Ann Arbor

Stable Fixation of Intertrochanteric Fractures

The combined roles of three different positions of reduction and three different fixation devices in stabilization of a standard four-fragment intertrochanteric fracture were studied to determine which combination would best support the load of weight-bearing. Experimental four-part fractures were produced in forty-one pairs of embalmed adult femora. These fractures were stabilized using an anatomical reduction position, the Dimon-Hughston position of medial displacement, and the Wayne County General Hospital position of slight lateral and upward displacement of the femoral shaft fragment, combined with Jewett nail, telescoping screw, and Holt nail implants in all combinations. The stabilized specimens were loaded to failure and examined for the maximum load supported and for resistance to continued deformation under load. The implant device was found to play the major role in fixation stability. The three positions of reduction exerted only a minor influence on the maximum load supported.

Agents used in the prevention and treatment of nonsteroidal anti-inflammatory drug-associated symptoms and ulcers

Coprescription of gastroprotective agents is a common practice for patients requiring nonsteroidal anti-inflammatory drug (NSAID) therapy, although there is limited evidence that some of these agents are effective. The prostaglandin analog misoprostol and the proton pump inhibitor omeprazole appear to be efficacious in decreasing NSAID-associated ulcers. Misoprostol has also been shown to decrease NSAID-associated gastrointestinal (GI) complications by 40% compared with placebo. Despite the efficacy of these drugs, their effectiveness in the general population has not yet been adequately determined with respect to reduction of symptoms and improvement in patient quality of life. Sucralfate and bismuth appear to be largely ineffective, and histamine receptor antagonists, when given at traditional ulcer-healing doses, decrease symptoms and duodenal ulcers only. The issue of outcomes research, therefore, needs to be more fully incorporated into any analysis of the effectiveness or cost-effectiveness of the widespread clinical use of such gastroprotective drugs.