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PubMed1993

Ulnar wrist pain after Colles' fracture. 109 fractures followed for 4 years.

109 patients with unilateral Colles' fracture, treated with closed reduction and cast immobilization, were re-examined after 4 (1-9) years. At follow-up, 40 patients had persistent ulnar wrist pain. The most important factor for predicting ulnar pain was final dorsal angulation of the radius. Initial and final radial shortening, fracture of the distal radioulnar joint, ulnar styloid fracture, or instability of the distal ulna were not correlated to ulnar wrist pain. We suggest that ulnar wrist pain following Colles' fracture is caused by incongruity of the distal radioulnar joint.

Adolescent↗

PubMed2006

Effect of enamel preparations on fracture resistance of composite resin buildup of fractures involving dentine in anterior bovine teeth: an in vitro study.

Sixty bovine teeth with simulated mesio-incisal angle fracture were randomly and equally divided in one untreated (control) group and three experimental groups (Bevel, Chamfer and newly introduced Stair-step Chamfer preparation group) to evaluate the effect of enamel preparations on the fracture resistance of composite resin. Post restoration, fracture mechanics approach was used to quantify the failure of composite resins in testing the samples in Instron testing machine. Mean peak failure load (Newton) of composite amongst experimental groups was observed in the order; Chamfer (326.09 +/- 72.73), Stair-step chamfer (315.21 +/- 81.77) and Bevel (253.83 +/- 67.38). Results of the One-Way ANOVA revealed significant difference in the mean peak failure load values of the four different groups. (P<0.001) Scheffe's Post-Hoc comparison test (Subset for alpha = 0.05) revealed that there was no significant difference in the mean peak failure load values of the bevel, stair-step chamfer and chamfer preparation when considered together, but the mean peak values of control group (605.22 +/- 48.96) were observed significantly higher. Failure mode evaluation revealed, majority of failures occurred as cohesive and mixed type for all the experimental groups. Adhesive type failure was observed maximum (33%) in the bevel group. Stair-step chamfer preparation showed greatest potential for application and use as it no only demonstrated comparable values to Chamfer preparation ['t' value (0.39) (P > 0.05)] but also involved sacrificing less amount of tooth structure adjacent to fractured edge.

Animals↗

PubMed2000

Crown fractures: effectiveness of current enamel-dentin adhesives in reattachment of fractured fragments.

OBJECTIVE: The introduction of the current enamel-dentin adhesives has simplified the reattachment of fractured dentinal fragments. The objective of this study was to determine the strength needed to detach coronal fragments reattached with the most recent adhesives. METHOD AND MATERIALS: A complete coronal fracture was caused on the incisal one third of 40 noncarious maxillary and mandibular lateral and central incisors. Each fractured coronal fragment was reattached to its tooth with the enamel-dentin adhesive Scotchbond MP, All-Bond 2, Dentastic, or One-Step (10 specimens each). RESULTS: There was no statistically significant difference between 2 similar fourth-generation adhesives that use orthophosphoric acid as etchant (Dentastic and All-Bond 2) and a fourth-generation adhesive that uses maleic acid as etchant (Scotchbond MP). The values obtained with the fifth-generation adhesive (One-Step) were significantly inferior to those obtained with the other 3 enamel-dentin adhesives. CONCLUSION: In the reattachment of fractured tooth fragments, fourth-generation adhesives can guarantee a bonding force stronger than fifth-generation adhesives.

Dental Bonding↗

PubMed1999

[Measurement of tibia bone content and fracture threshold by quantitative ultrasonography in normal and fractured women in Taiyuan].

OBJECTIVE: To establish the reference range of tibia bone content in normal female of Taiyuan area and to explore the diagnostic criterion for osteoporotic fracture threshold by quantitative ultrasonography (QUS). METHODS: The tibia bone contents (QUS value) of 1,681 normal women (aged 7-92 years) and 63 fractured women (aged 46-91) in Taiyuan were measured by QUS. RESULTS: The QUS value increased with age in normal women before age 30, and peaked at age 30-40, then decreased and reached significance after age 50. There was a negative correlation between QUS value and duration after menopause (P < 0.01). Taken the mean QUS value of normal female aged 20-40 years minus 2.5 s (3,667 m/s) as a cutoff threshold, 93.7% of the 63 fractured women had their QUS value below this threshold. CONCLUSION: It is suggested that the above cutoff QUS value may be considered as the risk threshold of osteoporotic fracture in women.

Adolescent↗

PubMedDate not supplied

Scalp closure without fracture elevation does not reduce the risk of infection in patients with compound depressed skull fractures.

We conducted this study in order to determine whether suturing the scalp wound prior to referral for definitive surgery reduces the rate of wound infection in patients with compound depressed skull fracture and to propose guidelines for the initial management of the wound. We conducted a retrospective analysis of 79 patients with compound depressed skull fractures treated surgically in our unit between January, 1987 and August, 1998 and compared the rate of infection in patients who presented with open wounds with the rate in patients whose scalps were sutured prior to presentation to us. Adults and children were nearly equally represented in this study group. The male to female ratio was 3.6:1. Majority (49/79) of the fractures resulted from vehicular accidents. A total of 27 wounds were infected giving a rate of infection of 34%. Nine of the infections were present pre-operatively while the remaining 18 occurred post-operatively. Of the 52 patients with open wounds (OW) at presentation, 15 had wound infection. In the remaining 27 patients in whom the scalp had been sutured prior to referral (SW), there were 12 wound infections. There was no significant difference in the proportions of infected wounds between the two groups (X2 = 1.92, P > 0.5). In compound depressed skull fractures, suturing the scalp laceration alone prior to referral for definitive surgery did not reduce the rate of infection of the cranial wound. We recommend haemostasis, thorough irrigation of the scalp wound and application of sterile dressings prior to transfer for definitive management, in patients who do not have immediate access to neurosurgical care. Prospective studies are required to validate these findings.

Accidents, Traffic↗

PubMed2002

[Atlas burst fracture (Jefferson fracture) requiring surgical treatment after conservative treatment--report of two cases].

Most cases of atlas burst fracture do not require surgical stabilization, because they can be successfully treated with external immobilization. The authors present two cases of atlas burst fracture in which surgical stabilization was required after external immobilization. The first patient was a 50-year-old male and the second patient was a 34-year-old male. Both presented with neck pain without neurological symptoms after a traffic accident. Neuroradiological examinations revealed atlas burst fracture in both patients. They were initially treated with conservative treatment; one with a rigid collar and the other with a halo vest. However, lateral offset of the atlas on the axis increased and atlanto-axial instability became evident three months later in both patients. They underwent upper cervical arthrodesis with satisfactory results. The authors review surgical indication and its timing in patients with atlas burst fracture.

Adult↗

PubMed2004

A fracture liaison service for patients with osteoporotic fractures.

A fracture liaison service, led by a specialist nurse, has been set up in one trust to offer an assessment for osteoporosis to all men and women over 50 with new fractures. The aim is to identify those who have osteoporosis because they are at greatest risk of further fractures. The service delivers strategies to reduce future fracture risk, targeted at those patients at highest risk.

Aged↗

PubMed2005

[An isolated sacral fracture and a fracture dislocation in two pediatric patients].

Isolated sacral fractures are very rare in children. Two children, aged eight and 12 years, presented with an isolated sacral type III fracture and a fracture dislocation, respectively, both of which were not associated with any neurologic problems. Without any attempts for reduction, the fractures healed completely with conservative treatment. These cases demonstrated a high remodeling potential in children for spontaneous healing.

Child↗

PubMedDate not supplied

[Odontoid process fractures associated with fractures of the pedicles of the axis (author's transl)].

The authors report their experience concerning eleven cases of that original and frequent association of fractures. The ligamentous lesions associated with those fractures are considered, justifying the necessary dynamic X rays. The eleven cases are reviewed and a classification supported by an iconography is given, according to the unstability of the odontoid or of the pedicles. The complications after orthopaedic or surgical treatment are analysed and the authors give their conclusions. The proposed treatment is conservative when the fractures are neither displaced nor unstable, and surgical when one of the two fractures is unstable. The best procedure is bi-pedicular screwing associated with C1/C2 wiring.

Aged↗

PubMed2005

Fracture pattern interpretation in the skull: differentiating blunt force from ballistics trauma using concentric fractures.

There have been several anthropological studies on trauma analysis in recent literature, but few studies have focused on the differences between the three mechanisms of trauma (sharp force trauma, blunt force trauma and ballistics trauma). The hypothesis of this study is that blunt force and ballistics fracture patterns in the skull can be differentiated using concentric fractures. Two-hundred and eleven injuries from skulls exhibiting concentric fractures were examined to determine if the mechanism of trauma could be determined by beveling direction. Fractures occurring in buttressed and non-buttressed regions were examined separately. Contingency tables and Pearson's Chi-Square were used to evaluate the relationship between the two variables (the mechanism of trauma and the direction of beveling), while Pearson's r correlation was used to determine the strength of the relationship. Contingency tables and Chi-square tests among the entire sample, the buttressed areas, and the non-buttressed areas led to the null hypothesis (no relationship) to be rejected. Pearson's r correlation indicated that the relationship between the variables studied is greater than chance allocation.

Biomechanical Phenomena↗

PubMed1991

[The Gamma Nail in per- and intertrochanteric femoral fractures--alternative or supplement to the dynamic hip screw? A prospective randomized study of 100 patients with per- and intertrochanteric femoral fractures in the surgical clinic of the City Hospital of Triemli, Zurich, September 1989 - June 1990].

In a prospective randomised trial between September 89 and June 90 one hundred patients with per- and subtrochanteric fractures were consecutively treated by Gamma-nail or DHS. The average age of both groups was about 80 years. The operation time for Gamma-nailing was longer than for DHS-implantation and also the postoperative blood loss was higher in the Gamma-nail-group. We found no difference of intraoperative blood loss, of perioperative letality and in duration of hospital care. 90% of Gamma-nail-patients and 80% of DHS-patients were successfully able to walk four days after operation with full weight bearing on the operated limb. Six patients (12%) with DHS had to be reoperated within 6 weeks. Three patients with unstable fractures got cranial perforation of the cephalic screw after mobilisation. The other three patients had soft tissue complications. Five patients (10%) of the Gamma-nail-group were reoperated, one case because of missed distal locking, one because of cranial perforation of the cephalic screw after varus dislocation of the proximal fragment. One patient suffered intraoperatively a proximal femur shaft fracture which was corrected during operation. In one case a wound hematoma was evacuated, an other patient needed secondary wound closure. Despite technical imperfection of implant and instruments, we conclude that the Gamma-nail allows a very high percentage early and full weight bearing immediately after operation. So we consider that in the treatment of unstable pertrochanteric fractures of geriatric patients, the Gamma-nail has proven to be more efficient than the DHS.

Adult↗

PubMed1991

[Three-dimensional measurement of fracture gap motion. Biomechanical study of experimental tibial fractures with anterior clasp fixator and ring fixator].

A computer-linked magnetic motion tracker was used to monitor the six components of elastic fracture motions in cadaver tibia with simulated mid-shaft oblique fractures or segmental defects. The limbs were mounted in a servo-hydraulic load frame and stabilized with an Ilizarov frame or an AO-Unifix external fixator. A cyclic load of 150 or 300 N was applied along the long axis of the tibia. Under 150 N load, elastic displacements ranged up to 1.7 mm and elastic rotations ranged up to 0.6 degrees. Under 300 N load, elastic displacements went up to 3.6 mm and elastic rotations ranged up to 1.5 degrees. Comparison of the two fixators showed that the Ilizarov permitted up to 1.75 times more axial pistoning and up to 4 times more A-P displacement. The AO-Unifix permitted up to 4 times more varus-valgus and up to 7 times more A-P angulation. The technique developed for measuring the three-dimensional motion of fractures may have wide applications in further biomechanical and fracture healing studies.

Biomechanical Phenomena↗

PubMed1990

[Posterior depression-separation fracture in bimalleolar fractures].

The authors analyse the anatomic character and the functional consequences of the posterior depression-separation in ankle fractures. The posterior depression fracture was present in 20 per cent of the ankle fractures of the studied series. The major depression was noticed 1 by 3. The lesion justified a specific operation. Its presence had also to be searched in rotation fractures treated conservatively, when the lateral malleolus was uncorrectly reduced. These two situations unnoticed or neglected create an incontinence of the talus leading to a triple desaxation, even if it does not appear on usual x-ray views. Tomographic sagittal x-ray views are on that score an important contribution to the diagnostic. Ankles showing such a residual defect deteriorated to an early articular narrowing during the first 6 months and to arthrosis during the first or second year.

Ankle Injuries↗

PubMed1989

Occult central acetabular fracture resulting in fracture-dislocation. A case report.

A 71-year-old white female experienced a nondisplaced right central acetabular fracture in a motor vehicle accident. Despite anteroposterior (AP) roentgenograms of the pelvis, Judet views, and plain tomograms, no fracture was detected. These negative findings did not entirely explain the continued presence of pain. The patient was treated with physical therapy and encouraged to bear weight on the leg as tolerated. The fracture then progressed to a central fracture dislocation readily apparent on AP views of the pelvis. This case illustrates the need for further diagnostic studies (bone scanning, computed tomography, and magnetic resonance imaging) when, despite negative objective findings, a high degree of suspicion persists.

Acetabulum↗

PubMed1988

Scintigraphical observation to predict fracture healing in intracapsular fracture of the femoral neck.

Predictive clinical value of scintigraphical classification of the femoral head in intracapsular fracture of the femoral neck, as classified by Hirano, et al. in 1987, was investigated by long-term follow-up (mean; 4 years and 7 months). Normal healing was achieved in 21 of 24 patients. In those cases, early 99mTc-MDP scintigraphy revealed an over-all increase of radionuclide uptake (Type A) and band-like decrease along the fracture (Type B1). Late segmental collapse of the femoral head was found in 3 patients who showed either a decrease in the weight-bearing area (Type B2) or over-all decrease of radionuclide uptake (Type C). The results of fracture healing were well correlated to each type of scintigraphical classification. The changes of radionuclide uptake in the fracture site were also followed by serial 99mTc-MDP scintigraphy.

Adult↗

PubMed1985

[Stress fractures of the navicular bone. Roentgen diagnosis of a rare fracture].

Stress fracture of the tarsal navicular are rare and their diagnosis is often delayed. 1982 and 1983 we found stress fractures of the os naviculare pedis in 16 patients, 8 fractures were complete and 10 incomplete. Three types of radiographic findings are sclerosis, radiolucency and radiolucency with sclerotic borders. The fractures were localized in the middle third of the tarsal navicular. Laminography is necessary to evaluate the radiographic changes and their extension.

Adolescent↗

PubMed1984

[Changes in the orientation of the fracture plane of cell membranes during freeze-fracturing as an index of change in membrane structure].

Using freeze-fracture method it is shown that the direction of the fracture plane is a sensitive indicator of the membrane structural organization. A decrease in the proportion of longitudinal fractures is noted upon the membrane rearrangement presumably associated with changes in the lipid phase, and, on the contrary, an increase in the proportion of these fractures is observed upon some actions resulting, presumably, in changes of the protein phase of membranes.

Candida↗

PubMed1995

Supracondylar femoral fractures in the frail elderly. Fractures in need of treatment.

The investigators of this study reviewed 112 consecutive frail elderly patients with supracondylar femoral fractures to evaluate primarily functional outcomes to optimize initial treatment of these challenging patients. A high 1-year mortality rate (22%) and significant decrease in function and quality of life occurred in frail elderly patients who sustained supracondylar femoral fractures. No statistical relationship could be found among preinjury function, age, cognitive function, type of fracture, treatment, and overall results. Nine percent of patients required late above-knee amputation in the involved extremity because of displacement of the fracture or infection or both. Optimal treatment for this type of patient remains elusive. Primary above-knee amputation may be the preferred treatment in patients who are this severely affected.

Aged↗