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We compared the prevalence of previous fractures among 428 women and 147 men who had hip fractures with the fracture prevalence of the general population. An increased prevalence of previous fractures was found in patients with a hip fracture up to the age of 70 for women and 80 for men. Below these age limits, the probability of a later hip fracture increased with the number of previously sustained fractures.
We measured the proximal-distal and anterior-posterior displacement of the femoral head in 200 femoral neck fractures. The numerical data were compared with the Garden classification. The average displacement of the Stages I and II fractures were almost equal. Moreover, the displacement of the Stage III fractures did not differ from the displacement of the Stage IV fractures. The Garden Stages I and II fractures displayed a more posterior position of the femoral head than did the normal hips. The femoral heads of Stages III and IV were situated more posterodistally than those of the Stages I and II fractures. Classification of femoral neck fractures into two groups without (Stages I and II) and with (Stages III and IV) proximal displacement is probably sufficient for clinical use.
In 1992 a retrospective case control study was performed, based on all patients with ankle fractures (n 1063) treated at the Department of Orthopedics in Malmö, Sweden, between 1950-1951 and 1961-1965. As all radiographic examinations have been saved in Malmö, we were able to study all subsequent fractures that this group had sustained. 260 patients from 1961-1965 who were still living in Malmö today were also compared with an age- and gender-matched control group regarding the location and type of subsequent fractures. The group with former ankle fractures continued to have a two-fold increase incidence of all sorts of fractures. The same result was found when looking at the upper and lower extremities separately. However, the risk of sustaining new fractures in the once-fractured extremity was not increased compared to the uninjured side.
OBJECTIVE: To evaluate the secondary effect of childhood miniature pig longitudinal fracture and transverse fracture of mandibular condyle to Temporomandibular Joint (TMJ). METHODS: Longitudinal and transverse fractures on condyle of 14 childhood miniature pigs were created respectively. After 3 and 6 months the TMJs were studied macroscopically and microscopically. RESULTS: The transverse fracture of mandibular condyle brought about TMJ adaptive changes. There was no adhesion between disc and condyle. The longitudinal fracture led usually to bifid condyle deformity and adhesion between disc and condyle. Many fibroblasts and chondrocytes were seen in the adhesion between disc and condyle. Blood vessels and fatty degeneration appeared in the articular disc. CONCLUSION: Two different types of childhood condylar fractures are apparently different in the aspects of secondary lesions on TMJ. It suggests that an evident correlation between mandibular condyle longitudinal fracture and TMJ ankylosis.
BACKGROUND: Pubic rami fractures are common in the elderly, resulting from low energy traumatic falls. The recovery of some of these patients may be disproportionately slow. OBJECTIVE: To investigate the characteristics of older patients admitted with pubic rami fractures and possible associated pelvic fractures. PATIENTS AND METHODS: We have prospectively examined nineteen consecutive female patients admitted from the emergency ward with a diagnosis of pubic rami fractures, during a one-year period. Patients underwent bone scans and pelvis computerized tomography. RESULTS: Six of these patients had associated sacral fractures as demonstrated by pelvic CT scan. None of these sacral fractures was diagnosed on admission to the emergency ward. CONCLUSION: There is a considerable high rate of association of combined pubic and sacral fractures. Greater awareness of this clinical condition is required.
415 spinal fractures were analysed retrospectively. A simultaneous occurrence of vertebral fracture and abdominal trauma was found in 14 patients (3.4%). The mechanism of injury was a fall from a considerable height in 9 cases, a car accident in 3 and a motorcycle accident in 2. Isolated fractures of the transverse processes and rotational injuries of the spine were found to be associated particularly frequently with an abdominal trauma (3 of 14 isolated fractures of the transverse processes = 22%, 5 of 61 rotational injuries = 8.2%), while compression injuries only showed such a simultaneous abdominal injury in 2% of the 300 fractures of this type. We never encountered the combination of distraction injury/abdominal trauma. This is probably because two-point lap-type seat belts are only rarely used in our country. In 2 patients with rotational injuries neurological deficits were observed. The abdominal injuries encountered in our patients were: massive concussion of the kidney (6 cases), rupture of the spleen (3 cases), rupture of the liver (2 cases), rupture of the mesocolon (2 cases), rupture of the caecum (1 case), rupture of a pre-existent aneurysm of the aorta (1 case), rupture of a renal artery (1 case), massive retroperitoneal haematoma (1 case). Other injuries were present in 12 of the 14 patients: 3 craniocerebral injuries, 7 fractures of the long bones, 6 injuries to the thorax and 3 to the pelvis. In conclusion, a simultaneous finding of vertebral fracture and abdominal trauma is rare in our patients.(ABSTRACT TRUNCATED AT 250 WORDS)
Posterior dural lacerations associated with lumbar burst fractures are caused by impaction of the dural sac into the vertical lamina fracture. Neural elements may be extruded outside of the dura and become entrapped in the lamina fracture. This diagnosis must be made before surgery and is based on the patient's clinical presentation, the fracture pattern, and the radiographic findings. Entrapped neural elements can be successfully extracted from the lamina fracture by an opening laminoplasty of the posterior neural arch. Patients with lumbar burst fractures and radiographic evidence of posterior displacement of the neural elements in the lamina fracture should undergo posterior exploration of the spinal canal, extraction of cauda equina neural elements, and repair of the dural laceration before any spinal reduction maneuver.
The incidence of fracture of the upper end of the humerus by age group and sex was studied for a 32-year period from 1950 to 1982. The following numbers of humeral fractures occurred: 1950-1954, 411 fractures; 1961-1964, 552 fractures; 1971-1973, 639 fractures; and 1981-1982, 523 fractures. There was a progressive increase in the age-related incidence in older persons, especially in women. There was a higher incidence of fractures classified as severe in the 1980s compared with the 1950s.
Avulsion fractures of the tibial tubercle prior to epiphyseal closure are being treated with greater frequency. Watson-Jones Types I and III fractures are the most common; both require open reduction and internal fixation. Type II fractures respond to closed reduction and plaster immobilization. The authors have found only 76 fractures reported in the literature since 1935. Four cases were bilateral. Fifty-nine patients were boys, and two were girls; the sex was not reported for 11 patients. Type III fractures occurred most often in older adolescents. Types I and II fractures occurred in younger patients. No reports of growth disturbance of the proximal tibial epiphysis occurring after a Type III fracture were found.
Coronal slab sections of 78 femoral heads removed from patients with fractures of the proximal end of the femur were examined by radiographical and histological methods and a classification of fracture types based on the epiphysial scar holding an anatomical landmark was presented. The transepiphysial type (type I) showed total necrosis, and in the subepiphysial type (type II) some new bone formation was found at the "subepiphysial" zone, though no such reactive changes were seen in most parts of the specimens. Although necrosis was observed in different degrees and extent in the subcapital type (type III), some reactive new bone formation was always observed in the vicinity of the fracture surface. In the type III which was most frequent, viabilities of the trabeculae were examined in cases of fresh and old fractures (over one month after fractures), with or without internal fixation in old cases. It was then found that bone viabilities were remarkable in the fresh head than the old, and the head excised for failed internal fixation proved to be more viable than the head for primary insertion of a prosthesis. In about a half to one third of the type III the inferior metaphysial vessels were spared. Considering the types of fractures with post-fracture course, the initial type III may be changed into types I, II or III and the initial type II can remain as it is or be transformed into type I.
Since the diagnosis of rib fractures caused by blunt thoracic trauma is often missed on X-ray, attempt have been made to detect unknown fractures with ultrasound. Ultrasound was initially researched, as a diagnostic technique in a preliminary study of 10 patients with known rib fractures. Subsequently, in the main study, 21 patients with clinically suspected rib fractures but normal thoracic X-rays were examined with ultrasound, and rib fractures were detected in 16 patients. The diagnosis of rib fractures by ultrasound was substantiated by an increase of activity in the technetium scintigram in 11 of 11 patients. We found further increases of activity in the scintigram in two more ribs in 7 of these 11 patients. This finding is explained by the presence of nondislocated rib fractures that are veiled to ultrasound when a disconnection of the rib's contour is missed during respiration. The diagnostic procedure is explained with reference to case studies. In summary, findings recorded in this study showed that ultrasound investigation is a more reliable method of diagnosis than X-rays examination.
Anterior and posterior marginal fracture dislocations of the distal radius are unusual injuries, both of which are called Barton's fracture in the current world literature. Barton's original description delineates only the posterior marginal injury. An attempt is made to clarify the nature of these injuries by a complete review of the literature and a study of the clinical experience at UCLA Hospital from 1972 through 1975. Ten anterior and five posterior marginal fractures were treated during that period of time, constituting 2.3 per cent of all distal forearm fractures. Fractures in males typically stemmed from high velocity accidents in the younger age group and were associated with significant additional injuries. The injuries in females resulted from simple falls, generally in the older age group. Eight fractures were treated open and seven closed without complications; treatment results have not been determined yet. Eponym descriptions should be discontinued and replaced with a lucid anatomically descriptive classification such as anterior and posterior marginal fracture-dislocations of the distal radius.
The treatment of pilon fractures and distal metaphysial tibia fractures demands very high standards on the osteosynthesis material regarding the soft tissue and the essential joint reconstruction. The selection of the surgical entrance, particularly in case of a critical arterial or venous circulation and the possible irritation of the soft tissue caused by the osteosynthesis material led us to search for alternative osteosynthesis methods. After the elaboration of a pre-clinical study and good first results in the treatment of patella, olecranon and ankle joint fractures by means of the XS-nail the latter is now also employed for pilon fractures. Within a time period of 8 month 5 fibula fractures coming with pilon fractures had been treated with the XS-nail. This case report will demonstrate both the technique of treatment and the flexibility of the new implant.
Thirty-four patients with three- and four-part proximal humeral fractures from two different trauma centres were studied retrospectively. Sixteen were treated without osteosynthesis and compared with 18 patients treated with tension-band fixation. Fracture classification and clinical examination were made by the same persons in both groups. Most of the three-part fractures healed with good pain relief and good function in daily life but often with a loss of motion. Four-part fractures often led to pain, loss of motion and of function. Conservative treatment seemed superior to tension-band fixation for three-part fractures. Four-part fractures healed with better function and range of motion after tension-band fixation.
There have been no reports of bilateral femoral neck fractures followed by bilateral femoral intertrochanteric fractures. A 28-year-old man presenting with bilateral femoral neck fractures due to generalized convulsions was diagnosed with chronic renal failure and treated with percutaneous screw osteosynthesis and hemodialysis. During rehabilitation, the patient again had convulsions resulting in bilateral femoral intertrochanteric fractures 2 months after the operation. He was treated with a compression hip screw on the right side and conservatively on the left side. This is the first well-documented report on bilateral femoral neck fractures followed by bilateral femoral intertrochanteric fractures.
The results following internal fixation of displaced subcapital femoral fractures are poorer than for undisplaced fractures and are determined by both the quality of the initial reduction and the accuracy of implant placement. In a series of 26 consecutive displaced fractures internally fixed with Richards hip pins, satisfactory reduction was achieved in only 15 hips. Accurate reduction is a prerequisite for correct screw placement and occurred in only 4 of the 11 poorly aligned fractures, as opposed to 11 of the 15 well reduced ones. A total of 10 hips required a further surgical procedure as the result of complications. These results highlight the importance of accurate fracture reduction in facilitating implant placement as well as the importance of good surgical technique rather than reliance purely upon the implant. These already common fractures are assuming increasing socioeconomic importance as the elderly population grows, and successful management is vital for both the individual patient and future demands on the health service.
BACKGROUND: With increasing atrophy, fractures of the edentulous mandible tend to have a higher incidence of nonunion. However, the connection between disturbances of bony consolidation and inadequate primary stability is often insufficiently discussed. FIXATION: Rigid internal fixation with 2.7 or now 2.4 AO compression and reconstruction plates is a safe procedure to achieve short-term rehabilitation in the mostly elderly patients by ensuring immediate function without intermaxillary fixation. With increasing atrophy, our concept suggests the use of stronger plates and fixation of screws in safe bony regions far from the fracture site. RESULTS AND DISCUSSION: This study reports the results of treatment of 40 fractures of the edentulous mandible in 25 patients from 1979 until 1996: 38 fractures (95%) showed primary healing, and only 1 nonunion was revealed after fracture of the plate. The criteria for choice of plates are discussed as well as fracture exposure and the question of primary and secondary bone grafting.
Clinical experience and published studies suggest that oblique fractures of the tibia are associated with delayed healing and non-union. Experimental studies have attributed this to increased shear at the fracture site. We have adopted the practice of using supplementary olive wires to reduce shear when using circular fixation for these fractures. A complete cohort of 54 oblique tibial fractures treated with the Sheffield Ring Fixator (Orthofix, Verona) was reviewed to elucidate the effect of using additional olive wires on fracture healing/treatment times. Fifty patients were studied in the final analysis. With low-energy injuries, the use of olive wires reduced treatment times significantly (no olives: 37 weeks, olives: 22 weeks, P<0.05), although this was not seen with higher energy injuries (no olives: 44 weeks, olives: 39 weeks, P=NS). There was no evidence of additional complications related to their use. We recommend the use of additional olive wires in the circular fixation of these difficult fractures.