Effect of the blood HbA1c level on surgical treatment outcomes of diabetics with ankle fractures.

OBJECTIVE: To investigate whether blood haemoglobin A 1c (HbA1c) levels was predicative of diabetic patients' responsiveness to surgical treatment of ankle fractures. METHODS: The relationship between blood HbA1c levels and surgical treatment outcomes of 21 diabetic patients undergoing open reduction internal fixation (ORIF) for ankle fractures was analyzed with Pearson correlation testing and t testing. All patients were treated with ORIF using standard surgical techniques. Treatment outcomes were defined using radiological outcome, the American Orthopaedic Foot and Ankle Score (AOFAS) ankle-hindfoot scale score, surgical revision rate, and complication rate. RESULTS: HbA1c levels were found to have a statistically significant correlation with poor radiological outcomes (r = 0.547) and AOFAS ankle-hindfoot scores (r = -0.592). Additionally, though rates of poor radiological outcome, revision, and complication were high in the diabetic population as a whole, these rates were considerably higher among individuals with elevated HbA1c (≥6.5%) and considerably lower among individuals with lower HbA1c (<6.5%) levels. CONCLUSION: Blood HbA1c levels appear to be predictive of risk and complication rates in the surgical treatment outcomes of diabetic patients with ankle fractures.

Lumbar bone mineral density in very long-term renal transplant recipients: impact of circulating sex hormones.

The influence of circulating sex hormones and gender on the bone mineral density (BMD) in long-term renal transplant recipients needs further investigation. We performed a retrospective analysis of lumbar BMD between 6 years and 20 years after renal transplantation. In 67 patients (47+/-12 years, 38 male) with a minimum interval of 72 months after transplantation, lumbar BMD measurements (dual energy X-ray absorptiometry) were performed (=complete cohort). Thirty-one patients (=longitudinal cohort) underwent at least three serial BMD measurements (mean follow-up 39+/-18 months, start at 86+/-22 months). All patients received prednisolone. In the complete cohort, BMD was significantly reduced in comparison to young healthy (mean T-score -1.33+/-1.40) and age-matched controls (mean Z-score -0.91+/-1.45) at 88+/-31 months (p<0.05). Osteopenia or osteoporosis were present in two-thirds of patients. In the longitudinal cohort, a mean annual lumbar BMD loss of -0.6+/-1.9% was detectable equivalent to a -0.03+/-0.15 reduction of Z-scores per year (regression analysis). Impact of hormonal status: In the complete cohort, postmenopausal status was associated with significantly lower BMD levels compared to men (p=0.0441). Women and men within the lowest tertile of sex hormone levels (LH, FSH, DHEAS, testosterone, progesterone, estradiol) did not exhibit significant differences in terms of lumbar BMD compared to those in the highest tertile. The mean annual bone loss was statistically indistinguishable between men and women. There was no significant correlation of sex hormone levels and BMD in men and premenopausal women. In postmenopausal women, however, low estradiol and high LH levels correlated with the extent of annual BMD loss (p<0.05). Our data confirm significantly reduced lumbar T-scores in the very late period after renal transplantation. The lumbar BMD decreased by -0.6+/-1.9% per year. In postmenopausal long-term renal transplant recipients, low estradiol levels were associated with accelerated bone loss.

[The mineralization of the regenerate and the hormonal regulation of bone formation during the treatment of a malunited diaphyseal fracture of the shin bones]. / Mineralizatsiia regenerata i gormonal'naia reguliatsiia kosteobrazovaniia pri lechenii nepravil'no srosshegosia pereloma diafiza kostei goleni.

In 68 patients with imperfectly united fracture of the crural bones who underwent treatment with the use of the Ilizarov's method, the processes of mineralization of the osseous regenerate being formed were studied. The most rapid deposition of the mineral substances was noted in gradual elimination of a deformity. In shortening of an extremity, the rate of mineralization depended on a size of the elongation performed. Increase in content of the osteotropic hormones and cyclic. nucleotides was indicative of the presence of favourable conditions for formation of osseous regenerate in correction of angular deformity by means of the Ilizarov's method.