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PubMed2006

[Treatment of femoral neck fractures with compressed screw and sartorius bone flap in youth or middle age].

OBJECTIVE: To study the application and the curative effect of compressed screw and sartorius bone flap in treating femoral neck fractures in youth or middle age. METHODS: From February 1996 to December 2004, 86 patients with femoral neck fracture were treated by open reduction compressed screw and sartorius bone flap, aging from 21 to 49 years. Fracture was caused by traffic accident in 35 cases, fall from height in 27 cases and fall in 24 cases. According to Garden classification, 23 cases were type II, 25 cases were type III, and 15 cases were type IV. We analyzed fracture healing and evaluate function by observation of the postoperative X-ray films. RESULTS: Of the 86 patients, 62 were followed up 6 months to 7 years (2 years and 5 months on average). According to Weijie's criterion for nonunion and necrosis of femoral head, nonunion occurred in 4 cases; the healing rate of fracture was 93.5%. In healed patients, necrosis of femoral head occurred in 7 cases (11.3%) after 3 years. The results of hip joint function evaluation were excellent in 44 cases, good in 8 cases, fair in 6 cases and poor in 4 cases; and the excellent and good rate was 83.9%. CONCLUSION: Compressed screw and sartorius bone flap was simple and effective for femoral neck fractures in youth or middle age.

Adult↗
PubMed2000

Post-traumatic findings of the spine after earlier vertebral fracture in young patients: clinical and MRI study.

STUDY DESIGN: A study comparing magnetic resonance imaging findings of degenerative changes in intervertebral discs in young patients with previous wedge-shaped compression fracture and age-matched and sex-matched control subjects. OBJECTIVES: To find out the role of fractures in disc degeneration and to assess the clinical outcome of the patients. SUMMARY OF BACKGROUND DATA: Several experimental studies have postulated that trauma is one of the major reasons for disc degeneration. Wedge compression fractures in vertebrae of children have been considered insignificant, but this has not been verified in the literature. METHODS: Fourteen patients 8.8 to 20.8 years of age (mean, 15.5 years) with a history of wedge-shaped vertebral compression fracture at least 1 year previously (mean, 3.8 years) and asymptomatic healthy control subjects were studied by thoracolumbar spine magnetic resonance imaging. The patients also underwent a clinical examination. RESULTS: Eight (57%) of the 14 patients had disc degeneration, and seven of them had it at the trauma level. Of these 7 subjects, 6 also had endplate damage at this level. The association between endplate damage and adjacent intervertebral disc degeneration was significant (P < 0.01). Only 2 of the patients were symptomatic. In the control group, only 1 subject had disc degeneration with endplate changes and disc herniation. CONCLUSIONS: The patients had more disc degeneration than did those in the control group. Endplate injury was strongly associated with disc degeneration. No correlation between previous vertebral fracture and back pain was seen in this study.

Adolescent↗
PubMed2004

Whole spine MRI in the assessment of acute vertebral body trauma.

OBJECTIVE: To determine the incidence and types of multilevel vertebral body injury in association with acute spinal trauma as assessed by whole spine MRI. DESIGN AND PATIENTS: All acute admissions to a regional spinal injury unit had whole spine MRI carried out, to detect occult vertebral body injury. Two radiologists assessed 127 cases prospectively, over a period of 3 years. All cases had T2-weighted sagittal imaging of the whole spine (where possible using a T2-weighted fat-suppressed sequence), with T1-weighted imaging in both sagittal and axial planes covering the primary injury. The incidence of secondary injury (defined as either bone bruising, wedge compression fracture or burst fracture) was determined and defined by type, site and relationship to the primary injury. RESULTS: Seventy-seven per cent of cases had a secondary injury level. Of these, bone bruising was the commonest but often occurred in combination with secondary wedge compression fracture or burst fracture. MRI detected 27 non-contiguous wedge compression fractures and 16 non-contiguous burst fractures, giving an incidence of secondary level, non-contiguous fracture of approximately 34%. CONCLUSION: A higher frequency of secondary vertebral body injury may be defined by MRI than has been described in previous studies based on radiographic evaluation of the whole spine. Whole spine MRI in assessment for occult vertebral body fracture enables increased confidence in the conservative or surgical management of patients with severe spinal injury.

Acute Disease↗
PubMed2006

[Kyphoplasty using an enhanced balloon expander: an experimental study].

OBJECTIVE: To test the efficacy of kyphoplasty using an enhanced balloon expander in restoring the height of vertebral compression fractures (OVCF). METHODS: Fifteen lumbar vertebral bodies (L1-L5) were harvested from 3 young male fresh cadavers and separated into individual vertebral bodies with the bilateral pedicles of the vertebral arch removed. Before operation, plain X-ray films of all the vertebral bodies were obtained. All the vertebral bodies were compressed lengthwise to approximately 80% of their original heights using a universal material-testing machine to result in compression fractures. Post-compression vertebral bodies were then repaired using an enhanced balloon expander, and the delivery of the bone cement into the vertebral bodies was observed. The heights of the anterior and posterior borders of the vertebral bodied were measured before and after compression as well as after kyphoplasty. RESULTS: The inflation of the balloon expander averaged 2.95-/+0.18 ml and the pressure was 122.67-/+27.89 psi (1 psi=6895 Pa). Kyphoplasty resulted in significant restoration of the vertebral body height lost due to the compression (P<0.01). CONCLUSION: Kyphoplasty using an enhanced balloon expander may restore vertebral body height damaged by compression and correct the kyphotic deformity. The balloon expander can be a effective and economic choice for kyphoplasty for its relatively low cost.

Adult↗
PubMed2000

[Spinal fractures in the elderly and their treatment].

Spinal injuries referring to banal falls are common injuries in elderly persons. Up to 55 years of age spinal fractures are more frequent in men while its opposite in older persons. There are two typical lesions: odontoid fracture in the upper cervical spine and compression fracture in thoracolumbar spine. Odontoid fracture is the most frequent lesion in cervical spine in the elderly. This is caused by trabecular structure of dens axis and spine's stiffness in old age. Instable fractures in extension type II are most common. In many cases the instability of the lesion is hidden and can be first seen in functional examination controlled by x-ray. Conservative treatment is efficient in stable lesions type III while there is a high risk for pseudarthrosis in treatment of instable lesions in elderly with Halo Fixateur e.g. We think that the best operation for these fractures is the anterior screw fixation. If this is not sufficient because of low bone mass or early dislocation of the screws a dorsal fusion C1/C2 with trans-articular screwing e.g. should be done. Because of rare symptoms thoracolumbar fractures in osteoporosis are hidden frequently. In many cases it's not easy to distinguish acute lesions from healed fractures or tumor lesions. Neurological deficit is rare. Therefore there are just few compression fractures (A type) that have to be treated operatively. Instable lesions type B and C must be operated as well in the elderly as in the young. Because of low bone mass in elderly the dorsal instrumentation should include more than just the two injured segments. An even more adequate stabilisation is done with an additional vertebral replacement.

Aged↗
PubMed1984

Postmenopausal spinal osteoporosis: flexion versus extension exercises.

Fifty-nine women with postmenopausal spinal osteoporosis and back pain were instructed in a treatment program that included extension exercises (E) for 25 patients, flexion exercises (F) for 9, combined (E + F) exercises for 19, or no therapeutic exercises (N) for 6. Ages ranged from 49 to 60 years (mean, 56 years). Follow-up ranged from one to six years (means for the groups, 1.4 to 2 years). All patients had spine x-ray studies before treatment and at follow-up, at which time any further wedging and compression fractures were recorded. Additional fractures occurred as follows: group E, 16%; F, 89%; E + F, 53%; and N, 67%. In comparison with group E, the occurrence of wedging or compression fractures was significantly higher in group F (p less than 0.001) and group E + F (p less than 0.01). This study suggests that a significantly higher number of vertebral compression fractures occur in patients with postmenopausal osteoporosis who followed a flexion exercise program compared with those using extension exercises. Extension or isometric exercises seem to be more appropriate for patients with postmenopausal osteoporosis.

Exercise Therapy↗
PubMed2002

Vertebral metastases: assessment with apparent diffusion coefficient.

The authors evaluated the apparent diffusion coefficient (ADC) in the assessment of vertebral metastases and acute vertebral compression fractures in 22 patients with known or suspected vertebral metastases. On the basis of significantly (P <.03) different ADCs, vertebral metastases (0.69 x 10(-3) mm2/sec) and pathologic compression fractures (0.65 x 10(-3) mm2/sec) can be safely distinguished from vertebral bodies (1.66 x 10(-3) mm2/sec) and benign compression fractures (1.62 x 10(-3) mm2/sec). Thus, the use of ADCs may increase the specificity of magnetic resonance imaging in these patients.

Echo-Planar Imaging↗
PubMed2006

Effectiveness of a self-adhesive resin luting system on fracture resistance of teeth restored with dentin-bonded crowns.

Laboratory studies have demonstrated satisfactory fracture resistance of all-ceramic crowns placed using a conventional resin-composite luting material and a dentine bonding system. This study investigated the fracture resistance of teeth restored with dentine-bonded ceramic crowns luted with a self-etching luting material. Standardized preparations were carried out on two groups of ten sound, unrestored, maxillary premolar teeth. Ceramic crowns were constructed, their internal surfaces etched and placed using two luting system combinations. Compressive fracture resistance was determined for each group using a Universal Testing Machine. Mean compressive fracture resistance of 890 (222) N and 760 (271) N were recorded for the RelyX Unicem Aplicap and Mirage groups, respectively. There was no significant difference in the mean compressive fracture resistance of the restored teeth in both groups (P<0.05). The failure modes were different for each cements with more severe (Mode V)failures associated with the Mirage group compared with the consistent Mode II failures associated with RelyX Unicem Aplicap. We conclude that the fracture resistance of dentine-bonded crowns luted with a self-adhesive resin-based luting material was no different from that of a conventional resin-based luting system. The fracture resistance of dentine-bonded ceramic crowns may be clinically satisfactory when a self-adhesive resin-based luting material is utilised.

Analysis of Variance↗
PubMed2001

A comparison of the mechanical properties of a gallium-based alloy with a spherical high-copper amalgam.

OBJECTIVES: The aim of the present study was to investigate how the mechanical properties of a palladium free gallium-based alloy (Galloy) compare with a leading spherical high-copper amalgam (Tytin). METHODS: Cylindrical specimens were mechanically condensed, according to the ISO 1559:1986 standard, to measure compressive strength, Vickers hardness, static creep and dimensional change on setting. Disc and beam shaped specimens were manually prepared to assess the diametral tensile and flexural strengths of the investigated alloys. RESULTS: The mean hardness, 1h compressive fracture strength, 24 h diametral tensile and 24h flexural strengths of Galloy were significantly lower (P<0.001) than Tytin. No significant differences in modulus of elasticity, creep, dimensional change on setting, 24 and 168 h compressive fracture strength for the two alloys were identified. SIGNIFICANCE: The significant reduction in the 1 h mean compressive fracture strength and hardness identified for Galloy compared with Tytin possibly indicate a slower setting reaction in the gallium-based alloy. Manual condensation of the gallium-based alloy produced specimens with inferior mechanical properties possibly due to the increased likelihood of introducing voids within the test specimens. Previous reports indicating poor corrosion resistance and moisture sensitivity of gallium-based alloys highlight the need for further research to investigate the effect of the oral environment on the gallium-based alloy.

Compressive Strength↗
PubMedDate not supplied

Evaluation of vertebroplasty with a validated outcome measure: the Roland-Morris Disability Questionnaire.

BACKGROUND AND PURPOSE: Vertebroplasty is rapidly disseminating as a treatment for vertebral compression fractures, but its efficacy has not been assessed with a well-validated, back pain-specific instrument. We report the use of the Roland-Morris Disability Questionnaire (RDQ) in patients undergoing vertebroplasty for painful osteoporotic compression fractures. METHODS: Retrospective review of patients treated with vertebroplasty who completed the RDQ and 2 verbal pain scales (0-10) for pain at rest and pain with activity at baseline, 1 week, 1 month, 6 months, and 1 year post-vertebroplasty. Changes in outcome measures were analyzed by using a paired t test and correlations were assessed with Spearman rho. Multiple linear regression was used to analyze the relationship between baseline scores and independent variables. RESULTS: One hundred thirteen patients were treated at 164 vertebral levels. At baseline, RDQ scores were associated with rest and activity pain (P < .001 and P = .002, respectively) but were not associated with other independent variables. All 3 outcome scores decreased by 1 week and remained improved through maximal follow-up (P < .001). RDQ scores improved by a mean of 7.0 points at 1 week and remained improved at 1 year (P = .02). RDQ scores correlated with both rest and activity pain, but the absolute correlation was slightly better (+0.15 on average) with activity pain. CONCLUSIONS: Patients who underwent vertebroplasty experienced relief of back pain and symptoms, as shown by improvement in verbal pain and RDQ scores. The RDQ correlates well with measures of pain, shows clinically significant improvement and is responsive to changes across time. More important, the RDQ provides an easily administered, well-validated, back pain-specific outcome measure that could be adopted to assess vertebroplasty outcomes.

Adult↗
PubMed2006

[Application of vertebroplasty, neuronavigation and kyphoplasty in the treatment of multiplex osteoporotic vertebral fractures--case report].

Vertebroplasty is a image-guided therapeutic procedure, consisting of an injection of acrylic cement through a bone biopsy needle into a vertebral body. Main indication for vertebroplasty is painful vertebral body compression fracture due to osteoporosis. The procedure is an efficient mean with high success in pain release and prevention of further collapse of the treated vertebrae; however, the technique does not allow to realign the spine. Kyphoplasty was designed to address the kyphotic deformity. It involves the percutaneous placement of an inflatable bone tamp into a vertebral body (VB). Restoration of VB height and kyphosis correction is achieved by inflation of the tamp with contrast material liquid. After deflation a cavity is created that eases the cement application. The most modern way of guidance in spinal surgery is neuronavigation--the use of frameless stereotaxy. The system reformats patient-specific CT images acquired prior surgery, performs image fusion with intraoperative plain X-ray. Before the operation, the surgeon may create surgical plan and simulate advancement of a virtual instrument along one or more surgical trajectories. During surgery, the system tracks the position of specialized surgical instruments. All three modalities mentioned above have been applied in the treatment of our patient suffered from multiple osteoporotic vertebral body compression fractures. Using kyphoplasty an almost total VB height restoration could be achieved. The pain relief was more than 50% after both operation.

Aged↗
PubMedDate not supplied

Intravertebral clefts opacified during vertebroplasty: pathogenesis, technical implications, and prognostic significance.

BACKGROUND AND PURPOSE: Intravertebral clefts have long been considered as pathognomonic for avascular necrosis and as a rare cause of compression fracture. We have observed unsuspected clefts opacifying frequently during vertebroplasty. Our purpose in this study was to determine the incidence of these clefts in symptomatic osteoporotic compression fractures, assess the sensitivity of MR imaging and conventional radiography in the detection of these clefts, and determine whether there is any prognostic significance of these clefts in patients treated with vertebroplasty. METHODS: Retrospective chart reviews were conducted of 135 vertebroplasty procedures performed during a 2-year period. MR images and conventional radiographs were reviewed for the presence of clefts defined as fluid-filled cavities on MR images or gas-filled cavities on conventional radiographs. Digital radiographs obtained at the time of the procedure were inspected for the presence of opacified clefts. Imaging findings were correlated with subjective pain scores documented before the procedure and at 1 week, 1 month, 6 months, and 12 months after vertebroplasty. RESULTS: Two hundred thirty-six osteoporotic compression fractures were treated with polymethylmethacrylate in 125 patients. Thirty-one and eight-tenths percent of the fractures were noted to contain clefts at the time of vertebroplasty. Fluid-filled clefts were detected on preoperative MR images in only 52.8% of the fractures with opacified clefts at vertebroplasty. Gas-filled clefts were evident on preoperative conventional radiographs in only 11.4% of the fractures with opacified clefts at vertebroplasty. No significant difference was noted in numerical pain scores between the two populations at baseline or 1 week or 1 month after the procedure. Pain scores at 6 and 12 months after vertebroplasty showed a trend toward greater pain relief in patients with clefts, although the difference was not statistically significant. A sustained, statistically significant decrease in pain scores after treatment (P <.01) was noted in both groups. CONCLUSION: Intravertebral clefts are much more common than previously described and probably represent fracture nonunions. Imaging is not sensitive in detecting these clefts before vertebroplasty. We advocate complete filling of the cleft with cement during vertebroplasty to maximize stabilization of the fracture fragments. There is a trend toward greater pain relief being achieved 6 and 12 months after the procedure in patients with clefts that are opacified at the time of vertebroplasty.

Aged↗
PubMed1982

Bone mineral content of the lumbar spine in normal and osteoporotic women: cross-sectional and longitudinal studies.

1. Bone mineral content of the second, third and fourth lumbar vertebrae was determined in normal women and women with clinical osteoporosis by using dual-photon (153Gd) absorption. 2. A cross-sectional study of 70 normal (aged 19-88 years) showed a bone loss of 44% from the age of around 34 years throughout life. 3. Longitudinal data from 59 normal women confirmed that the vertebral bone loss started before the menopause. An accelerated bone loss amounting to nearly 6% per year was seen immediately after the menopause. The bone loss of older women was slower. 4. Mean lumbar bone mineral content of 36 women (aged 48-93 years) with recent fractures of their femoral neck after minor trauma equalled that of aged-matched normal women. Lumbar bone mineral content of the women with intratrochanteric femoral neck fractures was lower than that of the women with medial femoral neck fractures. 5. Mean lumbar bone mineral content of 72 women (aged 58-59 years) with primary osteoporosis was 41% lower than that of normal premenopausal women and 18% lower than that of age-matched controls. A weak inverse relationship between lumbar bone mineral content and the number of compression fractures was found. A weak inverse relationship between lumbar bone mineral content and the number of compression fractures was found. 6. Women with lumbar bone mineral content values below the 95% confidence limits for normal premenopausal women are at risk of future vertebral compression fractures, the fracture risk being inversely related to lumbar bone mineral content.

Adult↗
PubMed2005

The monotonic and fatigue properties of osteoporotic thoracic vertebral bodies.

STUDY DESIGN: Measurement of the monotonic and fatigue properties of osteoporotic thoracic vertebral bodies. OBJECTIVES: To determine the loading values at which osteoporotic vertebral bodies are susceptible to failure. SUMMARY OF BACKGROUND DATA: Vertebral compression fractures are the most common osteoporotic fracture. Eighty-three percent of vertebral compression fractures are caused by moderate or less trauma, and there is not a specific traumatic event in 59% of these cases. Fatigue loading can lead to premature failure, although the relationship between loading and cycles to failure is not well established. METHODS: Eighteen osteoporotic thoracic vertebral bodies were tested in monotonic compression to determine the correlation between the bone mineral content and the ultimate compressive load. Seventeen osteoporotic thoracic vertebral bodies were cyclically loaded at varying percentages of the ultimate compressive load until failure to determine the relationship between loading and fatigue life. RESULTS: The bone mineral content was linearly correlated with ultimate compressive load. Based on our regression analysis, a 10% decrease in bone mineral content will lead to an approximate 10% decrease in ultimate compressive load. The percentage of ultimate compressive load was inversely correlated to the logarithm of cycles to failure, with specimens loaded at 60%, 70%, and 80% of ultimate compressive load lasting on average 5.6 x 10, 4.0 x 10, and 31 cycles to failure, respectively. CONCLUSIONS: The bone mineral content is a strong predictor of the ultimate compressive load, while the percentage of the ultimate compressive load is a strong predictor of the cycles to failure for osteoporotic thoracic vertebral bodies.

Adult↗
PubMed2006

The biomechanical effect of vertebroplasty on the adjacent vertebral body: a finite element study.

The increased use of vertebroplasty for the treatment of osteoporotic vertebral compression fractures has led to concerns that the technique may increase the risk of fracture in the adjacent vertebrae. The aim of this study was to simulate the biomechanical effects of vertebroplasty using an osteoporotic two-vertebrae finite element model. Following a simulated compression fracture, the model was augmented with one of three volumes of PMMA-based cement or left untreated. Upon reloading, an increase in segment stiffness was found with increasing volumes of cement. However, in all the treated models there was an increase in endplate deflection into the adjacent vertebra causing plastic failure of the surrounding trabecular bone. More damage was caused in the adjacent vertebra of the treated models than in the untreated model. The model results suggest that clinicians should be wary of using standard vertebroplasty cements to treat compression fractures in patients with highly osteoporotic bone.

Animals↗
PubMed1987

Pinhole collimator scintigraphy in differential diagnosis of metastasis, fracture, and infections of the spine.

The informational gains obtained by the use of pinhole collimator scintigraphy (PCS) have been well documented. The present study has been undertaken to prospectively investigate its efficacy in diagnosing several commonly occurring spinal diseases. Patient material consisted of metastatic cancer (39 vertebrae), compression fractures (33 vertebrae), tuberculous spondylitis (17 vertebrae), and pyogenic spondylitis (six vertebrae). PCS findings were characterized in terms of localization, appearance, and homogeneity of abnormal radionuclide accumulation. Thus, metastatic cancer manifested as diffusely or focally homogeneous accumulation within the vertebral body or as a typical short-segmental accumulation along the end-plate, whereas compression fracture manifested as characteristic board-like accumulation along the entire length of end-plates. Tuberculous spondylitis, on the other hand, revealed homogeneous accumulation throughout the vertebral body, and pyogenic spondylitis revealed accumulation at the end-zone of opposing vertebral bodies giving sandwich-like appearance. The disk space at the affected level was not narrowed in the former two diseases but it was narrowed in the latter two. It was concluded that PCS may be useful in differentiating metastatic cancer, compression fracture, tuberculous spondylitis, and pyogenic spondylitis.

Adult↗
PubMed1999

[Osteosynthesis of subcondylar fractures using compression screws with the Eckelt technic. Experiences and difficulties with the technic over 5 years].

With creation of new fixation material, the surgical treatment of displaced subcondylar fractures is most frequently used in adults. The Eckelt compression osteosynthesis is described as an easy procedure in the current literature, but, in our experience, several problems require our attention. We report the treatment of 57 patients with displaced subcondylar fractures where compression osteosynthesis was indicated. The difficulty of this technique is presented on the basis of a 5-years experience.

Adult↗