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PubMed2004

A unique fracture pattern of the proximal phalanx in children: fractures through the phalangeal neck with an attached dorsal bony flange.

This paper describes a unique fracture pattern of the proximal phalanx in children that has not been specifically studied in the literature. Volarly, the fracture line passes through the phalangeal neck and then the fracture line passes dorsally to include a dorsal flange of the metaphysis. Fractures were classified into three types: type I fractures were undisplaced with no finger deformity; type II fractures were mildly displaced in the antero-posterior plane without lateral angulation or scissoring; while type III fractures were severely displaced or had associated lateral angulation or scissoring deformity. Over a 6-year-period, nine cases were seen by the authors. The mechanism of injury was by entrapping the digit in a closing door in all cases. The mean age of patients was 5 years. Types I and II fractures were seen in five children and all were treated by splinting with an excellent outcome. Two children with type III fractures were treated with closed reduction and either splinting (one case) or k-wire (one case), and both had a poor initial outcome. The remaining two children with type III fractures were treated with open reduction and internal fixation with an excellent outcome. Differences between these fractures and the classic phalangeal neck fractures are discussed.

Child↗
PubMed1996

Periprosthetic fractures of the femur. An analysis of 93 fractures.

A retrospective review of 93 periprosthetic fractures and 102 periprosthetic fracture treatments showed that the type of prosthesis (cemented, ingrowth, Austin-Moore) and the presence of preexisting stress risers play a role in determining where the fractures occur. The site of fracture and the prefracture interface influence treatment of periprosthetic fractures. This study suggests that fractures associated with a loose interface, cemented or cementless, are best treated by removal of the prosthesis, reduction of the fracture, and insertion of a long stemmed prosthesis with additional fixation as needed. Treatment of a periprosthetic fracture associated with a stable prosthesis depends on the site of fracture. Fractures proximal to the tip of a fixed prosthesis usually can be treated nonoperatively or with limited internal fixation. Fractures at the tip of the prosthesis may be managed by revision or internal fixation, and fractures below the prosthesis can be managed operatively or nonoperatively.

Accidental Falls↗
PubMed1998

Serum 1alpha,25-dihydroxyvitamin D3 accumulates into the fracture callus during rat femoral fracture healing.

1,25-dihydroxyvitamin D3 (1,25(OH)2D3) is thought to be an important systemic factor in the fracture repair process, but the mechanism of action of 1,25(OH)2D3 has not been clearly defined. In this study, the role of 1,25(OH)2D3 in the fracture repair process was analyzed in a rat closed femoral fracture model. The plasma concentration of 1,25(OH)2D3 rapidly decreased on day 3 and continued to decrease to 10 days after fracture. We assessed whether this decrease was based on the accelerated degradation or retardation of the synthesis rate of 1,25(OH)2D3, from 25(OH)D3. After radiolabeled 3H-1,25(OH)2D3 or 3H-25(OH)D3 was injected i.v. into fractured or control (unfractured) rats, the concentrations of 25(OH)D3 and 1,25(OH)2D3 metabolites were measured by HPLC. The plasma concentrations of these radiolabeled metabolites in fractured group were similar to those in control rats early after operation. However, radioactivity in the femurs of fractured rats was higher than that of the control group. Furthermore, the radioactivity was concentrated in the callus of the fractured group analyzed by autoradiography. 1,25(OH)2D3 receptor gene expression was detected early after fracture and, additionally, both in the soft and hard callus on days 7 and 13 after fracture. These results showed that the rapid disappearance of 1,25(OH)2D3 in the early stages after fracture was not due to either increased degradation or decreased synthesis of 1,25(OH)2D3, but rather to increased consumption. Further, these results suggest the possibility that plasma 1,25(OH)2D3 becomes localized in the callus and may regulate cellular events in the process of fracture healing.

Animals↗
PubMed2001

The economic cost of hip fractures among elderly women. A one-year, prospective, observational cohort study with matched-pair analysis. Belgian Hip Fracture Study Group.

BACKGROUND: We conducted a prospective study to assess the costs of initial hospitalization for a first hip fracture and to evaluate the excess costs attributable to the hip fracture during the one-year period following hospital discharge. METHODS: This investigation was designed as a one-year prospective cohort study with matched-pair analysis. Elderly women who were receiving care for a first hip fracture at four Belgian hospitals were matched, with respect to age and residence, with women (control subjects) with no history of hip fracture who lived in the same neighborhood. The initial hospitalization costs were tabulated from the hospital invoices. To estimate the costs during the year after hospital discharge, health-care services utilized by the hip-fracture patients and by the control subjects were recorded. We used the official reimbursement rates to assign a cost to these services, and the results are reported in United States dollars. RESULTS: The mean age of the 159 patients who had a hip fracture was 79.3 years, and that of the 159 control subjects was 78.7 years. The total mean cost of the initial hospitalization was $9534 for the hip-fracture patients. The total direct costs during the year after discharge averaged $13,470 for the hip-fracture patients and $6170 for the control subjects. Thus, the excess direct cost during the one-year period following hospital discharge averaged $7300 for the hip-fracture patients. The largest cost differences were attributable to nursing-home stays (31%), rehabilitation-center stays (31%), hospitalizations (16%), and home physical-therapy services (14%). Two-fifths of the excess costs were spent during the three months following hospital discharge. Moreover, we observed a shift in resource utilization after hospital discharge. CONCLUSIONS: Our one-year prospective study demonstrated that the costs of treating a hip-fracture patient are about three times greater than those of caring for a patient without a fracture. This study also highlights the savings to society if a hip fracture can be avoided.

Aftercare↗
PubMed2001

[Bisphosphonate treatment prevents hip fractures in 70-79 year old women with osteoporotic vertebral fractures].

According to the data of a fracture intervention trial, in women aged 55-80 years with vertebral fractures or osteoporosis diagnosed by bone mineral density measurement, treatment with the bisphosphonate alendronate prevented hip fractures with numbers-needed-to-treat within 5 years of treatment of 46 and 66, respectively. In a large risedronate hip fracture study, this new bisphosphonate only showed a beneficial effect in women aged 70-79 years with moderately severe osteoporosis as judged by femoral neck T-score, when one or more vertebral fractures were present at the start of the treatment. The number-needed-to-treat was 29. However, in women aged over 80 years and who were selected predominantly on the basis of clinical risk factors for hip fracture, no effect was found with this drug on hip fracture rate, suggesting that most were not osteoporotic and/or that the clinical risk factors used did not have the clinical utility in identifying hip fracture risk. Other factors besides osteoporosis may play a more important role in causing hip fracture in this elderly group. Diagnosis of osteoporotic vertebral fractures in women aged 70-79 years is predictive of not only new vertebral fractures but also of hip fractures, and could therefore form an indication for drug treatment.

Age Factors↗
PubMedDate not supplied

The significance of soft tissue trauma for fracture healing: a prospective study on 70 tibial shaft fractures.

In a prospective study, the significance of the fracture type, the dynamization of the external fixator, the soft tissue damage and the second osteosynthesis was evaluated for the fracture healing of 70 tibial shaft fractures. All fractures, included in the study, had a second or third degree closed or open soft tissue damage. In all fractures, a careful debridement was performed primarily. All fractures were stabilised with the Monofixator, and the fracture site was covered with vital soft tissues. If there was any sign of a delayed fracture healing after healing of the soft tissues, a secondary internal osteosynthesis was carried out as quick as possible. The mean hospital stay of the 70 patients was 32 days, the fixator was dynamized after an average of 9 weeks and removed after 18.4 weeks. Consolidation was registered after an average of 26.5 weeks. In 30% a secondary internal osteosynthesis was carried out after an average of 19.6 weeks. After this second osteosynthesis, no late problems were seen. In the statistical evaluation of the results, the paramount importance of the soft tissue damage for fracture healing became very clear; soft tissue damage had a significant influence on the duration of the hospital stay, on the consolidation time and on the frequency of the re-osteosynthesis. There was also an indirect influence on the functional end results: the quicker the fracture healing, the better the end results. A thorough clinical examination of the soft tissue damage in the early posttraumatic phase is of great importance to become a correct idea of the prognosis of a tibial shaft fracture. The more severe the soft tissue trauma, the more difficult the fracture healing will be.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Changes in bone mass and fracture type in patients with hip fractures. A comparison between the 1950s and the 1980s in Malmö, Sweden.

A consecutive series of 970 hip fractures from 1950 to 1958 were reevaluated and compared with roentgenograms of 1359 hip fractures from 1983 to 1985. The femoral neck index (FNI) was measured and the Singh index (SI) determined. The number of trochanteric fractures has increased more than the number of cervical fractures during the past 30 years. There has been a shift during the last 30 years toward more dislocated cervical fractures. There has been no change in the distribution between stable and unstable trochanteric fractures. The FNI was significantly lower in the 1980s compared with the 1950s, both in men and women. In the 1980s, men and women with cervical fractures had a lower FNI compared with men and women with trochanteric fractures, even after age correction. The SI was significantly lower in the 1980s than in the 1950s, both in men and women, but the difference was significant in trochanteric fractures only. In the 1980s, trochanteric fractures had a lower SI compared with cervical fractures; this relationship was significant both in men and women. Our findings indicate that the bone mass, both cortical and trabecular, measured on roentgenograms of the hip, has diminished in the urban population during the past three decades. This could be one of many reasons for the increased incidence of hip fractures.

Age Factors↗
PubMed1989

Rotational stability of diaphyseal fractures of the radius and ulna fixed with Rush pins and/or fracture bracing.

The rotational stability of fractures of the radius and ulna treated with Rush pins and/or fracture bracing was studied in six fresh cadaver forearms. Forearm rotation and fracture site motion (rotation) were measured as functions of applied forearm torque and rotation (pronation-supination). Values were obtained from the forearm: (1) intact and with both bones fractured; (2) without fixation; (3) with a fracture brace; (4) with Rush pins; and (5) with a combination of Rush pins and a fracture brace. A brace was ineffectual in reducing fracture site motion when the wrist was rotated to specified angles compared to fracture site motion for the forearm with no fixation treatment rotated to the same angles. When loading to specific torque levels, however, the brace reduced fracture site motion to one-half the motion with no fixation treatment. Under both loading conditions, Rush pin fixation significantly and markedly reduced the fracture site motion (to approximately one-eighth of the motion with no fixation treatment), whereas a brace in conjunction with Rush pins did not significantly further reduce the fracture site motion. The radius showed more motion at fracture site than the ulna.

Bone Nails↗
PubMed1987

Background factors in patients with hip fractures--differences between cervical and trochanteric fractures.

Comparisons were made between 133 men with cervical fractures and 151 men with trochanteric fractures and 308 women with cervical fractures and 449 women with trochanteric fractures. All patients with hip fractures were studied consecutively and prospectively. Patients were interviewed a few days after admission and their medical records studied. We found great differences in background factors between patients with cervical and trochanteric fractures but these differences seemed to depend largely on age. In an age-matched material we find that patients with trochanteric fractures are more prone to such fragility fractures as vertebral fracture, trochanteric fracture and fracture of the upper end of the humerus. This could mean that trochanteric fractures occur in bone of lower trabecular mass.

Activities of Daily Living↗
PubMed1983

Prosthetic arthroplasty for fractures and fracture-dislocations of the proximal humerus.

During the period from 1970 through 1979, proximal humeral arthroplasty with prostheses of the Neer design was performed in 49 shoulders (48 patients) with complex acute or chronic fractures and fracture-dislocations of the proximal humerus. Follow-up evaluation included physical and roentgenographic examination at least two years after surgery for 43 of the 48 patients and averaged 38 months (range, 2-10 years). Of the 43 patients with adequate follow-up evaluation, 16 had acute and 27 (1 bilateral) had chronic fracture problems. Pain relief was satisfactory in all of the 16 shoulders with acute fractures and in 25 of the 28 shoulders with chronic fracture problems. Active abduction averaged 101 degrees in the acute fracture group (range, 35 degrees-160 degrees) and 112 degrees in the chronic fracture group (range, 20 degrees-180 degrees). Complications in shoulders with acute fractures were associated with problems in tuberosity and rotator cuff healing. Complications were more frequent in shoulders with chronic fractures and fracture-dislocations, and were generally related to surgical difficulty, extensive tissue scarring, and distortion of anatomy. The Neer prosthesis affords satisfactory pain relief for both acute and chronic complex fracture-dislocations of the proximal humerus, but the return of function is governed by the security of tuberosity-muscle cuff repair, sufficient protection after operation, and long-term physiotherapy. If possible, surgery should be performed early to avoid the scarring and inelasticity that engender complications and limit functional recovery in shoulders with chronic fractures.

Adult↗
PubMed1993

Fracture incidence after tibial shaft fractures. A 30-year follow-up study.

Based on all patients with tibial shaft fracture (n = 767) treated in the department of orthopedics in Malmö from 1955 to 1963, a retrospective cohort study was performed in 1990. Two hundred sixty-nine of the patients were still living in Malmö or had died in the city. Since all roentgenograms were available, all other fractures that this group of patients had sustained up to 1990 were included. Data were compared with an age- and gender-matched control group with respect to location and types of fractures. The group with previous tibial shaft fractures had an increased incidence of all sorts of fractures. When comparing the risk of sustaining new fractures in the previously fractured limb with the uninjured side, only a statistically insignificant tendency toward more fractures was found. A similar tendency was observed in fractures of the upper limb. Therefore, remaining osteopenia in the injured limb after tibial shaft fracture is not associated with further fractures; rather, this group of patients were more fracture prone in general.

Adolescent↗
PubMed2006

Changes in total alkaline phosphatase level after hip fracture: comparison between femoral neck and trochanter fractures.

BACKGROUND: Biochemical bone metabolic markers are affected by fractures, and total alkaline phosphatase (ALP) is considered one of the bone formation markers. Only a few reports have dealt with changes in bone formation markers during the healing process of bone fragility hip fractures. Despite the difference in the amount of callus formation and bone fusion rate, no significant differences in longitudinal change of total ALP between femoral neck and trochanter fracture have been reported. METHODS: A total of 69 osteoporotic patients with femoral neck or trochanter fracture whose serum concentrations of total ALP were examined at least four times at six periodic examination points (1, 2, 3, 4, 6, and 8 weeks after surgery) and whose state of bone union was obtained within 24 weeks after surgery were selected for this retrospective study. The characteristic longitudinal change of total ALP during the healing process was shown, and the possibility of total ALP as a predictive factor for the state of osteosynthesis of hip fractures is discussed. RESULTS: Changes in the total ALP level according to the healing process were similar for femoral neck and trochanter fractures. The concentration of total ALP rose to a maximum at 3 weeks after surgery and then gradually decreased for both fractures. However, the range of change was significantly greater for trochanter fractures than for femoral neck fractures. For trochanter fractures, total ALP decreased from 3 to 6 weeks after surgery in all but one patient. CONCLUSIONS: Increases in the concentration of total ALP after surgery and the subsequent decreases may reflect the normal healing process. A significant difference in the changes of total ALP after surgery between femoral trochanter and neck fractures was shown. Periodic measurement of total ALP might be useful for obtaining information on the osteosynthesis state.

Age Factors↗
PubMed1981

Fractures in amputation stumps: review of treatment of 16 fractures.

A retrospective study of patients who sustained a fracture of the amputation stump was carried out to determine how these injuries might be prevented and to develop an optimum method of treatment. Review of the records of the Mayo Clinic from 1956 through 1978 revealed that 14 patients had a fracture in the amputation stump and 2 patients had two separate episodes of fracture, for a total of 16 fractures. Each patient's history and the available x-ray films were carefully reviewed. Fifteen fractures involved the femur or hip, and one involved the tibia and fibula. All fractures went on to union, but four of nine treated with internal fixation had comp]lications, three of which required further surgical procedures. At least five fractures in this series might have been prevented by better patient instruction and closer attention to fitting the prosthesis. Half of the fractures resulted from falls in the elderly patient. All five fractures that were treated without internal fixation healed well in a short time. The relatively high complication rate associated with internal fixation contrasted with the relatively rapid rate of union of the fractures treated without internal fixation suggests that these fractures should be treated by conservative measures if possible.

Adolescent↗
PubMed1993

[Combined fractures of the femoral neck with femoral shaft fractures].

Ipsilateral fractures of the femoral neck and shaft presents diagnostic difficulties and complex choices as to treatment. The surgeon is often faced with a multiply-injured patient with an obvious fracture of the femoral shaft. The accompanying femoral neck fracture can be overlooked (20-50%). Most frequently, the missed fracture is a minimally displaced vertical fracture of the femoral neck. Reviewing the literature on the subject offers little guidance of managing this fracture combination. Our present protocol for this double fracture is treatment with immediate internal fixation: 1. ISS < 25: Interlocking nailing for the shaft fracture and supplementary screws for the neck fracture, 2. ISS > 25: Plating for the shaft fracture and screwing for the neck fracture. The aseptic necrosis of the femoral head is not frequent.

Femoral Fractures↗