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PubMed2002

[Analysis of complications in the treatment of fracture leg fractures with unreamed intramedullary nailing].

Based on their group of 52 patients the authors analyze the complications they encountered in the treatment of crural fractures by a not predrilled intramedullary nail. Consistent with the literature they found that this method is successful in the treatment of closed and open fractures of the crural diaphysis. They mention, however, a relatively high percentage of complications which in the long run are not a impediment for healing of the fracture but influence it. In the discussion these complications are analyzed in detail in an attempt to find a solution and to avoid them in future patients. They conclude that even this relatively simple and effective method of fractures of the crural diaphysis has its pitfalls and its indication and implementation call for much attention.

Adolescent↗
PubMed1997

Spontaneous subcapital femoral neck fracture after healed trochanteric fracture.

Two hundred thirty-three patients with an unstable trochanteric hip fracture were randomized prospectively for stabilization with a fixed angle blade plate or a compression hip screw. Twenty patients had the implant removed after the fracture was healed (average, 20.5 months; range, 12-42 months). In seven of these 20 patients, a spontaneous fracture of the femoral neck occurred at an average of 19 days after implant removal. Four of the seven patients had been treated with the fixed angle blade plate and three with the sliding screw plate. The histologic examination of three specimens was inconclusive. The authors have not observed subcapital fracture among patients whose implants were not removed. The mechanism behind this complication is unknown.

Aged↗
PubMed1998

Fracture of the anterior superior process of the calcaneus: an often misdiagnosed fracture.

Fracture of the anterior superior process of the calcaneus has been considered an unusual injury. Following a sudden twist there is immediate pain on the outer aspect of the mid-portion of the foot and discomfort on weight-bearing. Three mechanisms of injury have been reported to cause the fracture. The diagnosis is often missed, and prolonged disability and local pain at the calcaneocuboid joint deserve further consideration. Oblique X-rays of the foot are helpful to visualize the fracture. Type III fractures may cause cartilage lesions and arthrosis; therefore, one should not wait long before excision or refixation of the fragment.

Adult↗
PubMed1994

Prediction of fracture union after internal fixation of intracapsular femoral neck fractures.

This study was based on a series of 470 patients with an intracapsular proximal femoral fracture treated by internal fixation; the characteristics of those patients with non-union were contrasted with those of patients in which union occurred, to determine which variables would predict bony union of the fracture. Radiological factors studied included measurements of fracture displacement, anatomical site and degree of osteoporosis. Patient characteristics studied were age, sex, prefracture mobility and mental state. Patient age and pre-operative fracture displacement were found to be of the greatest value in predicting non-union.

Age Factors↗
PubMed1999

Microvascular composite tissue transfer for the management of type IIIB and IIIC fractures of the distal leg and compound foot fractures.

Patients who sustain high-energy, compound fractures with severe contamination and soft tissue loss, face high rates of delayed union, nonunion, infection and, in some instances, amputation. The authors reviewed 18 patients with compound foot fractures and IIIB and IIIC tibial fractures. All patients were treated by early free-flap coverage and simultaneous bone reconstruction. Corticocancellous bone grafting, composite osteocutaneous free flaps, or bone transport techniques were utilized, as required. Bony union was achieved in all cases; rehabilitation and return to work occurred within 12 to 18 months, with no major complications. The authors believe that the reconstruction ladder usually followed should be altered in certain cases in which severe periosteal stripping and soft-tissue contamination necessitate distant free composite tissue transfer, particularly those cases involving the distal third of the leg and foot. Simultaneous reconstruction is superior to other methods of wound management in providing early coverage of extensive wounds, a barrier against bacterial contamination, prevention of osteomyelitis, and enhanced union of the fractures.

Bone Transplantation↗
PubMed1980

Torsional fractures and the third dimension of fracture management.

Torsional strength is the weakest structural property of bone. Fractures produced by common indirect mechanisms are likely to have significant rotational components that bear on their management. The characteristics of torsional fracture lines in bone specimens are completely predictable and reproducible. The physician who is aware of these biomechanical consistencies can use them for fracture reduction and can anticipate and treat fracture deformities accentuated by torsional loading.

Adolescent↗
PubMedDate not supplied

Coronal split fracture of the proximal tibia epiphysis through a partially closed physis: a new fracture pattern.

SUMMARY: A comminuted coronal split fracture of the proximal tibial epiphysis is an uncommon injury in children. The authors evaluated and treated two patients who sustained an epiphyseal fracture through a partially closed proximal tibial epiphysis. Plain radiography and computed tomography with three-dimensional reconstruction showed a comminuted coronal split fracture of the proximal tibial epiphysis. Each patient underwent definitive operative fixation of the fracture and was followed at least 1 year after clinical union. A mechanism consisting of three-point bending on the tibial plateau is proposed.

Accidental Falls↗
PubMed2003

Talus fracture associated with a fracture dislocation of the distal tibia in an immature skeleton.

A 12-year-old boy with a severe injury of his right ankle was treated in the accident unit. The local condition was an extensive open wound with parts of the fractured bones prominent. Radiographs showed a severely displaced fracture of the body of the talus associated with a Salter-Harris IV injury of the distal tibia and subluxation of the ankle. After proper debridement the fractured bones were reduced and fixed. Eleven years later both fractures are completely healed without any sign of avascular necrosis, the patient has full painless ankle movement and he can perform his demanding occupation without any problem.

Accidents, Traffic↗
PubMed1979

Changes in connective tissue metabolism due to bone fractures in children aged 10--14 years. III. Urinary hydroxyproline and glycosaminoglycan excretion following bone fractures treated in different ways.

Urinary hydroxyproline and glycosaminoglycan excretion was studied in the course of fracture healing in twenty 10--14-year-old children with fracture of the femur or of the tibia and fibula. In 11 children reduction and plaster cast were used, in 5 osteosynthesis, and in 4 extension of 6--21 days duration combined with immobilization by plaster cast. In the state of resorption, an increase was observed in the urinary excretion of hydroxyproline and total glycosaminoglycans and in the six glycosaminoglycan fractions studied. As a result of the soft tissue damage accompanying the fracture, the excretion of hyaluronic acid, heparan sulphate, and dermatan sulphate showed the most marked increase. No statistically significant relationship could be demonstrated between the mode of treatment and the amounts of urinary hydroxyproline and glycosaminoglycan, but the stage of resorption was prolonged in the case of treatment with traction. At the beginning of regeneration, a decrease in hydroxyproline excretion and then an increase corresponding to the intensive synthesis of collagen were demonstrated. Glycosaminoglycan excretion during the development of fibrous callus was considerably below the control value. Excretion of the metabolites decreased markedly in the five operated patients. in the case of extension, the stage of regeneration prolonged by 4 to 10 days. In the stage of calcification, urinary hydroxyproline excretion was increased while the excretion of glycosaminoglycan and its fractions was the same as in the controls except in the patients treated with traction. No statistically significant relationship was found between the urinary amounts of hydroxyproline and glycosaminoglycan and the mode of treatment. In the case of traction, fracture repair and the formation of connective tissue callus were prolonged.

Adolescent↗
PubMed1977

Subcapital fracture of the hip: a rare complication of intertrochanteric fracture of the femur.

Three cases of subcapital fracture of the hip that occurred after an intertochanteric fracture of the femur had been nailed have been described in the literature. The tip of the nail failed to penetrate the femoral head and a stress fracture occurred in two at the tip of the nail and in the other at the tip of a blade plate. This paper reports three further cases of this recently recognized and rare complication of intetrochanteric fractures. It is emphasized that the condition must be recognized and treated without delay.

Aged↗
PubMed1996

[Extra-articular proximal femur fracture in the elderly--dynamic hip screw or intramedullary hip screw for fracture management?].

Over a 6-year period we treated 119 pertrochanteric fractures using dynamic hip screws (DHS). During the following 3 years we stabilized 112 per-, sub- and intertrochanteric, as well as "trochanter-associated" fractures by means of intramedullary hip screws (IMHS) or gamma nails (GN). Within comparable patient groups we encountered the following complications: DHS vs IMHS/GN: secondary varus malalignment of the collum femoris with "cut out": 1.7% vs. 1.8%; secondary varus malalignment without "cut out": 0.8% vs. 1.8%; infections: 5.0% vs. 2.7%; hematomas needing revision operations: 2.5% vs. 0%; torn out plate: 1.7% vs. 0%; intraoperative fissures of the shaft: 0% vs. 1.8%; intraoperative perforations of the shaft: 0% vs. 0.9%. Thus, the rate of reoperation for complications within the DHS series was 11.8%, while the rate within the IMHS/GN series was 6.3%. For stable pertrochanteric fractures we therefore acknowledge DHS as the ideal implant in our opinion, while for all other extraarticular proximal fractures of the femur we recommend IMHS or GN.

Adolescent↗
PubMed1990

Use of Peldri II as a sublimation dehydrant in place of critical-point drying in fracture-label cytochemistry and in backscattered electron imaging fracture-label.

Peldri II, a fluorocarbon compound solid at room temperature, was used as a sublimation dehydrant in place of critical-point drying (CPD) in freeze-fracture cytochemistry. Its applicability to the fracture-label replica method was demonstrated using freeze-fractured rat pancreas labeled with Helix pomatia lectin-gold complex and phospholipase A2-gold complex for the detection of glycoconjugates and phospholipids, respectively. No difference in morphology and labeling pattern was detected in CPD-treated and Peldri II-treated tissue samples. The use of Peldri II was further extended to freeze-fractured rat duodenum labeled with wheat germ agglutinin-ovomucoid-gold complex. Again comparable results were obtained when duodenal samples were prepared according either to the conventional CPD method or to the Peldri II sublimation method. Freeze-fractured replicas of hamster ovaries labeled with Ricinus communis I-gold complex revealed that Peldri II could also be used as a sublimation dehydrant for preparing tissue samples for examination in the scanning electron microscope by the backscattered electron imaging mode.

Animals↗
PubMed1994

Broadband ultrasound attenuation and dual energy X-ray absorptiometry in patients with hip fractures: which technique discriminates fracture risk.

There is considerable interest in predicting risk of hip fracture in order to allow targeting of preventive care. This study aimed to determine which of two methods best discriminates a hip fracture population from controls. Fifty women with fractured neck of femur, and 50 control subjects were scanned using dual energy X-ray absorptiometry (DXA) of the spine and hip and broadband ultrasound attenuation (BUA) of the os calcis. Significant differences between the two populations could be found for both DXA and BUA, with BUA showing the largest percentage difference (27%). The mean z-scores showed that BUA had the lowest, with the exception of DXA trochanter. However, no significant difference between BUA and DXA trochanter Z-scores was found. A receiver operator characteristic (ROC) analysis showed that BUA has a superior sensitivity and specificity compared with DXA measurements, with DXA of the hip being better than the spine. This retrospective study shows that BUA is a better discriminator of hip fracture than DXA lumbar spine or DXA hip, which may have important implications for predicting those at risk of future hip fracture.

Absorptiometry, Photon↗
PubMed1997

Unstable vertebral fractures in the lower third of the spine treated with closed reduction and transpedicular posterior fixation: a retrospective analysis of 82 fractures in 78 patients.

Seventy-eight patients were treated with closed reduction and transpedicular fixation for 82 spine fractures. The fractures were localised in the lower third of the spine and were all, according to the Denis classification, considered unstable. Eighteen patients had neurological deficiencies. One patient with a fracture in T11 was completely paraplegic, four patients had a cauda equina syndrome while the rest had radicular symptoms only. Primary reconstruction of the vertebral height and the physiological curves of the spine was satisfactorily obtained. An improvement in the neurological symptoms was observed in all patients with fractures distal to the spinal cord, while the patient with the dislocated fracture of T11 remained completely paraplegic during the follow-up. The complication rate of the transpedicular fixation method used reported by other authors could not be confirmed in our material. Iatrogenic neurological damage was not observed. A partial loss in the correction of the traumatic kyphosis was observed after removal of the implant in 11 patients.

Adolescent↗
PubMed1994

Racial differences in hip axis lengths might explain racial differences in rates of hip fracture. Study of Osteoporotic Fractures Research Group.

Compared with white women, Asian women have about a 40%-50% and blacks a 50%-60% lower risk of hip fracture, but the reason for this racial difference is not known. Women with a shorter hip axis have a lower risk of hip fracture. To test the hypothesis that a shorter hip axis length could account for the lower risk of hip fracture among Asian and black women, we measured hip axis length in 135 Caucasian, 74 Asian and 50 black women. The mean hip axis lengths of Asian and black women were significantly shorter (1.2 and 0.7 standard deviations, respectively) than that of the whites (p < 0.0001). We estimate that, compared with white women, Asians would have a 47% lower risk (95% confidence interval: 32%-63%) and blacks would have a 32% (15%-45%) lower risk of hip fracture because of their shorter hip axis. We conclude that a shorter hip axis length might be a major factor accounting for Asian women's lower risk of hip fracture and might contribute to the lower risk in black women.

Aged↗
PubMed1989

The predictive value of fracture, disease, and falling tendency for fragility fractures in women.

In 1,076 women who had been interviewed from 1970 to 1976 with regard to previous fracture and disease, all fragility fractures that occurred from 1975 to 1985 were recorded. Hip and vertebral fractures were good predictors of future fragility fractures but mainly in younger women (less than 70 years) and this was also the case for fracture of the distal end of the forearm in the age group 40-59. Later in life, falling tendency became the important predictor.

Accidental Falls↗
PubMed1996

Differences in body composition between female geriatric hip fracture patients and healthy controls: body fat is more important as explanatory factor for the fracture than body weight and lean body mass.

Body weight and body composition change with advancing age. In elderly women, the loss of body weight is partially due to loss of body fat. We compared the body composition of 71 healthy female hip fracture patients and 51 controls. Body composition was estimated with an electrical impedance technique. The fracture patients had lower body weight, lean body mass, body fat, body fat percentage, body mass index and age than the control group. No significant differences were found between the different fracture groups, except for a higher mean age in patients with subtrochanteric fractures. Multivariate logistic regression analysis of body composition, body mass index, and age showed that the amount of body fat, when adjusted for age, had greater explanatory value for fracture, than body weight, lean body mass, and body mass index.

Adipose Tissue↗
PubMed2005

Screening elderly women for risk of future fractures--participation rates and impact on incidence of falls and fractures.

We have assessed the acceptability of a method for screening for risk of future hip fracture in elderly women. After receipt of an initial response to a mailed risk-factor questionnaire sent out to 5,306 women, women were randomly assigned to active or control groups. The active group was invited to participate in a screening visit that comprised a life-style questionnaire and a quantitative ultrasound heel scan. General practitioners (GPs) of women who were found to be in the lowest quartile of broadband ultrasound attenuation and/or who had two or more risk factors for hip fracture were advised to prescribe a calcium and vitamin D supplement. A second mailed questionnaire was sent to both groups 1 to 3 years later. Compared with the control group, the active group had a 56% lower risk of fracture (odds ratio [OR], 0.44; 95% confidence interval [CI], 0.24-0.81 adjusted age, weight, and treatment status). At follow-up, the proportion of fallers in the active group (25.3%) was lower than that in the control group (29.6%) (P = 0.064). The control group was found to have a higher rate of falls at follow-up than the active group (95% CI, 0.02-0.22); no difference was found at baseline (95% CI, -0.08 to +0.14). The screening method used was found to be acceptable to the majority of elderly women in this study. Screening the elderly in this way together with simple advice on treatment appears to reduce the age-associated increase in fall rates and the number of subsequent fractures. This form of screening may provide a cost-effective method to reduce falls and fractures in free-living elderly women. However, no such cost-effectiveness analysis has been performed to date.

Accidental Falls↗