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J Bone Metab 2021 May 31;28(2):171-178. Epub 2021 May 31.

Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

Paget's disease of bone (PDB) is a progressive bone disorder characterized by increased osteoclast-mediated bone resorption and abnormal bone formation. Incomplete atypical femoral fracture, appearing radiographically as a stress fracture at the lateral aspect of the femur, is an uncommon low-trauma fracture frequently seen in association with long-term bisphosphonate therapy. We describe the case of a 61-year-old female patient with PDB who developed a stress fracture at the lateral femoral cortex after 5 doses of intravenous bisphosphonate. Read More

J Bone Metab 2021 May 31;28(2):139-150. Epub 2021 May 31.

Department of Cardiology, Sri Jayadeva Institute of Cardiac Sciences and Research, Bengaluru, India.

Background: There are limited studies comparing the risk of osteoporosis and fractures between different direct oral anticoagulants (DOACs) and vitamin K antagonists (VKA) in non-valvular atrial fibrillation (AF). Using a network meta-analysis (NMA), we compared osteoporotic fractures among 5 different treatment arms, viz. dabigatran, rivaroxaban, apixaban, edoxaban, and VKA. Read More

J Bone Metab 2021 May 31;28(2):123-129. Epub 2021 May 31.

Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Background: The purpose of this study was to investigate the characteristics of women with subsequent distal radius fracture (DRF) and to compare bone fragility variables in women with initial and subsequent DRF.

Methods: We enrolled 227 women who experienced DRF (203 women with initial DRF and 24 women with subsequent DRF) between September 2016 and April 2019. We compared demographic characteristics and bone fragility variables, including bone mineral density, trabecular bone score, hip geometry, bicortical thickness of the distal radius, and fracture risk assessment tool (FRAX) scores between the 2 groups. Read More

J Bone Metab 2021 May 31;28(2):115-122. Epub 2021 May 31.

Department of Orthopedic Surgery, Ewha Womans University, College of Medicine, Mokdong Hospital, Seoul, Korea.

Osteoporosis does not take a break while Coronavirus disease 2019 (COVID-19) stunned and overtook everyone's lives. Medical resources were immediately shifted, self-isolation and telemedicine were expanded, ambulatory care services such as bone densitometry and osteoporosis-centered clinics came to a near halt. Progress with fracture prevention has been challenged because osteoporotic fracture with low energy injury is more prevalent even though restriction of people's movement. Read More

J Bone Metab 2021 May 31;28(2):101-113. Epub 2021 May 31.

Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.

The trabecular bone score (TBS) was introduced as an indirect index of trabecular microarchitecture, complementary to bone mineral density (BMD), and is derived using the same dual energy X-ray absorptiometry images. Recently, it has been approved for clinical use in Korea. Therefore, we conducted a comprehensive review to optimize the use of TBS in clinical practice. Read More

J Affect Disord 2021 Jun 7;292:204-211. Epub 2021 Jun 7.

Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospitals, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark; Section for Epidemiology, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Copenhagen K 1014, Denmark.

Background: Patients with affective disorder seem to experience higher risks of several somatic diseases, but no studies have provided estimates of both absolute and relative risks for these diseases in the same population.

Methods: A prospective cohort of all patients age ≥18 years old with a hospital contact with affective disorder between 1997-2014 (n=246,282) and a random sample from the background population (n=167,562) was followed for hospitalizations with cardiovascular disease, diabetes, cancers, chronic obstructive pulmonary disease (COPD), asthma, inflammatory bowel disease, hip fracture, psoriasis, migraine, or dementia. Adjusted absolute and relative risk estimates were calculated using multivariable adjusted Aalen's additive and Cox proportional hazard regression models. Read More

World Neurosurg 2021 Jun 12. Epub 2021 Jun 12.

Department of Spine surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China; Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510700, China. Electronic address:

Background: Pedicle screw fixation (PSF) was considered to be the preferred surgery for treatment of severe osteoporotic vertebral compression fracture (sOVCF), while sOVCF was traditionally regarded as a relative contraindication to minimally invasive percutaneous kyphoplasty (PKP). Debate continues on the selection of surgical methods for sOVCF. This study aimed to compare the efficacy and safety between PKP and PSF. Read More

Acta Biomater 2021 Jun 12. Epub 2021 Jun 12.

Department of Biomedical Engineering, Vanderbilt University, 2201 West End Ave, Nashville TN 37235; Department of Chemical and Biomolecular Engineering, Vanderbilt University, 2201 West End Ave, Nashville TN 37235; Vanderbilt Center for Bone Biology, Vanderbilt University Medical Center, 1211 Medical Center Dr., Nashville, TN 37212; Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, 1211 Medical Center Dr., Nashville, TN 37217. Electronic address:

Most fractures heal by a combination of endochondral and intramembranous ossification dependent upon strain and vascularity at the fracture site. Many biomaterials-based bone regeneration strategies rely on the use of calcium phosphates such as nano-crystalline hydroxyapatite (nHA) to create bone-like scaffolds. In this study, nHA was dispersed in reactive polymers to form composite scaffolds that were evaluated both in vitro and in vivo. Read More

Acta Orthop Belg 2021 Mar;87(1):159-166

Children with attention deficit hyperactivity disorder (ADHD) have an increased risk of sustaining fractures during their preschool years. Supracondylar humerus fractures (SHFs) comprise the majority of fracture surgeries in the pediatric age range. We hypothesized that ADHD symptoms would be present in children with SHFs, and this characteristic trauma may be associated with an ADHD diagnosis. Read More

Acta Orthop Belg 2021 Mar;87(1):143-149

The literature on forearm overgrowth after plating in traumatic conditions is relatively poor though this technique can be useful when intra-medullary nailing is not sufficient in pediatric cases. The goal of this study was to assess a potential overgrowth after plating and identify impact on function. We conducted a retrospective study of all pediatric patients who underwent open surgery of the radius and/or ulna diaphysis with internal fixation by plating, in our institution, between October 2013 and July 2019. Read More

Acta Orthop Belg 2021 Mar;87(1):125-136

The study aim is to evaluate functional and radio- logical outcomes following a suggested protocol based on the four-column classification for management of posterolateral column tibial plateau fractures. A prospective cohort study was performed in level I academic center on 42 patients with mean age of 36 years (22-59). Eleven patients had isolated posterolateral column fractures whereas 31 patients had associated columns fractures. Read More

Acta Orthop Belg 2021 Mar;87(1):111-116

Purpose: distal femoral periprosthetic fracture (DFPPF) is a serious complication following total knee arthroplasty (TKA). Recently, treatment of DFPPF with distal femoral arthroplasty (DFA) has gained popularity because of its posited benefits for both patients and the medical system. Short-term follow-up trials investigating DFA have demonstrated acceptable results with regards to function, pain relief and lower postoperative complications than ORIF in elderly patients. Read More

Acta Orthop Belg 2021 Mar;87(1):85-92

Open tibia fracture (OTF) treatment is well documented in developed countries. Yet, this fracture pattern remains challenging because it is associated with an increased risk of infection and delayed union, particularly in case of Gustilo III B and C open fractures. Since access to healthcare is limited in Sub- Saharan African countries, this paper explores the results of OTF management in this setting. Read More

Acta Orthop Belg 2021 Mar;87(1):41-45

The concern of extensive fracturing and bone damage during implant removal has been reported for ingrowing stems, in particular in extended porous coated stems, potentially impeding successful re- implantation of a femoral revision implant and consequently debilitating patients for life. The aim of the present study is to describe this particular complication and comparing the occurrence in porous coated and hydroxyapatite (HA) coated femoral implants. 62 consecutive revision hip replacements were per- formed between January 2010 and December 2016 at a single academic institution. Read More

Acta Orthop Belg 2021 Mar;87(1):35-39

Current national guidelines (NICE) recommends that all medically fit, independently-mobile patients without cognitive impairment receive a total hip arTHAoplasty(THA) for displaced intracapsular neck of femur (NOF) fractures. Dislocation is a concern(2-10%). Dual mobility cups have been suggested to address this complication. Read More

Acta Orthop Belg 2021 Mar;87(1):25-34

Spontaneous subcapital fracture (SSF) of femoral neck in pre-existent osteonecrosis of femoral head (ONFH) is a rare presentation. Only a few cases have been reported so far and majority of them have been reported to have unilateral hip involvement. We retrospectively reviewed clinical-radiological data of 10 patients (12 hips) with SSF complicating ONFH. Read More

Acta Orthop Belg 2021 Mar;87(1):17-23

The success of conversion Total Hip Arthroplasty (THA) among primary THA and revision THA re- mains unclear. We hypothesized that most conversion THAss can be performed using primary implants and will have an uncomplicated post-operative course. Thirty-six patients (23 females, mean age 68,0y) who underwent conversion THA for failed interventions for proximal femur fractures in the period 2006-2018 were matched sequentially against patients of the same sex and age who underwent primary THA or revision THA. Read More

Acta Orthop Belg 2021 Mar;87(1):1-7

Elderly patients who present with an inability to weight bear following a fall, with normal radiographs, should be appropriately investigated to rule out an occult hip fracture (OHF). We aim to identify both the range and incidence of the differential diagnosis of acute traumatic hip pain in a large series of patients investigated for OHF. A retrospective analysis of consecutive patients investigated for an OHF with magnetic resonance imaging (MRI) was performed. Read More

PLoS One 2021 15;16(6):e0251894. Epub 2021 Jun 15.

Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland.

Introduction: To date, it is unclear what the clinical benefit of cement augmentation in fixation for trochanteric fractures is. The aim of this meta-analysis is to compare cement augmentation to no augmentation in fixation of trochanteric femur fractures in the elderly patients (>65 years) following low energy trauma.

Methods: PubMed/Medline/Embase/CENTRAL/CINAHL were searched for both randomized clinical trials (RCT) and observational studies comparing both treatments. Read More

J Bone Joint Surg Am 2021 Jun 15. Epub 2021 Jun 15.

Department of Orthopaedic Surgery and Traumatology, Kantonsspital St. Gallen, St. Gallen, Switzerland.

Background: Previous studies have identified risk factors for different types of treatment of proximal humeral fracture (PHF) and allowed the development of a patient-specific, evidence-based treatment algorithm with the potential of improving overall outcomes and reducing complications. The purpose of this study was to evaluate the results and complications of treating PHF using this algorithmic approach.

Methods: All patients with isolated PHF between 2014 and 2017 were included and prospectively followed. Read More

JBJS Case Connect 2021 06 15;11(2). Epub 2021 Jun 15.

Department of Pediatric Orthopaedics, Phoenix Children's Hospital, Phoenix, Arizona.

Case: An adolescent girl presented with groin pain without any history of trauma. Imaging showed a tension-sided stress fracture of the femoral neck. Vitamin D deficiency (VDD), and raised alkaline phosphatase and parathyroid hormone levels were found. Read More

JBJS Case Connect 2021 06 15;11(2). Epub 2021 Jun 15.

Department of Orthopedic Surgery, John Peter Smith Hospital, Fort Worth, Texas.

Case: A 29-year-old man presented with a displaced medial clavicle fracture. Surgical repair was performed using a precontoured plate designed for the contralateral distal clavicle, and medial fixation was accomplished at the sternum. The patient had no complications and demonstrated full strength and range of motion at the 8-month follow-up. Read More

J Orthop Res 2021 Jun 15. Epub 2021 Jun 15.

University of California Davis Health, Department of Orthopaedic Surgery.

We previously showed that femur fracture in mice caused a reduction in bone volume at distant skeletal sites within 2 weeks post-fracture. Osteocytes also have the ability to remodel their surrounding bone matrix through perilacunar/canalicular remodeling (PLR). If PLR is altered systemically following fracture, this could affect bone mechanical properties and increase fracture risk at all skeletal sites. Read More

Eur J Trauma Emerg Surg 2021 Jun 15. Epub 2021 Jun 15.

School of Medical Sciences, Orebro University, 702 81, Orebro, Sweden.

Purpose: Dementia, present in 20% of hip fracture patients, is associated with an almost threefold increase in postoperative mortality risk. These patients have a substantially higher incidence of cardiovascular, respiratory, and cerebrovascular mortality after hip fracture surgery compared to patients without dementia. This study aimed to investigate the association between beta-blocker therapy and postoperative mortality in patients with dementia undergoing hip fracture surgery. Read More

Osteoporos Int 2021 Jun 15. Epub 2021 Jun 15.

Division of Policy, Research and Evaluation, Ministry of Health, Singapore, Singapore.

Comorbidity and hip fracture independently increased mortality risk for 9 years in both sexes, with a significant additive interaction in the first year among women and through 6 years among men.

Introduction: Hip fracture is associated with a persistently elevated mortality risk, but it is unknown whether the elevated risk is due to the fracture or to pre-fracture comorbidity.

Methods: In a population-based study in Singapore with 9 years of follow-up, patients age > 50 with first hip fracture from 2008 to 2017 were pair-matched to a cohort without hip fracture by age, sex, ethnicity, and pre-fracture Charlson Comorbidity Index (CCI). Read More

Osteoporos Int 2021 Jun 15. Epub 2021 Jun 15.

Bone and Mineral Research Unit (ISPA) (REDinREN), Hospital Universitario Central Asturias, Oviedo University, Asturias, Spain.

The European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) CKD-MBD working group, in collaboration with the Committee of Scientific Advisors of the International Osteoporosis Foundation, published a position paper for the diagnosis and management of osteoporosis in patients with CKD stages 4-5D (eGFR < 30 ml/min 1.73 m). The present article reports and summarizes the main recommendations included in this 2021 document. Read More

Medicine (Baltimore) 2021 Jun;100(24):e26392

Department of Orthopedic Surgery, Korea University Guro Hospital, Korea University Medical Center, Seoul, Republic of Korea.

Abstract: Although infra-acetabular screws have been used for anterior and posterior column transfixation, a screw penetrating the hip joint can result in harmful complications. However, the most accurate intraoperative radiologic imaging tool for identifying articular penetration has not been established. The purpose of the present study was, therefore, to evaluate the consistency with which standard pelvic radiographs compared with computed tomography (CT) can be used for demonstrating articular penetration. Read More

Medicine (Baltimore) 2021 Jun;100(24):e26383

Department of Radiology.

Rationale: Sphenoid sinus pseudoaneurysm arising from the cavernous segment of the internal carotid artery (ICA) caused by traumatic vessel injury is rare, and rarer is a concomitant carotid-cavernous fistula (CCF). In particular, delayed subarachnoid hemorrhage (SAH) due to pseudoaneurysm rupture has not been reported to-date in literature. Here, we report a case of sphenoid sinus pseudoaneurysm with CCF presenting with delayed SAH. Read More

J Orthop Trauma 2021 Jun 14. Epub 2021 Jun 14.

R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA University of British Columbia, Department of Orthopaedic Surgery, Vancouver, BC, Canada.

Objectives: To determine if changes in pelvic trauma care and treatment protocols has affected overall mortality rates after pelvic ring injury.

Design: Retrospective chart review.

Setting: Level I trauma center. Read More

Am Surg 2021 Jun 15:31348211024973. Epub 2021 Jun 15.

Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange, CA, USA.

Introduction: Extensive research relying on Injury Severity Scores (ISS) reports a mortality benefit from routine non-selective thoracic CTs (an integral part of pan-computed tomography (pan-CT)s). Recent research suggests this mortality benefit may be artifact. We hypothesized that the use of pan-CTs inflates ISS categorization in patients, artificially affecting admission rates and apparent mortality benefit. Read More