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PubMed1996

Aspirin and NSAID use in older women: effect on bone mineral density and fracture risk. Study of Osteoporotic Fractures Research Group.

Prostaglandin inhibition by aspirin or nonsteroidal anti-inflammatory drug (NSAIDs) may inhibit bone loss and preserve bone mineral density (BMD) in vitro and in animal models. The effect of these agents on BMD and fracture risk in postmenopausal women in unknown. We assessed the risk factors for osteoporosis and the use of aspirin and NSAIDs in 7786 white women over age 65. Axial BMD was measured at the same time, and fractures were prospectively documented over the subsequent 4 years of follow-up. In age-adjusted analyses, daily use of aspirin or NSAIDs was associated with a 2.3-5.8% increase in BMD of the hip and spine. The relationship persisted even after adjustment for weight, a variety of medications, self-reported arthritis, and for radiographic findings of osteoarthritis, but the multiply adjusted increase in BMD was only 1.0-3.1%. Fracture risk was similar among daily users of aspirin and NSAIDs and nonusers. After adjustment for potential confounders, among daily aspirin users the relative risk of hip fracture was 1.1 (95% confidence interval [CI]: 0.7, 1.6), and among daily NSAID users the risk was 0.9 (CI: 0.6, 1.4). Considering all nonspine fractures together, the risk among aspirin users was 1.0 (CI: 0.8. 1.2), and among NSAID users the risk was also 1.0 (CI; 0.8, 1.2). Regular use of aspirin or NSAIDs may have a modest beneficial effect on BMD in postmenopausal women. This effect persists after adjustment for obesity and the presence of osteoarthritis. However, among women who take aspirin or NSAIDs regularly, there is no clinically significant protective effect on the subsequent risk of fractures.

Aged↗
PubMed1989

The effect of radiation on the fracture repair process. A biomechanical evaluation of a closed fracture in a rat model.

The effects of a single dose of irradiation on the biomechanical parameters of the fracture healing process were studied in a rat model. Intramedullary pinning was performed before production of a closed femoral midshaft fracture. The experimental group was exposed to 900 rad 3 days after fracture and was compared with a control group with a similar fracture that received no irradiation. Animals were killed at intervals ranging from 2-16 weeks after surgery and the bones were tested until failure in torsion. In the irradiated groups, a delay of 4 weeks was noted in the biomechanical parameters associated with fracture healing (torque to failure, torsional stiffness, angle to failure, and biomechanical stage). Despite this delay in the normal temporal progression, the staging and stiffness approached normal controls within an 8-week period. However, the torque to failure remained below normal levels at the conclusion of this study. These results differ from a previous study using an open fracture model.

Animals↗
PubMed1990

Case report 624. Stress fracture of distal portion of tibia associated with previously incurred gross fracture of more proximal segment of tibia.

A stress fracture occurring in the distal tibial metaphysis is presented. This fracture occurred in an area of disuse osteoporosis approximately 3 months following a gross traumatic fracture of the more proximal portion of the tibia. A stress fracture of the distal tibial metaphysis occurring secondary to a bimalleolar fracture of the same bone is also cited. The clinical settings in which tibial stress fractures have been reported are reviewed, as well as the difficulties inherent in the diagnosis and management of this entity.

Adult↗
PubMed2004

Risk of fracture among women who lose bone density during treatment with alendronate. The Fracture Intervention Trial.

It is commonly believed that the response to treatment in patients on alendronate is proportional to the increase in bone mineral density (BMD), and that those who lose BMD during treatment might not respond to treatment. In the Fracture Intervention Trial 6,459 women were randomly assigned to treatment with alendronate or placebo; BMD was measured annually, and new spine fractures were assessed by lateral spine films, taken at baseline and end of follow-up. Among subjects who took at least 70% of the study drug (5,220 women), we compared reductions in risk of spine fractures at end of follow-up (3 or 4 years) within various levels of change in total hip and spine BMD after 1 and 2 years of treatment, after adjustment for differences in characteristics between the treatment and control groups. Women "losing" BMD at the lumbar spine (0% to 4%) while on alendronate had a reduction of 60% in vertebral fracture risk [OR = 0.40 (0.16, 0.99)] compared to their counterparts in the placebo group. The few women that lost more than 4% did not have a significant benefit [OR = 0.15 (0.02, 1.29)]. Those who "gained" BMD (0% to 4%) during treatment had a reduction in risk of 51% [OR = 0.49 (0.30, 0.78)]. Similarly, women who "lost" total hip BMD (0% to 4%) during the first year on alendronate had a 53% decreased risk of vertebral fracture compared to their controls taking placebo [OR = 0.47 (0.27, 0.81)], whereas those "gaining" BMD (0% to 4%) had a comparable risk reduction [OR = 0.49 (0.34, 0.71)]. This was not observed for the few women who lost more than 4% [OR = 0.61 (0.11, 3.45)]. Patients who lost BMD at both the hip and spine were not protected by alendronate. Among patients who adhere to treatment with alendronate, even those who lose BMD benefit from a substantial reduction in risk of vertebral fracture. So, the reduction in bone turnover induced by alendronate might be more important than BMD changes. The few women who lose the most BMD (more than 4% per year) might not benefit from the treatment.

Absorptiometry, Photon↗
PubMed2005

Operative management of acetabular fractures. A review of 73 fractures.

Between June 1994 and December 2000, 80 displaced acetabular fractures were treated by open reduction and internal fixation, where possible by a single surgical approach. We report our results in 72 patients (73 fractures) who completed a minimum follow-up of 2 years. The average age of patients was 39.5 years (range 15-76 years). Thirty-four fractures were classified as simple and the remaining 39 were complex fractures. Twenty-four patients were recorded to have posterior dislocation of the hip joint at the time of initial presentation and at surgery eight patients were noted to have varying degrees of damage to the head of the femur. The average time to surgery was 11.7 days (range 1-35 days); 80% of cases were operated within 2 weeks period. The average follow-up was 45.5 months (range 24-96 months). In 67 fractures (92%), only a single approach was used (Anterior Ilioinguinal 26 cases; Posterior Kocker-Lagenbach 41 cases). Five fractures needed an extensile triradiate approach and only one case required a combined anterior and posterior approach. Congruent reduction was achieved in 89% of cases. Main complications included deep infection in two patients (2.7%) and severe degenerative changes in three patients (4.2%). A total of four patients (5.5%) required a total hip replacement. There were no cases of deep vein thrombosis or pulmonary embolism. Heterotopic ossification grade III was seen in three (4.1%) cases and none were grade IV. At the latest follow-up the average Harris hip score was 85 (range 20-100). We conclude that in the majority of cases internal fixation is possible through a single approach provided patients are referred early to a specialist unit. This results in satisfactory outcome with reduced morbidity and complication rate.

Acetabulum↗
PubMed2006

Radiographic evaluation of the fate of developing tooth buds on the fracture line of mandibular fractures.

PURPOSE: The goal was to suggest guidelines for the treatment of developing tooth buds located on the fracture line of mandibular fractures. PATIENTS AND METHODS: The long-term radiographic follow-up records of 28 patients with mandibular fractures involving 66 tooth buds were examined for the occurrence of abnormalities in development or eruption. The fates of the involved teeth were compared according to the fracture conditions and other factors, and the cause of the abnormalities was surveyed. RESULTS: Abnormal findings were observed in 30 of 66 developing teeth (45%); these included deficient root formation, abnormal bend of the root, nodule formation on the root, partial obliteration of the pulp cavity, impaction, growth arrest, and external resorption. No relationship was found between the presence of abnormalities and the condition of the fracture or the developmental stage of the tooth buds. However, infection, rotation of the tooth bud, and a surgical wire passing through the follicular space were associated with arrested growth and impaction. CONCLUSIONS: The tooth buds present on the fracture line should be preserved except in cases of infection, and careful attention should be paid to avoiding further injury to the tooth bud and the soft tissues of the follicle at the time of surgery.

Adolescent↗
PubMed2006

Minimally invasive fracture treatment with cannulated lag screws in intracapsular fractures of the condyle.

PURPOSE: We examined the use of cannulated lag screw osteosynthesis for the treatment of fractures of the mandibular condylar head in providing a high-quality durable fixation, while at the same time reducing the trauma necessary for an open approach to the fracture site. PATIENTS AND METHODS: A preauricular approach was used for exposure, reduction, and osteosynthesis in 5 cases of type B condylar fractures. A cannulated screw system was used that allowed optimum placement of the self-cutting cannulated lag screw following insertion of a guiding wire and using clinical control to ensure its correct position. The joints were submitted to functional exercises immediately following surgery and postoperative radiologic, axiographic, and clinical follow-ups were performed. RESULTS: Radiologic follow-up revealed correct reduction and fixation in all 5 cases. Axiographic and clinical follow-up showed an initial limitation, but normal mobility of the condyles was achieved within 3 months postoperatively, with a maximum mouth opening of 41.2 +/- 9.4 mm after 6 months. There were no occlusal disturbances, no trismus, no lateral deviations of the mandible, and no nerve lesions. Intraoperatively, the method applied shortened the time necessary for and simplified the procedure of reduction and osteosynthesis. CONCLUSION: By using a cannulated lag screw, it was shown that the major factor in the extent of the trauma relating to surgical access was the reduction of the fracture fragments. The method ensured stable fixation of the fracture with a minimum of osteosynthesis material, while reducing the operative time. In combination with intraoperative imaging techniques it can also successfully be applied to other fractures in maxillofacial surgery.

Biomechanical Phenomena↗
PubMed2004

A false negative technetium 99m bone scan in a 53-year-old man with a fractured tibia and fractured clavicles conducted 88 h after the accident.

BACKGROUND: Technetium (Tc) 99m bone scan is used as a diagnostic tool in cases of suspected fractures, and in differentiating between old and acute fracture. The false negative rate 72h after the injury in the under 65-year-old population is less than 5%. CASE PRESENTED: A 53-year-old motorcyclist was admitted to the emergency room after a road accident, suffering fractures of the tibia and both clavicles. A Tc 99m bone scan that was performed more than 72h after the injury, because of suspicion of an undiagnosed hip fracture, did not demonstrate increased uptake at the fracture sites. UNIQUENESS: The person involved was relatively young (53 years old), and the bone scan was performed more than 3 days after the injury. Despite these two facts, the bone scan was negative at the fracture sites.

Accidents, Traffic↗
PubMed2004

Three part posterior fracture dislocation of the hip without fracture of the femoral head: review of literature and a case report.

This case report describes a rare posterior dislocation of the hip with fractures of the ipsilateral femoral neck and greater trochanter, without fracture of the femoral head, in a young adult male following a railway accident. This patient was managed within 6h of injury by open reconstruction. This unusual injury has not been reported previously. Cases of posterior fracture dislocation of the hip with a fracture of the femoral neck without fracture of the femoral head were reviewed from the literature. Mechanism of injury, controversies regarding operative procedures and appropriate surgical approach are discussed. The authors also believe that this injury pattern merits inclusion in the existing classification system of fracture dislocation of hip for management and prediction of outcome.

Accidents↗
PubMed1992

Undisplaced fractures of the distal third of the radius in children: an innocent fracture?

A series of 107 undisplaced or minimally displaced distal third radial fractures in children were assessed to try to identify the incidence and the factors associated with displacement. Of 27 fractures showing a volar (pronation) pattern, there were no cases of progression of the deformity. Of the 80 fractures showing a dorsal (supination) pattern, 22.5 per cent progressed. Of the unicortical fractures, 13.6 per cent showed a progression of the deformity compared with 47.6 per cent of the bicortical fractures. Of the unicortical fractures, 7.1 per cent of those showing a dorsal buckle displaced compared with 29.4 per cent of those with a cortical breach.

Casts, Surgical↗
PubMed1997

Fatigue root fracture: a spontaneous root fracture in non-endodontically treated teeth.

A series of 46 cases of root fracture with four different patterns occurring in 51 non-endodontically treated teeth were studied. All of the patients had chewing habits which induced a unique root fracture. The results of this study suggest an additional cause of root fracture that has not been described previously. Here, the new term 'fatigue root fracture' is used to describe a fracture that results from an excessive, repetitive, heavy masticatory stress applied to a tooth. The majority (80%) of cases of this kind of fracture are vertical and occur mainly (96%) in persons over the age of 40. In addition, all the teeth affected were posterior teeth, and the majority (51%) were mandibular first molars.

Adult↗
PubMed1983

Intra-articular fractures of the distal tibia: the pilon fracture.

Forty-two patients with pilon fractures were followed 24 to 96 (mean, 53) months post-fracture. Fractures were classified as Type I (26%), Type II (29%), or Type III (45%) as defined by Ruedi and Allgower. Type I fractures were usually torsional in nature whereas Type II and III injures were usually the result of a fall from a height or motor vehicle accident. Type I and II pilon fractures were amenable to anatomic open reduction and stable internal fixation and 80% or more had satisfactory results. Only 44% of Type III fractures treated by open reduction and internal fixation produced a satisfactory outcome. Nonanatomic reduction, unstable fixation, infection, nonunion, and/or angulation were the usual causes of failure of this form of treatment.

Adult↗
PubMed2001

The complex triplane fracture: ipsilateral tibial shaft and distal triplane fracture.

BACKGROUND: The complex triplane fracture (ipsilateral tibial shaft and distal tibial triplane fracture) is a rare combination. It has not previously been described in the literature. This combination can be easily overlooked and has the potential for serious sequelae if it is missed. METHODS: Six patients, having sustained this combined injury, were reviewed at a tertiary children's hospital. Clinical assessment, radiographs, computed tomographic scans, bone age, and scanogram assessment of leg length at maturity were completed. RESULTS: Average age at injury was 14 years. Tibial fractures were midshaft or short oblique. There were 3 three-part and 3 two-part intra-articular distal tibial triplane fractures. Diagnosis of the distal triplane fracture was delayed in two cases. Treatment involved application of a long leg cast. No patients required open reduction. At follow-up (average, 22 months), all patients were asymptomatic. All fractures were well healed and there was no evidence of joint incongruity, or angular or rotational deformity. Leg length discrepancy averaged 6.8 mm. CONCLUSION: A high index of suspicion should be maintained to avoid missing this rare combination, as it has the potential for long-term sequelae.

Adolescent↗
PubMed2002

Some complications of common treatment schemes of thoracolumbar spine fractures can be predicted with magnetic resonance imaging: prospective study of 53 patients with 71 fractures.

STUDY DESIGN: Prospective cohort study. OBJECTIVES: To study the predictive value of magnetic resonance imaging (MRI) findings of thoracolumbar spine fractures concerning the radiologic and clinical outcome. SUMMARY OF BACKGROUND DATA: Disagreement about the proper treatment of thoracolumbar spine fractures is caused by insufficiency of conventional imaging techniques. Previous studies have shown that MRI is capable of distinguishing injury to all structures of the fractured spine and thus may help develop schemes with higher predictive power. METHODS: A total of 53 patients with 71 fractures were studied with MRI in a prospective fashion. A total of 24 patients with 39 fractures were treated conservatively and 29 patients with 32 fractures were treated operatively after a protocol concerning the treatment options. MRI scans were obtained within 1 week of injury and at the 2-year follow-up. Pain scores were obtained at the 2-year follow-up. Previously described MRI schemes concerning the trauma and post-trauma conditions were used. RESULTS AND CONCLUSIONS: An unfavorable outcome in the conservative group was related to the progression of kyphosis, which in most cases was predictable with the use of trauma MRI findings concerning the endplate comminution and vertebral body involvement. In the operatively treated group, recurrence of the kyphotic deformity was predictable by the lesion of the posterior longitudinal ligamentary complex together with endplate comminution and vertebral body involvement as seen on trauma MRI. The authors recommend the use of MRI to develop reliable prognostic criteria for these injuries.

Adolescent↗
PubMedDate not supplied

Distribution of physeal and nonphyseal fractures in 2,650 long-bone fractures in children aged 0-16 years.

The distribution of 2,650 long-bone fractures in children is presented. Fractures involving the humerus, radius, ulna, femur, tibia, and fibula were classified according to Salter and Harris. Growth plate injuries accounted for 30% of fractures. Nonphyseal fractures occurred twice as often in the upper extremity as in the lower extremity. Girls with physeal fractures on the average were 1.5 years younger than boys with the same type of fracture in the same location.

Adolescent↗
PubMed1998

Postoperative weight-bearing after a fracture of the femoral neck or an intertrochanteric fracture.

Sixty patients who had had operative treatment of a fracture of the femoral neck or an intertrochanteric fracture were allowed to bear weight as tolerated on the injured limb. The average age was seventy-seven years. Computerized gait-testing was performed at one, two, three, six, and twelve weeks postoperatively to quantify weight-bearing. For the purpose of analysis, the patients were divided into three groups according to whether they had internal fixation of a stable fracture, internal fixation of an unstable fracture, or a primary hemiarthroplasty. Thirty-two patients completed the entire twelve-week study. The average amount of weight that these patients placed on the injured limb increased progressively with time. The average load supported by the injured limb was 51 per cent that of the uninjured limb at one week, and it gradually increased to 87 per cent at twelve weeks. During the first three weeks, the patients who had had internal fixation bore substantially less weight than those who had had a hemiarthroplasty. By six weeks, we could detect no significant differences, with the numbers available, among the groups with regard to weight-bearing or other measured gait parameters. We concluded that elderly patients who are allowed to bear weight as tolerated after operative treatment of a fracture of the femoral neck or an intertrochanteric fracture appear to voluntarily limit loading of the injured limb.

Aged↗
PubMed1979

Tibial shaft fractures. The frequency of local complications in tibial shaft fractures treated by internal compression osteosynthesis.

Ninety-two tibial shaft fractures in 90 patients over the age of 15 were treated by compression osteosynthesis according to the AO method, but using plates and screws of Vitallium. Fifteen fractures (14 patients) were excluded, because the follow-up period was less than 12 months. The frequency of complications in the remaining 77 fractures, 44 per cent comminuted and 30 per cent open fractures, were: skin necrosis over the osteosynthesis material: 5.2 per cent, osteitis: 1.3 per cent, delayed osseous healing necessitating secondary operation: 2.6 per cent, loosened screw (not requiring secondary operation): 5.2 per cent, loosened screw + refracture: 1.3 per cent, plate bending: 1.3 per cent, plate fractured: 1.3 per cent, and refracture after removal of the plate (new relevant traumas): 4.8 per cent. In this series there was a markedly high frequency of complications in comminuted fractures with laceration of skin and muscles, whereas an increased tendency for complications to develop in the remaining injury groups was not seen.

Adolescent↗
PubMed1999

Is there an association between fractures of the cervical spine and first- and second-rib fractures?

OBJECTIVE: To investigate a potential association between cervical spine injury and first- and second-rib fractures. METHODS: Retrospective review of the radiologic and medical records of 28 consecutive patients admitted to an acute spinal injury unit. RESULTS: A total of 10 (36%) of the patients with cervical spine trauma also had fractures of either the first or second ribs. Eight of these 10 patients had a fracture or fracture-subluxation of the seventh cervical vertebra or the C6/7 segment. CONCLUSION: Almost one-third of patients with traumatic cervical spine injury have an associated upper-rib fracture. The strongest association is between injury at the C7 level and first-rib fracture.

Adolescent↗