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Background: Femoral neck stress fracture (FNSF) is considered rare, and, as a consequence, is easily misdiagnosed due to a lack of awareness. The initial presentation can be subtle, but serious sequelae, including avascular necrosis of the femoral head or non-union could occur without proper management. Case Report: A left FNSF in a regularly exercising postmenopausal woman treated by in situ fixation with multiple cannulated screws is presented. Dual energy X-ray absorptiometry (DXA) scan revealed osteopenic bone marrow density (BMD) T-score. Subcutaneous denosumab injection was prescribed immediately following the operation according to World Health Organization (WHO) recommendation. Successful radiographic union was observed after three months without complications, and the patient was able to return to sports activities after six months. Conclusion: An early and accurate diagnosis of FNSF is essential in returning to sport and preventing undesirable harmful consequences. [ABSTRACT FROM AUTHOR]

Background: Hip fractures are a major public health problem. Patients who have suffered a hip fracture have an increased risk of a subsequent hip fracture. This study examines the incidence ofsecondhip fractures and attempts to identify underlying risk factors., Objective: To examine the incidence ofsecond hip fractures in osteoporotic patients at Chiang Mai University Hospital and to identify risk factors related to second hip fractures., Material and Method: A retrospective review was conducted of all low-energy mechanism hip fracture patients admitted during 2008 and 2009. Analysis of second hip fractures was conducted using survival analysis and logistic regression analysis., Results: A total of 191 patients were observed for 391.68 person-years (mean 2.05 person-years per patient). Among that group, nine second hip fractures were identified, an overall incidence rate of 0.023 second fractures per person-year. Second hip fractures tended to occur within the first year following an initial hip fracture. There were no significant differences related to either gender or comorbid medical conditions. Logistic regression analysis revealed that increased risk of a second hip fracture was associated with age (highest between 80 to 89 years) and patients who were not treated for osteoporosis following their initial fracture., Conclusion: The incidence of second hip fractures at Chiang Mai University Hospital was 0.023 per person-year Careful follow-up of older patients, especially those over 80, and treatment ofosteoporosis with bisphosphonate plus vitamin D and calcium supplements was correlated with a reduction in the incidence of second hip fractures.

Objective: To investigate the one-year mortality rate after osteoporotic hip fracture and to identify factors associated with that mortality rate., Material and Method: A retrospective review of 275 osteoporotic patients who sustained a low-trauma hip fracture and were admitted in Chiang Mai University Hospital during January 1, 2006 to December 31, 2007 was accomplished. Eligibility criteria were defined as age over 50 years, fracture caused by a simple fall and not apathologicalfracture caused by cancer or infection. Results of this one-year mortality rate study were compared to studies of hip fracture patient mortality in 1997 and the period 1998-2003., Results: The average one-year mortality rate in 2006-2007 was 21.1%. Factors correlated with higher mortality were non-operative treatment, delayed surgical treatment, and absence of medical treatment for osteoporosis. The 2006-2007 mortality rate was slightly higher than for the 1997 and 1998-2003 periods., Conclusion: The one-year mortality rate after osteoporotic hip fracture of 21.1% was approximately 9.3 times the mortality rate for the same age group in the general population, indicating that treatment of osteoporosis as a means of helping prevent hip fracture is very important for the individual, the family, and society as a whole.

Background: Fracture prevention in osteoporotic patients is the primary treatment goal in assessing bone mineral density, identification of fracture risk, and determination of who should be treated. The literature shows that parameters of proximal femoral bone geometry such as hip axis length, femoral neck shaft angle (FNA), femoral neck width (FNW) and femoral neck cortical thickness (FNCT) can predict the risk of hip fracture. Those parameters are presented automatically with dual energy X-ray absorptiometry (DXA) scans, which are available in well-equipped hospitals., Objective: To determine the correlation between proximal femoral bone geometry and the parameters from DXA scans and those from plain radiographs., Material and Method: Forty-eight patients with no previous hip fractures or history of secondary osteoporosis underwent both a DXA scan of the hip area and a plain hip radiograph done in the same position, 25 degrees internal rotation. Bone geometries from both groups were measured to determine the correlation using Pearson correlation coefficient., Results: Correlation between the parameters HAL, FNA, FNW andFNCT from the DXA scans and from the measurement of the plain radiograph was significant (p < 0.01) and the level of correlation was moderate to high. The FNCT had least mean difference (0.04). In addition, the parameter FNCT less than 0.29 mm in both DXA scans and plain radiographs, showed a significant correlation with osteoporosis (T-score <-2.5)., Conclusion: The bone geometry parameters from either DXA scans orplain radiographs may be used to predict osteoporotic hip fracture with a moderate to high correlation. Plain radiographs are very helpful when DXA scan results are not available. The FNCT parameter has a strong correlation with osteoporosis.

Background: To perform total knee arthroplasty, some surgeons prefer to use a fixed valgus angle, for example 5° or 6°, for the distal femoral cut with every patient. This angle may be appropriate for some patients, but may not be for all., Objective: To determine the proper angle of the distal femoral cut during total knee arthroplasty (TKA) in Thai patients with osteoarthritis of the knee., Material and Method: A cross-sectional study was conducted of 80 osteoarthritic knees of 50 Thai patients with a mean age of 69 years (range 52-82, SD 7.64) who had received total knee arthroplasty at Chiang Mai University Hospital between January 2011 and March 2013. The femoral mechanical-anatomical (FMA) angle, femorotibial (FT) angle, mechanical femorotibial (MFT) angle, femoral bowing angle, femoral length, hip offset, gender, and age of the patients were analysed using multivariate regression analysis., Results: Average FMA angle was 6.46° (range 4°-10°, SD 1.26°). The FMA angle was 6.85° and 5.28° in patients with varus and valgus deformity, respectively. Fifteen percent of all patients showed a FMA angle either less than 5° or greater than 7°., Conclusion: The average FMA angle of patients with gonarthrosis was 6.46°. If it is not possible to measure the FMA angle in Thai patients, 7° valgus cut angle is recommended for patients with varus deformity. Variation in this angle was high. Pre-operative measurement of FMA angle is beneficial for precise TKA.

Vitamin D insufficiency of Thai elderly women in urban area were higher than in rural area because of the difference in life style. Until now there are no any evidences about vitamin D status in Thai premenopausal women. This study was the multicenters study from 5 provinces of Thailand which cover all region of Thailand except southern area. The mean (SE) of calcidiol level of Thai premenopausal women was 29.09 (0.42) ng/ml, and with the cut point of < or = 35 ng/ml; the prevalence of vitamin D insufficiency was 77.81%. Chiang Mai had lowest calcidiol level (25.09 ng/ml) and had highest PTH, and bone resorption markers. The prevalence of vitamin D insufficiency was highest in Khon Kaen (88.78%) and Chiang Mai (84.62%) province respectively. Life style modification to expose more sunlight should be advised for increasing the serum vitamin D and lowering the risk of osteoporosis.

Objective: To study the possibility of primary human chondrocytes culture in gelatin scaffold and the effects of exogenous HA on chondrocyte differentiation and synthesis of the hyaline-like extracellular matrix., Material and Method: Cartilage tissue was engineered by using primary human chondrocytes with HA-treated gelatin scaffolds and gelatin scaffolds. The chondrogenic properties were monitored for chondrocyte proliferation, adhesion, and hyaline-like extracellular matrix production in both groups. The results were compared to each other., Results: Chondrocyte proliferation, adhesive activity, and new HA production were significantly increased in HA-treated gelatin scaffold (p < 0.05). Immuno histochemistry for WF6 epitope demonstrated the higher quality of hyaline-like extracellular matrix production. Moreover, the scanning electron micrograph showed a higher filling of extracellular matrix in the pore of scaffold of HA-treated gelatin scaffold than that in non-HA treated scaffold., Conclusion: The present study demonstrated the possible role of commercial gelatin-based scaffold in cartilage tissue engineering. It also demonstrated that exogenous HA-treated scaffold provides positive effects for chondrocytes.

The primary objective was to determine the factors which influence the requirement of surgical treatment of posterior cruciate ligament (PCL) injury. Ninety one PCL injured patients diagnosed in the "Sports Medicine Clinic", Maharaj Nakorn Chiang Mai Hospital from January 1998 to December 2000 were included in the present study. There were 63 males and 28 females with an average age of 29 years. All of the PCL-insufficient knees were initially treated by non-operative method including 3 phases of rehabilitation. They were followed through to the end of December 2003. Analysis showed that the degree of posterior laxity was the only factor that had a statistical significant correlation to failure of conservative treatment. In addition, the need for surgical treatment was not associated with gender age, cause of injury, and concomitant of injury. The authors concluded that PCL injured patients with posterior laxity greater than 10 millimeters should be treated by PCL reconstruction.

The incidence of hip fracture varies worldwide. From 1997 to 1998, the incidence of hip fracture in Chiang Mai was 151.2 and 185.2 per 100,000 from the hospital survey and the community survey respectively. The mortality rate in hospital following hip fracture was 2.1% and the one-year mortality rate rose steadily to 37%. In addition, morbidity after hip fracture may also carry serious implications on the functional independence and quality of life. Concerning the costs for treatment, hip fracture is also a great burden for the health service in Thailand. The risk factors for hip fracture include age, medical co-morbidities, current use of antihistamine, history of fracture, alcoholic consumption, low calcium intake and lack of physical activity, whereas calcium intake and physical activity were demonstrated as important protective factors against hip fracture. Improved understanding for epidemiology of hip fracture in Thailand could enhance the effectiveness for prevention of the fracture.

Background: Osteoporosis is defined as a skeletal disorder characterized by compromised bone strength predisposing a person to an increased risk of fracture. Hip fracture is the common and serious consequence of osteoporosis. To improve bone quality and prevent new fracture, osteoporosis should be treated while the patient was admitted with hip fracture problem. Several medications have been proven to be effective. Objectives of the present study were to determine the adequacy of diagnosis and treatment of osteoporosis in hip fracture patients., Material and Method: A retrospective study of all low energy trauma hip fracture patients, between 1998 and 2003 at the age of 50 years old or more. The National Osteoporosis Foundation guideline was used to identify adequacy of diagnosis and treatment of osteoporosis in this group of patients. Age, sex, admitted diagnosis, mechanism of injury, admission medication, treatment procedures, discharge medication, BMD investigation were analysed., Results: The percentage of calcium supplementation for the discharged patients in 1998 to 2003 was 0%, 10.5%, 33.3%, 32.7%, 39.3% and 43.0% respectively. The percentage of combination of calcium and vitamin D supplementation for the discharged patients was 0%, 8.8%, 21.1%, 12.7%, 24.6% and 37.5% respectively. Bisphosphonate was ordered in 9 and calcitonin in 20 patients. 7% of patients were diagnosied as osteoporosis. The quantity of osteoporosis was confirmed by DXA measurement in only one patient., Conclusions: In the past 6 years, most of the hip fracture patients were underdiagnosed and undertreated for osteoporosis. There was also a good trend for better treatment.