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PubMed1992

Different patterns of mandibular fractures in children. An analysis of 220 fractures in 157 patients.

157 paediatric patients with a total of 220 mandibular fractures were evaluated retrospectively. All patients had been examined with the aid of orthopantomography. 72% of the children had fractures in the condylar region. The patients were divided into four age groups according to the development of the dentition (group A: 0-5 years, B: 6-9 years, C: 10-12 years, and D: 13-15 years). Bicycle accidents and falls were the two main causes of the fractures in all age groups. However, there were significant differences in the causes and location of the fractures between groups A+B and C+D. The proportion of condylar fractures decreased and the proportion of body and angle fractures increased with increasing age; fractures in the horizontal part of the mandible were mainly observed in groups C and D. Both aetiological factors and fracture patterns in the patients older than 10 years of age resembled those of adults. The differences observed should be taken into consideration in studies concerning mandibular fractures in paediatric patients. In this respect the age limit between the adult and child should probably be lowered significantly.

Accidents, Traffic↗
PubMed1999

[The MR tomographic imaging of uncomplicated secondary fracture healing exemplified by the distal radius fracture].

PURPOSE: To investigate the normal sequential MR-pattern of uncomplicated fracture healing within the first 6 weeks. METHODS: In 8 patients with distal radius fracture, 4 by 4 with and without intraarticular fracture, MR examinations were performed 3-4 days after the onset of fracture and after 1, 2, 3, 4, 5 and 6 weeks using the following techniques: T1-weighted spin echo, T2-weighted spin echo, T2 proton density weighted, STIR (short inversion time inversion recovery), T2-weighted turbo spin-echo and fast field echo (FFE, gradient echo). Sequential examinations were analysed regarding 1) the appearance of fracture line, 2) development of bone marrow signal, and 3) signal changes in surrounding soft tissue. Maximum contrast of bone marrow and soft tissue was measured. RESULTS: The fracture line in bone marrow was best detectable in FFE- and T2-weighted spin ech images during the first week and in T2-weighted fast spin echo and proton density-weighted images from the 2nd to 4th week. Beginning in the 5th-6th week an increase of signal intensity in the fracture gap was typical in all sequences except for T1-weighted spin echo. The contrast maximum of bone marrow and soft tissue, best detectable in STIR- and T2-weighted spin echo images, occurred in the 1st-2nd week. CONCLUSIONS: MRI shows a typical time-depending pattern of the fracture line, surrounding bone marrow and soft tissue in normal fracture healing. The degree of injury influences the development of signal changes.

Adult↗
PubMed1992

Intramedullary nailing of acute femoral shaft fractures without a fracture table: technique of using a femoral distractor.

Intramedullary nails were placed prospectively in 25 acute femoral shaft fractures in 25 patients without the use of a fracture table. A femoral distractor was used in 21 of the 25 patients to aid in obtaining and holding a reduction. Our goals were to determine if the technique was safe and effective for insertion of intramedullary nails in a wide spectrum of femoral fractures--with no increase in morbidity when compared to the use of the more familiar fracture table--and to determine the potential complications and pitfalls of using this technique. A retrospective evaluation of the most recent 25 patients with 27 femoral fractures that underwent intramedullary nailing on a fracture table was done to compare operative time, estimated blood loss, complications, and postoperative fracture alignment. In addition to the clinical evaluation, cadaveric dissections were undertaken to determine the exact location of the proximal distractor screw in relation to the contents of the femoral triangle. The femoral nerve was a minimum of 2.5 cm, and the femoral artery a minimum of 3.0 cm from the proximal screw. In comparing the two studies, no significant difference was noted in the age of the patients, fracture types or locations, associated injuries, operative time, estimated blood loss, final fracture reduction, or nail position. No complications were encountered in the placement of the proximal femoral distraction screw. Although the distraction method is technically difficult because the reduction is obtained entirely during the procedure, there are certain situations when this technique could be employed with the benefit of decreasing intraoperative patient manipulation, thereby shortening operative time.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Intramedullary nailing of acute femoral shaft fractures using manual traction without a fracture table.

Intramedullary (IM) nails were prospectively placed in 32 consecutive femoral shaft fractures without the use of a fracture table. All fractures were reduced using manual traction. Pathologic and nonacute fractures and those requiring a reconstruction nail were excluded. The results are compared with results of two prior study groups from this institution that underwent IM nailing with or without a fracture table using a femoral distractor. Ten patients had unstable spine or pelvis fractures. Four nailings followed exploratory laparotomy. Twelve patients underwent two or more procedures on the lower extremities under the same preparation and drape. Six fractures were open. Sixty-seven percent of results were anatomic, 27% had < 5 mm lengthening/shortening or < 5 degree varus/valgus, and 7% had > 5 mm lengthening/shortening or > 5 degree varus/valgus. Average operative time was 95 min. No complications occurred that were attributable to the technique. Compared with the prior study groups, no statistical difference in the fracture types or results was found. However, operative time was significantly less in the manual traction group (p < .05). We feel that this technique is a safe, simple, and effective alternative to using a fracture table. The technique is especially useful in the polytrauma patient, significantly decreasing anesthetic time.

Adolescent↗
PubMed1995

Quality of reduction and cortical screw support in femoral neck fractures. An analysis of 72 fractures with a new computerized measuring method.

The aim of this study was to compare the quality of reduction and the position of the fixating screws with the rate of union in 72 femoral neck fractures. The degree of fracture displacement after reduction and the position of the two fixating screws were determined with a new computerized measuring method that compensates for the variations in hip rotation in routine radiographs. All 13 nondisplaced fractures united. Sixteen of 18 fractures healed in the group of displaced fractures where both the fixating screws were placed within 3 mm from the femoral neck cortex, compared with 13 of 22 healed fractures in the group where only one screw had the same close contact with the femoral neck cortex (p < 0.05). Nonunion developed in all five displaced fractures where none of the two fixating screws were placed within 3 mm from the femoral neck cortex. The quality of reduction did not affect the healing rate; however, the number of poorly reduced fractures was only 10%. The results of this study underline the importance of achieving cortical support for the fixating screws in femoral neck fracture surgery.

Aged↗
PubMed1984

Problems in the management of type III (severe) open fractures: a new classification of type III open fractures.

Between 1976-1979, 87 Type III open fractures (in 75 patients) were treated at the Hennepin County Medical Center. Factors leading to increased morbidity in Type III fractures were: massive soft-tissue damage; compromised vascularity; severe wound contamination; and marked fracture instability. This study demonstrates, because of varied severity and prognosis, that the current designation of Type III open fracture is too inclusive. We recommend, therefore, that Type III open fractures be divided, in order of worsening prognosis, into three subtypes. Type IIIA--Adequate soft-tissue coverage of a fractured bone despite extensive soft-tissue laceration or flaps, or high-energy trauma irrespective of the size of the wound. Type IIIB--Extensive soft-tissue injury loss with periosteal stripping and bone exposure. This is usually associated with massive contamination. Type IIIC--Open fracture associated with arterial injury requiring repair. Wound sepsis in the three subtypes were: Type IIIA, 4%, IIIB, 52%; and IIIC, 42%; while amputation rates were, respectively, 0%, 16%, and 42%. Only two patients developed osteomyelitis, and 12 patients had delayed or nonunions. Five patients died, all as a result of multisystem trauma. The bacterial pathogens in infected open fractures have changed dramatically over the years. In the present series (1976-1979), 77% of infections were due to Gram-negative bacteria, compared with 24% previously (1961-1975). A change of antibiotic therapy from a first-generation cephalosporin alone to a combination of a cephalosporin and an aminoglycoside, or a third-generation cephalosporin, is currently indicated in Type III open fractures.

Adolescent↗
PubMed1993

A biomechanical study of odontoid fractures and fracture fixation.

The purpose of this study was to measure the stability of the odontoid process after fracture and subsequent screw fixation. To accomplish this, we mechanically reproduced Type II and Type III odontoid fractures on isolated C2 vertebrae by varying the direction of load. These fractures were subsequently stabilized with a single 3.5 mm screw and retested for multidirectional stability and load to failure. Reduced and instrumented specimens were found to have a stiffness equivalent to one half of that of the unfractured odontoid. Load to failure was also slightly less than one half of the original fracture force (average 160 lb). Screw failure was by a cut-out mechanism in all Type III fractures and by bending of the screw in all Type III fractures. Our findings, in conjunction with the existing literature, strongly suggest that Type III fractures result from extension forces, whereas Type II fractures result from lateral or oblique loading forces. Single screw fixation of an odontoid fracture will provide stability equal to approximately one half that of the unfractured bone.

Aged↗
PubMedDate not supplied

Complications of pediatric femur fractures treated with titanium elastic nails: a comparison of fracture types.

The purpose of this study was to analyze complications seen in children with femur fractures stabilized with titanium elastic nails, comparing their use in stable and unstable fracture patterns. A retrospective review was performed on 39 consecutive children with femur fractures treated with titanium elastic nails. Patients with comminuted or long oblique fractures were classified as having "length-unstable" fractures. Patients were analyzed qualitatively for any predictive factors or treatment variables that increased the risk of complications. There were 24 patients with complications (62%). Eight patients (21%) underwent unplanned surgery prior to complete fracture union. Six of the eight requiring unplanned surgery were treated for "length-unstable" fractures. The complications that required unplanned surgery for either prominent nails or loss of reduction occurred more commonly in unstable non-transverse fracture patterns. The authors conclude that in patients with "length-unstable" femur fractures, consideration should be given to methods of treatment other than titanium flexible intramedullary nails.

Bone Nails↗
PubMed2005

Lumbar chance fracture in an adult snowboarder: unusual mechanism of a chance fracture.

STUDY DESIGN: A case of a Chance fracture in an adult snowboarder following a fall is presented. The mechanism of this fracture is reported. OBJECTIVE: To increase awareness of the spinal injuries in snowboarders and to propose the mechanism of this unusual fracture. SUMMARY OF BACKGROUND DATA: Chance fractures rarely occur in adults and are very unusual in children. Nearly all of the reported cases are in conjunction with lap-type seat belt injuries. To the authors' knowledge, this is the first reported case of a lumbar Chance fracture in an adult snowboarder. METHODS: A 25-year-old snowboarder sustained an L1 Chance fracture following a fall backward. The patient was placed in a hyperextension cast, and the cast was changed to a thoracolumbar orthosis after 12 weeks. RESULTS: Complete bony union was obtained with body cast immobilization, and an excellent functional restoration was obtained. CONCLUSIONS: Chance fractures are horizontal splitting fractures of the posterior elements of the vertebrae, and the mechanism of the injury is that of a hyperflexion of the spine over a fulcrum. A Chance-type fracture can be seen in an adult snowboarder, when acute hyperflexion of the spine occurs following a fall backward.

Accidental Falls↗
PubMed2001

Fractures and fracture dislocations of the midfoot: occurrence, causes and long-term results.

Etiology and outcome of 155 patients with midfoot fractures between 1972 and 1997 were analyzed to create a basis for treatment optimization. Cause of injuries were traffic accidents (72.2%), falls (11.6%), blunt injuries (7.7%) and others (5.8%). Isolated midfoot fractures (I) were found in 55 (35.5%) cases, Lisfranc fracture dislocations (L) in 49 (31.2%), Chopart-Lisfranc fracture dislocations (CL) in 26 (16.8%) and Chopart fracture dislocations (C) in 25 (16%). One hundred and forty eight (95%) of the midfoot fractures were treated operatively; 30 with closed reduction, 115 with open reduction, 3 patients had a primary amputation. Seven (5%) patients were treated non-operatively. Ninety seven (63%) patients had follow-up at an average of 9 (1.3-25, median 8.5) years. The average scores of the entire follow-up group were as follows: AOFAS - sum of all four sections (AOFAS-ET): 296, AOFAS-Midfoot (AOFAS-M): 71, Hannover Scoring System (HSS): 65, and Hannover Questionnaire (Q): 63. Regarding age, gender, cause, time from injury to treatment and method of treatment no score differences were noted (t-test: p>0.05). L, C or I showed similar scores and CL significantly lower scores (AOFAS-ET, AOFAS-M, HSS, Q). The highest scores in all groups were achieved in those fractures treated with early open reduction and operative fixation. Midfoot fractures, particularly fracture dislocation injuries, effect the function of the entire foot in the long-term outcome. But even in these complex injuries, an early anatomic (open) reduction and stable (internal) fixation can minimize the percentage of long-term impairment.

Adolescent↗
PubMedDate not supplied

Jones' fractures and related fractures of the proximal fifth metatarsal.

At least three fracture types occur in the proximal fifth metatarsal: the Jones' fracture, the proximal diaphysial stress fracture, and the tuberosity avulsion fracture. Each has distinct characteristics. The diaphysial stress fracture is commonly confused with the Jones' fracture, thereby obscuring vital differences in prognosis and treatment. Anatomical and biomechanical characteristics, as well as vascular studies of the proximal portion of the fifth metatarsal, are discussed in an attempt to better understand their diverse healing potentials. Guidelines for treatment are controversial, and must frequently be individualized. Although surgical intervention for certain proximal fifth metatarsal fracture types may speed recovery time, most fractures heal with immobilization. Treatment of displaced, intra-articular fractures, delayed unions, and nonunions usually requires operative methods.

Fractures, Bone↗
PubMed1998

Recombinant human basic fibroblast growth factor accelerates fracture healing by enhancing callus remodeling in experimental dog tibial fracture.

Effect of recombinant human basic fibroblast growth factor (bFGF) on fracture healing was investigated using a tibial fracture in beagle dogs. Transverse fractures in the middle of the diaphyses were created in the right tibiae and bFGF was injected into the fracture sites at a single dose of 200 micrograms. The time course of changes in callus volume and morphology of the fracture sites were evaluated at weeks 2, 4, 8, 16, and 32 after treatment, and the fracture strength was analyzed at weeks 16 and 32. At week 2, a radiogram of the fracture site showed obvious membranous ossification in the group injected with bFGF. Basic FGF extended the callus area at week 4 and increased the bone mineral content (BMC) in the callus at week 8. bFGF also increased the osteoclast number in the periosteal callus at weeks 2 and 4. In the bFGF group, a maximal increase in the osteoclast index was found at week 4, and an identical increase was recognized in the control group at weeks 8 and 16. These findings strongly suggested that bFGF stimulated not only callus formation but osteoclastic callus resorption. BMC in the bFGF group was followed by a rapid decrease from week 8, while that in the control group was identical from week 4. Fracture strength of the bFGF group showed significant recovery by week 16, and recovery was still evident by week 32. We conclude that bFGF promotes the fracture healing in dogs by the stimulation of bone remodeling.

Absorptiometry, Photon↗
PubMed1998

Effect of recombinant human bone morphogenetic protein-2 on fracture healing in a goat tibial fracture model.

Bone morphogenetic proteins (BMPs) are considered to have important regulatory roles in skeletal embryogenesis and bone healing. Recombinant human BMPs (rhBMPs) have been shown to heal critical size defects and promote spinal fusion. We studied the effects of rhBMP-2 in an absorbable collagen sponge (ACS) on bone healing in a large animal tibial fracture model. Bilateral closed tibial fractures were created in 16 skeletally mature goats and reduced and stabilized using external fixation. In each animal, one tibia received the study device (0.86 mg of rhBMP-2/ACS or buffer/ACS), and the contralateral fracture served as control. The device was implanted as a folded onlay or wrapped circumferentially around the fracture. Six weeks following fracture, the animals were sacrificed and the tibiae harvested for torsional testing and histomorphologic evaluation. Radiographs indicated increased callus at 3 weeks in the rhBMP-2/ACS treated tibiae. At 6 weeks, the rhBMP-2/ACS wrapped fractures had superior radiographic healing scores compared with buffer groups and controls. The rhBMP-2/ACS produced a significant increase in torsional toughness (p = 0.02), and trends of increased torsional strength and stiffness (p = 0.09) compared with fracture controls. The device placed in a wrapped fashion around the fracture produced significantly tougher callus (p = 0.02) compared with the onlay application. Total callus new bone volume was significantly increased (p = 0.02) in the rhBMP-2/ACS fractures compared with buffer groups and controls regardless of the method of device application. The rhBMP-2/ACS did not alter the timing of onset of periosteal/endosteal callus formation compared with controls. Neither the mineral apposition rates nor bone formation rates were affected by rhBMP-2/ACS treatment. The increased callus volume associated with rhBMP-2 treatment produced only moderate increases in strength and stiffness.

Animals↗
PubMed2006

Fractures combination of the proximal antebrachium in an immature dog that resembles Monteggia fracture.

A 5-month-old German shepherd dog with a combination of a proximal radial physeal fracture and a proximal ulnar diaphyseal comminuted fracture, with cranial displacement of their distal fragment, was presented. This fractures combination resembles type I Monteggia fracture. After surgical reduction of the fractures, three full-cerclage wires were used to stabilize the ulnar fracture, and two positional screws were placed across the radius and ulna immediately distally to the growth plate to hold these bones in apposition. Four weeks post-operatively, the screws were removed since sufficient callus had been formed and the dog was free of lameness. It seems that if the appropriate conditions for a type I Monteggia fracture develop in an immature dog, proximal radial physeal fracture instead of radial head luxation may accompany ulnar diaphyseal fracture.

Animals↗
PubMed1989

[Surgical treatment of unstable trochanteric fractures of the femur. II. Elastooptic and tensometric studies of the isolated femur and fixed bones in trochanteric fractures using angular or intramedullary Y nails].

Here are presented the results of investigations on the isolated femur and after osteotomy the re-enacting of experimental 2nd degree trochanteric fractures. The connection of fractured bone fragments has been performed with the use of the angular or intramedullar Y nail. It has been stated that pressures (overload 2000 N) on the fracture surface in the bone connected by the use of the intramedullar Y nail are lower than the bone tension prior to fracture in the same place. So far as the angular nail is concerned the connections made by the use of that nail is characterized by lower pressures than tensions prior to fracture (overload 1000 N) and is 20% higher than tensions in the site of hypothetic fracture (overload 2000 N). Moreover, the intramedullar Y nail transfers the pressure below the site of the trochanteric fracture cross-section, relieving the pressure of the fracture site. The length of the intramedullar part of the Y nail is equal to 3/4's of the femur length and is sufficient for stabilization of post-fracture bone fragments.

Bone Nails↗
PubMed1995

Serum osteocalcin increases during fracture healing in elderly women with hip fracture.

The purpose of this study was to define the bone metabolic properties during the postfracture period in elderly women with hip fracture. Osteocalcin (Oc), a marker of bone formation, was measured in 58 women with hip fracture (77 +/- 7 years) admitted to the hospital from their own homes. Serum samples were taken on average 5 h (range 1-21) from fracture and at follow-up, on average 4.6 months later. Comparison was made with 58 age-matched (79 +/- 5 years) women. Women with hip fracture had initially 30% lower Oc levels compared to the controls (p = 0.0001). The Oc level was independent of time elapsed from trauma, within 18 h, after which the level further decreased. At follow-up, Oc showed a 44% increase (p = 0.0001) and had reached the level of the controls, but not beyond it. A concomitant, but less marked increase was noted for alkaline phosphatase (ALP) (p = 0.0001). We conclude that although the bone formation, as assessed by Oc, is apparently lower in elderly women who sustain a hip fracture, the ability to induce a fracture response, with an increased bone turnover during fracture healing is intact. Subsequently, it is essential that a time perspective is applied, as the bone metabolic changes in patients having sustained a fracture are related to the time elapsed from fracture.

Aged↗
PubMed1995

Fractures of the fifth metatarsal. Analysis of a fracture registry.

To understand better the natural history of fractures of the fifth metatarsal, a fracture registry was established consisting of patients who had acute fractures of the fifth metatarsal. The first 100 patients were studied to develop data on the natural history of injuries to this bone, and on the results of standard treatment for those injuries. In this study, 3 fracture subtypes were identified: avulsion, true Jones' fracture, and shaft/neck fracture. Avulsion fractures healed without immobilization, usually in 4 weeks. Shaft/neck fractures healed in plaster casts with weight bearing as tolerated in 4 to 6 weeks. True Jones' fractures required a prolonged time to heal when treated with 8 weeks of nonweight bearing and then weight bearing as tolerated in a cast. This method was, however, successful in 72% of patients (average time until union, 21.2 weeks). For the 7 patients in whom conservative treatment failed, surgical fixation at an average of 25 weeks after injury reliably achieved bony union in half the time required with cast treatment. This low-risk procedure met with higher patient satisfaction than prolonged casting.

Adult↗
PubMed1995

[Interlocking nail according to Seidel in recent diaphyseal fractures of the humerus. Review of 41 cases of 48 fractures].

The Seidel's humeral interlocking nail is used in our department since december 1986. We report about the 48 first cases, 41 of them have been reviewed with a mean time follow up of 14 months. The indications were humeral mid-shaft fractures with associated lesions (20 cases), failures of non operative treatment (10 cases) and compound fractures (7 cases). Primary radialis nerve lesions has to be explored before nailing. In 41 cases we used a static procedure; post-operative immobilisation average time: were 13 days. Consolidation occurred in all cases within an average time of 10.5 weeks. Post-operative complications consisted in 1 case of infection healed after removal of the nail, and 1 case of secondary displacement after dynamic nailing with secondary radio-circumflex paralysis. The results were appreciated concording to the criteria of Stewart and Hundlay. We noted 64 per cent excellent and good results for fractures of the upper third, 80 per cent for fractures of the middle third and 85 per cent for the distal third of the diaphysis. All transverse fractures had a very good result but also the transverse and spiral fractures with third fragment which represent very unstable fractures especially at the upper third. The closed interlocking nailing of the humeral fractures according to Seidel represents a reliable and stable fixation method. Consolidation occurs in all cases whatever the type or the level of fracture.

Adult↗