Changes in scaphoid bone density after acute fracture.

The radiographic density of the proximal fragments of 16 scaphoid fractures was assessed on scaphoid series radiographs taken at 6 to 12 weeks. In addition, dual energy X-ray absorptiometry measurements of bone mineral density in the distal radius and proximal and distal fracture fragments were performed at 1 to 2 weeks and 6 to 12 weeks. Median reductions of 9% and 10% were observed in bone mineral density in the proximal fracture fragment and the distal radius respectively, but these did not correlate with the radiographic density of the proximal fragment. A greater median reduction in bone mineral density (27%) was observed in the distal fracture fragment and more bone loss occurred at this site when there was an apparent increase in the radiographic density of the proximal fragment (median fall of 0.23 g/cm2 versus 0.14 g/cm2). Thus, apparent increased radiographic density of the proximal fragment may be due to increased bone loss from the distal fragment.

The cell surface receptor G6b, a member of the immunoglobulin superfamily, binds heparin.

The G6b gene, located in the human Major Histocompatibility Complex, encodes a receptor of the immunoglobulin (Ig) superfamily. In this study, we show using a variety of techniques that the extracellular domain of the G6b protein, containing a single Ig-like domain, binds to heparin with high affinity. In an ELISA assay, this binding was displaceable with soluble heparin with an IC50 value of approximately 0.5 microg/ml. Other sulfated glycans showed weaker or no competition. The observed interaction between G6b and heparin is strongly salt dependent suggesting a mainly electrostatic interaction. Heparin might modulate the interaction of G6b with its as yet unidentified protein ligand.

Dual energy X-ray absorptiometry (DXA): can it detect acute scaphoid fractures?

This prospective study investigated whether dual energy X-ray absorptiometry (DXA) could detect acute scaphoid fractures. We blindly compared 10 normal and 10 fractured scaphoid images produced with a new technique of DXA scan analysis. This measured and plotted the density of the scaphoid throughout its length, producing a linear graph of the scaphoids' density instead of a single area (g/cm2) measurement of bone density. These new plots only detected six of the 10 fractures and suggested that four of the normal controls were fractured. Thus, this technique of DXA scan analysis is neither sensitive nor specific for the detection of acute scaphoid fractures.

Reduced bone formation in UK Gulf War veterans: a bone histomorphometric study.

AIMS: Gulf War veterans report a high prevalence of musculoskeletal symptoms. The aim of this study was to establish whether there were abnormalities in bone turnover and remodelling in a group of symptomatic subjects who had served in the Gulf War. METHODS: Iliac crest bone biopsies were obtained from 17 Gulf War veterans who were seeking litigation and compared with those of 13 age and sex matched healthy controls. Bone histomorphometry was performed using image analysis. RESULTS: Cancellous bone area was significantly lower in Gulf War veterans than in control subjects (p = 0.027) and this was associated with a significantly reduced mineral apposition rate (p = 0.002), mean wall width (p < 0.0001), and bone formation rate at the tissue level (p < 0.0001). CONCLUSIONS: These results demonstrate that in this group of Gulf War veterans there was a significant reduction in bone formation at both the cellular and tissue level and this was associated with a reduction in cancellous bone area. The cause of these abnormalities is unknown but might be related to potentially harmful exposures during service in the Gulf War or to changes in life style as a result of chronic ill health. The clinical relevance of the observed reduction in bone formation remains to be established.

The management of osteoporosis.

Osteoporosis poses a significant orthopaedic problem of epidemic proportions. Clear guidelines for the management of osteoporosis presenting early or late are still being debated. Several recommendations, however, are now generally accepted. Measurements of BMD should be taken if the diagnosis is in doubt or as an adjunct to encourage patient compliance with treatment. Those with multiple risk factors and who are under the age of 65 years would benefit from a scan. Those with previous fractures and no obvious risk factors should also be sent for DXA assessment. The elderly with fractures and multiple risk factors do not need scanning and can normally be started on treatment. Mass population screening is not cost-effective. Prevention strategies should be targeted at high-risk patients and not offered to everyone. In the perimenopausal woman HRT is the first line of treatment and prevention, along with changes in lifestyle. Tibolone may be an option for those who find cyclical bleeding unacceptable. In the elderly, institutionalised patient, calcium and vitamin-D supplements should be considered to replace depleted levels, particularly for secondary prevention. Postmenopausal women with multiple risk factors and at least one insufficiency fracture should be treated. The most likely pharmacological agent will be a bisphosphonate with supplemental calcium if indicated. Each hospital should have a recognised link person through whom referrals can be channelled, either a clinical nurse specialist or physician. A protocol for treatment should be agreed locally and publicised among the primary health-care groups. The first step of identification of high-risk patients is most often in fracture clinics. Standardised letters attached to the clinic note to general practitioners are an easy way of 'getting these patients into the system'.

Ganglia: the patient's perception.

This study investigates the concerns of 50 patients with ganglia and their reasons for primary care consultation and referral to a hand unit. Although a minority of patients sought advice and treatment because of pain, more (38%) were concerned about the cosmetic appearance and a significant number (28%) were concerned that their ganglion was a malignant growth. The general practitioners referred 70% of patients to the hand clinic for "excision of the ganglion" and 30% for further "advice and treatment". However, 74% of patients were satisfied with aspiration of the ganglion and general advice.

Reduced bone formation after exposure to organophosphates.

Bone histomorphometric analysis in 24 agricultural workers with chronic organophosphate exposure showed significantly lower bone formation at tissue and cellular level than in healthy controls.

A prospective study of two conservative treatments for ganglia of the wrist.

This randomized prospective study assessed whether multiple puncture of the ganglion wall improves the results of simple ganglion aspiration. We found that 32% of ganglia resolved after aspiration alone in comparison with 22% after aspiration and multiple puncture. This difference was not significant. However, only 18% of patients requested formal surgical excision, suggesting that aspiration allays fears of malignancy and allows the patient to accept a minor cosmetic embarrassment.

Twenty-four hour ambulatory nasal pH monitoring.

The nasal delivery of drugs, both for systemic and local use, is an expanding field with many drugs being delivered by this route. It is known that changes in pH can affect drug absorption but there is no data regarding intranasal pH over time. We present the results of 24-h ambulatory nasal pH monitoring in four subjects, each of whom had monitoring on two separate occasions. The apparatus consisted of a pH monitor with two electrodes, thus enabling us to take readings from 1 and 4 cm behind the anterior end of the inferior turbinate. Measurements were recorded every 6 s by the posterior electrode and every 30 s by the anterior electrode. The recording apparatus was worn around the subjects waist. Analysis of the results showed that there was no diurnal variation and no significant differences between the subjects. The mean pH from the anterior electrode was higher than that from the posterior (7.1 versus 6.6). The pH did not fluctuate with daily activities such as eating, drinking or sleeping. The results are interesting and may be of importance with regard to the design of formulations for nasal drug delivery systems.