• Comparison of serum Dkk1 (Dickkopf-1) and bone mineral density in patients on bisphosphonate treatment vs no treatment.

      Memon, Adeel R; Butler, Joseph S; O'Riordan, Michael V; Guerin, Elizabeth; Dimitrov, Borislav D; Harty, James A; Department of Trauma and Orthopaedics, Cork University Hospital, Cork, Ireland. dowite2003@hotmail.com (2013-05-17)
      Complex pathways affect bone metabolism at the cellular level, and a balance between osteoblast and osteoclast activity is critical to bone remodeling. One of the major pathways affecting bone metabolism is Wnt/β-catenin signaling, and its disturbances lead to a wide range of bone abnormalities. An important antagonist of this pathway is Dickkopf-1 (Dkk1). Higher Dkk1 levels have been associated with increased bone loss due to inhibition of Wnt pathway. Currently, bisphosphonates are the most commonly used agents to treat primary osteoporotic patients. This study demonstrates the effect of bisphosphonates on Dkk1 levels and its correlation with bone mineral density (BMD). Eighty patients with low BMD were recruited and divided into 2 groups of 40 each (bisphosphonate treatment group and control group). The mean Dkk1 level in the treatment group was significantly reduced to 2358.18 vs 3749.80 pg/mL in the control group (p<0.001). Pearson correlation coefficient showed negative correlation between Dkk1 and BMD at lumbar spine (r=-0.55) and femoral neck in the control group; however, no such correlation was found in the treatment group (r=-0.05). Hence, bisphosphonate therapy leads to reduction in Dkk1 levels, but it does not correlate with BMD in such patients.
    • Infection or metal hypersensitivity? The diagnostic challenge of failure in metal-on-metal bearings.

      Galbraith, John G; Butler, Joseph S; Browne, Tara-Jane; Mulcahy, David; Harty, James A; Department of Trauma & Orthopaedic Surgery, Cork University Hospital & St Mary's Orthopaedic Hospital, Cork, Ireland. johng442@hotmail.com (2011-04)
      The use of second generation metal-on-metal hip articulations has gained favour in the past few years. A hypersensitivity reaction to the metal-on-metal bearing, although rare, is a reported complication and is a novel mode of failure of these implants. Differentiating failure secondary to infection from failure secondary to metal hypersensitivity represents a significant diagnostic challenge. A retrospective review of all cases of hip arthroplasty using metal-on-metal bearings over a 5-year period at a tertiary referral centre identified 3 cases of failure secondary to metal hypersensitivity. Clinical presentation, serological markers, radiological imaging and histological analysis of all cases identified were evaluated. Histological analysis of periprosthetic tissue in all 3 cases identified characteristic features such as perivascular lymphocytic aggregates and chronic inflammation consistent with aseptic lymphocytic vasculitis-associated lesions (ALVAL). This study highlights that failure secondary to metal hypersensitivity must be considered in patients presenting with the reappearance of persistent pain, marked joint effusion, and the development of early osteolysis in the absence of infection.
    • Opioid toxicity as a cause of spontaneous urinary bladder rupture.

      Galbraith, John G; Butler, Joseph S; McGreal, Gerard T; Department of Surgery, Mercy University Hospital Cork, Ireland. johng442@hotmail.com (Elsevier, 2011-02)
    • Recurrent spontaneous hip dislocation in a patient with neurofibromatosis type 1: a case report.

      Galbraith, John G; Butler, Joseph S; Harty, James A; Department of Trauma & Orthopaedic Surgery, Cork University Hospital & St, Mary's Orthopaedic Hospital, Cork, Ireland. johng442@hotmail.com. (2011)
      Neurofibromatosis type-1 is a common genetic disorder which often affects the skeleton. Skeletal manifestations of neurofibromatosis type-1 include scoliosis, congenital pseudarthrosis of the tibia and intraosseous cystic lesions. Dislocation of the hip associated with neurofibromatosis type-1 is a rare occurrence and is underreported in the literature.
    • Sacral insufficiency fractures: an easily overlooked cause of back pain in the ED.

      Galbraith, John G; Butler, Joseph S; Blake, Simon P; Kelleher, Gemma; Department of Emergency Medicine, Cork University Hospital, Cork, Ireland. johng442@hotmail.com (2011-03)
      Sacral insufficiency fractures are an important and treatable cause of severe back pain. Despite publication of several case reports since its original description in 1982, awareness of these injuries remains inadequate in emergency medicine. Most patients are elderly women presenting with intractable lower back pain. Postmenopausal osteoporosis is the most significant risk factor. Marked sacral tenderness is common. Neurologic impairment is rarely detectable. Routine radiography of the spine and pelvis is usually inconclusive. Computed tomography remains the diagnostic modality of choice. Treatment is usually conservative.