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Ho, Michelle, B. David Horn, Ines C. Lin, Benjamin Chang, Robert B. Carrigan e Apurva Shah. "Musculoskeletal Injuries Resulting from Use of Hoverboards: Safety Concerns With an Unregulated Consumer Product". Clinical Pediatrics 57, n. 1 (22 gennaio 2017): 31–35. http://dx.doi.org/10.1177/0009922816687327.
Testo completoAbstract (sommario):
Hoverboards were recently introduced to the US consumer market and experienced rapid popularity. Given the high frequency of musculoskeletal injury with other wheeled recreation devices, we sought to analyze hoverboard injuries in children. A retrospective review of patients with musculoskeletal injury related to hoverboard use was performed at a tertiary care children’s hospital. From November 2015 to January 2016, 2.3% of all fractures were related to hoverboards. Common injury mechanisms were fall (79%) and finger entrapment between wheel and wheel-well (10%). The most frequently fractured sites included the distal radius (43%) and phalanx (17%). Common surgical procedures were nailbed repair and pinning for Seymour fracture and percutaneous pinning for distal radius fracture. There exists high risk for distal radius fractures from falls and phalanx fractures from finger entrapment between the wheel and wheel-well. Hoverboard safety can be improved with regular use of wrist guards and improved wheel-well design.
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Krauss, Margot R., Nadia U. Garvin, Michael R. Boivin e David N. Cowan. "Excess Stress Fractures, Musculoskeletal Injuries, and Health Care Utilization Among Unfit and Overweight Female Army Trainees". American Journal of Sports Medicine 45, n. 2 (25 novembre 2016): 311–16. http://dx.doi.org/10.1177/0363546516675862.
Testo completoAbstract (sommario):
Background: Musculoskeletal injuries are prevalent among military trainees and certain occupations. Fitness and body mass index (BMI) have been associated with musculoskeletal conditions, including stress fractures. Hypothesis: The incidence of, and excess health care utilization for, stress fracture and non–stress fracture overuse musculoskeletal injuries during the first 6 months of service is higher among unfit female recruits. Those who exceeded body fat limits are at a greater risk of incident stress fractures, injuries, or health care utilization compared with weight-qualified recruits. Study Design: Cohort study; Level of evidence, 3. Methods: All applicants to the United States Army were required to take a preaccession fitness test during the study period (February 2005–September 2006). The test included a 5-minute step test scored as pass or fail. BMI was recorded at application. There were 2 distinct comparisons made in this study: (1) between weight-qualified physically fit and unfit women and (2) between weight-qualified physically fit women and those who exceeded body fat limits. We compared the incidence of, and excess health care utilization for, musculoskeletal injuries, including stress fractures and physical therapy visits, during the first 183 days of military service. Results: Among the weight-qualified women, unfit participants had a higher non–stress fracture injury incidence and related excess health care utilization rate compared with fit women, with rate ratios of 1.32 (95% CI, 1.14-1.53) and 1.18 (95% CI, 1.10-1.27), respectively. Among fit women, compared with the weight-qualified participants, those exceeding body fat limits had higher rate ratios for non–stress fracture injury incidence and related excess health care utilization of 1.27 (95% CI, 1.07-1.50) and 1.20 (95% CI, 1.11-1.31), respectively. Weight-qualified women who were unfit had a higher incidence of stress fractures and related excess health care utilization compared with fit women, with rate ratios of 1.62 (95% CI, 1.19-2.21) and 1.22 (95% CI, 1.10-1.36), respectively. Among fit women exceeding body fat limits, the stress fracture incidence and related excess health care utilization rate ratios were 0.79 (95% CI, 0.49-1.28) and 1.44 (95% CI, 1.20-1.72), respectively, compared with those who were weight qualified. Conclusion: The results indicate a significantly increased risk of musculoskeletal injuries, including stress fractures, among unfit recruits and an increased risk of non–stress fracture musculoskeletal injuries among recruits who exceeded body fat limits. Once injured, female recruits who were weight qualified but unfit and those who were fit but exceeded body fat limits had increased health care utilization. These findings may have implications for military accession and training policies as downsizing of military services will make it more important than ever to optimize the health and performance of individual service members.
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Fatimah, Ayu Dinda. "Manajemen anestesi pada fraktur multiple os femur dan os tibia: Sebuah laporan kasus". SEHATI: Jurnal Kesehatan 2, n. 1 (28 febbraio 2022): 1–6. http://dx.doi.org/10.52364/sehati.v2i1.13.
Testo completoAbstract (sommario):
Fracture is a break in the continuity of bone, joint bone, epiphyseal cartilage, which is total or partial. Currently musculoskeletal disease has become a problem that is often found in health care centers around the world. Overall incidence of fractures was 11.3 in 1,000 per year, in males was 11.67 in 1000 per year, whereas in 10.65 in 1,000 women per year. The classic symptom is a history of trauma fracture, pain and swelling in the broken bones, deformity, musculoskeletal dysfunction, breaking the continuity of the bone, and neurovascular disorders. Principles of fracture treatment is to restore the position of the fracture to its original position (reposition) and held that position during the healing of fractures (immobilization). Special in open fractures, must be considered the danger of infection, either general or local infection. Mr. A 30 years old came with complaints of difficulty moving his left leg after a traffic accident 3 months ago and was taken to a sangkal putung but it didn't heal so he was taken to the hospital and got multiple fractures of the tibia and femur. The patient underwent surgery with the ORIF procedure under general anesthesia. Preoperative, intraoperative, and postoperative management needs to be done correctly and completely to support the success of the operation.
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Burton, Anya, Sarah Drew, Bilkish Cassim, Landing M. Jarjou, Rachael Gooberman-Hill, Sian Noble, Nyashadzaishe Mafirakureva et al. "Fractures in sub-Saharan Africa: epidemiology, economic impact and ethnography (Fractures-E3): study protocol". Wellcome Open Research 8 (21 giugno 2023): 261. http://dx.doi.org/10.12688/wellcomeopenres.19391.1.
Testo completoAbstract (sommario):
Background: The population of older adults is growing in sub-Saharan Africa. Ageing exponentially increases fragility fracture risk. Of all global regions, Africa is projected to observe the greatest increase in fragility fractures. Fractures cause pain, disability and sometimes death, and management is expensive, often requiring complex healthcare delivery. For countries to plan future healthcare services, understanding is needed of fracture epidemiology, associated health service costs and the currently available healthcare resources. Methods: The Fractures-E3 5-year mixed-methods research programme will investigate the epidemiology, economic impact, and treatment provision for fracture and wider musculoskeletal health in The Gambia, South Africa and Zimbabwe. These three countries are diverse in their geography, degree of urbanisation, maturity of health service infrastructure, and health profiles. The programme comprises five study types: (i) population-based cross-sectional studies to determine vertebral fracture prevalence. Secondary outcomes will include osteoarthritis and sarcopenia. Age- and sex-stratified household sampling will recruit 5030 adults aged 40 years and older; (ii) prospective cohort studies in adults aged 40 years and older will determine hip fracture incidence, associated risk factors, and outcomes over one year (e.g. mortality, disability, health-related quality of life); (iii) economic studies of direct health costs of hip fracture with projection modelling of future national health costs and cost-effectiveness analyses of different hip fracture care pathways; (iv) national surveys of hip fracture services (including traditional bonesetters in The Gambia); and (v) ethnographic studies of hip fracture care provision and experiences will understand fracture service pathways. Conclusions: Greater understanding of current and expected fracture burdens, fracture risk factors, and existing fracture care provision, is intended to inform national clinical guidelines, health service policy and planning and future health service development in sub-Saharan Africa.
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Mugabe, Herbert, Zorica Terzić-Šupić e Marko Bumbaširević. "Visual impairment and falls as risk factors of orthopaedic fractures". Medicinski podmladak 74, n. 2 (2023): 18–23. http://dx.doi.org/10.5937/mp74-38985.
Testo completoAbstract (sommario):
The musculoskeletal system represents one of the most affected systems in general traumatology. Fractures of the locomotor system and their effects are among the most severe and demanding injuries for the community in general and for the health system in particular. There are different factors that have been established as risk factors for fractures, with falls representing the main cause. Given the fact that vision has a key role in preserving gait and balance, various conditions of visual impairments have been related to an increase in fall-related injuries, and fractures of the locomotor system, especially in older population. Indeed, with an increased life expectancy, there is a rise in the number of visually impaired individuals and subsequently a rise in the number of falls and fractures. In this study, a review of the incidence and risk factors of musculoskeletal system fractures and falls was conducted, with the incidence of visual impairments in the general population. Another review of different types of visual impairments was done that included potential risk factors for fractures, falls and soft tissue injuries of the hand and if there has been any association between these specific visual impairments and the risk of falling, getting a fracture or a soft tissue injury of the hand.
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Khan, Abdul Rahman, Aziz Ullah, Muhammad Shuaib Chandio, Zulfiqar Ali Jatoi, Sajjad Hussain Bhatti, Sartaj Lakhani e Niaz Hussain Keerio. "Causes and Treatment of Birth Trauma-Related Femoral Fracture: A Longitudinal Study". Pakistan Journal of Medical and Health Sciences 16, n. 8 (31 agosto 2022): 642–43. http://dx.doi.org/10.53350/pjmhs22168642.
Testo completoAbstract (sommario):
Aim: To determine the causes and treatment of birth trauma related femoral fractures. Study design: A longitudinal study Place and Duration: This study was conducted at DIMC, Dow University of Health Sciences, Karachi from January2021 to January 2022. Methodology:The study included cases of femoral fractures in neonates caused by birth trauma. The cases of birth histories were investigated in terms of gestational age, birth weight,and mode of delivery. The category of femoral fracturesand the treatment performed were both noted. Cases were followed until they were recovered.A comprehensive clinical examination was performed. Other birth traumas, fractures, nerve palsies, and/or symptoms of other musculoskeletal, genetic diseases, such as blue sclera and hypermobile joints (osteogenesis imperfecta), were noted. Results:A total of 15 newborns with femoral fractures were included in this study.The average gestational age was 38.2 weeks, with an average diagnosis time of 3 days. In the majority of cases, the infant was born breech and delivered via Caesarean section. Eleven instances had mid-shaft fractures, while four had subtrochanteric fractures. After an average of 3.1 weeks, all patients had a complete union. Conclusion:A femoral fracture in a neonate due to birth related trauma is quite uncommon. It occurs more frequently in Caesarean sections performed for breech presentation. Preterm and/or low birth weight newborns are at a higher risk. The femur shaft is commonly fractured. The prognosis for these fractures is excellent, and they heal completely after immobilization. Keywords: Birth Trauma, Femoral Fracture, Management, Risk Factors
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Vikramaditya, Rai, Qureshi G Aniqa, Chimnani Morisha, Syed Wajiha e Ruddock-Scott A Zalika. "Musculoskeletal Complications Associated with Vitamin D Deficiency and Review of Current Interventions". International Journal of Current Research and Review 14, n. 22 (2022): 10–15. http://dx.doi.org/10.31782/ijcrr.2022.142201.
Testo completoAbstract (sommario):
Hypovitaminosis D is commonly prevalent in older populations the world over leading to increased levels of bone resorption, and reduced bone mass, often resulting in osteoporosis and increased chances of falls and fractures. In children, vitamin D deficiency is known to cause rickets due to the hypomineralization of bone. PubMed, EMBASE, Cochrane Library, and Google Scholar databases were searched from database inception until May 20, 2022. Searches were performed between January 2022 and May 2022. We studied whether daily vitamin D supplementation with or without calcium improves bone mineral density (BMD) and bone architecture. Supplementation with vitamin D for 3 to 5 years minimally decreased total fracture incidence, but the findings were not precise. Supplementation of vitamin D with calcium for 3 to 5 years had no significant effect on total fracture incidence or hip fracture incidence in men and women. Pediatric vitamin D status is associated with the avoidance of rickets. Observational studies point to at least 10µg/day of vitamin D supplementation for attaining optimum bone health in children, but the results of RCTs have been unclear. However, despite 10 RCTs reported on adolescent girls, the definitive amount of vitamin D supplementation and its association with optimal bone mineralization remains ambiguous, and not much is known regarding the needs of male children. The available evidence from completed RCT studies provided only limited or no support for the effect of vitamin D alone on the prevention of fracture. However, vitamin D supplementation combined with calcium seemed to slightly reduce the likelihood of fractures. Before recommending the use of vitamin D alone or in conjunction with calcium for the prevention of fractures in high-risk individuals, RCTs evaluating the effects of daily doses of vitamin D on fracture risk are required.
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Walker, Jennie. "Osteoporosis: prevention and management". Nursing and Residential Care 25, n. 3 (2 marzo 2023): 1–7. http://dx.doi.org/10.12968/nrec.2020.0015.
Testo completoAbstract (sommario):
Osteoporosis is a common skeletal condition that is characterised by low bone mass, increased bone fragility and an increased risk of fracture. It is important to understand who may be at risk of developing osteoporosis and sustaining fragility fractures so that appropriate steps can be taken to minimise any modifiable risk factors. Simple lifestyle changes, such as increasing physical activity, stopping smoking and ensuring adequate nutritional intake, can improve musculoskeletal health and reduce fracture risk.
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Adami, G., A. Fassio, C. Benini, O. Viapiana, D. Gatti, D. Bertelle e M. Rossini. "POS0388 IMPACT OF GLUCOCORTICOIDS AND ANTI-OSTEOPOROTIC TREATMENT ON BONE HEALTH IN PATIENTS WITH INFLAMMATORY RHEUMATIC MUSCULOSKELETAL DISEASES (IRMD): A LONGITUDINAL STUDY". Annals of the Rheumatic Diseases 82, Suppl 1 (30 maggio 2023): 448.2–449. http://dx.doi.org/10.1136/annrheumdis-2023-eular.949.
Testo completoAbstract (sommario):
BackgroundThe negative effects of glucocorticoids (GCs) on the bone depend on dose and treatment duration. However, it is unclear whether a safe dose exists, especially for patients with inflammatory rheumatic musculoskeletal diseases (iRMDs).ObjectivesThe primary objective of the present study was to determine, in a real-life setting, the risk of fragility fracture associated with the dose of glucocorticoids in iRMD.MethodsWe conducted a longitudinal cohort study on women with iRMD. Data were extracted from the DeFRA database (2012-2020). DeFRA is a fracture risk assessment tool similar to FRAX. Bone mineral density and fractures were assessed prospectively and compared to a matched cohort (propensity score matching, PSM with age, T-score and the % 10-year fracture risk estimated with DeFRA fracture risk assessment tool). Kaplan-Meier curves with log-rank test were made for iRMD (stratified for glucocorticoid use and dosage) and matched cohort respectively.Results884 women with iRMD and 1,766 controls (age, T-score, and 10-year fracture risk matched) were included in the study and followed for up to 6 years. BMD levels decreased significantly in all GCs users not receiving anti-osteoporosis treatment (-4.26% p 0.0011, -4.23% p 0.0422, -2.66% p 0.0006 for ≥5 mg/day, 2.5 mg to 5 mg and 0 to 2.5 mg/day of prednisolone, respectively). As regards patients receiving anti-osteoporosis medications, BMD levels decreased significantly only in patients receiving ≥5 mg/day of pred eq (-3.01%, p 0.0012), whereas in patients receiving 2.5 mg to 5 mg and 0 to 2.5 mg/day, concomitantly treated with anti-osteoporotic drugs, BMD did not decrease significantly (+3.10% p NS, +1.12% p NS, respectively).figure 1A. Fracture incidence was greater in patients with iRMD compared to controls but only GC doses above 5 mg/day were associated with significantly higher risk of fracturefigure 1B. 21, 12 and 29 fractures were reported for patients receiving ≥5 mg/day, 2.5 mg to 5 mg and 0 to 2.5 mg/day respectively, corresponding to a crude fracture rate of 4.8 fractures per 100 person-year, 2.8 fractures per 100 person-year and 2.5 fractures per 100 person-year respectively. 103 fractures were registered in the PSM cohort (crude fracture rate of 2.2 fractures per 100 person-year). We also explored the effects of GC on serum C-terminal telopeptide of type 1 collagen (CTX) in a subset of patients with available data (n=335). We found that the proportion of patients with low bone turnover (<400 ng/L) was numerically greater in patients receiving ≥5 mg/day compared to other doses and controls (p NS)ConclusionGC doses as low as 2.5 mg/day were associated with BMD loss in iRMD but this effect was preventable. BMD loss in patients taking ≥5 mg/day was not totally prevented by anti-osteoporotic medications currently used in clinical practice, resulting in higher risk of fracture.Figure 1.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsGiovanni Adami Speakers bureau: Theramex, Eli-Lilly, BMS, Amgen, UCB, Fresenius Kabi, Galapagos, Angelo Fassio: None declared, Camilla Benini: None declared, Ombretta Viapiana: None declared, Davide Gatti: None declared, Davide Bertelle: None declared, Maurizio Rossini: None declared.
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Key, Brandon M., John Symanski, Matthew J. Scheidt e Sean M. Tutton. "Vertebroplasty, Kyphoplasty, and Implant-Based Mechanical Vertebral Augmentation". Seminars in Musculoskeletal Radiology 25, n. 06 (dicembre 2021): 785–94. http://dx.doi.org/10.1055/s-0041-1739531.
Testo completoAbstract (sommario):
AbstractVertebral compression fractures are a global public health issue with a quantifiable negative impact on patient morbidity and mortality. The contemporary approach to the treatment of osteoporotic fragility fractures has moved beyond first-line nonsurgical management. An improved understanding of biomechanical forces, consequential morbidity and mortality, and the drive to reduce opioid use has resulted in multidisciplinary treatment algorithms and significant advances in augmentation techniques. This review will inform musculoskeletal radiologists, interventionalists, and minimally invasive spine surgeons on the proper work-up of patients, imaging features differentiating benign and malignant pathologic fractures, high-risk fracture morphologies, and new mechanical augmentation device options, and it describes the appropriate selection of devices, complications, outcomes, and future trends.
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Stepanyan, Hayk, David Gendelberg e William L. Hennrikus. "Simple Clavicle Fractures, a Primary Care Musculoskeletal Injury". Pediatrics 141, n. 1_MeetingAbstract (1 gennaio 2018): 204. http://dx.doi.org/10.1542/peds.141.1ma3.204.
Testo completo
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Iacob, Roxana, Emil Robert Stoicescu, Simona Cerbu, Daniela Iacob, Elena Amaricai, Liliana Catan, Oana Belei e Emil Radu Iacob. "Could Ultrasound Be Used as a Triage Tool in Diagnosing Fractures in Children? A Literature Review". Healthcare 10, n. 5 (29 aprile 2022): 823. http://dx.doi.org/10.3390/healthcare10050823.
Testo completoAbstract (sommario):
Fracture is one of the most frequent causes of emergency department visits in children, conventional radiography being the standard imaging tool used for following procedures and treatment. This imagistic method is irradiating and harmful, especially for children due to their high cell division rate. For this reason, we searched the literature to see if musculoskeletal ultrasound is a good alternative for diagnostic and follow-up regarding fractures in the pediatric population. After searching the databases using MeSH terms and manual filters, 24 articles that compare X-ray and ultrasound regarding their specificity and sensitivity in diagnosing fractures were included in this study. In the majority of the studied articles, the specificity and sensitivity of ultrasound are around 90–100%, and with high PPVs (positive predictive values) and NPVs (negative predictive values). Although it cannot replace conventional radiography, it is a great complementary tool in fracture diagnosis, having a sensitivity of nearly 100% when combined with clinical suspicion of fracture, compared with X-ray.
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Pei, Yixuan A., Mattia A. Mahmoud, Keith Baldwin e Corinna Franklin. "Comparing Musculoskeletal Injuries across Dance and Gymnastics in Adolescent Females Presenting to Emergency Departments". International Journal of Environmental Research and Public Health 20, n. 1 (28 dicembre 2022): 471. http://dx.doi.org/10.3390/ijerph20010471.
Testo completoAbstract (sommario):
(1) Background: Studies have yet to identify if there are any differences in musculoskeletal injury patterns between dance and gymnastics. This study aimed to determine if different injury patterns exist in adolescent females participating in those two popular sports. (2) Methods: A cross-sectional study was conducted using data collected from patients presenting to U.S. emergency departments participating in the publicly available, de-identified U.S. Consumer Product Safety Commission’s National Electronic Injury Surveillance System (NEISS) throughout the year 2020. Regression analyses were performed to explore if injury patterns were predictive of gymnastics or dancing participation. (3) Results: 518 adolescent females with dance-related injuries and 597 adolescent females with gymnastics-related injuries in 2020 were examined. Strain/sprains (33.3%) and fractures (37.3%) were the most reported dance- and gymnastics-related diagnoses, respectively. Participants were 74% less likely to have a strain/sprain diagnosis in gymnastics compared to dance (OR = 0.26, 95% CI [0.18, 0.38]) and were 3.84 times more likely to have a fracture diagnosis from gymnastics compared to dance (OR = 3.84, 95% CI [2.67, 5.57]), even after adjusting for body party injured. (4) Conclusions: Dance is associated with more sprains while gymnastics typically resulted in a greater likelihood for fractures.
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Hernigou, J., e F. Schuind. "Tobacco and bone fractures". Bone & Joint Research 8, n. 6 (giugno 2019): 255–65. http://dx.doi.org/10.1302/2046-3758.86.bjr-2018-0344.r1.
Testo completoAbstract (sommario):
Objectives The aim of this study was to review the impact of smoking tobacco on the musculoskeletal system, and on bone fractures in particular. Methods English-language publications of human and animal studies categorizing subjects into smokers and nonsmokers were sourced from MEDLINE, The Cochrane Library, and SCOPUS. This review specifically focused on the risk, surgical treatment, and prevention of fracture complications in smokers. Results Smokers have an increased risk of fracture and experience more complications with delayed bone healing, even if they have already stopped smoking, because some adverse effects persist for a prolonged period. Some risks can be reduced during and after surgery by local and general prevention, and smoking cessation is an important factor in lessening this risk. However, if a patient wants to stop smoking at the time of a fracture, the cessation strategies in reducing tobacco use are not easy to implement. The patient should also be warned that using e-cigarettes or other tobaccos does not appear to reduce adverse effects on health. Conclusion The evidence reviewed in this study shows that smoking has a negative effect in terms of the risk and treatment of fractures. Cite this article: J. Hernigou, F. Schuind. Tobacco and bone fractures: A review of the facts and issues that every orthopaedic surgeon should know. Bone Joint Res 2019;8:255–265. DOI: 10.1302/2046-3758.86.BJR-2018-0344.R1.
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Schachinger, Florian, e Sebastian Farr. "The Effects of Preterm Birth on Musculoskeletal Health-Related Disorders". Journal of Clinical Medicine 10, n. 21 (29 ottobre 2021): 5082. http://dx.doi.org/10.3390/jcm10215082.
Testo completoAbstract (sommario):
Preterm birth is associated with various diseases and conditions which demand multidisciplinary medical care. Approximately 10% of all neonates are born prematurely with an increasing survival rate in almost all Western countries. This ongoing, yet desirable trend is creating new challenges for sufficient medical treatment regimens, which should be upheld throughout the patients’ lives. Orthopedic surgeons are focused on musculoskeletal disorders and the improvement of patients’ ability to cope with the challenges of everyday life. The most common conditions associated with preterm birth are cerebral palsy and a dysregulation of the calcium/phosphorus metabolism, which may lead to fractures. These diseases may vary greatly in their organic manifestation and clinical presentation. This demands multidisciplinary cooperation and parental support. Clinical management is aimed on the early enhancement of a patient’s physical, as well as neurological condition, and to prevent the development of secondary musculoskeletal disorders. In this article, we give an overview of the current literature on the most common musculoskeletal disorders associated with preterm birth and critically discuss state of the art diagnostic standards and treatment algorithms.
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Amarowicz, Jarosław, Edward Czerwiński, Katarzyna Zając e Anna Kumorek. "Fracture Liaison Services - Polish Experience. Methods of Secondary Prevention of Osteoporotic Fractures". Ortopedia Traumatologia Rehabilitacja 18, n. 6 (30 novembre 2016): 569–81. http://dx.doi.org/10.5604/15093492.1230554.
Testo completoAbstract (sommario):
Background. Fragility fractures are a major challenge to health systems around the world. The risk of a subsequent fracture may increase even 11-fold after one’s first fracture event. A coordinator-based system (Fracture Liaison Services) was established in Poland in order to fill the gap in the care of patients with osteoporotic fractures. In the past years, the FLS has become a crucial part of orthopaedic facilities worldwide, bringing benefits to patients and savings to health systems’ budgets. Material and methods. In 2015, the European Foundation of Osteoporosis and Musculoskeletal Diseases (EFOM) implemented the FLS in Poland under the name “System Zapobiegania Złamaniom (SZZ)”. It was established in 16 centres in different parts of Poland. During the preparation phase, 42 healthcare professionals from 17 sites participated in courses organized by EFOM. Results. A total of 1,579 patients were included in the SZZ, with a total of 746 DXA scans performed in that group. Patients were educated about osteoporotic fractures, including the methods of prevention (causes of fractures, problem of falls, vitamin D and calcium supplementation). The number of patients receiving antiresorptive treatment increased by 74.1%. The percentage of patients taking vitamin D and calcium supplements increased by an average of 10.8%. Although all the participating patients had suffered a fragility fracture, only 42% fulfilled the WHO clinical criteria for osteoporosis. Conclusions. 1. The implementation of the Fracture Liaison Service concept in Poland is possible and beneficial for the patients and healthcare system. 2. The current WHO definition of osteoporosis might be insufficient. 3. The use of an integrated database in different facilities, in terms of fracture epidemiology, significantly improves the quality of data being collected.
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Escobio-Prieto, Isabel, María Blanco-Díaz, Elena Pinero-Pinto, Alvaro Manuel Rodriguez-Rodriguez, Francisco Javier Ruiz-Dorantes e Manuel Albornoz-Cabello. "Quantitative Ultrasound and Bone Health in Elderly People, a Systematic Review". Biomedicines 11, n. 4 (13 aprile 2023): 1175. http://dx.doi.org/10.3390/biomedicines11041175.
Testo completoAbstract (sommario):
Reduced bone mineral density (BMD), osteoporosis, and their associated fractures are one of the main musculoskeletal disorders of the elderly. Quickness in diagnosis could prevent associated complications in these people. This study aimed to perform a systematic review (SR) to analyze and synthesize current research on whether a calcaneal quantitative ultrasound (QUS) can estimate BMD and predict fracture risk in elderly people compared to dual-energy x-ray absorptiometry (DXA), following the PRISMA guidelines. A search was conducted in the main open-access health science databases: PubMed and Web of Science (WOS). DXA is the gold standard for the diagnosis of osteoporosis. Despite controversial results, it can be concluded that the calcaneal QUS tool may be a promising method to evaluate BMD in elderly people, facilitating its prevention and diagnosis. However, further studies are needed to validate the use of calcaneal QUS.
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Zainol Abidin, Nurdiana. "Obesity and Musculoskeletal Health of Young and Older Malaysian Women: A Cross-Sectional Study". Malaysian Journal of Medical Sciences 30, n. 1 (28 febbraio 2023): 137–51. http://dx.doi.org/10.21315/mjms2023.30.1.12.
Testo completoAbstract (sommario):
Background: Asian women are more susceptible to musculoskeletal disorders compared to their Caucasian counterparts, and employed women are substantially more prone to musculoskeletal disorders compared to men. Data on musculoskeletal health in Malaysian women are lacking. The study’s goal was to evaluate the body composition and functional performance of older and younger Malaysian women for obesity and musculoskeletal health problems. Methods: The study included 141 post-menopausal Malaysian women and 118 young Malaysian women between 18 years old and 32 years old of age. Body composition, bone density, handgrip strength and physical performance were assessed using bio-electrical impedance analyser, calcaneal quantitative ultrasound, hand dynamometer and modified short physical performance battery test, respectively. Results: There was a higher prevalence of ‘low muscle mass’ among the younger age group compared to their older counterparts (48 young women [40.0%] versus 44 post-menopausal women [31.2%]). Conversely, there was a higher prevalence of ‘obesity’ and ‘low bone density’ among the older age group compared to their younger counterparts. Mean broadband ultrasound attenuation (BUA) for both age groups was ≥ 70.0 dB/MHz. The majority of post-menopausal women had a ‘minor functional decline’ (40.6%), followed by moderate (28.1%), major (22.7%), severe (6.3%) and the lowest percentage for ‘no decline’ (2.3%). Conclusion: There was a high prevalence of obesity with poor musculoskeletal health in older Malaysian women, which may lead to frailty and higher incidences of falls and fractures at an advanced age. The screening of musculoskeletal conditions among Malaysian women may aid in early detection of abnormalities and timely intervention.
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Troxler, David, e Johannes Mayr. "POCUS Diagnosis of Sternal Fractures in Children without Direct Trauma—A Case Series". Children 9, n. 11 (3 novembre 2022): 1691. http://dx.doi.org/10.3390/children9111691.
Testo completoAbstract (sommario):
Sternal fractures in children are rare and tend to be caused by high-energy injury. However, sternal fractures may also be caused by minor and indirect trauma and might therefore not be as rare as previously stated. Ultrasound examination is the method of choice for the diagnosis of sternal fractures. We present three cases of sternal fractures not caused by direct trauma that were presented to our A&E department within a period of only 62 days. All of them exhibited localized tenderness, but none had an associated injury. Children presenting to the A&E unit with musculoskeletal thorax pain should be screened by POCUS for sternal fractures, even if they do not report any direct trauma to the thorax.
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Dworkin, M., K. J. Agarwal-Harding, M. Joseph, G. Cahill, D. Konadu-Yeboah, E. Makasa e C. Mock. "Indicators for the evaluation of musculoskeletal trauma systems: A scoping review and Delphi study". PLOS ONE 18, n. 8 (31 agosto 2023): e0290816. http://dx.doi.org/10.1371/journal.pone.0290816.
Testo completoAbstract (sommario):
Background Trauma is a leading cause of mortality and morbidity, disproportionately affecting low- and middle-income countries. Musculoskeletal trauma results in the majority of post-traumatic morbidity and disability globally. The literature has reported many performance indicators relating to trauma care, but few specific to musculoskeletal injuries. Study objectives The purpose of this study was to establish a practical list of performance indicators to evaluate and monitor the quality and equity of musculoskeletal trauma care delivery in health systems worldwide. Methods A scoping review was performed that identified performance indicators related to musculoskeletal trauma care. Indicators were organized by phase of care (general, prevention, pre-hospital, hospital, post-hospital) within a modified Donabedian model (structure, process, outcome, equity). A panel of 21 experts representing 45 countries was assembled to identify priority indicators utilizing a modified Delphi approach. Results The scoping review identified 1,206 articles and 114 underwent full text review. We included 95 articles which reported 498 unique performance indicators. Most indicators related to the hospital phase of care (n = 303, 60%) and structural characteristics (n = 221, 44%). Mortality (n = 50 articles) and presence of trauma registries (n = 16 articles) were the most frequently reported indicators. After 3 rounds of surveys our panel reached consensus on a parsimonious list of priority performance indicators. These focused on access to trauma care; processes and key resources for polytrauma triage, patient stabilization, and hemorrhage control; reduction and immobilization of fractures and dislocations; and management of compartment syndrome and open fractures. Conclusions The literature has reported many performance indicators relating to trauma care, but few specific to musculoskeletal injuries. To create quality and equitable trauma systems, musculoskeletal care must be incorporated into development plans with continuous monitoring and improvement. The performance indicators identified by our expert panel and organized in a modified Donabedian model can serve as a method for evaluating musculoskeletal trauma care.
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Cielen, Nele, Karen Maes e Ghislaine Gayan-Ramirez. "Musculoskeletal Disorders in Chronic Obstructive Pulmonary Disease". BioMed Research International 2014 (2014): 1–17. http://dx.doi.org/10.1155/2014/965764.
Testo completoAbstract (sommario):
Chronic obstructive pulmonary disease (COPD) is a lung disease characterized by airway obstruction and inflammation but also accompanied by several extrapulmonary consequences, such as skeletal muscle weakness and osteoporosis. Skeletal muscle weakness is of major concern, since it leads to poor functional capacity, impaired health status, increased healthcare utilization, and even mortality, independently of lung function. Osteoporosis leads to fractures and is associated with increased mortality, functional decline, loss of quality of life, and need for institutionalization. Therefore, the presence of the combination of these comorbidities will have a negative impact on daily life in patients with COPD. In this review, we will focus on these two comorbidities, their prevalence in COPD, combined risk factors, and pathogenesis. We will try to prove the clustering of these comorbidities and discuss possible preventive or therapeutic strategies.
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Mulligan, Angela A., Richard P. G. Hayhoe, Robert N. Luben e Ailsa A. Welch. "Positive Associations of Dietary Intake and Plasma Concentrations of Vitamin E with Skeletal Muscle Mass, Heel Bone Ultrasound Attenuation and Fracture Risk in the EPIC-Norfolk Cohort". Antioxidants 10, n. 2 (22 gennaio 2021): 159. http://dx.doi.org/10.3390/antiox10020159.
Testo completoAbstract (sommario):
The prevalence of sarcopenia, frailty and fractures is increasing. Prevention options are limited, but dietary factors including vitamin E have the potential to confer some protection. This study investigated cross-sectional associations between dietary and plasma concentrations of vitamin E with indices of skeletal muscle mass (SMM) (n = 14,179 and 4283, respectively) and bone density (n = 14,694 and 4457, respectively) and longitudinal fracture risk (n = 25,223 and 7291, respectively) in European Prospective Investigation Into Cancer and Nutrition (EPIC)-Norfolk participants, aged 39–79 years at baseline. Participants completed a health and lifestyle questionnaire, a 7-day diet diary (7dDD) and had anthropometric measurements taken. Fat-free mass (as a SMM proxy) was measured using bioimpedance and bone density was measured using calcaneal broadband ultrasound attenuation (BUA) and incident fractures over 18.5 years of follow-up. Associations between indices of SMM, BUA and fracture risk were investigated by quintiles of dietary vitamin E intake or plasma concentrations. Positive trends in SMM indices and BUA were apparent across dietary quintiles for both sexes, with interquintile differences of 0.88–1.91% (p < 0.001), and protective trends for total and hip fracture risk. Circulating plasma α- and γ-tocopherol results matched the overall dietary findings. Dietary vitamin E may be important for musculoskeletal health but further investigation is required to fully understand the relationships of plasma tocopherols.
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Armstrong, Maxwell Luke, Nicholas Smith, Rhiannon Tracey e Heather Jackman. "The Orthopedic Effects of Electronic Cigarettes: A Systematic Review and Pediatric Case Series". Children 9, n. 1 (4 gennaio 2022): 62. http://dx.doi.org/10.3390/children9010062.
Testo completoAbstract (sommario):
Electronic cigarette (EC) use is highly prevalent, especially in the adolescent population, where 29% of Canadian adolescents have used an EC in the past thirty days per national surveys. Our pediatric orthopedic referral centre observed a cluster of delayed unions of bone fractures in adolescents using ECs and present the case series here. We then asked whether electronic cigarettes impair bone healing or influence orthopedic outcomes. A PRISMA-compliant systematic review was carried out, which revealed no human clinical studies and a general paucity of evidence around ECs and musculoskeletal health. The existing experimental evidence relevant to orthopedics is summarized. The effect of ECs on the musculoskeletal system is poorly understood and is a target for further research.
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Musonda, Webster, Derek Freitas, Kaunda Yamba, William Jim Harrison e James Munthali. "Prognostic factors for surgical site infection following intramedullary nailing of diaphyseal fractures of the femur and tibia in adult patients at a tertiary hospital in Lusaka, Zambia". Tropical Doctor 52, n. 1 (21 dicembre 2021): 15–22. http://dx.doi.org/10.1177/00494755211064657.
Testo completoAbstract (sommario):
Our study aimed to identify prognostic factors for surgical site infection following long bone fracture intramedullary nailing at a tertiary hospital in a low-resource setting. This was a longitudinal observational study involving 132 participants enrolled over a one-year period with femoral and tibial diaphyseal fractures scheduled for ORIF. Participant median age was 30 years (range: 26 – 42). The prevalence of surgical site infection was 16%. Male sex (AOR=0.26, 95% CI [0.70–0.98]; p = 0.047) was associated with lower odds of surgical site infection while associated non-musculoskeletal injuries were associated with higher odds of developing surgical site infection. Our study confirms a higher surgical site infection rate than normally accepted. However, intramedullary nailing in our setting is justified as it allows an early return to a pre-injury state. These interventions must be carried out in the best possible circumstances. Future studies could explore alternative methods of fracture fixation.
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Lane, Tyler J., Luke Sheehan, Shannon E. Gray, Dianne Beck e Alex Collie. "Step-downs reduce workers’ compensation payments to encourage return to work: are they effective?" Occupational and Environmental Medicine 77, n. 7 (27 marzo 2020): 470–77. http://dx.doi.org/10.1136/oemed-2019-106325.
Testo completoAbstract (sommario):
ObjectiveTo determine whether step-downs, which cut the rate of compensation paid to injured workers after they have been on benefits for several months, are effective as a return to work incentive.MethodsWe aggregated administrative claims data from seven Australian workers’ compensation systems to calculate weekly scheme exit rates, a proxy for return to work. Jurisdictions were further subdivided into four injury subgroups: fractures, musculoskeletal, mental health and other trauma. The effect of step-downs on scheme exit was tested using a regression discontinuity design. Results were pooled into meta-analyses to calculate combined effects and the proportion of variance attributable to heterogeneity.ResultsThe combined effect of step-downs was a 0.86 percentage point (95% CI −1.45 to −0.27) reduction in the exit rate, with significant heterogeneity between jurisdictions (I2=68%, p=0.003). Neither timing nor magnitude of step-downs was a significant moderator of effects. Within injury subgroups, only fractures had a significant combined effect (−0.84, 95% CI −1.61 to −0.07). Sensitivity analysis indicated potential effects within mental health and musculoskeletal conditions as well.ConclusionsThe results suggest some workers’ compensation recipients anticipate step-downs and exit the system early to avoid the reduction in income. However, the effects were small and suggest step-downs have marginal practical significance. We conclude that step-downs are generally ineffective as a return to work policy initiative.Postprint link: https://www.medrxiv.org/content/10.1101/19012286
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Hedbeck, Carl Johan, Jan Tidermark, Sari Ponzer, Richard Blomfeldt e Gunnar Bergström. "Responsiveness of the short musculoskeletal function assessment (SMFA) in patients with femoral neck fractures". Quality of Life Research 20, n. 4 (12 novembre 2010): 513–21. http://dx.doi.org/10.1007/s11136-010-9784-4.
Testo completo
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Hirase, Tatsuya, Yoshiro Okubo, Kim Delbaere, Jasmine C. Menant, Stephen R. Lord e Daina L. Sturnieks. "Risk Factors for Falls and Fall-Related Fractures in Community-Living Older People with Pain: A Prospective Cohort Study". International Journal of Environmental Research and Public Health 20, n. 11 (2 giugno 2023): 6040. http://dx.doi.org/10.3390/ijerph20116040.
Testo completoAbstract (sommario):
(1) Background: This prospective study aimed to identify predictors of falls and fall-related fractures in community-dwelling older people with pain; (2) Methods: Participants comprised 389 community-dwelling older people aged 70+ years who had musculoskeletal pain in the neck, back, hip, leg/knee and/or feet. Demographic, anthropometric, balance, mobility, cognitive function, psychological status and physical activity level measures were obtained at baseline. Falls were monitored with monthly falls calendars for 12 months. Logistic regression analyses were performed to identify predictors of falls and fall-related fractures during a 12-month follow-up; (3) Results: Of the 389 participants, 175 (45.0%) and 20 (5.1%) reported falls and fall-related fractures during the 12-month follow-up, respectively. Greater postural sway on foam, more depressive symptoms and lower physical activity levels at baseline were associated with falls during the 12-month follow-up. Slower walking speed at baseline was associated with fall-related fractures during the 12-month follow-up. These associations remained significant after adjusting for age, sex, body mass index, comorbidities and medication use; (4) Conclusions: This study suggests poor balance, low mood and a less active lifestyle are predictors of falls, and slower walking speed predicts fall-related fractures among community-dwelling older people with pain.
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Di Marcello, Francesca, Giulia Di Donato, Debora Mariarita d’Angelo, Luciana Breda e Francesco Chiarelli. "Bone Health in Children with Rheumatic Disorders: Focus on Molecular Mechanisms, Diagnosis, and Management". International Journal of Molecular Sciences 23, n. 10 (20 maggio 2022): 5725. http://dx.doi.org/10.3390/ijms23105725.
Testo completoAbstract (sommario):
Bone is an extremely dynamic and adaptive tissue, whose metabolism and homeostasis is influenced by many different hormonal, mechanical, nutritional, immunological and pharmacological stimuli. Genetic factors significantly affect bone health, through their influence on bone cells function, cartilage quality, calcium and vitamin D homeostasis, sex hormone metabolism and pubertal timing. In addition, optimal nutrition and physical activity contribute to bone mass acquisition in the growing age. All these factors influence the attainment of peak bone mass, a critical determinant of bone health and fracture risk in adulthood. Secondary osteoporosis is an important issue of clinical care in children with acute and chronic diseases. Systemic autoimmune disorders, like juvenile idiopathic arthritis, can affect the skeletal system, causing reduced bone mineral density and high risk of fragility fractures during childhood. In these patients, multiple factors contribute to reduce bone strength, including systemic inflammation with elevated cytokines, reduced physical activity, malabsorption and nutritional deficiency, inadequate daily calcium and vitamin D intake, use of glucocorticoids, poor growth and pubertal delay. In juvenile arthritis, osteoporosis is more prominent at the femoral neck and radius compared to the lumbar spine. Nevertheless, vertebral fractures are an important, often asymptomatic manifestation, especially in glucocorticoid-treated patients. A standardized diagnostic approach to the musculoskeletal system, including prophylaxis, therapy and follow up, is therefore mandatory in at risk children. Here we discuss the molecular mechanisms involved in skeletal homeostasis and the influence of inflammation and chronic disease on bone metabolism.
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Пустовойт, Б. А., e Р. А. Комаров. "Physical therapy for fractures of the bones of the ankle joint". Physical rehabilitation and recreational health technologies, n. 1 (23 dicembre 2019): 4–13. http://dx.doi.org/10.15391/prrht.2019-1.01.
Testo completoAbstract (sommario):
Purpose: to provide a clinical and physiological rationale for the use of physical therapy for patients with ankle bone fractures. Materials and methods: Theoretical analysis and generalization of data from the scientific and methodological literature on physical therapy for patients with ankle bone fractures. Results: physical therapy methods and their effectiveness were evaluated and analyzed. The use of physical therapy programs allows to restore the function of the musculoskeletal system and the working capacity of patients. Conclusions: it was established that the improvement of the results of treatment and rehabilitation depends on complex medical and physical therapy.
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AL-Bashaireh, Ahmad M., Linda G. Haddad, Michael Weaver, Debra Lynch Kelly, Xing Chengguo e Saunjoo Yoon. "The Effect of Tobacco Smoking on Musculoskeletal Health: A Systematic Review". Journal of Environmental and Public Health 2018 (11 luglio 2018): 1–106. http://dx.doi.org/10.1155/2018/4184190.
Testo completoAbstract (sommario):
This systematic review explored associations between smoking and health outcomes involving the musculoskeletal system. AMSTAR criteria were followed. A comprehensive search of PubMed, Web of Science, and Science Direct returned 243 articles meeting inclusion criteria. A majority of studies found smoking has negative effects on the musculoskeletal system. In research on bones, smoking was associated with lower BMD, increased fracture risk, periodontitis, alveolar bone loss, and dental implant failure. In research on joints, smoking was associated with increased joint disease activity, poor functional outcomes, and poor therapeutic response. There was also evidence of adverse effects on muscles, tendons, cartilage, and ligaments. There were few studies on the musculoskeletal health outcomes of secondhand smoke, smoking cessation, or other modes of smoking, such as waterpipes or electronic cigarettes. This review found evidence that suggests tobacco smoking has negative effects on the health outcomes of the musculoskeletal system. There is a need for further research to understand mechanisms of action for the effects of smoking on the musculoskeletal system and to increase awareness of healthcare providers and community members of the adverse effects of smoking on the musculoskeletal system.
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Jennings, Amy, Angela A. Mulligan, Kay-Tee Khaw, Robert N. Luben e Ailsa A. Welch. "A Mediterranean Diet Is Positively Associated with Bone and Muscle Health in a Non-Mediterranean Region in 25,450 Men and Women from EPIC-Norfolk". Nutrients 12, n. 4 (21 aprile 2020): 1154. http://dx.doi.org/10.3390/nu12041154.
Testo completoAbstract (sommario):
Research on Mediterranean diet (MD) adherence and musculoskeletal health is limited. The current study determined if adherence to the alternative MD score (aMED) and MD score (MDS), quantified from 7-d food diaries, was associated with fracture incidence, bone density (calcaneal broadband ultrasound attenuation (BUA)) and fat free mass (expressed over BMI (FFMBMI) using bioelectrical impedance) in 25,450 men and women recruited to the European Prospective Investigation into Cancer study in Norfolk, UK. During 17.4 years of follow up (443,178 total person years) 2195 incident fractures occurred. Higher aMED adherence was associated with 23% reduced total (Q5–Q1 HR 0.77; 95% CI 0.67, 0.88; p-trend < 0.01) and 21% reduced hip (Q5–Q1 HR 0.79; 95% CI 0.65, 0.96; p-trend = 0.01) fracture incidence, and significantly higher BUA (Q5–Q1 1.0 dB/MHz 95% CI 0.2, 1.9; p-trend < 0.01) and FFMBMI (Q5–Q1 0.05 kg/(kg/m2) 95% CI 0.04, 0.06; p-trend < 0.01), comparing extreme adherence quintiles. Higher MDS was also associated with reduced total fractures (Q5–Q1 HR 0.83; 95% CI 0.71, 0.96; p-trend = 0.03) and significantly higher BUA (Q5–Q1 1.4 dB/MHz 95% CI 0.5, 2.3; p-trend < 0.01) and FFMBMI (Q5–Q1 0.03 kg/(kg/m2) 95% CI 0.01, 0.04; p-trend < 0.01). This evidence supports the need to develop interventions to enhance MD adherence, particularly in women, where evidence for associations was stronger.
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Chen, L. K., B. T. Sullivan e P. D. Sponseller. "Submuscular plates versus flexible nails in preadolescent diaphyseal femur fractures". Journal of Children's Orthopaedics 12, n. 5 (ottobre 2018): 488–92. http://dx.doi.org/10.1302/1863-2548.12.180036.
Testo completoAbstract (sommario):
Purpose To compare patient characteristics, operative time, estimated blood loss (EBL), postoperative length of hospital stay (LOS) and complications after insertion and removal of submuscular plates (SMPs) versus flexible nails (FNs) for paediatric diaphyseal femur fractures. Methods We reviewed records of 58 children (mean age, 7.7 years SD 2.0) with diaphyseal femur fractures who underwent treatment with SMPs (n = 30) or FNs (n = 28) from 2005 to 2017 (mean follow-up, 22 months SD 28). Patients with pathological fractures or musculoskeletal comorbidities were excluded. Alpha = 0.05. Results Insertion of FNs was associated with shorter operative time (ß = –24 mins) and less EBL (ß = –38 mL) (both, p < 0.001) compared with insertion of SMPs, after adjusting for fracture type and time from beginning of study period. Removal of FNs was also associated with shorter operative time (ß = –15 min) compared with removal of SMPs (p < 0.001). EBL during removal was similar between groups (p = 0.080). The FN group had a shorter LOS after insertion (ß = –0.2 d) compared with the SMP group (p = 0.032). Four patients treated with SMPs and three treated with FNs developed surgical site infections. Two patients treated with SMPs and seven treated with FNs experienced implant irritation that resolved with removal. No other complications occurred. Conclusion Compared with SMPs, FNs were associated with shorter operative time (for insertion and removal), less EBL (for insertion) and shorter post-insertion LOS in patients with diaphyseal femur fractures. Level of Evidence: III
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Firman, Nicola, Marta Wilk, Gill Harper e Carol Dezateux. "Are children with obesity at school entry more likely to have a diagnosis of a musculoskeletal condition? Findings from a systematic review". BMJ Paediatrics Open 6, n. 1 (agosto 2022): e001528. http://dx.doi.org/10.1136/bmjpo-2022-001528.
Testo completoAbstract (sommario):
BackgroundChildren with obesity at school entry are at increased risk of persistent obesity throughout childhood and adulthood. Little is known about associations with adverse health outcomes with onset during childhood including those affecting the musculoskeletal system. We examined the association between obesity present at school entry and adverse musculoskeletal diagnoses with onset during childhood.MethodsWe searched three electronic databases to identify longitudinal studies published in English between January 2000 and June 2022 assessing associations between obesity measured at school entry (around age 5 years) and musculoskeletal diagnoses made before age 20 years. Two reviewers screened titles, abstracts and full-text using EPPI-Reviewer software. Bias and quality of eligible studies were appraised using The Quality Assessment tool for Observational Cohort and Cross-sectional studies and findings synthesised.ResultsWe identified four eligible studies from 291 unique records, three conducted in Spain and one in Scotland. These studies reported on 1 232 895 children (available data: 51.4% boys; none reported ethnic distribution) with study sample sizes ranging from <2000 to 600 000 and length of follow-up from 2 to 13 years. Quantitative synthesis of findings across these four studies was not possible due to differences in outcomes and effect sizes reported. Children with obesity at school entry were more likely to receive diagnoses of slipped capital femoral epiphysis, back pain, fractures and musculoskeletal complaints made in primary care settings. Included studies were assessed as of ‘fair’ to ‘good’ quality.ConclusionThere is good to fair evidence to suggest children with obesity at school entry are more likely to receive a diagnosis of a musculoskeletal condition during childhood. Further research is needed to replicate these findings in ethnically diverse populations and to investigate whether these are causal associations. The implications of this for children’s mobility and quality of life and future musculoskeletal health warrants further assessment.
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Skryabin, Evgeny G., Sergey V. Naumov, Pavel B. Zotov e Mikhail A. Akselrov. "Sternal fractures in children". Pediatric Traumatology, Orthopaedics and Reconstructive Surgery 9, n. 3 (4 ottobre 2021): 317–25. http://dx.doi.org/10.17816/ptors64202.
Testo completoAbstract (sommario):
BACKGROUND: Sternal fractures are a rare nosological form of injuries in children. The injuries of the sternum often are accompanied by fractures of the long bones of the skeleton or thoracic vertebrae. Isolated fractures of the sternum in children are rarely diagnosed. The medical information on pediatric sternum injuries is limited by a small number of scientific publications.
AIM: Our aim is to study the peculiarities of traumagenesis, clinic, diagnostics, treatment of sternal fractures in children.
MATERIALS AND METHODS: Clinical material for the served as experience in providing traumatology assistance to 8 children who received sternal fractures. The average age of the injured children was 11.5 years. 87.5% of the victims were boys. In all patients, sternal fractures had been diagnosed along with other damage to the musculoskeletal system. During the survey, traditional diagnostic methods for emergency traumatology were used.
RESULTS: The leading mechanism of injury, i.e., falling from a height of 2 meters and more were found in 62.5% of victims. In all clinical observations, fractures were localized at the level of the body of the sternum. All the children, besides sternal fractures, had uncomplicated fractures of the vertebral bodies. A total of 30 bodies of the vertebrae were compressed. Most often (in 16.75% of cases), the ThV vertebra was compressed. The reliable symptoms of sternal fractures in patients were difficult and painful breathing, local swelling of soft tissues, soreness of the sternum during palpation, and amplification of the pain in the fracture area during pressure applied on half of the chest. Compliance with the strict bed mode on the roller-reclinator under the area of the compreated vertebrae and the exclusion of the axial load on the spine was a favorable fact sufficient and led to pain disappearance in 37 days. In all cases, the sternum fractures did not require any surgery. Fractures of the bodies of the vertebrae in 7 children were also treated conservatively. The Corsets Orlett was used for immobilization, ensuring a reliable degree of fixation. The average hospital stay amounted to 16. The duration of the hospital stay was influenced by the accompanying bone-articular damage to the skeleton. The evaluation of the long-term results was performed in 4 children. The results were interpreted as good.
CONCLUSIONS: When applying for emergency traumatology assistance to children with chest injury and spine, it is necessary to purposefully explore the state of the sternum.
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Si, Lei, John A. Eisman, Tania Winzenberg, Kerrie M. Sanders, Jacqueline R. Center, Tuan V. Nguyen e Andrew J. Palmer. "Microsimulation model for the health economic evaluation of osteoporosis interventions: study protocol". BMJ Open 9, n. 2 (febbraio 2019): e028365. http://dx.doi.org/10.1136/bmjopen-2018-028365.
Testo completoAbstract (sommario):
IntroductionOsteoporosis is a systemic skeletal disease that is characterised by reduced bone strength and increased fracture risk. Osteoporosis-related fractures impose enormous disease and economic burden to the society. Although many treatments and health interventions are proven effective to prevent fractures, health economic evaluation adds evidence to their economic merits. Computer simulation modelling is a useful approach to extrapolate clinical and economic outcomes from clinical trials and it is increasingly used in health economic evaluation. Many osteoporosis health economic models have been developed in the past decades; however, they are limited to academic use and there are no publicly accessible health economic models of osteoporosis.Methods and analysisWe will develop the Australian osteoporosis health economic model based on our previously published microsimulation model of osteoporosis in the Chinese population. The development of the model will follow the recommendations for the conduct of economic evaluations in osteoporosis by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases and the US branch of the International Osteoporosis Foundation. The model will be a state-transition semi-Markov model with memory. Clinical parameters in the model will be mainly obtained from the Dubbo Osteoporosis Epidemiology Study and the health economic parameters will be collected from the Australian arm of the International Costs and Utilities Related to Osteoporotic Fractures Study. Model transparency and validates will be tested using the recommendations from Good Research Practices in Modelling Task Forces. The model will be used in economic evaluations of osteoporosis interventions including pharmaceutical treatments and primary care interventions. A user-friendly graphical user interface will be developed, which will connect the user to the calculation engine and the results will be generated. The user interface will facilitate the use of our model by people in different sectors.Ethics and disseminationNo ethical approval is needed for this study. Results of the model validation and future economic evaluation studies will be submitted to journals. The user interface of the health economic model will be publicly available online accompanied with a user manual.
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Sprague, Sheila, Diane Heels-Ansdell, Sofia Bzovsky, Radovan Zdero, Mohit Bhandari, Marc Swiontkowski, Paul Tornetta, David Sanders e Emil Schemitsch. "Prognostic factors for predicting health-related quality of life after intramedullary nailing of tibial fractures: a randomized controlled trial". Bone & Joint Open 2, n. 1 (1 gennaio 2021): 22–32. http://dx.doi.org/10.1302/2633-1462.21.bjo-2020-0150.r1.
Testo completoAbstract (sommario):
Aims Using tibial shaft fracture participants from a large, multicentre randomized controlled trial, we investigated if patient and surgical factors were associated with health-related quality of life (HRQoL) at one year post-surgery. Methods The Study to Prospectively Evaluate Reamed Intramedullary Nails in Patients with Tibial Fractures (SPRINT) trial examined adults with an open or closed tibial shaft fracture who were treated with either reamed or unreamed intramedullary nails. HRQoL was assessed at hospital discharge (for pre-injury level) and at 12 months post-fracture using the Short Musculoskeletal Functional Assessment (SMFA) Dysfunction, SMFA Bother, 36-Item Short Form 36 (SF-36) Physical, and SF-36 Mental Component scores. We used multiple linear regression analysis to determine if baseline and surgical factors, as well as post-intervention procedures within one year of fracture, were associated with these HRQoL outcomes. Significance was set at p < 0.01. We hypothesize that, irrespective of the four measures used, prognosis is guided by both modifiable and non-modifiable factors and that patients do not return to their pre-injury level of function, nor HRQoL. Results For patient and surgical factors, only pre-injury quality of life and isolated fracture showed a statistical effect on all four HRQoL outcomes, while high-energy injury mechanism, smoking, and race or ethnicity, demonstrated statistical significance for three of the four HRQoL outcomes. Patients who did not require reoperation in response to infection, the need for bone grafts, and/or the need for implant exchanges had statistically superior HRQoL outcomes than those who did require intervention within one year after initial tibial fracture nailing. Conclusion We identified several baseline patient factors, surgical factors, and post-intervention procedures within one year after intramedullary nailing of a tibial shaft fracture that may influence a patient’s HRQoL. Cite this article: Bone Jt Open 2021;2(1):22–32.
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Chatzimavridou Grigoriadou, Victoria, Lisa H. Barraclough, Ivona Baricevic-Jones, Robert G. Bristow, Martin Eden, Kate Haslett, Karen Johnson et al. "RadBone: bone toxicity following pelvic radiotherapy – a prospective randomised controlled feasibility study evaluating a musculoskeletal health package in women with gynaecological cancers undergoing pelvic radiotherapy". BMJ Open 12, n. 6 (giugno 2022): e056600. http://dx.doi.org/10.1136/bmjopen-2021-056600.
Testo completoAbstract (sommario):
IntroductionPatients receiving radiotherapy are at risk of developing radiotherapy-related insufficiency fractures, which are associated with increased morbidity and pose a significant burden to patients’ quality of life and to the health system. Therefore, effective preventive techniques are urgently required. The RadBone randomised controlled trial (RCT) aims to determine the feasibility and acceptability of a musculoskeletal health package (MHP) intervention in women undergoing pelvic radiotherapy for gynaecological malignancies and to preliminary explore clinical effectiveness of the intervention.Methods and analysisThe RadBone RCT will evaluate the addition to standard care of an MHP consisting of a physical assessment of the musculoskeletal health, a 3-month prehabilitation personalised exercise package, as well as an evaluation of the fracture risk and if required the prescription of appropriate bone treatment including calcium, vitamin D and—for high-risk individuals—bisphosphonates. Forty participants will be randomised in each group (MHP or observation) and will be followed for 18 months. The primary outcome of this RCT will be feasibility, including the eligibility, screening and recruitment rate, intervention fidelity and attrition rates; acceptability and health economics. Clinical effectiveness and bone turnover markers will be evaluated as secondary outcomes.Ethics and disseminationThis study has been approved by the Greater Manchester East Research Ethics Committee (Reference: 20/NW/0410, November 2020). The results will be published in peer-reviewed journals, will be presented in national and international conferences and will be communicated to relevant stakeholders. Moreover, a plain English report will be shared with the study participants, patients’ organisations and media.Trial registration numberNCT04555317.
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van Leeuwen, Janneke, Marienke van Middelkoop, Winifred D. Paulis, Herman J. Bueving, Patrick J. E. Bindels e Bart W. Koes. "Overweight and obese children do not consult their general practitioner more often than normal weight children for musculoskeletal complaints during a 2-year follow-up". Archives of Disease in Childhood 103, n. 2 (18 agosto 2017): 149–54. http://dx.doi.org/10.1136/archdischild-2017-313118.
Testo completoAbstract (sommario):
BackgroundChildhood obesity is associated with self-reported musculoskeletal complaints, injuries and fractures. In the current study, we investigated the association between weight status of children and the frequency and type of musculoskeletal consultations at the general practitioner (GP) during a 2-year follow-up.MethodsData from a prospective longitudinal cohort study including children aged 2–18 years presenting in general practices in the Netherlands were used. Height and weight were measured at baseline, at 6-month, 1-year and 2-year follow-ups. Electronic medical files were used to collect information on the frequency and type of consultations at the GP during the 2-year follow-up period. Associations between weight status and frequency and type of GP consultations were calculated.ResultsOf the 617 included children, 111 (18%) were overweight or obese and 506 (82%) were non-overweight. Overweight children were significantly older (mean age in years (SD): 9.8 (3.6)vs7.8 (4.0), p=0.004). Overweight children consulted the GP in general significantly more frequent during the 2-year follow-up than non-overweight children (mean (SD): 7.3 (5.7)vs6.7 (5.4), OR 1.09, 95% CI 1.01 to 1.18). No significant difference was seen in the number of overweight and non-overweight children consulting their GP for musculoskeletal complaints (OR 1.20 (0.86 to 1.68)). Additionally, no significant difference between overweight and non-overweight children was seen for the number of consultations for further specified musculoskeletal disorders.ConclusionNo association was seen between childhood weight status and the frequency and type of musculoskeletal consultations at the GP during a 2-year follow-up.
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Sivakumar, Gaya, Alex Koziarz e Forough Farrokhyar. "Vitamin D Supplementation in Military Personnel: A Systematic Review of Randomized Controlled Trials". Sports Health: A Multidisciplinary Approach 11, n. 5 (3 luglio 2019): 425–31. http://dx.doi.org/10.1177/1941738119857717.
Testo completoAbstract (sommario):
Context: Vitamin D supplementation is important in military research because of its role in musculoskeletal health. Objective: This systematic review examined the effects of vitamin D supplementation on serum 25-hydroxyvitamin D (25(OH)D) concentrations and musculoskeletal health outcomes in military personnel. Data Sources: A comprehensive search was conducted using MEDLINE, EMBASE, CINAHL, SportDiscus, and the Cochrane Library databases and the reference lists of existing review articles and relevant studies. Study Selection: Reviewers independently screened titles, abstracts, and full texts of the articles using predefined criteria. Study Design: Systematic review of randomized controlled trials (RCTs) using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Level of Evidence: Level 3. Data Extraction: Three reviewers independently extracted data and assessed the methodological quality. Mean differences with 95% CI in serum 25(OH)D concentrations between the vitamin D and placebo arms were calculated. Results: Four RCTs were included in the qualitative analyses. The 25(OH)D concentrations were improved with 2000 IU/d supplementation (mean difference, 3.90 ng/mL; 95% CI, 0.22-7.58). A trial on female Navy recruits showed a significant decrease in stress fractures (risk ratio, 0.77; 95% CI, 0.62-0.95), particularly tibial fractures, from daily supplementation of 800 IU vitamin D and 2000 mg calcium. Conclusion: There was a positive trend in 25(OH)D concentrations from higher doses of supplementary vitamin D in military submariners and a possible benefit to bone health when vitamin D was combined with calcium.
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Minetto, Marco Alessandro, Alessandro Giannini, Rebecca McConnell, Chiara Busso, Guglielmo Torre e Giuseppe Massazza. "Common Musculoskeletal Disorders in the Elderly: The Star Triad". Journal of Clinical Medicine 9, n. 4 (23 aprile 2020): 1216. http://dx.doi.org/10.3390/jcm9041216.
Testo completoAbstract (sommario):
Musculoskeletal disorders are debilitating conditions that significantly impair the state of health, especially in elderly subjects. A pathological triad of inter-related disorders that are highly prevalent in the elderly consists of the following main “components”: sarcopenia, tendinopathies, and arthritis. The aim of this review is to critically appraise the literature relative to the different disorders of this triad, in order to highlight the pathophysiological common denominator and propose strategies for personalized clinical management of patients presenting with this combination of musculoskeletal disorders. Their pathophysiological common denominator is represented by progressive loss of (focal or generalized) neuromuscular performance with a risk of adverse outcomes such as pain, mobility disorders, increased risk of falls and fractures, and impaired ability or disability to perform activities of daily living. The precise management of these disorders requires not only the use of available tools and recently proposed operational definitions, but also the development of new tools and approaches for prediction, diagnosis, monitoring, and prognosis of the three disorders and their combination.
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Jensen, Andrew E., Melissa Laird, Jason T. Jameson e Karen R. Kelly. "Prevalence of Musculoskeletal Injuries Sustained During Marine Corps Recruit Training". Military Medicine 184, Supplement_1 (1 marzo 2019): 511–20. http://dx.doi.org/10.1093/milmed/usy387.
Testo completoAbstract (sommario):
Abstract Musculoskeletal injuries cost the U.S. Marine Corps approximately $111 million and 356,000 lost duty days annually. Information identifying the most common types of injuries and events leading to their cause would help target mitigation efforts. The purpose of this effort was to conduct an archival data review of injuries and events leading to injury during recruit training. An archival dataset of Marine recruits from 2011 to 2016 was reviewed and included 43,004 observations from 28,829 unique individuals. Injuries were classified as mild, moderate, and severe and categorized into new overuse, preexisting overuse, and traumatic. Injury classification and categorization were stratified by event in which the injury occurred. The majority of injuries were due to overuse, and the most common types were sprains, strains, iliotibial band syndrome, and stress fractures, which constituted over 40% of all injuries. Conditioning hikes were the primary event leading to injury, with 31% of all injuries occurring during this training; running claimed 12%. Most injuries sustained during basic training comprised sprains and strains. Marines who remained uninjured during basic training outperformed those who reported at least one injury on fitness tests. These results point to enhanced conditioning as a potential entry point to target future intervention efforts.
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Kalahasthi, Ravibabu, Bhavani Shankara Bagepally e Tapu Barman. "Association between Musculoskeletal Pain and Bone Turnover Markers in Long-Term Pb-Exposed Workers". Journal of Research in Health Sciences 21, n. 3 (6 luglio 2021): e00522-e00522. http://dx.doi.org/10.34172/jrhs.2021.55.
Testo completoAbstract (sommario):
Background: On chronic exposure, Lead (Pb) deposits in the skeletal system, replaces calcium ions, and alters the normal physiological processes, which in turn, lead to stunting, delayed fracture healing, and high resorption of collagen molecules. The present study aimed to assess the association of musculoskeletal pain and discomfort with bone turnover markers (BTMs) among long-term Pb-exposed workers. Study design: A cross-sectional study. Methods: The study recruited 176 male Pb-exposed workers and 80 control subjects who were matched for age, gender, and socio-economic status. Blood lead levels (BLLs), bone growth markers, such as serum osteocalcin (OC), alkaline phosphatase (ALP), bone alkaline phosphatase (BAP), and bone resorption markers: serum pyridinoline (Pry), deoxypyridinoline (DPry), tartrate-resistant acid phosphatase-5b(TRACP-5b), and hydroxyproline in urine (HyP-U) of participants were investigated. Pain and discomfort in the musculoskeletal system were assessed using Nordic Musculoskeletal Questionnaire. Results: Pb-exposure was significantly associated with musculoskeletal discomfort of the lower back (P<0.001), upper back (P<0.001), and ankle/foot (P=0.011). Among bone formation markers, serum OC was significantly lower in musculoskeletal discomfort of elbows (P=0.033) and ankle/foot (P=0.042). Among bone resorption markers, serum DPry was significantly lower in musculoskeletal discomfort of the neck (P=0.049) and shoulders (P=0.023). HyP-U was significantly higher in musculoskeletal discomfort of shoulders (P=0.035) and lower back (P=0.036). Conclusion: As evidenced by the obtained results, Pb-exposure was associated with musculoskeletal discomfort of the lower back, upper back, and ankle/foot. Lower bone formation (serum OC) marker was noted with musculoskeletal discomfort of elbows and ankle/foot. Furthermore, bone resorption markers were associated with musculoskeletal discomfort of the neck, shoulders, and lower back. The findings of the present study suggested that long-term Pb-exposure and BTMs were associated with musculoskeletal discomfort.
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Mostoufi-Moab, Sogol, e Leanne M. Ward. "Skeletal Morbidity in Children and Adolescents during and following Cancer Therapy". Hormone Research in Paediatrics 91, n. 2 (27 novembre 2018): 137–51. http://dx.doi.org/10.1159/000494809.
Testo completoAbstract (sommario):
Skeletal abnormalities are common in children and adolescents diagnosed and treated for a malignancy. The spectrum ranges from mild pain to debilitating osteonecrosis and fractures. In this review, we summarize the impact of cancer therapy on the developing skeleton, provide an update on therapeutic strategies for prevention and treatment, and discuss the most recent advances in musculoskeletal research. Early recognition of skeletal abnormalities and strategies to optimize bone health are essential to prevent long-term skeletal sequelae and diminished quality of life in childhood cancer survivors.
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Conzade, Romy, Steven Phu, Sara Vogrin, Ebrahim Bani Hassan, Walter Sepúlveda-Loyola, Barbara Thorand e Gustavo Duque. "Changes in Nutritional Status and Musculoskeletal Health in a Geriatric Post-Fall Care Plan Setting". Nutrients 11, n. 7 (9 luglio 2019): 1551. http://dx.doi.org/10.3390/nu11071551.
Testo completoAbstract (sommario):
Understanding how changes in nutritional status influence musculoskeletal recovery after falling remains unclear. We explored associations between changes in nutritional status and musculoskeletal health in 106 community-dwelling older adults aged ≥65 years, who attended the Falls and Fractures Clinic at Sunshine Hospital in St Albans, Australia after falling. At baseline and after 6 months, individuals were assessed for Mini Nutritional Assessment (MNA®), grip strength, gait speed, Timed Up and Go (TUG) test, Short Physical Performance Battery (SPPB), and bone turnover marker levels. Associations were examined using multiple linear regression, adjusted for baseline covariates and post-fall care plans. Over 6 months, the prevalence of malnutrition or risk thereof decreased from 29% to 15% using MNA <24/30. Specifically, 20 individuals (19%) improved, 7 (7%) deteriorated, and 73 (69%) maintained nutritional status, including 65 (61%) who remained well-nourished and 8 (8%) who remained malnourished/at risk. A 1-point increase in MNA score over 6 months was associated with an increase of 0.20 points (95% confidence interval 0.10, 0.31, p < 0.001) in SPPB score. Improvement in nutritional status was associated with improvement in physical performance, providing a basis for interventional studies to ascertain causality and evaluate nutritional models of care for post-fall functional recovery in older adults.
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Kini, Sanjay, Aravind Shanbhag e Sachin Chandramohan. "Recurrent Infections in a Patient with Multiple Myeloma". Journal of Health and Allied Sciences NU 09, n. 02 (aprile 2019): 81–84. http://dx.doi.org/10.1055/s-0039-1693844.
Testo completoAbstract (sommario):
AbstractAn 80-year-old woman with recurrent urinary tract infection presented to the orthopaedic OPD at KS Hegde Memorial Health Center, Bailur, with gradual onset of generalized weakness, fatigue, anorexia, musculoskeletal pain, and particularly severe backache. The patient was diagnosed to have anemia but renal function tests were normal. X-ray spine showed multiple compression fractures. Serum electrophoresis confirmed the diagnosis of multiple myeloma. In an elderly patient with myalgia, anemia, and recurrent infections, the differential diagnosis of multiple myeloma should be kept in mind as it is often missed by clinicians.
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Palmer, Scott E., Sean P. McDonough e Hussni O. Mohammed. "Reduction of Thoroughbred racing fatalities at New York Racing Association racetracks using a multi-disciplinary mortality review process". Journal of Veterinary Diagnostic Investigation 29, n. 4 (14 giugno 2017): 465–75. http://dx.doi.org/10.1177/1040638717713051.
Testo completoAbstract (sommario):
Between January 1, 2013 and December 31, 2015, findings of a New York State Gaming Commission–Cornell University postmortem examination program were utilized in a multi-disciplinary mortality review process to review 129 racing fatalities at Thoroughbred racetracks operated by the New York Racing Association (NYRA). Musculoskeletal fractures comprised 79% of the fatalities; cardiopulmonary conditions accounted for 12% of the fatalities. Other causes of death included gastrointestinal (3%), respiratory (5%), and central nervous system (2%) conditions. Fetlock failure represented 50% of the musculoskeletal fatalities. The general distribution of these findings was very similar to that reported by the California Animal Health and Food Safety Laboratory System during the same period. These findings, used in conjunction with a comprehensive mortality review process and regulatory reform, have contributed to a significant reduction of the incidence of Thoroughbred racing fatalities at NYRA racetracks during the period of this review.
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Papageorgiou, Maria, e Emmanuel Biver. "Interactions of the microbiome with pharmacological and non-pharmacological approaches for the management of ageing-related musculoskeletal diseases". Therapeutic Advances in Musculoskeletal Disease 13 (gennaio 2021): 1759720X2110090. http://dx.doi.org/10.1177/1759720x211009018.
Testo completoAbstract (sommario):
Despite major progress in the understanding of the pathophysiology and therapeutic options for common ageing-related musculoskeletal conditions (i.e. osteoporosis and associated fractures, sarcopenia and osteoarthritis), there is still a considerable proportion of patients who respond sub optimally to available treatments or experience adverse effects. Emerging microbiome research suggests that perturbations in microbial composition, functional and metabolic capacity (i.e. dysbiosis) are associated with intestinal and extra-intestinal disorders including musculoskeletal diseases. Besides its contributions to disease pathogenesis, the role of the microbiome is further extended to shaping individuals’ responses to disease therapeutics (i.e. pharmacomicrobiomics). In this review, we focus on the reciprocal interactions between the microbiome and therapeutics for osteoporosis, sarcopenia and osteoarthritis. Specifically, we identify the effects of therapeutics on microbiome’s configurations, functions and metabolic output, intestinal integrity and immune function, but also the effects of the microbiome on the metabolism of these therapeutics, which in turn, may influence their bioavailability, efficacy and side-effect profile contributing to variable treatment responses in clinical practice. We further discuss emerging strategies for microbiota manipulation as preventive or therapeutic (alone or complementary to available treatments) approaches for improving outcomes of musculoskeletal health and disease.
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Hill, Thomas R., e Terry J. Aspray. "The role of vitamin D in maintaining bone health in older people". Therapeutic Advances in Musculoskeletal Disease 9, n. 4 (14 febbraio 2017): 89–95. http://dx.doi.org/10.1177/1759720x17692502.
Testo completoAbstract (sommario):
This review summarises aspects of vitamin D metabolism, the consequences of vitamin D deficiency, and the impact of vitamin D supplementation on musculoskeletal health in older age. With age, changes in vitamin D exposure, cutaneous vitamin D synthesis and behavioural factors (including physical activity, diet and sun exposure) are compounded by changes in calcium and vitamin D pathophysiology with altered calcium absorption, decreased 25-OH vitamin D [25(OH)D] hydroxylation, lower renal fractional calcium reabsorption and a rise in parathyroid hormone. Hypovitaminosis D is common and associated with a risk of osteomalacia, particularly in older adults, where rates of vitamin D deficiency range from 10–66%, depending on the threshold of circulating 25(OH)D used, population studied and season. The relationship between vitamin D status and osteoporosis is less clear. While circulating 25(OH)D has a linear relationship with bone mineral density (BMD) in some epidemiological studies, this is not consistent across all racial groups. The results of randomized controlled trials of vitamin D supplementation on BMD are also inconsistent, and some studies may be less relevant to the older population, as, for example, half of participants in the most robust meta-analysis were aged under 60 years. The impact on BMD of treating vitamin D deficiency (and osteomalacia) is also rarely considered in such intervention studies. When considering osteoporosis, fracture risk is our main concern, but vitamin D therapy has no consistent fracture-prevention effect, except in studies where calcium is coprescribed (particularly in frail populations living in care homes). As a J-shaped effect on falls and fracture risk is becoming evident with vitamin D interventions, we should target those at greatest risk who may benefit from vitamin D supplementation to decrease falls and fractures, although the optimum dose is still unclear.
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Samad, Navira, Hanh H. Nguyen, Peter R. Ebeling e Frances Milat. "Musculoskeletal Health in Premature Ovarian Insufficiency. Part Two: Bone". Seminars in Reproductive Medicine 38, n. 04/05 (settembre 2020): 289–301. http://dx.doi.org/10.1055/s-0041-1722849.
Testo completoAbstract (sommario):
AbstractAccelerated bone loss and muscle loss coexist in women with premature ovarian insufficiency (POI), but there are significant gaps in our understanding of musculoskeletal health in POI. This review describes estrogen signaling in bone and its role in skeletal health and disease. Possible mechanisms contributing to bone loss in different forms of POI and current evidence regarding the utility of available diagnostic tests and therapeutic options are also discussed. A literature review from January 2000 to March 2020 was conducted to identify relevant studies. Women with POI experience significant deterioration in musculoskeletal health due to the loss of protective effects of estrogen. In bone, loss of bone mineral density (BMD) and compromised bone quality result in increased fracture risk; however, tools to assess bone quality such as trabecular bone score (TBS) need to be validated in this population. Timely initiation of HRT is recommended to minimize the deleterious effects of estrogen deficiency on bone in the absence of contraindications; however, the ideal estrogen replacement regimen remains unknown. POI is associated with compromised bone health, regardless of the etiology. Ongoing research is warranted to refine our management strategies to preserve bone health in women with POI.
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Millar, Ian L., Folke G. Lind, Karl-Ake Jansson, Michal Hajek, David R. Smart, Tiago D. Fernandes, Rosemary A. McGinnes et al. "Hyperbaric Oxygen for Lower Limb Trauma (HOLLT): an international multi-centre randomised clinical trial". Diving and Hyperbaric Medicine Journal 52, n. 3 (30 settembre 2022): 164–74. http://dx.doi.org/10.28920/dhm52.3.164-174.
Testo completoAbstract (sommario):
Introduction: Hyperbaric oxygen treatment (HBOT) is sometimes used in the management of open fractures and severe soft tissue crush injury, aiming to reduce complications and improve outcomes. Methods: Patients with open tibial fractures were randomly assigned within 48 hours of injury to receive standard trauma care or standard care plus 12 sessions of HBOT. The primary outcome was the incidence of necrosis or infection or both occurring within 14 days of injury. Results: One-hundred and twenty patients were enrolled. Intention to treat primary outcome occurred in 25/58 HBOT assigned patients and 34/59 controls (43% vs 58%, odds ratio (OR) 0.55, 95% confidence interval (CI) 0.25 to 1.18, P = 0.12). Tissue necrosis occurred in 29% of HBOT patients and 53% of controls (OR 0.35, 95% CI 0.16 to 0.78, P = 0.01). There were fewer late complications in patients receiving HBOT (6/53 vs 18/52, OR 0.22, 95% CI 0.08 to 0.64, P = 0.007) including delayed fracture union (5/53 vs 13/52, OR 0.31, 95% CI 0.10 to 0.95, P = 0.04). Quality of life measures at one and two years were superior in HBOT patients. The mean score difference in short form 36 was 2.90, 95% CI 1.03 to 4.77, P = 0.002, in the short musculoskeletal function assessment (SMFA) was 2.54, 95% CI 0.62 to 4.46, P = 0.01; and in SMFA daily activities was 19.51, 95% CI 0.06 to 21.08, P = 0.05. Conclusions: In severe lower limb trauma, early HBOT reduces tissue necrosis and the likelihood of long-term complications, and improves functional outcomes. Future research should focus on optimal dosage and whether HBOT has benefits for other injury types.