Low 25(OH) D serum levels are related with hip fracture in postmenopausal women: a matched case-control study.

PURPOSE: There is limited information on the prevalence of vitamin D deficiency among patients diagnosed with hip fracture in the Chinese Han population. Therefore, the aim of this study was to assess the effects of change in the serum levels of 25-hydroxyvitamin D [25(OH) D] and intact parathyroid hormone (iPTH) among postmenopausal women in North China with confirmed hip fracture. METHODS: This study was done from May 1, 2012 to April 30, 2014. Three hundred and forty-nine postmenopausal women who were diagnosed with first-ever hip fracture and 349 matched controls without fracture were used for this study. The 25(OH) D, iPTH, alkaline phosphatase, calcium, and phosphorus levels were measured in fasting venous blood samples collected from the subjects. A predesigned questionnaire was used to collect information on covariates for multivariate analyses to evaluate the hypothesized relationship between vitamin D deficiency and fracture risk. RESULTS: The serum 25(OH) D levels were found to be significantly (P < 0.0001) lower in hip fracture patients than in the controls [37.0 (interquartile range [IQR] 28.0-48.0) nmol/L vs. 41.3 (IQR 32.0-54.5) nmol/L; P < 0.0001], and the iPTH levels were significantly higher in the former group [10.2 (IQR 6.3-14.9) pmol/L vs. 5.8 (IQR 4.1-6.6) pmol/L; P < 0.0001]. Further, a 25(OH) D level ≤50 nmol/L was found to independently indicate the occurrence of hip fracture [odds ratio (OR), 3.023; 95 % confidence interval (CI) 2.154-4.298], as well as hip fracture with concomitant upper limb fracture (OR 4.473; 95 % CI 2.984-10.532). Similarly, a serum iPTH level ≥6.8 pmol/L independently indicated the development of hip fracture (OR 2.498; 95 % CI 1.764-3.942), as well as hip fracture with concomitant upper limb fracture (OR 3.254; 95 % CI 1.998-7.984). CONCLUSIONS: Vitamin D insufficiency and secondary hyperparathyroidism were found to be common problems in the sample of postmenopausal women who had experienced hip fracture. Monitoring the alterations in the serum levels of 25(OH) D and iPTH could be applied clinically as independent risk factors for hip fracture.

[Fibular head composite flap for bone and skin defect at medial malleolus in children: a report of 4 cases].

OBJECTIVE: To investigate the therapeutic effect of fibular head composite flap for bone and skin defect at medial malleolus in children. METHODS: From Aug. 2005 to Apr. 2009, 4 children cases (2 male, 2 female, from 3 to 11 year) with bone and skin defect at medial malleolus were reconstructed with fibular head composite flaps pedicled with lateral inferior genicular vascular bundle. The skin defect was 3- 6 cm x 8-10 cm in size. RESULTS: All the 4 composite flaps survived completely. The patients were followed up for 4 months to 4 years with good bony healing. Both esthetic and functional results were satisfactory in ankle joint. CONCLUSIONS: The fibular head composite tissue flap has a good therapeutic effect for bone and skin defect at medial malleolus in children.

[Application of pre-fabricated free flap in reconstruction and repair of skin defect of foot in weight-bearing area].

OBJECTIVE: To investigate the clinical effect of pre-fabricated free skin flap in reconstruction and repair of skin defect of foot in weight-bearing area. METHODS: Eight cases of skin defect of foot in weight-bearing area, due to trauma, were repaired by such an approach; free skin flap was designed and pre-fabricated at the contralateral plantar center, and 3 weeks later the free skin flap, with sensory nerve was transplanted to the site of skin defect, fixed by stitches through drilled holes in the calcaneous bone. All of 8 cases were followed up for 15 to 23 months before clinical evaluation. RESULTS: The wound healed well with no ulcer or deformity. According to American AOFAS scoring standard, it was more than 80 in 5 cases, more than 75 in 2 cases and 70 in one case. CONCLUSION: The pre-fabricated free skin flap from the contralateral plantar center is a good option to reconstruct and repair the skin defect of foot in weight-bearing area, with low ulcer occurrence and good contour.