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PubMed1986

[Butel's hip screw-plate in osteosynthesis of fractures of the upper end of the femur. Apropos of 241 osteosyntheses (100 true cervical fractures and 141 fractures of the trochanter)].

Butel's hip plate was used for osteosynthesis of 241 fractures of upper end of femur (100 true cervical - 141 trochanteric and subtrochanteric fractures). Results for true cervical fractures were assessed as satisfactory in 89.5% of cases, with only 3 pseudarthroses and 4 cases of femoral head necrosis (2 septic, 2 aseptic), a total complication rate of 7.5%. These clinical results confirm the value of screw fixation at several cephalic anchorage sites (demonstrated biomechanically) in true cervical fractures. Results in trochanteric and subtrochanteric fractures were rated as satisfactory in 86.9% of cases, complications including 2 ruptures of plate, 1 sepsis and 4 early loosening of plate. The latter sequela was avoided by an improved choice of indication for the procedure and by substitution of this compound material (screw-plate) for a monobloc piece ("anti-loosening cervicocephalic screw apparatus"), in compound fractures of trochanter.

Adult↗
PubMed2003

[New possibilities in fracture visualization by means of CT: reconstructions, 3D plannings--difficult joint fractures--modern management--improved visualization and operative planning in joint fractures].

After having been introduced in the seventies computed tomography (CT) has become an important instrument for the diagnosis of difficult joint fractures. With the evolution of the Spiral-CT with multiplanar reformations and three-dimensional (3D-) reconstructions the quality of visualization has been improved considerably. In comparison with conventional radiography the actual CT scanners give a clear image of the fracture configuration and the degree of fragment displacement in joint fractures. Additional information about sub-/luxations of the joint, impaction and comminution is also clearly visualized by the CT. This means a rise in quality of fracture classification and enables a detailed view of the fracture pattern. These findings provide the basis for gratifying treatment regimens and surgical management of the injured joint. By the use of innovative reconstruction methods the CT allows exact visualization of internal fixations/osteosynthesis and secondary angular/rotation or length deformities postoperatively. Furthermore, reconstructed 3D-views enable preoperative computer simulated plannings of internal fixations and of reduction control intraoperatively. In fact, the actual Spiral-CT scanners are nearly equivalent in costs and total radiation dose compared to the performance of special projections of conventional radiographs. Thus, we recommend to enlarge the performance of additional CT diagnostic in difficult joint fractures and special pre- or postoperative cases.

Cost-Benefit Analysis↗
PubMed1995

A review on 161 subtrochanteric fractures--risk factors influencing outcome: age, fracture pattern and fracture level.

The results obtained in 161 subtrochanteric fractures of the femur following treatment with a 95 degrees condylar blade plate or a dynamic condylar screw or a gamma nail were retrospectively analyzed. A 95 degrees angular blade plate was used in 107 cases, a dynamic condylar screw in 25, and a gamma nail in 29. There were 114 patients who were admitted after a simple fall and 47 who had sustained a high-energy trauma. In the type of trauma, associated lesions, ISS, pre-existing diseases and finally age we found statistically significant difference (P < 0.001) between patients admitted after a simple fall and patients admitted after a high-energy trauma. The mean operating times for the 95 degrees angled blade plate, the dynamic condylar screw and the gamma nail were 86, 85 and 74 min, respectively. Of the 161 patients, 18 required a revision operation. Of these 18 patients, 8 were initially treated using a 95 degrees condylar blade plate, 2 with a dynamic condylar screw and finally 8 with insertion of a gamma nail; 5 of these patients were less than 70 years old, while the other 13 were older than 70 years (P = 0.025; Fisher's exact test P = 0.042). The post-injury roentgenogram showed a fracture at the level of the lesser trochanter in 11 of the patients older than 50 years (P = 0.017; Fisher exact P = 0.053). Among the 18 patients who underwent revision operations, the post-injury roentgenograms showed 6 type IIIA fractures and 5 type V fractures.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Prediction of hip fractures from pelvic radiographs: the study of osteoporotic fractures. The Study of Osteoporotic Fractures Research Group.

To determine whether simple measurements made on conventional radiographs of the hip could predict hip fractures, we obtained pelvic radiographs on 9704 white women age 65 or older. We analyze the radiographs of all 162 women who subsequently suffered a hip fracture and 162 randomly selected women who did not. Adjusting for age, four measurements independently predicted hip fractures: reduced thickness of the femoral shaft cortex (odds ratio 1.7 per standard deviation; 95% confidence interval 1.2, 2.3) and of the femoral neck cortex (1.4 per standard deviation; 1.0, 1.9), reduction in an index of tensile trabeculae (2.0 per unit; 1.4, 2.9), and wider trochanteric region (1.4 per standard deviation; 1.0, 2.0). The combination of these four measurements predicted hip fracture at least as strongly as did measurement of bone density of the femoral neck (areas of the receiver-operating characteristic curve = 0.81 and 0.80, respectively). We conclude that simple measurements made on pelvic radiographs predict hip fractures as well as bone density of the hip.

Absorptiometry, Photon↗
PubMed1999

Relationship between ligamentous laxity and the site of upper extremity fractures in children: extension supracondylar fracture versus distal forearm fracture.

Eighty children who had fallen on an outstretched hand and sustained either a displaced supracondylar fracture (group 1) or a displaced distal forearm fracture (group 2) were prospectively studied. Ligamentous laxity in these 80 patients was determined by four methods: (a) contralateral elbow hyperextension, (b) knee hyperextension, (c) the ability to touch the thumb to the ipsilateral forearm, and (d) the ability to extend the thumb past the ulnar border of the clenched fist. Elbow hyperextension averaged 10.5 degrees in group 1 and 4.4 degrees in group 2 (P < 0.0001). Knee hyperextension averaged 7.2 degrees in group 1 and 2.4 degrees in group 2 (P < 0.001). Twenty-one of 38 patients in group 1 (55%) compared with 8 of 42 patients in group 2 (19%) could touch the thumb to the ipsilateral forearm (P < 0.001). Twenty-seven of 38 patients in group 1 (71%) compared with 5 of 42 patients in group 2 (12%) could extend the thumb past the ulnar border of the clenched fist (P < 0.001). The authors conclude that a child who demonstrates ligamentous laxity is more likely to sustain an extension supracondylar humerus fracture than a distal forearm fracture when he or she falls on the outstretched hand to break the force of the fall.

Accidental Falls↗
PubMedDate not supplied

[A hip fracture bandage for the prevention of femoral neck fractures in the elderly. The femoral neck fracture, a biomechanical problem].

In the industrial countries, the number of hip fractures will double or even triple in the next 20 years. Pathogenetically, it is a complex matter of medical as well as biosocial factors. Gerontoprophylactically, it is more a biomechanical problem. Therefore a light fall on to the hip at the greater trochanter is of the greatest importance. We have constructed an impact neutralizer, also designed as a hip fracture bandage, to absorb the impact forces which act on aged people during a fall. It is made of a special silicone rubber. The impact neutralizer permits an impulse amplification by a factor of approximately two. Also, the critical height of the fall is increased by a factor of three. That means that the number of hip fractures occurring in elderly people can be reduced by 30-50%, depending on the type of fall and assuming that all elderly people liable to fall wear the hip fracture bandage.

Aged↗
PubMed1992

Case report 725. Posterior displacement of proximal end of the right radius and capitulum with supracondylar fracture causing a displaced fracture rather than a fracture dislocation.

An 11-month-old boy with a swollen, painful right elbow demonstrated a supracondylar fracture on plain film radiographic studies. Sonography was subsequently performed to exclude dislocation of the elbow and demonstrated the supracondylar fracture as well as a normal relationship of the capitulum and radius, signifying a displaced fracture without associated dislocation. A bone dislocation would generally require dosed reduction alone, whereas distal humeral epiphyseal separation usually requires open reduction or percutaneous (pin) fixation. This case demonstrates the utility of ultrasound in the evaluation of physeal disruption and dislocation in the elbow prior to ossification of the secondary centers of ossification.

Diagnosis, Differential↗
PubMed1994

[Are "Busch fracture", "avulsion fracture of the extensor tendon" or "fracture of the dorsal terminal finger joint" synonyms? Anatomic studies of the insertion of the extensor aponeurosis and significance in hand surgery].

With the help of thick transparent cross-sections of fingers, it has been shown that fibers of the extensor aponeurosis insert distal to the avulsed fragment of the distal phalanx. The consequence for hand surgery is not to expose the fragment through a dorsal incision but through a mid-lateral one. In this way, the distant parts of the aponeurosis distal to the fracture remain intact and there is no break in the continuation of the dorsal extensior plate.

Adult↗
PubMed2003

Severity of prevalent vertebral fractures and the risk of subsequent vertebral and nonvertebral fractures: results from the MORE trial.

Prevalent vertebral fractures and baseline bone mineral density (BMD) predict subsequent fracture risk. The objective of this analysis is to examine whether baseline vertebral fracture severity can predict new vertebral and nonvertebral fracture risk. In the randomized, double-blind 3-year Multiple Outcomes of Raloxifene Evaluation (MORE) trial, 7705 postmenopausal women with osteoporosis (low BMD or prevalent vertebral fractures) were randomly assigned to placebo, raloxifene 60 mg/day, or raloxifene 120 mg/day. Post hoc analyses studied the association between baseline fracture severity and new fracture risk in the placebo group and the effects of placebo, raloxifene 60 mg/day, and raloxifene 120 mg/day on new fracture risk in women with the most severe prevalent vertebral fractures (n = 614). Vertebral fracture severity was visually assessed using semiquantitative analysis of radiographs and categorized by estimated decreases in vertebral heights. Reported new nonvertebral fractures were radiographically confirmed. Baseline vertebral fracture severity predicted vertebral and nonvertebral fracture risk at 3 years. In women without prevalent vertebral fractures, 4.3 and 5.5% had new vertebral and nonvertebral fractures, respectively. In women with mild, moderate, and severe prevalent vertebral fractures, 10.5, 23.6, and 38.1% respectively had new vertebral fractures, whereas 7.2, 7.7, and 13.8% respectively experienced new nonvertebral fractures. Number of prevalent vertebral fractures and baseline BMD also predicted vertebral fracture risk, but the severity of prevalent vertebral fractures was the only predictor of nonvertebral fracture risk and remained a significant predictor after adjustment for baseline characteristics, including baseline BMD. In patients with severe baseline vertebral fractures, raloxifene 60 mg/day decreased the risks of new vertebral [RR 0.74 (95% Cl 0.54, 0.99); P = 0.048] and nonvertebral (clavicle, humerus, wrist, pelvis, hip, and leg) fractures [RH 0.53 (95% CI 0.29, 0.99); P = 0.046] at 3 years. To prevent one new fracture at 3 years in women with severe baseline vertebral fractures with raloxifene 60 mg/day, the number needed to treat (NNT) was 10 for vertebral and 18 for nonvertebral fractures. Similar results were observed in women receiving raloxifene 120 mg/day. In summary, baseline vertebral fracture severity was the best independent predictor for new vertebral and nonvertebral fracture risk. Raloxifene decreased new vertebral and nonvertebral fracture risk in the subgroup of women with severe vertebral fractures at baseline. These fractures may reflect architectural deterioration, independent of BMD, leading to increased skeletal fragility.

Aged↗
PubMed1996

Comparison of semiquantitative visual and quantitative morphometric assessment of prevalent and incident vertebral fractures in osteoporosis The Study of Osteoporotic Fractures Research Group.

The assessment of radiographs for vertebral fractures is important in the clinical evaluation of patients with suspected osteoporosis, in the epidemiological evaluation of elderly populations, and in clinical trials of osteotrophic drugs. The purpose of this study is to compare visual semiquantitative (SQ) approaches and quantitative morphometric approaches for assessing prevalent and incident vertebral fractures in postmenopausal osteoporosis. We analyzed lateral thoracolumbar spine radiographs (baseline and approximately 3.5 year follow-up) of 503 women (age > or = 65) randomly selected from the Study of Osteoporotic Fractures (SOF) population. SQ assessment by an experienced radiologist graded vertebral fractures from 0 (normal) to 3 (severe). Incident fractures by SQ were defined as an increase of > or = 1 grade on follow-up radiographs. Trained research assistants visually triaged women as normal, uncertain, or probably fractured and visually flagged vertebrae with moderate/severe (grade > or = 2) prevalent fractures or with any (grade > or = 1 change) incident fracture. The radiographs were also digitized by research assistants, and quantitative morphometry (QM) was used to classify vertebral deformities at several cut-offs based on standard deviation (SD) reductions in height ratios from normal means, e.g., QM > or = 3 SD. Incident fractures by QM were defined as a decrease in height of more than 15% (QM15) on follow-up radiographs. Finally, a combination of these methods was used to detect moderate/severe prevalent fractures and any grade of incident fractures. In the overall analysis, the prevalence of fractures varied from 14 to 33% and the incidence from 5 to 10% by woman, depending upon the method and cut-off criteria. In the detailed analysis, considering visually triaged uncertain as abnormal, triage by research assistants detected 97.0% (163/168) of women with SQ grade > or = 1 fractures and 100% (70/70) with SQ grade > or = 2 fractures. Visual flagging by research assistants detected 88.5% (108/122) of SQ > or = 2 prevalent fractures (kappa score, kappa = 0.82) and 85.2% (52/61) of SQ incident fractures (kappa = 0.79). QM > or = 3 SD detected 37.9% (141/372) of SQ > or = 1 prevalent fractures (kappa = 0.51) and 79.5% (97/122) of SQ > or = 2 prevalent fractures (kappa = 0.68), plus 18 vertebrae without SQ fractures. QM 15 detected 59% (36/61) of SQ incident fractures (kappa = 0.70), plus five vertebrae without SQ incident fractures. The combination assessment detected 92% (112/122) of SQ > or = 2 prevalent fractures (kappa = 0.76) and 84% (51/61) of SQ incident fractures (kappa = 0.91). The precision errors of QM vertebral height measurements (baseline versus follow-up) ranged from 2.71 to 2.92%. Nevertheless, excluding the 5719 vertebrae that were clearly normal by morphometry, i.e., within 2 SD of the normal means at both baseline and follow-up, two-thirds (358/556) of the remaining vertebrae changed classification by at least 1 SD category. Visual triage and visual flagging by research assistants appear to be highly effective methods for vertebral fracture assessment in osteoporosis, potentially reducing the number of false-positive and false-negative fractures detected by QM, at least relative to SQ by the radiologists. There is higher concordance among the visual approaches studied than between the visual SQ and quantitative morphometric approaches, with QM having limited ability to detect mild fractures but good ability to detect moderate/severe fractures, as classified by SQ. Use of a combination of sensitive qualitative and quantitative criteria, with adjudication by an experienced radiologist, is feasible and draws upon the relative strengths of each of the methods. Quantitative morphometry should not be performed in isolation, particularly when applying highly sensitive morphometric criteria at low threshold levels, without visual assessment to confirm the detected prevalent or incident vertebral defor

Aged↗
PubMedDate not supplied

Treatment with alendronate prevents fractures in women at highest risk: results from the Fracture Intervention Trial.

BACKGROUND: The efficacy of antiresorptive therapy in preventing fractures in women at highest fracture risk, such as very elderly women or those with severe osteoporosis, is uncertain. PARTICIPANTS AND METHODS: Using data from a double-blind, randomized, placebo-controlled clinical trial that enrolled 2027 postmenopausal women aged 55 to 81 years with low femoral neck bone mineral density (BMD) and existing vertebral fractures, we examined the consistency of the effect of treatment with alendronate sodium in preventing fractures within a priori-specified risk subgroups defined at baseline by age, bone density, number of preexisting vertebral fractures, and history of postmenopausal fracture. The women were randomized to oral administration of alendronate or placebo and followed up for an average of 2.9 years. The initial dose of alendronate sodium was 5 mg/d; the dosage was increased from 5 to 10 mg/d at 24 months. New vertebral fractures, the primary end point of this arm of the trial, were defined by morphometry as a decrease of 20% and at least 4 mm in any vertebral height between baseline and a follow-up radiograph at 36 months. Incident clinical fractures, the secondary end point, included nonspine and clinical (symptomatic) vertebral fractures. All clinical fractures were confirmed with x-ray film reports or, in the case of clinical vertebral fractures, x-ray films. RESULTS: Overall, there was a 47% significant reduction in risk of new vertebral fractures in the alendronate group compared with the placebo group. The reduction in risk of new vertebral fracture was consistent across fracture risk categories including age (relative risk [RR], 0.49 in women < 75 years compared with 0.62 in those > or = 75 years), BMD (RR, 0.54 in women with a femoral neck BMD < 0.59 g/cm2 [median] compared with 0.53 in those with a BMD > or = 0.59 g/cm2), and number of preexisting vertebral fractures (RR, 0.58 in women with 1 vertebral fracture compared with 0.52 in those with > or = 2). The overall significant 28% reduction in risk of incident clinical fractures in the alendronate group compared with the placebo group was also observed within these subgroups. Compared with the number of lower-risk women, a similar or smaller number of high-risk women needed to be treated to prevent 1 fracture. For example, 8 women aged 75 years or older compared with 9 women younger than 75 years, or 4 women with 2 or more existing vertebral fractures compared with 16 women with 1 existing vertebral fracture, needed to be treated with alendronate for 5 years to prevent 1 new vertebral fracture. CONCLUSIONS: Alendronate effectively reduces fracture risk in postmenopausal women with vertebral fractures and low BMD, including those women at highest risk because of advanced age or severe osteoporosis. Since the risk reductions observed with alendronate treatment were consistent within fracture risk categories, more fractures were prevented by treating women at highest risk.

Administration, Oral↗
PubMedDate not supplied

Limb fractures in elderly men as indicators of subsequent fracture risk.

BACKGROUND: Whether limb fracture in elderly men predicts future fracture is unknown. METHODS: Electronic health records were examined to determine fracture incidence among men 60 years or older who were members of a large health maintenance organization, experienced no fracture in the past 2 years, and experienced an ankle, hip, humerus, or wrist fracture between July 1, 1997, and August 31, 2001. Proportional hazards models were used to compare risk of new fracture (ankle, hip, humerus, or wrist) between groups. Recurrent fractures of the same type were excluded from analysis. RESULTS: During the follow-up period (mean duration, 2.4 years), 0.5% of the control subjects without fractures experienced a subsequent ankle fracture; 0.6%, a hip fracture; 0.2%, a humerus fracture; and 0.4%, a wrist fracture. A limb fracture was about 4 times more likely to occur in persons who experienced a previous humerus fracture (relative risk, 3.9; 95% confidence interval, 2.5-6.0), about 3 times more likely to occur in persons who experienced a previous hip fracture (relative risk, 2.8; 95% confidence interval, 1.7-4.5), and about 2 times more likely to occur in persons who experienced a previous wrist fracture (relative risk, 2.2; 95% confidence interval, 1.4-3.5) than in controls. In contrast, persons who experienced a previous ankle fracture had no greater risk of subsequent fracture than nonfracture controls (relative risk, 1.0; 95% confidence interval, 0.5-1.9). CONCLUSIONS: Among men 60 years or older, a recent hip, humerus, or wrist fracture is a statistically and clinically significant predictor of future limb fracture risk. An increased risk of future fracture is greatest after a humerus fracture and is lowest after a wrist fracture; however, among elderly men, a previous ankle fracture is not an indicator of future fracture risk.

Aged↗
PubMed2003

Comparison of biochemical markers of bone turnover and bone mineral density between hip fracture and vertebral fracture.

Bone density and the biochemical markers of bone turnover were compared between 26 hip-fracture patients and 41 vertebral-fracture patients after age adjustment to investigate whether or not type of osteoporosis differs between hip fracture and vertebral fracture. C-Terminal propepides of type I collagen (PIPC) was lower in hip fracture than vertebral fracture. The other bone formation markers (bone-specific alkaline phosphatase [ALP], osteocalcin) tended to be lower, and bone resorption markers (deoxypyridinoline, C-telopeptide crosslinking of type I collagen [CTX] tended to be higher in hip fracture compared to vertebral fracture. Mean of Z-scores of spine bone mineral density (BMD) in hip fracture and vertebral fracture were -0.461 and -0.919, respectively. Mean of Z-scores of femoral neck BMD in hip fracture and vertebral fracture were -0.994 and -0.361, respectively. All Z-scores were negative values, which means reduction of BMD compared to decade-matched controls. Z-scores of bone formation markers, such as bone-specific ALP, osteocalcin, and PIPC, were positive values in vertebral fracture, which means an increase against decade-matched controls, whereas those were negative values in hip fracture. Z-scores of bone resorption markers, such as deoxypyridinoline and CTX, were greater in hip fracture than in vertebral fracture. To express bone balance between formation and resorption in hip fracture and vertebral fracture, we calculated an uncoupling status index (USI) by the values of biochemical markers. USI of hip fracture showed a great negative value (-1.29), which indicates excess of bone resorption over formation, whereas that of vertebral fracture showed a small positive value (0.23). In conclusion, bone formation markers increase in vertebral fractures, but decrease in hip fracture. Bone resorption markers increase in both fracture, but greater increase in hip fracture.

Aged↗