Non-union of acetabular fractures.

Non-unions of acetabulum are rare. Seven cases of acetabular non-unions are reported in this retrospective study. Five out of our seven patients had either transverse or associated transverse with posterior wall fractures. All patients had surgical stabilisation of their index fractures. A diagnosis of non-union was made at an average of 5.8 months from the original injury based on clinical and radiological features. Five of the six patients who underwent re-stabilisation and bone grafting of the non-union healed where as the remaining one did not heal after two attempts at re-stabilisation and was treated with excision arthroplasty. Two of the healed five, subsequently developed osteoarthritis and had total hip arthroplasty where as one patient had already developed degeneration of his hip at the time of diagnosis and hence treated with total hip arthroplasty. Analysis of the non-unions confirmed that fixation was unstable in all with residual displacement seen in two of them. In conclusion acetabular fracture non-union appear to be associated with transverse fractures and unstable fixation.

Duplex detected ankle peak systolic velocity: a new parameter for the assessment of degree of peripheralischemia.

AIM: The objective of this study was to assess the sensitivity and specificity of a newly developed parameter: the ankle peak systolic velocity (APSV) to provide an objective assessment of the degree of peripheral ischemia. METHODS: In phase 1 of the study: data was prospectively collected for 21 ischemic limbs and 5 healthy volunteers. APSV was calculated as the mean value of the distal anterior and posterior tibial arteries peak systolic velocities (PSV). Ankle brachial index (ABI) was calculated for the anterior tibial and posterior tibial arteries. A mean ABI for both tibial arteries was also calculated. APSV was correlated with the mean ABI. Cut off values were calculated to differentiate critical, moderate and no ischemia. In phase 2 of the study data was prospectively collected for 37 ischemic limbs and 5 healthy volunteers, to assess the sensitivity and specificity of the cut off values of the APSV to identify limbs with critical ischemia, moderate ischemia, and no ischemia. RESULTS: APSV correlated strongly with the mean ABI (r=0.8, p<0.01). The sensitivity and specificity of APSV in identifying critical ischemia were 90% and 87%, for moderate ischemia they were 75% and 88%, and for differentiating limbs with any degree of ischemia from normal limbs they were 100% and 100%, respectively. CONCLUSIONS: APSV can be used as an alternative to ABI for the assessment of degree of peripheral ischemia.

Reduced spinal bone mineral density in adolescents of an Ultra-Orthodox Jewish community in Brooklyn.

OBJECTIVES: Bone mass increases throughout childhood, with maximal bone mass accrual rate occurring in early to mid-puberty and slowing in late puberty. Prevention of osteoporosis and its morbidities depends primarily on the establishment of adequate peak bone mass. Physical activity, calcium intake, and vitamin D stores (from sunlight conversion of precursors of vitamin D and to a lesser degree from dietary intake) are vital determinants of bone mineral density (BMD). BMD is further controlled by genetic and environmental factors that are poorly understood. Observance of ultra-Orthodox Jewish customs may have a negative effect on the factors that promote bone health, and there have been anecdotal reports of higher fracture rates in this population. The ultra-Orthodox Jewish lifestyle encourages scholarly activity in preference to physical activity. Additionally, modest dress codes and inner-city dwelling reduce sunlight exposure. Orthodox Jews do not consume milk products for 6 hours after meat ingestion, leading to potentially fewer opportunities to consume calcium. Foods from the milk group are some of the best sources of dietary calcium. Our aims are to examine BMD in a group of healthy ultra-Orthodox Jewish adolescents in an urban community and to attempt to correlate it to physical activity and dietary factors. DESIGN AND METHODS: We recruited 50 healthy, ultra-Orthodox Jews, ages 15 to 19 years (30 males and 20 females). None were taking corticosteroids or had evidence of malabsorption. All girls were postmenarchal and nulliparous. Pubic hair Tanner stage for boys and breast Tanner stage for girls were determined. Weight and height standard deviation scores were calculated. Calcium, phosphorus, protein, vitamin D, and calorie intake were assessed using a comprehensive food questionnaire referring to what has been eaten over the last year. Hours per week of weight-bearing exercise and walking were determined. Serum levels of calcium, intact parathyroid hormone (PTH), 25 hydroxyvitamin D (25[OH]D) and 1,25 dihydroxyvitamin D (1,25[OH](2)D) were measured. Lumbar spine (L) BMD was assessed by dual energy radiograph absorptiometry. The pediatric software supplied by Lunar Radiation Corporation, which contains gender- and age-specific norms, provided a z score for the lumbar BMD for each participant. L2 to L4 bone mineral apparent density (BMAD) was calculated from L2 to L4 BMD. RESULTS: BMD of L2 to L4 was significantly decreased compared with age/sex-matched normative data: mean z score was -1.25 +/- 1.25 (n = 50). The mean L2 to L4 BMD z score +/- standard deviation was -1.71 +/- 1.18 for boys and -0.58 +/- 1.04 for girls. Eight boys (27%) had L2 to L4 BMD z scores <-2.5, which defines osteoporosis in adulthood. Twenty-seven adolescents (54%), 16 boys and 11 girls, had Tanner stage V. Two participants (4%) had delayed development of Tanner stage V. Mean consumption of calcium by participants under 19 years old was 908 +/- 506 mg/day (n = 46), which is lower than the adequate intake of 1300 mg/day for this age. The consumption of phosphorus was 1329 +/- 606 mg/day, and the consumption of vitamin D was 286 +/- 173 IU/day (n = 50). The mean serum 25(OH)D level was 18.4 +/- 7.6 ng/mL, and the mean serum 1,25(OH)(2)D level was 71.1 +/- 15.7 pg/mL (n = 50). Boys had significantly higher serum levels of 1,25(OH)(2)D than did girls (74.9 +/- 16.46 pg/mL vs 65.25 +/- 12.8 pg/mL, respectively). The serum levels of PTH, calcium, and protein were (mean +/- standard deviation): 33 +/- 16 pg/mL, 9.5 +/- 0.69 mg/dL, and 7.8 +/- 0.6 g/dL, respectively (n = 50). L2 to L4 BMD z score had positive correlation with walking hours (r = 0.4). L2 to L4 BMD z score had negative correlation with serum level of 1,25(OH)(2)D )r = -0.33; n = 50). We could not find significant correlation between L2 to L4 BMD z scores for the entire cohort and any of calcium, vitamin D, phosphorus, or protein intake. However, the L2 to L4 BMD z scores of boys had positive correlation with calcium, phosphorus, and protein intake (r = 42, r = 44, and r = 43, respectively). After adjustment for Tanner stage, boys who had Tanner stage V (n = 16) had stronger positive correlation between L2 to L4 BMD z scores and calcium and protein intake (r = 0.55 and r = 0.57, respectively), as was the correlation between L2 to L4 BMD z score and weight-bearing activity and walking hours (r = 0.77 and r = 0.72, respectively; n = 16). By multiple regression analysis with stepwise selection, sex, walking hours, weight-standard deviation scores, and serum PTH predicted 54% of the variability in L2 to L4 BMD z score. Sex, walking hours, and age predicted 65% of the variability in L2 to L4 BMAD. CONCLUSIONS: Lumbar BMD is significantly decreased in ultra-Orthodox Jewish adolescents living in an urban community. Boys had profoundly lower spinal BMD than did girls. Previous studies have introduced estrogen as a critical factor in bone mineralization. (ABSTRACT TRUNCATED)