Shah Waliullah

Association of vitamin D receptor gene polymorphism (TaqI and Apa1) with bone mineral density in North Indian postmenopausal women

Vitamin D receptor (VDR) gene has an important role as a candidate gene for the regulation of bone mass in osteoporosis. However, its association with bone mineral density (BMD) is controversial and has not been established in different ethnic populations. To enhance the understanding of VDR gene polymorphism in the context of BMD, we investigated the plausible genetic association of TaqI and ApaI polymorphism with BMD in North Indian postmenopausal women with osteoporosis.254 osteoporotic women (Age 55.82 ± 6.91) and 254 postmenopausal non osteoporotic women (Age 54.76 ± 6.26) were included in the study. VDR TaqI and ApaI polymorphism were determined by PCR (polymerase chain reaction) and RFLP (restriction fragment length polymorphism). BMD was assessed by dual energy X-ray absorptiometry (DXA) at the lumbar spine (L1-L4), hip, forearm and femoral neck. The average BMD with TT genotype was significantly lower at lumbar spine, hip and forearm. The Frequency of TT genotype and t allele was significantly high in osteoporotic women when compared with controls. The average BMD with Aa genotype was higher in ApaI. Furthermore, comparison of frequency distribution of genotype and allele for VDR ApaI between osteoporotic patients and controls did not show any significant difference. Our findings revealed that TaqI gene TT genotype was associated with low BMD in North Indian osteoporotic women. Moreover, TT genotype and t allele associated significantly with osteoporosis in postmenopausal women. Therefore, VDR TaqI gene is an important determinant of risk factor for osteoporosis.

Association of Vitamin D Receptor (FokI and BsmI) Gene Polymorphism with Bone Mineral Density and Their Effect on 25-Hydroxyvitamin D Level in North Indian Postmenopausal Women with Osteoporosis

Osteoporosis is a systemic disease with a strong genetic component. Vitamin D receptor (VDR) has been suggested as a candidate gene for osteoporosis. Therefore the present study was aimed to investigate the pattern of allelic variants of VDR gene polymorphism (FokI and BsmI), its influence on vitamin D levels and bone mineral density (BMD) in North Indian postmenopausal women with osteoporosis for possible genetic association. 254 postmenopausal osteoporotic women and 254 postmenopausal non osteoporotic women were included in the study. VDR FokI and BsmI gene polymorphism gene were assessed by the PCR-RFLP method. Serum 25-hydroxyvitamin D was measured by the ELISA. BMD at the L1–L4 lumbar spine, hip, forearm and femoral neck was assessed by dual energy X-ray absorptiometry. The average BMD at spine and hip in postmenopausal women with bb and spine, hip, femoral neck and forearm with ff genotype had significantly low BMD. The frequency of ff genotype and f allele was significantly higher in postmenopausal osteoporotic women when compared with postmenopausal non osteoporotic women. However, no significant association was found between the genotypes and vitamin D levels. Our study reveals that VDR gene FokI and BsmI polymorphism is significantly associated with low bone mineral density. Therefore the ff genotype and f allele of VDR FokI gene may be used as an important risk factor for osteoporosis.

Management of type C distal humeral fracture using Von Gorder approach

Introduction: Exposure of articular fragments is a key factor to achieve accurate anatomical reduction in distal humeral fractures. Olecranon osteotomy is considered as gold standard for these fractures. Von Gorder′s approach allows exposure of articular surface by forming an inverted V-shaped flap of distal tricep in the distal humeral fracture. We evaluated the functional outcome in the management of distal humeral fractures treated by open reduction and internal fixation by Von Gorder′s approach. Method and Material: Total 22 patients with AO Type C distal humeral fracture were taken, C1 include 11, C2 includes 5 and rest 6 were C3 type. All patients were managed by open reduction and internal fixation through Von Gorder approach. Out of 22 bicolumnar fracture,19 were by recon plate and dynamic compression plate while 3 fractures were fixed by pre-contoured locking plates. Cases were followed up clinically as well as radiologically. Functional outcomes of patient were accessed in terms of Mayo Elbow Performance score (MEPS). Results: All patients had shown radiological union at an average 12.4 weeks, 17 (77%) patients had shown good to excellent score, 4 patients (18%) had fair outcome while 1 (4%) had poor outcome Mean MEPS score at final recent follow-up was 87. No patient had loss of rotatory motion although 86% patients had loss of terminal range of flexion/extension as compared to the normal side but their functional range of movement was good. The range of flexion was 123.0° (range 90°-135°), range of extension was 7° (range 0°-13°). Conclusion: Tricep Reflecting approach can be used in management of most of the distal humeral fractures as it provides adequate visualization and reduction however fractures having communition of trochlea and fractures involving anterior capitellum should not be attempt with this approach.

Difference between radiological and functional outcome with deltoid-splitting approach versus deltopectoral approach for the management of proximal humeral fractures with philos plate

Background: Proximal humeral fractures are one of the common fractures of upper extremity. Good results by various studies have been reported for proximal humeral locking plate (PHILOS) fixation in proximal humeral fractures. We want to evaluate whether it is only the implant which has given good results or different surgical approach utilized for fixation of plate also affects result. Materials and Methods: A total of 57 patients with proximal humeral fractures were divided in two groups, in Group A, patient′s classical deltopectoral approach utilized, while in Group B deltoid-splitting approach was used. All patients were managed by PHILOS plate fixation. Cases were followed up clinically as well as radiologically at 4-6 weeks after operation and thereafter at 10-12 weeks and then at 6 monthly for long-term complications. Functional outcomes of patient were accessed in terms Constant Scoring System, while radiological evaluation was done by taking x-rays to access quality of reduction and union of fracture. Results: All patients were followed for a minimum of 18 months. In Group B, reduction of tuberosities was better in 3 part and 4 part fractures. Mean Constant score in Group A at the end of 3 months was 56, while in Group B it was 62 and statistically significant (P = 0.02). At the end of 18 months, mean Constant score in Group A was 79, while in Group B it was 81 and statistically insignificant (P = 0.72). One patient in Group B showed axillary nerve paresis in postoperative period and recovered at the end of 3 months. Conclusion: We recommend that deltoid-splitting approach can be used in 3 part and 4 part complex proximal humeral fractures and in posterior fracture dislocation shoulder, which are difficult to approach with deltopectoral approach; however, care should be taken while inserting calcar screw in PHILOS plate fixation to avoid iatrogenic axillary nerve injury.

AB0625 Prevalence of post menopausal osteoporosis in patients with rheumatoid arthritis undergoing lower limb arthroplasty

Background Rheumatoid disorder is a common systemic disorder that causes joint destruction and frequently require joint replacement surgery. Osteoporosis is a recongnize complication of rheumatoid arthritis. Osteoporosis can affect the final outcome of any joint replacement surgery, if not diagnose and treated early. Objectives We have evaluated prevalence of post menopausal osteoporosis in Post menopausal female patients with Rheumatoid disorder awaiting for lower limb joint replacement surgery. Methods 87 patients, after satisfying inclusion and exclusion criterias, were enrolled in our study and bone mineral density was assessed by Dual Energy X-ray Absorptiometry (DEXA) scan and classified as per World Health Organisation classification. The logistic regression and multivariate analysis were used to find out the risk factors associated with osteoporosis in post menopausal female patients with rheumatoid arthritis. Results The overall rate of osteoporosis at any site was 39% and a further 41% of patients found to osteopaenic as per World Health Organization criteria. Significant risk factors associated with post menopausal osteoporosis in our study are Age, Body mass index, Onset of arthritis at younger age, History of prior fracture, Long term steroid intake and Co-morbidities. Conclusions High prevalence of osteoporosis found in our study suggests, BMD testing in post menopausal women should be made in patient undergoing arthroplasty surgery, to achieve successful functional outcome of arthroplasty surgery. Disclosure of Interest None Declared