Age related changes in the bone microstructure in patients with femoral neck fractures.

BACKGROUND: The risk of femoral neck fracture progressively increases with age. However, the reasons behind this consistent increase in the fracture risk can't be completely justified by the decrease in the bone mineral density. The objective of this study was to analyze the correlation between various bone structural features and age. STUDY DESIGN & METHODS: A total of 29 consecutive patients who suffered an intracapsular hip fracture and underwent joint replacement surgery between May 2012 and March 2013 were included in this study. A 2 cm × 1 cm Ø cylindrical trabecular bone sample was collected from the femoral heads and preserved in formaldehyde. Bone mineral density (BMD), microarchitecture, organic content and crystallography were analyzed using a Dual-energy X-ray absorptiometry scan, micro-CT scan, and high resolution magic-angle-spinning-nuclear magnetic resonance (MAS-NMR), respectively. Statistical correlations were made using Spearman´s or Pearson´s correlation tests depending on the distribution of the continuous variables. RESULTS: The mean patient age was 79.83 ± 9.31 years. A moderate negative correlation was observed between age and the hydrogen content in bone (1H), which is an indirect estimate to quantify the organic matrix (r = -0.512, p = 0.005). No correlations were observed between BMD, trabecular number, trabecular thickness, phosphorous content, apatite crystal size, and age (r = 0.06, p = 0.755; r = -0.008, p = 0.967; r = -0.046, p = 0.812; r = -0.152, p = 0.430, respectively). A weak positive correlation was observed between Charlson´s comorbidity index (CCI) and c-axis of the hydroxiapatite (HA) crystals (r = -0.400, p = 0.035). CONCLUSION: The femoral head relative protein content progressively decreases with age. BMD was not correlated with other structural bone parameters and age. Patients with higher comorbidity scores had larger HA crystals. The present results suggest that the progressive increase in the hip fracture risk in elderly patients could be partially explained by the lower bone protein content in this age group.

Triple rotura del complejo suspensorio del hombro / Triple fracture of the shoulder suspensory complex

El complejo suspensorio del hombro (CSSH) es una estructura anular cuya integridad es fundamental para mantener la biomecánica del hombro. Las lesiones aisladas del CSSH son relativamente frecuentes, pero las lesiones que afectan a 3 componentes son extremadamente raras. Hay solamente 3 casos publicados en la literatura, y nosotros en este trabajo exponemos uno más. Presentamos una triple lesión del CSSH en un varón de 26 a˜nos con una fractura de la apófisis coracoides tipo i de Ogawa, fractura de acromion tipo iii de Kuhn y fractura de clavícula tipo ii de Neer. Se realiza una reducción abierta y fijación interna de la clavícula con 2 agujas de Kirschner roscadas y síntesis del acromion con 2 tornillos canulados. La fractura de coracoides se trató de forma conservadora. A los 24 meses de la cirugía las 3 fracturas consolidaron correctamente y el paciente obtuvo un resultado funcional excelente según las escalas de Constant-Murley y QuickDASH (AU)

The superior suspensory complex of the shoulder (SSCS) is a ring shaped structure composed of bones and soft tissues that play a fundamental role in the stability of the shoulder joint. Isolated injuries of the SSCS are relatively common, but injuries that affect 3 components are extremely unusual. We present a triple injury of the SSCS in a 26 year old patient with a Neer type ii clavicular fracture, a Kuhn type iii acromion fracture and an Ogawa type i coracoid fracture. An open reduction and stabilization of the clavicle was performed with 2 Kirschner nails. The acromial fracture was synthesized with 2 cannulated screws, and the coracoid fracture was treated conservatively. After 24 months of follow up the patient had an excellent functional outcome according to the Constat-Murley shoulder score and QuickDASH scoring system, and all the fractures healed correctly (AU)

[Triple fracture of the shoulder suspensory complex]. / Triple rotura del complejo suspensorio del hombro.

The superior suspensory complex of the shoulder (SSCS) is a ring shaped structure composed of bones and soft tissues that play a fundamental role in the stability of the shoulder joint. Isolated injuries of the SSCS are relatively common, but injuries that affect 3 components are extremely unusual. We present a triple injury of the SSCS in a 26 year old patient with a Neer type ii clavicular fracture, a Kuhn type iii acromion fracture and an Ogawa type i coracoid fracture. An open reduction and stabilization of the clavicle was performed with 2 Kirschner nails. The acromial fracture was synthesized with 2 cannulated screws, and the coracoid fracture was treated conservatively. After 24 months of follow up the patient had an excellent functional outcome according to the Constat-Murley shoulder score and QuickDASH scoring system, and all the fractures healed correctly.

Púrpura fulminante: resultado funcional en 2 pacientes pediátricos tras sufrir múltiples amputaciones / Purpura fulminans: functional results in two paediatric patients after suffering multiple amputations

La púrpura fulminante (PF) es un proceso hemorrágico inusual, que se asocia habitualmente a la sepsis meningocócica y a otros procesos infecciosos. Suele afectar a neonatos y a niños pequeños, y comienza como una infección benigna que progresa presentando fiebre alta, equimosis purpúrica, coagulopatía intravascular diseminada, necrosis y gangrena. El tratamiento de estos niños suele requerir la toma de decisiones difíciles, ya que el cirujano y los familiares deben plantearse la posibilidad de continuar con una línea de tratamiento agresiva que puede dejar múltiples secuelas mutilantes o seguir un tratamiento paliativo. En este estudio revisamos la presentación clínica, tratamiento y resultados funcionales de 2 casos de PF tratados en nuestro centro entre los años 2002 y 2005. Los niños presentados en este estudio tuvieron un buen resultado funcional a largo plazo y una calidad de vida aceptable a pesar de haber sido sometidos a múltiples amputaciones (AU)

Purpura fulminans (PF) is an unusual haemorrhagic process that is usually associated with meningococcal sepsis and other infectious processes. It usually affects neonates and young children, and starts with a benign infection that progresses to a high fever, purpura ecchymosis, disseminated intravascular coagulopathy, necrosis and gangrene. The treatment of these children usually requires making difficult decisions, since the surgeon and the families must come to terms with the possibility of following an aggressive line of treatment that could lead to multiple mutilating sequelae, or follow palliative treatment. In this study, we review the clinical presentation, treatment and results of two cases of PF treated in our hospital between the years 2002 and 2005. The children presented in this study had a good long-term functional result and an acceptable quality of life, despite being subjected to multiple amputations (AU)

[Purpura fulminans: functional results in two paediatric patients after suffering multiple amputations]. / Púrpura fulminante: resultado funcional en 2 pacientes pediátricos tras sufrir múltiples amputaciones.

Purpura fulminans (PF) is an unusual haemorrhagic process that is usually associated with meningococcal sepsis and other infectious processes. It usually affects neonates and young children, and starts with a benign infection that progresses to a high fever, purpura ecchymosis, disseminated intravascular coagulopathy, necrosis and gangrene. The treatment of these children usually requires making difficult decisions, since the surgeon and the families must come to terms with the possibility of following an aggressive line of treatment that could lead to multiple mutilating sequelae, or follow palliative treatment. In this study, we review the clinical presentation, treatment and results of two cases of PF treated in our hospital between the years 2002 and 2005. The children presented in this study had a good long-term functional result and an acceptable quality of life, despite being subjected to multiple amputations.