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At least 649 records · Page 36Linked to original sources
PubMed2000

Adult monteggia fracture with ipsilateral distal radius fracture: case report.

Although the adult Monteggia fracture is a well-known injury, the combination of a Monteggia fracture and an ipsilateral distal radius fracture is extremely rare. It is important for the treating physician to recognize that this injury involves not only the bone elements but also their articulations. The distortion of the integrity of both the elbow and the wrist results in the potential for functional compromise, if inadequately treated. The case report presented here describes a 21-year-old woman with this complex injury resulting from a fall. The injury included a Monteggia type II fracture and an ipsilateral distal radius intra-articular fracture in the left forearm. An excellent result was obtained by surgical intervention in both the radial and ulnar bones. The factors we believe contributed to the excellent result were early diagnosis, anatomic reduction, stable fixation, and early physical exercise. The mechanism of injury giving rise to this rare combination of fractures is discussed, as well as a review of the literature.

Adult↗
PubMedDate not supplied

Physeal fractures, part II: fate of interposed periosteum in a physeal fracture.

This study describes the histologic features of periosteum interposed into a physeal fracture of the rat proximal tibia. Periosteum was introduced into a physeal fracture in two groups of animals: those with an intact physis after fracture, and those with the medial half of the physis surgically ablated. Specimens of the proximal tibia underwent histologic analysis at 2, 4, 6, 10, and 21 days after fracture to determine the histologic features of interposed periosteum in a physeal fracture. In animals with an intact physis, interposed periosteum underwent one of two fates: it was degraded by giant cells in the fracture plane, which allowed cellular infiltration, or if the periosteum was closely surrounded by physeal cartilage, the physis grew around it and appeared to force it toward the metaphysis. In animals whose physis received surgical ablation, physeal bar formation was always present, with poor organization of the remaining lateral growth plate. Histologic evidence from this study also underscores the fact that physeal bar formation occurs from the migration of osteoblasts and osteoclasts along vertical septa.

Animals↗
PubMed1989

[Surgical treatment of unstable trochanteric fractures of the femur. IV. Evaluation of the surgical treatment of trochanteric fractures of the femur using intramedullary Y nails].

Here is shown a method of operating a trochanteric fractures of the femur by use of a modified intramedullary Y nail. During a period of 18 months this method was performed on 36 patients with unstable trochanteric fractures. It was established that this operating procedure is simple, from a technical point of view. It ensures excellent stabilization of bone fragments in all types of trochanteric fractures, including fractures of the IV degree, as well as enabling the patient to be completely weight bearing immediately after operation on the injured extremity. Stabilization of bone fragments in trochanteric fractures can be achieved due to the fact that part of the intramedullary nail is 3/4 the length of the femur. The possibility of early weight bearing on the operated extremity caused that 70% of operated patients regained efficiency of movement similar to efficiency prior to fracture of the extremity, 6 weeks after being operated on.

Adult↗
PubMed1989

A scaphoid fracture associated with a displaced distal radial fracture in a child.

A hyperextension injury to the wrist caused a transverse scaphoid fracture associated with a displaced distal radial fracture in an 11-year-old boy. Anatomic reduction and immobilization in a long-arm cast for a period of 12 weeks resulted in subsequent healing of these fractures. The coexistence of a scaphoid fracture with a distal radius fracture in a child is important to recognize because reduction maneuvers are modified to effectively treat this combination of injuries. Patients with distal radial physeal injuries should be closely evaluated for clinical and roentgenographic signs of scaphoid fractures.

Carpal Bones↗
PubMed1986

An unusual fracture of the talus associated with a bimalleolar ankle fracture. A case report and review of the literature.

A 53-year-old man sustained a fall from 1.25 m, injuring his hindfoot and ankle. Roentgenographic examination demonstrated a displaced vertical fracture through the neck of the talus with dislocation at the subtalar and tibiotalar joints (Hawkins Group III) and an ipsilateral bimalleolar fracture. Prompt anatomic reduction of the talus and bimalleolar fracture with rigid internal fixation was performed. Roentgenograms three years postinjury confirmed solid union of all fractures. Avascular necrosis of the talus had not occurred. Minimally disabling post-traumatic arthritis as both the ankle and subtalar joints was the only sequela. Only four similar injuries seem to have been reported previously in the literature. Despite the generally high incidence of avascular necrosis in Hawkins Group III talar neck fractures, none of these four cases developed this complication. A possible explanation is that with the presence of ipsilateral bimalleolar fracture, there is preservation of the extraosseous vascular supply that accompanies the deltoid and talofibular ligamentous complexes.

Ankle Injuries↗
PubMed1987

Age- and sex-specific incidence of femoral neck and trochanteric fractures. An analysis based on 20,538 fractures in Stockholm County, Sweden, 1972-1981.

The risk of fracturing the proximal femur is high for individuals with metabolic bone disease or with low bone mass associated with advanced age. Incidences of 20,538 trochanteric and femoral neck fractures in adult Swedish men and women, from a computerized medical information register for all hospitals in Stockholm County, were analyzed for age- and sex-dependence. The rate of increase in the occurrence of fracture was nearly constant for both sexes, exponentially increasing with age for men over 20 years old and for women over 30 years old. The incidence of trochanteric and femoral neck fracture for men doubled every 7.8 and 7.0 years, respectively. The doubling rate of fracture incidence for premenopausal women, aged 30 to 49 years, did not significantly differ from that for postmenopausal women, aged 50 to 69 years. These findings suggest that age-associated factors common to both sexes provide the main risk for fracturing the proximal femur. Menopause does not pose a major risk.

Adult↗
PubMed1985

[An unusual form of isolated fracture of the orbital floor: "valve fracture". Therapeutic problems].

Among isolated fractures of the orbital floor, the authors are pointing out an unusual clinical type characterized by the irreducibility of the orbital contents ruptured in the maxillary sinus by using classical procedures. This primary failure is due to a bone fragment dropped in the sinus and being attracted by the herniated collar when trying to integrate the hernia in the orbit. To name this type of lesion, the word "valve fracture" is proposed because of the analogy of the one way function of a valve and its different mechanism from the classical trapdoor fracture. The different concepts of the pathogenesis of isolated fractures of the orbital floor and the physiopathology of the frequently associated ocular disturbances are briefly exposed. The authors report the case which confronted them to the valve fracture. Following a direct trauma to the right orbital area a 13-year-old child presented a limitation of the upwards movements of the right eye with diplopia and a positive forced duction test. The surgical exploration shows an orbital hernia in the sinus which is impossible to reposition either with a higher incision (under the orbital rim) or with a lever incision, upper vestibular incision (through maxillary sinus). Only the infraorbital marginotomy described by P. Tessier exposes completely the lesions and allows understanding of the mechanism of this primary irreducibility related to the valve movement of the fractured bone fragment. Above all, marginotomy allows an atraumatic set. If is performed combining gentle handles of pulling and forcing back on the ruptured pieces while keeping opened the valve.

Adolescent↗
PubMed1981

Healing of femoral neck fractures; influence of fracture reduction and age.

In the present study, the influence on healing of femoral neck fractures of reduction of the fracture and the age of the patients were investigated in 446 consecutive cases treated by internal fixation. If the fracture was reduced in valgus position anteroposteriorly, 90% of the cases healed, and if anatomical reduction was achieved the figure was 77%. However, if the fracture remained in varus position bone union was obtained in only 63%. After a good lateral reduction internal fixation resulted in failures in 22% of cases, if a satisfactory in 26%, but poor lateral reduction was followed by failure in 49% of cases. There was correlation to reduction position in all Garden's Stages. With regard to the healing of the fracture, reduction in lateral as well as anteroposterior views were of equal importance. The patient's age did not influence the failure rate in 22% of cases. With increasing age progressive decrease of healing was encountered. The number of patients attending for follow-up until bony union decreased also due to a high mortality rate in these patients. Internal fixation was found to be the treatment of choice in femoral neck fractures, provided that a satisfactory reduction could be obtained.

Adolescent↗
PubMed1993

[The effect of location and shape of the fracture line on results of conservative treatment of closed tibial shaft fractures].

One hundred seventy five closed crural shafts fractures have been analysed. They have been classified depending on the location and shape of the fracture line. Clinical and radiological assessment were taken into consideration. The best final results have been achieved in fractures of middle third of the tibia and in fractures of transverse fracture line. The disturbances of bone union most often occurred between middle and distal third of the tibia and transverse fractures.

Fractures, Closed↗
PubMed1994

[Treatment of subcapital fractures of the 4th and the 5th metacarpus. A clinical trial of the results after treatment without immobilization and reposition and a study of the treatment of these fractures at casualty departments in Denmark].

The aim of the study was to evaluate the results of treating subcapitular fractures of the fourth and fifth metacarpal bones with immediate mobilization and without splinting or reduction. Thirty-six such fractures were prospectively treated in this fashion and evaluated clinically. After four weeks only four patients (11.1%) had restricted movement of the metacarpal-phalangeal joint (less than 0-80 degrees of movement). The fracture was healed in 33 patients (91.7%) and 31 (86.1%) were fully satisfied. In order to investigate the types of treatment given in other accident and emergency departments in Denmark, a questionnaire was sent to all such departments. The results showed that most (90%) departments used plaster of Paris immobilization of the fracture. The average period of immobilization was 3.6 weeks (two to six). The indications given for reduction was an average volar angulation of 32 degrees (10-70). We conclude that treatment of subcapitular fractures of the fourth and fifth metacarpal bones without reduction and with a supporting bandage and mobilization to the pain-limit seems to secure a rapid restitution of function. These fractures are generally treated in Denmark with plaster immobilization and sometimes reduction, which appears to constitute overtreatment.

Adolescent↗
PubMed1997

Nonunion of tibial fractures treated with external fixation. Contributing factors studied in 71 fractures.

We analyzed factors of importance for nonunion in a series of 39 closed and 32 open fractures of the tibia which were treated with external fixation. Factors analyzed included, age and sex of the patients, the mechanism of injury, the amount of soft tissue damage, the grade of comminution, the level at which the tibia was fractured, the presence of an intact fibula, the presence of multiple injuries, the type of external fixation used (Orthofix, STAR-90 or Hoffmann) and the need to supplement the stability of the reduction. We found that the type of open fracture, comminution of the fracture, extension the original wound for satisfactory reduction and fracture of the ipsilateral fibula, played a role in the development of nonunion.

Female↗
PubMed1994

Impending and actual pathological fractures in patients with bone metastases of the long bones. A retrospective study of 233 surgically treated fractures.

OBJECTIVE: Analysis of short-term and long-term complications after cemented osteosynthesis for pathological fractures. DESIGN: Retrospective study. SETTING: South Municipal Hospital and the Daniël den Hoed Cancer Centre, Rotterdam, The Netherlands. SUBJECTS: 199 patients consecutive surgically treated between 1978 to 1990 for 233 fractures (161 actual and 72 impending) caused by metastatic lesions of the femur, humerus and tibia. INTERVENTIONS: Local resection of the tumour was followed by endoprostheses (n = 52) and by internal plate osteosynthesis (n = 167); 14 fractures were treated with intramedullary nails. Bone cement was added in 211 cases (91%). MAIN OUTCOME MEASURES: Pain relief, mobilisation, complications. RESULTS: Pain relief was achieved in about 90%. 145 (76%) who were treated for fractures of the lower extremity were able to walk again. There were 13 local complications: 26 (11%) implanted devices failed (cumulative probability 40%, after 60 months). In 11 cases the fixation failed after 7 weeks. The failure rate was 16% in the subtrochanteric region treated with an angled blade (probability 70% after four years). The patients' survival rate was 55% after six months and 20% at two years. CONCLUSION: Despite the poor life expectancy, our results indicate that hemiarthroplasty or osteosynthesis with bone cement for treatment of pathological (impending) fractures is a safe way to restore limb function and to improve quality of life.

Adult↗
PubMed1997

Open fractures caused by high velocity missiles: the outcome of treatment of 39 fractures followed for 1-3 years.

Between 1993 and 1995, thirty-three patients having 39 fractures caused by missiles fired from a high velocity rifle were reviewed retrospectively between 1 and 3 years after injury and the outcome of treatment assessed. Majority (33 out of 39) were Grade III. Union was achieved in 35 out of 39 fractures, there was deep infection and delayed union in one case each. Non-union occurred in three fractures. The fractures were stabilized using different techniques, but highest complication rate was seen with the use of the static external fixator. This was related to the severe nature of the injury as well as the inherent limitations of the external fixator. Revision of the external fixator with internal fixation after healing of the soft tissues seems to be the direction of the future.

Adolescent↗
PubMed1985

External fixation of tibial shaft fractures. A review of 42 fractures by the Hoffman-Vidal-Adrey external fixation system.

Over a 6-year period (1977-1983), 59 patients with 61 tibial shaft fractures were treated by external fixation. Of these patients, 42 with 42 fractures were followed up until solid union. Thirty-seven fractures were caused by high-energy impact, mainly road accidents. Seventeen fractures were closed and 25 were open. In 33 patients an external quadrilateral frame system was applied primarily, and in the remaining nine within 1-2 weeks. No predrilling was done, and in 16 patients nonthreaded connection rods were used throughout the period in the fixator. The process of union was monitored by repeated noninvasive measurements of stability. Average time form injury to dismantling of the external fixation was 5.2 months (range 2-12.5 months) and time-to-union for the whole series was 10.0 +/- 5.5 months (range 4-31 months). Sixteen fractures failed to unite. Compared with other published series treated by external fixation, the incidence of non-union in the present series is high. On the basis of the present findings it is concluded that a compression device should be mounted either primarily or as soon as possible during the process of union, and that compression should be applied at regular intervals. If an external fixator is used, the surgeon must bear in mind the possible complications. It is probably safer to reduce rather than to prolong time-to-removal of the external system.

Adolescent↗
PubMed1994

The prevention of infection in open fractures: an experimental study of the effect of fracture stability.

An experimental model of a contaminated open fracture has been developed. This model has been used to test the hypothesis that stable fixation of a contaminated open fracture will reduce its susceptibility to infection. The tibiae of male New Zealand white rabbits were fractured and then fixed with either a dynamic compression plate (stable group) or a loose-fitting intramedullary rod (unstable group). The fracture site was then inoculated with a standard inoculum of Staphylococcus aureus. There were 20 rabbits in the stable group and osteomyelitis developed in seven (35 per cent); in the unstable group 15 (71 per cent) out of 21 animals developed osteomyelitis. This difference in infection rates was statistically significant (P < 0.02). This experimental study supports the concept of stabilization of open fractures in man.

Animals↗
PubMed2004

[Calcaneal fractures--the most frequent tarsal fractures].

Operative treatment of intra-articular calcaneal fractures with anatomical reduction and early mobilisation has lead to a considerable improvement of the functional results of these severe injuries over the recent two decades. New tendencies like modified approaches tailored according to the vascular anatomy, arthroscopic control of joint reduction in conjunction with open or percutaneous procedures, early flap coverage for severe open fractures or closed fractures with full thickness skin necrosis, the use of interlocking plates that further minimises the need of bone grafting and subtalar arthrolysis at the time of hardware removal for fibrous overgrowth have the potential for further improvement of the outcome. The observation from several comparative studies that operative treatment leads to superior results in displaced intra-articular calcaneal fractures has been qualified in a recent prospective, randomised multicentre trial. This paper presents and the authors' experience with the demanding operative treatment of these fractures together with new developments aiming at improving the clinical results.

Arthroscopy↗
PubMed1997

Nonunion of distal radial fractures associated with distal ulnar shaft fractures: a report of four cases.

Although complications following distal radial fractures are common, nonunion is rare. We report four cases of radial nonunion following distal radial fractures that occurred in elderly women after low-energy falls. The distinctive feature of these injuries was the presence of an associated distal ulnar shaft fracture. All patients had initial closed reduction and cast immobilization, which was unsuccessful. Reconstruction was complicated by deformity, disuse osteoporosis, radiocarpal stiffness, and distal radioulnar joint disruption. Wrist arthrodesis improved function and decreased pain and deformity in three patients. Metaphyseal distal radial fractures associated with distal ulnar shaft fractures represent an unstable injury pattern, and closed reduction and casting may not be adequate treatment. Once established nonunion is present, wrist arthrodesis is a useful salvage procedure.

Aged↗
PubMed2003

Closed reduction and percutaneous fixation of supracondylar fracture of the humerus and ipsilateral fracture of the forearm in children.

We treated 22 children with a supracondylar fracture of the humerus and an ipsilateral fracture of the forearm by closed reduction and percutaneous fixation. There were four Gartland type-II and 18 Gartland type-III supracondylar fractures of the humerus. There were fractures of both bones of the forearm in 16 and of the radius in six. Both the supracondylar and the distal forearm fractures were treated by closed reduction and percutaneous fixation. The mean follow-up time was 38.6 months. At the latest follow-up there were 21 excellent or good results and one fair result. There were no cases of delayed union, nonunion or malunion. Five nerve injuries were diagnosed on admission and all recovered spontaneously within eight weeks. No patient developed a compartment syndrome.

Bone Wires↗