B¯okin-b¯obai

Bone scintigraphy has a long and useful track record in the early detection of trauma, both acute and chronic, since its introduction in the 1970s as a new imaging modality. It has been widely used in the early detection of occult bone injury that is not evident on plain x-ray, with a significant increase in sensitivity with the adoption of SPECT. Adoption of scintigraphy into the investigation of sporting injuries was a more successful enterprise in the last 1970s and 1980s and, in many instances of stress fracture and the medial tibial stress syndrome, became the reference standard. MRI has diminished the role of scintigraphy with its exquisite contrast resolution and excellent spatial resolution, especially for soft-tissue injury. It reflects the cyclical nature of technological advances in imaging. We are now at another exciting crossroad, where SPECT has been combined with CT, allowing the marriage of the superb contrast resolution of SPECT with the high spatial resolution of CT. Early experience suggests that there is an incremental value of 25-30 % over SPECT or CT alone, opening up exciting possibilities for imaging trauma. Evidence for its utility in sporting and non-sporting trauma will be evaluated

Fixation using alternative implants for the treatment of hip fractures (FAITH): design and rationale for a multi-centre randomized trial comparing sliding hip screws and cancellous screws on revision surgery rates and quality of life in the treatment of femoral neck fractures

BACKGROUND: Hip fractures are a common type of fragility fracture that afflict 293,000 Americans (over 5,000 per week) and 35,000 Canadians (over 670 per week) annually. Despite the large population impact the optimal fixation technique for low energy femoral neck fractures remains controversial. The primary objective of the FAITH study is to assess the impact of cancellous screw fixation versus sliding hip screws on rates of revision surgery at 24 months in individuals with femoral neck fractures. The secondary objective is to determine the impact on health-related quality of life, functional outcomes, health state utilities, fracture healing, mortality and fracture-related adverse events. METHODS/DESIGN: FAITH is a multi-centre, multi-national randomized controlled trial utilizing minimization to determine patient allocation. Surgeons in North America, Europe, Australia, and Asia will recruit a total of at least 1,000 patients with low-energy femoral neck fractures. Using central randomization, patients will be allocated to receive surgical treatment with cancellous screws or a sliding hip screw. Patient outcomes will be assessed at one week (baseline), 10 weeks, 6, 12, 18, and 24 months post initial fixation. We will independently adjudicate revision surgery and complications within 24 months of the initial fixation. Outcome analysis will be performed using a Cox proportional hazards model and likelihood ratio test. DISCUSSION: This study represents major international efforts to definitively resolve the treatment of low-energy femoral neck fractures. This trial will not only change current Orthopaedic practice, but will also set a benchmark for the conduct of future Orthopaedic trials. TRIAL REGISTRATION: The FAITH trial is registered at ClinicalTrials.gov (Identifier NCT00761813)