Atypical femoral fractures in elderly women: a fracture registry-based cohort study.

An atypical femoral fracture (AFF), with a transverse fracture radiologically through the lateral cortex is a rare but serious condition. In order to improve our ability to identify patients with this condition, we retrospectively surveyed all subtrochanteric, peri-implant and diaphyseal femoral fractures in patients aged ≥ 65 years who underwent surgical treatment at our hospital between 2004 and 2011. We describe the incidence of atypical fractures and their characteristics, with observational data including a review of the hospital and general practitioner records. Clinical outcomes were evaluated using the Harris hip score (HHS) and the timed up-and-go (TUG) test. Atypical fractures only occurred in women with an incidence of 9.8 per 100,000 person-years. The incidence in those who were treated with bisphosphonates was 79.0 per 100,000 person-years; eight of 17 fractures occurred around metal implants. There was a high incidence of delayed union and revision surgery. A total of nine patients (ten AFFs) were available for review at a mean follow-up of 36.5 months (10 to 104). The clinical outcome was poor with a mean HHS of 58.9 (95% CI 47.4 to 70.4) and a mean TUG test of 25.7 s (95% CI 12.7 to 38.8). The delay in diagnosis and treatment of AFF may result from a lack of knowledge of this condition.

Development of a femoral stem providing strong anchorage and facilitated removal. An experimental study in goats.

OBJECTIVE: Prosthetic elements must be securely anchored to bone. Should revision surgery be necessary, preservation of bone stock is crucial. The goal of this study was to develop and assess a femoral stem combining secure anchorage and facilitated removal in a goat model. METHODS: The development of the uncemented femoral stem was part of an innovation process to fulfill the combined requirements. The stem was designed with two longitudinal semicircular grooves to accommodate a drill bit to unanchor the stem. These grooves were interconnected by canals, each 1 mm in diameter. The surface was partly coated with hydroxyapatite (HA). The stems were inserted in the left hip of 35 goats. Perioperatively, the grooves were filled with autologous bone grafts, and standard cemented canine acetabular component and head were used. The pull-out force was measured six months postoperatively. Following randomization, 11 animals had the grooves of the stem drilled to remove anchoring tissue. Twelve animals were left undrilled (controls). RESULTS: There was a significant difference in mean pull-out force between the group that had been drilled (1526 N) compared with the controls (2033 N, p = 0.028). Most of the HA had been resorbed. CLINICAL SIGNIFICANCE: The stems had a high retention force. The procedure for un-anchoring by drilling significantly reduced the pull-out force.

[New drugs in the treatment of advanced colorectal cancer]. / Nye medikamenter i behandlingen av avansert kolorektalcancer.

BACKGROUND: Colorectal cancer is one of the leading cancers in industrialised countries in terms of incidence and mortality. Advanced colorectal cancer has traditionally been treated with 5-fluorouracil, alone or in combination with leucovorin. This treatment has shown response rates of 10-25%; however, little effect has been observed on survival. MATERIAL, METHODS AND RESULTS: In recent years, a number of new drugs for advanced colorectal cancer have been developed and tested. We have made a comprehensive survey of the literature and find that phase II and phase III clinical studies show improved response rates compared to the traditional use of 5-fluorouracil and leucovorin. Thymidylate-synthase inhibitors, oxaliplatine and topoisomerase inhibitors, used singly or in combination, improve response rates and show a significant effect on survival in patients with metastatic colorectal disease. INTERPRETATION: Several new drugs now available in hospital treatment of metastatic colorectal cancer show improved response and increased survival compared to traditional 5-fluorouracil regimens.

[Fluorinated pyrimidines in oral treatment of advanced colorectal cancer]. / Fluorinerte pyrimidiner i peroral behandling av avansert kolorektalcancer.

BACKGROUND: For several years, fluorinated pyrimidines have been used in the treatment of advanced colorectal cancer, mainly in the form of intravenous injections of 5-fluorouracil (5-FU), alone or in combination with leucovorin. Oral treatment with 5-FU has been difficult because of high toxicity and low bioavailability. MATERIAL, METHODS AND RESULTS: Increased knowledge of the metabolism of 5-FU, reviewed in this article, has led to the development of a number of new oral drugs for the treatment of advanced colorectal cancer. Administration of prodrugs and inhibitors of 5-FU-catabolic enzymes has led to stable and high levels of active drug. Several drugs have shown promising results in new clinical trials. INTERPRETATION: New 5-FU related drugs for oral administration show results comparable to those of the cytotoxic drugs that have been administered in hospital. In the future, general practitioners could possibly treat and follow up a larger proportion of these patients.