Shoulder periprosthetic fracture in elderly patient: a minimally invasive osteosynthesis and "off-label" treatment with teriparatide. A case report and literature review.

A case of shoulder periprosthetic fracture in elderly patient. The patient underwent a minimally invasive osteosynthesis and "off-label" treatment with teriparatide. An 80-year-old woman patient following an accidental fall reported a transverse displaced diaphyseal fracture of the right humerus, distal to the stem of the inverse prosthesis. The patient suffering from severe osteoporosis and chronic ischaemic heart disease. The patient underwent fracture osteosynthesis surgery using a Hoffmann III mono-axial external fixator. Teriparatide administered at a dosage of 20 micrograms/day, for four months. At six months from the beginning of th e hybrid treatment, a complete healing of the fracture was observed radiologically and clinically. It is possible to affirm that the use of teriparatide off-label has a positive and additive effect in promoting the healing of fractures.

[Polydistrectual atherosclerosis in the elderly. Ischemic cardiopathy and obliterative peripheral arteriopathy of the lower limbs]. / Aterosclerosi polidistrettuale nell'anziano. Cardiopatia ischemica e arteriopatie obliteranti periferiche degli arti inferiori.

BACKGROUND: Numerous epidemiological studies have recently drawn attention to the polydistrict nature of atherosclerotic disease. In particular, it has been made clear the frequent association between coronary heart disease and peripheral arterial disease of the lower limbs. We have therefore evaluated the frequency of peripheral arterial disease in a consecutive unselected series of patients affected by coronary heart disease, over 65 and under 65. We have besides evaluated the frequency of some factors of risk for atherosclerotic disease on the subjects affected by coronary heart disease alone and in those with associated peripheral arterial disease. METHODS: We have studied 502 patients (280 males and 222 females) with coronary heart disease admitted to the II Division of General Medicine of Pugliese-Ciaccio Hospital of Catanzaro. Of the 502 patients examined, 367 (72.7%) over 65 and 137 (27.3%) under 65. Factors of risk considered were familiarity, cigarette smoking, diabetes mellitus, dyslipidosis, arterial hypertension. RESULTS AND CONCLUSIONS: Peripheral arterial disease was present in 37% of the subjects examined. In the elderly group there was a frequency of 87.6%, while in subjects under 65 the frequency was 12.4%. Symptoms of claudicatio were present in 100% of the subjects under 65 and 58.6% of the elderly subjects. Risk factors that apply with greater frequency were diabetes mellitus, arterial hypertension and smoking. The results of our study show the importance of searching for stenosis even if asymptomatic in patients with coronary heart disease, above all if elderly.