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OBJECTIVES: To investigate the expression level and clinical significance of Methyl-CpG binding Protein 2 (MECP2) in elderly patients with hip fractures. METHODS: This prospective observational study included 367 elderly patients with hip fractures between April 2016 and December 2018. All the patients were treated with internal fixation or joint replacement. In addition, 50 healthy elderly individuals were enrolled as healthy controls. The serum levels of MECP2 and inflammatory factors Interleukin (IL)-1ß, IL-6, IL-8, and Tumor Necrosis Factor (TNF)-α was determined by enzyme-linked immunosorbent assay. Data on patients' basic characteristics and postoperative complications were collected. The Harris score was used to assess hip function at 1-month, 3-months, and 6-months after surgery. Patient quality of life was measured using the Barthel Index (BI) score 3-months after surgery. The 1-year mortality was analyzed using the Kaplan-Meier curve, and logical regression was used to analyze the risk factors for mortality. RESULTS: No significant differences were observed in the basic clinical characteristics of all patients. The serum MECP2 levels were remarkably high in patients with hip fractures and negatively correlated with serum IL-1ß, IL-6, and TNF-α levels. Patients with higher MECP2 predicted higher dynamic Harris scores, lower postoperative complications, lower 1-year mortality, and higher BI scores. Logical regression showed that age was the only independent risk factor for postoperative 1-year mortality in elderly patients with hip fractures. CONCLUSION: Lower MECP2 predicted poor prognosis and higher 1-year mortality in elderly patients with hip fractures.

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INTRODUCTION: in older adults, deficit of Vitamin D and hip fractures are common. There exists relationships between both conditions, and it have been shown that supplementation of Vitamin D improve prognosis of hip fractures. In the case of Chile, information about relationship between Vitamin D and hip fractures is scarce. OBJECTIVE: quantify plasma levels of vitamin D and relate them to the anatomical location of hip fracture. METHODS: cross-sectional study. 222 Chilean adults ≥60 years, hospitalized for hip fracture between June, 2014 and June, 2015. We use data of medical records about gender, age, seasonality and anatomical location of hip fracture (intra and extracapsular). We measure plasmatic levels of Vitamin D (PLVD) and glomerular filtration rate (GFR) (MDRD-6). Kolmogorov-Smirnov test and non-parametric test were used. For determine relations between PLVD and anatomical location we use linear regression. RESULTS: there was a predominance of women (80.6%). The average age was 80.7 years (SD=7.8). Intracapsular hip fractures were 43.2%. 80% of the sample presents Vitamin D in deficitary levels (n = 180). PLVD average was 13.3 ng/cc (SD=6.7), in subjects with intracapsular fractures were significantly lower (p<0.001). CONCLUSIONS: PLVD in subjects with hip fracture should be monitored, as there are differences according to anatomical location of the fracture. This precedent could favor the treatment and recovery of subjects presenting for the first time hip fracture.

Introducción: en los adultos mayores son frecuentes el deficit de vitamina D y las fracturas de cadera (FC). Existe relacion entre ambas condiciones, demostrandose que la suplementacion de vitamina D mejora el pronostico de las FC. En el caso de Chile, existe escasa informacion sobre la relacion entre vitamina D y FC. Objetivo: cuantificar los niveles plasmaticos de vitamina D (NPVD) y relacionarlos con la ubicacion anatomica de la FC. Métodos: estudio transversal. 222 adultos mayores chilenos ≥60 anos hospitalizados por FC entre junio de 2014 y junio de 2015. Se utilizaron los datos de ficha clinica de genero, edad, estacionalidad y ubicacion anatomica (FIC = intra, FEC = extracapsular) de la FC. Se midio NPVD y velocidad de filtrado glomerular (VFG) (MDRD- 6). Se utilizaron la prueba de Kolmogorov-Smirnov y pruebas no parametricas. Para determinar la relacion entre NPVD y el tipo de fractura se uso regresion lineal. Resultados: hubo predominio de mujeres (80,6%), la edad promedio fue 80,7 anos (DE=7,8) y se encontro 43,2% de FIC. Los NPVD promedio fueron 13,3 ng/cc (DE=6,7); los sujetos con FIC tienen 4,52 ng/cc menos de vitamina D que aquellos con FEC (p.

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OBJETIVO: determinar en pacientes con infarto agudo del miocardio, la existencia de asociación entre la aterosclerosis carotídea y la osteoporosis de la columna lumbar y caderas. MÉTODOS: se exploraron 104 pacientes con diagnóstico clínico y de laboratorio de infarto agudo del miocardio. A cada paciente se les realizó ultrasonido doppler carotídeo, en el que se describió grosor íntima-media, localización y tipo de placas ateromatosas, grado de estenosis e índice aterogénico; seguido de densitometría de columna lumbar y caderas. Se clasificaron los niveles de densidad mineral ósea en normal, osteopenia y osteoporosis, según T score. RESULTADOS: no se encontró correlación entre el valor de la densidad mineral ósea y la magnitud del daño aterosclerótico del sector carotídeo. La mayoría de los factores de riesgo se asociaron con valores normales de grosor íntima-media, índice aterogénico aumentado y baja prevalencia de estenosis significativa, así como de osteopenia densitométrica; el envejecimiento y la hipertensión resultaron los predominantes. CONCLUSIONES: más allá de la existencia de factores de riesgo en común, no hubo asociación entre la osteoporosis y la aterosclerosis carotídea en los pacientes con infarto agudo del miocardio.

OBJECTIVE: determine the relationship between carotid atherosclerosis and lumbar spine and hip osteoporosis in patients with acute myocardial infarction. METHODS: a study was conducted of 104 patients with a clinical and laboratory diagnosis of acute myocardial infarction. All patients underwent carotid Doppler ultrasonography for intima media thickness, location and type of atheromatous plaques, stenosis degree and atherogenic index, followed by lumbar spine and hip densitometry. Bone mineral density levels were classified as normal, osteopenia or osteoporosis, according to the T-score. RESULTS: no correlation was found between bone mineral density values and the extent of atherosclerotic damage to the carotid sector. Most risk factors were associated with normal intima media thickness values, an increased atherogenic index, a low prevalence of significant stenosis, and densitometric osteopenia. Aging and hypertension were the predominant risk factors. CONCLUSIONS: except for the existence of common risk factors, no association was found between osteoporosis and carotid atherosclerosis in patients with acute myocardial infarction.

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El Síndrome de Compresión Longitudinal del Miembro Inferior (SCLMI) es la asociación de una fractura diafisiaria de fémur con una fractura de cadera ipsilateral. Es una condición clínica muy rara con una incidencia de 2,5 % al 5 %. La fractura de cadera es considerada de baja energía, ocasionada por la energía residual no disipada de del accidente a alta velocidad, que principalmente originó la fractura diafisiaria, y son fracturas de con mínimo o sin desplazamiento, lo cual dificulta su diagnóstico. Se ha reportado que cerca de un 30 % de las fracturas de cadera en un SCLMI pasa desapercibida. Las lesiones de rodilla ipsilateral se encuentran presentes en 34 % y las de pierna, tobillo y pié en 19 %. Se presenta el caso de un paciente masculino de 24 años, quien ingresa posterior a hecho vial por colisión en moto, presentando fractura diafisiaria del fémur y posterior a la realización de estudios protocolares de pelvis, se diagnóstica la fractura de cadera. Se presenta su tratamiento y evolución

Lower limb’s Longitudinal Compression Syndrome (LLLCS) is the association of a femoral shaft fractures with ipsilateral hip fracture. It’s a very rare clinical condition with an incidence of 2.5% to 5%. Hip fracture is considered low-energy, caused by residual energy dissipated at high speed crash, which originated mainly diaphyseal fracture, and are fractures with minimal or no displacement, which makes hard their diagnosis. It is reported that about 30% of hip fractures in a LLLCS unnoticed. Ipsilateral knee injuries are present in 34% and leg, ankle and foot in 19%. We report of a 24 years male, who is admitted after motorcycle collision presenting femoral diaphyseal fracture. After post-protocol studies of pelvis, hip fracture is diagnosis. We present his treatment and evolution

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As fraturas intertrocantéricas do fêmur ocorrem normalmente na população idosa e o número de novas fraturas cresce devido ao aumento na expectativa de vida. O objetivo deste estudo foi realizar uma revisão sobre aspectos epidemiológicos de prevenção e reabilitação das fraturas intertrocantéricas do fêmur no idoso. Foi realizada uma revisão da literatura de artigos em português, inglês e espanhol, dos últimos 10 anos, sobre a incidência, fatores de risco, prevenção, tratamento, taxa de mortalidade e morbidade das fraturas intertrocantéricas do fêmur. As fraturas do quadril são consideradas atualmente como um problema de saúde pública e a segunda principal causa de hospitalização do idoso, o que provoca aumento nos gastos com os serviços de saúde. Apesar da constante evolução do tratamento cirúrgico, as taxas de morbidade e mortalidade continuam elevadas. No primeiro ano pós-fratura a expectativa de vida reduz de 15 por cento a 20 por cento e a taxa de mortalidade pode chegar a 50 por cento. Vários fatores podem predispor o idoso a apresentar a fratura intertrocantérica, como a osteoporose, diminuição da acuidade visual, menopausa, dentre outros. A visão multidisciplinar envolvendo a atenção de outros especialistas além do ortopedista é de fundamental importância para a boa evolução clínica dos pacientes.

The intertrochanteric fractures of the femur occur normally in aged population and the number of new fractures increases due to rise in life expectancy. The aim of this study was to carry out a revision about epidemiological aspects of prevention and rehabilitation of intertrochanteric fractures in elderly people. A literature review of articles in Portuguese, English and Spanish, during the last 10 years, about the incidence, risk factors, prevention, treatment, mortality and morbidity of intertrochanteric fractures was carried out. The hip fractures are considered nowadays a problem of public health and the second leading cause of hospitalization in elderly population, increasing health services costs. Although the constant evolution of the surgical treatment, rates of mortality and morbidity is still high. In the first year after hip fractures life expectancy decreases from 15 percent to 20 percent and rates of mortality can reach 50 percent. Some factors can predispose the elderly population to develop intertrochanteric fractures: osteoporosis, reduction of visual acuity, menopause, among others. The multidisciplinary attention involving other specialists besides the orthopedists is very important for patients’ good clinical evolution.

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UNLABELLED: We compared hip axis length (HAL) in 157 non-Hispanic white women, 292 African-American women, and 210 Mexican-American women. After adjusting for maximal hip girth, there were no residual differences in HAL by ethnicity. Differences in hip fracture risk seen between these groups cannot be explained by ethnic differences in HAL. INTRODUCTION: Hip axis length (HAL) has been reported to be an independent predictor of hip fracture. Significant ethnic differences in HAL have been noted, but no direct comparison has been made between African-American, Mexican-American, and non-Hispanic white women using the same protocol. METHODS: We compared 157 non-Hispanic white women from the Rancho Bernardo Study, 292 women from the Health Assessment Study of African-American Women, and 210 women from the Skeletal Health of Mexican-American Women Project. A standardized questionnaire was used to obtain medical history; height, weight, waist girth, and hip girth were measured; and percentage body fat and HAL were obtained using dual energy X-ray absorptiometry. All HAL comparisons were adjusted for maximum hip girth to control for differences in size magnification by fan-beam absorptiometry. RESULTS: Though there were ethnic differences in the unadjusted HAL measurement, after adjusting for hip circumference, there were no residual differences in HAL with regard to ethnicity: 10.7 cm in Mexican-American women vs. 10.8 in non-Hispanic white women and African-American women (p = 0.61). CONCLUSIONS: There were no ethnic differences in HAL in women from the three ethnic groups. Differences in fracture risk among these groups cannot be explained by ethnic differences in HAL.

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OBJECTIVE: To examine the association between previous fracture and risk of new hip and nonhip fractures over a seven-year period among older Mexican Americans. METHOD: Data used are from the Hispanic Established Population for the Epidemiological Study of the Elderly (H-EPESE) (1993-2001). Measures included history of previous fracture (hip fracture only, a nonhip fracture, hip and nonhip fractures, and no fractures), sociodemographic factors, smoking status, medical conditions (arthritis, diabetes, stroke and cancer), activities of daily living disability, and high depressive symptoms. Cox proportional regression model was used to estimate the seven-year incidence of fractures. RESULTS: Of the 2,589 subjects, 42 reported a hip fracture, 328 reported a nonhip fracture, and 2,219 did not report a fracture at baseline. After controlling for all covariates, the hazard ratio (HR) of new hip fracture at seven-year follow-up was 6.48 (95% CI: 3.26-12.97) for subjects with only hip fracture at baseline and 1.96 (95% CI: 1.22-3.16) for subjects with nonhip fracture at baseline. The HR of new nonhip fracture was 1.90 (95% CI: 0.96-3.77) for subjects with only hip fracture at baseline and 2.62 (95% CI: 1.95-3.52) for subjects with nonhip fracture at baseline. CONCLUSIONS: A previous history of fractures in older Mexican Americans is the strongest predictor of recurrent fractures at hip and nonhip sites, independent of other health measures. Our findings of recurrent fractures suggest the need for more aggressive detection and adequate treatment of osteoporosis- and fall-related factors in this population.

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El presente trabajo tiene como objetivo revisar las historias clínicas de todos los pacientes intervenidos quirúrgicamente de prótesis de cadera, en un período de 5 años para determinar que prótesis se complicaron con fracturas periprotésicas; obteniéndose un total de 190 pacientes; de las cuales 12 tuvieron fracturas alrededor de la prótesis, 03 casos intraoperatorios. 05 ocurrieron en prótesis total y 7 en prótesis parcial. Los 12 casos se presentaron en prótesis cementadas. Todas las fracturas ocurrieron alrededor del vástago femoral y fueron clasificadas según la región anatómica comprometida en: Tipo 1 Proximal: 03 casos, Tipo T1 Medio: 05 casos, Tipo III Distal: 04 casos, prótesis de tallo largo: 04 casos, cerclaje:03 casos, placa BMP: 1 caso.

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Las fracturas de cadera constituyen una patología de importante repercusión socio-económica y de salud pública, dado por el incremento de la población adulta mayor en las últimas décadas. Esto ha llevado a realizar mejoras en el tratamiento quirúrgico y a renovar los enfoques de los programas de rehabilitación. Este estudio clínico pretende evaluar la aplicación de un protocolo kinésico en pacientes con fractura de cadera, extraído de la tesis de grado "Revisión del tratamiento kinésico postquirúrgico inmediato en pacientes con fractura de cadera" (2001), y además dimensionar su repercusión en la funcionalidad a corto plazo, mediante la utilización de escalas de valoración funcional para la cadera, en pacientes del Servicio de Traumatología del Hospital Regional de Talca entre noviembre del 2001 y enero del 2002.

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