Bone quality and the conditions that affect it make up a large field of study. One specific area of interest is the loss in bone strength during exposure to microgravity. The femoral neck (FN) region in particular is an important region of study since a FN failure has such a detrimental effect on mobility. The objective of this study was to characterize the effects of microgravity and recovery on the FN in the adult male hindlimb unloaded (HU) rat model. This was done through peripheral quantitative computed tomography (pQCT), mechanical testing in two different loading conditions, and estimated strength indices. Adult male Sprague-Dawley rats (6-mo) were grouped into baseline (BL), ambulatory cage control (CC) and hindlimb unloaded (HU); HU and CC animals were further divided into sub-groups (n=15 each): HU euthanized after 28 days of suspension, and HU euthanized after 28, 56, and 84 days of recovery with CC groups being euthanized at each of these time points. The excised right and left femoral necks were both scanned ex vivo using pQCT. Quasi-static mechanical testing was performed with the right femurs positioned vertically and the left femurs positioned laterally at a -10 degree angle. A series of strength indices was used to attempt to predict the mechanical testing results, including a compression index, a bending index and an alternative combination of the two. HU exposure led to 6.3 percent lower bone mineral content (BMC), compared to BL and 7.8 percent lower total volumetric bone mineral density (vBMD) at the FN. The vertical or axial loading showed a 17.1 percent drop in mechanical strength due to HU exposure. The lateral loading test revealed a 5.4 percent drop in strength, showing that HU had a greater effect on the axial loading configuration. Also, after just 28 days of recovery, the axial loading test revealed a complete recovery of strength. None of the strength indexes completely predicted the mechanical behavior of the FN. In the right femur, the combined index had the highest correlation with an R value of 0.94. The bending strength index had the highest correlation in the left lateral testing with an R value of 0.98. However, in all the cases, the strength indexes failed to predict the mechanical behavior at all the time points. In general, the strength indexes provide valuable input, but fail to replace mechanical testing.

Diss. (sammanfattning) Stockholm : Karol. inst., 2002. / Härtill 6 uppsatser.

Thesis (Ph. D.)--University of Washington, 1999. / Vita. Includes bibliographical references (leaves 42-48).

Em razão da complexidade da osteossíntese nas regiões de colo e cabeça femorais, aliado à dificuldade da boa redução e fixação da fratura, objetivou-se estudar comparativamente os efeitos das cargas com forças axiais nos conjuntos osso-parafuso convencional e osso-parafuso canulado. O parafuso canulado possui eficiente capacidade compressiva e por possuir uma cânula central é capaz de simplificar a técnica cirúrgica se comparado aos parafusos ósseos convencionais. Foram utilizados dois parafusos dispostos paralelamente, inseridos da porção lateral do fêmur, abaixo do trocânter maior, em direção à cabeça femoral em 14 fêmures de cães acima de 20 kilos de peso, subdivididos em 2 grupos de 7 fêmures com parafusos convencionais e 7 fêmures com parafusos canulados , sem sinais macroscópicos ou radiográficos de moléstias ósseas. Os resultados obtidos mostraram que não houve diferenças estatísticas na força máxima e na rigidez nos dois grupos, e em todos os ensaios, os implantes não sofreram deformação, portanto conclui-se que as resistências dos parafusos convencional e canulado, utilizados na osteossíntese de fraturas de cabeça e colo de fêmur, são semelhantes. / Because of the complexity of osteosynthesis of femoral head and neck fractures and the difficulty of good reduction and fixation of the fractures, we studied comparatively the effects of load and axial forces of bone-conventional screws and bone-cannulated screws. The cannulated screw presents efficient compressive capacity and it presents a central cannula capable of simplifying the surgical technique if compared to conventional bone screws. We used two screws placed parallel, inserted in the lateral aspect of the femur, beneath the greater trocanter, directed to the femoral head, in fourteen femurs of dogs over 20Kg, subdivided in two groups of seven femurs each, the first with conventional screws and the second with cannulated screws, with no macroscopic or radiographic signs of bone diseases. The results didn´t show any statistical differences in maximum strength and rigidity of both groups and the implants didn´t suffer deformities in any essays, therefore we conclude that the resistances of conventional and cannulated screws, used in of femoral heads and necks fracture repairs, are similar.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2009.

Pacientų, patyrusių šlaunikaulio kaklo lūžius, gydymas – aktuali senstančios visuomenės problema, todėl literatūroje gausu publikacijų, analizuojančių įvairius šios patologijos gydymo aspektus. Analizuojant literatūros duomenis pastebima, kad nėra išskiriamas laikas nuo traumos iki patekimo į ligoninę, o laikas pradedamas skaičiuoti tik nuo tada, kada pacientas jau paguldytas į ligoninę. Šis veiksnys gali turėti reikšmingos įtakos galutiniams gydymo rezultatams, nes laikotarpio nuo traumos iki patekimo į ligoninę trukmė gali labai svyruoti tarp įvairių pacientų grupių. Todėl buvo tikslinga atlikti tyrimą, kuriame būtų įvertintas būtent šis laikotarpis ir nustatyta jo reikšmė pacientų mirštamumui ir funkciniams gydymo rezultatams. Savo darbe tyrėme veiksnius, įtakojančius šlaunikaulio kaklo lūžius patyrusių pacientų mirštamumą ir funkcinius gydymo rezultatus. / Treatment of patients with femoral neck fractures is an important issue in an ageing population; therefore, in the scientific literature, there are a lot of publications analysing various aspects of management of this pathology. However, while analysing the literature data, it was noted that the time from trauma to hospital admission is not taken into account, and the time is being counted just from that moment, when a patient is already hospitalised. This factor may have a great influence on treatment outcome because the time from trauma to hospital admission can vary significantly among different patient’s groups. Therefore, it was purposeful to carry out a study where exactly this period would be evaluated and its influence on patients’ mortality and functional outcome would be determined.

Acute confusional state (ACS) or delirium according to DSM-III-R holds a central position in the medicine of old age. ACS is a common and sometimes the only symptom of diseases and medical complications in the elderly patient. The aim of this study was to elucidate ACS in patients with femoral neck fractures and patients with acute stroke with regard to frequency, predictors, possible pathogenetic mechanisms, associated complications, assessment and documentary routines and the clinical outcome for the patients. An intervention program to prevent postoperative ACS based on our results was developed and evaluated. The main findings of the study were high frequencies of ACS in elderly patients with femoral neck fractures (61 %) and in patients with acute stroke (48 %). The main risk factors for ACS in patients with femoral neck fractures were old age, diseases and drug treatment interfering with cerebral cholinergic metabolism. There was no link between anaesthetic technique and ACS but the connection between peroperative hypotension, early postoperative hypoxia and ACS was close. In stroke patients the degree of extremity paresis and old age were independent ACS risk factors. ACS was commonly associated with post stroke complications such as myocardial infarction, pneumonia, urinary infection and urinary retention. In stroke patients there was a close connection between high hypothalamic-pituitary-adrenal axis (HPA-axis) activity and ACS. High HPA-axis activity and disturbances in the cerebral cholinergic system may be two important ACS mechanisms. A correct diagnosis is a prerequisite for proper treatment of ACS and its underlying causes. In the orthopaedic wards both physicians and nurses diagnosed and documented ACS poorly and therefore associated complications were insufficiently treated. The intervention program for postoperative ACS, aimed mainly at protecting the cerebral oxidative metabolism and thereby the cerebral cholinergic metabolism which is especially sensitive to hypoxia. Postoperative complications associated with ACS were also treated. The intervention resulted in reduced frequency, duration and severity of postoperative ACS and in shorter orthopedic ward stay for patients with femoral neck fractures.Key words: Acute confusional state, delirium, elderly / <p>S. 1-76: sammanfattning, s. 77-175: 6 uppsatser</p> / digitalisering@umu

Delirium is probably the most common presenting symptom of disease in old age. Delirium, as defined in DSM-IV, is a neuropsychiatric syndrome characterized by disturbance in attention and consciousness, which develops over a short period of time and where the symptoms tend to fluctuate during the course of the day. The overall aim was to increase knowledge about the risk factors and outcome of delirium in old patients with femoral neck fracture and to develop and evaluate a multi-factorial intervention program for prevention and treatment of delirium in these patients. In a prospective study of 101 consecutive patients with a femoral neck fracture, 29.7% were delirious before surgery and another 18.8% developed delirium postoperatively. Of those who were delirious preoperatively all but one remained delirious postoperatively. The majority of those delirious before surgery were demented, treated with drugs with anticholinergic properties (mainly neuroleptics), had had previous episodes of delirium and had fallen indoors. Patients who developed postoperative delirium had perioperative falls in blood pressure and seemed to have more postoperative complications, such as infections. Patients with preoperative delirium had a poorer walking ability on discharge compared to patients with postoperative delirium only. In a five-year prospective follow up study 30 out of 78 (38.5%) non-demented patients with a femoral neck fracture developed dementia. Twenty out of 29 (69%) who were delirious postoperatively developed dementia compared to 10 out of 49 (20%) who were not delirious during hospitalization (p&lt;0.001). Twenty-one (72.4%) of those with postoperative delirium died within 5 years compared to 17/49 (34.7%) of those who remained lucid postoperatively (p=0.001). A non-randomized multi-factorial intervention study with the aim of preventing and treating delirium among patients with femoral neck fracture (n=49) showed that the incidence of delirium was significantly lower than reported in previously published studies. The incidence of other postoperative complications was also lower and a larger proportion of the patients regained independent walking ability and could return to their previous living conditions on discharge. A similar multi-factorial intervention program evaluated as a randomized controlled trial including 199 femoral neck fracture patients showed that fewer intervention patients than controls suffered postoperative delirium (56/102, 55% vs. 73/97, 75%, p=0.003). For intervention patients the postoperative delirium was also of shorter duration (5.0±7.1 days vs. 10.2±13.3 days, p=0.009). Eighteen percent in the intervention ward and 52% of controls were delirious after the seventh postoperative day (p&lt;0.001). Intervention patients suffered from significantly fewer in-hospital complications, such as decubital ulcers, urinary tract infections, nutritional complications, sleeping problems and falls, than controls. Total postoperative hospitalization was shorter in the intervention ward (28.0±17.9 days vs. 38.0±40.6 days, p=0.028). In conclusion, pre- and postoperative delirium is common and seems to be associated with various risk factors, which require different strategies for prevention and treatment. Delirium is also associated with the development of dementia and a higher mortality rate. Multifactorial intervention programs can successfully be implemented and result in the reduction of delirium, fewer complications and shorter hospitalization.

Ziel der vorliegenden Arbeit war es, retrospektiv die Ergebnisse der bei medialer Schenkelhalsfraktur mittels 3-fach Verschraubung osteosynthetisch versorgten Patienten zu ermitteln und die Ergebnisse im aktuellen Kontext im Vergleich zu den Ergebnissen anderer Studien darzustellen. Aufgrund der zunehmenden sozioökonomischen Bedeutung der Therapie der medialen Schenkelhalsfraktur ist es im Prozess des Findens einer optimalen Versorgung der betroffenen Patienten erforderlich, die aktuell angewandten Therapieverfahren klinischen Studien zu unterziehen, um für künftige Patienten eine fundierte Entscheidung für das entsprechende Therapieverfahren treffen zu können. Die retrospektive Arbeit bezog sich auf 86 Patienten, welche auf Grund einer medialen Schenkelhalsfraktur durch 3-fach Verschraubung versorgt worden sind. Es wurden entscheidende präoperative Daten, wie der präoperative Zustand des Patienten, deren Alter, Geschlecht, Frakturklassifikation und die Zeit zwischen Aufnahme in der Unfallambulanz und Operation erfasst. Zusätzlich wurden postoperative Daten zu Komplikationen erhoben und Langzeitergebnisse im Rahmen einer klinischen Nachuntersuchung erfasst. Bei einem Frauenanteil von 63% hatte das Patientenkollektiv ein Durchschnittsalter von 73 Jahren. Zum Zeitpunkt der Nachuntersuchung waren 38,4% der Patienten verstorben. Insgesamt kam es bei 10,5% der Patienten zu einer Redislokation, wobei der Anteil der Redislokationen bei den Patienten mit einer dislozierten Fraktur 26% und bei den Patienten mit einer nicht dislozierten Fraktur 3,4% betrug. Im Patientenkollektiv entwickelten 4,7% der Patienten eine Pseudarthrose und bei 5,8% der Patienten konnte die Entstehung einer Hüftkopfnekrose beobachtet werden. Bei den 24 nachuntersuchten Patienten konnte ein durchschnittlicher Harris Hip Score von 89,5 Punkten ermittelt werden.

Diss. (sammanfattning) Umeå : Univ. / Härtill 4 uppsatser.