Vertebral fracture assessment by DXA is inferior to X-ray in clinical severe osteoporosis.

UNLABELLED: Spine fractures are diagnosed by X-ray or vertebral fracture assessment (VFA) by dual-energy X-ray absorptiometry (DXA) scanning. The use of VFA evaluation by DXA is still debated. We demonstrate that VFA is inferior relative to X-ray in visualizing vertebrae properly in the upper spine and therefore with a reduced diagnostic performance in detecting fractures. INTRODUCTION: Vertebral fracture assessment (VFA) by DXA has been evaluated for many years, and its use in clinical practice is still debated. In a cross-sectional setting, we aimed to compare VFA with traditional radiography in vertebral fracture (VF) diagnosis in severe osteoporotic patient. METHODS: A total of 207 patients referred to the outpatient clinic for teriparatide treatment were screened, out of whom 35 (16.9 %) severe osteoporotic patients were identified (mean age 67.5 ± 11.3 years and median T-score -3.2 interquartile range (IQR) (-1.9 to -3.7). VF diagnosis was performed independently using VFA and X-ray in accordance with the semiquantitative (SQ) approach. The same technician performed the primary interpretation on both sets of images, after which a radiologist and an endocrinologist reviewed the evaluation for a conclusive judgement. RESULTS: In total, 180 radiographic fractures were detected, corresponding to 5.1 fractures per individual. Using VFA, 18.5 % of vertebrae were considered unreadable, compared to 2.0 % on X-ray. The accuracy of VFA in VF detection using X-ray as a reference resulted in sensitivity and specificity of 75.5 and 86.7 %, respectively. Sensitivity decreased from the lumbar to thoracic level. Nevertheless, VFA only identified fractures consistently between Th11 and L3. CONCLUSION: Our data, based on a severe osteoporotic population, demonstrate that VFA is inferior relative to X-ray in visualizing vertebrae properly in the upper spine, resulting in vertebrae not being assessable for analysis and a reduced diagnostic performance in detecting fractures. Improvements in DXA techniques are needed for it to be comparable with X-ray in VF diagnosis.

[Thrombolytic therapy in acute lower extremity ischemia]. / Trombolysebehandling ved akut underekstremitetsiskaemi.

During a period of four and a half years 37 lower extremities with acute ischaemia were treated with thrombolysis. Angiographically, 35 cases demonstrated no suitable arteries for distal reconstruction. In two cases vascular surgery was not performed because of cardiac incompensation. Two patients died within one month and limb salvage was 69%. During 22 months (3-48) of follow-up another six patients were amputated two to nine months later. The 18 salvaged lower extremities (49%) had an ankle-brachial pressure index of 0.63 (0.30-1.-09). Review of all angiograms revealed a demonstrable effect of thrombolytic therapy only in 13 (35%) cases. In conclusion, thrombolytic therapy should be considered in the case of acute lower extremity ischaemia unsuitable for reconstructive procedures. Even though the effect of thrombolytic therapy cannot be demonstrated on the angiogram, that should not necessarily deem the treatment to be a failure.

McBride's operation for hallux valgus can be used in patients older than 30 years.

Over a 10-year period, 46 feet with hallux valgus in 36 patients were treated with the McBride procedure. The median age was 35 years. At follow-up of 2 to 11 years after operation, a reduction in the hallux valgus angles, the intermetatarsal angles and the width of the forefeet was found. In patients older than 30 years there were significant reductions. In patients younger than 30 years, the reduction was not significant. The rate of problems with daily footwear was reduced from 36 of 46 feet to 13 of 38 feet. The authors noted few problems and a high rate of satisfied patients, despite the age. In 37 of 46 feet the overall result was found satisfactory by the patients. The authors find that McBride's operation can be used for hallux valgus, also in patients above 30 years, in spite of the generally accepted restriction to younger individuals.

McBride's operation for hallux valgus. A 2-11-year follow-up of 46 cases.

During a 10-year period, 46 feet with hallux valgus in 36 patients were operated on a.m. McBride. At the follow-up examination a median of 9 (2-11) years after the operation, a reduction in the hallux valgus angle from 32 degrees to 26 degrees and in the intermetatarsal angle from 13 degrees to 10 degrees was found; but on analyzing the single parts of the operation, we found that the result was only significant in those patients that had had the original procedures done, i.e., tenotomy and reattachment of the conjoined tendon, lateral capsulotomy, and lateral sesamoidectomy. McBride's operation for hallux valgus should be performed as described by the originator of the method.

Chest radiography after minor chest trauma.

The results of chest radiography in 581 patients with blunt minor thoracic trauma were reviewed. Frontal and lateral views of the chest indicated pathology in 72 patients (12.4%). Pneumothorax was present in 16 patients; 4 had hemothorax. The physical examination and the results of chest radiography were not in accordance because in 6 (30%) of the 20 patients with hemo/pneumothorax the physical examination was normal. Consequently there is wide indication for chest radiography after minor blunt chest trauma.