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Freeze-fracture of 2-cell mouse embryos. A new method for fracture of very small and scarce biological samples.

Membrane morphology and development of intercellular junctions in 2-cell mouse embryos was studied with freeze-fracture electron microscopy. In order to circumvent the dual problem of relative scarcity of samples and their very small size (about 50 micrometers per blastomere), both of which made conventional microtomy-induced freeze-cleavage impractical, a new protocol for handling 2-cell embryos was derived from freeze-fracture procedures established for monolayer cultures. Freshly-collected 2-cell embryos were placed within a 2 mm2 area on plastic Thermonox or Polystyrene coverslips which had been previously coated with 0.002% poly-l-lysine. The embryos were then fixed in 2.5% glutaraldehyde buffered to pH 7.3 with sodium cacodylate and containing 0.01% ruthenium red. The embryos were washed three times in buffer and then glycerinated. The next day, the 2 mm2 area of coverslip containing the embryos (75-100) was cut out with a fine scalpel, inverted and placed on a drop of Elvanol-glycerol mixture and frozen in a slurry of liquid nitrogen-cooled Freon-22. Fracturing was achieved in a Balzers BAF 301 Freeze-Etch Unit by positioning the microtome blade underneath a corner of the inverted coverslip and raising the knife until the coverslip 'popped off'. This procedure left the surface of the Elvanol droplet covered with fractured embryos. The exposed tissue was shadowed with platinum and coated with carbon. This protocol produces large expanses of blastomere plasma membrane as well as cross-fractures of entire blastomeres and 2-cell embryos. The replicas revealed blastomeres endowed with a rich assortment of pleomorphic microvilli.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Early progressive kyphosis following compression fractures. Two case reports from a series of "stable" thoracolumbar compression fractures.

In an 18-year-old man and an 18-year-old woman, significant kyphotic deformity progressively developed in the course of the healing of apparently stable thoracic compression fractures. The common features were: (1) multiple adjacent fractures; (2) location in the thoracic spine; (3) associated thoracic injury; and (4) youth. The possibility of early progressive kyphotic deformity should be carefully monitored so that appropriate treatment can be instituted before the deformity becomes significant. Although both isolated fractures and multiple-level fractures of the thoracolumbar spine occur predominantly between T12 and L2, there is a secondary area that is predisposed to compression fractures in sequence from T5 to T7.

Accidents↗

Fracture brace for the treatment of humerus shaft fractures caused by gunshot wounds.

Humeral shaft fractures are amenable to conservative treatment. In this article, the authors define their indications and methods of treatment of gunshot-caused fractures of the humerus. They emphasize use of a humeral fracture brace. Successful fracture brace treatment requires attention to and comprehension of proper technique. When used appropriately, fracture bracing is safer, less expensive, and more effective than surgical alternatives.

Algorithms↗

Fracture-dislocation of the femoral head with associated ipsilateral trochanteric and shaft fracture of the femur.

An exceptional fracture-dislocation of the femoral head with associated trochanteric and shaft fracture of the same femur in a severely multi-injured 25-year-old man has been treated by open reduction of the dislocation and internal fixation of the trochanteric and shaft fractures, with a 130 degrees and a straight plate, respectively. At the 27-months follow-up examination the patient showed good evidence of fracture healing, and avascular necrosis of the femoral head had not developed, even though there had been a 5-day delay in reduction of the dislocation. The reported observation not only illustrates this extremely rare combination of injuries, but also shows that this therapeutic plan, which is able to provide the basis for eventual and further reconstructive procedures, may also offer unpredictable and gratifying outcomes in certain instances.

Adult↗

Early detection of delayed union in lower leg fractures using a computerised analysis of mechanical vibration reactions of bone for assessing the state of fracture healing.

Standard X-ray techniques are used to follow up the healing process of bone fractures. However, these methods allow only indirect conclusions about the stability of the healing bone, depending on the experience of the clinician. In addition, by radiologic means, delayed union or non-union can only be diagnosed on the basis of the absence of specific changes such as callus formation. Therefore, efforts have been made to develop alternative methods for monitoring the healing process. The measuring principle of a non-invasive method is based on evaluation of changes in mechanical vibration reactions. The measuring system is composed of two sound transducers, an amplifier module and an AD converter attached to a PC. The assessment of 150 healthy individuals as well as an initial measuring series after treatment of tibial fractures with an external fixator system revealed highly significant differences between intact and fractured tibias. Thus, computerised sonometry is capable of supplying quantitatively recordable information about the stability of a fractured bone at any time in the healing process. Furthermore, this non-invasive technique allows early diagnosis of disorders in the repair process by the absence of change in the parameters.

Biomechanical Phenomena↗

[Treatment of proximal humeral fractures with the PHILOS angular stable plate. Presentation of 225 cases of dislocated fractures].

BACKGROUND: Proximal fracture of the humeral head is the third most frequent fracture in humans. Most (70%) of those affected are over 60 years old. It is hoped that advanced locking medullary screws or plates will reduce the risk of secondary dislocation of screws or fracture segments when the bone of the humeral head is osteoporotic. METHODS: From January 2002 to August 2005, 225 displaced humeral head fractures in 223 patients aged on average 66+/-15 years were treated with a new locking proximal humeral plate. RESULTS: In 176 patients in whom follow-up was possible, the average Constant Score after 9 months was 70+/-19 points (raw data), or 81+/-22% in the normalized score. No significant difference was detected between the younger group up to 65 years of age (73% points) and those over 65 years of age (80% points). Axial deviations by more than 30 degrees were noted in 11 (5%), and of 159 displaced tubercles, malreduction by more than 5 mm was noted in 14 (9%). Two infections and two haematomas had to be treated so far. Primary screw perforations were seen in 24 (11%) cases as well as further implant dislocations in 3 (1,7%). Plate dislocations out of the shaft existed in 4 (2,4%) and 14 collapses of the humeral head with secondary screw perforations were recorded. All other complications arose out of technical faults, such as 24 screw perforations (11%) into the glenohumeral joint and 3 (1.7%) cases of secondary implant dislocation from the humeral head and 5 (3%) from the shaft, and 14 (8%) sinterings with glenohumeral screw perforation. So far, in addition to 1 case of pseudarthrosis with a broken plate, 5 (3%) cases of total and 9 (5%) of partial avascular humeral head necrosis have been observed. CONCLUSION: The new implant provides superior stability in the fixation of humeral head fragments and has proved its worth in everyday clinical practice when additional indirect fixation of the tubercle is needed, as it frequently is in elderly patients.

Aged↗

[Bilateral acetabulum fractures of the anterior column and vertebral body fracture after alcohol-induced seizure].

The case of a 54-year-old male with a compression fracture of the T 12 vertebral body and a bilateral anterior column fracture of the acetabulum is presented. The origin of this rare combination of fractures is explained by the action of the patient's own muscle force on bone of very poor quality. The treatment of these lesions is comparable to the treatment of similar fractures in bone of normal quality.

Acetabulum↗

Helix wire osteosynthesis for proximal humeral fractures: unacceptable nonunion rate in two- and three-part fractures.

INTRODUCTION: Fractures of the proximal humerus are very common, but controversy still exists about the preferred type of operative treatment in displaced fractures. MATERIALS AND METHODS: We followed 15 patients (12 female and 3 male, average age 70 years) with 15 dislocated type II (9) and III (6) proximal humeral fractures after helix wire osteosynthesis. RESULTS: A nonunion developed in seven cases (47%). Three patients were reoperated (prosthesis: 2, repair: 1). Seven patients were available for follow-up (average: 14 months). Three patients had a Constant score of 80 or more and four patients had a score under 70 points. CONCLUSION: The results of the helix wire osteosynthesis for proximal humeral fractures are poor and we do not recommend its further use.

Adult↗

Rigid internal fixation of mandibular fractures. An analysis of 270 fractures treated using the AO/ASIF method.

The results are reported on 214 patients treated for 270 mandibular fractures, using rigid internal fixation. Of these, 172 fractures (63.7%) in 131 patients had been re-evaluated at final follow-up in connection with plate and screw removal, on average 15.2 months, postoperatively. Although one-third of the patients had a history of alcohol abuse, and 86% were treated with a delay of more than 24 h (mean 3.2 days), good primary bone healing was observed in 93.9% of the patients. Infections, seen in 6.1% of the patients, were related exclusively to inadequate stability of the fracture. Malocclusion, observed in 18.2% of 159 dentate patients, was caused by incorrect plate bending and insufficient fracture reduction. Immediate postoperative dysfunction of the inferior alveolar nerve in 58.1% of the cases, and of the mandibular branch of the facial nerve in 12.7%, was followed by almost total recovery 1 year after operation. It is concluded that rigid internal fixation is a reliable method of treatment, especially indicated for patients with reduced healing capacity and poor co-operation.

Adolescent↗

Complications and timing of follow-up after closed reduction and percutaneous pinning of supracondylar humerus fractures: follow-up after percutaneous pinning of supracondylar humerus fractures.

The purpose of this study was to evaluate the need for clinical evaluation with radiographs within 10 days of closed reduction and percutaneous pinning for the treatment of displaced supracondylar humerus fractures. Between May 1 and December 31, 2001, the authors evaluated the complications with closed reduction and percutaneous pinning of 104 displaced supracondylar humerus fractures. Fifty-two of the patients had the initial follow-up examination with radiographs 10 days or less after pinning; the other 52 patients had the initial follow-up examination with radiographs either after 10 days or on the day of pin removal. The overall complication rate for the series was 7.7% (8/104). All eight complications were in type III fractures. The early follow-up group had six complications; the late follow-up group had two complications. Baumann's angle, lateral humerocapitellar angle, and lateral rotational percentage were not significantly different between the two groups. The only variable tested that was associated with a complication was pin configuration. No association between late follow-up and complications was identified. The authors conclude that clinical and radiographic evaluation of routine displaced supracondylar humerus fractures requiring closed reduction and percutaneous pinning may be safely delayed until pin removal.

Bone Nails↗

Operative treatment of displaced intra-articular fractures of the calcaneus using absorbable internal fixation: a prospective study of twenty-five fractures.

OBJECTIVE: To document the use of absorbable implants in the operative treatment of displaced intra-articular fractures of the calcaneus. DESIGN: Prospective clinical study. SETTING: Level one trauma center, university hospital. PATIENTS: Twenty-five displaced intra-articular calcaneal fractures in twenty-one patients. INTERVENTION: The fractures were reduced operatively and fixed with absorbable self-reinforced polyglycolide rods. MAIN OUTCOME MEASUREMENTS: Reduction, healing, and stability of fixation were assessed on radiographs. The functional result was scored using the method of Crosby and Fitzgibbons. Patient satisfaction was recorded. RESULTS: The mean Böhler angle was -12 degrees (standard deviation 22 degrees) preoperatively and 20 degrees (standard deviation 13 degrees) postoperatively. After a two-year follow-up, seven patients had excellent, five good, three fair, and six poor functional results. Subjectively, fifteen patients were satisfied and six were dissatisfied. Twelve patients returned to work within one year, three were unemployed, two were retired prior to the accident, and four were unable to work because of the calcaneal fracture. The postoperative Böhler angle and later the appearance or absence of posttraumatic subtalar arthritis were significant prognostic factors. CONCLUSIONS: Results with absorbable implants are similar to those with other operative methods. Advantages include the absence of secondary procedures for implant removal and undisturbed computed tomography scans postoperatively.

Absorbable Implants↗

Malar/orbital/zygomatic fracture causing fracture of underlying coronoid process.

In 1 week two patients with depressed fractures of the malar/orbital/zygomatic complex presented with roentgen evidence of fractures of the underlying coronoid process caused by the transmitted impact of the malar/orbital/zygomatic fragment without direct injury to the mandible. No similar cases had been seen in the previous 12 years, and reports found in the literature stated that this type of fracture occurs in only about 2% of all mandible fractures. Conservative treatment is recommended unless there is obvious displacement.

Adolescent↗

Femoral shaft fractures associated with unstable pelvic fractures.

From December 1986 to December 1989, 23 consecutive adult patients with femoral shaft fractures associated with unstable pelvic fractures were prospectively studied. The mortality rate was 8.7%. An anterior frame of an external fixator was sometimes inserted emergently in patients with multiple injuries to improve their bedside care. Early reamed femoral intramedullary nailing accompanying closed or open reduction with internal fixation, external fixation or both for unstable pelvic fractures was the favored treatment method. Twenty cases were followed for an average of 26 months. The union rate was high (95%) and the complication rate was low (5%). Hip and knee joint function was also satisfactory. Combined femoral shaft and unstable pelvic fractures are severe injuries and necessitate aggressive emergent management. With the techniques described, patients can achieve optimal outcome.

Adolescent↗

Pisiform bone fracture-dislocation and distal radius physeal fracture in two children.

We report two children with a Salter-Harris type 1 and 2 distal radius physeal fracture associated with a fracture-dislocation of the pisiform bone. The two patients were treated with closed reduction of both the distal radius and dislocated pisiform under general anaesthesia. Then a long-arm cast was applied for 30 days resulting in full healing of the fractures. The patients were re-evaluated after 30 years, and the wrists did not show any functional impairments. On radiographic evaluations, there were no signs of osteoarthritis or misalignment between the pisiform and the triquetral, in contrast to what has been reported in adult carpal fractures.

Adolescent↗

The complications of displaced intracapsular fractures of the hip: the effect of screw positioning and angulation on fracture healing.

We have studied the placement of three screws within the femoral head and the degree of angulation of the screws in 395 patients with displaced intracapsular fracture of the hip to see if either was related to the risk of failure of the fracture to unite. No relationship between nonunion of the fracture was found regarding the position of the screws on the anteroposterior radiograph. However, we found that a reduced spread of the screws on the lateral view was associated with an increased risk of nonunion of the fracture.

Adult↗

Modified fracture brace for tibial fracture with varus angulation: a case report.

Sarmiento introduced the functional fracture brace for the management of tibial shaft fracture in 1963. However, tibial angulation with varus deformity cannot be prevented or corrected by such a device. In this paper, a case of tibial shaft fracture with varus angulation treated with a modified below-knee fracture brace was reported.

Adult↗

Juvenile fracture of tillaux. A distal tibial epiphyseal fracture.

The juvenile fracture of Tillaux is a Salter-Harris type III fracture of the distal tibial epiphysis. The mechanism of injury is an external rotational force of the foot. The fracture fragment is avulsed from the anterolateral aspect of the distal tibial epiphysis by the anteroinferior tibiofibular ligament. Treatment is based on the amount of displacement after closed reduction techniques are attempted. If complete anatomical reduction cannot be obtained, the authors recommend open reduction with internal fixation. The method of internal fixation should be based on the skeletal maturity of the distal tibial epiphysis. The prognosis usually is good if anatomical reduction is performed. The most serious complication reported is pain and stiffness secondary to articular incongruity following inadequate closed reduction techniques. The case of a 14-year-old girl with a juvenile Tillaux fracture treated by open reduction with excellent functional results at 11 months follow-up was presented.

Adolescent↗

[Fractures of the radius neck associated with ulna fractures in children].

The author has described one of the typical combinations of injuries in the elbow joint area in children, i.e. fractures of the neck of the radius with a simultaneous fracture of the ulna. The study is based on 37 cases observed by the author. Two types of the above-mentioned fractures have been distinguished: abduction (32) and extension (5) fractures. The methods of closed reposition of each type have been presented. These methods allow to reach the desired results even in major dislocations (60-90 degrees) of the head of the radius.

Adolescent↗