In a 3-year prospective randomized trial, the prognostic value of osteoporosis in terms of predicting healing complications due to implant failures or loss of fracture reduction has been studied in 113 patients with inter-trochanteric hip fractures treated with either a sliding screwplate or Ender nailing. According to the Barnet and Nordin's osteoporosis index, 66 patients were considered to have moderate or severe osteoporosis. There were no differences between patients with or without osteoporosis as regards the number of fractures with collapse in varus > 10 degrees, redislocation > 10 mm, or compression exceeding 10 mm. Six months after surgery, 48 patients failed in healing or healed with complications. These cases disclosed increased osteoporosis in comparison with those showing noncomplicated healing. Patients with osteoporosis who had unstable fractures treated by Ender nailing were found to have the worst prognosis for healing complications (p = 0.006). Of the 33 fractures with implant failures, 25 (76%) occurred in patients with osteoporosis (p = 0.04). In patients with osteoporosis, the frequency of mechanical failures was significantly higher in fractures with the device positioned incorrectly. Independently of the device used, patients with unstable trochanteric hip fractures and osteoporotic bone were the group with the highest risk for failures of the implant.

The outcome of 150 patients with herniated lumbar disc treated by either microsurgical or standard discectomy were retrospectively reviewed after an average of 3 years. Both techniques provided satisfactory results, with 85 percent good or excellent outcome. Microsurgery gave less intraoperative bleeding, shorter hospitalization, and more rapid return to work. The main drawback was a higher recurrence rate of disc prolapse.

A prospective evaluation of cardiopulmonary tolerance to maximal exercise in adolescent idiopathic scoliosis. To evaluate ventilatory functional restrictions during a maximal exercise tolerance test in idiopathic scoliosis patients with mild and moderate curves and to compare them with the results obtained in healthy adolescents matched in age undergoing similar test. Adolescents with idiopathic scoliosis with mild curves do not exhibit significant restrictions in ventilatory parameters measured by conventional static spirometry. Few reports have dealt with cardiorespiratory response to maximal exercise in adolescent idiopathic scoliosis with mild to moderate curves. Although results seem to show a reduced exercise tolerance in these patients, the frequency and signification of the restricted work capacity is uncertain because of important design limitations in previous studies. Thirty-seven girls diagnosed with adolescent idiopathic scoliosis with a mean age of 13 years (range, 11-16) and an average scoliotic curve of 32.8 degrees Cobb (range, 20-45 degrees) were studied by basal spirometry and dynamic ventilatory parameters during a maximal exercise tolerance test. Similar studies were performed in a control group of 10 healthy girls matched in age. Exercise test consisted of a ramp protocol on treadmill starting at a speed of 0.75 m/second (2.7 km/hour) with increments of 0.2 m/second (0.72 km/hour) per minute. All subjects completed the test to exhaustion to determine maximal oxygen uptake (VO2 max) and ventilatory efficiency parameters. There were no differences between scoliotic and healthy girls in basal ventilatory parameters (FVC, FEV1). However, adolescents with idiopathic scoliosis showed worse tolerance to exercise test with lower maximal speed average (9.4 km/hour versus 11.5 km/hour, P < 0.005), lower ventilatory efficiency at maximal exercise (VE: 68.9 L/minute versus 82.3 L/minute, P < 0.01), early anaerobic threshold, and a lower aerobic power expressed by 23% decreased body weight normalized VO2 max (38.6 mL/kg/minute versus 49.0 mL/kg/minute, P < 0.001). VEmax values were correlated to the severity of the scoliotic curve. Patients with more severe curves had greater limitation of ventilatory capacity (r = -0.374, P < 0.05). Maximal breath frequency was higher in scoliotic girls (54 versus 47, P < 0.05) suggesting a compensatory mechanism adopted in response to the lower ventilatory capacity during demanding exercise. When ventilatory efficiency was considered by the VE/VO2 ratio, scoliotic girls disclosed higher values than control (average 35.2 versus 29.6, P < 0.001) indicating an inefficiency in their ventilation. Patients wearing a brace at the time of ventilatory functional assessment did not exhibit any difference in the parameters investigated both at basal spirometry and during exercise tolerance test. Although patients with mild or moderate scoliosis do not exhibit cardiopulmonary restrictions in basal static conditions, they do show a significant lower tolerance to maximal exercise. Respiratory inefficiency together with lower ventilation capacity and lower VO2 max may be responsible for reduced exercise tolerance in adolescents with idiopathic scoliosis. Exercise deconditioning in scoliotic patients cannot be attributed to brace treatment.

All traumatic and overuse injuries occurring during an average period of 4 years (2002/09) in a group of 51 currently active road top-level cyclists were retrospectively registered through clinical interviews. Average age was 25.8 years. Average training and competition period was 28.3 ± 2.4 h a week. Only 8 cyclists (15.6%) were completely free from lesions during the period of study. The remaining 43 cyclists suffered a total of 112 lesions; however, 9 out of these were unrelated to their cycling practice. These 103 cycling-related injuries include 50 (48.5%) traumatic and 53 (51.5%) overuse injuries. Twenty-eight fractures were reported, the clavicle being the most frequently affected bone (11 cases). The 68.5% of overuse injuries were located in the lower limbs. Most overuse injuries (89.6%) occurred during the training period. According to the Injury Abbreviated Scale (AIS), severe lesions were only found in 4 cases (8% of traumatic injuries). Overall injury rates were 0.50 per racer/year, 2.02 per studied racer, and 0.007 per 1,000 km of training and competition. Active professional top-level cyclists are exposed to a high injury risk. According to the scarce previously published data the current study provides relevant information on the injury occurrence of still active top-level road cycling.

Different anatomic parameters were measured on radiographs of the healthy hip of 47 patients with unilateral slipped capital femoral epiphysis (SCFE). Data were compared with those from 36 hips of 23 healthy adolescents matched in age, weight, and stature. During 5 years of follow-up, eight patients with unilateral SCFE developed slippage of the contralateral side. Patients with unilateral SCFE had a lower physis-diaphysis angle and a larger angle of physeal sloping in the AP view than controls, reflecting a more vertical orientation of the capital femoral physis. In the axial view, control patients had a mean value of the posterior sloping angle of the capital femoral physis of 5 degrees, compared with 12 degrees in unilateral SCFE cases and 18 degrees in patients developing bilateral SCFE. The risk of developing bilateral disease can be predicted by measuring hip morphometric parameters, the most important factor being the posterior sloping of capital femoral physis in the axial view. Prophylactic pinning of the healthy contralateral side should be strongly recommend only in patients with unilateral SCFE showing an axial posterior sloping angle of the physis of over 12 degrees.

A consecutive series of 34 patients with femoral neck fractures was included in a prospective study aimed at evaluating preoperative variations in intracapsular pressure after changes in hip position, hip traction, and aspiration of hemarthrosis and their influence on the development of femoral head necrosis. Patients were observed for 7 years after surgery. Before aspiration, the mean intracapsular pressure in the antalgic physiologic position was 44.4 mm Hg. There were no differences between displaced and undisplaced fractures. The pressure was a maximum (mean value, 124.8 mm Hg) with the hip in extension and inward rotation, this pressure being greater than the blood systolic pressure in most cases. Hip traction of 3 kg in the antalgic physiologic position was found to be highly effective in preventing any bone flow tamponade effect in displaced and undisplaced femoral neck fractures: the mean intracapsular pressure decreased to 28.5 mm Hg. Aspiration of the hemarthrosis induced a significant decrease in intracapsular pressure only in cases with impaired vascularity of the femoral head as measured by scintigraphy using 99mTc labeled methyldiphosphonate. Aspiration of the hemarthrosis therefore is indicated only in the above cases, although it is less effective than hip traction in the antalgic position. There was no significant correlation between intracapsular pressure and the scintigraphy ratio. Avascular necrosis of the femoral head was detected in six cases. Among these, five patients had an intracapsular pressure below their diastolic blood pressure. This could indicate that vascular damage related to the fracture could be an important cause of bone necrosis despite that blood supply can be decreased by a tamponade effect.