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1.
Eur J Clin Invest ; 45(8): 800-6, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26036839

RESUMO

BACKGROUND: Reduced bone mineral density (BMD) together with muscle wasting and dysfunction, that is sarcopenia, emerges as a risk factor for hip fracture. The aim of this study was to examine body composition and BMD and their relationship with trauma mechanisms in young and middle-aged patients with femoral neck fracture. MATERIALS AND METHODS: Altogether, 185 patients with femoral neck fracture aged 20-69 were included. BMD, body composition and fat-free mass index (FFMI) were determined by dual-X-ray absorptiometry (DXA), and trauma mechanisms were registered. RESULTS: Ninety per cent of the whole study population had a femoral neck BMD below the mean for age. In the young patients (< 50 years), 27% had a Z-score of BMD ≤ -2 SD. More than half of the middle-aged patients (50-69 years) had osteopenia, that is T-score -1 to -2.5, and 35% had osteoporosis, that is T-score < -2.5, at the femoral neck. Patients with low-energy trauma, sport injury or high-energy trauma had a median standardised BMD of 0.702, 0.740 vs. 0.803 g/cm(2) (P = 0.03), and a median FFMI of 15.9, 17.7 vs. 17.5 kg/m(2) (P < 0.001), respectively. FFMI < 10th percentile of an age- and gender-matched reference population was observed in one-third. CONCLUSIONS: A majority had low BMD at the femoral neck, and one-third had reduced FFMI (i.e. sarcopenia). Patients with fracture following low-energy trauma had significantly lower femoral neck BMD and FFMI than patients with other trauma mechanisms. DXA examination of both BMD and body composition could be of value especially in those with low-energy trauma.


Assuntos
Composição Corporal , Densidade Óssea , Fraturas do Colo Femoral/epidemiologia , Osteoporose/epidemiologia , Sarcopenia/epidemiologia , Absorciometria de Fóton , Adulto , Distribuição por Idade , Idoso , Doenças Ósseas Metabólicas/diagnóstico por imagem , Doenças Ósseas Metabólicas/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoporose/diagnóstico por imagem , Fatores de Risco , Sarcopenia/diagnóstico por imagem , Adulto Jovem
2.
Acta Orthop ; 84(1): 54-9, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23343373

RESUMO

BACKGROUND AND PURPOSE: There have been few prospective studies examining young and middle-aged patients with hip fracture. We therefore investigated background data, risk factors, and the trauma mechanism in young and middle-aged patients with femoral neck fracture. PATIENTS AND METHODS: 185 patients, 27 young (20-49 years old) and 158 middle-aged (50-69 years old) were prospectively included in a multicenter study lasting 3 years. Background data and risk factors for osteoporosis and fracture were obtained, and the type of injury was classified as low-energy trauma, high-energy trauma, or sports injury. RESULTS: In the young age group, the fracture occurred because of low-energy trauma in two-fifths of patients and because of sport injury in two-fifths of patients. The rest occurred because of high-energy trauma. The corresponding proportions for the middle-aged group were four-fifths, one tenth, and one tenth (p < 0.001). There was a higher proportion of men (19/27) in the young group than in the middle-aged group (69/158) (p = 0.001). One fifth of the young patients were smokers as compared to two-fifths in the middle-age group (p = 0.04). One quarter of the patients reported high-volume alcohol drinking, with no difference between the two groups. Furthermore, three-quarters of the young patients and four-fifths of the middle-aged patients had one or more risk factors for osteoporosis and fracture. INTERPRETATION: A minority of patients in each age group had high-energy trauma as the cause of their femoral neck fracture. Lifestyle factors and other non-trauma-related risk factors appear to have been important contributors to the occurrence of femoral neck fracture in both age groups.


Assuntos
Fraturas do Colo Femoral/etiologia , Adulto , Fatores Etários , Idoso , Consumo de Bebidas Alcoólicas/efeitos adversos , Traumatismos em Atletas/etiologia , Distribuição de Qui-Quadrado , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoporose/complicações , Osteoporose/etiologia , Qualidade de Vida , Fatores de Risco , Fatores Sexuais , Estatísticas não Paramétricas , Adulto Jovem
3.
J Arthroplasty ; 25(7): 1170.e11-3, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-20705423

RESUMO

We describe an infection with Ureaplasma urealyticum causing rapid loosening of a cemented total hip arthroplasty. When reviewing the literature we found that no such case has been reported previously. Taking intraoperative cultures for U urealyticum during revision surgery is not a standard procedure. In cases with rapid, presumed aseptic, loosening of a total hip arthroplasty, an infection with U urealyticum should be considered.


Assuntos
Artroplastia de Quadril , Prótese de Quadril/microbiologia , Infecções Relacionadas à Prótese/cirurgia , Infecções por Ureaplasma/cirurgia , Ureaplasma urealyticum/isolamento & purificação , Idoso , Feminino , Humanos , Falha de Prótese , Reoperação , Resultado do Tratamento
4.
J Bone Joint Surg Am ; 94(21): 1921-8, 2012 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-23014835

RESUMO

BACKGROUND: Clinical trials with short and intermediate-term follow-up have demonstrated superior results for total hip replacement as compared with internal fixation with regard to hip function and the need for secondary surgery in elderly patients with a displaced intracapsular femoral neck fracture. The aim of the present study was to compare the results of total hip replacement with those of internal fixation over a long-term follow-up period of seventeen years. METHODS: We enrolled 100 patients who had sustained a femoral neck fracture in a single-center, randomized controlled trial;all patients had had a healthy hip before the injury. The study group included seventy-nine women and twenty-one men with a mean age of seventy-eight years (range, sixty-five to ninety years). The subjects were randomly assigned to either total hip replacement (the arthroplasty group) (n = 43) or internal fixation (the control group) (n = 57). The primary end point was hip function, evaluated with use of the Harris hip score. Secondary end points included mortality, reoperations, gait speed, and activities of daily life. Follow-up evaluations were performed at three months and at one, two, four, eleven, and seventeen years. RESULTS: The Harris hip score was higher in the total hip arthroplasty group, with a mean difference of 14.7 points (95%confidence interval, 9.2 to 20.1 points; p < 0.001 [analysis of covariance]) during the study period. We found no difference in mortality between the two groups. Four patients (9%) in the total hip replacement group and twenty-two patients (39%) in the internal fixation group had undergone a major reoperation (relative risk, 0.24; 95% confidence interval, 0.09 to 0.64).The overall reoperation rate was 23% (ten of forty-three) in the total hip replacement group and 53% (thirty of fifty-seven) in the internal fixation group (relative risk, 0.44; 95% confidence interval, 0.24 to 0.80). The results related to gait speed and activities of daily living favored the arthroplasty group during the first year. CONCLUSIONS: Over a period of seventeen years in a group of healthy, elderly patients with a displaced femoral neck fracture, total hip replacement provided better hip function and significantly fewer reoperations compared with internal fixation without increasing mortality. LEVEL OF EVIDENCE: Therapeutic Level I.


Assuntos
Artroplastia de Quadril , Fraturas do Colo Femoral/cirurgia , Fixação Interna de Fraturas , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Estudos Prospectivos , Recuperação de Função Fisiológica , Reoperação
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