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At least 685 records · Page 38Linked to original sources
PubMed2002

Endoscopic transnasal approach for the treatment of medial orbital blow-out fracture: a technique for controlling the fractured wall with a balloon catheter and Merocel.

The authors repaired a medial blow-out fracture by using an endoscopic transnasal technique with a balloon catheter and Merocel packing in 17 subjects. The follow-up periods were from 6 weeks to 2 years, and averaged 6 months. The length of the operation was 50 minutes on average. The enophthalmos was corrected in seven of the eight patients. Supporting material for the fractured medial orbital wall was kept in place for 1 to 3 weeks. The mean volume of balloon inflation was 2 cc. The result was satisfactory. No complications resulted from the transnasal endoscopic technique. This endoscopic transnasal approach allows for a better aesthetic result because it eliminates external scarring and permits a direct approach to the medial orbital wall and has a superior visualization. A balloon catheter was used to support the fractured medial orbital fracture, which was adapted, ballooned, and then visualized using a radiopaque dye (Visipaque) in 11 cases. A postoperative computed tomographic scan revealed that this is a very useful method for controlling the status of the reduced orbital wall and eliminates the possibility of complications resulting from infection. A resected uncinate process was used as a bone graft material to repair the large defect in five cases. This method provides several advantages including a mucoperiosteal attached bone graft, working in the same operative field, and cost-effective surgical time. A transnasal endoscopic technique for medial orbital fracture is also very useful for releasing entrapment of the medial rectus muscle, because it directly pushes against the fractured wall and gives good exposure of the medial orbital wall.

Adult↗
PubMed1984

The thoracolumbar crush fracture. An experimental study on instant axial dynamic loading: the resulting fracture type and its stability.

Seven vertebral preparations of L1, with surrounding discs, facet joints, and ligaments were exposed to an instant axial dynamic force in order to produce a burst or crush fracture. The resulting fractures were similar to fractures observed clinically and showed a comminuted vertebral body with fractured vertebral end-plates, dislocated disc nucleus, bone fragments severely encroaching upon the spinal canal, and facet joint laxity. The flexion-extension range was increased considerably. This implies that this fracture type should be regarded as unstable with a risk of progressive flexion deformity, neurologic deterioration and pain. The fracture could be reduced by an axial distraction force of 400 N simulating the effect of Harrington distraction rods. However, the distraction resulted in an "empty" vertebral body with small areas of spongious bone mixed with fragments of the disc nucleus and fragments of the vertebral end-plate.

Biomechanical Phenomena↗
PubMed2005

Have the causes of maxillofacial fractures changed over the last 16 years in Finland? An epidemiological study of 725 fractures.

A retrospective study was undertaken to assess causes of maxillofacial fractures in Helsinki in 1981 and 1997. Hospital records of 725 patients were analyzed according to several factors including age, sex, cause of fracture and time of the injury. The time intervals between the accident and hospital examination were also evaluated. Number of maxillofacial fractures was 318 in 1981 and 407 in 1997 (27.9% increase) and most patients were men. The male to female ratio was 2.8:1 in 1981, 3:1 in 1997. In 1981, most affected patients were in the age group of 31-40 years (33.2% of men, 28.9% of women). Sixteen years later the most affected age group was 41-50 years (23.3% of men, 30.4% of women). Assault was the cause of the injury in 42% of patients followed by traffic accidents (26%) and fall (17%). During the study period violence had become more severe in nature. Kicking as the cause of maxillofacial fracture increased by 7.3% and use of a weapon by 5.7% between the years studied. Bicycle accidents increased by 19.3% but motor vehicle accidents decreased by 31.6% between the years. Falls, and bicycle and pedestrian accidents were the causes that accounted for most of the increase in maxillofacial fracture. In 1997, maxillofacial fractures were slightly more common from June to August and from Friday to Sunday than at other times (45.2 and 50%, respectively).

Accidents, Traffic↗
PubMed1978

[Results with non-fixed silicone implants in the treatment of blow-out-fracture and fracture of the orbit].

The number of difficult maxillofacial fractures increases with the number of traffic accidents. 80% of all accidents of this kind are accompanied by juries of the head. In the treatment of combined blow-out-fracture and fracture of the orbit, the most important task is a repair of all orbital structures in collaboration of the ophthalmologist with the otolaryngolist and the oral surgeon. A knowledge of all orbital fractures (stages according to Bleeker) is an essential basic requirement. Bigger defects of the orbital walls are closed by me with one, two or three perforated silicon implants in accordance with Whyte. The open repair of the orbital ring with intraosseous fixation is the modern method of treatment of dislocated orbital bones. After a detailed description of my own operative procedure the treatment results of 75 combined blow-out-fractures--among them 4 orbital fractures of the floor, walls, roof and margins--are given. The following complications are listed: 1 case of orbital hemorrhage, 36 cases of persistent lower lid edema, 4 cases of tissue reaction to the alloplast, 3 cases of infection )amoung them one otolaryngolical case) and 5 cases of extrusion of the implant.

Adolescent↗
PubMedDate not supplied

Fractures of the distal shaft of the fifth metatarsal. "Dancer's fracture".

We retrospectively reviewed the office records of the senior author--which include two national ballet companies--and identified 35 dancers who sustained distal shaft fractures of the fifth metatarsal. The usual fracture pattern is a spiral, oblique fracture starting distal-lateral and running proximal-medial. Treatment consisted of open reduction and internal fixation for 2 patients, closed reduction and percutaneus fixation for 2 patients, short leg weightbearing cast for 7 patients, and an elastic wrap and treatment of symptoms for 24 patients. Patients with marked displacement of the fracture underwent internal fixation early in the study period; but more recent treatment emphasized nonoperative means, even for displaced fractures. The average time to pain free walking was 6.1 weeks (range, 0 to 16); return to barre exercises, 11.6 weeks (range, 4 to 48); and return to performance, 19 weeks (range, 6 to 52). There was one delayed union (7 months) and one refracture (2 months) that subsequently healed. All patients returned to professional performance without limitation and no patient reported pain with performance at followup. Spiral fractures of the distal shaft of the fifth metatarsal are common injuries and can usually be treated nonoperatively for these high performance athletes without long-term functional sequelae.

Adult↗
PubMed2003

Aberdeen Colles' fracture brace as a treatment for Colles' fracture. A multicentre, prospective, randomised, controlled trial.

We carried out a randomised, prospective, multicentre clinical trial of the treatment of Colles' fractures. A total of 339 patients was placed into two groups, those with minimally displaced fractures not requiring manipulation (151 patients) and those with displaced fractures which needed manipulation (188 patients). Treatment was by either a conventional Colles' plaster cast (a control group) or with a prefabricated functional brace (the Aberdeen Colles' fracture brace). Similar results were obtained in both groups with regard to the reduction and to pain scores but the brace provided better grip strength in the early stages of treatment. This was statistically significant after five weeks for both manipulated and non-manipulated fractures. At the tenth day the results were statistically significant only in manipulated fractures. There was no significant difference in the functional outcome between the two treatment groups. However, younger patients and those with less initial displacement had better functional results.

Adult↗
PubMed1982

CT of acetabular fractures: analysis of fracture patterns.

Thirty-one consecutive patients who sustained acetabular fracture or posterior femoral head dislocations were examined by computed tomography (CT). By analysis of closely spaced, thin CT images, it was possible to characterize the three-dimensional nature of these injuries. Traditional classification into anterior column, posterior column, and complex two-column fractures was facilitated. CT was especially useful in evaluation of the two-column fractures in which unique information concerning the configuration of the fracture, integrity of the acetabular dome and quadrilateral surface, and identification of the stable fragment was obtained. Surprisingly constant fracture patterns were identified. CT was also useful in determination of presence or absence of loose bodies in the joint and in evaluation of the femoral head and sacroiliac joint in all types of fracture.

Acetabulum↗
PubMed2000

Epidemiology of fractures and assessment of fracture risk.

Osteoporosis is a common condition that is clinically important because of its association with fracture. Fracture risk is ultimately determined by the relation between bone strength and propensity to trauma. Bone density is a key determinant of bone strength, and depends on the bone gained during growth and consolidation, and the subsequent rate of bone loss. Many factors (both genetic and environmental) influence the risk of future fracture through effects on these key intermediary mechanisms. Fracture risk increases greatly with age and is generally higher in women than in men and in whites than in other races. Around 30% to 40% of the variance in peak bone mass is genetically determined, and polymorphisms for several candidate genes are currently being identified. Sex hormone deficiency after the menopause is a key factor in the pathogenesis of osteoporosis in women. In addition, however, there are environmental influences that affect bone density, such as cigarette smoking, alcohol consumption, physical inactivity, and nutrition. Using age, BMD, and other risk factors, it is now possible to identify populations at high risk of osteoporotic fractures. Such populations will potentially derive maximal benefit from therapies and other strategies that reduce fracture risk.

Adult↗
PubMedDate not supplied

Pertrochanteric fractures in the elderly. Is the Belgian VDP prosthesis the best treatment for unstable fractures with severe comminution?

During a ten year period (1978-1988) 565 patients, aged 70 years and over, suffering a fresh pertrochanteric fracture have been treated in the Department of Traumatology at the University Hospitals of Leuven, Belgium. According to the system of Evans and Jensen, 388 fractures were classified as unstable. Special attention was given to the 324 cases of type I C and I D fractures. The method of treating greatly changed during the period of study. All patients were followed up prospectively during one year. Our study showed that for these unstable fractures, fixation with an angled plate or Ender nails should be forsaken. The overall results of the dynamic hip screw treatment were good (reoperation rate 2%, good functional results in 64%), but as this treatment has a risk for serious collapse and pain in about 80% of all type I D fractures, one could suggest to treat these complex multifragment fractures primarily with an endoprosthesis. This treatment needs no longer to be considered as a severe intervention, as the danger of mechanical complications being very minimal (less than 1%).

Aged↗
PubMed1990

[Strength of teeth to fracture by impact. Testing of fractural strength against impact force, using replication models of human permanent teeth].

Traumatic injury anterior teeth is often encountered clinically. A number of clinical and statistical studies have so far been undertaken for the incidences, causes and ages in terms of the site of fracture. However, little has been attempted at fundamental estimation of the fractural resistance of anterior teeth that are susceptible to fracture. This has been studied in only an erect position of eruption by Nose or Chin. Changes in resistance of teeth in a twisted position or at different angles of eruption still remain unstudied. We took an interest in the relation between physicopositional conditions of human teeth and changes in their fractural strength against impact. Determination of the resistance of teeth to a variety of experimental conditions was attempted by use of an Izod-type tester. Epoxy resin replication models of human anterior teeth were used as experimental specimens, since human teeth were considered inappropriate because of their large individual differences and an anticipated difficulty in precise reproduction of the angles of eruption and torsion. The following results were obtained; (1) In the replication models of teeth erected positioned at 90 degrees vertically to the horizontal plane, the fractural strength against impact was highest for the maxillary cuspid model and was lowest for the mandibular central incisor model. (2) In the replication models of teeth with their mesial or distal incisal margin twisted 45 degrees medially, the fractural strength was reduced for all the teeth except the maxillary central incisors. (3) In comparison of the strength between the replication models with the mesial incisal margin twisted 45 degrees medially and those with the distal incisal margin twisted likewise am marked reduction in strength was found for the maxillary cuspid model prepared in the former condition of torsion. For the mandibular cuspid model, a relatively large reduction of the strength was found in the latter condition of torsion. (4) In comparison of the strength of teeth positioned at various angles, the strength was decreased by slanting either labially or lingually for all the replication models except the maxillary and mandibular cuspid models.

Cuspid↗
PubMed1988

Unstable thoracolumbar fractures, with emphasis on the burst fracture.

There is much controversy as to the appropriate treatment of unstable thoracolumbar fractures. If surgery is decided upon, this article suggests a plan to accomplish the reduction of the fracture and decompression of the neural elements. The fractures are divided into compression injuries, seat belt injuries, fracture-dislocations, and burst fractures. In each case the goal is to realign and stabilize the spine and allow adequate room for the spinal cord or the cauda equina. A burst fracture requires the most careful planning. Some decompression can be accomplished by distraction alone but impaction of the fragments posteriorly or removal of the fragments anteriorly may be required. The experience at the author's university has demonstrated that by using these techniques, the preoperative neurocanal compromise can be significantly improved over those series using posterior distraction alone. If canal compromise cannot be accomplished posteriorly, then anterior surgery is required.

Fractures, Bone↗
PubMed1979

[The role of marginal fractures in the prognosis of ankle fractures (author's transl)].

Based on review examination of 224 patients 5 years after their ankle fractures, the authors demonstrate a significant worsening of prognosis with fractures of the anterior or posterior tibial margin. In cases without marginal fractures severe late X-ray, or clinical changes remained less than 4%, in cases with small marginal fractures their number was under 20%, with great articular surface fractures however over 30%. The unfavourable trend becomes evident even in marginal fractures not extending to the articular surface or involving only a minor part of it. It is concluded, that a dislocating force in the sagittal direction is more damaging for the joint than a force acting in the lateral direction.

Biomechanical Phenomena↗
PubMedDate not supplied

Fractures of the craniovertebral junction associated with other fractures of the spine: overlooked entity?

In a review of 155 craniovertebral fractures (occiput-C1-C2), 40 of these had associated fractures and/or dislocations or subluxations elsewhere in the spine. This rather common occurrence, one of four, has not been emphasized in the recent literature, indicating that the radiologic examination should not stop after the craniovertebral fracture is identified. Furthermore, in 13 patients, neurologic deficits were encountered that in all instances were from associated lower-level fracture. From this experience it was believed that a minimum of anteroposterior and lateral views of the entire spine should be obtained in patients in whom a craniovertebral fracture is found, especially if neurologic deficits are present. The other sites of injury were in the lower cervical spine in 17 patients, in the thoracic spine in five, in the lumbar spine in two, and in the sacrococcygeal spine in two patients. Eight patients had three or more levels of fracture.

Atlanto-Occipital Joint↗
PubMed1980

Influence of different freeze-fracture pretreatments on the fine structure of Physarum polycephalum. A freeze-fracture and freeze-substitution study.

The influence of different fixatives (glutaraldehyde, osmium, osmium/glutaraldehyde, and osmium/mercuric chloride) and freeze-protecting agents (glycerol and sucrose) on the fine-structural preservation of micro- and macroplasmodia of the acellular slime mold Physarum polycephalum was investigated in both freeze-substituted and freeze-fractured material. Glutaraldehyde fixation and subsequent infiltration with glycerol or sucrose caused severe destruction in the morphology of plasmodial strands and protoplasmic drops, whereas osmium- or osmium/mercuric chloride fixation prevented the formation of normal fracture planes running through the hydrophobic core of the plasma membranes. A short prefixation in a mixture of osmium/glutaraldehyde followed by postfixation in glutaraldehyde delivered the most satisfactory results in the preservation of the fine structure. For comparison, the distribution of integrated membrane particles (IMP) was analysed in freeze-fracture replicas of unfixed controls as well as glutaraldehyde- and osmium/glutaraldehyde-fixed specimens by evaluating the number of IMP per 1 micrometer 2 in two different plasmodial regions; in the peripheral plasmalemma and in the central plasmalemmal invaginations. In controls not receiving chemical pretreatment and in specimens fixed with osmium/glutaraldehyde, the central plasmalemmal invaginations showed a clearly reduced total amount of IMP (exoplasmic + protoplasmic fracture face: about 3100) as compared with the peripheral plasma membrane (about 3700). In addition both membrane systems were characterized by an asymmetrical distribution of IMP between the protoplasmic fracture face (PF) and the exoplasmic fracture face (EF): the PF:EF ratio (particle partition coefficient) in the peripheral plasma membrane is the same in controls and in osmium/glutaraldehyde-fixed specimens (2.4:1 and 2.5:1, respectively), whereas the PF:EF ratio in the central plasmalemmal invaginations is 1.5:1 in controls and 3.5:1 in fixed specimens. This shows that the membrane of the central plasmalemmal invaginations is more sensitive to chemical fixation than the peripheral plasmalemma. The results point to differences in the physiological properties and functions between the plasmalemma of the cell periphery and the plasmalemma of the invagination system.

Cell Membrane↗
PubMed1994

[Scaphoid fractures. Fracture types and localization].

The incidence, localization, and type of scaphoid fractures found in a well-defined population is described. Fractures of the carpal scaphoid (n = 442) of which 19 (5%) were nonunions were identified during an eight-year period. Among inhabitants living in the Odense Municipality (population at risk 170,648 in 1983 to 174,948 in 1989) 222 males and 51 females who sustained scaphoid fractures during a seven-year period were used for computation of incidence. During the survey, there was an average annual incidence of scaphoid fracture of eight per 100,000 females, and 38 per 100,000 males. The average annual incidence per 100,000 inhabitants of carpal scaphoid fractures according to the location was proximal two, middle 15, and distal six. Average annual incidence per 100,000 inhabitants of carpal scaphoid fractures according to type was transverse seven, horizontal oblique nine, vertical oblique one, avulsion/fracture of the tuberosity five, and not stated one.

Adolescent↗
PubMed1992

Stress fracture of the radius following non-union of an isolated fracture of the ulna.

Non-union of the ulnar diaphysis after isolated ulnar shaft fracture is uncommon. Complications due to non-union of the ulna must therefore be very rare. A case of a stress fracture of the radius in a postmenopausal woman following an isolated ulnar shaft fracture and non-union is presented. The mechanism of the stress fracture and propositions for preventing non-union of the ulnar shaft after an isolated fracture in the osteoporotic patient are discussed.

Aged↗
PubMed2003

Fracture of the distal end of the fibula through a persistent physis in an adult with fracture of the medial malleolus.

A 26-year-old woman was injured in a motor vehicle accident and sustained a bimalleolar fracture of the right ankle. Radiographs revealed a shearing fracture of the medial malleolus and a gap in the distal end of the right fibula that resembled epiphysiolysis in children. Fracture of the distal end of the fibula through a persistent physis was suspected. Histological examination of material obtained from the fracture site during surgery revealed remnants of hyaline cartilage. We believe that the fracture occurred at a persistent physis of the distal end of the fibula.

Adult↗
PubMed1990

Subtrochanteric fractures following Gouffon pinning of subcapital femoral fractures.

Of the first 158 patients in a series of 292 consecutive patients treated for a femoral neck fracture with multiple pinning according to Gouffon's method (Howmedica Inc.), four (2.5 per cent) subsequently suffered a subtrochanteric fracture at the site of the distal pins. The configuration of the fractures was identical. These fractures occurred spontaneously while walking, and one occurred after slight direct trauma. Re-osteosynthesis was required in all four cases using a screw-plate device. If necessary, one or two pins were left in place to secure rotational stability. After a review of these cases and the literature, various modifications to Gouffon's method were introduced, and none of the following 134 patients suffered secondary fractures.

Aged↗