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At least 613 records · Page 34Linked to original sources
PubMed1999

Local administration of activin promotes fracture healing in the rat fibula fracture model.

Osteogenic activities of activin, a member of the transforming growth factor (TGF)-beta superfamily, have been demonstrated in both in vitro and in vivo studies. The present study investigates the effects of topical application of activin on fracture healing using rat fibula fracture models. Activin (0.4-10 microg/day) was injected locally to the fracture once a day for 2 weeks. Activin promoted callus formation in a dose-dependent manner and both callus volume and callus weight were significantly increased with doses of 2-10 microg/day activin. Also, 3 weeks of activin treatment increased the mechanical strength of the healing bone in addition to the callus mass. Histological study 2 weeks after the fracture revealed that activin promoted endochondral bone formation. Immunohistochemical examination of the fractured tibia revealed that activin was localized to osteoblasts and chondrocytes in the region ossified both endochondrally and intramembranously. These findings suggest that activin expressed during fracture healing promotes the healing process through an autocrine/paracrine mode of action.

Activins↗
PubMed2001

Extra-articular transverse fractures of the base of the distal phalanx (Seymour's fracture) in children and adults.

A series of 25 extra-articular transverse fractures of the base of the distal phalanx (Seymour's fracture) in children, adolescents and adults are presented. Prior to closure of the distal phalangeal epiphysis, the fracture line is usually entirely through the metaphyses, 1 to 2 mm distal to the growth plate. In adults, the fracture line is just distal to the insertion of the extensor tendon. Eighteen of these fractures were treated by closed reduction and splinting and one of these developed an infection and three had mild residual flexion deformities of the finger. Five fractures were treated by K-wire fixation and all healed without complications. Two adult patients presented 4 to 5 weeks after injury with malunion, and of these one underwent refracturing and K-wire fixation with an excellent result.

Adolescent↗
PubMed2004

Minimal-invasive treatment of distal femoral fractures with the LISS (Less Invasive Stabilization System): a prospective study of 30 fractures with a follow up of 20 months.

BACKGROUND: There is no consensus on the best treatment of distal femoral fractures. PATIENTS AND METHODS: In a prospective study, we treated 29 patients with 30 distal femoral fractures with the Less Invasive Stabilization System (LISS) from 1997 to 2000. Almost 1/2 of them had open fractures, 1/3 extraarticular type A and 2/3 articular fractures type C (AO classification) and these had been caused by high-energy trauma with concomitant severe injuries or osteoporosis. RESULTS: The follow-up examinations after mean 20 (13-42) months consisted of radiographs, and determination of the Lysholm Knee Score and Knee Society Score (KSS). The outcome correlated with the severity of the fracture, anatomic reduction, exact positioning and fixation of the LISS and concomitant injuries. INTERPRETATION: We found the LISS for treatment of distal femoral fractures of all types to be a safe procedure with good results after careful planning and experience with this surgical technique. There is usually no need for primary cancellous bone grafting.

Adolescent↗
PubMedDate not supplied

One-year outcome after tibial shaft fractures: results of a prospective fracture registry.

OBJECTIVES: To describe the outcome in a consecutive series of patients with tibial shaft fractures and to determine whether prospective registration of fracture care produces useful data for clinical purposes. DESIGN: A prospective follow-up study. SETTING: A large teaching hospital in Stockholm, Sweden. PATIENTS: Sixty-four consecutive patients with a tibial shaft fracture. INTERVENTION: Patients were surgically treated according to the protocols at our institute and were followed up prospectively for one year. MAIN OUTCOME MEASUREMENTS: Clinical outcome, functional results, Short Form 36 Health Survey, Olerud Molander Ankle score, visual analogue scale. RESULTS: The fractures were classified as 42A (61 percent), 42B (31 percent), and 42C (8 percent). Forty-three (67 percent) patients were treated with an interlocked tibial nail. The complication rate was low and associated with high-energy trauma. The quality of life according to the Short Form 36 Health Survey was diminished at four and twelve months after the injury, as compared with the preinjury status. Twelve months after the injury, 44 percent had not regained full function of the injured leg, although all but two of the patients had returned to preinjury working status. CONCLUSIONS: Although the complication rate was low, twelve months after the injury, nearly half the patients still experienced functional limitations related to the fracture, which was also reflected in the quality-of-life parameters. There were difficulties in retrieving data for this registry. We think that periodic, rather than continuous, registration of patient-related outcome after fracture treatment is more beneficial from a clinical and economic point of view.

Adolescent↗
PubMed2005

Anterior dislocation of the radial head with fractures of the olecranon and radial neck in a young child: a Monteggia equivalent fracture-dislocation variant.

We present a case of a type I Monteggia equivalent lesion in a 7-year-old child consisting of anterior dislocation of the radial head, radial neck fracture, and a fracture of the olecranon without an associated fracture of the ulnar diaphysis or metaphysis. After a review of the literature, we report this fracture pattern as a rare type I Monteggia equivalent fracture-dislocation variant. This report describes delayed surgical treatment and outcome after close follow-up of a rare type I Monteggia equivalent lesion. Diagnostic challenges with and treatment options for pediatric Monteggia equivalent fracture-dislocations are discussed.

Child↗
PubMed2006

Closed antegrade interlocked nailing of femoral shaft fractures operated up to 2 weeks postinjury in the absence of a fracture table or C-arm.

BACKGROUND: We present our technique of closed nailing in diaphyseal femoral fractures treated between 1 to 14 days postinjury. The purpose of the study was to demonstrate the fact that such fractures can be treated closed in the absence of a fracture table or C-arm. METHODS: In all, 200 consecutive closed femoral fractures were fixed 1 to 14 days postinjury during a period of 2 years. Skeletal traction was applied immediately at admission and sufficient weight was applied to overcome muscle spasm. In most cases, a closed nailing was successfully performed. Distal locking was achieved with either a medinov nail with wings for distal locking, or a standard nail with a jig for the distal lock. RESULTS: The average age of the patients was 30 years. Follow up ranged from 6 to 12 months. Mean duration of follow up was 10 months. All patients had a functional range of movement at the hip and knee with a normal gait. The average time taken for surgery was 90 minutes with an average blood loss of 50 to 100 mL. Time in hospital after surgery was 2 to 10 days. CONCLUSIONS: Delayed closed nailing of femoral fractures can be achieved without a C-arm or a fracture table provided adequate skeletal traction is applied preoperatively and proper attention is paid to the surgical steps as described.

Adult↗
PubMed2001

Low-intensity pulsed ultrasound accelerates rat femoral fracture healing by acting on the various cellular reactions in the fracture callus.

Low-intensity pulsed ultrasound (LIPUS) has been shown to accelerate fracture healing in both animal models and clinical trials, but the mechanism of action remains unclear. In fracture healing, various consecutive cellular reactions occurred until repair. We investigated whether the advanced effects of LIPUS depended on the duration and timing of LIPUS treatment in a rat closed femoral fracture model to determine the target of LIPUS in the healing process. Sixty-nine Long-Evans male rats that have bilateral closed femoral fractures were used. The right femur was exposed to LIPUS (30 mW/cm2 spatial and temporal average [SATA], for 20 minutes/day), and the left femur was used as a control. Rats were divided into four groups according to timing and duration of treatment (Ph-1, days 1-8; Ph-2, days 9-16; Ph-3, days 17-24; throughout [T], days 1-24 after the fracture). Animals were killed on day 25. After radiographs and microfocus X-ray computed tomography (muCT) tomograms were taken, the hard callus area (HCA), bone mineral content (BMC) at the fracture site, and mechanical torsion properties were measured, and histological analysis was conducted. Interestingly, the maximum torque of the LIPUS-treated femur was significantly greater than that of the controls in all groups without any changes in HCA and BMC. The multiviewing of three-dimensional (3D) muCT reconstructions and histology supported our findings that the partial LIPUS treatment time was able to accelerate healing, but longer treatment was more effective. These results suggest that LIPUS acts on some cellular reactions involved in each phase of the healing process such as inflammatory reaction, angiogenesis, chondrogenesis, intramembranous ossification, endochondral ossification, and bone remodeling.

Animals↗
PubMed1975

Iatrogenic subcapital fracture of the hip: a new complication of intertrochanteric fractures.

A recently recognized complication of intertrochanteric fracture is a subcapital fracture occurring at the tip of the blade of an intertrochanteric fracture fixation blade plate. Histological examination reveals that this is not a fatigue fracture but is the result of stress concentration effects of a stiff metalic device. This fracture may be prevented by using a blade plate with a long blade which is well seated in the head, and by removing the metallic device as soon as it is safe to do so. Ultimate prevention lies in using a more compatible material for the internal fixation of fractures.

Aged↗
PubMed1987

Fractures of the tibial plafond. The pilon fracture.

The fracture of the tibial plafond or pilon fracture is an uncommon but difficult fracture to manage. Fracture of the plafond occurs when the talus is driven into the tibia from axial compression. The type of fracture that occurs will depend on the position and rotation of the foot at the time of impact. Historically, these fractures have been treated in a number of manners, but the best results have occurred when stable internal fixation is accomplished using plates and screws. Basic steps in reconstruction are restoration of anatomic length of the fibula with plate fixation, reconstruction of the tibial articular surface, cancellous bone grafting of the metaphyseal defect, and buttress plating either anteriorly or medially of the distal tibia. If anatomic reconstruction of the joint surface can be restored and stable fixation achieved, early motion of the ankle is made possible. This early motion reduces stiffness of the ankle and will yield the most satisfying results.

Bone Plates↗
PubMed1978

[Femoral neck fractures and pertrochanteric fractures due to skiing accidents].

Pertrochanteric and femoral neck fractures are common in elderly patients. These fractures are mostly caused by domestic accidents. Femoral head necrosis and non-union are severe complications. Even if these fractures are not typical skiing-fractures, 101 fractures of the proximal femor were found to be caused by a skiing-accident. The age of the patients averaged 41 years, only one third were female. More than half of all patients participated in a control examination about one year after the accident. All fractures were operated according to the principles of the ASIF. The results showed twice an infection, in 3% dystrophia of the bone and in 3% mild osteoarthritis. There were no necroses of the femoral head, no non-union and no breaking of the implanted material. In 90% the results were good or excellent from the point of view of the patient as well as the orthopedic surgeon.

Adult↗
PubMed1994

Fracture of the occipital condyle as an incidental finding during CT-evaluation of a maxillary fracture.

A 43-year-old male presented with blunt facial trauma after a motor-vehicle accident. CT-evaluation revealed a right-sided maxillary fracture and a fracture of the left occipital condyle. The fracture of the occipital condyle is potentially unstable and fatal cases have been described. Plain radiographs are not diagnostic. This occipital condyle fracture was an incidental finding during CT-evaluation of a maxillary fracture and is probably the first case with coronary CT scans of this type of fracture.

Adult↗
PubMed1996

Triplane fracture associated with a proximal third fibula fracture.

The case of a Maisonneuve fracture occurring in association with a triplane fracture in an adolescent wrestler is presented. In this combination of injuries, the deltoid ligament may be ruptured, and/or the medial malleolus fractured. If the proximal fibula fracture is not discovered, and the syndesmosis rupture is not treated, the resulting chronic talocrural instability may lead to chronic ankle pain and degenerative arthritis. The orthopedist should be aware of the possibility of a Maisonneuve fracture occurring in association with a triplane fracture, and should treat both injuries appropriately.

Adolescent↗
PubMed1994

[Surgical treatment of diaphyseal tibial fractures. Choice of procedure and results of treatment of 187 fractures].

From 1988 to 1990 a total of 187 fractures of the tibia (92 compound, 95 closed fractures) were treated with a primary osteosynthesis. In 102 fractures an external fixation was performed, 85 internal fixations were divided into 58 intramedullary nails and 27 plates. In a follow-up study the fracture healing was analysed, 90% of the patients were examined about 18 months after the accident. The mean healing time was between 12 weeks (internal fixation) and 16 weeks (external fixateur). After primary Fixateur externe 54 were treated by secondary internal fixation, intramedullary nailing was the method of choice. Contamination rate of the tibia, taken by an intraoperative wound swab before nailing was 30%. Infection occurred in 3.2%, non union and refractures in 1.5% and 1%. Over all 80% excellent and good results were found after consolidation. 10% fair and 10% bad results including three amputations after III degrees compound fractures and three death after polytrauma.

Adolescent↗
PubMed2006

Metatarsal shaft fractures and fractures of the proximal fifth metatarsal.

Metatarsal fractures represent a relatively common injury, especially in athletes. The pertinent anatomy, evaluation, diagnosis, classification, and treatment of acute and chronic (stress) metatarsal shaft fractures are discussed. Fractures of the proximal fifth metatarsal, which are unique and important injuries, are also discussed. Treatment remains relatively straightforward for the traumatic metatarsal injury, whereas traditional stress fractures typically heal with decreased activity. The problematic proximal fifth metatarsal fracture (Jones fracture) frequently requires surgical intervention in patients who want to avoid non-weight-bearing cast immobilization. The authors' current treatment for this fracture includes the option of intramedullary fixation versus cast immobilization.

Athletic Injuries↗
PubMed2006

An investigation of the constituent elements and modes of fracture of in vivo fractured metallic posts.

OBJECTIVES: The objective of this investigation was to determine the materials used in metallic post and core construction and investigate and the modes of failure that occurred resulting in post fracture. METHODS: Eighty-five fractured metal posts were clinically retrieved over a 5-year period. The tooth with the fractured post, and relevant clinical details were recorded. Investigation of the fractured posts was undertaken to determine their constituent elements and modes of fracture using scanning electron microscopy (SEM) and energy-dispersive X-ray analysis (EDX). RESULTS: The results showed that 77% of the posts were cast and 23% wrought. The modes of fracture were ductile (67%) or brittle (52%) although some posts exhibited both within the same specimen. In addition, evidence of fatigue was present in 20% of posts and porosity in 48%. CONCLUSIONS: A large variety of materials were used in the construction of post and cores although low-gold silver-palladium alloy most commonly encountered. Their failure was predominantly ductile in nature although a significant amount of brittle fracture was also noted. Porosity within castings also appeared to be a contributory factor in some cases and this was particularly evident in high-palladium castings. Evidence of fatigue was noted in a minority of posts.

Dental Alloys↗
PubMed2003

Fracture toughness of resin-modified glass ionomer restorative materials: effect of powder/liquid ratio and powder particle size reduction on fracture toughness.

OBJECTIVES: The objectives of the current investigation were two-fold: (1) to examine the effect of different powder/liquid (P/L) ratios on the fracture toughness of commercial resin-modified glass ionomer cement and conventional glass ionomer cement, and (2) to evaluate the effect of powder size reduction on the fracture toughness of experimental resin-modified glass ionomers in order to improve their physical properties. METHODS: The P/L ratios of the glass ionomer and resin-modified glass ionomers were varied from the manufacturer's recommended ratio to 2.0 and 1.0 by weight. The powder particle sizes for the experimental resin-modified glass ionomers tested were 2, 5, 10 and 25 micro m in diameter. Fracture toughness was determined on ring-shaped specimens with a fatigued pre-crack. RESULTS: The fracture toughness of the resin-modified glass ionomers was significantly higher (p<0.005) than that of the glass ionomer and was not greatly influenced by the P/L ratio. For the experimental resin-modified glass ionomers, it was observed that fracture toughness gradually decreased as the powder particle size became finer. SIGNIFICANCE: The resin components in the liquid play an important role in the improvement of the physical properties of the resin-modified glass ionomer. A reduction in the powder particle size of up to 10 micro m, which resulted in a smoother surface, can maintain high fracture toughness. The high fracture toughness values of the resin-modified glass ionomer may be one of the factors contributing to a favorable clinical outcome in high stress-bearing areas.

Analysis of Variance↗
PubMedDate not supplied

Does the combination of a simultaneous subcapital fracture of humerus and hip fracture in elderly patients carry a prognostic value?

The most important factor to cause hip fractures in elderly is probably osteoporosis. Other factors are the increase in fall frequency and the protective response to trauma. Osteoporotic fractures occur most commonly, at the hip, vertebra, distal radius and proximal humerus. A combination of these is uncommon. Thirty-two women and six men treated between January 1990 and December 1999 for a combination of subcapital fracture of the humerus and hip fractures were evaluated retrospectively. The following parameters were reviewed: age, sex, pre-fall function, use of drugs, chronic and acute comorbidity, circumstances of the fall, length of hospitalization, treatment procedure, complications and post-hospitalization rehabilitation. Group I consisted of 15 patients aged 70-80 years and group II consisted of the remaining 23 patients, older than 80 years. In all 38 patients the simultaneous fractures were ipsilaterally. Hospital stay ranged from 7 to 17 days for the discharged 37 patients. Twenty-six of 28 patients, who were transferred to a rehabilitation center, returned to their previous activity of daily living (ADL). Among the nine remaining patients only five gained full recovery. A combination of fractures, occurs in the higher-age group, is quite traumatic to the patient and probably involves a greater impact force. In all patients it occurs in the ipsilateral side. In the elderly, even a minimal transmission to the osteoporotic hip can cause a fracture. The double trauma represents a better pre-morbid condition relative to patients in the same age group, thus it may serve as a prognostic indicator for success in rehabilitation.

Journal Article↗
PubMed2000

Heparin, low molecular weight heparin and physical methods for preventing deep vein thrombosis and pulmonary embolism following surgery for hip fractures.

BACKGROUND: Hip fracture patients have a high risk of thromboembolic complications following surgical management. OBJECTIVES: To examine the effects of heparin (unfractionated (U), and low molecular weight (LMW) heparins), and physical methods (compression stockings, calf or foot pumps) for prevention of deep venous thrombosis (DVT) and pulmonary embolism after surgery for hip fracture in the elderly. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group trials register, Medline, Embase, and reference lists of published papers and books. We contacted trialists and other workers in the field. Date of most recent search: September 1996. SELECTION CRITERIA: Randomised and quasi-randomised trials evaluating the use of heparins and physical agents for prevention of DVT and pulmonary embolism in patients undergoing surgery for hip fracture. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed methodological quality and extracted data. Trials were grouped into four categories (heparin versus control, mechanical versus control, LMW heparin versus U heparin, and miscellaneous) and results pooled where possible. MAIN RESULTS: The 26 included trials involved 2600 predominantly female and elderly patients. Overall, trial quality was disappointing. Ten trials involving 826 patients which compared U heparin with control, and four trials of 471 patients which compared LMW heparin with control, showed a reduction in the incidence of lower limb DVT (121/511 (24%) versus 203/519 (39%); Peto odds ratio 0.41; 95% confidence interval 0.31 to 0.55). There were insufficient data to confirm the efficacy of either agent in the prevention of pulmonary embolism. There was a non significant increase in overall mortality in the heparin group (46/420 (11%) versus 35/423 (8%); Peto odds ratio 1.39; 95% confidence interval 0. 86 to 2.23). Data were inadequate for all other outcomes including wound complications. There is insufficient evidence from five trials, involving 644 patients, to establish if LMW heparin was superior to U heparin. Most trials evaluating heparins had methodological defects. Four trials, involving 442 patients, testing mechanical pumping devices were also methodologically flawed, and so pooled results need to be viewed cautiously. Mechanical pumping devices may protect against DVT (12/202 (6%) versus 42/212 (19%); Peto odds ratio 0.24; 95% confidence interval 0.13 to 0.44). Although the limited data indicated a potential benefit, they were inadequate to establish any effect on the incidence of pulmonary embolism and overall mortality. Problems with skin abrasion and compliance were reported. REVIEWER'S CONCLUSIONS: U and LMW heparins protect against lower limb DVT. There is insufficient evidence to confirm either protection against pulmonary embolism or overall benefit, or to distinguish between various applications of heparin. Foot and calf pumping devices appear to prevent DVT, may protect against pulmonary embolism, and reduce mortality, but compliance remains a problem. Good quality trials of mechanical methods as well as direct comparisons with heparin should be considered.

Anticoagulants↗