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PubMed1976

Correlated x-ray diffraction and freeze-fracture studies on membrane model systems. Perturbations induced by freeze-fracture preparative procedures.

Lipid-water and protein-lipid-water phases have been examined by X-ray methods before and after freezing. Frozen samples have been subsequently fractured and replicated, thus permitting an evaluation of the nature of structural perturbations in samples examined by freeze-fracture electron microscopy. Important results are summarized: (1) Freezing low water content (approx. less than 25%) phases causes perturbations in the packing of hydrocarbon chains. The results suggest that freezing liquied paraffin chains produces a condensed "glass-like" packing. (2) Additional perturbations occur in high water content samples. After freezing, much smaller lamellar repeat distances, intense ice reflections, and extensive perturbation of fracture faces are consistant with the expulsion of water from between lamellae. Presence of glycerol generally relieves these perturbations but in some cases introduces additional lattice disorder. (3) Surprisingly, cooling by a stream of cold N2 gas (-140 degrees C) produces qualitatively the same results as rapid cooling in liquid Freon-22 (-160 degrees C). (4) Complex perturbations occur in phases containing integral membrane proteins. Interesting results have been obtained with cytochrome b5-lecithin lamellar associations which display both smooth and rough fracture faces without clearly defined particles.

Binding Sites↗
PubMed1992

Salmon calcitonin reduces vertebral fracture rate in postmenopausal crush fracture syndrome.

The effectiveness of calcitonin on the vertebral fracture rate in postmenopausal osteoporosis was assessed through the skeletal deformity index (SDI) and the new vertebral fracture rate per 100 patient-years in a group of 32 women with postmenopausal osteoporosis treated by us with 100 IU of salmon calcitonin and 500 mg of elemental calcium for 10 consecutive days each month, and in another group of 28 women with postmenopausal osteoporosis treated with 500 mg of elemental calcium only for 10 consecutive days each month. Both groups were age-matched. The follow-up was a retrospective randomized study over 24 months. Thirty of the 32 women of the calcitonin group and 27 of 28 women of the calcium group finished treatment. The SDI was stabilized after six months in the calcitonin group (0.57 +/- 0.13, 0.62 +/- 0.18, 0.63 +/- 0.16 and 0.64 +/- 0.17, at base line, 6, 12 and 24 months respectively). The calcium group showed a significant increase only at 12 months (P less than 0.01) and 24 months (P less than 0.05) (0.61 +/- 0.16, 0.63 +/- 0.16, 0.69 +/- 0.16, and 0.73 +/- 0.15, at base line, 6, 12 and 24 months respectively). At 24 months, the new vertebral fracture rate decreased by 60% (20%, 14% and 8% at 6, 12 and 24 months respectively) in the calcitonin group and increased by 35% (31%, 33% and 42%, at 6, 12 and 24 months respectively) in the calcium group (P less than 0.025). These results show that calcitonin induced a significant reduction in postmenopausal osteoporotic vertebral fractures.

Aged↗
PubMed2006

Fat embolism: special situations bilateral femoral fractures and pathologic femoral fractures.

Few data are available in the literature regarding fat embolism in cases of bilateral femoral and pathological femoral fractures. The incidence of bilateral femoral fractures ranges from 2-9.5% of the total number of patients with femoral fractures, and they usually occur in high energy trauma and multi-trauma patients. Although injury severity scores tend to underestimate the severity of these injuries, fat embolism seems to occur in increased frequency ranging from 4.8-7.5%. Intramedullary nailing, which is the preferred surgical treatment, triggers a systemic inflammatory response that poses an additional burden to pulmonary function. In addition, the femur is a common site of metastatic bone disease. The treatment of impending and actual pathological fractures is complicated by increased rates of lung damage due to various factors. Fat embolism during treatment--mainly with intramedullary nails--generally seems to range from 0-10%.

Embolism, Fat↗
PubMed2006

A clinically applicable fracture classification for distal humeral fractures.

The purpose of this study was to design a clinically applicable classification for distal humeral fractures that would provide guidance to the surgeon with regard to surgical approach and operative management. The new classification was assessed by use of the original radiographs from a study comparing distal humeral fracture classifications undertaken in Oxford, England, and was validated by use of the exact methodology of that study. Nine independent assessors were asked to classify 33 sets of radiographs on 2 separate occasions using the classifications of Riseborough and Radin, Mehne and Jupiter, and the AO, as well as the new classification system. With the use of the kappa statistic, the level of interobserver and intraobserver agreement was determined. The new classification system was found to be both substantially reliable (kappa, 0.664) and reproducible (kappa, 0.732). The new classification achieved superior interobserver and intraobserver agreement compared with the other 3 classification systems, with a low proportion of unclassifiable fractures. Used in conjunction with a management algorithm, we believe that the new classification aids the surgical decision-making process for these complex fractures.

Adult↗
PubMed2004

Could this unusual scaphoid fracture occurring in a badminton player be a stress fracture?

An unusual fracture of the scaphoid occurred in an otherwise healthy young badminton player, caused by a violent movement of extension/flexion of the wrist while performing a smash. There was no direct blow or fall on the wrist, nor history of wrist pain prior to the fracture. No underlying pathology was identified. Conservative treatment failed and surgical stabilization was required to achieve bone union. The diagnosis of stress fracture was suggested. The characteristics of these uncommon fractures are reviewed.

Adult↗
PubMedDate not supplied

Pisiform and hamulus fractures: easily missed wrist fractures diagnosed on a reverse oblique radiograph.

We present a review of the current literature involving fractures of the pisiform and hook of the hamate. This is highlighted by two cases in which the fracture lines are seen only on the reverse oblique wrist radiograph, a view obtained with the wrist in a supinated rather than a pronated position. These fractures are not seen on standard two or three view wrist examination. Both of these fractures were initially missed in the emergency department. Serious sequelae can result from both of these injuries and can be avoided if diagnosed acutely. The reverse oblique radiograph can be quick, cost-effective, and diagnostic in this setting. If properly treated by immobilization or excision, the results can be excellent.

Adult↗
PubMed2005

An osteoporosis and fracture intervention program increases the diagnosis and treatment for osteoporosis for patients with minimal trauma fractures.

BACKGROUND: As fewer than 25% of patients with an osteoporotic minimal trauma fracture (MTF) are evaluated and treated for osteoporosis, an osteoporosis and fracture intervention program (OFIP) was developed. METHODS: Patients hospitalized with MTF were educated about and treated for osteoporosis and were evaluated by the osteoporosis team at 6 and 12 months after discharge. Patients seen in the emergency department were given information about osteoporosis and encouraged to seek medical care at the osteoporosis office. RESULTS: While 165 patients hospitalized with an MTF participated in the OFIP, 38 patients received routine osteoporosis education. At the 6-month follow-up, in the OFIP group, 68% of patients with hip fracture and 54% of patients with non-hip fracture were taking antiresorptive medications. There was no change in treatment rate among patients receiving conventional care. CONCLUSIONS: The rates of diagnosis of osteoporosis and treatment implementation following an MTF increased when the intervention occurred at the time of hospitalization.

Academic Medical Centers↗
PubMed1983

[Dislocated supracondylar femoral fractures, slipped epiphyses and epiphyseal fractures in children].

Dislocated supracondylar femoral fractures are usually transverse fractures and are unstable. In our opinion the primary treatment of these fractures should be surgical in order to save the patient a protracted healing period. Osteosynthesis using a straight plate is impossible, as the distal fragment is too short. Condylar plates are contraindicated and angular plates have too little stability. We feel that intramedullary pins are unsuitable in children. They provide too little stability when the distal fragment is short. Up to now we have achieved the best results with external fixation. Slipped epiphyses and epiphyseal fractures do not present problems as far as the surgical procedure is concerned (removal of the displaced periosteum, repositioning and compression). Healing is not delayed. The long-term results are poor, however, due to premature closure of the damaged epiphyseal plate.

Adolescent↗
PubMed2001

A high ratio of dietary animal to vegetable protein increases the rate of bone loss and the risk of fracture in postmenopausal women. Study of Osteoporotic Fractures Research Group.

BACKGROUND: Different sources of dietary protein may have different effects on bone metabolism. Animal foods provide predominantly acid precursors, whereas protein in vegetable foods is accompanied by base precursors not found in animal foods. Imbalance between dietary acid and base precursors leads to a chronic net dietary acid load that may have adverse consequences on bone. OBJECTIVE: We wanted to test the hypothesis that a high dietary ratio of animal to vegetable foods, quantified by protein content, increases bone loss and the risk of fracture. DESIGN: This was a prospective cohort study with a mean (+/-SD) of 7.0+/-1.5 y of follow-up of 1035 community-dwelling white women aged >65 y. Protein intake was measured by using a food-frequency questionnaire and bone mineral density was measured by dual-energy X-ray absorptiometry. RESULTS: Bone mineral density was not significantly associated with the ratio of animal to vegetable protein intake. Women with a high ratio had a higher rate of bone loss at the femoral neck than did those with a low ratio (P = 0.02) and a greater risk of hip fracture (relative risk = 3.7, P = 0.04). These associations were unaffected by adjustment for age, weight, estrogen use, tobacco use, exercise, total calcium intake, and total protein intake. CONCLUSIONS: Elderly women with a high dietary ratio of animal to vegetable protein intake have more rapid femoral neck bone loss and a greater risk of hip fracture than do those with a low ratio. This suggests that an increase in vegetable protein intake and a decrease in animal protein intake may decrease bone loss and the risk of hip fracture. This possibility should be confirmed in other prospective studies and tested in a randomized trial.

Absorptiometry, Photon↗
PubMed1996

Freeze-fracture enzyme cytochemistry: application of enzyme cytochemistry to freeze-fracture cytochemistry.

We present a novel freeze-fracture cytochemistry method based upon enzyme cytochemistry. By this method, freeze-fractured membranes are labeled with cerium as an enzyme cytochemical marker on replicas. The cerium capture method was suitable for freeze-fracture enzyme cytochemistry because the cerium phosphate reaction product is stable after replica-cleaning. As a model system, acid phosphatase, which is a well-known lysosomal marker, was detected on freeze-fractured membranes of lysosomes in the proximal tubular epithelium of the rat kidney. This technique should be a useful addition for analyzing the ultrastructure of biological membranes.

Acid Phosphatase↗
PubMed1975

Fractures of the scapula: a review of 53 fractures.

A series of 53 fractures of the scapula has been reviewed. Almost three fourths of our patients were injuried in automobile or motorcycle accidents in which severe force was applied to the shoulder region. There is rarely a problem in diagnosis, but one may need to take special roentgenographic views to delineate the extent of the fracture clearly. A geographic classification of these fractures was used, and it was found that 66% occur in the region of the scapular neck. It was emphasized that 81% of these patients had other associated injuries, many of which were life threatening. Symptomatic immobilization of the scapular fracture seems to be adequate for the vast majority, if not all, patients.

Adolescent↗
PubMed2005

Analysis of the crown fractures and crown-root fractures due to dental trauma assisted by the Integrated Clinic from 1992 to 2002.

The purpose of this study was to analyze crown fractures and crown-root fractures due to dentoalveolar trauma, treated in the Integrated Clinic comprehensive dental care at Aracatuba School of Dentistry (UNESP), from January 1992 to July 2002. The data were obtained from files of trauma cases. On the analysis period, 293 patients had crown fractures or crown-root fractures, in 605 teeth. Sixty-nine percent were males and 31% were females. Adolescents between 11 and 18 years old were the most prevalent group (41.6%) and the maxillary arch was the most commonly traumatized (83%). The most commonly affected tooth was the maxillary central incisor (58.3%). The most frequent causes were falls from bicycles (30.8%). It was concluded that the reality of the local service is similar to the published data.

Accidental Falls↗
PubMed2007

Multidisciplinary treatment approach for crown fracture and crown-root fracture - a case report.

The increased incidence of traumatic injuries to anterior teeth is a consequence of leisure activities, where the most common injuries are crown fractures. Treatment of the dental trauma is complex and requires a comprehensive and accurate diagnostic and treatment plan. It is also important to consider the biological, functional, esthetic and economic aspects, as well as the patient's desire. The purpose of this article is to report a case that shows the multidisciplinary approach required to successfully manage the rehabilitation of a maxillary central incisor with a complex crown fracture and a maxillary lateral incisor, that at first presented an oblique crown-root fracture, and after the orthodontic extrusion, suffered a more apical new crown-root fracture.

Adult↗
PubMed1982

Fracture of the first and second rib: incidence of vascular injury relative to type of fracture.

Fractures of the first or second rib may be associated with underlying arterial injury in patients with blunt chest trauma. A total of 58 patients with fracture of the first of second rib was investigated; all patients subsequently underwent arteriography. The type of rib fracture (posterior, lateral), or anterior) was not found to be a useful predictor of underlying vascular injury. Also, the degree of displacement of the fracture fragments was of no value in predicting arterial injury.

Angiography↗
PubMed2003

In vivo measurement of apparent trabecular bone structure of the radius in women with low bone density discriminates patients with recent wrist fracture from those without fracture.

The purpose of this cross-sectional case-control study was to determine whether indices of bone structure at the 4% site of the radius discriminate women who have sustained a recent low-energy fracture of the contralateral distal radius (n = 21) from women with similar bone density and no history of fracture (n = 21). Images of the distal forearm were acquired using peripheral quantitative computed tomography (pQCT) and were analyzed using in-house-developed software to determine indices of trabecular bone structure (average hole size [H(A)], maximum hole size, and connectivity index). The same images were analyzed using commercial software to determine bone density, mass, geometry, and torsional strength. The fracture group had significantly larger H(A) (p = 0.03). No other bone variable differed between groups. Individual H(A) values were compared to the mean value for young adult women (n = 42). The odds ratio (95% confidence interval) associated with an H(A) >2 SDs above the young adult mean was 5.4 (1.2-24.3). Thus, estimation of in vivo trabecular bone porosity by measuring the average diameter of the pQCT-imaged marrow spaces in the ultradistal radius identifies individuals with low bone mass most at risk for osteoporotic fracture.

Bone Density↗
PubMed2005

How old is this fracture? Radiologic dating of fractures in children: a systematic review.

OBJECTIVE: We conducted a systematic review of the literature to define the evidence for radiologic dating of fractures in children in the context of child protection. CONCLUSION: Radiologic dating of fractures is an inexact science. Most radiologists date fractures on the basis of their personal clinical experience, and the literature provides little consistent data to act as a resource. There is an urgent need for research to validate the criteria used in the radiologic dating of fractures in children younger than 5 years.

Child↗
PubMed1985

Rotary-shadowed freeze-fracture replicas: a simple method for the analysis of fracture faces.

In rotary-shadowed freeze-fracture replicas, intramembrane particles on the periphery of a membrane fracture face are not uniformly shadowed from all sides. Those eccentrically positioned intramembrane particles with a net centripetally directed shadowing are on a convex fracture face. In contrast, those eccentrically positioned intramembrane particles with a net centrifugally directed shadowing are on a concave fracture face. Centrally positioned intramembrane particles on convex faces are uniformly shadowed from all sides; however, central depressions of concave faces are often unshadowed.

Animals↗