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PubMed1993

Posterior instrumentation and fusion for unstable fractures and fracture-dislocations of the thoracic and lumbar spine. A comparative study of three fixation devices in 70 patients.

Acute unstable thoracic and lumbar spine fractures were treated with either Harrington rods and hooks, Luque rods with sublaminar wires, or A-O dynamic compression plates with pedicle screws. The results demonstrated failure of all three techniques to maintain the sagittal plane correction at 12 months' follow-up. Furthermore, in lumbar fractures, Harrington rods did not restore or maintain sagittal plane alignment as well as Luque rods or pedicle screws and plates. Lastly, the pedicle screw fixation system required a shorter segment fusion.

Adolescent↗
PubMed1996

Bone mineral density and risk of breast cancer in older women: the study of osteoporotic fractures. Study of Osteoporotic Fractures Research Group.

OBJECTIVE: To test the hypothesis that bone mineral density (BMD) is associated with the risk of developing breast cancer in older women. DESIGN: Prospective cohort study with mean (SD) follow-up of 3.2 (1.6) years. SETTING: Four clinical centers, one each located in the following areas: Baltimore, Md; Minneapolis, Minn; Portland, Ore; and the Monongahela Valley in Pennsylvania. PARTICIPANTS: A total of 6854 nonblack women who were 65 years of age or older and enrolled in the Study of Osteoporotic Fractures. MEASUREMENTS: Radius and calcaneus BMD by single photon absorptiometry at baseline; hip and spine BMD by dual-energy x-ray absorptiometry 2 years later. MAIN OUTCOME MEASURE: Breast cancer confirmed by medical record review. RESULTS: A total of 97 women developed breast cancer. In the multivariate model, adjusting for age, the degree of obesity, and other important covariates, the risk of breast cancer was about 30% to 50% higher per 1 SD increase in BMD (relative risk, distal radius BMD=1.50; 95% confidence interval, 1.16-1.95). The age-adjusted incidence rate of breast cancer per 1000 person-years among women in the lowest quartile of distal radius BMD was 2.46, compared with 5.99 among women with the highest BMD. Women with BMD above the 25th percentile were at 2.0 to 2.5 times increased risk of breast cancer compared with women below the 25th percentile. Results were consistent across all BMD sites. CONCLUSIONS: Bone mineral density predicts the risk of breast cancer in older women. The magnitude of the association is similar to that observed between BMD and all fractures. Our findings suggest a link between 2 of the most common conditions affecting a woman's health. Identifying a common denominator for these conditions should substantially improve our understanding of their etiology and prevention.

Absorptiometry, Photon↗
PubMed1997

Fixation of complex elbow fractures, Part II. Proximal ulna and radius fractures.

Complex fractures of the elbow often include significant injury to the proximal ulna and/or proximal radius. Such injuries are often combined with injury to the periarticular soft tissues. Appropriate treatment is dependent on accurate diagnosis, definitive treatment of both the skeletal and ligamentous components of injury, and initiation of rehabilitation programs the stress early motion.

Fracture Fixation↗
PubMed1991

Type III tibial fractures in the elderly: results of 23 fractures in 20 patients.

A series of 23 type III fractures of the tibia in 20 elderly patients (over 60 years of age) presenting for combined plastic and orthopaedic surgical management over a period of 15 years are reviewed. Overall limb salvage was 53 per cent, with an average inpatient duration not significantly different from that for amputation, suggesting that an age of over 60 years is not necessarily a contraindication to attempts at limb salvage in type III injuries.

Aged↗
PubMed2003

Shear movement at the fracture site delays healing in a diaphyseal fracture model.

This study tested the hypothesis that interfragmentary axial movement of transverse diaphyseal osteotomies would result in improved fracture healing compared to interfragmentary shear movement. Ten skeletally mature merino sheep underwent a middiaphyseal osteotomy of the right tibia, stabilized by external fixation with an interfragmentary gap of 3 mm. A custom made external fixator allowed either pure axial (n=5) or pure shear movement (n=5) of 1.5 mm amplitude during locomotion by the animals. The movement of the osteotomy gap was monitored weekly in two sheep by an extensometer temporarily attached to the fixator. After 8 weeks the sheep were killed, and healing of the osteotomies was evaluated by radiography, biomechanical testing, and undecalcified histology. Shear movement considerably delayed the healing of diaphyseal osteotomies. Bridging of the osteotomy fragments occurred in all osteotomies in the axial group (100%), while in the shear group only three osteotomies (60%) were partially bridged. Peripheral callus formation in the shear group was reduced by 36% compared to the axial group (p<0.05). In the axial group bone formation was considerably larger at the peripheral callus and in between the osteotomy gaps but not in the intramedullary area. The larger peripheral callus and excess in bone tissue at the level of the gap resulted in a more than three times larger mechanical rigidity for the axial than for the shear group (p<0.05). In summary, fixation that allows excessive shear movement significantly delayed the healing of diaphyseal osteotomies compared to healing under axial movement of the same magnitude.

Animals↗
PubMed1993

Fractures of the shaft of the radius after treatment of Colles fractures with pins and plaster or external fixation.

Refracture of the radius through a pin site after the removal of pins and plaster or an external fixator for Colles fracture is rarely mentioned in the literature. We present the details of three such cases and review two others reported in the literature. Our aim is to alert orthopedists to the potential for this complication. Patients with superficial or deep pin tract infections appear to be at greater risk.

Accidental Falls↗
PubMed1996

Internal fixation of femoral shaft fractures in children and adolescents: a ten- to twenty-one-year follow-up of 52 fractures.

In a long-term follow-up (mean 16 years) of 52 femoral shaft fractures treated by internal fixation in 50 children and adolescents, we noted a mean overgrowth of 1 mm after plating and a mean undergrowth or relative shortening of 2 and 9 mm after nailing with broad (IMN) and slender (flexible rods: IMR) intramedullary nails, respectively. The mean overgrowth was 8 mm in children, but adolescents had a mean undergrowth of 5 mm (p < 0.01). Excessive overgrowth tended to occur less frequently after intramedullary nailing than after plating (p = 0.1). Undergrowth tended to occur with increasing frequency with increasing age and attained troublesome levels in three patients with severe trauma. Three cases of moderate valgus deformity of the hip and one case of late arthrosis of the hip occurred after intramedullary nailing with IMN introduced through the greater trochanter. We conclude that this method should not be used in patients with open physes.

Adolescent↗
PubMed1991

Ankle fractures and alcoholism. The influence of alcoholism on morbidity after malleolar fractures.

The postoperative morbidity after osteosynthesis of malleolar fractures was investigated retrospectively by comparing 90 alcohol abusers with 90 controls. The two groups were selected from 626 male patients and were matched regarding trauma, treatment for cardiovascular, pulmonary and endocrine diseases, age, weight, smoking habits, anaesthesia and duration of surgery. The alcohol abusers developed significantly more early complications, especially infections, after surgery. Follow-up at six, nine and 12 weeks after surgery also revealed a significantly higher morbidity among the alcoholics.

Alcohol Drinking↗
PubMed1991

[Follow-up of elderly patients with fractures. Results of a catamnestic study of patients with femoral-(neck-)fractures].

A random sampling of n = 30 patients with fractures of the (neck of the) femur was followed up approx. 1 year after surgery, early mobilisation and rehabilitation. The average age was 79 years. The follow-up revealed a noticeable decrease in independence compared to the status at the time of discharge from hospital. This is in part due to health but mainly due to mental, social and organisational factors. The results agree with the assumption that the potential gained during the inpatient treatment period may be relatively invalidated during the subsequent outpatient phase unless measures are taken to ensure long-term quality assurance. This preservation of quality involves, among other factors, in particular satisfactorily exhaustive information and guidance of the patient and his relatives (by giving competent medical advice), clarification of the domestic situation already during the inpatient period, and cooperation with all aftercare institutions including the next of kin.

Aftercare↗
PubMed1993

Developmental plasticity in cerebellar tactile maps: fractured maps retain a fractured organization.

Plasticity following deafferentation has been repeatedly demonstrated in topographic sensory maps in the mammalian brain. In this paper we investigated the developmental plasticity of the fractured somatotopic map found in the tactile regions of the rat cerebellum. At various stages of postnatal development between postnatal days 1 and 30, we cauterized the infraorbital branch of the trigeminal nerve, which innervates the upper lip, furry buccal pad, and vibrissae that are represented within cerebellar folium crus IIa. The organization of the crus IIa map was then examined 2 to 3 months after denervation. We found that tactile receptive fields had reorganized throughout the denervated area but maintained a fractured somatotopy. Comparison of the reorganization in different animals showed that the denervated upper lip region was consistently and predominantly replaced by representation of the upper incisors. Analysis of evoked field potentials revealed an alteration, in denervated animals, of the response of the granule cell layer to brief tactile stimulation. This response in normal animals consists of two components at different latencies. Animals lesioned later in development were less likely to have the short latency component. This result suggests a difference in the developmental sensitivity of different cerebellum-related pathways to nerve lesions.

Animals↗
PubMed2001

Diffuse damage accumulation in the fracture process zone of human cortical bone specimens and its influence on fracture toughness.

This study was concerned with the mechanics and micromechanisms of diffuse (ultrastructural) damage occurrence in human tibial cortical bone specimens subjected to tension-tension fatigue. A nondestructive technique was developed for damage assessment on the surfaces of intact compact tension specimens using laser scanning confocal microscopy. Results indicated that diffuse damage initiates as a result of fractures in the inter-canalicular regions. Subsequent growth of those microscopic flaws demonstrated multiple deflections from their paths due to 3D spatial distribution of microscopic porosities (lacunae-canalicular porosities) and the stress-concentrating effects of lacunae. Damage dominating effects in the early stages of fatigue had been verified by the observed variations of the fracture toughness due to artificially induced amounts of damage. Toughening behavior was observed as a function of diffuse damage.

Journal Article↗
PubMed1986

Fracture toughness of dental composites determined using the short-rod fracture toughness test.

Plane strain fracture toughness (KIC) has been evaluated for a number of commercially-available dental composites. A modified Short-rod Fracture Toughness (SRFT) specimen design has been used, enabling small specimens to be tested conveniently. The effect on KIC of aging in water at 37 degrees C for seven days, one month, and six months has been determined for conventional, microfilled, and hybrid (coarse and fine filler particle-containing) composites. Our results suggest that aging for one month or more caused a reduction of KIC for the composites so aged. Comparison of the KIC values determined using the modified SRFT specimen with values obtained using more conventional specimen geometries gave good agreement, thereby suggesting the suitability of the small SRFT specimens for valid KIC determinations.

Composite Resins↗
PubMed2003

Evaluation of brittleness of porcelain fused to pure titanium by fracture toughness, hardness and fracture energy.

To elucidate the cause of brittleness of porcelain fused to pure titanium (PFPT) which leads to chipping and cracking similar to that of conventional porcelain in clinical use, fracture toughness KIc, hardness (Hv and Hk) and fracture energy gamma reflecting the bonding energy of atoms were evaluated. In KIc there were no differences between PFPT and conventional porcelain, nor for Hv and Hk, but for the gamma of PFPT calculated from the KIc and the Young modulus measured by the resonance method there was less than that of conventional porcelain. These results indicate that mechanical properties such as KIc and hardness cannot always substantiate the brittleness of PFPT experienced in practical use. However, a comparatively small gamma of PFPT may suggest a fatigue crack growth as a more likely phenomenon as it occurs more easily than the conventional one in oral.

Dental Porcelain↗
PubMed2005

Fracture toughness measurement of dental ceramics using the indentation fracture method with different formulas.

This study examined fracture toughness (KIC) measurements obtained using the indentation fracture (IF) method with a view to improving their reliability. The KIC values of five dental ceramics were measured using the IF method with five different formulas, and the single-edge precracked beam (SEPB) method was used as a control. The elastic moduli of the dental ceramics were evaluated by dynamic hardness test. Load conditions of the dental ceramics that produced a median/radial crack for the IF method formulas were investigated. Based on the resultant c/a and P/c1.5 values, the indentation load (P) required for median/radial crack occurrence varied greatly from 29.4 to 196 N depending on the ceramic used. Among the five formulas, none of the KIC values obtained by the IF method with Miyoshi's formula differed significantly (p > 0.05) from the values obtained using SEPB method. These results suggested that, after an appropriate indentation load is determined, reliable KIC values for small dental ceramic specimens can be easily obtained using the IF method if Miyoshi's formula is used in combination with the dynamic hardness test.

Algorithms↗
PubMed1999

Posterior fracture through the sternoclavicular physis associated with a clavicle fracture: a case report and literature review.

Three reported cases of fractures in teenagers of the medial clavicle associated with a posterior disruption at the sternoclavicular joint have similar findings. The medial fragment is rotated 90 degrees to the coronal plane. The medial fragment is usually stripped of its periosteum. Treatment requires open reduction and internal fixation of the clavicle fracture. We are reporting similar findings in a fourth case.

Adolescent↗
PubMed2005

Catheter fracture and cardiac migration--an unusual fracture site of totally implantable venous devices: report of two cases.

Totally implantable venous devices (TIVDs) are used increasingly in patients with cancers and other debilitating diseases requiring long-term chemotherapy, total parental nutrition, and fluid replacement. The TIVDs are surgically inserted and fixed in the soft tissues of the chest wall to prevent infection and accidental dislodgment. Acute and chronic complications associated with these catheters include infection, thrombosis, venous perforation, catheter leakage, dislodgment and fall out, subintimal entrapment, and tip migration to neighboring veins after satisfactory initial placement. Catheter fracture and cardiac migration is a rare complication and most reported cases have developed between the clavicle and the first rib as a consequence of a pinch-off sign. We present two patients with metastatic colon cancers with unusual catheter fracture site and migration and discuss the clinical implications.

Adult↗
PubMed1977

Harrington instrumentation and spine fusion for unstable fractures and fracture-dislocations of the thoracic and lumbar spine.

Of forty patients with unstable fractures and fracture-dislocations of the thoracic or lumbar spine treated with Harrington instrumentation and spine fusion, thirty-five had a neural deficit (twenty-three with incomplete or cauda equina lesions and twelve with complete lesions). Laminectomy or posterolateral decompression was performed prior to instrumentation and fusion in twenty-three patients and at the time of stabilization, in thirteen. Solid fusion was obtained in all but one patient. Back pain persisted in four. No patient had residual spinal deformity. Twenty-one patients with incomplete or cauda equina lesions regained some neural function, while all twelve with complete lesions remained unchanged. The advantages of this technique include effective stabilization of the spine, early mobilization and rehabilitation, and prevention of late deformity.

Adolescent↗