Cost-Utility Analysis of Osteoporotic Hip Fractures in Thais.

A prospective study was conducted among osteoporotic hip fracture in 2008. It was aimed to assess cost per quality adjusted life year (QALY) of hip fracture in the context of a developing country. The patients who were diagnosed as hip fracture and admitted to the orthopedic wards were included. Any pathological fractures or missing data were discarded from the analysis. Median cost was evaluated from a societal perspective. EQ-5D was used to assess health utility state and then converted into a time trade off Cost per QALYwas estimated at one year of follow-up. Forty-two patients completed a quality of life assessment. The average age was 75.6 years old and 71% were female. Most of them were undergone either hemiarthroplasty or internal fixation. The median total cost per year was US$ 4,210.60. The median QALY was 0.636 and cost per QALY was US$ 6,620.52. Cost utility of a hip fracture in Thai setting was lower than other developed countries due to strong family support and insufficient rehabilitation. However it has high impact on 78.8% of the Thai Gross National Product. Prevention of hip fracture is needed in underdeveloped countries as much as others, worldwide.

The Association of Bone Mineral Density and G2014A Polymorphism in the Estrogen Receptor Alpha Gene in Osteoporotic Hip Fracture in Thai Population.

OBJECTIVE: This study aimed to determine the association of a recent identified G2014A single nucleotide polymorphism (SNP) genotype distribution in exon 8 of the estrogen receptor in postmenopausal Thai women. MATERIAL AND METHOD: A prospective study was conducted at Ramathibodi Hospital between July 2005 and July 2006. Postmenopausal Thai women, aged more than 55 years and had sustained osteoporotic hipfracture, were included. Exclusion criteria were renal and metabolic bone diseases. Age, body mass index (BMI), blood tests for metabolic bone disease, and G2014A SNP genotype, bone mineral density (BMD) were collected. The relationship between the degree of osteoporosis (normal, osteopenia, and osteoporosis) and SNP genotype was analyzed by Fisher's exact test. RESULTS: Sixty-five postmenopausal women with osteoporosis were included. The average age was 76.2 ± 10.9 years old, and the average BMI was 21.3 ± 3.5 kg/m2. The data expressing the genotype distribution of gene G2014A SNP were G/G 23.1%, G/A 29.2% and A/A 47.7%. There was no statistical difference between age and BMI in each genotype. Gene G2014A was associated with osteoporosis of lumbar spine, femoral neck, ward triangle, and femoral neck. CONCLUSION: It could be concluded that a G2014A SNP genotype in exon 8 of the estrogen receptor was associated with postmenopausal women who had osteoporotic hip fracture.

The Impacts of Early Hip Surgery in High-Risk Elderly Taking Antithrombotic Agents and Afflicted with Intertrochanteric Fracture.

OBJECTIVE: To compare the outcome of early hip surgery in intertrochanteric fracture between high surgical risk patients receiving antiplatelet and anticoagulant drugs and those who did not. DESIGN: Retrospective study. MATERIAL AND METHOD: One hundred and four elderly patients with intertrochanteric fracture and having American Society of Anesthesiologist grade III-IV who underwent early hip surgery (within 72 hours after admission) with proximalfemoral nail anti-rotation (PFNA), were recruited and allocated into two group: antiplatelet and anticoagulant (AA-AC) group (n = 65), and no drug group (n = 39). Perioperative and postoperative outcomes were recorded and analyzed. RESULTS: The mean age was 81?8 years. The overall 1-year mortality was 6.7% (7 patients: 5 AA-AC group, and 2 no drug group, p = 0.7). Intra-operative blood loss in AA-AC group and No drug group were 87 ± 70 and 91 ± 65 ml, respectively (p = 0.74). There was no significant difference in blood transfusion, postoperative complications, and 1-year ambulatory status between both groups (p > 0.05 all). However, AA-AC group showed significant longer in duration of hospital stay compared with no drug group (p = 0.02). CONCLUSION: Early hip fracture surgery with PFNA in patients who received antiplatelet and anticoagulant medications is safe and does not significantly increase perioperative blood loss, blood transfusion, and postoperative mortality and morbidity.

Morphometric evaluation of subaxial cervical spine using multi-detector computerized tomography (MD-CT) scan: the consideration for cervical pedicle screws fixation.

BACKGROUND: Cervical pedicle screw (CPS) insertion is a technically demanding procedure. The quantitative understanding of cervical pedicle morphology, especially the narrowest part of cervical pedicle or isthmus, would minimize the risk of catastrophic damage to surrounding neurovascular structures and improve surgical outcome. The aim of this study was to investigate morphology and quantify cortical thickness of the cervical isthmus by using Multi-detector Computerized Tomography (MD-CT) scan. METHODS: The cervical CT scans were performed in 74 patients (37 males and 37 females) with 1-mm slice thickness and then retro-reconstructed into sagittal and coronal planes to measure various cervical parameters as follows: outer pedicle width (OPW), inner pedicle width (IPW), outer pedicle height (OPH), inner pedicle height (IPH), pedicle cortical thickness, pedicle sagittal angle (PSA), and pedicle transverse angle (PTA). RESULTS: Total numbers of 740 pedicles were measured in this present study. The mean OPW and IPW significantly increased from C3 to C7 while the mean OPH and IPH of those showed non-significant difference between any measured levels. The medial-lateral cortical thickness was significantly smaller than the superior-inferior one. PTA in the upper cervical spine was significantly wider than the lower ones. The PSA changed from upward inclination at upper cervical spine to the downward inclination at lower cervical spine. CONCLUSIONS: This study has demonstrated that cervical vertebra has relatively small and narrow inner pedicle canal with thick outer pedicle cortex and also shows a variable in pedicle width and inconsistent transverse angle. To enhance the safety of CPS insertion, the entry point and trajectories should be determined individually by using preoperative MD-CT scan and the inner pedicle width should be a key parameter to determine the screw dimensions.

Non-union and avascular necrosis of delayed reduction and screw fixation in displaced femoral neck fracture in young adults.

OBJECTIVE: Management of displaced femoral neck fracture is crucial and vulnerable to develop complications. The present study was performed to evaluate the clinical outcome of delayed reduction with multiple screw fixations in young patients who had displaced femoral neck fracture. MATERIAL AND METHOD: The authors conducted a retrospective study in young patients, aged less than 50 years old, who underwent delayed fixation for traumatic displaced femoral neck fracture (Garden classification III or IV) at Phetchabun Hospital between 1997 and 2002. Either closed or open reduction was performed to achieve an acceptable alignment and fixed with 2 or 3 cancellous screws. Study factors were age, gender Garden classification, time to reduction, type of reduction, number of screw fixation and Garden alignment index. Non-union and avascular necrosis was assessed by clinical and radiographic findings. RESULTS: There were 26 eligible patients. The average duration of delayed surgery was 13 days (range 2 to 30 days). Twenty-three patients had completed followed-up at average 28.4 months (range 14-52 months). All patients revealed complete union and independently ambulated within 10-16 months postoperatively. Clinical and radiographic avascular necroses of the femoral head developed in 2 patients (8.7%) at 20 and 24 months after surgery. Three patients who had early fixation failure underwent hemiarthroplasty except one patient refused to re-operate. CONCLUSION: Within 30-day delayed reduction and screw fixation for the treatment of displaced femoral neck fracture in the young is still good alternative treatment to preserve the femoral head with low rate of avascular necrosis.

Lumbopelvic alignment on standing lateral radiograph of adult volunteers and the classification in the sagittal alignment of lumbar spine.

The analysis of the sagittal balance is important for the understanding of the lumbopelvic biomechanics. Results from previous studies documented the correlation between sacro-pelvic orientation and lumbar lordosis and a uniqueness of spino-pelvic alignment in an individual person. This study was subjected to determine the lumbopelvic orientation using pelvic radius measurement technique. The standing lateral radiographs in a standardized standing position were taken from 100 healthy volunteers. The measurements which included hip axis (HA), pelvic radius (PR), pelvic angle (PA), pelvic morphology (PR-S1), sacral translation distance (HA-S1), total lumbosacral lordosis (T12-S1), total lumbopelvic lordosis (PR-T12) and regional lumbopelvic lordosis angles (PR-L2, PR-L4 and PR-L5) were carried out with two independent observers. The relationships between the parameters were as follows. PR-S1 demonstrated positive correlation to regional lumbopelvic lordosis and revealed negative correlation to T12-S1. PA showed negative correlation to PR-S1 and regional lumbopelvic lordosis, but revealed positive correlation to HA-S1. T12-S1 was significantly increased when PR-S1 was lesser than average (35°-45°) and was significantly decreased when PR-S1 was above the average. PR-L4 and PR-L5 were significantly reduced when PR-S1 was smaller than average and only PR-L5 was significantly increased when PR-S1 was above the average. In conclusion, this present study supports that lumbar spine and pelvis work together in order to maintain lumbopelvic balance.

Functional outcome after decompression and instrumented arthrodesis in degenerative lumbar spinal stenosis: factors influencing unsuccessful outcome change.

OBJECTIVE: To determine functional outcome after decompressive laminectomy and instrumented arthrodesis in patients with degenerative lumbar spinal stenosis and identify predictors of failed clinical outcome in these patients. MATERIAL AND METHOD: A retrospective cohort data were collected from January 1999 to February 2004. Degenerative lumbar spinal stenosis patients who had decompressive laminectomy and instrumented fusion with pedicular screw system and completed at least 2 years follow-up were enrolled in the present study. Outcomes included Oswestry Disability Index (ODI), Roland Morris score and patient satisfaction. Factors evaluated as outcome variables were age, gender onset, patient income, associated diseases, smoking, diagnosis of spondylolisthesis or scoliosis, number of levels of instrumentation and presence of S1 fusion. Univariate analysis for factors influencing failed clinical outcome used Chi-square and Fisher exact test and multivariate analysis used the logistic regression. RESULTS: One-hundred and fifty-eight patients were included in the present study. Mean follow-up was 2.64 years (range, 2-5 years). The mean age of the patients at the time of surgery was 60.3 years (range, 34-87 years) and 129 cases (81.7%) were female. According to the US FDA, the criteria of significant successful clinical outcome change is reduction of ODI at least 15%, the proportion of patients reporting significant successful clinical outcome change was 63.9%. Multivariate analysis identified age > 65 years, onset > 24 months and number of levels of instrumentation > 4 as the factors of failed clinical outcome change (p < 0.05). CONCLUSION: Decompression and instrumented arthrodesis in degenerative lumbar spinal stenosis gained satisfactory functional outcome. Older age, prolonged onset and long level of instrumentation were the factors of failed clinical outcome change.

The results of decompression and instrumented fusion with pedicular screw plate system in degenerative lumbar scoliosis patients with spinal stenosis: a prospective observational study.

OBJECTIVE: To study pain relief curve correction, and functional outcomes after decompression and instrumented arthrodesis in degenerative lumbar scoliosis patients with spinal stenosis. MATERIAL AND METHOD: Thirty-one degenerative scoliosis patients with symptom of spinal stenosis who underwent decompression and fusion with pedicular screw plate instrumentation and completed at least 2-year follow-up were included in this study Functional outcomes were obtained using Oswestry Disability Index (ODI) and Roland Morris score. The VAS pain relief walking ability and curve correction were collected as a result of the surgery. RESULTS: Average age of the patients at the time of surgery was 64.87years (range, 50-87years) and mean follow-up was 32 months (range, 24-60 months). There was significant improvement in all outcome parameters including pain scales, walking ability, ODI, and Roland Morris score (p < 0.05) Five patients had major complications with two cases requiring re-operation. CONCLUSION: Degenerative scoliosis with spinal stenosis is a complex spinal disease that requires decompression and stabilization procedures. Wide decompressive laminectomy and instrumented arthrodesis with pedicular screw plate system provided satisfied outcome included pain relief and functional restoration.

Is ankle fracture related to low bone mineral density and subsequent fracture? A systematic review.

OBJECTIVES: Ankle fractures are common in the elderly. However, their association with osteoporosis remains controversial. This systematic review aims to determine the relationship between ankle fracture and bone mineral density (BMD), and to investigate the risk of subsequent fractures after ankle fracture. METHODS: MEDLINE and Scopus publications were searched from inception to March and April 2019, respectively. Articles were selected by 2 independent reviewers for cross-sectional, cohort, or case-control studies comparing BMD or subsequent fracture risk in low-energy ankle fractures patients with that of the normal population. Data extraction was performed by 2 investigators. Discrepancies were resolved with the third reviewer. Quality assessment was conducted using the modified Newcastle-Ottawa Scale. RESULTS: Overall, 19 articles were included. The quality assessment showed a generally low-to-moderate risk of bias among studies, mainly due to potential confounders and inadequate follow-up. Of 13 studies exploring BMD in ankle fractured-patients, lower central and peripheral BMD was found in 3 and 2 studies, respectively. The risk of subsequent fracture was examined in 11 studies with relative risks ranging from 0.7 to 4.59. An increased risk of any subsequent fractures in women, both genders, and men was found in 5, 2, and 1 articles, respectively. CONCLUSIONS: Despite the lack of clear association with BMD, the contribution of ankle fracture to increased subsequent fracture risk and its associated microarchitectural changes cannot be overlooked. Moreover, its potential role as an early predictor of future fracture may promote secondary prevention. Further studies with longer follow-up and stricter confounder control are recommended.

Floor activities and degenerative spinal diseases.

BACKGROUND: The typical oriental life style in Thailand involves significant time spent on activities on the floor. This introduces an abnormal load against the spine and can cause the low back pain leading to the degenerative change of the lumbosacral region. OBJECTIVE: To determine whether various floor activities in the early adult life could result in late degenerative lumbar stenosis in the elderly patients. A case-controlled study was conducted. The patients having undergone spinal surgery according to the degenerative spinal stenosis were the case subjects. The control group consisted of the subjects having no significant back pain. The cases and the controls were matched by age, gender, and residence location. The data were collected from their medical records, roentgenograms and the standardized questionnaire. A variety of floor activities categorized by common behaviors in the Thai life style was recorded. RESULTS: There were 65 matches of cases and controls. Fifty-four patients were female performing floor activities for more than 28 times/week or more than 2 hours/week for longer than 10 years significantly increased the risk of degenerative spinal diseases by more than 15 times when being compared to the control. The most predictable activities related to the degenerative spinal diseases were occupational, cooking, and latrine use. CONCLUSION: Floor activities increased the risk of symptomatic degenerative spinal diseases in the Thai population. The question whether the prolonged postures of these routine activities could result in lumbar spinal stenosis needs more investigation in further studies.

A comparison between the Cotrel-Dubousset and the pedicle screw-plate instrumentations in the adolescent idiopathic scoliosis.

BACKGROUND: The Cotrel-Dubousset instrumentation (CD) is one of the standard instrumentations in the scoliosis surgery. Since the pedicle screw-plate system (PSP) was developed, it has resulted in the three-planar and three-dimensional correction with the minimal neurological complications. However, the correction effectiveness between these two methods is still open to question. OBJECTIVE: To compare the results of using the CD and the PSP in the treatment of adolescent idiopathic scoliosis. MATERIAL AND METHOD: A retrospective cohort study was conducted in all patients having an adolescent idiopathic scoliosis who underwent the surgery with either the CD or the PSP instrumentation at the Department of Orthopedics, Ramathibodi Hospital, during 1991 to 1998. The data of the Cobb angle, kyphotic angle, plumb line, rib hump difference and vertebral rotation were collected pre-operatively, post-operatively, and at the last follow-up. RESULTS: Forty-three patients having an adolescent idiopathic scoliosis were included. Eighteen patients: 16 females and 2 males were operated by the CD multiple hooks, and 25 patients: 23 females and 2 males were operated by the PSP instrumentation. The PSP system significantly reduced the Cobb angle and de-rotated the vertebrae in comparison with the CD group (p-value < or = 0.05). The percentage of the correction in King Type III, IV and T-L curve was higher than the other types. Both instrumentations could restore thoracic kyphosis without any major complications. CONCLUSION: The PSP system was more effective in the sagital correction, vertebral derotation and rib hump compared to the CD instrumentation. Although the PSD is a technically demanded operation, the PSP system is currently one of the most appropriate instrumentation for the adolescent idiopathic scoliosis treatment.

Safety and antisorptive power of Ibandronate applied in the real-life setting.

This study involved 78 participants taking 150 mg of Ibandronate once a month for the investigation of the drug efficacy and safety. Ibandronate had a strong antiresorptive action that decreased 67.9 per cent of bone resorption. The total cases of unwanted effect were 21 that showed the common adverse events like other bisphosphonate. The most common events were flu-like symptom (8.75%) and dyspepsia (7.5%) which occurred at the first tablet. Most participants subsided after the following months, but only one case persisted in these symptoms through the study period while the others had a myalgia, diarrhea and burning of epigastric in percent of 6.25, 2.5, 1.25 respectively. Ibandronate (150 mg) showed the strong antiresorptive effect and good compliance for taking once a month.

Association of estrogen receptor-alpha single-nucleotide polymorphism (codon 594 G-->A) and Thai patients affected by knee osteoarthritis.

BACKGROUND: Estrogen receptor-alpha single-nucleotide polymorphism (ER-alpha SNP) has previously shown its susceptibility to knee osteoarthritis (OA) but this association cannot be applied to ethnic groups with different genetic backgrounds. OBJECTIVE: To characterize the genetic association between ER-alpha SNP and knee OA in the Thai. MATERIAL AND METHOD: A case-control study was conducted at Ramathibodi Hospital from August 2007 to May 2008. Altogether, 104 cases affected by knee OA and 104 controls were included in this study. SNP rs2228480 (codon 594 G!A) on the ER-alpha gene was genotyped by a PCR-RFLP-based technique. Genotype frequencies were analyzed by logistic regression. RESULTS: ER-alpha SNP was normally distributed through the Hardy-Weinberg Equilibrium (HWE). The risk of knee OA was genetically associated to AG an AA genotypes compàred with homozygous wild-type GG (OR: 1.02, 95% CI: 0.60-1.80 for AG; OR: 1.27, 95% CI: 0.30-4.90 for AA). CONCLUSION: Our study showed that these genetic alterations might be associated with knee osteoarthritis in the Thai population. Further investigation on other informative SNPs on the ER-alpha gene should be performed to create a reliable haplotype that might provide a stronger link between genetic profiles and clinical picture.

A comparative study of risk factors of femoral neck and intertrochanteric fracture in Thai men.

OBJECTIVE: The objective of this study was to compare the risk factors related to hip fracture between intertrochanteric fracture and femoral neck fracture in Thai men. MATERIAL AND METHOD: The study was conducted in Bangkok and its vicinity from July 1997 to September 1998. The cases were recruited and matched with the controls by age and sex. Multilogit model was performed for finding the significant factors associated to each type of hip fracture. RESULTS: There were 73 femoral neck fractures, 144 intertrochanteric fractures, and 177 controls. It was found that both types of hip fracture were associated with the physical activity and the cerebrovascular accident. However, the Chinese parent race was significantly related to the femoral neck only (adjusted odds ratio (OR) 2.59, 95% confidence interval (CI): 1.21, 5.54) whereas the walking disability was specifically associated with the intertrochanteric fracture (adjusted OR 3.23, 95% CI: 1.29, 8.08). CONCLUSION: Types of hip fracture should be concerned for strategic prevention in men since they have significant difference of risk factors.

Different risk magnitudes of femoral neck and intertrochanteric fractures in Thai women.

OBJECTIVE: To study the risk factors associated of femoral neck and intertrochanteric fractures in Thai women. MATERIAL AND METHOD: A case,control study was conducted in Bangkok and its vicinity between 1997 and 1998 to compare factors related to each type of hip fracture in Thai women. Cases, aged > or =51 years old, were diagnosed as intertrochanteric or femoral neck fracture and were matched with controls by age and sex. Multinomial logistic regression was performed for significant associated factors. RESULTS: Recent physical activity and steroid-containing traditional medicine were strongly associated with intertrochanteric fractures (adjusted odds ratio (OR) 0.17 (95% CI: 0.07, 0.42) and 6.50 (95% CI: 1.93, 21.82), respectively) when compared to femoral neck fractures. Cerebrovascular accident (CVA) was more related to femoral neck fractures when compared to intertrochanteric fractures (adjusted OR 8.63 (95% CI: 2.28, 32.66), and 4.79 (95% CI: 1.19, 19.29), respectively). CONCLUSION: Intertrochanteric fracture could be minimized more by encouraging physical activities and avoidance of steroid use while the reduction of femoral neck fracture should be achieved more by CVA prevention.

Prevalence of High-Riding Vertebral Artery and Morphometry of C2 Pedicles Using a Novel Computed Tomography Reconstruction Technique.

STUDY DESIGN: Cross-sectional, matched-pair comparative study. PURPOSE: To determine whether a thin-sliced pedicular-oriented computed tomography (TPCT) scan reconstructed from an existing conventional computed tomography (CCT) scan is more accurate for identifying vertebral artery groove (VAG) anomalies than CCT. OVERVIEW OF LITERATURE: Posterior atlantoaxial transarticular screw fixation and C2 pedicle screws can cause vertebral artery (VA) injury. Two anatomic variations of VAG anomalies are associated with VA injury: a high-riding VA (HRVA) and a narrow pedicle of the C2 vertebra. CCT scan is a reliable method used to evaluate VAG anomalies; however, its accuracy level remains debatable. Literature comparing the prevalence of C2 VAG anomalies between CCT and TPCT is limited. METHODS: A total of 200 computed tomography scans of the upper cervical spine obtained between January 2008 and December 2011 were evaluated for C2 VAG anomalies (HRVA and narrow pedicular width) using CCT and TPCT. The prevalence of C2 VAG anomalies was compared using these two different measurement methods via a McNemar's test. RESULTS: Of the 200 patients studied, 23 HRVA (6.01%; 95% confidence interval [CI], 3.61%-8.39%) were detected with CCT, whereas 66 HRVA (16.54%; 95% CI, 12.85%-20.23%) were detected with TPCT (p<0.001). Sixty-two narrow pedicles (15.58%; 95% CI, 11.99%-19.15%) were detected with CCT, whereas 90 narrow pedicles (22.83%; 95% CI, 18.58%-26.87%) were detected with TPCT (p<0.001). CONCLUSIONS: VAG anomalies are commonly observed. A preoperative evaluation using TPCT reconstructed from an existing CCT revealed a significantly higher prevalence of C2 VAG anomalies than did CCT and showed comparable prevalence to previously published studies using more sophisticated and higher risk techniques. Therefore, we propose TPCT as an alternative preoperative evaluation for C2 screw placement and trajectory planning.

Anatomic Considerations of Intervertebral Disc Perspective in Lumbar Posterolateral Approach via Kambin's Triangle: Cadaveric Study.

STUDY DESIGN: Anatomical study. PURPOSE: To evaluate the anatomy of intervertebral disc (IVD) area in the triangular working zone of the lumbar spine based on cadaveric measurements. OVERVIEW OF LITERATURE: The posterolateral percutaneous approach to the lumbar spine has been widely used as a minimally invasive spinal surgery. However, to our knowledge, the actual perspective of disc boundaries and areas through posterolateral endoscopic approach are not well defined. METHODS: Ninety-six measurements for areas and dimensions of IVD in Kambin's triangle on bilateral sides of L1-S1 in 5 fresh human cadavers were studied. RESULTS: The trapezoidal IVD area (mean±standard deviation) for true working space was 63.65±14.70 mm2 at L1-2, 70.79±21.88 mm2 at L2-3, 99.03±15.83 mm2 at L3-4, 116.22±20.93 mm2 at L4-5, and 92.18±23.63 mm2 at L5-S1. The average dimension of calculated largest ellipsoidal cannula that could be placed in IVD area was 5.83×11.02 mm at L1-2, 6.97×10.78 mm at L2-3, 9.30×10.67 mm at L3-4, 8.84×13.15 mm at L4-5, and 6.61×14.07 mm at L5-S1. CONCLUSIONS: The trapezoidal perspective of working zone of IVD in Kambin's triangle is important and limited. This should be taken into consideration when developing the tools and instruments for posterolateral endoscopic lumbar spine surgery.

Demineralized Bone Matrix Add-On for Acceleration of Bone Healing in Atypical Subtrochanteric Femoral Fracture: A Consecutive Case-Control Study.

BACKGROUND: Delayed union and nonunion are common complications in atypical femoral fractures (AFFs) despite having good fracture fixation. Demineralized bone matrix (DBM) is a successfully proven method for enhancing fracture healing of the long bone fracture and nonunion and should be used in AFFs. This study aimed to compare the outcome after subtrochanteric AFFs (ST-AFFs) fixation with and without DBM. MATERIALS AND METHODS: A prospective study was conducted on 9 ST-AFFs patients using DBM (DBM group) during 2013-2014 and compared with a retrospective consecutive case series of ST-AFFs patients treated without DBM (2010-2012) (NDBM group, 9 patients). All patients were treated with the same standard guideline and followed up until fractures completely united. Postoperative outcomes were then compared. RESULTS: DBM group showed a significant shorter healing time than NDBM group (28.1 ± 14.4 versus 57.9 ± 36.8 weeks, p = 0.04). Delayed union was found in 4 patients (44%) in DBM group compared with 7 patients (78%) in NDBM group (p > 0.05). No statistical difference of nonunion was demonstrated between both groups (DBM = 1 and NDBM = 2, p > 0.05). Neither postoperative infection nor severe local tissue reaction was found. CONCLUSIONS: DBM is safe and effective for accelerating the fracture healing in ST-AFFx and possibly reduces nonunion after fracture fixation. Trial registration number is TCTR20151021001.

Apical derotation in the treatment of idiopathic scoliosis.

STUDY DESIGN: A prospective study of the pedicular screw plate system in the treatment of idiopathic scoliosis. OBJECTIVES: To study the efficacy of apical derotation of pedicular screw plate system in idiopathic scoliosis correction and evaluate the feasibility of the technique. SUMMARY OF BACKGROUND DATA: In the surgical treatment of idiopathic scoliosis, the standard technique of fixation currently utilized the linkage of the pedicle screws via rods. Alternatively the technique of apical correction of the deformity by sagittally contoured plates found to be a convenient and effective mean of deformity correction and rigid fixation. MATERIAL AND METHOD: Twenty-five patients who were diagnosed as idiopathic scoliosis and underwent posterior spinal fusion and fixation with pedicle screws and plates were prospectively analysed. The parameters were compared between preoperative and postoperative by paired t-test. These parameters included Cobb angles, body height, shoulder height difference, coronal trunk balance, hump difference and vertebral rotation. RESULTS: There was statistically significant difference between the pre-op and post-op parameters studied. CONCLUSION: The instrument can effectively correct the scoliosis of moderately severed deformity in 3 dimensions especially regarding the vertebral derotation and restoration of thoracic kyphosis.

Cost analysis of osteoporotic hip fractures.

OBJECTIVE: To assess the total costs of hip fracture treatment subsequently incurred in 1 year MATERIAL AND METHOD: A cohort study was conducted from January 1, 2002 to December 31, 2004. All new osteoporotic hip fracture patients were enrolled with informed consent. A total cost was estimated, and multivariate analysis was performed to determine factors related to costs. RESULTS: A total of 37 patients were included. Average age was 75 +/- 11.8 years. Four of them (11%) died. Median total cost of hip fracture treatment in 1 year was 116,458.6 Baht (range 21,428.5-5,070,665.0). Median direct cost was 59,881.6 Baht (range 21,428.5-595,520.4). Direct cost per live-year saved was 118,168. 3 Baht. Preoperative status was the only factor related to direct cost. CONCLUSION: Cost incurred from hip fracture in 1 year was high. The appropriate solution to prevent hip fracture might bring about good health in the Thai elderly and reduce its cost in the future.