Pertrochanteric femoral fractures treated with a dynamic hip screw or a proximal femoral nail. A randomised study comparing post-operative rehabilitation.

We treated 108 patients with a pertrochanteric femoral fracture using either the dynamic hip screw or the proximal femoral nail in this prospective, randomised series. We compared walking ability before fracture, intra-operative variables and return to their residence. Patients treated with the proximal femoral nail (n = 42) had regained their pre-operative walking ability significantly (p = 0.04) more often by the four-month review than those treated with the dynamic hip screw (n = 41). Peri-operative or immediate post-operative measures of outcome did not differ between the groups, with the exception of operation time. The dynamic hip screw allowed a significantly greater compression of the fracture during the four-month follow-up, but consolidation of the fracture was comparable between the two groups. Two major losses of reduction were observed in each group, resulting in a total of four revision operations. Our results suggest that the use of the proximal femoral nail may allow a faster post-operative restoration of walking ability, when compared with the dynamic hip screw.

Femoral shaft medialisation and neck-shaft angle in unstable pertrochanteric femoral fractures.

We analysed the time-dependent mean changes in the femoral neck length, neck-shaft angle and hip offset in a randomised study comprising 48 patients who were treated with the dynamic hip screw (DHS) or the proximal femoral nail (PFN) for an unstable intertrochanteric femoral fracture. As a consequence of fracture compression, the mean post-operative neck length was significantly shorter in patients treated with the DHS. During the first 6 weeks after the operation, a mean decrease of 4.6 degrees was observed in the neck-shaft angle, but there was not a significant difference between the treatment groups. The radiographic measures remained virtually unaffected during the interval from 6 weeks to 4 months in both groups. When the operated hip was compared to the opposite hip, patients who had received the DHS showed significantly greater medialisation of the femoral shaft at 4 months than those treated with the PFN. We thus recommend that unstable intertrochanteric fractures should be initially reduced in a slight valgus position in order to achieve an outcome after healing that is as normal as possible. As a result of differences in operative technique and implant stability, the PFN may be superior to the DHS in retaining the anatomical relations in the hip region in unstable intertrochanteric fractures.

Distribution of fibronectins and their integrin receptors in interface tissue from aseptic loosening of hip prostheses.

OBJECTIVES: To assess the distribution of fibronectins (FNs) and their integrin (Int) receptors in synovial membrane-like interface tissue (SMLIT) from aseptic loosening of total hip replacement (THR), and potential role of FN-Int interaction in the loosening process. METHODS: The alkaline phosphatase anti-alkaline phosphatase (APAAP) method was used to detect the distribution of FNs and their Int receptors in SMLIT and control samples. Double immunofluorescence labeling was used to reveal the different co-localizations. RESULTS: Intensive FN staining appeared in the lining layers, sublining area, and vascular endothelium, while immunoreactivities for Int alpha 4, alpha 5, beta 1 subunits were detected in the lining and endothelial cells of SMLIT. Immunofluorescence labeling revealed Int alpha 5 and collagenase-1/collagenase-3 double positive cells in lining layers and sublining area of SMLIT. CONCLUSION: Increased expression of FNs, Int alpha 4 beta 1 and alpha 5 beta 1 appeared in SMLIT compared with that in OA synovial membrane. FN-Int interactions may play a role in local collagenase production.

Phonation in the newborn, infant cry.

Sound spectrographic studies have shown that the crying of newborn infants has a fundamental frequency of about 400-600 cycles per second, and mostly a slightly rising-falling melody contour. In sick infants, and especially those with diseases affecting the central nervous system, abnormal cry characteristics occur. The fundamental frequency has been increased, and the melody contour is unstable. Various cry characteristics, which rarely occur in cries of healthy infants, are more often present in cries of the sick ones. Studies of cries in newborn infants have been especially aimed to determine whether cry analysis could be successful in diagnostics and in the early detection of the infant at risk for developmental difficulties.

Expression of tenascin-C in aseptic loosening of total hip replacement.

OBJECTIVE: To assess if the bonding interlayer between the implant and bone in aseptic loosening of total hip replacement (THR) is qualitatively deteriorated by excessive accumulation of anti-adhesive glycoprotein, tenascin-C. METHODS: Alkaline phosphatase-anti-alkaline phosphatase (APAAP) method was used for immunohistochemical staining of tenascin-C in interface tissue and control synovial tissue. RESULTS: Tenascin-C was found to be a major component of the extracellular matrix at a hitherto unrecognised site, namely the synovial membrane-like interface tissue between implant and bone in aseptic loosening of THR. The overall tenascin-C staining (median score 4.0) was greatly increased in aseptic loosening compared with synovial membrane (median score 2.0; p < 0.001) and fibrous capsule (median score 2.0; p < 0.001) from primary THR operations. Topological analysis disclosed that tenascin-C was also found at the critical implant-interface and interface-bone surfaces. CONCLUSION: Local tenascin-C expression is increased as a result of a chronic foreign body type reaction associated with excessive cytokine production and tissue injury mediated by microtrauma and neutral endoproteinases. This qualitative and topological deterioration of the bonding interlayer by an increase of anti-adhesive tenascin-C expression may inadvertantly contribute to loosening.