Clinical Cases in Mineral and Bone Metabolism最新文献

{"title":"Recurrent diabetic ketoacidosis: a rare presenting manifestation of primary hyperparathyroidism.","authors":"Rajesh Rajput,&nbsp;Ashima Mittal,&nbsp;Jasminder Singh,&nbsp;Satish Dalal,&nbsp;Shaweta Vohra","doi":"10.11138/ccmbm/2016.13.3.262","DOIUrl":"https://doi.org/10.11138/ccmbm/2016.13.3.262","url":null,"abstract":"<p><p>We report a rare case of primary hyperparathyroidism in a young female who presented with recurrent diabetic ketoacidosis. The patient had suffered an episode of acute pancreatitis in the past. On evaluation patient was found to have primary hyperparathyroidism and after removal of left inferior parathyroid adenoma her insulin requirement decreased by twelve units.</p>","PeriodicalId":47230,"journal":{"name":"Clinical Cases in Mineral and Bone Metabolism","volume":"13 3","pages":"262-264"},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5318186/pdf/262-264.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34756824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Natural mineral waters: chemical characteristics and health effects.","authors":"Sara Quattrini,&nbsp;Barbara Pampaloni,&nbsp;Maria Luisa Brandi","doi":"10.11138/ccmbm/2016.13.3.173","DOIUrl":"https://doi.org/10.11138/ccmbm/2016.13.3.173","url":null,"abstract":"<p><p>Water contributes significantly to health and a daily intake of 1.5 to 2 liters of water should be guaranteed, because a good hydration is essential to maintain the body water equilibrium, although needs may vary among people. However, worldwide population is far from the Recommended Allowance for water intake. Among the waters for human uses, there are 'waters (treated or not), intended for drinking, used for the food and beverages preparation or for other domestic purposes' and <i>natural mineral waters,</i> that are 'originated from an aquifer or underground reservoir, spring from one or more natural or bore sources and have specific hygienic features and, eventually, healthy properties'. According to the European Legislation (2009/54/EC Directive), physical and chemical characterization is used to make a classification of the different mineral waters, basing on the analysis of main parameters. Mineral composition enables to classify natural mineral waters as bicarbonate mineral waters, sulphate mineral waters, chloride mineral waters, calcic mineral waters, magnesiac mineral waters, fluorurate mineral waters, ferrous mineral waters and sodium-rich mineral waters. Although the concerns about bottled mineral waters (due to plasticizers and endocrine disruptors), many are the health effects of natural mineral waters and several studies explored their properties and their role in different physiological and pathological conditions.</p>","PeriodicalId":47230,"journal":{"name":"Clinical Cases in Mineral and Bone Metabolism","volume":"13 3","pages":"173-180"},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.11138/ccmbm/2016.13.3.173","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34756965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fix and replace; an emerging paradigm for treating acetabular fractures.","authors":"Colin G Murphy,&nbsp;Andrew D Carrothers","doi":"10.11138/ccmbm/2016.13.3.228","DOIUrl":"https://doi.org/10.11138/ccmbm/2016.13.3.228","url":null,"abstract":"<p><p>Although technically challenging even for the experienced surgeon, simultaneous open reduction and internal fixation (ORIF) of acetabular fracture and total hip replacement (THR) have some potential advantages over the more traditional treatment options in specific patient subgroups; theoretically allowing immediate weight bearing and faster rehabilitation, reducing the cost of inpatient stay, and reducing the risks of early and late local complications associated with standard treatment for this type of injury. We review the evolution of the indications and techniques, outline the surgical challenges, and discuss implant options and outcomes for this treatment paradigm.</p>","PeriodicalId":47230,"journal":{"name":"Clinical Cases in Mineral and Bone Metabolism","volume":"13 3","pages":"228-233"},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5318177/pdf/228-233.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34756890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and effectiveness of teriparatide <i>vs</i> alendronate in postmenopausal osteoporosis: a prospective non randomized clinical study.","authors":"Gianfilippo Caggiari,&nbsp;Paolo Tranquilli Leali,&nbsp;Giulia Raffaella Mosele,&nbsp;Leonardo Puddu,&nbsp;Francesca Badessi,&nbsp;Carlo Doria","doi":"10.11138/ccmbm/2016.13.3.200","DOIUrl":"https://doi.org/10.11138/ccmbm/2016.13.3.200","url":null,"abstract":"<p><p>In this work we study the safety and effectiveness of teriparatide and alendronate in patients with postmenopausal osteoporosis at high risk of fracture; it was a double-blinded and it was done by examining the comparisons between teriparatide 20 μg/day and alendronate 10 mg/day. Safety and effectiveness analyses were based on data from 355 woman with a mean age of 68 years. Two groups (A and B) with T-score ≤-2.5 at bone mineral density were analyzed and 3 or more vertebral fractures on radiograph. Group A: was treated with teriparatide 20 μg/day and composed from 182 women, in post-menopausal age, without a history of cancer. Group B: was treated with alendronate 10 mg/day composed from 173 women, postmenopausal age, with previous history of cancer (non-active during the study). Clinical evaluations were on bone turnover markers (alkaline phosphatase, procollagene type 1 <i>N</i>-terminal propeptide, and <i>N</i>-telopeptide cross-links), dual-energy X-ray absorptiometry and health-related quality of life (HrQoL). Safety was assessed by reporting of adverse drug reactions (ADRs). The results of this study imply that teriparatide comparated with alendronate has a favorable safety profile and is effective in the treatment of patients with osteoporosis at high risk of fracture.</p>","PeriodicalId":47230,"journal":{"name":"Clinical Cases in Mineral and Bone Metabolism","volume":"13 3","pages":"200-203"},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5318172/pdf/200-203.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34756969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bone scintigraphy of severe hypercalcemia following simvastatin induced rhabdomyolysis.","authors":"Zubair B Mirza,&nbsp;Sophia Hu,&nbsp;Louis F Amorosa","doi":"10.11138/ccmbm/2016.13.3.257","DOIUrl":"https://doi.org/10.11138/ccmbm/2016.13.3.257","url":null,"abstract":"<p><p>Simvastatin induced rhabdomyolysis with renal failure is a well reported clinical entity with hyperkalemia recognized as a life threatening risk. The risk of delayed hypercalcemia during the recovery of renal function is not well appreciated as this varies in severity and can be caused by multiple mechanisms. We present a patient with high dose simvastatin induced rhabdomyolysis leading to late onset of severe hypercalcemia due to calcium phosphate deposition in muscles diagnosed by distinctive bone scintigraphy. A 60-year-old Asian male was admitted to the hospital for profound weakness one week following the initiation of simvastatin 80 mg daily post myocardial infarction. His clinical course was complicated by contrast nephropathy. One week later, he developed progressive weakness in all his extremities and inability to raise his head and eat. Simvastatin was discontinued at this point. CPK elevation to greater than 425,000 U was found, consistent with rhabdomyolysis. He became oliguric requiring hemodialysis. Muscle biopsy showed severe muscle necrosis and type 2 fiber atrophy. One month later, he developed hypercalcemia with suppressed intact PTH and 1, 25(OH) D levels. Whole body bone scintigraphy showed calcium phosphate deposition throughout his musculature. His calcium levels normalized in 1 week on hemodialysis. This patient's experience illustrates the marked risk of delayed severe hypercalcemia from rhabdomyolysis due to dissolution of myocellular calcium phosphate deposits. It also provides an opportunity to review the different mechanisms of hypercalcemia especially in statin induced rhabdomyolysis. Recognition of this phenomenon is critical for appropriate follow up and treatment of such patients.</p>","PeriodicalId":47230,"journal":{"name":"Clinical Cases in Mineral and Bone Metabolism","volume":"13 3","pages":"257-261"},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5318185/pdf/257-261.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34756822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Denosumab is really effective in the treatment of osteoporosis secondary to hypogonadism in prostate carcinoma patients? A prospective randomized multicenter international study.","authors":"Carlo Doria,&nbsp;Paolo Tranquilli Leali,&nbsp;Federico Solla,&nbsp;Gianluca Maestretti,&nbsp;Massimo Balsano,&nbsp;Robero Mario Scarpa","doi":"10.11138/ccmbm/2016.13.3.195","DOIUrl":"https://doi.org/10.11138/ccmbm/2016.13.3.195","url":null,"abstract":"<p><strong>Introduction: </strong>Osteoporosis is a complication of androgen deprivation therapy (ADT) in men with prostate carcinoma. The best defense against osteoporosis in prostate cancer is to identify patients with a high risk for fracture during the first clinical visit, select an effective anti-osteoporosis agent, and advise the patient to change his lifestyle and diet to prevent further bone loss. New agents include denosumab, a human monoclonal antibody that inhibits the RANK ligand (RANKL). RANKL promotes the formation, activity, and survival of osteoclasts and, thus, supports the breakdown of bone.</p><p><strong>Purpose: </strong>This is a multicenter, randomized, double-blind prospective study on use of denosumab <i>versus</i> alendronate in the therapy of secondary osteoporosis related to ADT in prostate cancer patients in three European countries (Italy, France, Switzerland).</p><p><strong>Patients and methods: </strong>In this 24-month observation study we enrolled 234 patients with diagnosis of osteoporosis underwent ADT for prostate cancer. All patients aged ≥55 years and had a dual-energy X-ray absorptiometry (DEXA) T-score <-1.0 (hip or spine, measured within last 2 years) and ≥ 1 fragility fracture. Patients were randomly assigned 1:1 to receive denosumab 60 mg subcutaneously every 6 months or alendronate (70 mg weekly) for 2 years. All patient received supplemental vitamin D (600 IU per day) and supplemental calcium to maintain a calcium intake of 1200 mg per day. Effectiveness of therapy in both groups (denosumab group and alendronate group) was assessed by changes in bone turnover markers (BTMs), Bone Mineral Density (BMD), fracture incidence, Visual Analogue Scale (VAS) score for back pain, and Short Form-8 (SF-8TM) health survey score for health-related quality of life (HRQoL). Percent changes from baseline in BTMs and BMD were assessed using the paired t test; a P-value 0.05). Mean changes in BMD at final follow-up differed significantly between two groups. BMD changes at the lumbar spine at 24 months were 5.6% with denosumab <i>vs</i> -1.1% with alendronate (P<0.001). New vertebral fractures developed in fewer patients in the denosumab group than in the alendronate group during the 24-month period, although this difference was not significant (P=0.10). Back pain significantly (P<0.001) improved from baseline at all time points during the study in both study groups. SF-8 health survey scores significantly improved following treatment with both drugs. Incidence of adverse drug reactions were similar in both groups.</p><p><strong>Conclusion: </strong>In our study denosumab and alendronate showed similar clinical efficacy in the therapy of ADT-related osteoporosis in men with prostate carcinoma; both drugs provided significant improvements in back pain and general health conditions. Denosumab showed significant increase of BTMs and BMD than alendronate with lower rate of new vertebral fractures.</p>","PeriodicalId":47230,"journal":{"name":"Clinical Cases in Mineral and Bone Metabolism","volume":"13 3","pages":"195-199"},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5318171/pdf/195-199.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34756885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From the Editor-in-Chief.","authors":"Maria Luisa Brandi","doi":"10.11138/ccmbm/2016.13.3.169","DOIUrl":"https://doi.org/10.11138/ccmbm/2016.13.3.169","url":null,"abstract":"","PeriodicalId":47230,"journal":{"name":"Clinical Cases in Mineral and Bone Metabolism","volume":"13 3","pages":"169"},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5318166/pdf/169.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34756964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hydroxyapatite in total hip arthroplasty. Our experience with a plasma spray porous titanium alloy/hydroxyapatite double-coated cementless stem.","authors":"Iacopo Castellini,&nbsp;Lorenzo Andreani,&nbsp;Paolo Domenico Parchi,&nbsp;Enrico Bonicoli,&nbsp;Nicola Piolanti,&nbsp;Francesca Risoli,&nbsp;Michele Lisanti","doi":"10.11138/ccmbm/2016.13.3.221","DOIUrl":"https://doi.org/10.11138/ccmbm/2016.13.3.221","url":null,"abstract":"<p><strong>Purpose: </strong>Total hip arthroplasty could fail due to many factors and one of the most common is the aseptic loosening. In order to achieve an effective osseointegration and reduce risk of lossening, the use of cemented implant, contact porous bearing surface and organic coating were developed. Aim of this study was to evaluate clinical and radiological mid-term outcomes of a porous titanium alloy/hydroxyapatite double coating manufactured cementless femoral stem applied with \"plasma spray\" technique and to demonstrate the possibility to use this stem in different types of femoral canals.</p><p><strong>Methods: </strong>Between January 2008 and December 2012, 240 consecutive primary total hip arthroplasties (THAs) were performed using a porous titanium alloy/hydroxyapatite double coating manufactured cementless femoral stem. 182 patients were examined: 136 were females (74.7%) and 46 males (25.2%); average age was 72 years old (ranging from 26 to 92 years old). For each patient, Harris Hip Scores (HHS) and Womac Scores were collected. All X-ray images were analyzed in order to demonstrate stem survival rate and subsidence.</p><p><strong>Results: </strong>Harris Hip Score was good or excellent in 85% of the cases (average 90%) and mean WOMAC score was 97.5 (ranging from 73.4 to 100). No cases of early/late infection or periprosthetic fracture were noticed, with an excellent implant survival rate (100%) in a mean period of 40 months (ranging from 24 and 84 months). 5 cases presented acute implant dislocation, 2 due to wrong cup positioning in a dysplastic acetabulum and 3 after ground level fall. Dorr classification of femoral geometry was uses and the results were: 51 type A bone, 53 type B bone and 78 type C bone. Stem subsidence over 2 mm was considered as a risk factor of future implant loosening and was evidenced in 3 female patients with type C of Dorr classification. No radiolucencies signs around the proximally coated portion of stem or proximal reabsorption were visible during the radiographic follow-up.</p><p><strong>Conclusions: </strong>Concerning the use of porous titanium alloy/hydroxyapatite double coating, this study reported an excellent implant survival rate in a mid-term period with a rate of 1,64% of subsidence in patients with type C of femoral canal but with an optimal HHS and Womac Score results. Regarding this stem, primary stability is guaranteed by trapezoid shape of proximal region and tapering in frontal plane through press-fit technique. Radiological absence of pedestal has been accepted as sign of no excessive stress transmission to distal cortex due to its tapered diaphyseal region. Thanks to the reported data, Authors can consider this double coating a valid choice with an excellent medium-term survival and encouraging subsidence results. Further studies are needed to ensure these results can be replicated.</p>","PeriodicalId":47230,"journal":{"name":"Clinical Cases in Mineral and Bone Metabolism","volume":"13 3","pages":"221-227"},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.11138/ccmbm/2016.13.3.221","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34756889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Atypical\" atypical femur fractures and use of bisphosphonates.","authors":"Denise M van de Laarschot,&nbsp;Matthijs P Somford,&nbsp;Agnes Jager,&nbsp;Edwin H Oei,&nbsp;P Koen Bos,&nbsp;M Carola Zillikens","doi":"10.11138/ccmbm/2016.13.3.204","DOIUrl":"https://doi.org/10.11138/ccmbm/2016.13.3.204","url":null,"abstract":"<p><strong>Background: </strong>Atypical femur fractures (AFFs) present a rare but serious condition associated with use of bisphosphonates. Underlying mechanisms and clinical risk factors remain unclear. According to the diagnostic criteria formulated by the ASBMR, a lateral localization of an AFF is required.</p><p><strong>Case history: </strong>We present a patient who developed bilateral leg pain while using an oral bisphosphonate and aromatase inhibitor in the course of adjuvant treatment for breast cancer. Initially she was diagnosed with bone metastases and received radiotherapy on the right femur. However, the bilateral periosteal reactions of the subtrochanteric femur are highly suggestive of AFFs. Our case meets all criteria for AFF except that she presented with lesions at the medial side of the femur. Therefore they could be best described as \"atypical\" atypical femur fractures.</p><p><strong>Discussion: </strong>Since the pathogenesis of AFFs is not fully understood, we cannot rule out that AFFs also occur in the medial femur or in other weight-baring bones. Hence we propose that medial stress reactions belong to a spectrum of atypical fractures associated with use of antiresorptive drugs. The localization may depend on yet unknown biomechanical factors.</p><p><strong>Conclusion: </strong>We propose that these periosteal reactions of the subtrochanteric femur are in fact AFFs with uncommon medial localization and could hence be considered \"atypical\" AFFs. We recommend being alert of AFFs in patients with bone pain and medial subtrochanteric lesions. More epidemiological studies are needed to investigate the occurrence of both medial and lateral AFFs and to gain more insight into its frequency and pathogenesis.</p>","PeriodicalId":47230,"journal":{"name":"Clinical Cases in Mineral and Bone Metabolism","volume":"13 3","pages":"204-208"},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5318173/pdf/204-208.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34756886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term outcome of grade III and IV chondral injuries of the knee treated with Steadman microfracture technique.","authors":"Marco Pellegrino,&nbsp;Ermanno Trinchese,&nbsp;Michele Bisaccia,&nbsp;Giuseppe Rinonapoli,&nbsp;Luigi Meccariello,&nbsp;Gabriele Falzarano,&nbsp;Antonio Medici,&nbsp;Luigi Piscitelli,&nbsp;Pellegrino Ferrara,&nbsp;Auro Caraffa","doi":"10.11138/ccmbm/2016.13.3.237","DOIUrl":"https://doi.org/10.11138/ccmbm/2016.13.3.237","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of our study is to demonstrate the effectiveness of Steadman microfracture technique in the management of high-grade chondral defects at the level of the knee by clinical follow-ups at eleven years.</p><p><strong>Materials and methods: </strong>This is a study conducted on fifteen patients suffering from Outerbridge grade III and IV chondral lesions of the knee, who underwent Steadman microfracture surgery between 2003 and 2004. Selective exclusion criteria to prevent that other treatments or comorbidities could invalidate the results were used. Patients were clinically evaluated with Lysholm and IKDC scale scores before surgery and at follow-ups at eleven years.</p><p><strong>Results: </strong>There has been an improvement in the Lysholm scores (59.33 ± 18.2 at time zero <i>vs</i> 82.13 ± 14.16 at time t; p value: 0.0342) and in the IKDC scores (45.13 ± 17.07 at time zero <i>vs</i> 68.66 ± 21.47 at time t; p value: 0.04) that appears statistically significant.</p><p><strong>Discussion: </strong>Currently microfracture surgery is not indicated in patients with high-grade chondral defects, but at the same time, it is a technique of easy execution, low cost and good results. The clinical improvement observed appears statistically significant, but we have also noticed a slight clinical worsening in two patients, possibly caused by: improper treatment, new trauma, incorrect rehabilitation and age at time of surgery.</p><p><strong>Conclusions: </strong>The study has shown significant clinical improvements in patients, despite the fact that indications to the use of microfracture are still very limited and selective. It's essential to underline the importance of the single patient assessment process, taking into account a variety of aspects including the site, the number and extent of the lesion, the degree of functionality, activity level, age and previous trauma. This shows the importance of a comprehensive assessment of the patient in order to choose the most suitable surgical option, which not necessarily has to strictly adhere to standard practice.</p>","PeriodicalId":47230,"journal":{"name":"Clinical Cases in Mineral and Bone Metabolism","volume":"13 3","pages":"237-240"},"PeriodicalIF":0.0,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5318179/pdf/237-240.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34756891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}