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PubMedDate not supplied

Fracture healing: bone healing, fracture management, and current concepts related to the hand.

Bones fracture frequently and often result in significant impairments, functional limitations, and disabilities, especially when the hand is involved. When fractures occur, there is a disruption of the skeletal tissue organization and a loss of mechanical integrity. The goal of fracture healing is to regenerate mineralized tissue in the fracture area and restore mechanical strength to the bone. Of equal importance is the reconstitution of the normal soft tissue gliding and movement about the fracture site. This article briefly reviews the history of fracture healing and the advances in mechanics and cellular and molecular biology, which should help the reader better understand the current mechanisms related to bone healing (primarily and secondarily). Fracture fixation modes also are described along with the temporal sequencing as to when to protect or move the fractured region.

Bone and Bones↗
PubMed2003

Sub- or intertrochanteric fracture following screw fixation of an intracapsular proximal femoral fracture: true complication or technical error?

PURPOSE: To review, retrospectively, the possible causes of sub- or intertrochanteric fractures after screw fixation of intracapsular fractures of the proximal femur. METHODS: Eighty-four patients with an intracapsular fracture of proximal femur were operated between 1995 and 1998 by using three cannulated 6.25 mm screws. The screws were inserted in a triangular configuration, one screw in the upper part of the femoral neck and two screws in the inferior part. Between 1999 and 2001, we use two screws proximally and one screw distally. RESULTS: In the first series, two patients died within one week after operation. Sixty-four fractures healed without problems. Four patients developed an atrophic non-union; avascular necrosis of the femoral head was found in 11 patients. Three patients (3.6%) suffered a sub- and/or intertrochanteric fracture after a mean postoperative time of 30 days, in one case without obvious trauma. In all three cases surgical revision was necessary. Between 1999 and 2001 we did not observe any fracture after screwing. CONCLUSION: Two screws in the inferior part of the femoral neck create a stress riser in the subtrochanteric region, potentially inducing a fracture in the weakened bone. For internal fixation for proximal intracapsular femoral fracture only one screw must be inserted in the inferior part of neck.

Adult↗
PubMed2004

Effects of fracture fixation stability on ossification in healing fractures.

Temporal distribution of intramembranous and endochondral bone formation was studied in experimental fracture defects in rats under different stability of fracture fixation and fracture environments. Animals were surgically treated with a specially developed external fixation construct: Group 1 had 42 rats with a 0-mm fracture gap with bone ends touching corresponding to an axial stiffness of 265.00 +/- 34.00 N/mm and Group 2 had 42 rats with a 2-mm fracture gap corresponding to an axial stiffness of 30.38+/- 2.07 N/mm. From each group, six animals were sacrificed at 4 days and 1, 2, 3, 4, 6, and 12 weeks. Qualitative histologic and morphometric analyses revealed that less fixation rigidity and increased fracture gap induces a later response of bone formation and greater endochondral bone formation leading to prolonged time for full ossification. Furthermore, in the early phase of fracture healing temporal distribution and histologic characteristics of periosteal and intramedullary bone formation are similar and not influenced by rigidity and fracture environment. Results also showed that if tissues associated with the intramedullary region are preserved, intramedullary bone formation is substantial. Finally, histologic data indicate that woven bone might be a prerequisite for the differentiation process of endochondral bone formation.

Animals↗
PubMed2003

External fixation of displaced femoral shaft fractures in children: a consecutive study of 98 fractures.

OBJECTIVE: To evaluate unilateral external fixation when applied as the standard treatment of children with displaced femoral shaft fractures. SETTING: Two county hospitals in central Sweden. DESIGN: A consecutive and prospective study including all children aged 3 to 15 years with displaced femoral fractures admitted to either of the two hospitals. Patients were followed clinically and radiographically until healing and at 1 year. RESULTS: A total of 96 children with 98 fractures were treated with the same kind of external fixator during the period 1993-2000. The mean age was 8.1 years (range 3-15 years). Average hospital stay was 8.7 days (median 7 days). Average time of external fixation was 61 days (range 37-127 days; median 56 days). Minor complications included pin track inflammation/infection in 36 of 98 (37%) fractures. In 18 of 36 fractures, a short treatment with oral antibiotics was given. Other minor complications were one heterotopic ossification, one patient with two rereductions, nine cases of clinically insignificant malunion (varus = valgus > 5 degrees or procurvatum > 10 degrees ), and one leg-length discrepancy greater than 2 cm. Major complications (6%) included two refractures, one through a pinhole and one at the fracture site, both after significant trauma. Three of the older children with transverse fractures after high-energy injury developed a bending due to premature removal of the fixator prior to healing and required corrective osteotomies. One boy had a third rereduction because of displacement after a fall. CONCLUSIONS: The use of external fixation as a standard treatment of uncomplicated displaced femoral shaft fractures in children gave satisfactory results. The surgical learning curve was short, and the advantages compared with nonsurgical treatment included shorter hospital stay, early mobilization, and fewer days out of school for the patient and out of work for the caregiver. We believe that the advantages far outweigh the complications, many of which can be avoided.

Adolescent↗
PubMed1983

The crush-cleavage fracture. A "new" thoracolumbar unstable fracture.

Among 14 patients with unstable thoracolumbar fractures examined by both conventional radiography and CT, we found seven patients with a "new" common fracture pattern. This fracture pattern consisted of (1) superior disc injury, (2) crush fracture of the upper half of the vertebral body, (3) sagittal fracture (cleavage fracture) of the lower half of the vertebral body, (4) bone fragments in the spinal canal, and (5) laminar fracture. Five of the seven patients had sustained their injuries in vertical falls; all five had primary neurological deficit symptoms. We consider this fracture to be unstable.

Adolescent↗
PubMed1997

Vertebral compression fractures in multiple myeloma. Part II. Assessment of fracture risk with MR imaging of spinal bone marrow.

PURPOSE: To determine the utility of bone marrow magnetic resonance (MR) imaging in the assessment of risk of vertebral compression fractures in patients with multiple myeloma. MATERIALS AND METHODS: In 50 patients with stage III multiple myeloma, 280 MR examinations of the thoracolumbar spine obtained at diagnosis and during treatment (mean follow-up, 28 months) were analyzed to determine MR patterns of bone marrow involvement before treatment and the occurrence of vertebral compression fracture at follow-up. Four MR patterns of marrow involvement were determined: A, normal marrow appearance; B, fewer than 10 focal lesions; C, more than 10 focal lesions; and D, diffuse infiltration. Fracture-free survival was compared according to these patterns. RESULTS: During follow-up, 131 vertebral compression fractures appeared in 37 patients. Patients with pattern A (n = 10) or B (n = 16) had significantly longer fracture-free survival before occurrence of the first, second, and third fractures than those with pattern C or D (P < 10(-5)). Relative risks of first, second, and third fracture occurrence for patients with pattern C or D compared with those with pattern A or B were 6.2, 9.1, and 11.0, respectively. CONCLUSION: Determination of MR patterns of spinal bone marrow involvement is a potential relevant factor to predict the risk of vertebral fractures in patients with stage III multiple myeloma.

Adult↗
PubMed1994

Compartment pressure in association with closed tibial fractures. The relationship between tissue pressure, compartment, and the distance from the site of the fracture.

We studied twenty-five consecutive patients who had a closed tibial fracture to determine whether there was a relationship between compartment pressure and the distance at which the pressure was measured from the site of the fracture. Tissue pressure was measured in all four compartments of the leg at the level of the fracture and at five-centimeter increments proximal and distal to the fracture. The peak pressure was usually found at the level of the fracture and was always located within five centimeters of the fracture. The highest pressures were recorded in the anterior and the deep posterior compartments in twenty patients, including all five of those who had had a fasciotomy. The measured pressure decreased steadily when sampled at increasing distances proximal and distal to the site of the highest recorded pressure. Decreases of twenty millimeters of mercury (2.67 kilopascals) five centimeters adjacent to the site of the peak pressure were common. Compartment syndrome was diagnosed in five patients on the basis of clinical findings, and the diagnosis was confirmed when peak compartment pressures of more than the critical threshold (within twenty millimeters of mercury [2.67 kilopascals] of the diastolic blood pressure) were recorded. Three of these five patients had measured pressures that were less than the critical threshold within five centimeters of the site of the peak pressure. Failure to measure tissue pressure within a few centimeters of the zone of peak pressure may result in a serious underestimation of the maximum compartment pressure. Our results suggest that measurements should be performed in both the anterior and the deep posterior compartments at the level of the fracture as well as at locations proximal and distal to the zone of the fracture to determine reliably the location of the highest tissue pressure in a lower extremity when a compartment syndrome is suspected clinically. The highest pressure should be used in the decision-making process.

Adult↗
PubMed2002

Mennen plate fixation for the treatment of periprosthetic femoral fractures: a multicenter study of thirty-six fractures.

BACKGROUND: The management of periprosthetic femoral fractures after total hip and knee replacement remains difficult and controversial. This study was performed to determine the results of Mennen plate fixation for the treatment of periprosthetic femoral fractures. METHODS: This retrospective multicenter study consists of a review of a consecutive series of thirty-five patients in whom a total of thirty-six periprosthetic femoral fractures were treated with Mennen plate fixation. The average duration of follow-up was twenty-seven months (range, eight to forty-six months). RESULTS: Twenty-six fractures (72%) had united at an average of five months (range, three to ten months) after surgery. One of them had varus bending (10 degrees) of the plate. The remaining ten fractures had a nonunion and varus bending (20 degrees to 30 degrees) of the plate, with a fracture of the plate in eight. A revision procedure was successfully performed in the eight patients with nonunion. CONCLUSIONS: The treatment of unstable periprosthetic femoral fractures with Mennen plate fixation was complicated by high rates of mechanical failure (31%) and nonunion (28%). For this reason, we do not recommend the use of the Mennen plate for the treatment of periprosthetic femoral fractures.

Adult↗
PubMed1987

Stress fractures of the distal tibia and calcaneus subsequent to acute fractures of the tibia and fibula.

Stress fractures (two in the calcaneus and four in the distal tibia) occurring distal to the site of a healing fracture of the tibia or fibula were discovered in five patients. Three of these fractures were identified radiographically at the time of their occurrence, and three were identified only after retrospective review of the radiographs of 74 patients with previous tibial or fibular fractures. Three of the patients were less than 10 years old. All five patients had disuse osteopenia and recently had begun weight-bearing. Four patients had healing of their acute fractures with angulation or displacement. Stress fractures can easily be overlooked on radiographic studies in this setting and may be a source of pain that mistakenly can be attributed to malunion or nonunion. Stress fractures should be considered in patients with fractures of the lower extremity, particularly those who experience new or persistent pain or discomfort.

Adolescent↗
PubMed2006

Adherence to bisphosphonate therapy and fracture rates in osteoporotic women: relationship to vertebral and nonvertebral fractures from 2 US claims databases.

OBJECTIVE: To characterize the relationships between adherence (complance and persistence) to bisphosphonate therapy and risk of specific fracture types in postmenopausal women. PATIENTS AND METHODS: Data were collected from 45 employers and 100 health plans in the continental United States from 2 claims databases during a 5-year period (January 1, 1999, through December 31, 2003). Claims from patients receiving a bisphosphonate prescription (alendronate or risedronate) were evaluated for 6 months before the Index prescription and during 24 months of follow-up to determine total, vertebral, and nonvertebral osteoporotic fractures, persistence (no gap in refills for >30 days during 24 months), and refill compliance (medication possession ratio > or = 0.80). RESULTS: The eligible cohort included 35,537 women (age, > or = 45 years) who received a bisphosphonate prescription. A subgroup with a specified diagnosis of postmenopausal osteoporosis was also evaluated. Forty-three percent were refill compliant, and 20% persisted with bisphosphonate therapy during the 24-month study period. Total, vertebral, nonvertebral, and hip fractures were significantly lower in refill-compliant and persistent patients, with relative risk reductions of 20% to 45%. The relationship between adherence and fracture risk remained significant after adjustment for baseline age, concomitant medications, and fracture history. There was a progressive relationship between refill compliance and fracture risk reduction, commencing at refill compliance rates of approximately 50% and becoming more pronounced at compliance rates of 75% and higher. CONCLUSIONS: Adherence to bisphosphonate therapy was associated with significantly fewer fractures at 24 months. Increasing refill compliance levels were associated with progressively lower fracture rates. These findings suggest that incremental changes in medication-taking habits could improve clinical outcomes of osteoporosis treatment.

Aged↗
PubMed1999

Does pulsed low intensity ultrasound allow early return to normal activities when treating stress fractures? A review of one tarsal navicular and eight tibial stress fractures.

We sought to evaluate the efficacy of daily pulsed low intensity ultrasound (LIUS) with early return to activities for the treatment of lower extremity stress fractures. Eight patients (2 males, 6 females) with radiographic and bone scan confirmed tibial stress fractures participated in this study. Additionally, a case report of a tarsal navicular stress fracture is described. All patients except one were involved in athletics. Prior to the study, subjects completed a 5 question, 10 cm visual analog scale (VAS) regarding pain level (10 = extreme pain, 1 = no pain) and were assessed for functional performance. Subjects received 20-minute LIUS treatments 5 times a week for 4 weeks. Subjects maintained all functional activities during the treatment period. Seven patients with posterior-medial stress fractures participated without a brace. Subjects were re-tested after 4 weeks of treatment. Mann-Whitney U tests (VAS data) and paired t-tests (functional tests) assessed statistical significance (p<0.05). Although the intensity of practice was diminished in some instances, no time off from competitive sports was prescribed for the patients with the tibial stress fractures. The patient with the anterior tibial stress fracture underwent tibial intramedullary nailing at the conclusion of a season of play. In this uncontrolled experience, treatment of tibial stress fractures with daily pulsed LIUS was effective in pain relief and early return to vigorous activity without bracing for the patients with posterior-medial stress fractures.

Basketball↗
PubMed2003

[Treatment of trimalleolar fractures. Is osteosynthesis needed in posterior malleolar fractures measuring less than 25% of the joint surface?].

OBJECTIVES: We evaluated the effect of posterior malleolar fractures, which measured less than 25% of the joint surface, on the results of ankle fractures. METHODS: The study included 44 patients (21 females, 23 males; mean age 44 years; range 17 to 76 years) who underwent surgical treatment for Weber types B or C ankle fractures. Fibula fractures were associated with deltoid ligament ruptures in 12 patients, and with medial malleolar fractures in 32 patients. Sixteen patients and 28 patients with and without posterior malleolar fractures, respectively, were evaluated as separate groups according to the Phillips' criteria for comparison of clinical, anatomical, and arthritic scores. The mean follow-up was 29.5 months (range 18 to 64 months). RESULTS: There were no significant differences between the two groups with regard to clinical and anatomical scores. Although the mean arthritic score was higher in patients with a posterior malleolar fracture, it did not reach significance (p>0.05). CONCLUSION: Our data show that satisfactory results can be achieved in posterior malleolar fractures measuring less than 25% of the joint surface when an acceptable reduction is performed even without osteosynthesis.

Adolescent↗
PubMed1989

[Surgical treatment of unstable trochanteric fractures of the femur. III. Comparative studies of the tensile strength of osteosynthesis in trochanteric fractures of the femur using angular and intramedullary Y nails].

Here is shown a comparison of endurance in different types of connected trochanteric fractures by the use of angular and intramedullary Y nails. Studies were made on 24 isolated femora, upon which an osteotomy was performed so as to experimentally reconstruct trochanteric fractures of the II, III and IV degree. Bone fragments were connected by the use of angular or intramedullary Y nails. Such connected bones underwent the gradual increase of weight in order to test the endurance of the connections applied. It was established that the angular nail stabilizes fragments in fractures of the II degree, but in fractures of the III degree it can only serve as a bone suture. On the other hand it is of no use in connected fractures of the IV degree. The intramedullary Y nail stabilizes bone fragments well in fractures of the II and III degree, as well as in fractures of the IV degree. The connection of trochanteric fractures of the II degree by use of the intramedullary Y nail is more beneficial than connection by use of the angular nail due an approximately doubled endurance in connections of this kind.

Bone Nails↗
PubMed1988

Traumatic posterior fracture-dislocation of the hip with fracture of the femoral head or neck, or both.

To determine the prognosis and best treatment for patients who have a posterior dislocation of the hip associated with a fracture of the femoral head or neck (Grade IV, according to the classification of Stewart and Milford), we surveyed the records of 201 patients who had been treated for 203 posterior dislocations from 1958 to 1985 and selected the cases of 19 patients (19 posterior fracture-dislocations of the hip) for further review. Each of the injuries had resulted from a motor-vehicle accident. Thirteen patients had had a posterior dislocation with an associated fracture of the femoral head located either caudad or cephalad to the fovea centralis (Pipkin Type-I or Type-II injury), one had had a posterior dislocation with associated fractures of the femoral head and neck (Pipkin Type III), two had had a posterior dislocation with associated fractures of the femoral head and the acetabular rim (Pipkin Type IV), and three had had a fracture-dislocation that we could not categorize according to the Pipkin classification. Twelve patients had been treated by closed reduction for a Type-I or Type-II injury; one, by open reduction after an unsuccessful closed reduction for a Type-I injury; one, by primary total hip replacement for a Type-III injury; and three, by open reduction with screw fixation of the acetabular fracture and removal of the fragment of the head for two Type-IV injuries and one unclassified injury. An additional two patients had had both a fracture of the femoral neck and a dislocation; one hip was treated primarily with a Moore prosthesis and the other was left unreduced.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

[Total mineral analysis of fracture callus in fracture healing--an animal experiment study].

The total mineral contents in the fracture callus was determined quantitatively on the fracture model of the closed fracture of the lower leg and the secondary bone fracture healing in rabbits with the technique by Cameron and Sörenson (1963) on the 7th, 14th, 21st, 28th, 42nd, 70th, 128th, and 168th day after the fracture. The total mineral contents in the fracture callus corresponds to the normal value of the non-traumatised tibia from the 42nd day after the fracture. The absorption measuring is a fast practicable and well reproducible method for the follow-up of the fracture healing.

Animals↗
PubMedDate not supplied

"Snowboarder's fracture": fracture of the lateral process of the talus.

BACKGROUND: As physicians caring for patients who sustain snowboarding ankle injuries, we have noted that fracture of the lateral process of the talus occurs frequently. The incidence of this fracture, however, is very low in other accounts of ankle injuries. We report a case of fracture of the lateral process of the talus and review the pertinent literature of this injury. METHODS: A literature review was performed using MEDLINE files from 1966 to the present. We found additional references from the bibliographies of available reports. RESULTS AND CONCLUSIONS: Physicians caring for snowboarders should look specifically for fracture of the lateral process of the talus in a snowboarder with a lateral ankle or foot injury. This fracture can mimic a lateral ankle sprain, yet the fracture is easily missed on plain radiographs of the ankle. Because displaced or comminuted fractures can cause long-term disability, primary care physicians and specialists alike need to be aware of the association of this fracture with snowboarding.

Adult↗
PubMed2000

Acceleration of fresh fracture repair using the sonic accelerated fracture healing system (SAFHS): a review.

The Sonic Accelerated Fracture Healing System (SAFHS) is a relatively new fracture management tool which incorporates the application of a specifically modified diagnostic ultrasound unit to healing fractures with the intention of accelerating repair. In an animal fracture model, this device has been shown to accelerate the rate of biomechanical healing by a factor of 1.4-1.6. In two randomized, controlled trials in humans, the same unit has been shown to reduce the time frame of clinical and radiographic healing by 38%. In the two fracture regions investigated, tibial diaphysis and distal radius, this represented a 58 day and 37 day reduction in healing time, respectively. Despite its effect on the entire process of fresh fracture repair, the effect of the SAFHS on the individual stages and processes involved has not been established. This paper reviews these stages and processes, and discusses the clinical and practical implications of the effect of the SAFHS on fracture repair and the need for further research into this modality.

Animals↗
PubMed2006

One fracture is enough! Experience with a prospective and consecutive osteoporosis screening program with 239 fracture patients.

BACKGROUND: Fracture and low bone mineral density both have strong predictive value for future fractures. The risk of future fractures can be reduced by medi-cal treatment if patients with osteoporosis are identified, for example by screening fracture patients for low bone mineral density. We suggest that these screening routines be organized at orthopedics departments and we report our experience with such a screening system. PATIENTS AND METHODS: We screened all patients between 50-75 years of age with a wrist, vertebral, proximal humerus, or hip fracture visiting our orthopedics department by measuring bone mineral density (BMD) using DEXA scans. After diagnosis, the patients were referred to their primary care physician for treatment. RESULTS: Between November 1, 2002, and October 31, 2003, 239 patients were investigated and only 13% had normal BMD values. 45% of the patients were diagnosed with osteopenia and 42% with osteoporosis. INTERPRETATION: Screening of fracture patients who visit an orthopedics department appears to be an effective way of identifying individuals with low bone mineral density. The screening routines can be organized as an osteoporosis team consisting of a doctor, a nurse and a secretary at each department. Today, these patients are largely undetected and untreated--at least in our region. In our series, only 13 patients had been DEXA-scanned and were treated by antiresorptive drugs at the time of fracture.

Aged↗