Preventive treatment in an osteoporotic femoral upper metaphysis-A clinical case: Me

OPEN ACCESS In 1992, a patient, born July 10, 1910, aged 82, with major osteoporosis [1-3], was operated on her left hip. The surgeon performs a biomaterial transplant using natural coral [4]. Follow-up is two years. She died in 1994 of acute respiratory failure. Three bone graft osteodensitometry [5] shows a regular increase in mineralization; however, on the opposite side, bone mineralization decreases. The anatomical part is examined using x-rays, scanners, photographs, histology [6]. The article reports the indings of this study. It is noted a partial resorption of the biomaterial essentially at the periphery of the graft as well as the different local connections of the preexisting bone with the newly formed bone from the grafted area. The severity of fractures of the femoral neck is no longer to be demonstrated [7]. Multiple therapeutic trials have demonstrated their effectiveness [8,9]. Twenty two patients were transplanted. There was no failure. All died without fracturing their grafted hips.

In 1992, a patient, born July 10, 1910, aged 82, with major osteoporosis [1][2][3], was operated on her left hip.The surgeon performs a biomaterial transplant using natural coral [4].Follow-up is two years.She died in 1994 of acute respiratory failure.Three bone graft osteodensitometry [5] shows a regular increase in mineralization; however, on the opposite side, bone mineralization decreases.The anatomical part is examined using x-rays, scanners, photographs, histology [6].The article reports the indings of this study.It is noted a partial resorption of the biomaterial essentially at the periphery of the graft as well as the different local connections of the preexisting bone with the newly formed bone from the grafted area.The severity of fractures of the femoral neck is no longer to be demonstrated [7].Multiple therapeutic trials have demonstrated their effectiveness [8,9].Twenty two patients were transplanted.There was no failure.All died without fracturing their grafted hips.

Clinical story
She is a person born on October 2, 1992, living in EPAD.She underwent a hysterectomy with oophorectomy at the age of 29!She has been treated for more than thirty years with 15 mg of cortisone, due to severe asthma.She walks with dif iculty, helped by physiotherapists.She cannot go up or down stairs due to her respiratory condition.There is no pain in the hips.She accepts the transplant.This was done on October 2, 1992.Three bone densitometry tests were performed three months, thirteen months and twenty months after the transplant.When the patient died, two years after the transplant, a histological examination of the transplanted hip was entrusted to Professor Maurice-Michel Forest, anatomopathologist at Cochin Hospital.

Material and methods
Intervention: Under epidural anesthesia, short external incision centered on the greater trochanter.Several biopsies only bring blood.The surgeon ills the gap with three bottles of natural coral granules [10].Three-point closure.The patient was put in the chair the next day with immediate support.

Operating suites
They were simple.Support was given the next day and the march resumed with the help of physiotherapists.As soon as the skin healed, there were thirty minutes of daily balneotherapy.

Bone densitometry
Three bone densitometries were performed by the same operator, with the same equipment, under the same conditions.is comparable -according to the Cartesian scienti ic method.This examination was not easy because the patient is 84 years old.The technical prowess of this examination is to be attributed to Dr J. Jabre.
The BMD (Bone Mineral Density) is stable on the right hip and there is a statistically signi icant gain of 88 mg/c2 in the grafted hip.

Choice of explored area
In order to eliminate any measurement error of the Bone Mineral Content linked to the presence of the natural coral graft, the explored area was chosen at the head-neck junction, outside the grafted area as can be seen in this image.The increase in D.M.O is only linked to the transformation of the mineral graft content into new-formed bone.
For the same reasons, the area explored is located exactly at the head-neck junction in order to compare what

Histological examination
The Morphological modi ications of the upper femoral metaphysis are conform to those described previously in other works [3].

Right femoral head:
The histological study carried out at the level of the cervical site con irms the clinical notions: there is a major osteoporosis leading to vast ranges of rarefaction illed by an adipose or hematopoietic marrow without cytological lesions.At the level of the cancellous lamellae there are numerous microfractures and multiple organized microcals.

Left femoral head (coral transplant 1992):
The center of the coral illing includes a connective tissue surrounding the granules.There are some lymphoplasmocytic in iltrates and rare giant resorptive cells.There is no osteogenesis at this level and the granules are detectable.
At the periphery, there is a complete or incomplete osteogenesis around the granules, the degree of calci ication of which is variable.Often there is only immature bone.Contacts with the neighboring cancellous are very variable: simple backing, continuity of neoformed osteogenesis with the peripheral lamellae at some points or interposition of ibrous tissue.Osteoporosis on the left is just as important with the presence of microcals.

Five conclusion:
The newly formed bone is distributed along the lines of force exerted on the cervico-metaphyseal overhang as shown by the scanner.The osteoid tissue, as well as the newly formed bone, is distributed at a distance from the graft as shown by the various osteo-densitometry.

Fifth conclusion:
In the beginning of our experiment, we did not knew the role of bone marrow in the metaplasia of cancellous and cortical bone.We were grafting a coral skeleton without any living cells.In this situation, it's properties were very different from those of an autologous cancellous living bone graftning.The living cells enhance the metaplastic process.Despite this lack of living cells, despite the âge, the graft started to work.The surgeon's honor is to be aware of new tretment, the surgeon's honor is to keep abreast of the latest treatment novelties, he must ensure that these novelties are true and healthy, that they are not fake-news.The surgeon's honor must be sure that the new treatment that the new treatment does not produce any side effects or secondary complications.The treatment must be easy to use and fully effective.The biomaterial ( natural coral ) has all its qualities.What are they waiting for ?« I have a dream !» Curiously it comes to my mind a very unhealthy thought.I will die before I see the dawn.Twenty-two affected patients were transplanted.There were no hip fractures grafted during the time of clinical observation.Two other patients died unrelated to their bone pathology.Surgeons have full cart The surgeons have their hands full of aces.Patients hope and expect a cure for their problems.What are surgeons waiting for to distribute the winning cards?