PubMed · 9301258
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T Inoue. 1997. [Fractures in the elderly].. https://doi.org/10.3143/geriatrics.34.451
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Autogenous tibial cancellous bone has been used for reconstructive operations in oral and maxillofacial surgery for over 10 years, and has reduced many of the problems associated with conventional sites of autogenous grafts such as the iliac crest. The ease of access for harvesting, the speed of the operation, and the abundance of bone, are advantages of this donor site. We report a patient who had a graft taken from the proximal tibia and had a displaced fracture 2 weeks later after a fall. Five similar cases have been reported previously, of which none has required surgical intervention.
A fall scenario is often given to explain the reason for a head injury to an infant. Mostly the examining doctor or forensic expert has to rely on his own experience and to appraise the situation to be consistent or not with his finds. An experiment carried out on an anatomical preparation showed that the skull of a newborn baby was able to repeatedly resist forces of up to 1000 N before breaking in. Even then the fracture lines followed the bony spikes (spiculae) from the ossification centers of the skull bones. If fractures are running across these spiculae there is reason to believe that high local force has been used, and a blow against a sharp edge must be considered.
We wanted to determine whether women aged 70 years and older, who presented to the emergency department (ED) with a fall and injury, received guideline care within 18 months of presentation. Women aged 70 years and older who presented to the ED with a fall were recorded prospectively from August 1, 2001 to May 1, 2002 (n=226). Structured telephone interviews were performed 18 months after the ED fall to obtain details of patient management (n=63). The most frequently reported referral was to the family physician (32%) and to physiotherapy (24%). We concluded that most older women who presented to the ED with a fall did not appear to be receiving current guideline care. We propose that future research use a prospective study design to assess whether or not guideline care is being delivered by a variety of health care providers after the patients leave the ED.