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PubMedDate not supplied

Effect of fractured or sectioned fragments on the fracture strength of different reattachment techniques.

This study evaluated the effect of fractured or sectioned fragments on the fracture strength recovery of four techniques used for reattachment and resin composite buildups. Ninety-one sound, permanent lower central incisors were used. Half the teeth were fractured in the incisal-proximal edge; the other half had the incisal-proximal edge sectioned by a diamond saw. Teeth from each half were randomly divided into five techniques: 1) bonded only; 2) chamfer; 3) over-contour; 4) internal dentinal groove and 5) resin composite buildup. An adhesive system and dual cure resin cement were employed for the reattachment. Restored teeth were subjected to load in a specific point on the buccal surface. Based on the fracture strength of sound teeth, a fracture strength recovery was calculated for each tooth. A one-way ANOVA and Tukey's test (alpha=0.05) were used to evaluate differences between the techniques for each method of obtaining fragments. The fracture strength recovery of similar techniques was evaluated by a Student t-test (alpha=0.05). No differences could be detected among reattachment techniques when fragments were obtained by sectioning. In groups where the fragments were fractured, Techniques 3 and 4 showed the highest fracture strength recovery. The resin composite buildup provided fracture strength recovery similar to intact teeth regardless the way fragments were obtained.

Analysis of Variance↗
PubMed2004

Dental fracture fragment attachment: fracture model and luting agent comparisons.

PURPOSE: The purpose of this study was twofold: 1. To compare two different research models for simulating a traumatic anterior tooth fracture: the blunt trauma method (standard method) and an AL2O3 sectioning method (experimental method). 2. To compare the bond strength of tooth fragments bonded with resin modified glass ionomer vs. a light cured composite resin. METHODS: Two hundred bovine incisors were used in the study and kept in plain tap water throughout. The study consisted of five basic steps: 1. Fracture of the teeth by either blunt trauma (chisel and hammer) or AL2O3 sectioning disc. 2. Luting of the fractured fragments back to the teeth using either a composite resin or resin modified glass ionomer. 3. Thermocycling of the repaired teeth. 4. Dislodging the teeth to determine the strength of repair. 5. Determination of fracture type. RESULTS: One-way ANOVA revealed a statistically significant difference in the forces required to fracture the resin modified glass ionomer and composite resin regardless of whether the teeth were originally fractured with the blunt force method (p=0.030) or the disc sectioning method (p=.001). One-way ANOVA also revealed a statistically significant difference between the forces required for fracture by blunt trauma and the disc fracture techniques with the resin modified glass ionomer group (p=0.000345). However, there was no significant difference when the two techniques were compared for the composite resin (p= 0.2941). CONCLUSIONS: 1. The resin modified glass ionomer was significantly stronger than the composite resin when both the blunt trauma and the disc fracture techniques were employed. 2. The study's results do not support substituting the ease of the AL2O3 disc for the more time-consuming blunt trauma method.

Analysis of Variance↗
PubMed2004

Understanding rib fracture patterns: incomplete and buckle fractures.

Reconstructing traumatic thoracic events, especially when soft tissues are absent, requires an advanced understanding of ribcage fracture patterns. The morphology and orientation of ribs complicate the fracture pattern, as a single blow often causes multiple fractures at various locations. Furthermore, fracture types observed in ribs are not explained easily by current bone biomechanic literature. Using evidential skeletal material archived at the Regional Forensic Center, Memphis, the ribs of 43 blunt force trauma cases were analyzed. A total of 195 incomplete fractures and 63 buckle fractures were noted. Incomplete fractures, previously thought to be common in children but rare in adults, were found among individuals ranging in age from 21-76 years. A buckle fracture, failure resulting from compressive instability, has been undefined previously in bone trauma literature but was repeatedly observed in this sample. This study elucidates recognizable rib fracture patterns while emphasizing gross bone examination for force and mechanical factors.

Adolescent↗
PubMed1989

Jaw fractures in the county of Stockholm (1978-1980). Jaw fractures in children and adolescents.

Jaw fractures are less frequent in children than in adults. Very few studies exclusively on jaw fractures in children have been reported. From an investigation earlier published about jaw fractures in the country of Stockholm during the years 1978, 1979 and 1980 the authors have selected all cases of jaw fractures in children and adolescents below the age of 20. One hundred and seventy-one patients were studied, 128 boys and 43 girls. The ratio between boys and girls was 3:1. The material was separated into 4 age groups: 0-5, 6-10, 11-15 and 16-20 years. Sixty percent of the fractures were found in the older age groups. The majority of the injuries (62%) occurred during the period May-September, mostly on Fridays and Saturdays, in the younger groups in day time, in the older group during the evening. Fractures due to falling and playing dominated in the younger age groups, but decreased with age. Even if all bicycle traffic accidents were excluded, this vehicle caused 31% of all play and sporting accidents. The relatively percentage of traffic accidents increased steadily from 17 to 42% in the age groups. In the oldest age group violence exceeded traffic as the dominating cause. Le Fort fractures were not found in the younger groups, were fractures of the mandibular condyle and maxillary alveolar process dominated. An erupted tooth in the fracture line was registered in 43% of the cases. Most patients received outpatient treatment.

Accidents↗
PubMed1997

Broadband ultrasound attenuation predicts fractures strongly and independently of densitometry in older women. A prospective study. Study of Osteoporotic Fractures Research Group.

BACKGROUND: Quantitative ultrasound of bone is a new radiation-free technique that measures bone mass and may assess bone quality. Retrospective studies have suggested that low-bone ultrasound of the calcaneus is associated with an increased risk for hip and other fractures in older women. OBJECTIVES: To establish the utility of calcaneal quantitative ultrasound of bone for the prediction of fractures and to compare quantitative ultrasound of bone with bone mineral densitometry by performing a prospective cohort study within the Study of Osteoporotic Fractures. SUBJECTS AND METHODS: We studied 6189 postmenopausal women older than 65 years of 4 US clinical centers. Broadband ultrasound attenuation (BUA), a measurement of the differential attenuation of sound waves transmitted through the calcaneus, and bone mineral density of the calcaneus and hip were measured. Subsequent hip and other nonspine fractures were documented during a mean follow-up of 2.0 years. RESULTS: In age- and clinic-adjusted analyses, each SD reduction in calcaneal BUA was associated with a doubling of the risk for hip fractures (relative risk [RR], 2.0; 95% confidence interval [CI], 1.5-2.7); a similar relationship was observed with bone mineral density of the calcaneus (RR, 2.2; 95% CI, 1.9-3.0) and femoral neck (RR, 2.6; 95% CI, 1.9-3.8). After adjustment for bone mineral density of the femoral neck, BUA was still associated with an increased risk for hip fracture (RR, 1.5; 95% CI, 1.0-2.1). Intertrochanteric fractures in particular were strongly associated with a low BUA measurement (RR, 3.3; 95% CI, 2.0-5.5). CONCLUSIONS: Broadband ultrasound attenuation predicts the occurrence of fractures in older women and is a useful diagnostic test for osteoporosis. The strength of the association between BUA and fracture is similar to that observed with bone mineral density.

Aged↗
PubMedDate not supplied

Avascular necrosis and nonunion after osteosynthesis of femoral neck fractures: effect of fracture displacement and time to surgery.

This study assessed the effect of fracture displacement and elapsed time before surgery on the development of avascular necrosis and nonunion after internal fixation of femoral neck fractures. Twenty-eight patients with 30 femoral neck fractures who underwent internal fixation and completed a minimum of 2 years' follow-up were retrospectively analyzed. The rates of avascular necrosis and nonunion were 12.5% and 25%, respectively, among patients who underwent surgery before 12 hours had elapsed and 14% and 27% among those who underwent surgery after that time. The rates of avascular necrosis and nonunion associated with fracture displacement were 6% and 18%, respectively, among patients with undisplaced (Garden stages 1 and 2) fractures and 23% and 38% among those with displaced (Garden stages 3 and 4) fractures. Nonunion and avascular necrosis led to the necessity for additional surgery in 11 of 30 (36%) hips. Internal fixation of femoral neck fractures is associated with a high initial complication rate, but if successful, the procedure ensures an excellent long-term outcome. Internal fixation should be considered the treatment of choice in young patients with nondisplaced fractures.

Adult↗
PubMed2000

[Traumatology. Mandibular fractures excluding condylar fractures].

Functionally stable fixation via bicortical osteosynthesis on the one hand, and monocortical non-compression osteosynthesis on the other, are still two competing concepts in treating mandibular fractures. A survey of the literature shows that complicated fractures with severe dislocation of the fragments have the lowest rate of complications after functionally stable fixation, whereas non-complicated fractures without significant dislocation in the distal part of the mandible can be treated successfully via monocortical non-compressive osteosynthesis as well. It seems that pre- and intraoperative parameters can be helpful in describing the character of a mandibular fracture in order to give a differential indication between the two therapeutical concepts. The consideration of only seven parameters, as the mandibular fracture score does, provides many combinations of describing a fracture, so that former studies with their small number of patients make only a rather inaccurate differential indication possible. As long as there is no prospective multi-center study giving a guideline to classify mandibular fractures, the rigid internal fixation via functionally stable osteosynthesis should be preferred in all cases which are not "clear, easy to handle" fractures.

Fracture Fixation, Internal↗
PubMed2005

Segmental fracture of the scaphoid: report of a rare fracture pattern.

INTRODUCTION: To the best of our knowledge, there are no reports in the orthopaedic and trauma literature of true segmental fracture of the scaphoid bone. We present such a case with a brief discussion of the morphology and mechanisms of injury of scaphoid fractures and the problems they present, particularly in diagnosis. CASE HISTORY: A 43-year-old male with polytrauma sustained in a motorcycle road traffic accident was treated at our hospital. His injuries included a fracture initially thought to involve the waist of the scaphoid. Because he had bilateral upper limb injuries, we elected to treat the fracture surgically to facilitate rehabilitation. At the time of surgery, the fracture was noted to be truly segmental, an unsuspected and rare finding. The fracture was internally fixed, with a satisfactory result. DISCUSSION: Scaphoid fracture patterns are generally consistent and predictable, occurring most commonly through the waist of the bone. Mechanism for injury is thought to be hyperextension of the wrist. Comminution, with or without a butterfly fragment, is occasionally seen, as are simultaneous tuberosity fractures. We suggest that the mechanism in this case may have been multiple or secondary trauma, or an effect of loaded rotation. We highlight the need for careful imaging of the scaphoid bone prior to choosing treatment.

Accidents, Traffic↗
PubMed2006

Experience in the use of the long Gamma nail for 16 femoral shaft fracture that have occurred following initial Asian Pacific Gamma nail fixation for pertrochanteric fractures.

From January 1993 to September 2002, 931 patients suffered from intertrochanteric fracture and subrochanteric fracture received open reduction and internal fixation with APGN in our institute. Among these patients, 16 patients (1.7%) developed a femoral shaft fracture after the initial fixation with APGN. Removal of the APGN, closed reduction and fixation with long Gamma nail (LGN) was performed in all the 16 patients. The patients were followed for 12-60 months (average, 39.8 months). The union time of fracture was 12-24 weeks (average, 18.5 weeks) for femoral shaft fractures and 12-20 weeks (average, 16 weeks) for peritrochanteric fractures. Two early complications were noted, including one superficial (6%) infection and one deep (6%) infection. Two malunions (12.5%) developed with no definite functional impairment. The functional results using the Harris hip score were good to excellent. In conclusion, closed reduction and internal fixation with a LGN is very effective in the management of a femoral shaft fracture, a complication of a previous APGN that had been initially used for stabilisation of a pertrochanteric fracture.

Aged↗
PubMed2003

Fracture stabilization of proximal tibial fractures with the proximal tibial LISS: early experience in Birmingham, Alabama (USA).

This study is a prospective evaluation of the Less Invasive Stabilization System (LTSS) for the treatment of high-energy tibial plateau and proximal tibial fractures treated between November, 1998 and June, 2000. Thirty-two patients sustained thirty-five acute fractures of the tibial plateau (25) or proximal tibia (10). These patients were injured primarily in blunt trauma accidents, with eighteen having multiple fractures, fifteen having ipsilateral extremity fractures, and eleven having major knee ligament injuries. Seventeen patients had open fractures. Thirty-four patients healed their fractures, with one developing a nonunion. Two patients developed infections, both following Type III open fractures. Final range of motion averaged 2 to 116 degrees. Alignment was well maintained, with no patient losing the alignment that was obtained in the operating room. The tibial LISS system worked well at stabilizing difficult fractures of the tibial plateau and proximal tibia with a low incidence of complications in this preliminary study with short-term follow-up.

Adult↗
PubMedDate not supplied

Influence of plate design on cortical bone perfusion and fracture healing in canine segmental tibial fractures.

OBJECTIVE: To investigate whether or not the limited contact design of the low-contact dynamic compression plate (LCDCP) provides advantages over the dynamic compression plate (DCP) in the context of cortical bone blood flow, biomechanical properties, and remodeling of bone in segmental tibial fractures. DESIGN: Randomized trial using canines. SETTING: Animal research laboratory. PARTICIPANTS: Eleven canines. INTERVENTION: Segmental tibial fractures were surgically created in canine tibiae. The tibiae were reduced and stabilized with 316L stainless-steel, 3.5-millimeter, ten-hole plates: LCDCP (n = 5) or DCP (n = 6). MAIN OUTCOME MEASUREMENTS: Laser Doppler flowmetry evaluated cortical bone perfusion in the proximal tibia, segmental piece, and distal tibia (a) before fracture, (b) after fracture, (c) immediately after plating, and (d) at ten weeks. After the dogs were killed at ten weeks, bending stiffness and load to failure of the tibiae were assessed. Tibial cortical bone porosity and new bone formation were measured. RESULTS: Cortical bone blood flow was similar between the LCDCP and DCP groups throughout the study. Bending stiffness and load to failure of the tibiae were similar between the two groups. Whereas cortical bone porosity and new bone formation were higher in all plated tibiae at ten weeks compared with controls, no differences in cortical bone porosity were seen between the LCDCP and DCP groups. There was a trend toward significantly more new bone formation in the LCDCP group. CONCLUSION: The LCDCP is not advantageous in fracture healing or restoration of cortical bone perfusion to devascularized cortex in segmental fractures when plate fixation has been chosen for fracture stabilization. The overall injury following segmental devascularization seems more important to outcome than the type of implant used for fracture fixation up to ten weeks.

Animals↗
PubMed2006

Treatment of distal tibia fractures without articular involvement: a systematic review of 1125 fractures.

BACKGROUND: The management of unstable distal tibia fractures remains challenging. The mechanism of injury and the prognosis of these fractures are different from pilon fractures, but their proximity to the ankle makes the surgical treatment more complicated than the treatment tibial midshaft fractures. A variety of treatment methods have been suggested for these injuries, including nonoperative treatment, external fixation, intramedullary nailing, and plate fixation. However, each of these treatment options is associated with certain challenges. Nonoperative treatment may be complicated by loss of reduction and subsequent malunion. Similarly, external fixation of distal tibia fractures may result in insufficient reduction, malunion, and pin tract infection. Intramedullary nailing can be considered the "gold standard" for the treatment of tibial midshaft fractures, but there are concerns about their use in distal tibia fractures. This is because of technical difficulties with distal nail fixation, the risk of nail propagation into the ankle joint, and the discrepancy between the diaphyseal and metaphyseal diameter of the intramedullary canal. Open reduction and internal plate fixation results in extensive soft tissue dissection and may be associated with wound complications and infections. The optimal treatment of unstable distal tibia without articular involvement remains controversial. OBJECTIVES: This study was designed to review the outcomes of different treatment methods for extra-articular distal tibia fractures. The English literature was systematically reviewed and the rates of malunion, nonunion, infection, fixation failure, and secondary surgical procedures were extracted.

Bone Plates↗
PubMed1998

Second fracture of the distal humerus after varus malunion of a supracondylar fracture in children.

Nine children sustained a second fracture of the distal humerus after union of an ipsilateral supracondylar fracture which had healed with cubitus varus. There were eight boys and one girl with a mean age of five years (1 to 8) at the time of the second fracture which occurred at a mean of 1.5 years after the first. In all patients, the second fracture was an epiphyseal injury of the distal humerus, either associated with a fracture of the lateral metaphysis below the site of the previous supracondylar fracture, or a fracture-separation of the entire distal humeral epiphysis. This suggests that the physis and epiphysis tend to be more subject to injury than the metaphysis of the distal humerus in children who have had a previous supracondylar fracture with varus malunion.

Child↗
PubMed2000

Body size and risk for clinical fractures in older women. Study of Osteoporotic Fractures Research Group.

BACKGROUND: Small body size predicts hip fractures in older women. OBJECTIVE: To test the hypothesis that small body size predicts the risk for other clinical fractures. DESIGN: Prospective cohort study. SETTING: Population-based listings in four areas of the United States. PATIENTS: 8059 ambulatory nonblack women 65 years of age or older. MEASUREMENTS: Weight, weight change since 25 years of age, body mass index, lean body mass and percent body fat, and nonspine fractures during 6.4 years of follow-up. RESULTS: Compared with women in the highest quartile of weight, women in the lowest quartile had relative risks of 2.0 (95% CI, 1.5 to 2.8) for hip fractures, 2.3 (CI, 1.1 to 4.7) for pelvis fractures, and 2.4 (CI, 1.5 to 3.9) for rib fractures. Adjustment for total-hip bone mineral density eliminated the elevated risk. Results were similar for other body size measures. Smaller body size was not a risk factor for humerus, elbow, wrist ankle, or foot fractures. CONCLUSIONS: Total body weight is useful in the prediction of hip, pelvis, and rib fractures when bone mineral density has not been measured.

Adipose Tissue↗
PubMed2001

Treatment of tibial diaphyseal fractures with closed flexible intramedullary ender nails: 39 fractures followed for a period of two to seven years.

OBJECTIVE: To assess the efficacy of flexible intramedullary Ender nails for the treatment of tibial diaphyseal. MATERIALS AND METHODS: This is a retrospective review of patients treated with the Ender Nail for both open and closed tibial shaft fractures. Between January 1989 and December 1994, 43 fractures were treated with these nails. The configuration of each fracture was determined using the Orthopedic Trauma Association classification and the extent of soft tissue damage was assessed using the Gustilo and Anderson's classification. Four patients were excluded from the study due to inadequate follow-up. There were 27 closed and 12 open fractures. RESULTS: The average time to union in 34 out of 39 fractures was 17 weeks. Delayed union and malunion occurred in two patients each and superficial wound infection in 1 patient. Nonunion occurred in 5 fractures that were all located in the distal 1/3 of the tibial diaphysis. We attribute this high rate of non-union to a poor rotational control on the distal fragment by these nails. CONCLUSIONS: The Ender nails provide effective fixation for the OTA stable class of tibial fractures, where they produce good axial and rotational stability by virtue of their three-point fixation. Rotational and angular stability should be improved by a supplementary cast immobilization for fractures with unstable configuration and those located in the distal third of the diaphysis.

Adolescent↗
PubMed2003

[Restoration of deformities caused by complex fracture of the orbit region and adjacent cranio-maxillofacial fracture].

OBJECTIVE: In order to improve the diagnosis and treatment of the complex fracture of the orbit region and adjacent cranio-maxillofacial fracture. METHODS: 73 cases with blowout fracture of the orbit and adjacent cranio-maxillofacial fracture in recent years were retrospectively analyzed and comparied with different methods of treatment. All cases had undertaken CT examinations. RESULTS: The positive rate of the CT examinations with blowout fracture of the orbit and adjacent cranio-maxillofacial region were 100%. Operating repositioning, rigid fixation and artificial material placement were used to treat this kind of deformities. CONCLUSIONS: With the progress of modern photographic methods, blowout fracture of the orbit and adjacent cranio-maxillofacial fracture can be diagnosed clearly and help the operation procedure. Operations with reduction, rigid fixation and filling materials can be used to restore this kind of fracture and appearance.

Adolescent↗
PubMed1986

Indications of primary osteosynthesis in patients with fractures of long bones of extremities with special regard to multiple and associated fractures of femur diaphysis.

Fractures of the long shaft-shaped bones were evaluated upto the sixties as an isolated therapeutic problem. During the past fifteen years, however, views as regards treatment of fractures of long bones began to change along with the increasing number of multiple fractures and polytraumas. It was revealed that fractures of the long bones and pelvic fractures have a bearing on the development of the syndrome of fat embolism, the syndrome of acute respiratory distress in adults, on the development of shock damage of the lungs, heart, kidneys, liver, pancreas etc. Evidence was accumulating that unstable fractures of the long shaft-shaped bones contribute towards the development of these complications. During the past ten years stable osteosynthesis of fractures of the long bones, in particular of the lower extremities, has gained priority among operations which have a positive effect on the stabilization of the organism in the early postinjury stage of polytrauma. Modern traumatology solves the dilemma which developed in practice from the need of early osteosynthesis on the one hand and reflections on possible deterioration of the general condition of the organism of the severely injured as a result of urgent or early osteosynthesis, on the other hand. Modern traumatology seeks a basis for objective assessment of conditions and parameters for possible primary or early delayed osteosynthesis in multiple injuries with the aim to shift the indication for stable osteosynthesis of fractures of the femur in multiple injuries to the onset of the stabilization phase.

Embolism, Fat↗