A systematic review of Vancouver B2 and B3 periprosthetic femoral fractures

Aims The aim of this study was to investigate the outcomes of Vancouver type B2 and B3 fractures by performing a systematic review of the methods of surgical treatment which have been reported. Materials and Methods A systematic search was performed in Ovid MEDLINE, Embase and the Cochrane Central Register of Controlled Trials. For inclusion, studies required a minimum of ten patients with a Vancouver type B2 and/or ten patients with a Vancouver type B3 fracture, a minimum mean follow-up of two years and outcomes which were matched to the type of fracture. Studies were also required to report the rate of re-operation as an outcome measure. The protocol was registered in the PROSPERO database. Results A total of 22 studies were included based on the eligibility criteria, including 343 B2 fractures and 167 B3 fractures. The mean follow-up ranged from 32 months to 74 months. Of 343 Vancouver B2 fractures, the treatment in 298 (86.8%) involved revision arthroplasty and 45 (12.6%) were treated with internal fixation alone. A total of 37 patients (12.4%) treated with revision arthroplasty and six (13.3%) treated by internal fixation only underwent further re-operation. Of 167 Vancouver B3 fractures, the treatment in 160 (95.8%) involved revision arthroplasty and eight (4.8%) were treated with internal fixation without revision. A total of 23 patients (14.4%) treated with revision arthroplasty and two (28.6%) treated only with internal fixation required re-operation. Conclusion A significant proportion, particularly of B2 fractures, were treated without revision of the stem. These were associated with a higher rate of re-operation. The treatment of B3 fractures without revision of the stem resulted in a high rate of re-operation. This demonstrates the importance of careful evaluation and accurate characterisation of the fracture at the time of presentation to ensure the correct management. There is a need for improvement in the reporting of data in case series recording the outcome of the surgical treatment of periprosthetic fractures. We have suggested a minimum dataset to improve the quality of data in studies dealing with these fractures

A powerful genome-wide feasible approach to detect parent-of-origin effects in studies of quantitative traits

There is currently a lot of interest in the role of genomic imprinting in mammalian development. Many human diseases, such as cancer, obesity, diabetes and behavioral traits, may be related to imprinted genes. When searching for genes related to complex disorders, the power of genome-wide association analysis can be improved by introducing parent-of-origin effects into the analyses. For quantitative traits, family-based TDT analysis has successfully implemented such an approach. Although attractive for several reasons, TDT-based tests are known to be less powerful than methods based on measured genotype approaches. In this study, we describe a fast, powerful method for detecting parent-of-origin effects in studies of quantitative traits using a measured genotype framework. First, for each locus studied, we estimate the probabilities of an allele's parental origin using multipoint haplotype reconstruction. Next, we introduce the parental origin of these alleles as a covariate in regression models during the second step of GRAMMAR, a fast approximation to the measured genotype approach. We show that, compared with a TDT-based analysis, our method has a higher power to detect a locus exhibiting a parent-of-origin effect. Moreover, our method is applicable to a wider range of data, including pedigree structures that are not very informative for TDT. The method gives no false positives in the absence of parent-of-origin effects, under both additive and dominant models. As this method is an extension of the rapid GRAMMAR analysis, it is fast enough to be suitable for genome-wide association scans