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Method and Instrumented Fixture for Femoral Fracture Testing in a Sideways Fall-on-the-Hip Position
Published on: August 17, 2017
Bone death in hip fracture in the elderly
C R Dunstan1, R A Evans, E Hills
1Metabolic Unit, Concord Hospital, Sydney, NSW, Australia.
Insights
Osteocyte viability in the femoral head declines with age. In hip fracture patients, reduced osteocyte viability and bone death may contribute to fractures, alongside osteoporosis.
Area of Science:
- Orthopedics
- Gerontology
- Biochemistry
Background:
- Osteocyte viability is crucial for bone health and integrity.
- Age-related changes in bone can increase fracture risk in the elderly.
- The role of osteocyte death in femoral neck fractures requires further investigation.
Purpose of the Study:
- To assess osteocyte viability in the femoral head using histochemical lactate dehydrogenase (LDH) activity.
- To compare osteocyte viability in healthy controls with that in patients suffering femoral neck fractures.
- To explore the relationship between osteocyte viability, bone mass, and microfracture callus in hip fracture patients.
Main Methods:
- Histochemical staining for lactate dehydrogenase (LDH) activity to determine osteocyte viability.
- Analysis of femoral head bone samples from 50 cadavers and 21 hip fracture patients.
- Samples were processed within 36 hours of death or fracture to ensure accurate viability assessment.
Main Results:
- A significant age-related decrease in mean osteocyte viability was observed in control subjects.
- Hip fracture patients exhibited variable osteocyte viability, with some showing extensive osteocyte death.
- Patients with extensive osteocyte death had less microfracture callus, while those with viable bone often had osteoporosis.
Conclusions:
- Osteocyte death, in addition to osteoporosis, may be a contributing factor to hip fractures in the elderly.
- Reduced osteocyte viability can compromise bone quality and increase susceptibility to fracture.
- Further research is needed to elucidate the mechanisms linking bone death and hip fracture incidence.
Abstract:
We examined femoral head bone from 50 cadavers and from 21 patients who had suffered pathologic fracture of the femoral neck. We used a histochemical technique for lactate dehydrogenase (LDH) activity to demonstrate osteocyte viability. The femoral heads were removed within 36 hours of death or fracture, as LDH activity persists in the cytoplasm of viable cells for this time at 37 degrees after interruption of the blood supply. In the controls, there was an age-related reduction in mean osteocyte viability, from 88 +/- 7% (mean +/- SD) at age 10-29 years to 58 +/- 12% at age 70-89 years. In the hip fracture patients, mean osteocyte viability was 58 +/- 21% but there was much variability in both osteocyte viability and bone mass. In 5 fracture patients, there was extensive osteocyte death, suggesting that most of the femoral head bone was nonviable; these patients had little microfracture callus. Others had predominantly viable bone which was usually osteoporotic, and their bone frequently showed microfracture callus. Osteomalacia was not seen in any patient. It is suggested that bone death, in addition to osteoporosis, may sometimes contribute to hip fracture in the elderly.
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