Ghassan Maalouf

Construction of the Femoral Neck During Growth Determines Its Strength in Old Age

Study of the design of the FN in vivo in 697 women and in vitro in 200 cross‐sections of different sizes and shapes along each of 13 FN specimens revealed that strength in old age was largely achieved during growth by differences in the distribution rather than the amount of bone material in a given FN cross‐section from individual to individual.

Prevalence and predictors of vitamin D inadequacy amongst Lebanese osteoporotic women.

In Middle-Eastern countries, more particularly in Lebanon, the incidence of vitamin D deficiency has been found to be surprisingly high in schoolchildren and young individuals. However, the prevalence and risk factors for vitamin D inadequacy amongst Lebanese osteoporotic women seeking medical health care has never been studied. We analysed vitamin D-inadequacy risk factors among the 251 Lebanese postmenopausal osteoporotic women (from both Muslim and Christian communities) who participated in a vitamin D international epidemiological study. Vitamin D inadequacy prevalence (25-hydroxyvitamin D (25(OH)D) , 30 ng/ml) was 84.9%. 25(OH)D was negatively correlated with BMI (r 20.41; P<0.001) and positively correlated with educational level (r 0.37; P<0.001) and self-reported general health (r 0.17; P<0.01). No significant correlation was found with age and no seasonal variation was observed. There was no significant correlation between 25(OH)D and sun exposure index or vitamin D-rich food consumption. However, 25(OH)D strongly correlated with vitamin D supplement intake (r 0.48; P<0.0001). Muslim community participants had lower 25(OH)D levels compared with their Christian counterparts (P<0.001). They also had higher BMI, lower educational level and vitamin D supplement consumption and followed more frequently a dress code covering the arms (P<0.0001 for all variables). In a multivariate model, in Muslims, inadequate vitamin D supplements and a dress code covering the arms are the independent predictors of 25(OH)D inadequacy (P<0.001 for both variables). However, in Christians, the predictors are inadequate vitamin D supplements, high BMI and low educational level (P<0.001; P=002 and P=0.02 respectively). There is an urgent need to increase vitamin D supplement use in Middle-Eastern osteoporotic women, more particularly in those from the Muslim community.

Dietary calcium and vitamin D intake in an adult Middle Eastern population: food sources and relation to lifestyle and PTH.

Little is known about calcium and vitamin D intakes in Middle Eastern countries, where the prevalence of hypovitaminosis D is high. This study identifies major sources of calcium and vitamin D in the Lebanese diet, examines lifestyle factors that may influence intake of these nutrients and investigates the relationship between nutritional or lifestyle factors and parathyroid hormone (PTH). Three hundred sixteen young healthy volunteers aged 30 to 50 (men, non-veiled and veiled women) were recruited from different rural and urban Lebanese community centers. Food frequency questionnaire was used to evaluate the consumption of vitamin D and calcium-rich foods. We also measured serum PTH levels. Mean daily calcium and vitamin D intake were respectively 683.8 +/- 281.2 mg and 100.6 +/- 71.0 IU. Daily vitamin D sources were divided as follows: 30.4 +/- 46.4 IU from milk and dairy products, 28.2 +/- 26.3 IU from meat and poultry, 25.8 +/- 25 IU from fish, 8.5 +/- 8.6 IU from eggs, and 7.8 +/- 14.3 IU from sweets (respectively 30.2%, 28%, 25.6%, 8.4% and 7.7% of the total vitamin D intake). Mean daily calcium from animal and vegetable sources were respectively 376.3 +/- 233.6 mg and 307.9 +/- 118.5 mg. Animal/total calcium intake ratio was 52% and was only statistically significantly higher in urban people compared to rural ones. Multivariate analysis showed that male sex and urban residence were independent predictors of both vitamin D and calcium intakes (p < 0.01 and p < 0.01 respectively). In addition, veiling was an independent predictor of low vitamin D intake (p < 0.05) and a high body mass index (BMI) was an independent predictor of low calcium intake (p < 0.05). Finally, PTH was inversely correlated with vitamin D intake and the animal/total calcium intake ratio (r = -0.18 and r = -0.22, p < 0.01), while no significant results were achieved for the vegetable calcium. In a multivariate model, urban living, female gender, low vitamin D and calcium intakes, low animal/total calcium intake ratio, and high BMI, are independent predictors of hyperparathyroidism. The deficient nutritional status of vitamin D and calcium in Lebanon justify the implementation of dietary public health measures. People at most risk for secondary hyperparathyroidism should be advised to increase their dietary calcium (mostly animal calcium) and vitamin D, to take supplements, or to increase their sun exposure.

Loss of regularity in the curvature of the thoracolumbar spine: A measure of structural failure

Departure from regularity (smoothness) in the curvature of the spine was quantified and correlated with the number of fractures, deficits in height, BMD, and identified women with vertebral fractures.

Long-term follow-up on microsurgical free-tissue transfer in foot and ankle reconstruction.

BACKGROUND We have previously reported on the efficacy of free-tissue transfer in ankle and foot reconstruction with a mean follow-up period of 3.7 years (9 months-7.5 years) postoperatively. This study will evaluate the long-term results of free-tissue transfer performed for soft tissue defect coverage, diabetic foot salvage and the treatment of chronic osteomyelitis in 38 patients. METHODS The long-term efficacy of free-tissue transfer for foot and ankle reconstruction was evaluated in a retrospective study among patients operated during a period of 5 years (January 1992-December 1996); 38 were available for follow-up. Indications for reconstruction included acute wounds with soft tissue defects, diabetic foot ulcers, and chronic osteomyelitis. RESULTS At a mean follow-up of 12 years, there were no major complications in the soft tissue defect group. Among the diabetic patients, two patients had recurrent ulcerations of the forefoot which were detected early and treated conservatively. In the osteomyelitis group, however, there were no recurrences of the foot infection. CONCLUSIONS The free-tissue transfer provided an excellent method of soft tissue reconstruction with a very minimal long-term complication rate, and a very high rate of success in the treatment of diabetic foot ulcers and chronic osteomyelitis.

Persistent bladder entrapment following acetabular fracture with subsequent vesical injury during total hip arthroplasty. A case report.

M ost urological injuries encountered by orthopaedic surgeons are associated with pelvic trauma. Acute injuries to the bladder, prostate, and urethra may occur in association with 13.5% to 46.6% of pelvic fractures1-3. Bladder ruptures account for the majority of these injuries4 and typically occur in association with high-energy trauma, such as motor-vehicle accidents, falls, industrial accidents, or abdominal blows5,6. While bladder rupture is much more common, three cases of acute bladder entrapment after pelvic fracture have been reported in the English-language literature4,7,8. Urological injuries following primary total hip arthroplasty are also infrequent. In patients with cemented acetabular components, acute injuries to the bladder can occur as the result of medial wall perforation or cement extrusion9,10 or in association with cement and component extraction during revision surgery11. In patients with uncemented acetabular components, acute urologic or gastrointestinal injuries can occur as a result of errant drill-bit or screw placement12. Late presentation of urologic complications has been reported as a consequence of medial migration of an acetabular component12,13. In the present report, we describe the case of a patient who had had a previous acetabular fracture that had healed with an unrecognized bladder entrapment and who sustained a penetrating bladder injury during primary total hip replacement. To our knowledge, injury of an entrapped bladder during hip arthroplasty has not been previously reported. The patient was informed that data concerning this case would be submitted for publication. A forty-three-year-old man was admitted to our institution for a right total hip arthroplasty. He had severe progressive mechanical pain in the right hip and a limited walking distance. Twenty years earlier, he had been involved in a motor-vehicle accident …

Ostéomyélite néonatale du col du fémur avec contamination articulaire : À propos d'un cas au recul de 10 ans et revue de la littérature

Acute hematogenous osteomyelitis most frequently occurs in children, generally around 6 to 9 years of age. If it occurs in early infancy, the infection usually involves both the bone and the joint, nearly simultaneously. Neonatal osteomyelitis is another presentation, with an osteomyelitic focus in the metaphysis. We report a case of septic arthritis following osteomyelitis of the hip joint in a neonate caused by a virulent pathogenic organism. Despite late diagnosis and treatment, outcome was very satisfactory with few sequelae for the joint and epiphysis. It should be emphasized that early diagnosis, with prompt and adequate treatment is essential to achieve good outcome. We discuss this case and present a review of the literature.