on the clinical evolution of each case. Radiographs of the femurs taken at 3 and 7 years after diagnosis were selected to assess the evolution of the femoral deformity. Deformities were classified according to the femoral shape, neck-shaft angle value, and the presence of shepherd's crook deformity evaluated on AP radiographs. The average age of the patients at diagnosis was 5 years (range, 2 to 11 y). At diagnosis, 30 femurs were type 1; 12, type 2; 1, type 3; 1, type 4; and 2, type 5. Three years later, 39% of the femurs had maintained the original deformity present at diagnosis, whereas only 13% did so 7 years after diagnosis.Predictors of change to a more severe type were: younger age at diagnosis, McCune-Albright syndrome, rapid spreading of fibrodysplastic tissue from the trochanteric area to the proximal femoral shaft, cortical thinning of the proximal femur, calcar osteolysis, and presence of an intertrochanteric cystic-like lesion eroding the calcar. In children with PFD affecting the femur, 61% of the femoral deformity present at diagnosis switched to a more severe type of deformity within 3 years from diagnosis, whereas 87% either shifted to a more severe type of deformity or already had corrective surgery within 7 years after diagnosis. Level IV.

How does lateral tilting affect the internal strains in the sacral region of bed ridden patients? — A contribution to pressure ulcer prevention

BackgroundRepositioning of individuals with reduced mobility and at risk of pressure ulcers is an essential preventive step. Manual or automatic lateral tilting is a way of doing this and the international guidelines propose a 30° to 40° side lying position. The goal of the present study was to determine the internal strains in individuals lying in a supine position and during tilting. MethodsBased on magnetic resonance imaging (MRI) of the sacral area of human volunteers, subject specific finite element models were developed. By comparing calculated contours of the skin, fat and muscle with MRI measurements on a flat surface the models were validated. A parameter study was performed to assess the sensitivity of the model for changes in material properties. Simulations were performed at tilting angles of volunteers between 0° and 45°. FindingsSubjects in a supine position or tilted have the highest strains in the muscle and fat. Tilting does affect the strain distribution, taking away the highest peak strains. There seems to exist an optimal tilting angle between 20° and 30°, which may vary depending on factors such as BMI of the subject and is in the current paper investigated only for the sacrum. InterpretationThe study shows that tilting indeed has a significant, positive influence on internal strains, which is important for the prevention of deep tissue injury. Additional studies are needed to draw conclusions about the greater trochanter area and the tissues around the shoulder.

Effect of the area of paries medialis defect on the stability of fracture ends after percutaneous compression plating for femoral intertrochanteric fracture

Objective To analyze the effect of different areas of paries medialis defect of femoral trochanter on the stability of fracture ends after percutaneous compression plating for femoral intertrochanteric fracture. Methods Thirteen preserved cadaveric specimens of adult femur were used in this experiment. The age of death ranged from 30 to 50 years. Oblique osteotomy was conducted under the same condition using a wire saw to create experimental models of fracture of Evans-Jensen type Ⅳ. The ratios of the area of paries medialis defect to the projected area of lesser trochanter in the specimens 1 to 13 were set respectively as 0, 10.0% , 14.5% , 20.2% , 23.4% , 30.6% , 45.8% , 56.8% , 76.8% , 88.7% , 99.8% , 121.3% and 149.4% . All the fractures were fixated by standard percutaneous compression plating. Cyclic load was applied on each specimen using Instron 2000 universal material tester. A vertical load of 600 N was applied for respectively 1, 10, 100 and 1,000 times to measure the displacements of proximal and distal fracture ends. Results When the ratio of the area of paries medialis defect to the projected area of lesser trochanter was 30.6% , the average displacements of the proximal and distal ends were 0.14 cm and 0.10 cm. When the ratio was 45.8% , the average displacement of the proximal end was 0.53 cm, 278.6% greater than that for 30.6% ; the average displacement of the distal end was 0.41 cm, 310.0% greater than that for 30.6% . When the ratio was 149.4% , the average displacement of the proximal end was 0.93 cm, 564.3% greater than that for 30.6% ; the average displacement of the distal end was 0.65 cm, 550.0% greater than that for 30.6% . Conclusions When the ratio of the area of paries medialis defect to the projected area of lesser trochanter reaches >45.8% , the area of paries medialis defect will have a significant effect on the stability of fracture ends after percutaneous compression plating for femoral intertrochanteric fracture. The displacement will increase linearly under the same compression with the increase in defect area. Key words: Hip fractures; Fracture fixation, internal; Bone plates; Biomechanics

Calcific tendonitis of the gluteus maximus tendon: A case report and review of the literature

Calcific tendonitis of gluteus maximus tendon is unusual and only few cases have been reported. A case of calcific tendonitis of gluteus maximus is presented here. A 46 year old female patient with a history of local pain over trochanteric area and radiating along the sciatic nerve. The x-ray showed amorphous calcification around the posterolateral aspect of the proximal femoral shaft, in the vicinity of the linea aspara. Magnetic resonance imaging confirmed the location of calcification over posterolateral aspect of the proximal femoral shaft, in the vicinity of the linea aspera with minimal fluid collection deep to tensor fascia lata and in intermuscular plane between gluteus maximus and medius, which is highly suggestive of calcific tendonitis at this unusual location. Ossifying enthesis with well defined cortical defect are frequent at the femoral insertion of the gluteus maximus muscle in asymptomatic subjects which must be differentiated from real cortical lesion sometimes associated with these calcific tendonitis.

Bone Mineral Density and Prevalence of Osteoporosis in Postmenopausal Korean Women with Low-Energy Distal Radius Fractures.

The aim of this study was to evaluate the bone mineral density and the prevalence of osteoporosis in postmenopausal Korean women with low-energy distal radius fractures and compared with those of aged-matched normal Korean women. Two hundred and six patients with distal radius fractures between March 2006 and March 2010 were included in this study. Patients were divided into three groups by age; group 1 (50-59 years), group 2 (60-69 years), and group 3 (70-79 years). Controls were age-matched normal Korean women. The bone mineral density values at all measured sites, except for the spine, were significantly lower in group 1 than those of control. While the bone mineral density values in group 2 and 3 were lower than those of controls, these differences were not statistically significant. All groups had significantly higher prevalence of osteoporosis at the Ward’s triangle; however, at the spine, femoral neck and trochanteric area it was not significantly different from those of age-matched controls. Although the prevalence of osteoporosis of the postmenopausal women with low-energy distal radius fractures may not be higher than that of the control, osteoporosis should be evaluated especially in younger postmenopausal patients to prevent other osteoporotic hip and/or spine fractures.

Treatment of trochanteric bursitis: our experience.

[Purpose] Trochanteric bursitis is a disease for which there are no effective standardized therapy protocols. Very often pain persists in spite of applying all therapeutic treatments. The purpose of this study was to determine whether treatment of trochanteric bursitis with a local injection of bicomponent corticosteroid and 2% lidocaine would improve patients’ conditions and relieve pain symptoms in the trochanteric area. [Subjects and Methods] A retrospective observational study was conducted of 2,217 patients in a 6 year follow-up period at the Special Hospital “Agens”, Mataruska Banja, Serbia. [Results] Of 2,217 examined patients, 58 (2.6%) patients were found to suffer from trochanteritis associated with low back pain, and 157 (7%) were found to suffer from trochanteric pains without low back pains. Local corticosteroid therapy followed by physical therapy was effective in 77 (49%) of these patients, and only corticosteroid injection in 61 (39%) patients. A single injection was given to 47 (29.9%) of the patients. Two injections were given to 9 (5.7%) patients, and from 3 to 5 injections were given repeatedly every 4–6 weeks to 7 (4.5%) patients. [Conclusion] For most patients, local injections of corticosteroids with lidocaine alone or followed by physical therapy gave satisfactory results.

Correlation between Parameters of Calcaneal Quantitative Ultrasound and Hip Structural Analysis in Osteoporotic Fracture Patients.

BackgroundCalcaneal quantitative ultrasound (QUS), which is used in the evaluation of osteoporosis, is believed to be intimately associated with the characteristics of the proximal femur. However, the specific associations of calcaneal QUS with characteristics of the hip sub-regions remain unclear.DesignA cross-sectional assessment of 53 osteoporotic patients was performed for the skeletal status of the heel and hip.MethodsWe prospectively enrolled 53 female osteoporotic patients with femoral fractures. Calcaneal QUS, dual energy X-ray absorptiometry (DXA), and hip structural analysis (HSA) were performed for each patient. Femoral heads were obtained during the surgery, and principal compressive trabeculae (PCT) were extracted by a three-dimensional printing technique-assisted method. Pearson’s correlation between QUS measurement with DXA, HSA-derived parameters and Young’s modulus were calculated in order to evaluate the specific association of QUS with the parameters for the hip sub-regions, including the femoral neck, trochanteric and Ward’s areas, and the femoral shaft, respectively.ResultsSignificant correlations were found between estimated BMD (Est.BMD) and BMD of different sub-regions of proximal femur. However, the correlation coefficient of trochanteric area (r = 0.356, p = 0.009) was higher than that of the neck area (r = 0.297, p = 0.031) and total proximal femur (r = 0.291, p = 0.034). Furthermore, the quantitative ultrasound index (QUI) was significantly correlated with the HSA-derived parameters of the trochanteric area (r value: 0.315–0.356, all p<0.05) as well as with the Young’s modulus of PCT from the femoral head (r = 0.589, p<0.001).ConclusionThe calcaneal bone had an intimate association with the trochanteric cancellous bone. To a certain extent, the parameters of the calcaneal QUS can reflect the characteristics of the trochanteric area of the proximal hip, although not specifically reflective of those of the femoral neck or shaft.