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PubMed1998

Fractures of the hip: does the type of fall really affect the site of fracture?

The purpose of this study was to test accepted theories relating the characteristics of a fall to the anatomical site of hip fracture in the elderly. Twisting injuries are said to result in intracapsular fractures and falls directly onto the side are said to result in extracapsular fractures. 618 consecutive patients with a hip fracture were studied prospectively by being questioned with regard to the nature of their fall. After exclusions, 552 patients were left in the study. Of these, 324 patients sustained intracapsular fractures and 228 extracapsular fractures. More intracapsular fractures were associated with a fall onto the affected side than extracapsular fractures and rotation at the hip during the fall had a significant association with extracapsular fractures. In this study 84 per cent of all fractures occurred by falling directly onto the affected side. The clinical significance of this finding is that protective padding on the hip might be beneficial.

Accidental Falls↗
PubMed2003

Fracture-toughening mechanisms responsible for differences in work to fracture of hydrated and dehydrated dentine.

This study investigates the nature of deformation and differences in the mechanisms of fracture and properties of dentine where there has been a loss of moisture, as may occur with removal of the pulp in the endodontic treatment of teeth. Controlled fracture toughness testing was conducted on bovine teeth to determine the influence of hydration on the work of fracture of dentine. Significant differences (p<0.01) were observed between the fracture toughness of hydrated (554+/-27.7J/m2) and dehydrated (113+/-17.8J/m2) dentine. Observations of the crack tip region during crack extension revealed extensive ligament formation occurred behind the crack tip. These ligaments provide considerable stability to the crack by significantly increasing the work of fracture, thereby acting as a fracture-toughening mechanism. Micro-cracking, reported as a fracture-toughening mechanism in bone, is also clearly seen. A zone of in-elastic deformation may occur as hydrated specimens revealed upon crack extension, a region about the tip that appeared to suck water into the structure and to exude water behind the crack tip. In dehydrated dentine, no in-elastic zone was observed. Micro-cracking is present though the cracks are smaller, straighter and with less opening than hydrated dentine. Only limited ligament formation just behind the crack tip was observed. These differences resulted in a significantly lower work of fracture with unstable brittle fracture characteristics. Based on these results, several fracture-toughening mechanisms were identified in dentine, with micro-cracking not considered the most important. These findings may be relevant for bone, a similar mineralised hydrated tissue.

Animals↗
PubMedDate not supplied

Periprosthetic humeral fractures: mechanisms of fracture and treatment options.

In 20 patients, 21 periprosthetic humeral fractures were reviewed retrospectively. The mean follow-up time was 27.1 months. Mild osteopenia was present in 45% of the patients, whereas 30% had severe osteopenia. Five mechanisms of fracture were identified, including 3 intraoperative causes that are avoidable. Treatment with stable intramedullary fixation utilizing the humeral stem and cerclage wiring provided superior results in terms of time to union, adverse effect on rehabilitation, and occurrence and severity of surgical complications. Diaphyseal fractures that were treated with standard stem arthroplasty with or without supplemental fixation had a longer time to fracture union, a higher complication rate, and prolonged rehabilitation. Fractures of the proximal humeral metaphysis can be treated with standard stem arthroplasty and cerclage wiring if the stem extends distal to the fracture site by at least 3 cortical diameters. Anatomic reduction of fractures treated by surgical means results in shorter healing times. Cast or brace immobilization can be used for management of postoperative fractures that occur distal to a well-fixed and stable prosthetic stem. Cast or brace immobilization results in fracture union but rehabilitation may be greatly impaired, and there is an increased risk of complications associated with immobilization of the extremity. Long-stem intramedullary fixation with cerclage wiring is the preferred surgical option for treatment of unstable humeral shaft fractures.

Adult↗
PubMed1995

Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group.

BACKGROUND: Many risk factors for hip fractures have been suggested but have not been evaluated in a comprehensive prospective study. METHODS: We assessed potential risk factors, including bone mass, in 9516 white women 65 years of age or older who had had no previous hip fracture. We then followed these women at 4-month intervals for an average of 4.1 years to determine the frequency of hip fracture. All reports of hip fractures were validated by review of x-ray films. RESULTS: During the follow-up period, 192 women had first hip fractures not due to motor vehicle accidents. In multivariable age-adjusted analyses, a maternal history of hip fracture doubled the risk of hip fracture (relative risk, 2.0; 95 percent confidence interval, 1.4 to 2.9), and the increase in risk remained significant after adjustment for bone density. Women who had gained weight since the age of 25 had a lower risk. The risk was higher among women who had previous fractures of any type after the age of 50, were tall at the age of 25, rated their own health as fair or poor, had previous hyperthyroidism, had been treated with long-acting benzodiazepines or anticonvulsant drugs, ingested greater amounts of caffeine, or spent four hours a day or less on their feet. Examination findings associated with an increased risk included the inability to rise from a chair without using one's arms, poor depth perception, poor contrast sensitivity, and tachycardia at rest. Low calcaneal bone density was also an independent risk factor. The incidence of hip fracture ranged from 1.1 (95 percent confidence interval, 0.5 to 1.6) per 1,000 woman-years among women with no more than two risk factors and normal calcaneal bone density for their age to 27 (95 percent confidence interval, 20 to 34) per 1,000 woman-years among those with five or more risk factors and bone density in the lowest third for their age. CONCLUSIONS: Women with multiple risk factors and low bone density have an especially high risk of hip fracture. Maintaining body weight, walking for exercise, avoiding long-acting benzodiazepines, minimizing caffeine intake, and treating impaired visual function are among the steps that may decrease the risk.

Aged↗
PubMed2005

Increased falling as a risk factor for fracture among older women: the study of osteoporotic fractures.

More frequent falling is associated with a higher risk of fracture among older women, but it is not known whether an increased rate of falling, independent of the average rate, also increases fracture risk. The authors examined the relation between an increase in the rate of falls during the first 4 years of follow-up and the subsequent fracture rate, reported for a median of 6.3 years (1986-1998), in 9,106 US women aged 65 years or more. Women in the upper quartile of increasing falls (>0.44 falls/year/year) had greater risks of subsequent hip fracture (rate ratio = 1.42, 95% confidence interval: 0.99, 2.04) and fracture of the proximal humerus (rate ratio = 1.79, 95% confidence interval: 1.08, 2.95) than women without an increase in falls, after adjustment for age, average rate of falls over 4 years, and known risk factors for fracture. Risks of distal forearm, ankle, or foot fracture were not elevated. The associations between fracture risk and increasing falls were not accounted for by baseline physical or cognitive function. An increase in the rate of falls, independent of the average rate, may be associated with a higher risk of frailty (hip and proximal humerus) fractures but not fractures at other sites.

Accidental Falls↗
PubMed2000

Pediatric atlas fracture: a case of fracture through a synchondrosis and review of the literature.

OBJECTIVE AND IMPORTANCE: Although uncommon, atlas fractures occur in the pediatric population. We present an illustrative case of a patient with a fracture through a synchondrosis of the atlas, and we review previous reports of pediatric first cervical vertebral fractures. The clinical and radiographic findings are described. In addition, we describe the use of magnetic resonance imaging in characterizing a pediatric atlas fracture. CLINICAL PRESENTATION: A 6-year-old boy who fell from a tree onto his vertex presented with neck pain, cervical muscle spasm, and head tilt. Computed tomographic and magnetic resonance imaging studies demonstrated a fracture through a left anterior synchondrosis with surrounding edema. In the literature, 10 cases of pediatric atlas fracture have been reported. INTERVENTION: Treatment of pediatric atlas fractures consists of rigid bracing such as a Minerva jacket. All of the cases of isolated C1 fracture in children, except the patient originally described by Sir Geoffrey Jefferson, survived and recovered with full function. Surgery is rarely indicated for isolated atlas fractures. CONCLUSION: The classic clinical presentation, combined with an appropriate injury scenario, should alert the clinician to the possibility of a pediatric atlas fracture and should prompt rapid evaluation with imaging studies to establish a diagnosis. When the injury is appropriately diagnosed and treated, an excellent outcome can be expected.

Braces↗
PubMed1998

Treatment of stable burst fracture of the atlas (Jefferson fracture) with rigid cervical collar.

STUDY DESIGN: A retrospective review of a clinical series. OBJECTIVE: To evaluate the use of a rigid cervical collar alone as the treatment for stable Jefferson fracture, and to devise an algorithm for treatment of Jefferson fracture with or without an associated cervical injury. SUMMARY OF BACKGROUND DATA: The traditional treatment for Jefferson fracture, if there is no indication for surgery, is immobilization by halo vest. Because halo vest placement is associated with intracranial infection and a significant degree of patient discomfort, slightly less rigid forms of external immobilization may be useful for the treatment of stable Jefferson fractures. No standard protocol calling for the use of one form of stabilization device has been reported. MATERIALS: The medical records and radiographs of 16 consecutive patients with Jefferson fracture during a 2-year period were reviewed. Each patient underwent a complete cervical radiograph series and a computed tomographic scan. The mean C1 lateral mass displacement was 1.8 mm. Cervical spine radiographs, including lateral flexion-extension views were obtained 10 to 12 weeks after injury before the removal of an external immobilization device. RESULTS: Of these 16 patients, 1 sustained a complete injury, and 7 sustained an incomplete injury. Eight patients were neurologically intact. Twelve patients sustained a stable Jefferson fracture and were treated with a rigid cervical collar (Miami-J collar [Jerome Medical, Moorestown, NJ]) alone from 10 to 12 weeks. The patient sustaining the complete neurologic injury died of multisystem trauma. All 15 live patients showed no instability on their follow-up plain radiographs before the removal of an external stabilization device. Six patients underwent further plain radiographs approximately 1 year after the fracture and similarly demonstrated no instability. CONCLUSIONS: Isolated stable burst fracture of the atlas can be treated effectively with a rigid cervical collar alone for 10 to 12 weeks with good neurologic recovery and segmental stability. Unstable Jefferson fractures with concurrent unstable fracture of other cervical vertebrae, especially C2, requires surgical stabilization.

Adolescent↗
PubMed2000

Urinary incontinence: does it increase risk for falls and fractures? Study of Osteoporotic Fractures Research Group.

OBJECTIVE: To determine if urge urinary incontinence is associated with risk of falls and non-spine fractures in older women. METHODS: Type and frequency of incontinent episodes were assessed by 6,049 community-dwelling women using a self-completed questionnaire. Postcards were subsequently mailed every 4 months to inquire about falls and fractures. Incident fractures were confirmed by radiographic report. Logistic and proportional hazard models were used to assess the independent association of urge urinary incontinence and risk of falling or fracture. RESULTS: The mean age of the women was 78.5 (+/- 4.6) years. During an average follow-up of 3 years, 55% of women reported falling, and 8.5% reported fractures. One-quarter of the women (1,493) reported weekly or more frequent urge incontinence, 19% (1,137) reported weekly or more frequent stress incontinence, and 708 (12%) reported both types of incontinence. In multivariate models, weekly or more frequent urge incontinence was associated independently with risk of falling (odds ratio = 1.26; 95% confidence interval (CI), 1.14-1.40) and with non-spine nontraumatic fracture (relative hazard 1.34; 95% CI, 1.06-1.69; P = .02). Stress incontinence was not associated independently with falls or fracture. CONCLUSIONS: Weekly or more frequent urge incontinence was associated independently with an increased risk of falls and non-spine, nontraumatic fractures in older women. Urinary frequency, nocturia, and rushing to the bathroom to avoid urge incontinent episodes most likely increase the risk of falling, which then results in fractures. Early diagnosis and appropriate treatment of urge incontinence may decrease the risk of fracture.

Accidental Falls↗
PubMed2006

Self-reported sleep and nap habits and risk of falls and fractures in older women: the study of osteoporotic fractures.

OBJECTIVES: To test the association between self-reported sleep and nap habits and risk of falls and fractures in a large cohort of older women. DESIGN: Study of Osteoporotic Fractures prospective cohort study. SETTING: Clinical centers in Baltimore, Maryland; Minneapolis, Minnesota; Portland, Oregon; and the Monongahela Valley, near Pittsburgh, Pennsylvania. PARTICIPANTS: Eight thousand one hundred one community-dwelling Caucasian women aged 69 and older (mean 77.0). MEASUREMENTS: Sleep and nap habits were assessed using a questionnaire at the fourth clinic visit (1993/94). Fall frequency during the subsequent year was ascertained using tri-annual questionnaire. Incident hip and nonspinal fractures during 6 years of follow-up were confirmed using radiographic reports. RESULTS: Five hundred fifty-three women suffered hip fractures, and 1,938 suffered nonspinal fractures. In multivariate models, women who reported napping daily had significantly higher odds of suffering two or more falls during the subsequent year (odds ratio=1.32, 95% confidence interval (CI)=1.03-1.69) and were more likely to suffer a hip fracture (hazard ratio (HR)=1.33, 95% CI=0.99-1.78) than women who did not nap daily. Those sleeping at least 10 hours per 24 hours had a higher risk of nonspinal fracture than (HR=1.26, 95% CI=1.00-1.58) and a similar but nonsignificant increased risk of hip fracture to (HR=1.43, 95% CI=0.95-2.15) those who reported sleeping between 8 and 9 hours. CONCLUSION: Self-reported long sleep and daily napping are associated with greater risk of falls and fractures in older women. Interventions to improve sleep may reduce their risk of falls and fractures. Future research is needed to determine whether specific sleep disorders contribute to these relationships.

Accidental Falls↗
PubMed2004

Relationship between changes in bone mineral density and vertebral fracture risk associated with risedronate: greater increases in bone mineral density do not relate to greater decreases in fracture risk.

Low bone mineral density (BMD) is correlated with increased fracture risk. Whether greater BMD increases induced by osteoporosis drugs are related to greater decreases in fracture risk is controversial. We analyzed the relationship between BMD change and fracture risk in postmenopausal osteoporotic women receiving antiresorptive treatment. The analysis combined data from three pivotal risedronate fracture end-point trials. Women received risedronate (n = 2047) or placebo (n = 1177) daily for up to 3 yr. The BMD and vertebral radiographs were assessed periodically during 3 yr. The estimated risk of new vertebral fracture was compared between patients whose BMD increased and those whose BMD decreased. Risedronate-treated patients whose BMD decreased were at a significantly greater risk (p = 0.003) of sustaining a vertebral fracture than patients whose BMD increased. The fracture risk was similar (about 10%) in risedronate-treated patients whose increases in BMD were < 5% (the median change from baseline) and in those whose increases were >/= 5% (p = 0.453). The changes in lumbar spine BMD explained only 18% (95% confidence interval [CI], 10%, 26%; p < 0.001) of risedronate's vertebral fracture efficacy. Although patients showing an increase in BMD had a lower fracture risk than patients showing a decrease in BMD, greater increases in BMD did not necessarily predict greater decreases in fracture risk.

Absorptiometry, Photon↗
PubMed2001

Diagnostic value of increased diffusion weighting of a steady-state free precession sequence for differentiating acute benign osteoporotic fractures from pathologic vertebral compression fractures.

BACKGROUND AND PURPOSE: Differentiating acute benign from neoplastic vertebral compression fractures can pose a problem in differential diagnosis on routine MR sequences, as signal changes can be quite similar. Our purpose was to assess the value of increasing the diffusion weighting of a diffusion-weighted steady-state free precession (SSFP) sequence for differentiating these two types of vertebral compression fractures. METHODS: Twenty-nine patients with 32 acute vertebral compression fractures caused by osteoporosis (n = 15) or malignancy (n = 17) were examined with a diffusion-weighted SSFP sequence, a T1-weighted spin-echo sequence, and a short-inversion-time inversion recovery sequence. The SSFP sequence was performed with increased diffusion weighting (delta = 0.6, 3.0, 6.0, and 9.0 ms). The signal intensities of the fractured vertebral bodies were rated on a five-point scale from markedly hypointense to markedly hyperintense relative to normal adjacent vertebral bodies. Quantitative analysis was performed by region-of-interest measurements and by calculating the bone marrow contrast ratio. Statistical analysis was performed with the Mann Whitney U test and Student's t test. RESULTS: At delta = 3 ms, the osteoporotic fractures yielded hypointense signal in seven cases, isointense signal in six, and hyperintense signal in two. The fractures showed a progressive signal loss with increased diffusion weighting, so that hypointensity was reached in all but one case. All metastatic fractures had hyperintense signal with delta = 3 and 6.0 ms. With delta = 9.0 ms, four fractures became isointense. CONCLUSION: Increasing diffusion weighting can reduce false-positive hyperintense osteoporotic fractures or make hypointensity more obvious in cases of osteoporotic fractures.

Acute Disease↗
PubMed1997

[Fracture toughness of cortical bone in tension, shear, and tear--a comparison of longitudinal and transverse fracture].

The fracture toughness at crack initiation was determined for bovine cortical bone under tension (mode I), shear (mode II), and tear (mode III). A total of 130 compact tension specimens, compact shear specimens and triple pantleg specimens were used for the measurement of fracture toughness under tension, shear, and tear, respectively. Multiple-sample compliance method was utilized to measure the critical strain energy release rate (Gc) at the a/W = 0.55 (crack length, a, to specimen width, W, ratio). The critical stress intensity factor (Kc) was also calculated from the critical loading (PQ) of the specimens at the a/W = 0.55. The effect of the anisotropy of bone on its resistance to crack initiation under shear and tear loading was investigated as well. The fracture toughness of bone with precrack orientations parallel(designed as longitudinal fracture) to and that with precrack orientations normal (designed as transverse fracture) to the longitudinal axis of bone were compared. In longitudinal fracture, the critical strain energy release rates(Gc) of cortical bone under tension, shear, and tear were 644 +/- 102, 2430 +/- 836, and 1723 +/- 486 N/m, respectively. In transverse fracture, the critical strain energy release rates(Gc) of cortical bone under tesion, shear, and tear were 1374 +/- 183, 4710 +/- 1284, and 4016 +/- 948 N/m, respectively. An analysis of variance demonstrated that the crack initiation fracture toughness of bone under shear and tear loading is significantly greater than that under tensile loading in both longitudinal and transverse fracture. Our results also suggest that cortical bone has been "designed" to prevent crack initiation in transverse fracture under tension, shear, and tesar.

Animals↗
PubMedDate not supplied

Re-attachment of anterior fractured teeth: fracture strength using different techniques.

Fracture of anterior teeth by trauma is a common problem in children and teenagers. Complex metal-ceramic crowns with considerable loss of remaining sound structure are no longer necessary due to adhesive techniques, such as composite restorations and re-attachment techniques. This study compared the fracture strength of sound and restored anterior teeth using a resin composite and four re-attachment techniques. A "one bottle" adhesive system (One-Step, BISCO) and a dual cure resin cement (Duo-Link, BISCO) were applied. Thirty-five sound permanent lower central incisors were fractured by an axial load applied to the buccal area and randomly divided into five groups. The teeth were restored as follows: 1) bonded only = just bonding the fragment; 2) chamfer-group = after bonding, a chamfer was prepared on the enamel at the bonding line and filled with composite; 3) overcontour group = after bonding, a thin composite overcontour was applied on the buccal surface around the fracture line; 4) internal dentinal groove = before bonding, an internal groove was made and filled with a resin composite; 5) resin composite group = after a bevel preparation on the enamel edge, the adhesive system was applied and the fractured part of the teeth rebuilt by resin composite. Restored teeth were subjected to the same loading in the same buccal area. Fracture strength after restorative procedure was expressed as a percentage of the original fracture strength and the results analyzed by Kruskal-Wallis statistical analysis. The mean percentages of fracture strength were: Group 1: 37.09%, Group 2: 60.62%, Group 3: 97.2%, Group 4: 90.54% and Group 5: 95.8%. It was concluded that the re-attachment techniques used in Groups 3 and 4, as well as the composite restored group (Group 5), were statistically similar and reached the highest fracture resistance, similar to the fracture resistance of sound teeth.

Bisphenol A-Glycidyl Methacrylate↗
PubMed2006

[Surgical treatment of fracture of the ring of axis - "hangman's fracture"].

PURPOSE OF THE STUDY: To evaluate surgical management of the fracture of the ring of axis (FRA), known as "hangman's fracture", and to discuss adequacy of this treatment. MATERIAL AND METHODS: Between 1994 and 2004, 41 patients with FRA were surgically treated in our hospital. We present a retrospective study of 30 cases treated by anterior cervical fixation and fusion and 11 cases treated by a posterior, CT-guided approach (published recently). Our diagnostic algorithm for evaluation of FRA included plain radiographs for basic diagnosis, detailed CT scan, MRI and finally passive lateral flexion-extension fluoroscopy (performed by physician) to assess stability. We also consider discography in selected cases, allowing further evaluation of discoligamentous injury. Fractures were classified according to Levine. Posterior compressive osteosynthesis according to Judet was performed in 11 patients with Levine type I fractures with fracture fragment distraction > 3 mm. Anterior graft and plate fixation was chosen in 30 patients with type II (25 patients) and type I (5 patients) fractures where C2/3 disc injury was confirmed by MRI or discography. There was no case of facet dislocation in our series (type III). Pain, motion restriction and overall satisfaction with neck status were assessed on a scale 1-5 (1 = best) in patients treated with anterior approach. Self-evaluation questionnaires were administered during follow-up (average, 7.3 years; 24 months to 11 years). RESULTS: Anatomically reduced fracture fusion was achieved in all cases (100%) at one year follow-up. Both autologous tricortical (22) and fibular allografts (8) were used for anterior approach. No perioperative complications occurred and no case was aborted. Average hospital stay in patients with standalone FRA was 6.8 days (3-15). Patients wore Philadelphia collar for 4-6 weeks. One patient died during follow up due to unrelated causes. None of the 29 patients treated with the anterior approach reported severe or very severe pain (grades 4 or 5). The average pain score was 1.28. Three patients with isolated FRAs reported slight subjective restriction of movement (grade 2). The "satisfaction with overall neck status" scale showed an average score of 1.62, never worse than grade 2. DISCUSSION: Despite increasing popularity of anterior surgical approach in the treatment of type II FRA, most authors still recommend conservative treatment. Surgical treatment is consensually recommended in type III fractures only. Type I is treated exclusively conservatively. There is currently no evidence-based data supporting any method of treatment of so called "hangman's fracture". The majority of treating surgeons do not consider the status of the intervertebral disc. Dynamic films, simulating the peak point of injury, are usually not performed. Hence, potentially unstable fractures are overlooked. This also explains the lack of long term follow-up data regarding the radiological status of C2/3 intervertebral disc as well as patients' subjective complaints. CONCLUSIONS: Surgery provides plausible results. Compared to conservative treatment, it can offer significant benefits: 1) immediate, better and stable reposition; 2) high fusion rate; 3) shortening of the treatment period with better quality of life. Contrary to conservative treatment modalities, surgery possesses a potential for further development.

Adolescent↗
PubMed1990

Thoracolumbar burst fracture with another spinal fracture.

From January 1985 to May 1988, thirty-six patients with thoracolumbar burst fracture were treated and nine of these (25%) were associated with another burst fracture or wedge compression fracture. The etiology of injury was a fall from a height in four patients, motorcycle accident in three, and elevator crushing and house crushing in each of the other two patients respectively. The neurological implications were caused by the main burst fractures, and L1 was the most involved segment of the main burst fracture (44.4%). All three patients had associated wedge compression fracture, as well as three patients who had associated burst fracture, found adjacent to the main burst fracture. The remaining three associated burst fractures were found at a distant level to the main burst fracture.

Adolescent↗
PubMed1986

[Radiotherapy of pathological fractures and skeletal lesions in danger of fractures].

Radiotherapy is of great importance in the treatment of pathologic fractures and skeletal lesions bearing the risk of fracture which are induced by malignomas, especially if these are in an advanced stage. In dependence on site and extent of skeletal destruction as well as on the general tumor dissemination, it can be distinguished between palliative radiotherapy and curative radiotherapy aiming at analgesia and remineralization. A retrospective analysis of 27 pathologic fractures and 56 skeletal lesions bearing the risk of fracture in malignoma patients showed an analgetic effect obtained by radiotherapy in 67% of pathological fractures and in 80% of skeletal lesions bearing the risk of fracture, whereas a remineralization could be demonstrated for 33% of pathological fractures and 50% of destructions bearing the risk of fracture. A stabilization of destructions progressing before therapy was found in 55% of pathological fractures and 40% of skeletal lesions bearing the risk of fracture. Thus a partial loading, supported by orthopedic prostheses, was possible for more than 50% of all patients.

Adult↗
PubMed1988

Displaced malleolar fractures associated with spiral fractures of the tibial shaft.

A displaced fracture of the lateral malleolus, of the posterior tibial margin (posterior malleolus), or of both requiring open reduction and internal fixation was observed in association with ipsilateral spiral tibial shaft fracture in five patients. The malleolus fracture components all were managed using AO (ASIF) instrumentation. The tibial shaft fracture was treated nonoperatively in three patients and with interfragmentary screw fixation in two with more severe initial displacement. The bony healing of all fractures was uneventful. These combined injuries amounted to 0.9% of all admitted tibial shaft fractures and 3.9% of those with spiral configuration. An associated displaced malleolar fracture in tibial shaft fractures, sometimes even indiscernible in the anteroposterior view, may be overlooked unless roentgenograms are focused on the ankle joint. Examination of the joints above and below the fracture is of particular importance in clinics advocating functional treatment of tibial shaft fractures.

Adult↗
PubMed1993

Treatment of ipsilateral femoral shaft fractures and hip fractures.

Ipsilateral femoral shaft fractures and hip fractures are difficult to treat. The treatment protocols are diversified. We report the results of treating 16 such fractures. The diaphyseal fractures are fixed with intramedullary locked nails and the hip fractures with cannulated lag screws. The average follow-up period is 21.8 months. The results show that all diaphyseal fractures healed, one proximal fracture had delayed union. Functionally, 14 (87.5 per cent) patients had good results and two (12.5 per cent) had fair results; additional procedures may be necessary if the treatment of fractures is delayed. It is concluded that the present treatment protocol gives predictable good results for these fractures. The use of the newly available long gamma nail is also discussed and illustrated.

Adult↗