RESUMO
A 16-year-old female patient showed up at the orthopaedics unit complaining of intolerable pain on her left hip. While being questioned and her clinical history written down, she shared that as part of her daily exercise routine, she ran 10 miles (16 km) daily at a speed of 9.5-10.5 mph (15-17 km/hour). MRI was consequently ordered, confirming the presence of a stress fracture. Therefore, immediate suspension of physical activity was indicated, followed by the prescription of crutches as well as restricted weight bearing. Gradually, she recovered complete functionality and approximately a month after she had entirely healed. While on a skiing trip, again she abruptly developed an acute pain on her right hip. Another MRI was ordered; its result confirmed a new stress fracture. Her previous treatment has proved so successful, a conservative approach was once again prescribed for her, showing optimum results 6 months later.
Assuntos
Traumatismos em Atletas , Reabsorção Óssea , Tratamento Conservador/métodos , Colo do Fêmur , Fraturas de Estresse , Dor Musculoesquelética/diagnóstico , Adolescente , Traumatismos em Atletas/diagnóstico por imagem , Traumatismos em Atletas/etiologia , Traumatismos em Atletas/fisiopatologia , Traumatismos em Atletas/terapia , Reabsorção Óssea/diagnóstico , Reabsorção Óssea/tratamento farmacológico , Reabsorção Óssea/etiologia , Muletas , Feminino , Fraturas do Colo Femoral/diagnóstico por imagem , Fraturas do Colo Femoral/etiologia , Fraturas do Colo Femoral/fisiopatologia , Fraturas do Colo Femoral/terapia , Colo do Fêmur/diagnóstico por imagem , Colo do Fêmur/patologia , Fraturas de Estresse/diagnóstico por imagem , Fraturas de Estresse/etiologia , Fraturas de Estresse/fisiopatologia , Fraturas de Estresse/terapia , Humanos , Imageamento por Ressonância Magnética/métodos , Dor Musculoesquelética/etiologia , Corrida , Resultado do TratamentoRESUMO
It has been shown that there is an association between air pollution and cardiovascular mortality. In bone pathology, studies show that air pollution is associated with a risk of developing osteoporosis and osteoporotic fracture associated with MP2.5 and nitrogen dioxide (NO2 ). The aim of our study was to determine whether or not there is an association between air pollution and osteoporotic disease, associating the incidence of femoral neck fracture in individuals aged 50 years or more and the contamination present in the several cities. Our results showed no statistically significant association between air pollution, evaluated using PM10 and PM2.5 as indicators, and the average annual incidence of osteoporotic hip fracture, comparing the most polluted cities and the less polluted cities of Chile
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Osteoporose/epidemiologia , Poluição Ambiental/efeitos adversos , Fraturas do Colo Femoral/epidemiologia , Osteoporose/complicações , Chile/epidemiologia , Incidência , Estudos Retrospectivos , Distribuição por Idade e Sexo , Material Particulado/efeitos adversos , Fraturas do Colo Femoral/etiologiaRESUMO
OBJECTIVE:: We aimed to analyze the applicability of a fracture risk assessment tool for the prediction of osteoporotic fractures in middle-aged and elderly healthy Chinese adults. METHODS:: A standard questionnaire was administered, and bone mineral density was measured in residents visiting the Dongliu Street Community Health Service Center. Paired t-tests were used to compare the FRAX-based probabilities of fractures estimated with and without consideration of bone mineral density. Risk stratification and partial correlation analyses were applied to analyze the associations between FRAX-based probabilities and body mass index or bone mineral density at different sites. RESULTS:: A total of 444 subjects were included in this study. Of these subjects, 175 (39.59%) were diagnosed as osteoporotic, and 208 (47.06%) were diagnosed as osteopenic. The Kappa value for the detection of osteoporosis at the L1-L4 lumbar spine and femoral neck was 0.314. The FRAX-based 10-year major osteoporotic fracture probability and hip osteoporotic fracture probability estimated without considering bone mineral density were 4.93% and 1.64%, respectively; when estimated while considering bone mineral density, these probabilities were 4.97% and 1.54%, respectively. A significant positive association was observed between the FRAX-based fracture probabilities estimated with and without consideration of bone mineral density, while significant negative associations between body mass index and the estimated FRAX-based fracture probabilities after adjustment for age and the estimated FRAX-based fracture probabilities and femoral neck bone mineral density were identified. These results remained the same after controlling for lumbar spine bone mineral density. CONCLUSIONS:: The Chinese FRAX model could predict osteoporotic fracture risk regardless of whether bone mineral density was considered and was especially appropriate for predicting osteoporotic fractures of the femoral neck.
Assuntos
Osteoporose/complicações , Osteoporose/fisiopatologia , Fraturas por Osteoporose/etiologia , Fraturas por Osteoporose/fisiopatologia , Medição de Risco/métodos , Absorciometria de Fóton/métodos , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Índice de Massa Corporal , Densidade Óssea/fisiologia , China , Feminino , Fraturas do Colo Femoral/etiologia , Fraturas do Colo Femoral/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Valores de Referência , Reprodutibilidade dos Testes , Fatores de Risco , Fatores Sexuais , População UrbanaRESUMO
OBJECTIVE: We aimed to analyze the applicability of a fracture risk assessment tool for the prediction of osteoporotic fractures in middle-aged and elderly healthy Chinese adults. METHODS: A standard questionnaire was administered, and bone mineral density was measured in residents visiting the Dongliu Street Community Health Service Center. Paired t-tests were used to compare the FRAX-based probabilities of fractures estimated with and without consideration of bone mineral density. Risk stratification and partial correlation analyses were applied to analyze the associations between FRAX-based probabilities and body mass index or bone mineral density at different sites. RESULTS: A total of 444 subjects were included in this study. Of these subjects, 175 (39.59%) were diagnosed as osteoporotic, and 208 (47.06%) were diagnosed as osteopenic. The Kappa value for the detection of osteoporosis at the L1-L4 lumbar spine and femoral neck was 0.314. The FRAX-based 10-year major osteoporotic fracture probability and hip osteoporotic fracture probability estimated without considering bone mineral density were 4.93% and 1.64%, respectively; when estimated while considering bone mineral density, these probabilities were 4.97% and 1.54%, respectively. A significant positive association was observed between the FRAX-based fracture probabilities estimated with and without consideration of bone mineral density, while significant negative associations between body mass index and the estimated FRAX-based fracture probabilities after adjustment for age and the estimated FRAX-based fracture probabilities and femoral neck bone mineral density were identified. These results remained the same after controlling for lumbar spine bone mineral density. CONCLUSIONS: The Chinese FRAX model could predict osteoporotic fracture risk regardless of whether bone mineral density was considered and was especially appropriate for predicting osteoporotic fractures of the femoral neck.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Osteoporose/complicações , Osteoporose/fisiopatologia , Fraturas por Osteoporose/etiologia , Fraturas por Osteoporose/fisiopatologia , Medição de Risco/métodos , Absorciometria de Fóton/métodos , Fatores Etários , Análise de Variância , Índice de Massa Corporal , Densidade Óssea/fisiologia , China , Fraturas do Colo Femoral/etiologia , Fraturas do Colo Femoral/fisiopatologia , Valor Preditivo dos Testes , Valores de Referência , Reprodutibilidade dos Testes , Fatores de Risco , Fatores Sexuais , População UrbanaRESUMO
Bilateral femur neck fractures in young adult patients are very rare in atraumatic circumstances. We report a young premenopausal female with osteomalacia secondary to vitamin D deficiency and spontaneous bilateral femur neck fractures. Patients had no reported risk factors for osteomalacia but hypovitaminosis D was noted on laboratory evaluation. Osteomalacia secondary to low serum levels of vitamin D may lead to stress and fragility fractures. Identification and treatment of at risk patients may decrease the incidence of stress fractures and its possible complications.
Assuntos
Fraturas do Colo Femoral/etiologia , Osteomalacia/complicações , Pré-Menopausa , Deficiência de Vitamina D/complicações , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: Associated neurological disorders pose a challenge hip joint reconstruction. The imbalance and poor muscle tone predispose to dislocation and loosening of the prosthesis. CLINICAL CASE: The following is the case of a 67 years old patient with a hemorrhagic cerebral vascular event with a secondary left hemiparesis. Ten years later had a femoral neck fracture on the affected side. Initially she was treated with conservative management resulting in pain and discapacity, valued with WOMAC scale as 12 points. Two years later was treated with total hip arthroplasty with large diameter femoral head. We present the follow up of 41 months, asymptomatic, walking using a cane and a WOMAC score of 41, with no signs of radiological loosening or dislocation. CONCLUSIONS: There is no experience documented in neurological disorders associated with hip diseases that requires a total hip arthroplasty. Loosening of the implants, dislocation and heterotopic ossification has been described as complications of the procedure. Large heads in total hip arthroplasty and a correct surgical technique associated with a multidisciplinary management in patients with neurological disorders offers an opportunity as a treatment in patient with hip disorders.
Assuntos
Artroplastia de Quadril , Fraturas do Colo Femoral/cirurgia , Idoso , Transtornos Cerebrovasculares/complicações , Feminino , Fraturas do Colo Femoral/etiologia , Humanos , Paresia/complicações , Paresia/etiologiaRESUMO
A fratura do colo femoral, sem trauma associado, após a consolidação da fratura transtrocantérica é um evento raro. Os autores relatam um caso de fratura transtrocantérica tratada com PFN, que duas semanas após a retirada da síntese, apresentou fratura do colo femoral, que foi tratada com artroplastia parcial.
Femoral neck fracture without associated trauma following consolidation of a transtrochanteric fractureis a rare event. The authors report a case of transtrochanteric fracture that was treated with PFN and which presented fracturing of the femoral neck two weeks after removal of the device. This occurrence was treated with partial arthroplasty.
Assuntos
Humanos , Feminino , Idoso de 80 Anos ou mais , Fraturas do Colo Femoral , Fixação Intramedular de Fraturas/reabilitação , Fraturas do Colo Femoral , Fraturas do Colo Femoral/reabilitação , Fraturas do Fêmur/complicações , Artroplastia , Fraturas do Colo Femoral/etiologia , Fixadores InternosRESUMO
BACKGROUND: Approximately one-third of vertebral fractures can be clinically diagnosed. AIM: To study the frequency of vertebral fractures in postmenopausal women. PATIENTS AND METHODS: We recruited 555 postmenopausal women from Santiago, Chile, aged 55-84 years, who manifested interest in their bone health. All were healthy by self-declaration and by general clinical and laboratory tests and had not taken any bone-active therapy. They all underwent a spine and femoral neck (FN) densitometry and a digital lateral spine X-ray from T4 to L4 was obtained. PTH, calcidiol, and other parameters of calcium metabolism were also measured. RESULTS: Overall, 142 of 478 patients with a complete study (29.7%) had at least one vertebral fracture. The proportion of women with fractures increased with age. A T score below -2.5 in the spine and hip was found in 32% and 14% of women, respectively. The proportion of women with spinal osteoporosis doubled between ages 55-70 and remained constant afterwards. In contrast, at the femoral neck, this proportion increased progressively reaching 53.3% at age 80-85. However, 56% of patients with vertebral fractures did not have densitometric osteoporosis in any location. Calcidiol levels were 16.8+/-6.8 ng/mL. With a cutoff point of 17 ng/mL, 47.5% of the patients had hypovitaminosis D. There was no association between calcidiol levels and vertebral fractures or bone density at the spine or femoral neck. Patients with fractures differed from those without fractures in that they had significantly lower bone density at the spine and hip and were older (p <0.001). However they did not differ in weight, body mass index, or calcidiol levels. CONCLUSIONS: Thirty percent of postmenopausal women in this series had a vertebral fractures. Osteoporosis and vitamin D deficiency were also common. Most vertebral fractures were observed in women without osteoporosis by densitometric criteria.
Assuntos
Conservadores da Densidade Óssea/sangue , Vértebras Lombares/lesões , Osteoporose Pós-Menopausa/epidemiologia , Pós-Menopausa/fisiologia , Fraturas da Coluna Vertebral/epidemiologia , Vitamina D/sangue , Absorciometria de Fóton , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Densidade Óssea/fisiologia , Calcifediol/sangue , Chile/epidemiologia , Métodos Epidemiológicos , Feminino , Fraturas do Colo Femoral/diagnóstico por imagem , Fraturas do Colo Femoral/epidemiologia , Fraturas do Colo Femoral/etiologia , Humanos , Pessoa de Meia-Idade , Osteoporose Pós-Menopausa/complicações , Osteoporose Pós-Menopausa/diagnóstico por imagem , Hormônio Paratireóideo/sangue , Pós-Menopausa/sangue , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/etiologia , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/epidemiologiaRESUMO
Background: Approximately one-third of vertebral fractures can be clinically diagnosed. Aim: To study the frequency of vertebral fractures in postmenopausal women. Patients and methods: We recruited 555 postmenopausal women from Santiago, Chile, aged 55-84 years, who manifested interest in their bone health. All were healthy by self-declaration and by general clinical and laboratory tests and had not taken any bone-active therapy. They all underwent a spine and femoral neck (FN) densitometry and a digital lateral spine X-ray from T4 to L4 was obtained. PTH, calcidiol, and other parameters of calcium metabolism were also measured. Results: Overall, 142 of 478 patients with a complete study (29.7 percent) had at least one vertebral fracture. The proportion of women with fractures increased with age. A T score below -2.5 in the spine and hip was found in 32 percent and 14 percent of women, respectively. The proportion of women with spinal opeoporosis doubled between ages 55-70 and remained constant afterwards. In contrast, at the femoral neck, this proportion increased progressively reaching 53.3 percent at age 80-85. However, 56 percent of patients with vertebral fractures did not have densitometric osteoporosis in any location. Calcidiol levels were 16.8±6.8 ng/mL. With a cutoff point of 17 ng/mL, 47.5 percent of the patients had hypovitaminosis D. There was no association between calcidiol levels and vertebral fractures or bone density at the spine or femoral neck. Patients with fractures differed from those without fractures in that they had significantly lower bone density at the spine and hip and were older (p <0.001). However they did not differ in weight, body mass index, or calcidiol levels. Conclusions: Thirty percent of postmenopausal women in this series had a vertebral fractures. Osteoporosis and vitamin D deficiency were also common. Most vertebral fractures were observed in women without osteoporosis by densitometric criteria.