Adverse plasma fatty acid composition in patients with femoral neck fracture1.

Our study aimed to examine the status of plasma fatty acids (FAs), inflammatory markers, and lipid peroxidation in patients with femoral neck fractures. The study included 20 patients (64-86 years) with femoral neck fractures indicated for surgery and a control group of 17 elderly subjects without fractures or serious chronic diseases. Plasma was obtained during the first 12 h postfracture and presurgery and 7 days postop. Compared to the control, patients had significantly higher saturated FA (SFA) and monounsaturated FA as well as increased TNF-α and IL-6. Opposite to that, levels of individual and total n-6 polyunsaturated FA (PUFA), individual and total n-3 PUFA, n-6/n-3 ratio, and levels of thiobarbituric acid reactive substances (TBARS) were markedly lower in the patient than in the controls. On the seventh day after the surgery, we showed a further rise in the SFA, oleic acid, and TNF-α and reductions of n-6 PUFA and IL-6. Taken together, our results suggest that altered FA status, especially reduced PUFA, may influence hip fracture repair and even contribute to femoral fracture susceptibility in the elderly. A potential benefit from nutritional intervention with PUFA in prevention and (or) fracture healing should be considered.

Interleukin-6 as possible early marker of stress response after femoral fracture.

Bone fracture healing is a complex process which at best results in full recovery of function and structure of injured bone tissue, but all the mechanisms involved in this process, and their mutual interaction, are not fully understood. Despite advancement of surgical procedures, this type of fractures is still a major public health concern. In the last few decades, a lot of attention is focused on the oxygen-free radicals and inflammatory response markers as important factors of skeletal injury. Thus, the aim of the present study was to follow the changes in redox balance and inflammatory response in elderly patients with femoral fractures during the earliest stages of fracture healing, by measuring the values of the observed markers immediately after fracture, as well as the first, third, and seventh postoperative day. Present study was performed on a group of 65 elderly patients with femoral neck fractures, recruited from the Orthopedic Clinic, Clinical Centre Kragujevac in the period from February to May 2015. Redox status was measured spectrophotometrically and evaluated by measuring the levels of index of lipid peroxidation (measured as TBARS), nitrite (NO2-), superoxide anion radical (O2-), and hydrogen peroxide (H2O2) in plasma, while activities of corresponding antioxidative enzymes, catalase (CAT), superoxide dismutase (SOD), and reduced glutathione (GSH) were measured in erythrocytes. The cytokine concentrations of interleukin (IL)-6 and tumor necrosis factor (TNF)-α were determined in plasma, using ELISA assays specific for human cytokines. Our study showed that redox status and TNF-α in elderly patients with femoral fractures did not show statistically significant changes during the early phase of fracture healing. On the other hand, IL-6 increased statistically in first day after intervention. This preliminary study has shown our observations, and we hope that these results may help in better understanding mechanisms which are included at fracture healing. More importantly, this study attempted to create a platform for further research.

Importance of Herrings classification in predicting the outcome of aseptic necrosis of the femoral head.

AIM: To highlight the importance of values of the ​​Herring's classification in the treatment planning of Legg-Calve-Perthes disease (LCPD). METHOD: The charts of 14 patients in a period of 4 years (2004-2008) were retrospectively reviewed. Inclusion criteria was unilateral LCPD and contralateral healthy hip. The patients were divided into three Herring groups according to radiographic images (A, B and C). For all patients the acetabulum/head index (AHI) was determined. RESULTS: The youngest patient was 4.9 years and the oldest 9.11 years; male patients were dominant (male:female 11:3). The right hip side was more affected comparing to the left one (8:6). The distribution of patients in Herring groups was three in the Group A, six in the Group B and five patients in the Group C. The AHI index was lowest in the group C. Patients in the group C were treated surgically. CONCLUSION: Herrings classification predicts patients with extensive changes and suggests what kind of treatment should be applied.