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Periprosthetic fractures of the distal femur most commonly present as fragility fractures associated with relatively minor trauma. These injuries are often complicated by osteopenia of the distal femur secondary to stress shielding or osteolysis. Effective management of periprosthetic fractures of the distal femur requires knowledge of both fracture fixation techniques and revision arthroplasty. This article reviews the treatment options for these challenging fractures with a particular focus on the management of displaced fractures with a stable prosthesis.

Introduction: The aim of this study was to point out some dilemmas about the existence and pathogenesis of primary diabetic osteopathy as a separate entity, based on currently available studies. Expert disagreements are present not only about the occurrence of generalized osteopathy with diabetic disease, but also about direct relationship between metabolic diabetes control and bone metabolism and influence of disease duration and sex on bone changes., Pathogenesis of Diabetic Osteopathy: Decreased bone formation is the basic mechanism leading to decreased bone mass. Biochemical markers showed no clear connection with bone density measurement. Insulin and insulin-like growth facotr (IGF) affect bone metabolism. OSTEOPATHY IN PATIENTS WITH DIABETIC DISEASE-TYPE1: Some clinical studies have shown that patients with diabetic disease-type have a mild decrease in bone mass, while others have not presented such results. OSTEOPATHY IN PATIENTS WITH DIABETIC DISEASE-TYPE2: In patients with diabetic disease-type 2 the risk for osteopathy is even less defined. Patients treated with oral hypoglycemics present with higher decrease of bone mass has than patients treated with insulin therapy. This could partly be explained by anabolic effects of insulin on bones., Bone Fractures in Patients With Diabetic Disease: Literature data are contradictory concerning the occurrence of bone fractures in diabetic patients. A survey of bone fracture occurrence in diabetic patients was performed in "Veljko Vlahović Medical Center" in Vrbas and it included a group of 100 patients with diabetic disease. The results show that 12 patients had some fractures: mostly females in postmenopause, aged and with secondary insulin-dependent diabetes and most frequently arm fractures. Considering contradictory literature data, further longitudinal studies are necessary.

There were studied 453 young servicemen with dyshormonal strain bone disease in whom the hormonal status, state of carbohydrate and protein metabolism were investigated. It was established that in 92.9% of patients the growth hormone--somatotropic hormone (STH) was significantly decreased, production of thyroid hormones necessary for physiologic osteogenesis (T3 and T4) was impaired and albuminous fraction dissociation was revealed. The authors consider that in dyshormonal strain bone disease in young people the insufficiency of hormonal regulation of growth processes and bone regeneration is the primary factor while the physical strain is the additional secondary factor.