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PubMed1980

Fractures and fracture-dislocations of the neck of the talus.

Forty fractures and fracture-dislocations of the neck of the talus are reviewed. Undisplaced fractures are associated with a high proportion of good results. Type II fractures, where there has been subluxation of the subtalar joint, require accurate reduction to avoid subtalar joint incongruity, and have a 20% incidence of avascular necrosis. Type III fractures, with dislocation of the body of the talus, have a poor prognosis and have a 100% incidence of avascular necrosis. Hawkins' sign of subcortical radiolucency is helpful in ascertaining the presence or absence of avascular necrosis. Accurate open reduction and rigid internal fixation with early range of motion of the involved joints is recommended where a closed reduction has failed to provide anatomic reduction.

Adolescent↗
PubMed1999

Secondary hyperparathyroidism in patients from Western Australia with hip fracture: relationship to type of hip fracture, renal function, and vitamin D deficiency.

OBJECTIVES: To determine the frequency of vitamin D deficiency and secondary hyperparathyroidism in Australian hip fracture patients living in the community. PATIENTS: A total of 283 consecutive patients with hip fracture admitted over a 15-month period to a university teaching hospital in Western Australia. Included were residents of hostels for the elderly, and excluded were nursing home residents and those with malignant fractures. METHOD: Data collected included biochemistry (25 hydroxyvitamin D, parathyroid hormone and creatinine levels), measurements of function and disability (Barthel Index, Frenchay Activity Index), sunshine exposure, and basic demographics. RESULTS: Vitamin D deficiency occurred in 31.7% and secondary hyperparathyroidism occurred in 17.7% of cases. The major determinants of vitamin D deficiency were outdoor sunshine exposure, ambient daily sunshine, and disability (low Frenchay Activity Index or ADL difficulty). Secondary hyperparathyroidism was related to older age, renal dysfunction, and vitamin D deficiency. Secondary hyperparathyroidism was associated with an excess of trochanteric over subcapital hip fractures. CONCLUSIONS: Secondary hyperparathyroidism appears to be a heterogeneous condition, caused in approximately equal proportions by vitamin D deficiency and renal dysfunction, that may confer increased cortical bone fragility and trochanteric fractures. Renal dysfunction in old age may be an important additional determinant of senile osteoporosis, which has implications for preventive therapy. Vitamin D deficiency occurs in disabled and, presumably, housebound older people despite near optimal climatic conditions.

Activities of Daily Living↗
PubMed1998

Hormone replacement therapy and risk of hip fracture: population based case-control study. The Swedish Hip Fracture Study Group.

OBJECTIVE: To determine the relative risk of hip fracture associated with postmenopausal hormone replacement therapy including the effect of duration and recency of treatment, the addition of progestins, route of administration, and dose. DESIGN: Population based case-control study. SETTING: Six counties in Sweden. SUBJECTS: 1327 women aged 50-81 years with hip fracture and 3262 randomly selected controls. MAIN OUTCOME MEASURE: Use of hormone replacement therapy. RESULTS: Compared with women who had never used hormone replacement therapy, current users had an odds ratio of 0.35 (95 % confidence interval 0.24 to 0.53) for hip fracture and former users had an odds ratio of 0.76 (0.57 to 1.01). For every year of therapy, the overall risk decreased by 6% (3% to 9%): 4% (1% to 8%) for regimens without progestin and 11% (6% to 16%) for those with progestin. Last use between one and five years previously, with a duration of use more than five years, was associated with an odds ratio of 0.27 (0.08 to 0.94). After five years without hormone replacement therapy the protective effect was substantially diminished (-7% to 48%). With current use, an initiation of therapy nine or more years after the menopause gave equally strong reduction in risk for hip fracture as an earlier start. Oestrogen treatment with skin patches gave similar risk estimates as oral regimens. CONCLUSIONS: Recent use of hormone replacement therapy is required for optimum fracture protection, but therapy can be started several years after the menopause. The protective effect increases with duration of use, and an oestrogen-sparing effect is achieved when progestins are included in the regimen.

Administration, Cutaneous↗
PubMed1987

Condylar fracture of the cannon bone with axial sesamoid fracture in three horses.

The case histories of three young thoroughbred racehorses with displaced lateral condylar fractures combined with an axial fracture of the lateral sesamoid bone are described. In two cases the condylar fracture was repaired surgically but both horses developed severe degenerative joint disease and remained lame. The third horse was destroyed humanely. It is important that axial fractures of the sesamoid bone are recognised so that a poorer prognosis can be given for treatment of condylar fractures in racing thoroughbreds.

Animals↗
PubMed1981

Fractures of the lateral margin of the distal tibia. The Tillaux fracture.

Fractures of the lateral margin of the distal tibia are usually avulsion fractures of the anterior or posterior tibial tubercle, caused when the anterior or posterior inferior tibiofibular ligament fails to tear during an injury. Since they are generally the result of external rotation and abduction, they are almost always seen in association with other fractures and ligamentous injuries at the ankle joint. While their presence usually does not change the therapeutic approach, occasionally a large fragment may require a separate fixation screw. Fractures of the posterior tibial tubercle should not be confused with fractures of the posterior articular margin (posterior malleolus), which have a worse prognosis.

Adolescent↗
PubMedDate not supplied

Proximal diaphyseal fractures of the fifth metatarsal--treatment of the fractures and their complications in athletes.

Twenty-one patients (age range, 15 to 26; 18 patients 15 to 20 years old) had proximal diaphyseal fractures of the fifth metatarsal. Clinical records and radiographs for all patients were available for review. Patient treatment had been individualized and included several methods, including rest, plaster immobilization, and bone grafting. Twenty of the 21 patients were boys or men participating in athletics. Nine of the 21 fractures and 8 of the reinjuries were sustained while playing basketball. Healing required a minimum of 3 months (with bone graft) and some fractures were not radiographically healed at 20 months, although the patients were clinically asymptomatic. The fracture of the proximal shaft of the fifth metatarsal, particularly the 1.5-cm segment distal to the tuberosity, is a troublesome injury in the active athlete. The clinical course does not appear to be influenced by the usual initial conservative treatment modalities, although many of these fractures will heal if the athlete is willing to restrict activities for a prolonged period of time. In this series, bone grafting with a tibial corticocancellous graft after thorough curettage of sclerotic bone obliterating the medullary canal was the most effective treatment modality for delayed union.

Adolescent↗
PubMed2005

Low 25-hydroxyvitamin D and osteopenia are prevalent in persons > or =55 yr with fracture at any site: a prospective, observational study of persons fracturing in the community.

Ethnic diversity and lower socioeconomic populations are poorly captured in most studies of osteoporosis and fracture risk. This article describes a prospective, observational study designed to analyze risk factors for fracture in an ambulatory, ethnically diverse, urban population aged > or =55 yr. The goal of the study was to determine the number of fractures associated with hypovitaminosis D (< or =15 ng/mL serum 25-hydroxyvitamin D) and osteopenia (T-score <-1.5) by bone mineral density (BMD). From January 1 to July 31, 2001, we identified 262 persons who fractured in our community; 83 chose to enroll in the study. Enrolled patients had a BMD examination at two sites; their blood was drawn for 25-hydroxyvitamin D (25VitD), calcium, phosphorus, albumin, and alkaline phosphatase. At the completion of the study a letter was sent to the patients detailing the findings, and a copy sent to their physician. Of the 83 persons enrolled, 73 (88%) had evidence of osteopenia or osteoporosis (T-score <-1.5) and/or low 25VitD. All fractures in the community in person > or =55 yr, with or without a history of antecedent trauma, should be assessed with BMD and screening for 25VitD.

Age Factors↗
PubMed1997

The efficacy and safety of the hematoma block for fracture reduction in closed, isolated fractures.

Fracture manipulation in the emergency department often requires some method of anesthesia. This study evaluates the efficacy and safety of the hematoma block in patients with closed, isolated fractures requiring manipulative reduction. Sixty-one patients treated with a hematoma block (HB group) prior to fracture manipulation were compared with 53 patients treated with either intravenous sedation or "conscious sedation" (NHB group). Using a pain analog scale, patients rated their pain from 1 (no pain) to 10 (severe pain) both prior to and during fracture manipulation. A pain differential score was calculated for each group. Results demonstrated pain differential scores of 2.7 and 0.8 for the HB and NHB groups, respectively. There were no complications associated with any of the procedures. Based on these results, we conclude that the hematoma block is an effective and safe method of providing anesthesia for fracture reduction in select patients.

Adolescent↗
PubMed1996

Less common orbital fracture patterns: the role of computed tomography in the management of depression of the inferior oblique origin and lateral rectus involvement in blow-in fractures.

During the past decade, advances in radiographic imaging have made it possible for the surgeon managing orbital fractures to adopt a rational therapeutic strategy based on a knowledge of alterations in surgical anatomy secondary to traumatic injury. To illustrate the value of computed tomography in the surgeon's armamentarium for management of orbital fractures, cases are presented in which imaging proved decisive in planning a course of therapy. Two patients presented with two types of isolated lateral blow-in fracture, an uncommon fracture pattern. The other cases underscore the value of defining involvement of the inferior oblique origin and lateral rectus muscles in imaging complex orbital fractures, issues not emphasized in earlier literature. Although diplopia alone does not always warrant surgical intervention, diplopia in the context of computed tomography-defined muscle entrapment or muscle origin displacement justifies operative therapy. These cases demonstrate the value of computed tomography in directing surgical therapy with resolution of diplopia and prevention and correction of enophthalmos.

Accidental Falls↗
PubMed1999

Prosthetic replacement in the management of unstable femoral neck fractures in the elderly. Analysis of the mechanical complications noted in 778 fractures.

From 1987 to 1996, 778 unstable fractures of the femoral neck Garden type III or IV in 736 patients over 70 years of age have been treated surgically. Based on age and functional preinjury status, 477 patients were treated with a hemiarthroplasty; a total hip prosthesis was implanted in another 301 patients. The overall mortality rate at one year was 20%. Of the 472 surviving patients pre-operatively classified as "independent", 68% regained an independent active level; in the remaining 32%, the femoral neck fracture caused an important additional impairment. One also has to admit that the complications after prosthetic replacement are not harmless: dislocation (2%) requiring an early revision arthroplasty in about half of the cases; deep infection (< 1%) leading to a Girdlestone situation and sometimes even to death. It is generally accepted that, if prosthetic surgery is chosen, the best implant for this category of patients is a bipolar system. Despite good functional results observed after total hip arthroplasty for fractures, we recommend this technique only in selected cases. The risk for prosthetic loosening is also much higher after replacement for fracture than after replacement for osteoarthritis (at least 14% within 5 years). Nevertheless, we prefer a total prosthesis implant in patients with a good life expectancy and good functional condition, aged between 70 and 80 years, presenting a severely displaced unstable fracture.

Activities of Daily Living↗
PubMed2001

[Treatment of scaphoid fractures and other intra-articular fractures with the Herbert screw: a preliminary report].

Treatment of scaphoid fractures and other intraarticular fractures with the Herbert screw is presented. It was used in 23 patients--17 with scaphoid fractures, 5 with radial head fractures and 1 with a Bennett fracture. The surgical technique is described. Stable fixation and early post-operative rehabilitation are the most important advantages of this technique.

Adolescent↗
PubMedDate not supplied

Re-attachment of anterior fractured teeth: fracture strength using different materials.

This study compared the fracture strength of two different techniques (bonded only and buccal chamfer) and different material combinations used to reattach tooth fragments. An axial load applied to the buccal area fractured 110 sound permanent lower incisors. Fifty teeth were designated for the bonded only group (no additional preparation) and 50 teeth were designated for a buccal chamfer group. For each group teeth were subdivided into five subgroups (n = 10) according to the restorative material combinations used: 1) adhesive system (A); 2) A + light cured luting cement; 3) A + dual cured luting cement; 4) A + flowable resin and 5) A + hybrid resin. In a control group (resin composite build-up), in the remaining 10 teeth, the crown portion was rebuilt with adhesive and resin composite. Restored teeth were subjected to the same loading in the same buccal area. Fracture strength after restorative procedures for all groups was expressed as a percentage of the original fracture strength and the results were analyzed by two-way ANOVA and Tukey's test for pair-wise comparison. The interaction and the material factor were not statistically significant (p = 0.140 and p = 0.943, respectively). The chamfer group showed higher fracture strength recovery (67.9%) than the bonded only group (41.1%), and both were statistically lower than the resin composite build-up (103.2%). It was concluded that the material used to reattach the fragment is less important than the chosen technique.

Analysis of Variance↗
PubMed1992

Operative management of displaced femoral head fractures: case-matched comparison of anterior versus posterior approaches for Pipkin I and Pipkin II fractures.

Because of the controversy surrounding the selection of the surgical approach for the operative management of femoral head fractures, we retrospectively reviewed the combined experience with femoral head fractures at two major trauma centers. Forty-three femoral head fractures in 41 patients were identified. Twenty-six of the 43 fractures were Pipkin types I and II, and were managed operatively. Of the 26 patients, 12 with > 2 years of follow-up were managed with posterior surgical approaches and 12 with anterior surgical approaches. These patients were assessed with respect to operative time, estimated blood loss and function, and the radiographs for reduction, avascular necrosis, and heterotopic ossification. There was a significant decrease in operative time, estimated blood loss, and improved visualization and fixation with the anterior approach; however, there was a significant increase in functionally significant heterotopic ossification. The functional results in the two groups were identical; 67% good and excellent in each. There were no cases of avascular necrosis of the femoral head associated with an anterior approach. Because of the greater ease of access to the fracture, the anterior approach is recommended when operative reduction of a displaced Pipkin type I or II is indicated, but newer methods of minimizing heterotopic ossification must be developed.

Adult↗
PubMed1990

[Mandibular fractures. 1. Etiology and fracture pattern in 348 patients].

We reviewed 348 consecutive patients with 536 mandibular fractures treated in the ENT department of Aalborg Hospital from 1982 to 1986 retrospectively. The most frequent causes of mandibular fractures were violence (37.3%) and traffic accidents (36.8%) in adults, and bicycle accidents in children. A total of 85 patients (24.4%) had associated injuries. The anatomic distribution revealed a high percentage (41.4%) of condylar fractures, while the rest of the fractures were distributed in accordance with similar studies. In 32 edentulous patients, body and condylar fractures were most frequent.

Adolescent↗
PubMed1989

The cell surface of Trypanosoma cruzi: a fracture-flip, replica-staining label-fracture survey.

Fracture-flip and replica-staining label-fracture were used to study the nanoanatomy and topochemistry of the cell surface of Trypanosoma cruzi. Fracture-flip surface images differentiate the three main developmental stages of T. cruzi. Epimastigotes display a smooth surface, except the cytostome which appears as a clearly demarcated, raised, roughly textured platform. Amastigotes and trypomastigotes are covered by numerous surface particles with diameters ranging from 10 to 20 nm and 15 to 30 nm, respectively. Labeling of concanavalin A receptors showed that the surfaces of amastigotes and trypomastigotes were labeled, with amastigotes displaying the highest density of gold particles. In contrast, epimastigotes were sparsely labeled with exception of the cytostome, where a higher density of labeling coincided with the raised platform seen in fracture-flipped specimens, and with the particle-free area exposed on fracture faces. Labeling of epimastigotes by Ricinus communis I and Wistaria floribunda lectins showed that surface receptors for these lectins were absent from the cytostome.

Animals↗
PubMed1988

Fractures of the atlas vertebra. The two-part burst fracture of Jefferson.

Burst fractures of the atlas are usually diagnosed and treated as four-part fractures as described by Jefferson in 1920. Review of the literature, roentgenogram, computed axial tomography (CAT) scans, and laboratory studies, indicates that the burst fracture is usually, if not always, a two-part fracture. These findings are contrary to the accepted concept of burst fractures, and indicate that routine roentgenograms are not adequate for proper diagnosis. Also, with disclosure of the true nature of these injuries, there is indication for further consideration and study relating to treatment of these injuries.

Cervical Atlas↗
PubMed1986

Effect of prostaglandin E2 on rib fracture healing in beagles: histomorphometric study on periosteum adjacent to the fracture site.

A histomorphometric study was done on healing defects in the ribs of Beagles. A transverse fracture was made in the left 9th and 10th ribs. Beagles were given either ethanol vehicle (n = 6) or prostaglandin (PG) E2 orally (n = 5) for the 30-day period after surgical manipulation to time of necropsy. Double fluorescent labels to measure bone matrix mineralization were given with each of 2 fluorochrome markers--calcein before dogs were surgically manipulated and oxytetracycline hydrochloride before they were euthanatized. The objectives were to determine the effects of fracture on regional remodeling in the periosteum, the effects of PGE2 on the regional remodeling changes in the periosteum induced by the fracture, and the systemic effect of PGE2 on remodeling changes of the contralateral matching sites. The fracture in the nontreated dogs (ethanol only) stimulated remodeling activity in the periosteum with increased resorption (P less than 0.01). However, after surgical manipulation (necropsy) was done, the extent of mineralization on the bone surface was decreased and was decreased more on the nonfractured ribs (right side) than on the fractured (healing) ribs (left side) (P less than 0.05). In the treated dogs, the administration of PGE2 increased the extent of mineralization on the bone surface on the healing ribs. However, as in the nontreated dogs, the administration of PGE2 did not alter the decreasing pattern of mineralization when comparing the bone surfaces at necropsy with the bone surfaces before surgical manipulation was done.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1987

Peripheral nerve injury associated with fracture or fracture-dislocation of the pelvis in dogs and cats: 34 cases (1978-1982).

Peripheral nerve injury was associated with fracture or fracture-dislocation of the pelvis in 23 dogs and 11 cats. In most cases, peripheral nerve injury resulted from ilial fracture with craniomedial displacement of bone fragments, or from sacroiliac fracture-dislocation with cranial displacement of the ilium. Sciatic nerve injury was associated with fracture of the acetabulum in 2 dogs. A combination of sensory, voluntary motor, and reflex abnormalities were observed in the ipsilateral extremity of affected animals. Signs of severe pain were noticed in 4 of the dogs and in 1 cat. Eight of the animals died or were euthanatized for reasons not directly related to the severity of peripheral nerve injury. Of the remaining 26 animals, 21 (81%) had good or excellent limb function 16 weeks after peripheral nerve injury was sustained. Limb function was lost or self-mutilation occurred in 4 (15%) of the animals.

Animals↗