Thai Osteoporosis Foundation (TOPF) position statements on management of osteoporosis.

The adjusted incidence rate of hip fracture in Thailand has increased more than 31% from 1997 to 2006. Mortality and morbidity after hip fracture are also high. One year mortality after a hip fracture has increased from 18% in 1999 to 21% in 2007. The Thai Osteoporosis Foundation (TOPF) developed the first Clinical Practice Guideline (CPG) in 2002 and keeps updating the CPG since then. This latest version of the CPG is our attempt to provide comprehensive positional statement on the diagnosis, prevention and treatment of osteoporosis in Thailand. The study group who revised this position statement contains experts from the TOPF, Four Royal Colleges of Thailand, includes the Orthopaedic Surgeons, Gynecologists and Obstetricians, Physiatrists, Radiologists and 2 Associations of Endocrinologists and Rheumatologists which have involved in the management of patients with osteoporosis.

The efficacy of an aerobic exercise and health education program for treatment of chronic low back pain.

Low back pain is one of the most common and important musculoskeletal disorders. In addition, chronic low back pain can deteriorate the patient's physical, psychosocial and socioeconomic status. The objective of this quasi-experimental research was to assess the efficacy of an aerobic exercise and health education program in the treatment of chronic low back pain. Seventy-two patients whose ages ranged from 30 to 50 years who had chronic low back pain were enrolled and randomly assigned into two groups. Eight men and 28 women in the experimental group participated in a series of 3 health education sessions and an aerobic exercise training program. Nine men and 27 women in the control group received regular health education and a lumbar flexion exercise program. After a 3-month period of treatment, the results revealed the experimental group had statistically significant improvement of pain score and resting pulse rates when compared to the values of the control group (p-value < 0.001 and < 0.01, respectively). The average serum High Density Lipoprotein-Cholesterol (HDL-C) in the experimental group was also significantly higher (p-value < 0.05) than that of the control group. This health education program is useful and may be applicable to patients with chronic low back pain as an alternative treatment.

Treatment of adolescent idiopathic scoliosis using Cotrel-Dubousset spinal instrumentation.

Eighteen patients with idiopathic scoliosis who underwent posterior spinal correction and fusion using Cotrel-Dubousset instrumentation between 1991 and 1996, were evaluated for curve correction and complications. Age at surgery averaged 14.7 years. Follow-up averaged 3.7 years. Thoracic curve correction averaged 65 per cent in those with King type III/IV curves and 51 per cent in those with King type II curves. At the recent follow-up, correction loss averaged 12 per cent and 8 per cent, respectively. Lumbar curve correction averaged 31 per cent after instrumentation in type II curves, with a loss of approximately 3 per cent correction at follow-up. Thoracic sagittal contour improved 14 degrees for hypokyphotic patients. Apical vertebral rotation improved an average of 37 per cent after derotation maneuver of the left side rod. No neurologic complications or deep infection occurred. In conclusion, frontal and sagittal thoracic curve correction can be satisfactorily achieved using Cotrel-Dubousset instrumentation.

Biplane fracture of distal femoral epiphysis: a case report.

We report a case of an unusual pattern of fracture in an 11 year-old girl who sustained a distal femoral epiphyseal injury of her right knee after a motorcycle accident. It is a combination of type I and type III epiphyseal injury. This is the so-called biplane fracture of distal femoral epiphysis. The pathomechanism of the injury is a combined adduction and hyperextension type. Open reduction and internal fixation are used in order to achieve anatomic reduction. Three months after operation the fracture was healed with good functional result.

Transient osteoporosis with bilateral fracture of the neck of the femur during pregnancy: a case report.

A case of bilateral non-nion of femoral neck fracture during the last trimester of pregnancy was reported. Bilateral hemiarthroplasty with bipolar prosthesis was performed in May, 2000. The result after one year follow-up was excellent.

Interspinous bursa and spinal instability.

STUDY DESIGN: This is a prospective study. Interspinous tissue was taken intraoperatively for pathological examination for the presence of bursa. The pathologist was unaware of the X-ray findings in each specimen. The presence of bursa was then correlated with X-ray evidence of hypermobility in each segment. OBJECTIVE: To verify the pathogenesis of interspinous bursal formation. SUMMARY OF BACKGROUND DATA: Interspinous bursa is common in the older population. It has been associated with degenerative lumbar diseases, aging and anatomical distance between the spinous process. However, no detailed exploration of the segmental instability as a cause of bursal formation has been done. METHOD: The insterspinous tissue was taken intraoperatively from patients diagnosed as multilevelled spinal stenosis who underwent extensive decompression, fusion and instrumentation. The specimens were examined by the same pathologist for the existence of bursa. The presence of bursa was correlated with X-ray motion study of each spinal segment by student t-test. RESULTS: The existence of bursal was significantly correlated with angular mobility of more than 10 degrees. CONCLUSION: Angular mobility is a possible cause of interspinous bursa. On the contrary, the presence of insterspinous bursa may be evidence of segmental hypermobility.

Treatment of giant-cell tumor of the spine: report of four cases.

Four patients who had a giant-cell tumor of the spine were managed in Ramathibodi Hospital from 1986 to 1993. All of the patients are female and the age onset was between 14-36 years. The location of the lesions was distributed in the sacrum (2 cases), lumbar spine (1 case) and cervical spine (1 case). Surgical approach was determined by the location, extent of involvement and feasibility of marginal resection. Anterior approach was performed in cases of tumor mass confined to the vertebral body and posterior approach was done in cases of posterior neural arch involvement. Adjuvant therapy and preoperative internal iliac artery ligation contributed to successful treatment in cases of sacral involvement. After follow-up of fifteen to fifty months (average, 30 months), the pain subsided and neural symptoms improved. Roentgenograms showed no evidence of local recurrence.

Effect of sacral buttress technique in Ramathibodi spinal system fixation on L5-S1 motion.

This is a retrospective study which reviewed the effects of the sacral buttress technique of Ramathibodi Spinal System (RSS) instrumentation for degenerative conditions of the spine on L5-S1 motion. The inclusion criteria included patients who were treated by wide decompression and fusion of the lumbar spine. Two treatment groups of a different fusion technique were identified; the first group was treated by conventional fixation and the second group was treated by the sacral buttress technique. The objective of this study was to evaluate the effect on L5-S1 motion and translation between the conventional group and sacral buttress group. The material consisted of 66 patients who were operated from 1996 to 1999 for degenerative conditions of the lumbosacral spine. The conventional group included 25 patients in whom instrumentation was stopped at the fifth lumbar spine and the buttress group consisted of 41 patients who underwent the sacral buttress technique with RSS fixation. Dynamic lateral radiographs were measured to determine the motion and translation before and after surgery. In the group with sacral buttress technique, post operation decrease in motion of the lumbosacral joint was statistically significant. Reduced motion was also associated with the level of fusion. The use of the sacral buttress technique with RSS led to significant control in lumbosacral motion without the need for screw fixation to the sacral spine. The usefullness of this technique is a valuable adjunct to spinal fusion in patients who undergo decompressed spinal surgery and may prevent the junctional problem of fusion at this segment and also the upper end of the above fusion level.

Evaluating the clinical relevance of codon 594 (g>a) polymorphism of estrogen receptor alpha in knee osteoarthritis.

UNLABELLED: It has been reported that oestrogen receptor alpha (ER-α) polymorphisms are associated with knee osteoarthritis (OA). In this study, we assessed whether there was any association between the codon 594 (G>A) polymorphism in ER-α and radiographic features of OA or patient function. Radiographs, WOMAC score and patient reported time of symptom onset were assessed in 194 patients presenting for total knee replacement at Ramathibodi hospital over a one year period. ESR-1 genotyping was assessed. There were 107 (55.15%) patients with common homozygote (GG), 78 (40.20%) patients with heterozygote (GA) and nine (4.65%) patients with rare homozygote (AA). There was poor correlation (r = <0.2) between group difference in the radiographic parameters, time of onset of symptom , or in WOMAC scores. This polymorphism is not associated with the clinical features of knee osteoarthritis. The role of this polymorphism is unlikely then to be used as a biological marker predicting the progression of knee OA. KEY WORDS: Oestrogen receptor alpha polymorphism, Knee osteoarthritis, Radiographic feature, Functional score.