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PubMed2002

Anterior tibiofibular ligament avulsion fracture in weber type B lateral malleolar fracture.

BACKGROUND: The purpose of this study was to determine the incidence, relationship with the ankle diastasis, and effect of treatment of the anterior tibiofibular ligament avulsion fracture (Wagstaffe fracture) combined with the Weber type B lateral malleolar fracture. METHODS: This study reviewed 94 cases of ankle fractures treated with operative methods. RESULTS: There were 52 cases of Weber type B lateral malleolar fractures and 13 cases of Wagstaffe fractures combined with them (25%). Ankle diastases were diagnosed in 20 cases (38.5%) in all Weber type B fractures and 11 (84.6%) of the 13 Wagstaffe fractures. CONCLUSION: The Wagstaffe fracture can be a good diagnostic clue of ankle diastasis in Weber type B lateral malleolar fracture. The accurate reduction and fixation of the avulsed fragment is important for restoration of the stable distal tibiofibular joint and to prevent the chronic ankle joint pain caused by impingement of the avulsed fragment.

Adolescent↗
PubMed2006

Comparison of different radiography systems in an experimental study for detection of forearm fractures and evaluation of the Müller-AO and Frykman classification for distal radius fractures.

OBJECTIVES: We sought to compare the diagnostic performance of screen-film radiography, storage-phosphor radiography, and a flat-panel detector system in detecting forearm fractures and to classify distal radius fractures according to the Müller-AO and Frykman classifications compared with the true extent, depicted by anatomic preparation. MATERIALS AND METHODS: A total of 71 cadaver arms were fractured in a material testing machine creating different fractures of the radius and ulna as well as of the carpal bones. Radiographs of the complete forearm were evaluated by 3 radiologists, and anatomic preparation was used as standard of reference in a receiver operating curve analysis. RESULTS: The highest diagnostic performance was obtained for the detection of distal radius fractures with area under the receiver operating curve (AUC) values of 0.959 for screen-film radiography, 0.966 for storage-phosphor radiography, and 0.971 for the flat-panel detector system (P > 0.05). Exact classification was slightly better for the Frykman (kappa values of 0.457-0.478) compared with the Müller-AO classification (kappa values of 0.404-0.447), but agreement can be considered as moderate for both classifications. CONCLUSIONS: The 3 imaging systems showed a comparable diagnostic performance in detecting forearm fractures. A high diagnostic performance was demonstrated for distal radius fractures and conventional radiography can be routinely performed for fracture detection. However, compared with anatomic preparation, depiction of the true extent of distal radius fractures was limited and the severity of distal radius fractures tends to be underestimated.

Area Under Curve↗
PubMed2005

Does alendronate reduce the risk of fracture in men? A meta-analysis incorporating prior knowledge of anti-fracture efficacy in women.

BACKGROUND: Alendronate has been found to reduce the risk of fractures in postmenopausal women as demonstrated in multiple randomized controlled trials enrolling thousands of women. Yet there is a paucity of such randomized controlled trials in osteoporotic men. Our objective was to systematically review the anti-fracture efficacy of alendronate in men with low bone mass or with a history of prevalent fracture(s) and incorporate prior knowledge of alendronate efficacy in women in the analysis. METHODS: We examined randomized controlled trials in men comparing the anti-fracture efficacy of alendronate to placebo or calcium or vitamin D, or any combination of these. Studies of men with secondary causes of osteoporosis other than hypogonadism were excluded. We searched the following electronic databases (without language restrictions) for potentially relevant citations: Medline, Medline in Process (1966-May 24/2004), and Embase (1996-2004). We also contacted the manufacturer of the drug in search of other relevant trials. Two reviewers independently identified two trials (including 375 men), which met all inclusion criteria. Data were abstracted by one reviewer and checked by another. Results of the male trials were pooled using Bayesian random effects models, incorporating prior information of anti-fracture efficacy from meta-analyses of women. RESULTS: The odds ratios of incident fractures in men (with 95% credibility intervals) with alendronate (10 mg daily) were: vertebral fractures, 0.44 (0.23, 0.83) and non-vertebral fractures, 0.60 (0.29, 1.44). CONCLUSION: In conclusion, alendronate decreases the risk of vertebral fractures in men at risk. There is currently insufficient evidence of a statistically significant reduction of non-vertebral fractures, but the paucity of trials in men limit the statistical power to detect such an effect.

Adult↗
PubMed1991

Stability of femoral neck fracture. Roentgen stereophotogrammetry of 29 hook-pinned fractures.

The stability of hook-pin fixation during weight bearing was studied in 29 femoral neck fractures using roentgen stereophotogrammetric analysis. Twenty-three fractures became stable within 1 to 9 months, whereas redisplacement or continuing movement of the fracture occurred in 6 cases. Displaced fractures shortened about 7 mm more than undisplaced ones before healing. The rotations of the femoral heads were greatest in the forward/backward direction, followed by varus-valgus tilting in both fracture groups. Rotation about the longitudinal axis was recorded in the displaced fractures, mainly as a retroversion, whereas no rotation occurred about this axis in the undisplaced fractures. Healing after 6 months, intermediate fracture fragments, and a decreased Pauwels' angle seemed to imply increased fracture compression or rotatory instability. Fractures that subsequently developed healing complications displayed an increased distal displacement of the femoral head during the first postoperative month.

Adult↗
PubMed2003

Mini-open intramedullary nailing of acute femoral shaft fracture: reduction through a small incision without a fracture table.

BACKGROUND: Femoral shaft fractures are usually treated with intramedullary nailing. In this study, we report on a modified surgical technique with reduction through a small incision for this type of fracture. METHODS: From 1994 to 1997, this technique was used on 74 patients with 82 femoral shaft fractures. Seventy patients (76 fractures) with at least 3 years of postoperative follow-up were included for clinical evaluation. The surgical technique involves a mini-wound at the fracture site, and fracture reduction is performed with 1 finger or a bone hook without the use of a fracture table. RESULTS: Seventy-four fractures (97%) healed in the first 6 months. In 2 patients, there was little evidence of fracture union at 6 months. One of these 2 patients was treated with an open bone graft, and the other was treated with a closed exchanging nail. Finally these 2 patients healed. The mean operation time for this procedure was 75 minutes. CONCLUSION: The advantages of this procedure include that no fracture table is needed, there is a shorter operation time, there is a small amount of blood loss, and it is especially suitable for multiple trauma patients.

Acute Disease↗
PubMed1998

[Fracture of the great trochanter treated by dynamic hip screw plate: measure of impaction according to fracture type].

INTRODUCTION: The sliding plate has appeared to be a reliable answer for trochanteric fractures. However, impaction allowed by the material may, have an adverse effect (medialisation, shortening, jutting out of the lag screw). The aim of our study was to measure the sliding of the screw in order to assess the impaction in various types of fracture, according to the Ender classification. MATERIAL AND METHODS: Hundred trochanteric fractures have been treated between 1991 and 1993. Eighty four have been analyzed with a follow-up of three months after surgery. The average age was 80.1 years with a 4.2 sex ratio (16 males). One hundred and thirty five degrees free sliding plates were employed for fracture fixation. Full weight bearing was allowed in 78.6 per cent of patients. According to Ender classification, 35 per cent of fractures were type 1, 4 or 5. This was the first group. The second group consisted of types 2 and 3 and the third group of types 6, 7 and 8. The results were assessed on AP and lateral X-rays. The ratio between screw thread length (constant) and screw outside the barrel length, was used to measure impaction on AP view. Osteoporosis was evaluated according to Singh. RESULTS: Despite two screw protrusions out of the femoral head and two failures of the plate, we have observed a healing rate of 100 per cent after three months. Sliding averaged 6.2 mm in group 1, 10.5 mm in group 2 and 16.4 mm in groupe 3. Weight bearing had a low influence on the amount of sliding. DISCUSSION: Group 1 consists of fractures (types 1, 4 and 5) which are two parts fractures considered as stable. Group 2 corresponds to types 2 and 3 considered as intermediate fractures with relative stability. In group 3 (types 6, 7 and 8) we have observed major fracture instability. Osteoporosis does not seem to be the major factor regarding screw sliding. CONCLUSION: The sliding plate is reliable. However, complex fractures healed in a wrong position which is definitely not acceptable, especially for young patients. Therefore, we advise to avoid the use of sliding plate in case of Ender type 6, 7 and 8.

Adult↗
PubMed2002

Paediatric maxillofacial fractures: their aetiological characters and fracture patterns.

OBJECTIVE: Paediatric maxillofacial fractures are not common and carry different clinical features when compared with adults. To clarify the differences of aetiology and patterns of fractures in paediatric patients, a clinical retrospective analysis was performed. PATIENTS: One hundred seventy-four paediatric patients younger than 16 years of age treated in the First Department of Oral and Maxillofacial Surgery, Osaka University Dental Hospital during a 15-year period were analysed. STUDY DESIGN: Age, sex, fracture patterns, incidence, common locations of the mandibular fractures and treatment were studied according to the patients' charts and radiographs. RESULTS: The ratio of boys to girls was 2:1 and the largest age subgroup was 15-years old. The most common cause of injury was bicycle accidents (26%), followed by falls (25%). The distribution of causes and ages revealed that the incidence of the fall-related injuries decreased in patients older than 10 years, and assaults became a common cause in patients older than 12 years. The yearly distribution showed a decrease of the group between 6 and 10 years and of bicycle-related accidents in the last 5-year period (1992-1996). Mandibular fractures were most common (56%), followed by fractures of the alveolar process (31%). Condylar fracture was common in children younger than 14 years, especially in those below 6 years. Fractures of the mandibular angle were the most common in those above 13 years. CONCLUSION: These results document that the aetiological characters and patterns of paediatric maxillofacial fractures gradually shifted towards those found in adolescents.

Accidental Falls↗
PubMedDate not supplied

Tibial shaft fractures: assessment of fracture healing with computed tomography.

OBJECTIVE: To assess the capability of CT in assessing stability of tibial shaft fractures with planimetry. MATERIALS AND METHODS: Eighteen patients with fracture of the tibial shaft were treated by external fixator. All patients underwent CT 1, 6, 12, and 18 weeks postoperatively to assess the fracture healing. The callus formation and compacta were determined with planimetry. Fractometry, a noninvasive method to measure stability, was used as the gold standard to determine the stability of the fracture. RESULTS: The patients were divided into three groups according to different periods of time for removal of external fixation. Twelve patients with stable fractures showed a steady increase of callus, which was 50% higher after 12 weeks. Three patients with delayed fracture healing demonstrated an increase of callus of > 50% after 18 weeks. Three patients with unstable fractures obtained only callus formation of < 20% after 15-18 weeks. The external fixator was removed and endomedullary nails were used for stabilization. CONCLUSION: The CT data allow quantification of callus and compacta formation and are able to determine the stability of tibial shaft fractures.

Adolescent↗
PubMed1999

Depression, falls, and risk of fracture in older women. Study of Osteoporotic Fractures Research Group.

BACKGROUND: Previous studies have suggested that depression is associated with falls and with low bone density, but it is not known whether depression leads to an increased risk of fracture. SUBJECTS AND METHODS: We conducted a prospective cohort study in elderly white women who were recruited from population-based listings in the United States. At a second visit (1988-1990), 7414 participants completed the 15-item Geriatric Depression Scale and were considered depressed if they reported 6 or more symptoms of depression. We measured bone mineral density (BMD) in the spine and hip using dual energy x-ray absorptiometry at the second visit, and asked participants about incident falls (yes/no) at 4 follow-up visits. Nonvertebral fractures were ascertained for an average of 6 years following the depression measure, and verified radiologically. We determined incident vertebral fractures by comparing lateral spine films obtained at the first visit (1986-1988) with repeat films obtained an average of 3.7 years later (1991-1992). RESULTS: The prevalence of depression (Geriatric Depression Scale score > or = 6) was 6.3% (467/7414). We found no difference in mean BMD of the hip and lumbar spine in women with depression compared with those without depression. Women with depression were more likely to experience subsequent falls than women without depression (70% vs 59%; age-adjusted odds ratio [OR], 1.6; 95% confidence interval [CI], 1.3-1.9; P<.001), an association that persisted after adjusting for potential confounding variables (OR, 1.4; 95% CI, 1.1-1.8; P=.004). Women with depression had a 40% (age-adjusted hazard ratio [HR], 1.4; 95% CI, 1.2-1.7; P<.001) increased rate of nonvertebral fracture (124 fractures in 3805 woman-years of follow-up) compared with women without depression (1367 fractures in 59 503 woman-years of follow-up). This association remained strong after adjusting for potential confounding variables, including medication use and neuromuscular function (HR, 1.3; 95% CI, 1.1-1.6; P=.008). Further adjustment for subsequent falls appeared to explain part of this association (HR, 1.2; 95% CI, 1.0-1.5; P = .06). Women with depression were also more likely to suffer vertebral fractures than women without depression, adjusting for history of vertebral fracture, history of falling, arthritis, diabetes, steroid use, estrogen use, supplemental calcium use, cognitive function, and hip BMD (OR, 2.1; 95% CI, 1.4-3.2; P<.001). CONCLUSIONS: Depression is a significant risk factor for fracture in older women. The greater frequency of falls among individuals with depression partially explains this finding. Other mechanisms responsible for the association between depression and fracture remain to be determined.

Accidental Falls↗
PubMed1995

Quantitative ultrasound and vertebral fracture in postmenopausal women. Fracture Intervention Trial Research Group.

Quantitative ultrasound is a promising technique to evaluate fracture risk. To test the hypothesis that reduction of one ultrasound measurement, broadband ultrasound attenuation (BUA), is associated with an increased risk of vertebral fracture in postmenopausal women, we performed a cross-sectional analysis of 442 women aged 55-80 years enrolling in a clinical trial of alendronate. Prior to randomization, we obtained bone mineral density (BMD) measurements of the hip, spine, and whole body, radiographs of lateral lumbar and thoracic spine, and duplicate measurements of calcaneal BUA with a Walker Sonix UBA575. Vertebral fractures were defined by morphometry and semiquantitative reading by a radiologist. After adjustment for potential confounders, the relative risk of vertebral fracture was 1.8 (95% CI 1.4-2.3) for each standard deviation reduction in BUA; for each standard deviation reduction in BMD, the relative risk was 1.7 (95% CI 1.3-2.1) at the femoral neck, and 2.2 (95% CI 1.7-2.9) at the spine. Adjustment for hip, spine, or whole body BMD did not significantly alter the relation between BUA and vertebral fracture. For example, after adjusting for spine BMD, the relative risk of vertebral fracture was 1.5 (95% CI 1.1-2.0) for each standard deviation reduction in BUA. We conclude that low BUA is associated with the presence of vertebral fractures in postmenopausal women. The relation between BUA and vertebral fracture is similar to that observed for BMD and vertebral fractures. Furthermore, the relation between BUA and vertebral fracture persists after adjustment for BMD.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMedDate not supplied

Predictors of first hip fracture and mortality post fracture in older women.

BACKGROUND: Hip fracture causes significant morbidity and mortality in older women. AIM: To document factors contributing to the risk of hip fracture in older women and to assess the effect of hip fracture on subsequent mortality. METHODS: Case-control study of 89 women with hip fracture and 89 controls, with two-year follow-up. Singh index and bone mineral density were calculated. RESULTS: Osteoporotic indices did not differ significantly between cases and controls. Significant predictors of risk were sleeping tablets, perception of health as fair/poor and a lower mental status score. Patients were 3.57 times more likely to die in the first year after fracture, with no difference between the groups in year two. After adjustment, hip fracture did not remain significantly associated with mortality. Inability to walk 100 yards alone prior to fracture and lower social class were significantly associated with mortality at 12 months. Age alone was significantly associated at 12-24 months. CONCLUSIONS: Factors related to falls and fracture may be more discriminatory predictors of hip fracture risk than osteoporosis in older females. Medications for sleep should be prescribed with caution. Hip fracture may have an independent effect on one year mortality, this effect is not seen in the second year.

Accidental Falls↗
PubMed2005

Older patients with distal forearm fracture. A challenge to future fall and fracture prevention.

BACKGROUND AND AIMS: Falls and fractures in older people are a common health problem. Patients with distal forearm fracture are at risk of sustaining new fractures. The aim of this work was to describe the characteristics of this patient group. METHODS: Sixty women and six men, mean age 68 years (50-86), with a recent fall-related distal forearm fracture, filled in a questionnaire about medical history, previous falls and fractures. Handgrip strength on the non-fractured side, one-leg standing, walking tests, and test of vibration sensation were measured and a video-nystagmoscopy was performed. RESULTS: One-third of the subjects had fallen during the last year, and one-third had had previous fall-related fractures during the last 10 years. Half of the patients took medication and were examined for chronic ailments regularly. Handgrip strength, balance and walking capacity declined with age and were similar to reference values. In three patients, the vibration sensation value was above the threshold value. Fifty patients (76%) had nystagmus, but no relationship between fall direction, physical performance and nystagmus was found. CONCLUSIONS: Although apparently healthy, many patients exhibited risk factors for new falls and fractures. Our recommendation is that these patients should be screened for fall and fracture risk and be targeted for preventive measures, besides fracture treatment. Physical therapists must play a major role in increasing and maintaining general physical functions in this patient group.

Accidental Falls↗
PubMed2003

Identification of risk factors for future fracture in patients following distal forearm fracture.

The challenge for healthcare systems around the world is delivering timely preventative strategies to subjects most likely to develop fragility fractures. The success or failure of national campaigns will be determined at local level, and many studies to date have found under-utilization of osteoporosis treatment strategies due to reduced public and healthcare professional awareness. An important link between the at-risk patients and their appropriate therapy is their identification and assessment. In the context of a medium sized secondary care provider, this study examined the efficiency of a nurse-led service for assessing women following distal forearm fracture, looking for additional risk factors for future fracture and also looking at uptake of the assessment programme among the target population. Two hundred and two women, median (range) age 69 (50-91) years presented with distal forearm fracture over a 9-month period. Fifty-four subjects did not participate in the study: they were significantly older than those who did ( P<0.002). One hundred and forty-eight subjects underwent assessment of falls risk, future hip fracture risk and calcaneal ultrasound attenuation measurement: 107 attended for assessment at the hospital and 41 required a health professional to visit at their place of residence-the latter group were significantly older ( P<0.0002). Of 148 subjects assessed, 76 (51%) had one or more risk factors for a fall: these subjects were significantly older ( P<0.0002) and more likely to have required a home visit ( P<0.002). Twenty-seven (18%) were considered at risk of a future hip fracture: again they were older and more likely to have required a home visit ( P<0.0005). Ninety-one subjects (61%) had a calcaneal ultrasound attenuation T-score below -2.0, and were referred for bone densitometry: again, they were older ( P<0.0002) and more likely to have required a home visit ( P<0.05). Bone densitometry demonstrated osteoporosis in 47 (52%) of those with low attenuation, osteopenia in 31 and normal bone density in 13. Of 76 subjects deemed to be at risk of falls, 31 (41%) had osteoporosis demonstrated on bone densitometry and of those at risk of future hip fracture, 12 (44%) had osteoporosis. Only nine (22%) subjects who received home visits had no risk factors for falls or hip fracture and normal bone density, compared to 45 (42%) of those who attended hospital. This study has demonstrated that the efficiency of a program to assess additional risk of future fracture in a population who have already fractured may be influenced by where the assessment is delivered: it may be that the patients at greatest risk did not avail of the service.

Accidental Falls↗
PubMed2005

Characteristics of elderly patients admitted to an urban tertiary care hospital with osteoporotic fractures: correlations with risk factors, fracture type, gender and ethnicity.

Osteoporosis is a major public health problem in the United States of America and around the world, largely due to the morbidity and mortality associated with osteoporotic fractures. In the past decade, large epidemiologic studies have contributed greatly to our understanding of patients who fracture. However, most studies are limited to postmenopausal white women. In this retrospective review, we analyze data from 185 men and women with acute fragility fractures who received osteoporosis consultations during admission to a single urban hospital between 2001 and 2003. Men and women differed in terms of risk factors for falls and osteoporosis but had areal bone mineral density (BMD) measurements remarkably similar, except at the total hip. Black and Hispanic subjects with fractures were significantly younger than whites yet were much more likely to have serious co-morbidities, such as diabetes mellitus and hypertension. In spite of significantly higher BMD measurements, black patients had the highest rates of vitamin D deficiency and secondary hyperparathyroidism. Patients admitted with hip fractures differed from those with non-hip fractures on a number of important variables. Based on these data, we conclude that elderly subjects admitted to an urban hospital with osteoporotic fractures are a heterogeneous group, with features that vary according to fracture type, gender and ethnicity. Future studies of patients with clinical fragility fractures should include ample numbers of men and ethnic minorities, since differences in underlying risk factors may suggest alternative strategies for fracture prevention.

Accidental Falls↗
PubMed2000

Bone mineral density, hip axis length and risk of hip fracture in men: results from the Cornwall Hip Fracture Study.

Bone mineral density (BMD) and hip axis length (HAL) are important determinants of fracture risk in women. There are, however, few data concerning their predictive risk in men. The aim of this study was to determine the relationship between BMD, HAL and the risk of hip fracture in men. A case-control design was used. Cases were men aged 50 years and over with a minimal-trauma hip fracture admitted to the Royal Cornwall Hospital, Truro, during 1995-1997. Controls were recruited from a large general practice within the catchment area of the hospital. Subjects were invited for assessment of BMD at the lumbar spine and proximal femur, using dual-energy X-ray absorptiometry. HAL was assessed using machine software. Data concerning BMD were available in 62 fracture cases and 100 controls. After adjusting for age, height and weight, a reduction in BMD was associated with a significant increase in the risk of hip fracture [odds ratio (OR) 1.8-4.0 per standard deviation (SD) reduction, depending on site]. HAL was similar in both fracture and control groups (12.0 cm vs 12.0 cm). After adjusting for height, there was no association between HAL and the risk of hip fracture (OR per 1 SD increase in HAL = 0.9; 95% confidence interval 0.6, 1.3). Compared with those with a cervical fracture (n = 31), those with an intertrochanteric fracture (n = 31) had lower BMD at all skeletal sites, though this was significant for the trochanteric site only. It is concluded that BMD though not hip axis length is a risk factor for low-trauma hip fracture in Caucasian men.

Aged↗
PubMed2002

Differences in bone mineral density, bone mineral content, and bone areal size in fracturing and non-fracturing women, and their interrelationships at the spine and hip.

Osteoporotic fractures are a major public health problem, particularly in women. Bone mineral density (BMD), bone mineral content (BMC), and bone size have been regarded as important determinants of osteoporotic fractures. In 1449 women over age 30 years, we studied the detailed relationship, at the spine and hip, between BMD, BMC, and bone areal size (all measured by dual-energy X-ray absorptiometry) and compared their relative magnitudes in fracturing and non-fracturing individuals. We find that, (1) BMD and BMC are significantly higher at the spine and hip in non-fracturing women. Bone areal size is significantly larger at the spine in non-fracturing women; however, the significance disappears when adjustment is made for the significant difference of height (stature) between fracturing and non-fracturing women. In contrast to the spine, bone areal size is always significantly largerin fracturing women at the hip. (2) The relationship among BMD, BMC, and bone areal size is different at the spine and hip. Specifically, at the spine, BMD increases with bone areal size linearly. At the hip, BMD has a quadratic relationship with bone areal size, so that BMD increases at lower bone areal sizes, then (after an intermediate zone of values) decreases with increasing bone areal size. However, BMD adjusted for BMC always decreases with increasing bone areal size, as expected by the definition of BMD. With no adjustment for BMC, the increase in BMD with bone areal size is due to a more rapid increase of BMC than increasing bone areal size, thus explaining the observations of association of both larger BMD and larger bone areal size with stronger bone. (3) At the spine, 86.2% of BMD variation is attributable to BMC and 12.6% to bone areal size. At the hip, 98.0% of BMD variation is due to BMC and 1.1% due to bone areal size. The current study may be important in understanding the relationship among BMD, BMC, and bone size as risk determinants of osteoporotic fractures.

Absorptiometry, Photon↗
PubMed2004

Weber B ankle fracture: an unnecessary fracture clinic burden.

Fifty-three patients with ankle fractures presenting to a trauma clinic at a busy district general hospital were used for this study. All subjects sustained fibular fractures at the syndesmosis without demonstrable medial instability or mortice incongruity. All cases were collected consecutively. Radiographs and case notes were studied for each patient. All fractures were categorised as Weber B [Pratique de l'osteosynthese. Les fractures malleolaires (1949)] without medial malleolar fracture. Data collected included the number of radiographs taken per patient and clinic reviews until discharge. Duration of immobilisation was recorded as well as weight bearing status. None of the 53 fractures showed any change in position following serial radiology. No patient underwent manipulation or internal fixation of the fracture. For Weber B fractures there was an average of six radiographs and 4.3 clinic reviews until discharge. There was a median time of 5.7 weeks spent in plaster immobilisation for these fractures. We conclude that once the decision is made to treat Weber B fractures as stable injuries they do not require regular review and serial radiographs. They require only one initial radiograph. Significant reductions in the number of trauma clinic consultations can be achieved as well as a national cost saving in the order of half a million pounds for the X-rays alone.

Adult↗
PubMed2005

Time for treating bone fracture using rhBMP-2: a randomised placebo controlled mouse fracture trial.

Although the mechanisms of osteoinduction by bone morphogenic proteins (BMPs) are increasingly understood, the most appropriate time to administer BMPs exogenously is yet to be clarified. The purpose of this study was to investigate when BMP may be administered to a fracture arena to maximise the enhancement of healing. Forty mice with externally fixed left femoral fractures were randomised into four groups: Group I, the control group was given a placebo of 30 microl saline at day 0; Groups II, III and IV were given 30 microl saline plus 2.5 microg rhBMP-2, at post-operative days 0, 4 or 8, respectively. Sequential radiographs were taken at days 0, 8, 16. On day 22 the mice were sacrificed and both femora were harvested for biomechanical assessment in 3-point bending and histological evaluation. Radiographic analysis indicated that healing of fractures in Groups II and III was significantly greater (p < 0.05) than those in Groups I and IV, at both 16 and 22 days post-fracture. The highest median bone mineral content at the fracture site was evidenced in Group III and II. Furthermore, Group III also had the highest relative ultimate load values, followed by Groups II, IV and I. Greater percentage peak loads were observed between Group I and both Groups II and III (p < 0.05). Histological examination confirmed that at 22 days post-fracture, only fractures in Groups II and III had united with woven bone, and Groups I and IV still had considerable amounts of fibrous tissue and cartilage at the fracture gap. Data presented herein indicates that there is a time after fracture when rhBMP administration is most effective, and this may be at the time of surgery as well as in the early fracture healing phases.

Animals↗