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PubMed1996

[Risk and prognosis of hip para-articular fractures. A comparison of treatment results of femoral neck and pertrochanteric femoral fractures].

Fractures of the femoral neck and the intertrochanteric region account for 7.2% of our surgically treated trauma-patients. Thanks to gentle anaesthetic methods, pre- and postoperative intensive care, and using dynamic hip screws for stabilizing intertrochanteric fractures or total hip replacement in hybrid technique for fractures of the femoral neck, hospital mortality has decreased to 4.8%. A rate of 8.5% local complications, 5% of them needing revisional surgery, did not influence the final outcome. However, success of rehabilitation of the elderly patients is limited by pre-existing multimorbidity. Despite of achieved weight bearing strength of reconstruction, the number of people confined to bed increases from preoperative 4.9% to postoperative 11.5% at the end of 4 weeks hospitalization and up to 22.6% after 1 year. The need for permanent help in daily life activities, provided by the family or nursing homes increases from 50% to 80% after hospital discharge, usually with an increasing need for care. In the future--besides more and better organized out-patient physiotherapy--only more possibilities to look after the patients in their own families or the supply with an increasing number of places in nursing homes will give a chance, to provide a maximum of rehabilitation for these patients.

Activities of Daily Living↗
PubMed1998

[Occult fracture of the femoral neck fractures of the proximal femur].

Bone scintigraphy is a highly sensitive method for the detection of fractures. In case a trauma and clear clinical signs are evident, but the radiography is inconspicuous, bone scintigraphy may lead to the final diagnosis. In the present case of an occult fracture in the proximal femur only scintigraphy indicated the fracture, which then was proved topographically by magnetic resonance imaging.

Aged↗
PubMed2006

Applied tracer tests in fractured rock: Can we predict natural gradient solute transport more accurately than fracture and matrix parameters?

Applied tracer tests provide a means to estimate aquifer parameters in fractured rock. The traditional approach to analysing these tests has been using a single fracture model to find the parameter values that generate the best fit to the measured breakthrough curve. In many cases, the ultimate aim is to predict solute transport under the natural gradient. Usually, no confidence limits are placed on parameter values and the impact of parameter errors on predictions of solute transport is not discussed. The assumption inherent in this approach is that the parameters determined under forced conditions will enable prediction of solute transport under the natural gradient. This paper considers the parameter and prediction uncertainty that might arise from analysis of breakthrough curves obtained from forced gradient applied tracer tests. By adding noise to an exact solution for transport in a single fracture in a porous matrix we create multiple realisations of an initial breakthrough curve. A least squares fitting routine is used to obtain a fit to each realisation, yielding a range of parameter values rather than a single set of absolute values. The suite of parameters is then used to make predictions of solute transport under lower hydraulic gradients and the uncertainty of estimated parameters and subsequent predictions of solute transport is compared. The results of this study show that predictions of breakthrough curve characteristics (first inflection point time, peak arrival time and peak concentration) for groundwater flow speeds with orders of magnitude smaller than that at which a test is conducted can sometimes be determined even more accurately than the fracture and matrix parameters.

Geological Phenomena↗
PubMed1970

An interpretation of liver cell membrane and junction structure based on observation of freeze-fracture replicas of both sides of the fracture.

A modification of the freeze-fracturing technique to permit observation of replicas of both sides of the fracture is described. It has been used to study mouse liver cell membrane structure. Membranes break to give two faces with three-dimensional complementarity, although there is some small-scale mismatching which is discussed. Since the two distinctive sets of membrane faces are complementary sets, they cannot be the two outside surfaces. In particular, structures (such as particles) seen on these faces are within the membrane. It is not possible from this work to say precisely where the fracture plane goes with respect to a plasma membrane, only that it must be close to the interface between membrane and cytoplasm, or at that interface. Models, consistent with the appearance of the matching replicas, are derived for three regions of the plasma membrane: (a) The nonjunctional plasma membrane, which contains many scattered particles. Except for these particles, the otherwise flat fracture face is not at variance with a bimolecular leaflet structure. (b) Gap junctions. Each of the two membranes comprising a gap junction contains a close-packed array of particles. (c) Tight junctions. Here membranes have ridges within them.

Animals↗
PubMed1994

Fracture surface characterization of dentin-bonded interfacial fracture toughness specimens.

Although the current trend in dentin bonding favors the development of a hybrid layer interdiffusion zone for micromechanical bonding, the exact nature of the dentin-composite bond is still unclear. The objective of this study was to characterize the fracture surfaces of specimens used to measure interfacial fracture toughness. Morphological (SEM) and chemical (EDS and XPS) surface analyses were used for characterization. Fracture toughness specimens generally failed along the dentin-bonded interface in agreement with observed clinical failure modes. Four sites of bond failure were identified within the dentin-composite interfaces when All-Bond 2, Scotchbond Multi-Purpose, and Scotchbond 2 were used as the dentinal adhesives. These were located within (1) the smear layer, (2) a resin-modified layer between the interdiffusion zone and the adhesive resin, (3) a well-infiltrated hybrid interdiffusion zone, and (4) a non-infiltrated unsupported collagen layer. The interfacial region had a complex architecture which varied with the nature of the dentin, the dentin surface treatment, and the dentin bonding system. The sites of bond failure appeared to correlate with the interfacial fracture toughness and the extent to which polymerized resin infiltrated and acted to support the organic dentinal structures.

Animals↗
PubMed1994

Hip Fractures: I. Overview and Evaluation and Treatment of Femoral-Neck Fractures.

Hip fractures remain a major source of morbidity and mortality in the elderly, and their incidence is increasing as the population ages. Surgical management followed by early mobilization is the treatment of choice for most patients with hip fractures. However, all comorbid medical conditions, particularly cardiopulmonary and fluid- electrolyte imbalances, must be evaluated and stabilized prior to operative intervention. Nondisplaced femoral-neck fractures should be stabilized with multiple parallel lag screws or pins. The treatment of displaced femoral-neck fractures is based on the patient's age and activity level: young active patients should undergo open reduction and internal fixation; older, less active patients are usually treated with hemiarthroplasty, either uncemented or cemented. Regardless of treatment method, the goal is to return the patient to his or her prefracture level of function.

Journal Article↗
PubMed1994

Hip Fractures: II. Evaluation and Treatment of Intertrochanteric Fractures.

Surgical stabilization followed by early mobilization is the treatment of choice for both nondisplaced and displaced intertrochanteric fractures. Fracture stability is dependent on the status of the posteromedial cortex. The sliding hip screw is the device mostly commonly used for fracture stabilization. The most important aspect of its insertion is secure placement within the femoral head. Although the sliding hip screw allows postoperative fracture impaction, it is essential to obtain an impacted reduction at the time of surgery. If there is a large posteromedial fragment, an attempt should be made to internally fix the fragment with a lag screw or cerclage wire. Although intramedullary hip screws have not been shown to be superior to the sliding hip screw, they may have selected indications.

Journal Article↗
PubMedDate not supplied

Fracture toughness (K(IC) of a hot-pressed core ceramic based on fractographic analysis of fractured ceramic FPDs.

PURPOSE: The objective of this study was to test the hypothesis that there is no significant difference between the fracture toughness (K(IC)) of an experimental hot-pressed core ceramic measured by fractographic analysis of failed ceramic prostheses and the values determined by other standard methods. MATERIALS AND METHODS: Four groups were subjected to one of four test methods: group 1 = indentation strength technique (standard numerical calculation); group 2 = indentation strength technique (fractographic analysis); group 3 = flexure test of precracked specimens (fractographic analysis); and group 4 = fractographic analysis of failed three-unit fixed partial dentures (FPD). For groups 1 to 3, 20 ceramic bar specimens were subjected to three-point flexure at a cross-head speed of 0.5 mm/min until fracture occurred. For group 4, 10 failed FPDs were collected from a previous study. Stress values at failure were calculated from either a flexure stress equation (groups 1 to 3) or from finite element analyses (group 4). K(IC) values were calculated from an equation and fractographic measurement data. RESULTS: Mean fracture toughness ranged from 3.1 MPa x m1/2 (SD 0.2) (group 1) to 3.4 MPa x m1/2 (SD 0.2) (group 4). The mean K(IC) value for group 1 was significantly different from that of group 4; however, no significant differences were found between groups 1, 2, and 3, or between groups 2, 3, and 4. CONCLUSION: Fracture toughness for an experimental hot-pressed core ceramic measured by fractographic analysis in combination with finite element analysis was comparable with the values determined with other standard fractographic methods.

Analysis of Variance↗
PubMed2005

Hyperbaric oxygen therapy for promoting fracture healing and treating fracture non-union.

BACKGROUND: Hyperbaric oxygen therapy (HBOT) consists of intermittently administering 100% oxygen at pressures greater than one atmosphere absolute (ATA) in a pressure vessel. This technology has been used to treat a variety of diseases and has been described as helping patients who have delayed healing or established non-union of bony fractures. OBJECTIVES: The aim of this review was to assess the evidence for the benefit of hyperbaric oxygen treatment (HBOT) for the treatment of delayed bony healing and established non-union of bony fractures. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group trials register (to January week 3, 2004), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 4, 2003), MEDLINE (OVID 1966 to January week 3, 2004), CINAHL (OVID 1982 to January week 3, 2004), EMBASE (OVID 1980 to February 2004), the locally developed Database of Randomised Controlled Trials in Hyperbaric Medicine (available at www.hboevidence.com) from inception to March 2004, and reference lists of articles. SELECTION CRITERIA: We aimed to include all randomised controlled trials that compared the effect of HBOT with no HBOT (no treatment or sham). DATA COLLECTION AND ANALYSIS: Two authors using standardised forms attempted to extract data independently. MAIN RESULTS: No trials met the inclusion criteria. We excluded one trial that compared HBOT with no treatment because no clinical outcomes were reported. AUTHORS' CONCLUSIONS: This systematic review failed to locate any relevant clinical evidence to support or refute the effectiveness of HBOT for the management of delayed union or established non-union of bony fractures. Good quality clinical trials are needed to define the role, if any, of HBOT in the treatment of these injuries.

Fracture Healing↗
PubMed1996

Effect of loading and fracture motions on diaphyseal tibial fractures.

A computerized motion sensor was used to record the three-dimensional components of interfragmentary motion during healing in three patients with closed, low-energy fractures of the tibial diaphysis treated with functional braces. At the first measurement session 2 weeks after fracture, the patients applied approximately 15 kg to the injured limb. Although this produced 1-4 mm of translation of the fragments, this was recovered when the load was removed. The maximum rotational and angulatory displacements often occurred as the patients rose from the chair with no weight applied to the limb and frequently were reduced as the 15 kg of load was applied. Under load, the maximum axial rotation was 3 degrees and the maximum angular displacement was 1 degree. As with the translations, the initial rotational and angulatory positions of the fragments were recovered when the load was removed and the patient returned to the seated position. At 8 weeks, the patient applied full body weight, producing a maximum interfragmentary translation of 0.5 mm and maximum axial rotation or angulation of 0.5 degrees. Abundant peripheral callus formed in all three fractures, and they healed by 15 weeks through typical gradual consolidation and mineralization of the callus, accompanied by a corresponding reduction in interfragmentary motions.

Adult↗
PubMed1994

Avulsion fractures of the pelvis in children: a report of 32 fractures and their outcome.

Avulsion injuries of the apophyses of the pelvis are mainly athletic injuries and are usually seen in adolescents. In a series of 80 pelvic fractures in children seen and managed in The Royal Liverpool Children's Hospital, Alder Hey, in the last 10 years, 32 avulsion fractures in 25 patients were diagnosed and treated. Twenty-two of these patients were followed for an average of 44 months (range 4-120 months). Eight (33%) were girls, a higher proportion than in other published series. The average age of the children was 13.8 years. These fractures, though generally regarded as trivial injuries, have left disability persisting into adult life, with limitation of sporting ability in 10 of the 22 patients and persistent symptoms in 6, mostly in those with ischial avulsion injuries. Fourteen patients with acute injuries needed hospitalisation, with an average stay of 5 days. The other 11 were suffering from chronic traction injuries sustained in sport. This distinction between acute and chronic injuries has not been emphasized in the other reviews. The radiological appearances, diagnostic problems and morbidity are discussed in order to increase awareness of these injuries.

Adolescent↗
PubMed1989

Fracture of the upper end of the femur is not associated with familial fracture disposition.

Based on the population of the city of Malmö, Sweden, we performed a retrospective cohort study. By choosing patients who had fractures of the upper end of the femur in the 1950s as an indication of senile osteoporosis, and by studying the roentgenographic records of their children from the 1950s and on we concluded that this type of osteoporosis is not a condition that is aggravated in certain families. Offspring of parents who had a hip fracture in the 1950s are not more prone to have fractures than a control group.

Aged↗
PubMed2006

[Direct osteosynthesis of instable Gehweiler Type III atlas fractures. Presentation of a dorsoventral osteosynthesis of instable atlas fractures while maintaining function].

This retrospective study evaluates eight patients with unstable fractures of the atlas vertebra, treated operatively in the Central Clinic Bad Berka between January 1995 and December 2001. In all cases, we were confronted with unstable and dislocated type III fractures according to Gehweiler, caused by an injured transverse ligament. Mean age was 34 years (range 20-49) in two women and six men. We introduce a new technique of direct reconstruction of the atlas vertebra. This technique leads to a stable ring construct that allows compression osteosynthesis of the fracture. Spinal fusion can be avoided, as can postoperative immobilization, since sufficient stability for functional postoperative treatment is achievable. The follow-up control 38 months (range 6-75) after surgery showed solid bony fusion in all cases, in one case after revision surgery. All patients showed good functional results, there was no need for analgesics and all patients could be reintegrated into their former occupation.

Bone Screws↗
PubMed1994

The pins and rubbers traction system for treatment of comminuted intraarticular fractures and fracture-dislocations in the hand.

The authors have developed a new skeletal traction system for comminuted intraarticular fractures and fracture-dislocations in the hand. The system consists of two or three Kirschner wires and rubber bands, and is easy to assemble. It is more compact and comfortable than the banjo splint, and equally effective, and it allows early motion of the affected digits. A description of the technique is followed by the clinical results of seven cases of severe articular injuries in the hand. At the time of follow-up, the average range of the affected PIP joint motion was about 80 degrees. The final active motion of the injured DIP joint ranged from 0 to 40 degrees in flexion and that of the affected thumb (trapezial fracture) was not limited. The average follow-up period was 13.1 months.

Adolescent↗
PubMed1985

Fracture of the hyoid bone associated with a mandibular fracture.

A fracture of the hyoid bone in association with a mandibular fracture in a 29-year-old man is reported. The literature pertaining to this rare injury is reviewed and the clinical presentation, diagnosis, and treatment of fractures of the hyoid bone are discussed.

Adult↗
PubMed2005

Fractures of the femoral neck in children: long-term follow-up in 62 hip fractures.

In this retrospective study, we evaluated the characteristics of 103 femoral neck fractures in 102 children seen our department between 1978 and 1994. In order to evaluate the correlation between the chosen procedure and complication risks, we further reviewed the late treatment results of 62 fractures in 61 children of the series whom we had followed for a minimum of 8 years. The ages of these children at the time of injury ranged from 2 to 14 years (average 10.2 years). Sixty-three hips were available for clinical and radiographic follow-up at a minimum of 8 years (mean 14 years). Overall, 67.2% radiologically good results were obtained. Complications were coxa vara in five (8%), avascular necrosis in nine (14.5%), premature epiphysis fusion in five (8%), coxa valga in two (3.2%), non-union in one (1.6%), limb shortening in seven (11.3%), and arthritic changes in two (3.2%). Our long-term follow-up revealed that the type of treatment influences the complication rate more than do the characteristics of the fracture itself, and that the end result cannot be satisfactorily determined until after physeal closure.

Adolescent↗