Improving osteoporosis management following minimal trauma fracture in a regional setting: The Coffs Fracture Card Project.

OBJECTIVES: To improve osteoporosis (OSP) management following minimal trauma fracture (MTF) with few additional resources. DESIGN: Population intervention with serial cross-sectional analysis. SETTING: Regional setting involving primary care, base hospital and private hospital. PARTICIPANTS: Patients with MTF. INTERVENTION: A 'Fracture Card' prompting OSP management was provided to all patients post-MTF. Patients were encouraged to attend their general practitioner (GP) with this to discuss bone health issues. The 2-year intervention was supported by a public health education campaign. MAIN OUTCOME MEASURES: Number of (i) serum 25-OH vitamin D assays, (ii) dual-energy X-ray absorptiometry (DXA) scans, and (iii) new Pharmaceutical Benefits Scheme (PBS)-subsidised prescriptions for bone protective therapy (bisphosphonates, raloxifene, strontium, teriparatide, denosumab). RESULTS: The number of serum 25-OH vitamin D assays ordered in Coffs Harbour increased from 329 ± 15 per month (July 2009-June 2010) to 568 ± 21 (July 2010-June 2012; P < 0.001). The number of DXA scans performed per month increased from 192 ± 14 (July 2009-June 2010) to 296 ± 12 (July 2010-June 2012; P < 0.001). There was no difference in the number of new PBS-subsidised prescriptions for bone protective therapy in the Coffs statistical subdivision over that time (176 ± 3.8 per month, July 2009-June 2010 versus 180 ± 3.5, July 2010-June 2012, P > 0.05). CONCLUSIONS: The intervention was associated with an increased number of 25-OH vitamin D assays and DXA scans but not with more prescriptions for bone protective therapy. This suggests that a public health education campaign and provision of a 'prompt' for GPs was only partially successful at improving OSP management post-MTF. This has driven establishment of a Fracture Liaison Service.

The effect of surgical alignment and soft tissue conditions on the kinematics and wear of a fixed bearing total knee replacement.

As life expectancy and activity levels of patients increase so does the demand on total knee replacements (TKRs). Abnormal mechanics and wear of TKRs can lead to implant loosening and revision. Component alignment after surgery varies due to the presurgical alignment, the accuracy of the surgical instrumentation and due to patient factors, such as the soft tissue balance. This study experimentally investigated the effect of variation in component alignment and the soft tissue conditions on the kinematics and wear of a fixed bearing TKR. DePuy Sigma fixed bearing TKRs with moderately cross-linked UHMWPE were used. Different alignment conditions were simulated in the coronal, sagittal and transverse planes in an ISO force-controlled simulation system. Three different soft tissue conditions were simulated using virtual springs to represent a stiff knee, a preserved PCL and a resected PCL. Four different alignment conditions were studied; ideal alignment, 4° tibial and femoral varus joint line, 14° rotational mismatch and 10° posterior tibial slope. The varus joint line alignment resulted in similar kinematics and lower wear rate compared to ideal alignment. The rotational mismatch alignment resulted in significantly higher tibial rotation and abduction-adduction as well as a significantly higher wear rate than ideal alignment. The posterior tibial slope alignment resulted in significantly higher wear than the ideal alignment and dislocated under the lower tension soft tissue conditions. Component alignment and the soft tissue conditions had a significant effect on the kinematics and wear of the TKR investigated in this study. The surgical alignment of the TKR is an important factor in the clinical outcome of the joint as factors such as increased tibial rotation can lead to anterior knee pain and instability and increased wear can lead to aseptic loosening and early failure resulting in revision.

Representing the effect of variation in soft tissue constraints in experimental simulation of total knee replacements.

As life expectancy and activity levels of patients increase so does the demand on total knee replacements (TKRs). Abnormal mechanics and wear of TKRs can lead to implant loosening and early failure. Polyethylene inserts of varying design and conformity have been introduced in the past decade to improve stability and patient's confidence in the replaced knee, particularly in cases where soft tissue support around the knee is sub optimal. This study experimentally investigated the effect of variation in the soft tissues on the kinematics and wear of a TKR on three different tibial insert designs. DePuy Sigma fixed bearing TKRs with moderately cross-linked UHMWPE and the ISO force control inputs were used. Different soft tissue constraints were simulated using virtual springs in an ISO force controlled simulation system. The spring gaps and stiffness' were varied and their effect on the output kinematics and wear rates assessed. The lower conformity inserts resulted in significantly higher displacements and more variation between the stations on the simulator. They were also more sensitive to changes in the soft tissue constraints than the high conformity insert. The wear rate for the high tension springs was significantly lower than for the lower tension springs tested. Tibial insert geometry and soft tissue constraints significantly affected kinematics and wear in these experimental simulations. Soft tissue constraints and the variability in patients are important considerations in the stratified design of TKRs and approach to patient selection.

Deposition of Ag and Ag-Au nanocrystalline films with tunable conductivity at the water-toluene interface.

Thin films of Au, Ag and Ag-Au alloy nanocrystals extending to areas of several square centimetres are obtained by deposition at the interface of water and toluene. Toluene containing chlorotris(triphenylphosphine)silver(i) and/or chlorotriphenylphosphine gold(i) is reacted with aqueous tetrakishydroxymethylphosphonium chloride to obtain nanocrystalline films adhered to the interfacial region. Alloying was induced by varying the composition of the toluene layer. The composition change results in regular and reproducible variation in the transport characteristics of the films, with the initially metallic deposits turning non-metallic with increased Au content. The films at the interface were transferred to different substrates and characterised using atomic force microscopy, UV-visible spectroscopy, X-ray diffraction, X-ray photoelectron spectroscopy, scanning and transmission electron microscopy.