Femoral neck strength of mouse in two loading configurations: method evaluation and fracture characteristics

We evaluated the mechanical strength of murine femoral neck in two loading configurations. The mechanical strength of the left femora of 25 male mice (weight 39 +/- 4 g) were measured in an axial configuration simulating one-legged stance in a human, and the right femora were tested in a configuration simulating a fall to the lateral side, on the trochanter. The reproducibility of the mechanical testing was 1.6% in the axial configuration and 3.7% in the fall configuration. The femoral neck was slightly stronger in the fall configuration. Typically, a load in the fall direction associated with a basicervical fracture, while axial loading resulted in both mid- and basicervical fractures. The linear bivariate correlation coefficient between the mechanical strengths in the two loading configurations was 0.83. Total bone mineral content (BMC), cortical bone mineral content (CtBMC), volumetric cortical bone mineral density (vCtBMD), and cross-sectional cortical area (CSA), measured at the femoral neck by peripheral quantitative computed tomography (pQCT), had a significant relationship with the femoral neck strength in the axial configuration. The coefficient of variation of the pQCT measurements was 9.1, 5.5, 2.3 and 5.5% for BMC, CtBMC, vCtBMD and CSA, respectively. We conclude that the precision of pQCT is moderate in evaluating the femoral neck of the mouse, and vCtBMD is the most reproducible parameter. The mechanical strength of the murine femoral neck can be measured with high precision by the two mechanical testing configurations presented here.     

Femoral nerve block in extracapsular femoral neck fractures

We randomised 50 patients with extracapsular fractures of the femoral neck to receive either a bupivacaine femoral nerve block or systemic analgesia alone. A femoral nerve block was found to be an easy and effective procedure which significantly reduced perioperative analgesic requirements and postoperative morbidity.     

The surgical procedure in neck wounds

The results of 44 patients treatment with neck wounds are analysed. Isolated wounds of the neck were shown to be in 77.3%, combined trauma was determined in 22.7% of examination. Cervical organ's injury had been revealed in 51 patients (84.1%). Postsurgical complications have developed in 6. The main reasons for complications occurred to be primary surgical wound treatment from little operative approach and noncomplete revision of the wound canal.     

Femoral nailing without a fracture table

This retrospective trail was designed to evaluate the effectiveness and safety of femoral nailing on a radiolucent table with manual traction only. Eighty-three femoral shaft fractures treated by antegrade nailing were included in this study. Group 1 consisted of 24 femur fractures that were reduced and nailed with manual traction. Group 2 consisted of 59 femur fractures treated with the aid of a fracture table. There were 10 patients in Group 1 and 19 patients in Group 2 needing multiple procedures. In Group 1, significantly fewer redrapings and table transfers were necessary. There was no increase in operative time. There were no operative complications in Group 1 and there was 1 operative complication in Group 2--a radial nerve palsy. Postoperative malalignment was minimal in both groups. Intramedullary nailing of femoral shaft fractures on a radiolucent table using manual traction is associated with no increase in morbidity. It also facilitated quicker and more effective treatment of the patient with polytrauma. No undue risks or contraindications were identified; however, the help of an assistant was invaluable.     

Femoral neck osteopenia in patients with inflammatory bowel disease

Bone morphogenetic proteins (BMPs) are considered to have important regulatory roles in skeletal embryogenesis and bone healing. Recombinant human BMPs (rhBMPs) have been shown to heal critical size defects and promote spinal fusion. We studied the effects of rhBMP-2 in an absorbable collagen sponge (ACS) on bone healing in a large animal tibial fracture model. Bilateral closed tibial fractures were created in 16 skeletally mature goats and reduced and stabilized using external fixation. In each animal, one tibia received the study device (0.86 mg of rhBMP-2/ACS or buffer/ACS), and the contralateral fracture served as control. The device was implanted as a folded onlay or wrapped circumferentially around the fracture. Six weeks following fracture, the animals were sacrificed and the tibiae harvested for torsional testing and histomorphologic evaluation. Radiographs indicated increased callus at 3 weeks in the rhBMP-2/ACS treated tibiae. At 6 weeks, the rhBMP-2/ACS wrapped fractures had superior radiographic healing scores compared with buffer groups and controls. The rhBMP-2/ACS produced a significant increase in torsional toughness (p = 0.02), and trends of increased torsional strength and stiffness (p = 0.09) compared with fracture controls. The device placed in a wrapped fashion around the fracture produced significantly tougher callus (p = 0.02) compared with the onlay application. Total callus new bone volume was significantly increased (p = 0.02) in the rhBMP-2/ACS fractures compared with buffer groups and controls regardless of the method of device application. The rhBMP-2/ACS did not alter the timing of onset of periosteal/endosteal callus formation compared with controls. Neither the mineral apposition rates nor bone formation rates were affected by rhBMP-2/ACS treatment. The increased callus volume associated with rhBMP-2 treatment produced only moderate increases in strength and stiffness.     

The fate of the articular cartilage in intracapsular fracture of the femoral neck (articular cartilage in femoral neck fracture)

The fate of the articular cartilage of the hip joint with intracapsular neck fracture was studied by histological, histochemical and autoradiographic techniques and by using a polarized microscope and a scanning electron microscope. Cartilage specimens from 93 femoral heads and 7 acetabula were obtained from fractured hips 2 days to 4 1/3 years postfracture and from control hips with various disorders. The cartilage degeneration appeared 2 weeks after fracture and advanced steadily with time. The matrix was covered, invaded and ultimately replaced by the fibrous tissue. Chondrocyte viability, though it was lost from the surface, was recognized in the deep matrix even in the oldest fracture examined. It is concluded that the humoral factor directly caused by the injury as well as the biomechanical impairment, i.e. a loss of physical stress, may play an essential role in the pathogenesis of the degeneration. The possibility of regeneration was discussed.     

Cosmetic surgery of the neck as an office procedure

A simple office procedure to eliminate permanently double chin deformity and senile neck cords and with nearly invisible scars is described. Postoperative complications are mitigated by the use of autogenous fat grafts and constant aspiration of the wound cavity both during and after surgery. Most patients are able to resume their normal activities in several days.     

股骨颈骨折的护理体会

股骨颈骨折是以髋部疼痛,腹股沟中点附近有压痛和纵轴叩击痛为主要表现的股骨头下至股骨颈基底部骨折.是老年常见的骨折之一,尤以老年女性较多.股骨颈骨折大多数是外旋暴力所引起的螺旋形骨折或斜形骨折.高龄患者因年老、体弱、多病、脏器功能减退等多方面原因,股骨骨折后易发生并发症.因此,对这类患者的护理工作极为重要.     

Intracapsular hip pressure after femoral neck fracture

A consecutive series of 34 patients with femoral neck fractures was included in a prospective study aimed at evaluating preoperative variations in intracapsular pressure after changes in hip position, hip traction, and aspiration of hemarthrosis and their influence on the development of femoral head necrosis. Patients were observed for 7 years after surgery. Before aspiration, the mean intracapsular pressure in the antalgic physiologic position was 44.4 mm Hg. There were no differences between displaced and undisplaced fractures. The pressure was a maximum (mean value, 124.8 mm Hg) with the hip in extension and inward rotation, this pressure being greater than the blood systolic pressure in most cases. Hip traction of 3 kg in the antalgic physiologic position was found to be highly effective in preventing any bone flow tamponade effect in displaced and undisplaced femoral neck fractures: the mean intracapsular pressure decreased to 28.5 mm Hg. Aspiration of the hemarthrosis induced a significant decrease in intracapsular pressure only in cases with impaired vascularity of the femoral head as measured by scintigraphy using 99mTc labeled methyldiphosphonate. Aspiration of the hemarthrosis therefore is indicated only in the above cases, although it is less effective than hip traction in the antalgic position. There was no significant correlation between intracapsular pressure and the scintigraphy ratio. Avascular necrosis of the femoral head was detected in six cases. Among these, five patients had an intracapsular pressure below their diastolic blood pressure. This could indicate that vascular damage related to the fracture could be an important cause of bone necrosis despite that blood supply can be decreased by a tamponade effect.     

Femoral and spinal bone mineral density in Japanese osteoporotics with hip fracture

In the present study, bone mineral density (BMD) of femoral neck and lumbar spine was compared between 38 Japanese female patients with hip fracture (age 63-89 years, mean +/- SD 76 +/- 7 years) and 162 age-matched female controls (age 62-90 years, mean +/- SD 75 +/- 7 years). BMD was measured in the femoral neck and lumbar spine (L2-4) using dual-photon absorptiometry (Norland model 2600). BMD values of femoral neck as well as lumbar spine were significantly lower in patients with hip fracture than in controls (0.504 +/- 0.097 v 0.597 +/- 0.101, p < 0.01, for femoral neck; 0.661 +/- 0.146 v 0.720 +/- 0.128, p < 0.05, for lumbar spine). Patients with hip fracture and controls were stratified according to their BMD levels at two measuring sites, and the ratio of the number of patients and controls at each BMD level was calculated as an indicator of fracture rate. This ratio showed an exponential increase as the femoral neck BMD declined, but only a gradual increase as the lumbar spine BMD declined. Specificity-sensitivity analysis revealed that BMD values of 0.59 and 0.54 g/cm2 at the femoral neck provided a specificity of 52% and 68% with a sensitivity of 90% and 75%, respectively. These findings suggest that Japanese patients with hip fracture are more osteoporotic than age-matched controls and that the selective measurement of femoral neck would be useful for predicting the risk of hip fracture.     

Use of the spiral pin for fracture of the humeral neck

Our new method of intramedullary fixation of humeral neck fracture is described. Spiral pin is made of stainless steel. The top is coiled, and the end is threaded. It is inserted from a small incision over the posterior surface of the supracondyle. It is passed across the fracture site into the head of the humerus, where it locks the head. The fracture surface is pressed together by tigtening nuts. The fracture fixation allows early movement of the shoulder joint. The method was used in eight patients. The average age was one-year-old.     

Cortical aging differences and fracture implications for the human femoral neck

Clinical imaging techniques cannot consistently identify individuals at risk for hip fracture. Individual differences in falling likelihood partly account for these inconsistencies, but it is also thought that microscopic bone changes may play a role. In this study, subcapital, mid-neck, and trochanteric sites from eight young adult (26 +/- 7 years) and nine older (63 +/- 3 years) males were studied using backscattered electron imaging to identify age-related microscopic structural and mineral changes around the cortex. Cortical bone volume (BV(Ct)/TV), cortical void volume (Vd.V(Ct)/TV), hypermineralized bone volume (BV(H-min)/TV), the number of osteons/mm2 (N.On/B.Ar), lacunae/mm2 (N.Lc/B.Ar(Ct)) in the cortex, lacunae/mm2 (N.Lc/B.Ar(H-min)) in the hypermineralized phase, and cortical thickness (Ct.Th) were measured at subcapital, mid-neck, and trochanteric levels. Cortical void volume showed no differences (P = 0.26) between levels in the younger group, but differences (P < 0.05) were observed in the older group, indicating locational osteopenic differences. Cortical thickness differences were greater at the subcapital (27.7%) and mid-neck (25.2%) levels than at the trochanteric level (10.5%). Both age (P = 0.0022) and level-location interaction (P < 0.0001) influenced the hypermineralized bone volume present, with larger hypermineralized regions generally occurring at the thinner superior locations. Significant (P < 0.05) lacunar differences with aging in the hypermineralized phase suggest a necrotic origin. Artifactual cracks occurred preferentially within the hypermineralized phase, indicating localized reductions in fracture toughness, which may provide a site for crack initiation following an impact.     

Long-term results of the Stamey bladder neck suspension: direct comparison with the Marshall-Marchetti-Krantz procedure

Non-glycosylated recombinant Locusta migratoria apolipophorin-III, apoLp-III, was expressed in E. coli and its physical-chemical properties were compared to those of the glycosylated native apoLp-III. Fluorescence quantum yield and acrylamide quenching studies indicated a slightly higher accessibility of the Trp residues in the recombinant apoLp-III. Far-UV CD spectroscopy indicated that the recombinant apoLp-III has a lower alpha-helical content than the glycosylated apoLp-III. Both proteins spontaneously formed discoidal recombinant lipoprotein particles when incubated with dimyristoylphosphatidylcholine (DMPC). Interaction with lipid promotes an increase in alpha-helical content. CD and fluorescence studies indicate that both proteins adopt the same conformation in the lipid-bound state. However, the kinetics of association of the recombinant protein with DMPC is 5-fold faster than that of the native protein. The results suggest that glycosylation inhibits the lipid binding activity by preventing the exposure of hydrophobic domains and/or decreasing the conformational flexibility of the protein.     

Postoperative Tc-scintimetry in femoral neck fracture. A prospective study of 46 cases

This article presents panic diary results of a dose-response study with imipramine hydrochloride in panic disorder with agoraphobia patients. Analysis of variance revealed significant time effects on panic frequency and severity measures, but group x time interaction effects were present for the severity measures only. Results also provided evidence for a positive dose-response relationship with 20 percent of patients in the placebo group, 31 percent in the low-dose group (0.5 mg/kg/day), 54 percent in the medium-dose group (1.5 mg/kg/day), and 70 percent in the high-dose (3 mg/kg/day) group being free of recurrent or severe panic attacks at posttreatment. Further stratified and logistic regression analyses revealed a direct linear relationship between total plasma tricyclic concentration and response. These findings affirm the dose-dependent nature and the specificity of imipramine's antipanic effects.