cholecalciferol and Fractures--Ununited

The incidence of insufficiency fracture (IF) at femoral neck is low, accounting for about 5% of all insufficiency fractures, and IF at bilateral femoral neck is less common with more occurrence in athlete or serviceman. With the aging of populations, more cases of bilateral femoral neck IF have occurred recently, while the standard clinical treatment still remains lacking due to the complexity of these patients.. A 55-year-old male patient complained pain in his bilateral hip, with no history of trauma, glucocorticoid hormone consumption or radiotherapy, and imaging examination revealed fracture nonunion and shortening in his left femoral neck, and double fracture line on the right femoral neck. The patient received a cementless THA for the left femoral neck fracture and conservative treatment for the right side, followed by Elcatonin injection and oral administration of Carbonate D3 Granules. After 4 months of fellow-up, the patient presented improved functional scorings in bilateral hip joints, with no signs of prothesis infection or loosening.. We present a rare case of bilateral femoral neck IF in a middle-aged male and the treatment is successful. The timely CT and MRI examinations of bilateral hip joints for patients was necessary for orthopedists to select proper therapeutic regimen. In addition, the choice for therapeutic regimen of bilateral femoral IF should not only be based on the professional judgement of orthopedists, but also on the wishes of patients.

Topics: Adolescent; Aged; Aged, 80 and over; Arthroplasty, Replacement, Hip; Bone Screws; Calcitonin; Calcium-Regulating Hormones and Agents; Cholecalciferol; Conservative Treatment; Female; Femoral Neck Fractures; Femur Neck; Follow-Up Studies; Fracture Fixation, Internal; Fractures, Stress; Fractures, Ununited; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Tomography, X-Ray Computed; Treatment Outcome; Young Adult

To evaluate the effect of a single early high-dose vitamin D supplement on fracture union in patients with hypovitaminosis D and a long bone fracture.. Between July 2011 and August 2013, 113 adults with a long bone fracture were enrolled in a prospective randomised double-blind placebo-controlled trial. Their serum vitamin D levels were measured and a total of 100 patients were found to be vitamin D deficient (< 20 ng/ml) or insufficient (< 30 ng/mL). These were then randomised to receive a single dose of vitamin D. In all, 100 (89%) patients had hypovitaminosis D. Both treatment and control groups had similar demographics and injury characteristics. The initial median vitamin D levels were 16 ng/mL (interquartile range 5 to 28) in both groups (p = 0.885). A total of 14 patients were lost to follow-up (seven from each group), two had fixation failure (one in each group) and one control group patient developed an infection. Overall, the nonunion rate was 4% (two per group). No patient showed signs of clinical toxicity from their supplement.. Despite finding a high level of hypovitaminosis D, the rate of union was high and independent of supplementation with vitamin D

Topics: Adult; Aged; Aged, 80 and over; Cholecalciferol; Double-Blind Method; Drug Administration Schedule; Female; Follow-Up Studies; Fracture Fixation; Fractures, Bone; Fractures, Ununited; Humans; Male; Middle Aged; Prospective Studies; Treatment Outcome; Vitamin D Deficiency; Vitamins

A 45-year-old man with Werner's syndrome had large asymptomatic calcium deposits about the elbows, hips, and shoulders. During the four-year follow-up, he developed insufficiency fractures of the pelvis, both ulnas, one radius and one metatarsal, all of which failed to heal. Bone mineral densities evaluated by dual-energy X-ray absorptiometry were at the lower end of the normal range, but a histomorphometric study showed a reduction in trabecular bone volume and marked decreases in osteoid parameters with a calcification rate of zero. Serum assays of 25 hydroxy vitamin D3, 1,25 dihydroxy vitamin D3, osteocalcin and alkaline phosphatase were normal. The nonunions in this patient may have been caused by impaired osteoblast function associated with Werner's syndrome and/or by decreased activity of growth factors involved in bone repair.

Topics: Bone Density; Calcium; Cholecalciferol; Elbow; Follow-Up Studies; Fractures, Spontaneous; Fractures, Ununited; Humans; Knee Joint; Male; Middle Aged; Sacroiliac Joint; Tomography, X-Ray Computed; Werner Syndrome