Vitamin D and Calcium Supplementation in Elderly Patients Suffering Fragility Fractures; The Road not Taken.

Background: Calcium and Vitamin D supplementation in elderly patients may decrease the risk of hip fracture by up to one-third. Many patients suffering fragility fractures do not go on to receive this treatment despite clear recommendations from the National Institute for Health and Clinical Excellence (NICE). The aim of this study was to audit the proportion of patients admitted with a hip fracture who had suffered a previous fragility fracture and were taking calcium and vitamin D supplements, with the standard being that all of these patients should have been taking bone protection.

Total hip arthroplasty with the MS-30 polished surface cemented stem: a single surgeon consecutive series study at 10 year follow-up.

The Morscher-Sportorno femoral stem is a stainless steel, straight, three-dimensionally tapered, collarless implant for cemented fixation in total hip replacement. The clinical and radiographic results of this implant at a minimum of 5-year follow-up have been extremely encouraging. However, the results at 10 years have yet to be reported.

Staff nurses revitalize a clinical ladder program through shared governance.

After 20 years of a static clinical ladder program at our institution, the clinical ladder program was completely redesigned using a staff nurse-led shared governance structure to re-envision the program as an innovative, staff leadership model to meet our organizational nursing mission and vision strategic plans around retention and professional development. The literature demonstrated a lack of outcome-driven findings on the sustainability of hospital-based clinical ladder programs. The authors cover the rationale for our clinical ladder model, the process used for revision, the implementation strategies, and the specific outcomes tracked regarding nurse satisfaction, affiliation, retention, and participation of staff nurses advancing to the optional upper levels of the ladder.

In vivo polyethylene wear of bilateral total hip replacements - cemented versus uncemented modular sockets.

We assessed polyethylene wear and osteolysis in 15 patients (30 hips) undergoing staged bilateral total hip arthroplasties, who had a cemented arthroplasty on one side and a hybrid arthroplasty on the other. All factors apart from mode of acetabular component fixation were matched. Wear was measured radiographically using Livermore's technique.

Identification and treatment of anaemia in patients awaiting hip replacement.

Introduction: The correction of anaemia prior to total hip arthroplasty reduces surgical risk, hospital stay and cost. This study considers the benefits of implementing a protocol of identifying and treating pre-operative anaemia whilst the patient is on the waiting list for surgery.

Patients And Methods: From a prospective series of 322 patients undergoing elective total hip arthroplasty (THA), patients identified as anaemic (haemoglobin (Hb) < 12 g/dl) when initially placed upon the waiting list were appropriately investigated and treated.

Lipopolysaccharide increases cell surface P-glycoprotein that exhibits diminished activity in intestinal epithelial cells.

Increasingly, it is recognized that commensal microflora regulate epithelial cell processes through the dynamic interaction of pathogen-associated molecular patterns and host pattern recognition receptors such as Toll-like receptor 4 (TLR4). We therefore investigated the effects of bacterial lipopolysaccharide (LPS) on intestinal P-glycoprotein (P-gp) expression and function. Human SW480 (P-gp+/TLR4+) and Caco-2 (P-gp+/TLR4-) cells were treated with medium control or LPS (100 ng/ml) for 24 h prior to study.

The effect of total hip replacement on the employment status of patients under the age of 60 years.

Introduction: A retrospective study was undertaken of a consecutive cohort of 86 patients (101 hips) under the age of 60 years operated on by a single orthopaedic team between 1993 and 2003 at a district general hospital.

Patients And Methods: Demographic and diagnostic data were collected from patients' hospital records, and a detailed questionnaire regarding occupational status was used at follow-up.

Results: Nearly all of the patients working prior to surgery returned to employment following surgery.

MRSA in patients presenting with femoral fractures.

Aim: To assess MRSA carrier status in patients from different residences presenting with femoral fractures and to assess the incidence of MRSA deep wound infections post-operatively with regard to MRSA status on presentation.

Method: One hundred and five patients were screened for MRSA on arrival over a 20-week period. They were then followed up post-operatively to determine the number of patients developing MRSA deep wound infection.

The influence of biomaterial on patterns of failure after cemented total hip replacement.

We examined aseptic loosening and osteolysis in 77 revised McKee-Arden total hip arthroplasties (THAs) using polyethylene cups and identical femoral stems made from either cobalt chrome alloy or titanium alloy. Time to failure was significantly shorter in the titanium group. Loosening and peri-prosthetic osteolysis occurred with significantly higher frequency in the titanium group compared to the cobalt chrome group.

Erythrocyte transfusion causes immunosuppression after total hip replacement.

A prospective study of 34 patients undergoing total hip replacement was done to determine whether homologous erythrocyte transfusion causes postoperative immunosuppression. In the transfused patient group (14 patients), there was a reduction in CD3+ and CD3+4+ cell numbers at Day 2, returning to preoperative levels by Day 7. In contrast, in the untransfused patient group (20 patients), there was no significant depression in these lymphocyte subgroups at Day 2 and an increase in total lymphocyte, CD3+, CD3+4+, and CD3+4-8- cell numbers at Day 7.

Prophylactic plating of the donor site of osteocutaneous radial forearm flaps.

We carried out a retrospective study of fracture morbidity of radial forearm osteocutaneous donor sites. During a period of three-and-a-half years, 12 patients had had composite flaps taken, and 5 of them had subsequently fractured the radius. We then elected to plate the radius prophylactically and found that over a period of just over two years, none of the 8 patients who had had prophylactic plating at the original harvesting operation had subsequently fractured the radius.

Blood loss during primary total hip arthroplasty: use of preoperative measurements to predict the need for transfusion.

The blood loss resulting from total hip arthroplasty was studied in 53 patients. Calculated blood loss exceeded measured blood loss in all cases. The most significant predictor of postoperative packed-cell volume (PCV) was the preoperative PCV.

Radiographic appearance and structural properties of proximal femoral bone in total hip arthroplasty patients.

The relationship between the morphology of the proximal femur and the physical properties of intertrochanteric trabecular bone was assessed in 26 patients undergoing total hip arthroplasty. Significant correlations were found between ash density and (1) Singh index, (2) "calcar-to-canal isthmus ratio," and (3) a modified "morphologic cortical index." Despite this, these radiographic indices accounted for only 30% of the variability in bone density and are therefore of limited predictive value in this context.

The use of reinforcement rings to reconstruct deficient acetabula.

We reviewed 64 patients in whom 66 acetabula had been reconstructed with either the Müller ring (46) or the Burch-Schneider anti-protrusio cage (20) at a mean follow-up of five years. Five hips had been revised a second time for loosening, all after a Müller ring had been used for a medial segmental defect (2), ungrafted cavitary defects (2) or after resorption of a block graft (1). The use of bone grafts with the implants reduced the incidence of failure from 13% to 6% and of circumferential radiolucent lines at the bone-implant interface from 39% to 2%.

Locked nailing for nonunion of the tibia.

We treated 24 patients with nonunion of tibial shaft fractures by locked intramedullary nailing, 18 by open and six by closed techniques. Union was achieved in 22 patients, failing only in two patients with active infection. Locked nailing prevented recurrence of deformity and allowed the patients to mobilise without external support.

Healing of residual screw holes after plate removal.

A single photon absorptiometric method of imaging residual screw holes after plate removal is described. Application of this technique to seven patients demonstrated that ingrowth into these defects is a protracted process which remained incomplete at 18 weeks in all seven patients. Bone mass at the site of the screw holes was, however, close to normal at 18 weeks in four young adults, lending support to the AO-ASIF recommendation that athletic activity should be avoided for 4 months after plate removal.

Refracture after the removal of plates from the forearm. An avoidable complication.

The incidence of refracture following the removal of screws and plates from the diaphyses of 115 forearm bones in 80 patients has been studied. Refracture occurred in four adult patients as a result of minimal trauma, in two patients at the original fracture site after premature plate removal, at the site of a countersunk interfragmentary screw in one and at the original fracture site in another who had required three operative procedures to achieve 'union'. It is suggested that refracture could have been avoided in at least two of these patients.

[Osseointegrated implants. Clinical cases and light and electron microscope study].

Titanium osseointegrated implants have been placed in maxilaries of partially edentulous patients. After a follow-up of 5 to 6 months, a clinical and radiographical evaluation was made in order to determine the osseointegration obtained. In two of these cases, the gingival tissue in contact with the implants was studied under a light and transmission electron microscope.

Bone weakness after the removal of plates and screws. Cortical atrophy or screw holes?

Bone weakness leading to refracture is a recognised complication of the removal of rigid fixation plates. We have used partially demineralised rabbit tibiae to simulate atrophic changes and to determine whether weakness is due to atrophy or to residual screw holes. Partial demineralisation and a screw hole each reduced maximum bending moment.

Bone structure after removal of internal fixation plates.

We used single-photon absorptiometry to assess the forearm bones after the removal of internal fixation plates in 14 patients. We found convincing evidence of cortical atrophy in only one patient, in whom the plates had been removed prematurely after only 16 months. It is suggested that such plates should be retained for at least 21 months, to allow bone density to return to its prefracture level.

[Subperiosteal mandibular implant. Clinical cases and microscopic study].

Subperiosteal surgical Vitallium implants have been set in the mandible of patients with loss of height of the osseous ridge and difficulty in the use of prostheses obtaining very good clinical and radiographical results. The optic microscopy showed a great tendency of adhesion of the gingiva's junctional epithelium to the implant.

Closed traction lesions of the brachial plexus--an epidemic among young motorcyclists.

One-hundred-and-sixty patients with closed traction lesions of the brachial plexus sustained in motorcycle accidents were asked about their accident. One-hundred-and-six responded. Most were young men with limited experience of riding motorcycles.

Disability following closed traction lesions of the brachial plexus sustained in motor cycle accidents.

102 patients with closed traction lesion of the brachial plexus resulting from motor cycle accidents have been studied. The majority were young men, with the dominant arm involved in 64%. 74% of the patients underwent early operative exploration and 54% of these were amenable to at least partial repair.