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[Occipital condyle fracture associated with Jefferson's fracture and injury of lower cranial nerves: case report].

Occipital condyle fracture(OCF) is rarely seen and can be missed during medical evaluation due to the variety of clinical presentations and the difficulty to be visualized radiographically. This fracture can be associated with cranial nerves injuries (31%), being the hipoglossal nerve the most frequently involved (67%). We report a 58 years old female patient who presented with OCF, injury of lower cranial nerves and Jefferson's fracture. The patient was treated with cervical traction for six weeks followed by halo immobilization for three months. There was bone consolidation recovery of the nervous injury after this period. This report emphazises the importance of investigating the skull-cervical transition in all patients with cervical trauma. Although Jefferson's fracture is rarely associated with OCF, it should be remembered and treated appropriately when diagnosed.

Cervical Vertebrae↗

Fractures and lifestyle: effect of cigarette smoking, alcohol intake, and relative weight on the risk of hip and forearm fractures in middle-aged women.

Cigarette smoking, alcohol consumption and low relative weight are often cited as risk factors for osteoporosis. In a prospective cohort study of 96,508 middle-aged nurses 35 to 59 years of age we found that smoking was not a risk factor for hip and forearm fracture. Women who drank more than 15 grams of alcohol per day and whose relative weight was less than 21 kg/m2 were at increased risk of fractures, but these risk factors were not independent. Only the combination of alcohol intake and thinness substantially increased the likelihood of fracture. The low weight women consuming more than one drink per day comprised but 4 per cent of our population of middle-class women and sustained 6 per cent of the fractures.

Adult↗

Effect of acute inpatient rehabilitation on outcome after fracture of the femoral neck or intertrochanteric fracture.

A study was performed to assess the impact of intensive inpatient rehabilitation on the outcome after a fracture of the femoral neck or an intertrochanteric fracture. Before 1990, our hospital did not have an inpatient rehabilitation program. On January 1, 1990, a diagnosis-related-group-exempt (DRG-exempt) acute rehabilitation program was initiated. Patients were discharged to this program after evaluation by a staff physiatrist. Before 1990, twenty-seven (9.0 per cent) of 301 patients were discharged to an outside rehabilitation facility. After January 1990, the percentage of patients who were discharged to the DRG-exempt program increased yearly, from nineteen (17 per cent) of 113 patients in 1990 to forty-one (64 per cent) of sixty-four patients in 1993; this difference was significant (p < 0.01). Before 1990, the average duration of the stay in the hospital was 21.9 days. After January 1990, the average duration for the patients who did not enter the rehabilitation program was 20.0 days whereas the average duration for those who did was 31.4 days (16.1 days for acute care and 15.6 days for the rehabilitation program). There were no differences in the hospital discharge status or in the walking ability, place of residence, need for home assistance, or independence in basic and instrumental activities of daily living at the six and twelve-month follow-up examinations between patients who had been managed before initiation of the rehabilitation program and those managed after it or between patients who had been discharged to this program after its initiation and those who had not. These results raise serious questions regarding the global cost-effectiveness of these programs for patients who have had a fracture of the femoral neck or an intertrochanteric fracture.

Aged↗

Supracondylar fractures of the humerus in children. A follow-up with particular reference to late results after severely displaced fractures.

A follow-up of 73 cases out of a 10-year material of 90 children with supracondylar fractures of the humerus is described. Forty-three children had fractures with gross displacement, whereas 30 children had undisplaced or slightly displaced fractures. This last group all achieved excellent results after simple conservative treatment. Twenty-three cases among the group with severe displacement were treated with vertical extension, 17 cases with one or more attempts at manipulative reduction and plaster fixation, and three with operation using Kirschner wires. The functional results were approximately the same in the first two groups and were satisfactory in 85-100%. The results with varus derformity were better in the group treated by extension (82% as opposed to 50% in the group treated by manual reposition). We conclude that extension in a vertical direction is the most suitable method of treatment of these often severely displaced fractures.

Adolescent↗

Hook of the hamate fractures in competitive golfers: results of treatment by excision of the fractured hook of the hamate.

Seven competitive golfers presented with isolated fractures of the hook of the hamate. All patients were treated with excision of the fractured hook of the hamate, with complete resolution of pain. All patients returned to their previous level of play. It is reasonable to deduce, with this group of patients, that this fracture pattern represents an overuse or repetitive motion injury. Regardless of etiology, prompt diagnosis and treatment of this injury with excision of the fractured hook of the hamate bone allows competitive golfers to return to their previous level of competition.

Adult↗

[Reconstruction of hip joint function: old fracture-dislocation of hip joint complicated with deformed healing of upper 1/3 of fractured femur--a case report].

OBJECTIVE: To explore a method of reconstruction of hip joint function after deformed healing of the upper 1/3 of fractured femur as a complication of old fracture dislocation of hip joint. METHODS: A patient with loss of function in hip joint and fusion of knee joint was treated with lock for femur intra-medullary fixation in April 1997. RESULTS: Before operation, the diseased hip joint lost its most functions and the entire lower extremity was disabled because the knee joint had been fused. One year after operation, the follow-up examination revealed that the patient could walk by crutches without discomfort, his daily life and work recovered to normal. CONCLUSION: It is effective to treat a patient suffering old fracture-dislocation of hip joint complicated with deformed healing of the upper 1/3 of fractured femur by means of individualized artificial joint replacement and a prosthesis body with lock for femur intra-medullary fixation, and it is helpful for the development of a new clinical idea to reconstruct functions in the management of some particular cases.

Accidents, Traffic↗

[External torsion fractures of the tibia combined with ankle joint fractures].

The aim of this retrospective study is to emphasize on combined fractures of the tibia with lesions of the ankle joint. The report bases on 820 fractures of the lower leg. 123 cases showed external rotation fractures of the tibia, which were combined with lesions of the ankle joint in 88 cases. 25 patients were operated on the ankle joint. Because of the combination of external rotation fractures with lesions of the ankle joint, which accounted to 65% of the posterior tibial margin, to 17% of the lateral malleolus and to 3% of the syndesmosis, it is important to investigate the ankle joint radiologically and clinically.

Ankle Injuries↗

[Elbow dislocation with fracture of the coronoid process and comminuted fracture of the radius head].

In fractures of the elbow with an associated fracture of the coronoid process, the size of the coronoid fragment determines the stability of the joint. A diminution of the arch of the incisura semilunaris by about 30 degrees causes instability of the elbow. We present an alternative way of treating the special case of a fracture of the coronoid process combined with comminuted fracture of the proximal end of the radius. A suitable fragment of the head of the radius is used to reconstruct the coronoid process. The stability achieved allows early functional postoperative treatment with a good range of movement at the elbow joint.

Aged↗

[Treatment of fractures of zygomatic bone and zygomatic arch. A method for the reduction of fracture by the use of U-shaped elevator].

The occurrence of maxillofacial bone fractures has gradually increased. These were two-hundred-fifty-nine cases of maxillofacial bone fractures from 1981 to 1988, in which fourteen cases were fractures of zygomatic bone and zygomatic arch. (The number of the fractures of zygomatic bone, zygomatic arch, zygomatic bone and arch, and zygomatic bone and mandibular bone were 5, 2, 4, and 3 cases, respectively). Pathognomonic symptoms were infra-orbital neuroparalysis, tristmus and recess of the buccal region. The incisional for open reduction were applied for the lateral brow, the lower eyelid, or intra-oral approach. U-shaped elevator was used for the reduction and miniplate and stainless wire were used for fixation.

Bone Plates↗

[Significance of the fracture type for treatment of femoral neck fractures].

The authors report on the results obtained with surgical treatment of 470 femoral neck fractures, which they analyzed with reference to the type of break. The found that a fracture line with a zig-zag course signified the best prognosis for both healing and stability, whereas fractures with a posterior fragment had a poorer prognosis. The results support the urgency of the operation and confirm the higher proportion of cases treated for jagged fractures among those with good results.

Aged↗

Treatment of severely comminuted diaphyseal fractures in the dog, using standard bone plates and autogenous cancellous bone graft to span fracture gaps: 11 cases (1979-1983).

Severely comminuted diaphyseal fractures in 11 dogs were repaired with standard bone plates that spanned a fracture gap filled with autogenous cancellous bone graft. Five dogs had closed injuries, 4 dogs had open fractures, and 2 dogs had infected nonunion fractures for which previous attempts at internal pin fixation had failed. A second autogenous cancellous bone graft was performed in 3 of the dogs during the healing period. The technique was successful in all dogs. The technique was considered a versatile and relatively simple alternative, compared with meticulous small fragment reconstruction and cortical bone allografts.

Animals↗

[A biomechanical study on the fracture treatment--intravital measurement of the strain on an intramedullary nail in the healing process of the femoral fracture in goats (author's transl)].

UNLABELLED: There have been many biomechanical studies throughout the world on the fracture treatment. However, only a few were performed under intravital condition. The purpose of the present study is to measure the successive strength changes of the callus after a fracture, in vivo in an animal. METHOD: Specifically designed Küntscher nails were made to meet the anterior convexity and the size of the medullary canal of the femora of goats. Three self-temperature-compensating semi-conductor strain-gauges were glued on the inner surface of the nail and coated with epoxy-resin and silicone rubber. The nail was inserted into the intact femur, and the initial measurement of the strains was performed using a specially designed wooden three point bending jig. Then the femur was transected at the middle. Periodical measurements of the strains were done, first, during walking and, then, with the three point bending jig under general anesthesia. Ten goats were used for the experiments. The measurement was undertaken every two to three weeks. Serial x-rays were taken. The femur was studied histopathologically after the death of the animal. RESULTS: 1. Although the nail with the strain-gauges presented some foreign body reaction and certain difficulties in sterilization, it was well tolerated by the animal, permitting the strain measurement for as long as 18 weeks after the fracture. 2. There was a tendency that the less loosening is found between the nail and the bone, the larger is the strain and the smaller becomes the dispersion of the strains. 3. On the three point bending test, the post-fracture strain changes were not directly proportional to the lapse of time. In the early phase, the strains remained large for about four weeks and tended to rapidly decrease in the middle and late phases in accordance with the development of callus formation on x-ray. 4. A similar strain change was observed on the walking test, although the animal presented with some painful limp. The results suggest that early excessive exercise to be avoided when an intramedullary fixation is not sufficiently rigid.

Animals↗

[Olecranon fractures. A retrospective examination of surgically treated fractures (author's transl)].

Retrospective examination of 27 patients with olecranon fractures who had undergone surgical treatment showed that--in agreement with theoretical considerations--osteosynthesis via tension wiring, although suitable for proximal fractures, is unsuitable for fractures of a more distal nature. A different method must be employed for distal fractures. Additional plaster immobilisation does not exercise any influence on consolidation, nor does it affect functional rehabilitation.

Casts, Surgical↗

[Retention in flexion of supracondylar fracture of the humerus in children. Comments apropos of the treatment of 120 displaced fractures].

The authors analyse the results obtained in 120 cases of supracondylar fracture of the humerus in children by reduction under general anaesthesia followed by fixation of the elbow in flexion, the wrist being placed close to the neck. The biomechanical basis of this technique is reviewed. It is essential that the posterior periosteum should be intact. Technical details are given together with indications. Seventy out of 120 fractures were reviewed after 2 years. There were 82 p. 100 of good results in grade II fractures. Six out of 24 grade IV fractures showed secondary displacement.

Biomechanical Phenomena↗

[Fracture healing after intramedullary nailing of simple tibial shaft fractures. A clinical comparison of reamed and unreamed procedures].

From January 1990 to June 1993, 56 patients with simple tibial shaft fractures were treated in the Surgical Department of the University/Municipal Hospital in Munich by primary intramedullary nailing, and 44 of these patients were followed up. The results in 17 who underwent unreamed intramedullary nailing (UTN) were compared with those in 27 in whom reamed procedures (RTN) were applied. There was no difference between the two groups in age, fracture type and localization. Soft tissue trauma prevailed, with 35% I degrees open fractures in the UTN group (RTN group, 3%). UTN patients were operated on an average of 45 h after trauma, and RTN patients, 5 days after trauma. Both groups showed about the same proportion of good and very good results (criteria of Johner and Wruhs), with 83% in the UTN group and 84% in the RTN group. The rate of complications was the same in both groups (11%), and we did not find any kind of infection. Two complications requiring revisions (nonunion, perforation of the nail) after UTN stress the importance of two-dimensional barring in the main fragments (especially when close to the metaphysis) and of reduced weight-bearing for 6 weeks after the operation. The slightly greater intramedullar instability after UTN did not cause a higher rate of nonunions or of fracture healing in a wrong position than RTN. The X-ray findings showed beginning osseous reunion after 13 weeks in the UTN group. This corresponds to earlier painless full weight-bearing after an average of 9.7 weeks, as against 12 weeks in the RTN group.

Adolescent↗

[Burst fracture: osteoporotic vertebral compression fracture associated with paraplegia].

It is rare that vertebral compression fracture of senile osteoporosis causes paraplegia. This article reviews 164 cases reported in Japan since 1974. These fractures were characterized as follows: 1) paraplegia occurred in elderly females (average 69.3 years old) with severe osteoporosis, 2) traumatic histories were revealed in 52%, 3) 91% of the fractures were classified into burst type, 4) location was in the thoracolumber region (80.5%), 5) average onset of paraplegia was 5.7 months after fracture. One hundred and twenty nine cases were surgically treated either by anterior vertebral fusion or by posterior instrumentation and 35 cases were conservatively treated. Surgical cases showed better recovery of walking ability than conservative cases.

Aged↗

Subcapital fracture complicating fixation of an intertrochanteric fracture from osteomyelitis.

Subcapital fractures after open reduction and internal fixation of intertrochanteric hip fractures have not previously been attributed to osteomyelitis. We report a unique case of a 63-year-old man with isolated subclinical osteomyelitis of the femoral neck causing ischemic necrosis and subcapital fracture after sliding screw plate fixation of an ipsilateral intertrochanteric fracture.

Anti-Bacterial Agents↗

[Fracture dislocation of the ankle with retro-tibial luxation of the fibula (Bosworth fracture) . Apropos of a case].

The authors present a case of fracture dislocation of the ankle joint with the proximal part of the fibula entrapped behind the tibia ; Bosworth's fracture. This fracture was described for the first time in 1848 by Hugier, and classified by Bosworth in 1947. In our case, diagnosis was not done in a first time, and closed reduction failed. This fracture was operated on and open reduction was performed. At the present time, the functional result is good.

Ankle Injuries↗