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PubMed1987

The relationship between oblique fractures of the medial malleolus and concomitant fractures of the anterolateral aspect of the tibial plafond.

Considerable disagreement exists concerning the mechanism by which the relatively uncommon oblique fracture of the medial malleolus is produced, and to our knowledge the relationship between it and a fracture of the anterolateral aspect of the tibial plafond has not previously been recognized. We treated a patient with these fractures whose deformed steel-reinforced work boot indicated that the mechanism of injury had been external rotation, dorsiflexion, and abduction. We found this fracture pattern in eleven other patients. We concluded that the malleolar fracture is an oblique avulsion injury and that impingement of the talus on the anterolateral aspect of the tibial plafond accounts for the other fracture. The identification of an oblique medial malleolar fracture should prompt a search for a fracture of the anterolateral aspect of the tibial plafond; the reverse is also true.

Adult↗

PubMedDate not supplied

Femoral fracture in children (a prospective study of two hundred and four fractures).

A PROSPECTIVE study of 204 femoral fractures in 200 children admitted continuously to a single surgical unit during a period of two years (1979-81), was carried out to determine the adverse effects on the overall outcome of treatment, due to lack of standard orthopaedic equipment to apply low friction traction. There was no case of fracture of the femoral neck, confirming its rarity in children. Left femur was fractured more than the right and middle third shaft was the commonest site. Spiral type of fracture was more common than the transverse or oblique type. Thirty percent of fractures were due to the Road Traffic Accidents while sport injuries were almost the same in number. 32 percent of total cases had other associated injuries, where skull fractures headed the list. To our satisfaction there was no death in this series. The stay in hospital for various different groups ranged from 21 days to 36 days. The average follow-up was 10 months (range 6 months to 2 years). All femoral fractures united and the only noteworthy complications was in two patients at the end of two years, who had residual shortening of upto 1.2 centimetres. The absence of longitudinal overgrowth in our series (a well known complication) may be due to our failure to maintain adequate reduction of the over-riding fragments probably due to the non-availability of the low friction traction appliances. A malposition of femoral fracture in children, to certain limits, should be left to the Nature's kindly help of remodelling the younger bones and surgical intervention should be avoided.

Accidents, Traffic↗

PubMedDate not supplied

Fracture strength and fracture patterns of maxillary premolars with approximal slot cavities.

The fracture strength and fracture patterns of maxillary premolar teeth prepared with two different cavity designs and tested with and without amalgam restorations were determined. No significant difference in the fracture strength of intact premolars and premolars prepared with conventional MOD cavities or slot MO/DO cavities was found whether or not the teeth were restored with amalgam. However, fracture pattern analysis revealed significant differences among the groups of teeth. Premolars with MO/DO slot cavities or slot amalgam restorations exhibited minimal fractures that involved enamel only in the majority of the cases. This behavior was similar to what was observed with intact premolars. In contrast, premolars with conventional MOD cavities or MOD amalgam restorations exhibited severe fractures that involved enamel, dentin, and the root in the majority of the cases. These severe fractures were statistically significantly different from those of premolars with slot cavities or slot restorations as well as from those of intact premolars. It is concluded that when maxillary premolars require restoration of carious lesions on both approximal sides without occlusal involvement, MO/DO slot amalgam restorations will be expected to result in teeth that are unlikely to undergo severe cuspal fracture compared to conventional MOD amalgam restorations.

Analysis of Variance↗

PubMed1998

[3-dimensional imaging of thalamic fractures of the calcaneum. Validation of classifying fractures into 3 forms].

UNLABELLED: Three dimensional CT scans enables to visualize the calcaneum and to follow the fracture pattern without any risk of errors. PURPOSE OF THE STUDY: This technique has been used to validate our previous classification (using three forms: vertical, horizontal, and mixed) which resulted from a two dimensional tomodensitometric study. MATERIAL: The study was based on a series of 74 fractures, all of them studied with 3D CT and 71 of which were operated. METHOD: The previous classification relied on correlation between lateral radiographs and position on coronal CT plane of the Palmer's fracture line. This we called the Fundamental Line (FL); so the vertical form had medial fundamental line, with thalamic verticalization; and so that the horizontal form with thalamic horizontalization had a lateral FL; the mixed form had a medio thalamic FL with double contoured image. RESULTS: In vertical fractures (16 cases, i.e. 20 per cent), the FL was seen denting the thalamus inwards, continuing forward and damaging the forward facet in about two thirds of cases. The thalamic fragment tilted on its axes frequently, with a great rotation movement; in about half cases, it extended backwards (propagated variation). This lateral fragment, called "cortico thalamic" (CT) explained the vertical thalamic x-ray image. In the horizontal fractures (15 cases, i.e. 20 per cent), the FL dents the thalamus outwards, the medial fragment, pushed downwards, explaining the horizontal image. In the mixed cases (40 cases i.e. 55 per cent) the FL was medio thalamic; the two fragments, downed medially and tilted laterally, are of equivalent importance, hence the double contoured image. In half cases, an accessory line separates the sustentaculum tali, creating the two lined mixed form (14 cases i.e. 35 per cent of the mixed). In those cases, the medial thalamic fragment is unsoldered, when in 50 per cent of cases (i.e. 7 out of 14), the pre-thalamic line, following the sinus tarsi, separates it from the forward part and completely isolates it. Therefore, the initial classification in three forms was in fact confirmed. Moreover, the fundamental line appears in all three forms, being the boundary between the lateral thalamic fragment (always tilted) and the medial fragment (always pushed downside). The anterior of cuboidian joint facets are frequently damaged by the forward prolongation of the Fundamental Line according to studied cases. DISCUSSION: This three form classification emphasizes the role of the Fundamental Line, which in effect acts as a boundary between the two typical displacements of this fracture: downward or rotation movement of the thalamic fragments (since it is there that the main displacements occur). A comparison with the Eastwood and Sanders classifications has been carried out. CONCLUSION: This three dimensional CT approach validates, visualizes and completes the three form classification. This will help us to understand fracture displacements in different forms, and therefore, the particular fracture reduction and osteosynthesis best suited for each case.

Calcaneus↗

PubMed1987

Duration of fracture healing after early versus delayed internal fixation of fractures of the femoral shaft.

The effect of delayed internal fixation in closed uncomplicated fractures of the femoral shaft was studied by comparing 40 patients from a hospital where this fracture was principally treated within 24 hours of the injury, with 46 patients from another hospital where this type of fracture was principally treated after a mean period of 13 days in skeletal traction. The two groups of patients were similar with regard to age, level of fracture, type of fracture and incidence of comminution. All fractures were treated by stable internal fixation. In the group treated by early operation considerably longer AO plates were used. Although delayed fixation resulted in more callus and although secondary bone healing was more frequent than in the group with early internal fixation, no difference in the rate of union of the fractures could be demonstrated.

Adolescent↗

PubMed2005

A pathological fracture of the femoral neck associated with osteonecrosis of the femoral head and a stress fracture of the contralateral femoral neck.

A pathological fracture of the right femoral neck associated with osteonecrosis of the right femoral head and a stress fracture of the contralateral femoral neck occurred in a 47-year-old man. Osteonecrosis was noted in almost the entire femoral head, and the pathological fracture occurred at the subcapital area. Six months later, a stress fracture was detected in the contralateral femoral neck. The stress fracture of the left femoral neck might have been caused by the incremental repetitive mechanical loading in the left hip as a result of the pathological fracture in the right hip. Therefore, it might be necessary to conduct a careful examination, using either a magnetic resonance imaging scan or a bone scan, of patients with extensive osteonecrosis of the femoral head because of the risk of osteonecrosis in the contralateral femoral head as well stress fractures in the contralateral femoral neck.

Arthroplasty, Replacement, Hip↗

PubMed2005

Complications after intracapsular hip fractures in young adults. A meta-analysis of 18 published studies involving 564 fractures.

UNLABELLED: Intracapsular hip fractures in young adults have a significant risk of complications. Consequently, some authors advocate urgent and/or open fracture reduction. Our aim was to analyse outcomes following such fractures with reference to influence of fracture displacement, timing of surgery and method of reduction (open/closed) on the incidence of non-union (NU) and avascular necrosis (AVN). METHODS: Specific search terms were used to retrieve relevant published studies from 1966 to May 2003. RESULTS: Eighteen studies involving 564 fractures were analysed. The overall incidence of NU was 50/564 (8.9%) and AVN was 130/564 (23.0%). There was a higher incidence of NU and AVN following displaced than undisplaced fractures. NU occurred more frequently after open reduction than closed reduction (10/89 [11.2%] versus 13/275 [4.7%]). There was an increased incidence of AVN after closed than open reduction but this was no longer statistically significant when one study with a markedly higher reported incidence of AVN was excluded. The difference in the incidence of NU and AVN following early (<12h) or late (>12 h) surgery was not significant for either NU or AVN. CONCLUSION: Early or open reduction of these fractures may not reduce the risk of NU or AVN. There is a suggestion of a higher incidence of NU following open reduction than closed reduction. Randomised studies with 2 year follow-up are required to report on a larger number of patients before definite conclusions on treatment can be made.

Adolescent↗

PubMed2001

Initial rotational stability of distal tibial fractures nailed without proximal locking: the importance of fracture type and degree of cortical contact.

Although distally locked (dynamic) nailing is generally recommended for fractures below the isthmus of the tibia in the presence of adequate proximal nail-bone contact, rotational stability in the above situation appears to be a major concern and can increase the risk of malunion. However, there is no published experimental evidence to quantify this mechanical parameter or to relate factors such as the fracture pattern with the final clinical outcome. This in-vitro biomechanical experimental study was set out to measure the initial rotational stability of dynamically nailed fractures of the distal tibial diaphysis. Using a composite tibial model, three non-comminuted types (spiral, oblique and transverse) and various comminuted patterns (comminution, 0-85%) of dynamically nailed fractures of the distal tibial diaphysis were tested. Using a special rig to simultaneously apply axial and torsional loading measurements of torsional stiffness and the previously described "spring-back angle" were carried out. Our results showed that in terms of torsional stiffness and the "spring-back" angle oblique fractures are the most stable followed by transverse and spiral fractures. Furthermore, when testing of the above parameters against the degree of comminution was carried out, a significant reduction of rotational stability was evident with comminution of 50% or above. It is concluded that oblique fractures of the distal tibial third that can be reduced with at least 50% cortical apposition present the optimal rotational stability following dynamic nailing.

Biomechanical Phenomena↗

PubMed2002

Femoral neck and intertrochanteric fractures: radiographic indicators of fracture healing.

Serial hip radiographs from 280 patients with proximal femoral fractures were analyzed retrospectively by 3 radiologists to evaluate conventional radiographic healing patterns. Patients with hemiarthroplasty or insufficient follow-up were excluded. In the remaining 41 patients, the fracture line and callus was assessed. Intertrochanteric fractures demonstrated increasing callus and sclerosis at the fracture site. No such association was seen in femoral neck fractures. Traditional indicators of fracture healing cannot be readily applied at the hip. Radiographic features relate more to fracture type and fixation method.

Adult↗

PubMed1987

Treatment of isolated ulnar shaft fractures with prefabricated functional fracture braces.

In a prospective study, from September 1980 to December 1984, 146 isolated ulnar shaft fractures were treated with prefabricated fracture braces. Clinical and roentgenographic follow-up data were available for 73 fractures. Functional results were rated excellent in 64 fractures (88%), good in seven (9%), and poor in two (3%). All fractures healed in an average time of 57 days. The mean angulation measured 6 degrees in the mediolateral plane and 4 degrees in the anteroposterior plane. The complication rate was 18%, relating mostly to residual angulation. Most isolated fractures of the distal one-half of the ulnar shaft can be treated successfully with prefabricated fracture braces.

Adult↗

PubMedDate not supplied

Stress fracture of the radius following a fracture of the ulna diaphysis.

A 70-year-old woman incurred a stress fracture of the radius following a fracture of the ulna. The patient had osteomalacia secondary to a Billroth II procedure. The primary reasons for the development of osteomalacia following a Billroth II procedure are: decreased transit time through the gut, which causes less Vitamin D and calcium absorption, and bypassing of the duodenum, where calcium absorption is highest. After treatment of the osteomalacia with calcium and Vitamin D, the fracture healed uneventfully. The present case report emphasizes the need to identify and treat diseases associated with fractures. Patients with severe osteomalacia and ulnar shaft fractures should have the forearm immobilized because motion at the fracture site may lead to a stress fracture of the radius.

Aged↗

PubMedDate not supplied

Colles' fracture and subsequent hip fracture risk.

The prevention of hip fractures, a major cause of morbidity and mortality in the elderly, is hampered by insufficient knowledge of the population at risk. A Colles' fracture associated with minor trauma is indicative of an overall 50% increase in the risk of a subsequent hip fracture. The relative risk of a subsequent hip fracture is greater for men with Colles' fracture (RR = 6.4) than for women (RR = 1.3). Among women, the risk is increased more than twofold for those whose Colles' fractures occurred at the age of 70 or older but is not increased for younger women. That greater predictive power was not achieved may be due to differences in the pathophysiology of osteoporosis at various fracture sites.

Adult↗

PubMed2000

[Management of comminuted and open fractures of the mandible and fractures in atrophic mandibles with titanium mesh].

Miniplate osteosynthesis is a standard method for the surgical treatment of mandible fractures today. Apart from easy handling, in the majority of cases it also ensures adequate fracture stability. The treatment of fractures of very atrophic mandibles as well as mandibular defects and comminuted fractures with miniplates and rigid plates is often difficult or only possible to an inadequate extent. Titanium mesh has proved successful for the treatment of such fractures. Compared with conventional miniplates this mesh is outstanding for its considerably higher stability due to its given geometry. The titanium mesh can be adapted and screwed individually in any situation, in contrast to miniplates and rigid plates. As a result, complications such as fracture gap infections and pseudoarthrosis can be avoided to a great extent.

Adult↗

PubMed2002

Scaphoid (navicular) fractures of the wrist in children: attention to the impacted buckle fracture.

We retrospectively analyzed the radiographic findings in 76 patients with proven scaphoid (navicular) fractures. The purpose of the study was to determine the incidence of the impacted buckle fracture of the scaphoid bone in children. Fourteen of the 76 patients (17%) demonstrated such a fracture, and all of the fractures occurred in the middle or distal third of the scaphoid bone. The mean age of this group of patients was 13.7 years, as compared to the mean age of 15.6 years in the patients with overt transverse fractures. One out of 14 of the patients with a buckle fracture was female. None developed complicating aseptic necrosis. The fractures were most clearly visualized on AP and oblique views of the wrist, and all cases demonstrated edematous thickening of the soft tissues and/or navicular fat pad obliteration adjacent to the scaphoid bone. The use of comparative views was extremely helpful in the detection of this fracture.

Journal Article↗

PubMed2001

Fracture force, deflection at fracture, and toughness of repaired denture resin subjected to microwave polymerization or reinforced with wire or glass fiber.

STATEMENT OF PROBLEM: The ultimate goal of denture repair is to restore the denture's original strength and avoid further fracture. The best materials and methods for repair have not been conclusively determined. PURPOSE: This study investigated the fracture force, deflection at fracture, and toughness of a heat-polymerized denture base material repaired with heat-polymerized resin, autopolymerized resin alone, or autopolymerized resin with glass fiber or wire reinforcement. MATERIAL AND METHODS: Eight groups were evaluated: 6 with autopolymerized resin repairs, 1 with heat-polymerized resin repairs, and a control group of intact specimens. The 6 autopolymerized resin groups included 1 group with no reinforcement, 1 treated with microwave irradiation after polymerization, 2 with monolayer or multilayer glass fiber reinforcement, and 2 with round or braided wire reinforcement. Each group consisted of 12 specimens. The experimental specimens were cut, and a 3-mm butt joint gap was repaired as indicated by the group assignment. A 3-point bending test was used to determine the fracture force, deflection at fracture, and toughness of the specimens. The data were analyzed with 1-way analysis of variance and the Tukey post-hoc test (alpha=.05). RESULTS: The fracture force (28.4 to 73.4 N), deflection (1.6 to 3.8 mm), and toughness (0.02 to 0.13 J) values for all repaired groups were significantly lower than those for the control group (82.79 N, 4.4 mm, and 0.16 J, respectively), with one exception: the mean fracture force of specimens reinforced with round wire (102.9 N). Failure mode was always adhesive, meaning that fracture occurred between the denture base and repair resin. CONCLUSION: Among the repair treatments tested, the most effective was microwave-irradiated, autopolymerized resin reinforced with round wire or monolayer glass fiber ribbon.

Analysis of Variance↗

PubMed2006

Case report of right hamate hook fracture in a patient with previous fracture history of left hamate hook: is it hamate bipartite?

BACKGROUND: Hamate hook fracture is a common fracture in golfers and others who play sports that involve rackets or sticks such as tennis or hockey. This patient had a previous hamate fracture in the opposing wrist along with potential features of hamate bipartite. CASE PRESENTATION: A 19 year old male presented with a complaint of right wrist pain on the ulnar side of the wrist with no apparent mechanism of injury. The pain came on gradually one week before being seen in the office and he reported no prior care for the complaint. His history includes traumatic left hamate hook fracture with surgical excision. CONCLUSION: The patient was found to have marked tenderness over the hamate and with a prior fracture to the other wrist, computed tomography of the wrist was ordered revealing a fracture to the hamate hook in the right wrist. He was referred for surgical evaluation and the hook of the hamate was excised. Post-surgically, the patient was able to return to normal activity within eight weeks. This case is indicative of fracture rather than hamate bipartite. This fracture should be considered in a case of ulnar sided wrist pain where marked tenderness is noted over the hamate, especially after participation in club or racket sports.

Journal Article↗

PubMed1997

Shop order fracture rate as a risk factor for strut fracture in Björk-Shiley CC60 degrees heart valves.

BACKGROUND AND AIMS OF THE STUDY: Previous studies have implicated a number of characteristics that predict strut fracture in Björk-Shiley convexo-concave heart valves, including valve size and position, opening angle, and weld date. This study examines whether the specific batch (shop order) with which a valve is associated during manufacture is related to the risk of fracture. MATERIAL AND METHODS: Our case-control study of CC60 degrees valves obtained detailed information on the manufacturing characteristics of 147 case and 1094 control valves used. Shop order fracture rate for each valve (percentage of other valves in the same shop order with a fracture) was obtained from the research database maintained by the valve manufacturer. RESULTS: Shop order was associated with fracture risk. Valves originating from shop orders with the highest two categories of fracture rate were at approximately twice the risk of fracture as other valves, after accounting for the effect of known risk factors. CONCLUSIONS: Shop order information may provide additional data for assessing the likelihood of valve fracture in individuals being considered for prophylactic explant of heart valves.

Analysis of Variance↗

PubMed1987

Delayed internal fixation of femoral shaft fractures--is there an advantage? A review of 320 fractures.

We have reviewed 402 traumatic fractures of the femoral shaft, 320 of which had been treated by operation and had a long follow-up. Of these, 228 closed fractures and 37 open fractures had been stabilised by plating. There was no significant difference in healing between those stabilised early and those having delayed internal fixation. Re-fracture after removal of the implant occurred more often after early operation. All 55 fractures treated by intramedullary nailing healed and there were no re-fractures after nail removal. We found no correlation between delay before operation and the incidence of postoperative infection.

Adolescent↗