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Evidence for impaired skeletal load adaptation among Canadian women with type 2 diabetes mellitus: insight into the BMD and bone fragility paradox.

https://arctichealth.org/en/permalink/ahliterature113056
Source
Metabolism. 2013 Oct;62(10):1401-5
Publication Type
Article
Date
Oct-2013
Author
Celeste J Hamilton
Sophie A Jamal
Thomas J Beck
Alia S Khaled
Jonathan D Adachi
Jacques P Brown
K Shawn Davison
Author Affiliation
Department of Exercise Sciences, University of Toronto, 55 Harbord St., Toronto, Ontario, M5S 2W6, Canada. Electronic address: celestejanehamilton@gmail.com.
Source
Metabolism. 2013 Oct;62(10):1401-5
Date
Oct-2013
Language
English
Publication Type
Article
Keywords
Absorptiometry, Photon - methods
Adaptation, physiological - physiology
Aged
Bone Density - physiology
Bone and Bones - physiology - radiography
Canada
Diabetes Mellitus, Type 2 - physiopathology - radiography
Female
Femoral Fractures - etiology - physiopathology - radiography
Femur Neck - physiology - radiography
Humans
Middle Aged
Prospective Studies
Stress, mechanical
Abstract
Recent data suggest that women with type 2 diabetes mellitus (T2DM) might be more susceptible to fractures due to an impaired adaptive response to mechanical load, despite reportedly higher bone mineral density (BMD). The purpose of this study was to use an engineering beam analysis to calculate and compare the load stresses on the femurs of healthy women and women with T2DM and compare these levels to conventional measures of femoral neck BMD.
We studied 3658 women who participated in the Canadian Multicentre Osteoporosis Study (CaMos), and who had available Hip Structure Analysis (HSA) data from baseline dual energy x-ray absorptiometry (DXA) scans. Women were categorized into two groups based on the presence or absence of self-reported T2DM. We computed stress in megapascals (MPa) at the infero-medial margin of the femoral neck in a one-legged stance using an engineering beam analysis incorporating dimensions and geometry from DXA scans using the HSA method. We used linear regression (SAS 9.3) to determine the association between T2DM status and stress. We also determined the association between T2DM status and femoral neck BMD.
Stresses were 4.5% higher in T2DM women than in non-diabetics (11.03±0.18 vs. 10.56±0.04 MPa; p=0.0093). Femoral neck BMD was 4.2% greater in women with T2DM than in non-diabetics (0.74±0.002 vs. 0.71±0.01 g/cm(2); p=0.0008).
Despite higher femoral neck BMD, higher stress indicates weaker skeletal geometry for a given load, and suggests an impaired skeletal adaptive response to load may be present in women with T2DM.
PubMed ID
23768546 View in PubMed
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Inferior outcome after intraoperative femoral fracture in total hip arthroplasty: outcome in 519 patients from the Danish Hip Arthroplasty Registry.

https://arctichealth.org/en/permalink/ahliterature85747
Source
Acta Orthop. 2008 Jun;79(3):327-34
Publication Type
Article
Date
Jun-2008
Author
Thillemann Theis M
Pedersen Alma B
Johnsen Søren P
Søballe Kjeld
Author Affiliation
Department of Orthopedics, Aarhus University Hospital, Denmark. tt@dce.au.dk
Source
Acta Orthop. 2008 Jun;79(3):327-34
Date
Jun-2008
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Arthroplasty, Replacement, Hip - adverse effects
Child
Denmark
Female
Femoral Fractures - etiology - surgery
Follow-Up Studies
Humans
Intraoperative Complications - etiology - surgery
Length of Stay
Male
Middle Aged
Osteoarthritis, Hip - surgery
Prosthesis Failure
Registries
Reoperation
Treatment Outcome
Abstract
BACKGROUND: Intraoperative femoral fracture is a well known complication of primary total hip arthroplasty (THA). Experimental studies have indicated that intraoperative fractures may affect implant survival. Very few clinical data are available, however. METHODS: We used data from the Danish Hip Arthroplasty Registry to identify patients in Denmark who underwent a primary THA due to primary osteoarthritis between 1995 and 2005 (n = 39,478). Data were linked to two national Danish databases in order to conduct time-dependent implant survival analyses. Implant survival and relative risk estimates were calculated for patients treated nonoperatively and for patients treated with osteosynthesis after sustaining intraoperative femoral fractures during THA surgery. THAs performed without sustaining intraoperative femoral fracture served as the reference group. RESULTS: 282 patients (0.7%) were treated non operatively due to intraoperative femoral fracture and 237 patients (0.6%) were treated with osteosynthesis. In the 0-6 month postoperative period, the adjusted relative risk (RR) of revision was 1.5 (95% CI: 1.1-1.7) for patients treated nonoperatively and 5.7 (3.3-10) for patients treated with osteosynthesis. In the period from 6 months to 11 years postoperatively, we did not find any statistically significant differences in the RR of revision between the groups. INTERPRETATION: Intraoperative fractures increase the relative risk of revision during the first 6 postoperative months. Thus, patients should be informed about the risk of revision after sustaining an intraoperative femoral fracture. Furthermore, initiatives aimed at reducing the risk of revision in the first 6 months following THA should be considered in patients with intraoperative fractures, including immediate change to a larger stem with distal fixation and restricted weight bearing.
PubMed ID
18622835 View in PubMed
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Intrinsic factors in falling among the elderly.

https://arctichealth.org/en/permalink/ahliterature238728
Source
Arch Intern Med. 1985 Jun;145(6):1089-93
Publication Type
Article
Date
Jun-1985
Author
H. Nickens
Source
Arch Intern Med. 1985 Jun;145(6):1089-93
Date
Jun-1985
Language
English
Publication Type
Article
Keywords
Accidents, Home - prevention & control
Aged - psychology
Aging
Central Nervous System Diseases - complications
Cervical Vertebrae - injuries
Denmark
England
Epidemiologic Methods
Female
Femoral Fractures - etiology
Gait
Hip Fractures - etiology
Homes for the Aged
Humans
Male
Risk
Sex Factors
Syncope - complications
Abstract
Falls even among home-dwelling elderly are frequently associated with death and morbidity. Yet, this is not generally appreciated by practitioners or researchers. Those who work with institutionalized elderly have been much more aware of falls as a serious problem. This review of the literature suggests (1) that while environmental causes for falling have a commonsense appeal, it is likely that intrinsic (host) factors become more important with age, and (2) that careful studies using such methodologies as case control, and longitudinal surveillance, are necessary to further elucidate risk factors for falling and to direct preventive strategy.
PubMed ID
4004435 View in PubMed
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Periprosthetic femoral fractures in total hip arthroplasty - a review.

https://arctichealth.org/en/permalink/ahliterature138626
Source
Hip Int. 2010 Oct-Dec;20(4):418-26
Publication Type
Article
Author
Faizal Rayan
Fares Haddad
Author Affiliation
Department of Orthopaedics, University College London Hospitals, London, UK. rayanmarakkar@yahoo.co.uk
Source
Hip Int. 2010 Oct-Dec;20(4):418-26
Language
English
Publication Type
Article
Keywords
Algorithms
Arthroplasty, Replacement, Hip - adverse effects
Female
Femoral Fractures - etiology - therapy
Humans
Intraoperative Complications
Male
Periprosthetic Fractures - etiology - therapy
Postoperative Complications
Prosthesis Failure - etiology
Reoperation
Sweden - epidemiology
Abstract
Periprosthetic femoral fractures (PFF) are among the more difficult and expensive complications of total hip arthroplasty. A rise in the elderly population and increase use of primary hip replacement has led to an escalating incidence. They can occur intra operatively and post operatively. The treatment algorithm defined by the Vancouver classification has universal acceptance. The epidemiology, etiology, classification and the management of periprosthetic femoral fractures in total hip arthroplasty are reviewed.
PubMed ID
21157744 View in PubMed
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[Playground accidents--fractures in the hip region]

https://arctichealth.org/en/permalink/ahliterature37185
Source
Ugeskr Laeger. 1991 Apr 8;153(15):1065-6
Publication Type
Article
Date
Apr-8-1991
Author
B E Lindblad
S S Mikkelsen
Author Affiliation
Ortopaedkirurgisk afdeling, Arhus Amtssygehus.
Source
Ugeskr Laeger. 1991 Apr 8;153(15):1065-6
Date
Apr-8-1991
Language
Danish
Publication Type
Article
Keywords
Accidental Falls - prevention & control
Child, Preschool
Denmark
English Abstract
Femoral Fractures - etiology
Hip Fractures - etiology
Humans
Play and Playthings
Abstract
In order to illustrate the severity of accidents with playground equipment, two cases of fractures in the hip region in children are presented. Both accidents occurred when the children fell on hard surface without the necessary shock absorbing properties as recommended by the Danish Standards. It should be impossible for a child falling accidentally from playground equipment to attain deceleration levels exceeding 50 G at the impact with the underlying surface.
PubMed ID
2024334 View in PubMed
Less detail

[Sheer madness at Huddinge Hospital: many injuries caused by the revolving door].

https://arctichealth.org/en/permalink/ahliterature237356
Source
Lakartidningen. 1986 Feb 26;83(9):702
Publication Type
Article
Date
Feb-26-1986

Venting during prophylactic nailing for femoral metastases: current orthopedic practice.

https://arctichealth.org/en/permalink/ahliterature182336
Source
Can J Surg. 2003 Dec;46(6):427-31
Publication Type
Article
Date
Dec-2003
Author
Dustin Dalgorf
Cornelia M Borkhoff
David J G Stephen
Joel Finkelstein
Hans J Kreder
Author Affiliation
University of Toronto, Division of Orthopaedics, Sunnybrook & Women's College Health Sciences Centre, Toronto, Ont.
Source
Can J Surg. 2003 Dec;46(6):427-31
Date
Dec-2003
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Embolism, Fat - etiology - prevention & control
Evidence-Based Medicine
Femoral Fractures - etiology - prevention & control
Femoral Neoplasms - complications - secondary - surgery
Fracture Fixation, Intramedullary - adverse effects - methods - statistics & numerical data
Fractures, Spontaneous - etiology - prevention & control
Health Knowledge, Attitudes, Practice
Humans
Logistic Models
Ontario
Orthopedics - education - methods - statistics & numerical data
Osteotomy - methods - statistics & numerical data
Physician's Practice Patterns - statistics & numerical data
Physicians - psychology
Practice Guidelines as Topic
Pressure
Questionnaires
Risk factors
Abstract
Reamed intramedullary nailing, recommended for impending fracture of a femur weakened by bone metastases, causes a rise in intramedullary pressure and increases the risk of a fat embolism syndrome. The pressure can be equalized by the technique of venting--drilling a hole into the distal cortex of the femur. Our objective was to study the current practice of orthopedic surgeons in Ontario with respect to venting during prophylactic intramedullary nailing for an impending femoral fracture due to bone metastases.
We mailed a questionnaire to all orthopedic surgeons from the Province of Ontario listed in the 1999 Canadian Medical Directory or on the Canadian Orthopaedic Association membership list, asking if they vent when prophylactically nailing an impending pathologic femoral fracture. The responses were modelled as a function of surgeon volume and year of graduation.
Of the 415 surveys mailed, 223 (54%) surgeons responded. Of these, 81% reported having prophylactically treated a femoral metastatic lesion during the previous year; 67% treated 1 to 3 metastatic lesions and 14% treated more than 3; 19% did not treat a metastatic femoral lesion prophylactically. Over two-thirds of surgeons had never considered venting, whereas one-third always or sometimes vented the femoral canal. More recent graduates were 3 times more likely to vent than earlier (before 1980) graduates (odds ratio [OR] = 3.2, 95% confidence interval [CI] 1.6-6.5) as were those who treat a greater number of impending fractures (OR = 1.4, 95% CI 1.1-1.7).
Although there is a theoretical rationale for routine venting, there is disagreement among Ontario orthopedic surgeons regarding the use of this technique during prophylactic nailing for femoral metastatic lesions. Prospective evidence will be required to warrant a change in the standard of care.
Notes
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PubMed ID
14680349 View in PubMed
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8 records – page 1 of 1.