Predicting fracture of the femoral neck

A prediction of the probability of safe loading of the femoral neck, based on queueing theory, is presented. The following methods have been applied: (I) criterion of bone fracture was formulated, taking into consideration the complex state of stress-strain in the porosity zones of the bone; (II) tensile stresses around pores in the stretched zone of the bone were evaluated; (III) the influence of random events of the critical regimes of loading was modeled. The evaluation of the probability of safe loading of bones was obtained based on the levels of the tensile stresses, Young's moduli and ultimate tensile stresses which are affected by the increase in bone porosity and the distribution of the pores. Examples of analysis involving typical mechanical properties of bone in areas of vascular and lacunar-canalicular porosity are demonstrated. The ranges of initial average values of effective Young's moduli and ultimate tensile strengths were taken as 15.8-17.5GPa and 83-95MPa, respectively. The present analysis discovers the existence of three levels of safe loading: (1) a relatively safe level of the nominal tensile stresses (smaller than (2.8-3.2)MPa) where the probability of safe loading is of the order of 0.95 for the bone porosity which is less than 0.15; (2) an intermediate level of safety where the nominal tensile stresses are below (4.2-4.8)MPa and the probability of safe loading is 0.89 or higher, for the same level of bone porosity; (3) a critical level of safe loading where the nominal tensile stresses are about (8.3-9.5)MPa; they lead to sharp drop of probabilities of safe loading to 0.85-0.8 if the porosity is about 0.10 and to probabilities of 0.41-0.4 if the porosity is about 0.15.     

Anatomical factors relative to the racial selectivity of femoral neck fracture

A comparative racial study of 200 femora from 50 American White and 50 American Negro female skeletons was carried out to determine whether any anatomical differences in femoral from exist between these groups which might account for the racial selectivity of hip fracture, Significant racial differences were found in neck-shaft angle, angle of inclination and oblique length. Negro females have longer femora, larger neck-shaft angles and a smaller angle of inclination than have White females. These differences in femoral morphology may, in some measure, contribute to the greater incidence of hip fracture in female Whites.     

Relevance of osteoporosis in women with fracture of the femoral neck.

A prospective study of fractures of the femoral neck was conducted over 12 months in order to ascertain the relevance of generalised osteoporosis as determined by metacarpal morphometry. A series of some 200 women sustaining a fracture of the femoral neck after minor trauma had bone mass measurements similar to those of a control population of normal women, and 16% were not osteoporotic. A history of previous fractures was documented in one third of the women, but this was unrelated to the presence or severity of osteoporosis, although over half of the fractures had occurred within the previous four years. Trochanteric fractures were seen more commonly in severely osteoporotic women (p less than 0.005), whereas cervical fractures predominated in those who were not osteoporotic. These findings support the hypothesis that postural instability is the major determinant for femoral neck fracture and that generalised osteoporosis, rather than being a prerequisite for fracture, merely determines the type of fracture sustained.     

The calm mouse: an animal model of stress reduction

Chronic stress is associated with negative health outcomes and is linked with neuroendocrine changes, deleterious effects on innate and adaptive immunity, and central nervous system neuropathology. Although stress management is commonly advocated clinically, there is insufficient mechanistic understanding of how decreasing stress affects disease pathogenesis. Therefore, we have developed a "calm mouse model" with caging enhancements designed to reduce murine stress. Male BALB/c mice were divided into four groups: control (Cntl), standard caging; calm (Calm), large caging to reduce animal density, a cardboard nest box for shelter, paper nesting material to promote innate nesting behavior, and a polycarbonate tube to mimic tunneling; control exercise (Cntl Ex), standard caging with a running wheel, known to reduce stress; and calm exercise (Calm Ex), calm caging with a running wheel. Calm, Cntl Ex and Calm Ex animals exhibited significantly less corticosterone production than Cntl animals. We also observed changes in spleen mass, and in vitro splenocyte studies demonstrated that Calm Ex animals had innate and adaptive immune responses that were more sensitive to acute handling stress than those in Cntl. Calm animals gained greater body mass than Cntl, although they had similar food intake, and we also observed changes in body composition, using magnetic resonance imaging. Together, our results suggest that the Calm mouse model represents a promising approach to studying the biological effects of stress reduction in the context of health and in conjunction with existing disease models.     

Vitamin C depletion and pressure sores in elderly patients with femoral neck fracture.

OBJECTIVE--To evaluate the contribution of specific nutritional deficiencies (as indicated by zinc; vitamin A, C, and E; albumin; and haemoglobin concentrations) to the risk of pressure sores. DESIGN--Observational cohort study. SETTING--St James''s University Hospital, Leeds. SUBJECTS--21 elderly patients presenting consecutively to the orthopaedic unit with femoral neck fracture. MAIN OUTCOME MEASURE--Full thickness epidermal break over a pressure bearing surface. RESULTS--10 patients (48%) developed a pressure sore during their hospital stay. Indices of zinc status and concentrations of albumin, haemoglobin, and vitamins A and E were similar in patients who developed a pressure sore and those who did not. Mean leucocyte vitamin C concentration, however, was 6.3 (SD 2.2) micrograms/10(8) cells in patients who developed a pressure sore as compared with 12.8 (4.6) micrograms/10(8) cells in patients who did not. CONCLUSIONS--Low concentrations of leucocyte vitamin C appear to be associated with subsequent development of pressure sores in elderly patients with femoral neck fractures.     

Work to fracture of canine femoral bone

The work-to-fracture of canine femoral bone has been measured using the technique of Tattersall and Tappin (1966). The work required to fracture a specimen in three point bending by slow crack propagation through a triangular cross section is obtained from the load-deformation curve. The area of the resulting fracture surface is measured by macrophotographic techniques, and the work-to-fracture is calculated as work per unit area. The values of fracture “toughness” measured in this way ranged from 5.36 × 10³ J/m² to 1.55 × 10⁴ J/m² in the samples tested with a mean of 9.03 × 10³ J/m² and a standard deviation of 3.27 × 10³ J/m². The work-to-fracture was found to vary with transverse variation in location in the femoral shaft. Scanning electron microscope photographs of the fracture surfaces indicate that the nature of the failure is similar to that of fiber reinforced composite materials. Samples which failed by catastrophic crack propagation were characterized by smooth fracture surfaces and had larger osteons than those which failed by slow crack propagation.     

Biomechanical and clinical alterations of the hip joint following femoral neck fracture and implantation of bipolar hip endoprosthesis

The implantation of a bipolar partial hip endoprosthesis is a treatment of choice for displaced medial femoral neck fracture. We present an experimental study which asses and compare biomechanical and clinical status through period before and after hip fracture and implantation of bipolar partial hip endoprosthesis. This study encompassed 75 patients who suffered from an acute medial femoral neck fracture and were treated with the implantation of a bipolar partial hip endoprosthesis. Their biomechanical status (stress distribution on the hip joint weight bearing area) and clinical status (Harris Hip Score) were estimated for the time prior to the injury and assessed at the follow-up examination that was, on average, carried out 40 months after the operation. Despite ageing, the observed Harris Hip Score at the follow-up examination was higher than that estimated prior to the injury (77.9 > 69.6; p = 0.006). Similarly, the hip stress distribution was reduced (2.7 MPa < 2.3 MPa; p = 0.001). While this reduction can be attributed to a loss of weight due to late ageing, the principal improvement came from the operative treatment and corresponding restoration of the biomechanical properties of the hip joint. The implantation of a bipolar partial hip endoprosthesis for patients with displaced medial femoral neck fractures improves the biomechanical and clinical features of the hip, what should have on mind during making decision about treatment.     

Pathological fractures of the femoral neck

In a review of subcapital fractures due to metastases in the femoral neck it was found that in the majority of cases pain in the region of the hip developed a few days prior to fracture. While the majority of subcapital fractures are sustained as the result of a single incident of trauma, in cases with metastases trabecular stress fractures occur in increasing numbers until finally femoral neck fracture occurs. It would seem that once a critical number of trabecular stress fractures has been reached the patient develops pain. Immediate radiologic examination should be performed, and if there is evidence of bone destruction approaching 50% of the cortex, prophylactic hip pinning is strongly indicated.     

p53-dependent glutamine usage determines susceptibility to oxidative stress in radioresistant head and neck cancer cells

The manner in which p53 maintains redox homeostasis and the means by which two key metabolic elements, glucose and glutamine, contribute to p53-dependent redox stability remain unclear. To elucidate the manner in which p53 deals with glucose-deprived, reactive oxygen species (ROS)-prone conditions in this regard, two isogenic cancer subclones (HN3R-A and HN3R-B) bearing distinct p53 mutations as an in vitro model of intratumoral p53 heterogeneity were identified. Following cumulative irradiation, the subclones showed a similar metabolic shift to aerobic glycolysis and increasing NADPH biogenesis for cellular defense against oxidative damage irrespective of p53 status. The radioresistant cancer cells became more sensitive to glycolysis-targeting drugs. However, in glucose-deprived and ROS-prone conditions, HN3R-B, the subclone with the original p53 increased the utilization of glutamine by GLS2, thereby maintaining redox homeostasis and ATP. Conversely, HN3R-A, the p53-deficient radioresistant subclone displayed an impairment in glutamine usage and high susceptibility to metabolic stresses as well as ROS-inducing agents despite the increased ROS scavenging system. Collectively, our findings suggest that p53 governs the alternative utilization of metabolic ingredients, such as glucose and glutamine, in ROS-prone conditions. Thus, p53 status may be an important biomarker for selecting cancer treatment strategies, including metabolic drugs and ROS-inducing agents, for recurrent cancers after radiotherapy.     

Interleukin-6 as possible early marker of stress response after femoral fracture

Toll-like receptor 4 (TLR4) activation is a key contributor to the carcinogenesis of colon cancer. Overexpression of galectin-1 (Gal-1) also correlates with increased invasive activity of colorectal cancer. Lactate production is a critical predictive factor of risk of metastasis, but the functional relationship between intracellular lactate and Gal-1 expression in TLR4-activated colon cancer remains unknown. In this study, we investigated the underlying mechanism and role of Gal-1 in metastasis and invasion of colorectal cancer (CRC) cells after TLR4 stimulation. Exposure to the TLR4 ligand lipopolysaccharide (LPS) increased expression of Gal-1, induced EMT-related cytokines, triggered the activation of glycolysis-related enzymes, and promoted lactate production. Gene silencing of TLR4 and Gal-1 in CRC cells inhibited lactate-mediated epithelial-mesenchymal transition (EMT) after TLR4 stimulation. Gal-1-mediated activation of a disintegrin and metalloproteinase 10 (ADAM10) and ADAM 17 increased the invasion activity and expression of mesenchymal characteristics in LPS-activated CRC cells. Conversely, inhibition of ADAM10 or ADAM17 effectively blocked the generation of lactate and the migration capacity of LPS-treated CRC cells. Thus, the TLR4/Gal-1 signaling pathway regulates lactate-mediated EMT processes through the activation of ADAM10 and ADAM17 in CRC cells.     

Prediction of susceptibility to the porcine stress syndrome

An experiment designed to compare different predictors of porcine stress syndrome (PSS) was conducted. Animals were exposed to the anesthetic gas, halothane, and their reactions monitored to determine susceptibility or resistance to PSS. Two blood creatine phosphokinase (CPK) traits plus their logs10 were examined as predictors of PSS susceptibility. These were Sigma CPK, Antonik CPK, log Sigma CPK, and log Antonik CPK. The accuracy of these predictors varied from 87 percent to 91 percent in agreement with halothane-determined stress susceptibility. In addition, the relationship of PSS and blood types systems (AO,H) were studied. Two blood types, (+,-/-) and (-,+/+), were consistently stress susceptible while three blood types, (+,a/a), (+,a/c), and (+,c/-), were consistently stress resistant. However, one blood type (+,a/-) contained both stress-susceptible and stress-resistant individuals.     

手术内固定对脑梗死后遗症期股骨颈骨折的临床疗效观察

目的观察手术内固定对脑梗死后遗症期股骨颈骨折的临床治疗效果。方法选取我院脑梗死后遗症期发生股骨颈骨折的患者60例,随机分为手术组及对照组各30例,手术组采用闭合复位内固定法治疗,对照组行非手术治疗,治疗2周后,观察比较两组患者的Harris髋关节评分。结果手术组患者的Harris髋关节评分优于对照组,差异具有统计学意义(P0.05)。结论手术内固定法治疗脑梗死后遗症期股骨颈骨折的效果满意,有利促进患者恢复。