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PubMed1999

Demineralized bone implants for nonunion fractures, bone cysts, and fibrous lesions.

Demineralized bone implants were used to treat eight patients with fracture nonunion, five patients with bone cysts, and eight patients with fibrous lesions. Five of the eight patients with nonunions had had previous unsuccessful attempts at reconstruction. After fixation and implantation with either human or bovine demineralized bone, all eight fractures healed. For those patients with nonunion fractures, mean followup time was 8 years, 5 months, and longest followup was 15 years, 3 months. The cystic lesions in five patients included three typical aneurysmal bone cysts and two recurrent unicameral bone cysts. The aneurysmal bone cysts had excellent healing and bone remodeling. The two unicameral bone cysts were repacked more densely after 1 year and healed. For these patients with bone cysts, the mean followup time was 12 years, 5 months, and longest followup was 15 years, 1 month. The various fibrous lesions in seven of the eight patients were healed within 6 months, with only one requiring repacking. For these patients with fibrous bone lesions, the mean followup time was 9 years, 8 months, and longest followup was 14 years. A biopsy of the lesions in five patients was performed and in two cases showed osteoblasts and new bone around small particles of the implants. These results with long term followup show that allogeneic or xenogeneic demineralized bone implants offer a reasonable alternative for the treatment of typical nonunion fractures, bone cysts, and fibrous lesions of bone.

Adolescent↗
PubMed2002

Multifactorial risk profile for bone fractures in primary hyperparathyroidism.

Primary hyperparathyroidism (pHPT) is associated with an increased fracture risk, and decreased bone density thus has been considered an indication for surgery. However, many pHPT patients have a multifactorial risk profile for osteoporosis and bone fractures. The aim of the present study was to evaluate variables associated with fracture risk within the group of pHPT patients. A series of 203 consecutive patients operated for pHPT were investigated with bone mineral content and biochemical and clinical risk factors for bone fracture. Seventeen patients (8%) had a history of at least one bone fracture up to 5 years before pHPT surgery. Twenty-six patients (13%) had a history of at least one fracture during the 10-year period prior to surgery. In the univariate analyses corticosteroid treatment, serum levels of alkaline phosphatase, 25-hydroxyvitamin D3, type I collagen telopeptide, and bone mineral content were found to be associated with a history of bone fractures up to 10 years before surgery. Additionally, age and menopausal status were of importance for fractures during the 10-year-period, whereas a history of cardiovascular disease was important for fractures during the 5-year-period prior to surgery. Multivariate analyses showed that serum level of PTH was independently associated with bone fractures during the 5-year period prior to pHPT surgery and further that serum level of 25-hydroxyvitamin D3 was associated with fractures up to 10 years before surgery. In conclusion, serum levels of 25-hydroxyvitamin D3 and PTH were independently associated with a history of bone fractures in pHPT. These variables should be considered when evaluating patients for parathyroid surgery.

Absorptiometry, Photon↗
PubMed2002

[Healing fibular bone fracture in rats during extended suspension ].

Healing of peroneal bone fracture was studied histologically and histomorphologically in rats exposed to a 30-d tail-suspension. To fracture bones, anesthetized rats were operated on day 15 of suspension. Hind limb deprivation of the support loading for a period of 30 days minimizes healing processes in fractured peroneal bones as was evidenced by undersized callus and lowered strength of bone consolidation. Mass-metric and histomorphometric investigations showed that, as compared with the control, on day 15 of regeneration the callous mass and volume in the suspended rats were by 34% and 35% less, respectively; the newly formed spongy bone, the fibrous-cartilaginous tissue and the cartilage were by 44%, 70% and 86% smaller in size, respectively. Nonetheless, healing dynamics in the suspended rats was not disturbed and the calluses were on the same phase of development as in the control, which is attested by similarity of the histological picture. Based on the comparative retrospective analysis of fracture healing in rats in 15- and 30-d experiments, the extended (30-d) suspension did not further impede the post-traumatic bone regeneration. It is suggested that minimization of bone fracture healing during the 15-d suspension was conditioned not only by inhibition of the growth hormone production but also by an acute stress reaction in the early period of adaptation.

Animals↗
PubMed1997

Bone fracture and sequestration as complications of external skeletal fixation.

A transverse tibial fracture and bone sequestrum at the pin-bone interface were diagnosed in a dog treated with external skeletal fixation for tarsal arthrodesis. The causes of the bone fracture were improper use of external fixator pins and trauma after the fixator became entangled in a fence. After removal of the original fixator, the tibial fracture was successfully repaired with an intramedullary pin, a type II external skeletal fixator and an autogenous cancellous bone graft. Bone sequestration and draining sinuses were successfully treated with curettage and antimicrobial therapy.

Animals↗
PubMed2000

Diet, smoking and anthropometric indices and postmenopausal bone fractures: a prospective study.

OBJECTIVE: Bone fractures are an important cause of morbidity and mortality among the elderly in the US. The present study assesses the possible role of a number of risk factors for postmenopausal bone fractures. METHODS: We analysed the relationships of anthropometric, demographic and lifestyle factors with the risk of bone fracture among 6250 postmenopausal women in a prospective cohort study, the New York University Women's Health Study. RESULTS: After an average of 7.6 years of follow-up, 1025 new incident bone fractures were reported, including 34 hip and 159 wrist fractures (incidence rates; 71.6 and 334.7 per 105 woman-years, respectively). The risk of fracture increased with increasing age, body height and total fat intake, while it was significantly lower among obese and African American women. The relative risk among African Americans was 0.45 (95% CI: 0.32-0.63) compared with non-African Americans. Women taller than 170 cm had a 64% increase in risk of fractures, as compared with those under 155 cm. These associations were generally more pronounced when fractures were limited to those at the hip and wrist. CONCLUSIONS: The present study provides an indication for a potential role of dietary fat in the development of postmenopausal fractures and further evidence to support protective effects of obesity, short stature and African American ethnicity.

Adult↗
PubMed2001

Effect of long-term exposure to fluoride in drinking water on risks of bone fractures.

Findings on the risk of bone fractures associated with long-term fluoride exposure from drinking water have been contradictory. The purpose of this study was to determine the prevalence of bone fracture, including hip fracture, in six Chinese populations with water fluoride concentrations ranging from 0.25 to 7.97 parts per million (ppm). A total of 8266 male and female subjects > or =50 years of age were enrolled. Parameters evaluated included fluoride exposure, prevalence of bone fractures, demographics, medical history, physical activity, cigarette smoking, and alcohol consumption. The results confirmed that drinking water was the only major source of fluoride exposure in the study populations. A U-shaped pattern was detected for the relationship between the prevalence of bone fracture and water fluoride level. The prevalence of overall bone fracture was lowest in the population of 1.00-1.06 ppm fluoride in drinking water, which was significantly lower (p < 0.05) than that of the groups exposed to water fluoride levels > or =4.32 and < or =0.34 ppm. The prevalence of hip fractures was highest in the group with the highest water fluoride (4.32-7.97 ppm). The value is significantly higher than the population with 1.00-1.06 ppm water fluoride, which had the lowest prevalence rate. It is concluded that long-term fluoride exposure from drinking water containing > or =4.32 ppm increases the risk of overall fractures as well as hip fractures. Water fluoride levels at 1.00-1.06 ppm decrease the risk of overall fractures relative to negligible fluoride in water; however, there does not appear to be similar protective benefits for the risk of hip fractures.

Aged↗
PubMed1988

Histopathology of the facial nerve after longitudinal temporal bone fracture.

The temporal bone histopathology in a patient who suffered repeated head trauma and a longitudinal temporal bone fracture shows unusual features associated with the facial nerve. In the distal meatal segment, a type of traumatic neuroma was found with disorganized nerve bundles and distinct areas of Schwann's cell proliferation but lacking fibrosis. Periosteal new bone formation in the labyrinthine segment narrows the fallopian canal and protrudes into the nerve, which completely fills the canal. The tympanic and mastoid segments of the nerve show severe degeneration of nerve fibers and an increase in connective tissue between fascicles. An attempted facial nerve decompression did not reach the area of primary pathology in the labyrinthine and meatal segments of the nerve, which could have been exposed by the transtemporal supralabyrinthine approach.

Adult↗
PubMed2006

[Applicational study of 3D reconstruction with spiral computed tomography in evaluation of anatomical complicated bones fracture].

OBJECTIVE: To investigate forensic diagnosis application of three-dimentional reconstruction with spiral computed tomography in fracture of anatomical complicated bones. METHODS: Selected eleven patients of bone fracture who were examined with SCT 3D and conventional X-ray examination. The location, number and characteristics were observed and analyzed. RESULTS: In all of eleven patients with bone fractures, X-ray examination could detect thirty-four rib fracture, one scapula fracture, two nasal fracture, one metacarpal bone incomplete fracture and one left tibia-fibula fracture, one pubis fracture. While there were forty-seven rib fracture, one scapula smash fracture, one nasal fracture with obvious displacement and eliminate one misplace, one left tibia-fibula obsolete fracture and one sacroiliac joint dislocation, one No 5 lumbar vertebrae pedicle of vertebrae arch fracture. Combining 3D reconstruction images, coronary and sagittal reconstruction images could show clearly the fracture line, location of fracture, number of fracture, displacement and recovery. CONCLUSION: 3D reconstruction technique of SCT is a very useful examination method in the objective forensic diagnosis of anatomical complicated bones fracture, it excels the routine X-ray examination.

Adult↗
PubMed1993

The C-reactive protein (CRP) in patients with long bone fractures and after arthroplasty.

Between March 1991 and February 1992 serial serum C-reactive protein (CRP) levels were measured prospectively for three weeks in 57 consecutive patients with fractures of long bones, and also in 11 patients who had undergone primary total hip or knee arthroplasty. A semi-quantitative capillary floculation method was used for measuring the CRP level. The highest values were usually recorded 2-3 days after trauma or operation, and the CRP was nearly normal by three weeks. In the patients with long bone fractures the amplitude of CRP response was affected by the type of treatment. Lower values were observed in those patients treated conservatively than in those who underwent operation, but the profile of CRP response was similar, regardless of the type of treatment. The CRP response was also affected by the severity of the trauma in conservatively treated patients, but in those who underwent operation the CRP response was similar, regardless of the severity of the injury. In patients with primary total hip or knee arthroplasty the pattern of CRP response after operation was similar to that in the patients with long bone fractures who underwent surgical treatment. Awareness of the natural course of the CRP response after fracture and arthroplasty may help in the diagnosis of early post-traumatic and postoperative complications, especially infections.

Adolescent↗
PubMedDate not supplied

Distribution of physeal and nonphyseal fractures in 2,650 long-bone fractures in children aged 0-16 years.

The distribution of 2,650 long-bone fractures in children is presented. Fractures involving the humerus, radius, ulna, femur, tibia, and fibula were classified according to Salter and Harris. Growth plate injuries accounted for 30% of fractures. Nonphyseal fractures occurred twice as often in the upper extremity as in the lower extremity. Girls with physeal fractures on the average were 1.5 years younger than boys with the same type of fracture in the same location.

Adolescent↗
PubMedDate not supplied

[Bioabsorbable poly(L-lactide) osteosynthesis plates and screws for the fixation of zygomatic bone fractures].

Ten unstable zygomatic bone fractures were treated with osteosynthesis plates and screws made of bioabsorbable poly(l-lactide) (PLLA). This study has shown that our PLLA plates and screws guarantee stable osteosynthesis of zygomatic bone fractures for an adequate period of time and allow undisturbed healing of the fracture. Bioabsorption takes more or less 18 months. Thus, a second operation for removal of the osteosynthesis material is avoided.

Biodegradation, Environmental↗
PubMed1994

Bone fractures in liver transplant patients.

Atraumatic bone fractures are a frequent complication in orthotopic liver transplantation (OLT). A retrospective study of 91 adult OLT patients was carried out to detect the prevalence of bone fractures, and to isolate predictive factors for their development. After OLT 22 patients (24%) developed 56 atraumatic bone fractures. All fractures occurred within the first 13 months following OLT. No predictive pre- or post-OLT risk factors for the development of bone fractures were identified.

Adult↗
PubMed1988

Temporal bone fractures: a clinical diagnosis.

Temporal bone fractures may be complicated by intracranial haemorrhage, C.S.F. leakage and infection, damage to the middle and inner ear and damage to the seventh and eighth cranial nerves. Accurate early diagnosis is important to enable adequate investigation and prompt treatment of any complications. We present eight cases seen in a 12 month period in which a temporal bone fracture was not diagnosed at presentation in spite of a full clinical examination and standard skull radiographs. Five of these cases developed complications which resulted in their referral. The absence of a visible fracture on plain skull radiographs does not exclude a fracture, and those patients with clinical signs of a fracture should be treated appropriately and further investigations performed. Therefore the clinical examination is vital in diagnosing temporal bone fractures and must include careful otoscopy together with assessment of the function of the seventh and eighth cranial nerves.

Adult↗
PubMed2002

Accurate, firm stabilization using external pins: a proposal for closed reduction of unfavorable nasal bone fractures and their simple classification.

Nasal bone fractures are the most common among facial fractures and are the third most common fractures in the human frame. Although many forms of treatment have been introduced, controversy regarding the optimal treatment still remains. Nasal bone fractures are complex, with significantly varying types that are often undermanaged in closed reduction procedures. The authors' experiences with nasal bone fractures have shown that the baseline for surgical intervention depends on the type of fracture and the method of maintenance after reduction, both of which have considerable impact on the final result. Therefore, it is very important and challenging to determine the proper method of reduction and maintenance. The periosteal covering plays an important role in the splinting action after closed reduction, but sagging, depression, and instability remain major complications in some cases. The authors devised a new method of accurate, firm stabilization of the fractured nasal bone by using external pins in those unfavorable fractures determined radiologically to gain optimal reduction and fixation. In the present study, fractures were grouped into favorable and unfavorable fractures, the latter being those that remained unstable or impacted even after reduction and thus needed open reduction. Unfavorable fractures were divided into four subclasses according to radiologic findings: (1) type I (frontal), including chip or tip fractures, which often depress the upper lateral cartilage and tend to sag after reduction; (2) type II (lateral), or laterally depressed segmental fractures with a lateral shift of the arch in fragments or as a unit; (3) type III (mixed), or type II with septal involvement; and (4) type IV (complex), including open or multiple comminuted fractures. After an initial evaluation to determine the fracture type, closed reduction and external fixation were performed for types I, II, and III fractures and open reduction was performed for type IV fractures 5 to 7 days after the fracture. Closed reduction with the use of external pins was done in eight cases: type I (two), type II (four), and type III (two). The mean age of the patients was 27.8 years, and the average follow-up period was 11.7 months. Functional and aesthetic results were satisfactory. This new method for support and fixation is an alternative to the conventional closed reduction and a promising way to prevent secondary deformity.

Adolescent↗
PubMed1998

The epidemiology of open long bone fractures.

Open long bone fractures occur with a frequency of 11.5 per 100,000 persons per year. They are more common in males and they have a bimodal age distribution. Open fractures of the tibial diaphysis are the commonest, but open femoral diaphyseal, distal femoral and proximal tibial fractures tend to occur in the most seriously injured patients. Lower limb open fractures are more severe than open fractures of the upper limbs. Not only is the soft tissue damage less in open upper limb fractures, but there are fewer associated musculoskeletal injuries.

Accidents, Traffic↗
PubMed2000

Nasal bone fracture.

OBJECTIVE: To study fracture nasal bone at King Faisal Hospital University in Al-Khobar from various aspects, to present our experience and to compare the result with previous works. METHODS: A prospective study conducted from January 1997 to May 1998 including all new cases of fracture nasal bone presented at our emergency department. Plain x-ray of the nose is requested for all patients except one in whom pregnancy is suspected. Reduction of fracture nose was carried out 2-7 days post injury by closed technique under general or local anesthesia with application of nasal cast for 2 weeks. Follow-up of those patients in our clinic is evaluated regarding shape, patency and satisfaction. RESULTS: Eighty six patients included in our study with peak incidence at age 1-30 years with male being dominant. Fall down and road traffic accidents were the common cause of fracture nasal bone. The common presentation was swelling and tenderness in all patients followed by deformity (30.5%) nasal obstruction (40%), and deviated nasal septum (15%). Negative x-ray finding was noticed in 30%, and computerized tomography scan was required for evaluating complicated cases. Only 30 patients (35%) required reduction by closed technique, 23% had poor outcome and were considered as failure. CONCLUSION: This paper stresses the importance of early evaluation of fracture nose in order to avoid complications. The diagnosis is made mainly based on clinical judgement. Closed reduction technique under general anesthesia within 2-10 days post injury is the standard treatment if needed. Failure by closed technique can be managed by septorhinoplasty months later.

Accidental Falls↗