Incidence of osteoporotic fractures in Sado,Japan in 2010

We conducted a survey of fracture incidences associated with senile osteoporosis in 2010 in Sado City, Niigata Prefecture, Japan, including compression vertebral fractures, hip fractures, distal radius fractures, and fractures of the proximal end of the humerus. We previously conducted a similar survey from 2004?2006 in Sado City. The purpose of the current study was to determine the incidence of osteoporotic fractures in Sado City in 2010 and to examine changes over time. We calculated the incidence of each fracture per 100,000 person-years based on the population of Sado City. Hip and vertebral fractures showed marked increases from 2004?2006, but a similar increase was not found from 2006?2010. The average age at injury increased in 2010 compared to 2004, except for fractures of the radius. Among the subjects with hip fractures, 14 % had a history of contralateral hip fracture. The percentage of patients taking medication for osteoporosis before injury was higher in 2010 compared with 2004, but these percentages were still only 7 and 13 % for those with subsequent hip and vertebral fractures, respectively.     

Increase in the incidence of cervical and trochanteric fractures of the proximal femur in Niigata Prefecture, Japan

This study aimed to determine the incidence of cervical and trochanteric fractures of the proximal femur in 1994 in Niigata Prefecture, Japan, and to compare this incidence with those previously reported in Niigata in 1985, 1987, and 1989. We visited all hospitals within Niigata Prefecture having an orthopedic department and reviewed the medical records and radiographs of all patients who sustained such fractures in 1994. The population of Niigata Prefecture was determined in 1994 to be 2 483 879 (1 205 151 males and 1 278 728 females). The population over 65 years of age was 428 795 (172 788 males and 256 007 females), representing 17.3% of the total population. In 1994, there were 1468 cervical or trochanteric fractures in 378 males and 1090 females, with a male-to-female ratio of 1 : 2.9. The incidence of these fractures in persons over 65 years of age was 304 fractures per 100 000 population per year. Of 528 cervical and 940 trochanteric fractures, the latter accounted for 64% of the total number. The age-specific incidence of the fractures in Niigata exhibited an exponential increase with age, similar to those reported in Sweden and the United States. However, the incidence was lower than in those countries. When comparing the number of cervical and trochanteric fractures in 1994 with the numbers reported in 1985, 1987, and 1989, it is evident that the overall number and incidence of these fractures has been increasing over this period. Even if the difference of the age-specific population among these years is adjusted, the fractures have been increasing. Received: Dec. 27, 1996 / Accepted: Jan. 14, 1999     

锁定钢板与传统钢板治疗老年肱骨近端骨折疗效比较

目的比较肱骨近端锁定钢板(LPHP)与传统钢板治疗老年肱骨近端骨折的疗效。方法将89例患者按手术方式不同分为LPHP固定组(46例)及传统钢板组(43例)。记录两组患者手术时间、术中失血量、住院天数以及并发症等各项指标。手术后6周、3个月、1年进行随访。肩关节功能采用美国肩肘外科医师(AS-ES)评分以及Constant-Murley评分,对两组疗效进行比较。结果手术时间、术中出血量及术后并发症发生率LPHP组均明显低于传统钢板组,术后肩关节功能评分LPHP组明显高于传统钢板组,差异均有统计学意义(P<0.05)。结论 LPHP组固定可靠,术后功能恢复满意,是治疗老年肱骨近端骨折的理想方法。     

The incidence of cervical and trochanteric fractures of the proximal femur in 1999 in Niigata Prefecture,Japan

 The purpose of this study was to determine the incidence of cervical and trochanteric fractures of the proximal femur in 1999 in Niigata Prefecture, Japan, and to compare this incidence with those previously reported in Niigata in 1985, 1987, 1989, and 1994. The authors visited all hospitals within Niigata Prefecture having an orthopedic department and reviewed the medical records and radiographs of all patients who sustained such fractures in 1999. The population of Niigata Prefecture was determined in 1999 to be 2 486 999 (1 208 195 males and 1 278 804 females). The population over 65 years of age was 515 290 (210 564 males and 304 726 females), representing 20.7% of the total population. In 1999, there were 1697 cervical or trochanteric fractures, in 400 males and 1297 females, with a male-to-female ratio of 1 : 3.2. The incidence of these fractures in persons over 65 years of age was 308.7 fractures per 100 000 per year. This incidence increased from 1985 to 1989 and from 1989 to 1994, but after that, the rate of increase in incidence from 1994 to 1999 slowed down slightly. This suggests that the prevention of fractures in the elderly population in Niigata Prefecture influenced the lower ratio. Received: December 28, 2001 / Accepted: February 28, 2002     

Incidence and cost of osteoporotic fractures in France during 2001. A methodological approach by the national hospital database

The objective of this study was to describe the hospital incidence rate and the in-patient costs of three peripheral osteoporotic fractures (proximal humerus and hip, distal radius and/or ulna) in women and men aged over 45 in France during 2001. Each stay for fracture was selected from the dataset of the French national hospital database in 2001. The incidence rate (CI 95%) was standardized by age and gender according to the last census of the French population (1999). The effect of age and existence of geographical difference in incidence rates has been studied. For each fracture, we described the number of stays, rate of surgical procedure and in-patient costs according to the 2004 French list of cost per diagnosis-related group (2004 Euros); 118,839 fractures were registered during 2001 (61% hip, 28% distal radius and 11% proximal humerus; sex ratio 0.26). The incidence rate for all fracture was 7,567 (7,519–7,615) and 2,312 (2,283–2,341) for 10⁶ inhabitants in women and men aged over 45 years, respectively. The incidence increased significantly whatever type of fracture and gender. There were more fracture incidents in the east of France compared to the west and in the south compared to the north, whatever type of fracture in women and only for hip fracture in men. Surgical procedures were performed in 91% of proximal hip fractures, 83% of distal radius fractures and 53% of proximal humerus fractures. The median in-patient costs were 3,786 Euros for the humerus, from 2,363 to 2,574 Euros for the radius and from 8,048 to 8,727 Euros for the hip. The evaluation of the burden of peripheral fractures is possible using national hospital data in France. The incidence of fractures increased with age and is more common in women. Hip fracture with its higher occurrence, rate of procedure and in-patient costs could be used as a marker of osteoporosis for evaluating strategies of management.     

南京地区低能量骨折老年患者存在维生素 D缺乏的回顾性研究

目的研究评估南京地区老年低能量骨折(桡骨远端和髋部骨折)患者维生素D[Vitamin D,Vit D; 25 (OH) D]水平,以及补充活性Vitamin D是否可以有效提高血清25 (OH) D水平。方法回顾性研究南京鼓楼医院骨折联络服务(FLS)病例中90名老年(≥65岁)患者,桡骨远端骨折49名,髋部骨折41名,受伤后均给予口服活性Vitamin D治疗。分析受伤时和伤后4周的25 (OH) D水平。结果所有桡骨远端骨折的患者,受伤时血清25 (OH) D水平为14.83 ng/m L,伤后4周为21.23ng/m L;在髋部骨折患者受伤时血清25 (OH) D水平为9.92 ng/m L,伤后4周为18.96 ng/m L。结论桡骨远端以及髋部骨折老年患者的25 (OH) D水平较低,有可能使肌肉力量下降导致跌倒风险增加,Vitamin D的补充可以有效提高血清25(OH) D水平。     

Fifteen-year outcome of displaced intra-articular fractures of the distal radius

PURPOSE: We previously reported the functional and radiographic outcomes of 21 young adults at an average of 7 years after open reduction and internal fixation of an intra-articular distal radius fracture (original study). The purpose of the current investigation was to evaluate the same cohort at an average of 15 years after surgery to evaluate the effect of additional time on both function and radiographic appearance. METHODS: We re-evaluated 16 of the original patients at an average of 15 years after surgery. Subjective assessment was performed with the Musculoskeletal Functional Assessment and the Hand Function Sort questionnaires. Objective assessment included a detailed physical examination and strength measurement. Standardized radiographs and computed tomography were used to assess wrist morphology, residual articular step and gap displacement, and the presence and degree of arthrosis. RESULTS: Subjectively patients continued to function at a high level at the last follow-up evaluation: the average Musculoskeletal Functional Assessment score was 10 and 14 of the 16 patients functioned at a high level according to the Hand Function Sort. Strength and range of motion remained essentially unchanged from the original report. Radiocarpal arthrosis was noted in 13 of the 16 wrists and joint space was reduced an additional 67% compared with the 7-year follow-up evaluation. Nonetheless there continued to be no correlation between the presence or degree of arthrosis and upper-extremity function. CONCLUSIONS: Radiocarpal arthrosis after intra-articular distal radius fractures can be expected to worsen over time. Despite joint space narrowing and evidence of advanced arthrosis, however, patients maintained a high level of function at the long-term follow-up evaluation. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic, Level II.     

Radiological and functional outcome in unstable, osteoporotic trochanteric fractures stabilized with dynamic helical hip system

A dynamic hip screw (DHS) remains the implant of choice for stabilization of trochanteric fractures because of its favourable results and low rate of non-union or hardware failure, but complication rates of the DHS are higher in unstable and osteoporotic trochanteric fractures. The proponents of the dynamic helical hip system (DHHS) report that it has the potential to decrease the cut-out rates in such fractures as helical blade allows compaction in osteoporotic femoral head which in itself improves anchorage. The purpose of the present study was to evaluate the radiological and functional outcome of DHHS in unstable and osteoporotic trochanteric fractures. This was a prospective observational study. The mean age of the 51 patients (24 men and 27 women) was 72.8 years. Fractures were type AO31A2.2 in 28 patients and AO31A2.3 in 23 patients. According to DEXA scans, 41 patients had osteoporosis and 10 patients had osteopenia. Osteoporosis was grade 3 in 36 patients and grade 2 in 15 patients according to Singh’s index. The mean follow-up was 1.84 years. The average sliding of the lag screw was 3.6 mm (range 2–10 mm). The mean operative time was 54.74 (range 48–65) min. The average tip–apex distance was 20.24 mm (range 12–28 mm). All but one fractures united. The average time to union was 13.14 (range 11–24) weeks. There were four mechanical complications namely late helical blade migration (n = 1), late medialization of shaft (n = 2) and varus collapse with cut through (n = 1). No patient was noted to have a plate pull-out. The average Harris hip score was 92.87 (range 76–97). The use of a DHHS for stabilization of unstable(AO31A2), osteoporotic trochanteric fractures in the elderly patients was associated with reliable rates of union and functional outcome and a decreased incidence of screw cut-out and side plate pull-out.     

Comparative stability of perpendicular versus parallel double‐locking plating systems in osteoporotic comminuted distal humerus fractures

In distal humerus fractures, the restoration of stability is important to allow early mobilization and hence more favorable functional outcomes. In this article, we compare the biomechanical stability of perpendicular and parallel locking plating systems for the internal fixation of AO Type C2 distal humerus fractures in osteoporotic bone. Fractures were simulated in paired cadaveric bones and fixed using either the perpendicular 3.5 mm LCP distal humerus plating system (Synthes; Sydney, Australia) or the parallel Mayo Clinic Congruent elbow plate system (Acumed; Hillsboro, OR), using locking screws in both systems. Both systems were then tested for their stiffness (in compression and internal/external rotation), plastic deformation, and failure in torsion. Comparatively, the parallel locking plate system provided a significantly higher stability in compression (p = 0.005) and external rotation (p = 0.006), and a greater ability (p = 0.005) to resist axial plastic deformation. Stability for both constructs appeared to be dependent on bone quality, however the stability of the perpendicular system was generally more sensitive to bone mineral density, indicating a possible need for additional independent interfragmentary screws. A disadvantage of the parallel locking plate system was wear debris produced by its tapping system. In summary, the biomechanical findings of this study suggest that both locking plate systems allow early mobilization of the elbow in patients with osteoporotic bone following fixation of a comminuted distal humerus fracture. However, the parallel locking system showed improved stability compared with the perpendicular locking system, and therefore may be more indicated. © 2008 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 26:778–784, 2008     

桡骨远端掌侧解剖锁定接骨板治疗桡骨远端骨质疏松性骨折的疗效观察

背景：近年来桡骨远端掌侧（DVR）解剖锁定接骨板广泛应用于桡骨远端骨折的治疗,尤其是桡骨远端骨质疏松性骨折。目的：评价DVR解剖锁定接骨板治疗桡骨远端骨质疏松性骨折的临床疗效。方法：2009年5月至2011年12月共收治桡骨远端骨折87例,确诊为桡骨远端骨质疏松性骨折的29例行DVR解剖锁定接骨板掌侧入路固定。男11例,女18例;年龄56-78岁,平均63岁;骨折按AO分型：A2型3例,A3型6例,B1型1例,B3型2例,C1型6例,C2型7例,C3型4例;受伤距手术时间为1～12d,平均5d。结果：术后伤口均一期愈合,无一例出现术后感染。29例中21例获得随访,随访时间为12～20个月,平均14个月。影像学检查示均达到骨性愈合,愈合时间为12～18周,平均15周。末次随访时患者腕关节活动度：背伸41°～68°,平均52°;掌屈45°～78°,平均57°;旋前63°～86°,平均77°;旋后57°～80°,平均74°。末次随访采用Sarmiento改良Gartland＆Werley评分方法：优13例,良6例,可2例,差0例;腕关节VAS评分：腕关节完全无痛18例,轻度疼痛2例（评分为2分和2.5分）,中度疼痛1例（评分为4分）。无一例出现肌腱激惹;正中神经卡压1例,骨折愈合后6个月取出内固定并行松解术后症状完全消失;骨折背侧骨片移位1例,未对腕关节功能产生影响遂未予以处理。在背伸、掌屈、旋前、旋后4个方向的活动度比较,A型与B型骨折比较无统计学差异;A型与C型,B型与C型比较均存在统计学差异。结论：DVR解剖锁定接骨板板治疗桡骨远端骨质疏松性骨折可以获得良好的功能转归,C型骨折较A、B型骨折对腕关节活动影响更大。     

Ulnar styloid fractures associated with distal radius fractures: incidence and implications for distal radioulnar joint instability

Ulnar-sided injuries of the wrist have received more attention recently for their potential negative impact on the outcome of distal radius fractures. Radiographs and medical records were retrospectively reviewed for 166 distal radius fractures treated during a 1-year interval. Distal radius fractures were classified according to the AO system, and accompanying ulnar styloid fractures were evaluated for both size and displacement. Each distal radius fracture was also evaluated for radiographic and clinical evidence of distal radioulnar joint instability. The distribution of ulnar styloid fractures was not random; greater than one third involved the base. All distal radius fractures complicated by distal radioulnar joint instability were accompanied by an ulnar styloid fracture. A fracture at the ulnar styloid's base and significant displacement of an ulnar styloid fracture were found to increase the risk of distal radioulnar joint instability.     

Adjacent vertebral Hounsfield unit value of acute osteoporotic vertebral fracture is a risk factor for concomitant domino osteoporotic vertebral fractures

BackgroundMost patients with acute osteoporotic vertebral fracture (AOVF) are successfully treated conservatively. However, the optimal management method and prognosis for multiple AOVFs are unclear. This study aimed to investigate the prevalence of multiple AOVFs and identify the associated risk factors.MethodsThis study enrolled 134 hospitalized patients (mean age 83 ± 7.6 years, 66% women) with AOVF treated conservatively between 2017 and 2020. The fractures were diagnosed by magnetic resonance imaging (MRI). The AOVFs were divided into two groups; single osteoporotic vertebral fractures (OVF) and domino OVFs (at least two OVFs). The adjacent vertebral Hounsfield unit values (HU) of the OVF and dual x-ray absorptiometry (DXA) of the lumbar spine or hip were used to evaluate the bone mineral density (BMD). Logistic regression analysis was performed to identify the risk factors for domino OVFs.ResultsDomino OVFs were noted in 21 (15.7%) of 134 patients. There were 10 cases of adjacent level and 11 cases of remote level. The BMI (18.5 ± 4.2 vs. 21.2 ± 4.6, p = 0.025) and adjacent vertebral HU value of OVF (57.3 ± 17.5 vs. 76.6 ± 24.1, p = 0.008) were significantly lower in the domino OVFs group than in the single OVF group. Logistic regression analysis revealed the adjacent vertebral HU value of the OVF as an independent risk factor for domino OVFs, (odds ratios (OR) 0.96, p = 0.012). The domino OVF group had a significantly higher decline in gait ability (76% vs. 48%, p = 0.017).ConclusionsThe adjacent vertebral HU value of AOVF is a useful tool for evaluating BMD for domino OVFs. The optimal treatment for osteoporosis should be considered to prevent subsequent domino OVFs.     

桡骨远端骨折治疗进展

桡骨远端骨折是临床最常见的骨折[1],其治疗仍存在争议。对这类骨折的处理许多学者强调了解剖复位、稳定的固定及早期关节功能锻炼的重要性[2],如果治疗不当将会产生明显的并发症。以往桡骨远端骨折治疗的主要方