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PubMed1994

Association of severe haemophilia A with osteoporosis: a densitometric and biochemical study.

Following a femoral neck fracture and vertebral compression fractures in two patients with severe haemophilia A, bone density and turnover were measured in 19 males with severe haemophilia A (all HIV negative, 18/19 hepatitis C antibody positive) and in 19 age/sex matched controls. Bone density at the lumbar spine (L2-4), measured by dual energy X-ray absorptiometry, was significantly lower in the haemophiliac patients (HPs) at (mean +/- SEM) 1.109 +/- 0.042 g/cm2 vs. 1.234 +/- 0.027 in controls; p = 0.018. Femoral neck density was also lower at 0.877 +/- 0.034 g/cm2 (HPs) vs. 1.067 +/- 0.032; p < 0.0005. No significant differences were evident between the groups for serum calcium, parathyroid hormone, luteinizing hormone, follicle-stimulating hormone or 1,25 dihydroxyvitamin D3, nor for fasting urinary hydroxyproline, pyridinoline or deoxypyridinoline excretion. Serum total alkaline phosphatases was elevated in HPs at 200 +/- 10 U/l vs. 158 +/- 8; p = 0.004. Similarly, gamma-glutamyl transferase was elevated at 42 +/- 7 U/l (HPs) vs. 20 +/- 2; p = 0.007. Serum total testosterone and sex-hormone-binding globulin (SHBG) were higher in HPs at 26 +/- 2.5 nmol/l vs. 17.4 +/- 1.6 (p = 0.009) and 56 +/- 6 nmol/l vs. 27 +/- 3 (p = 0.0005), respectively. Free androgen index, however, was lower in HPs at 44 +/- 5 vs 69 +/- 7; p = 0.008. These results suggest significant osteopenia associated with haemophilia A. This may be partly due to liver dysfunction in HPs, but other factors, e.g. relative immobilization, may also be relevant.

Absorptiometry, Photon↗
PubMed1998

Spine injuries associated with falls from hunting tree stands.

Spinal injuries resulting from falls out of tree stands are often associated with concomitant neurologic deficit, prolonged hospitalization, and long-term disability. The purpose of this study was to review the types of spinal injuries that resulted from falls from hunting tree stands. We retrospectively reviewed 27 patients who came to our institution for treatment of spine injuries related to tree-stand accidents between 1981 and 1997. Eleven percent of the falls were alcohol related. Mean height of the fall was 19.6 feet (range, 10 to 35 feet). There were 17 burst fractures, 8 wedge compression fractures, 4 fractures involving the posterior elements, and 1 coronal fracture of the sacral body. Significant neurologic injury occurred in 12 patients (44%). Sixteen patients (59%) had associated injuries. Nine patients (33%) had open reduction, internal fixation, and fusion of their spine fractures. One patient was treated with a halo jacket. The remaining patients were treated in rigid, molded, polypropylene thoracolumbar orthoses or lumbosacral corsets. Accidental falls from tree stands may result in significant spinal fractures often associated with concomitant neurologic injury, extended hospitalization, and permanent disability. Many of these injuries may be prevented through aggressive hunter safety education.

Accidental Falls↗
PubMed1992

[The nuclear magnetic resonance tomographic differentiation of osteoporotic and tumor-related vertebral fractures. The value of subtractive TR gradient-echo sequences, STIR sequences and Gd-DTPA].

42 patients with known malignancy and vertebral compressions underwent MRI. Sagittal T1-weighted spin-echo images pre and post Gd-DTPA, out of phase long TR gradient-echo images (GE) and short T1 inversion recovery images (STIR) were obtained at 1.0 T. The results were confirmed by histology (6/42) or clinical data (28/42) and follow up MRI studies (8/42). In 39 of 42 cases a correct differentiation between osteoporotic and tumorous vertebral compression fractures was possible by quantification and correlation of SE and GE signal intensities. Gd-DTPA did not improve differential diagnosis, since both tumour infiltration and bone marrow oedema in acute compression fracture showed comparable enhancement. STIR-sequences were most sensitive for pathology but unspecific due to a comparable amount of water in tumour tissue and bone marrow oedema. Susceptibility-induced signal reduction in GE images and morphologic criteria proved to be most reliable for differentiation of benign and tumour-related fractures. In the rare cases of single and nearly complete vertebral compressions with complete loss of bone marrow, differentiation with MRI was not possible.

Contrast Media↗
PubMed2004

Biomechanical analysis of the mechanism of elbow fracture-dislocations by compression force.

Fracture-dislocations of the coronoid and olecranon were produced experimentally, and their onset mechanisms were analyzed to clarify the effects of compression force on the coronoid and olecranon. The study used two-dimensional finite element method (2D-FEM) simulations and static loading experiments. The latter applied axial force distally to 40 cadaveric elbows. Posterior fracture-dislocations occurred between 15 degrees of extension and 30 degrees of flexion, anterior or posterior fracture-dislocations at 60 degrees, and only anterior fracture-dislocations at 90 degrees. Injuries were mainly to anterior or posterior support structures. The 2D-FEM simulations showed that the stress concentration areas moved from the coronoid process to the olecranon as position changed from extension to flexion. The very high frequency of concurrent fracture-dislocations of radial head or neck in the current study indicated that the radial head may also function as a stabilizer in the anterior support system.

Aged↗
PubMed2005

Acute posttraumatic paraplegia associated with asymptomatic thoracic meningioma.

A case of a patient with acute paraparesis after compression fracture of the twelfth vertebra with progressive neurological deterioration is reported. The occurrence of clinical asymptomatic thoracic meningioma and coincidence with posttraumatic compression fracture of the vertebra at the same level resulting in acute paraparesis is extremely rare.

Acute Disease↗
PubMed2005

Percutaneous vertebroplasty and facet joint block.

It is surprising that about 24% of patients with benign osteoporotic vertebral fracture die within a year from respiratory infection and urinary tract infection because of coughing and voiding difficulties, depending on the sites of compression fractures. We reviewed 500 patients on whom percutaneous vertebroplasty (PVP) was performed, at 612 levels in terms of patient selection, operation technique, medication, and clinical outcomes during the follow-up course for 2 yr study period. To confirm the most painful level among the multiple fracture sites, physical examination after facet joint block under the fluoroscope was the most reliable method. The mean total lumbar spine fracture threshold of bone mineral density was 0.81+/-0.05 g/cm2. The mean changes of numeric rating scale scores, Oswestry Disability Index except sex life, and Karnofsky performance status were -72.00, -83.50 and +60.62% in the osteoporosis group and -51.89, -45.02, and 69.03% in the tumor group. Complications related to the procedure were lateral spinal cord damage, transient paresthesia and transient hypotension. PVP with facet joint block is a profitable method for the vertebral compression fracture because of low risk and short duration of procedure with a high chance to result in pain relief and early mobilization.

Aged↗
PubMedDate not supplied

Spinal cord compression induced by steroid therapy: CT findings.

Long-term steroid therapy has many well documented complications. Both epidural fat deposition and vertebral compression fractures are among such complications. We report two cases in which acute paraplegia occurred following compression fracture without retropulsion of bone fragments or significant narrowing of the spinal canal. However, both patients had abnormally large epidural fat deposits as an underlying and contributing condition. Therapy to relieve the compression was disappointing.

Adrenal Cortex Hormones↗
PubMed1992

[Results after conservatively managed vertebral fractures of the thoracolumbar level with special reference to bony stenosis of the spinal canal].

Seventy-two patients with compression fractures of the lower thoracic and lumbar spine who were treated by the Böhler method from 1972 to 1987 were followed up to compare the clinical signs and the results of conventional radiography and spinal computed tomography. There were 33 men and 39 women with an average age of 44.3 years (23-69 years). Treatment by the Böhler method is indicated for fractures between T12 and L5, which constitute 60% of all vertebral fractures. The main distribution in our patients was T12 (n = 26) and L1 (n = 33). Four patients primarily had neurological symptoms. The mean duration of hospitalization was 16 days (4-54). In our results, back pain is the most frequent complaint. A comparison with the findings on the day of the accident showed that the vertebral deformity decreased in all cases (index: mean accident = 0.64; mean follow-up = 0.82). In the CT scan we found spinal stenosis in up to 30% in 9 patients (12.5%) with no neurological symptoms. Based on these results, the authors recommend the Böhler method in lower thoracic and lumbar compression fractures without neurological symptoms. The main aim of the treatment must be reduction of the vertebral deformity to a minimum in order to maximize the biomechanical integrity of the vertebral column and prevent degenerative changes. The use of computed tomography is recommended even in these fractures because of possible spinal stenosis. CT is accurate, especially in evaluating the nature of facet joint failure.

Adult↗
PubMed2002

Vertebroplasty in the mid- and upper thoracic spine.

BACKGROUND AND PURPOSE: Vertebroplasty performed in the mid- and upper thoracic spine presents technical challenges that differ from those in the lower thoracic and lumbar region. We herein report results of percutaneous vertebroplasty for treatment of painful, osteoporotic compression fractures in the mid- and upper thoracic spine. METHODS: Retrospective chart review identified vertebroplasty treatments performed for painful osteoporotic compression fractures at T4-T8. The following were catalogued: percentage of vertebral body compression, needle size, surgical approach, clinical outcome, volume of cement injected, and complications. RESULTS: Sixty-three vertebral bodies were treated in 41 patients. Mean percentage of compression was 44%. Bipediculate injections were used in 12 (19%) of 63 treatment levels, and unipediculate injections were used in 51 (81%) of treatments (75 injections performed). Eleven-gauge needles were used for 55 (73%) of the 75 injections, and 13-gauge needles were used for 20 (27%). Clinical follow-up was available for 76% of the patients. Mean pre- and postoperative pain intensity was 9.7 +/- 1.0 and 1.7 +/- 1.9, respectively (P <.0001). Mean pre- and postoperative medication scores were 3.4 +/- 0.7 and 1.7 +/- 1.7, respectively (P =.075). Fracture involving the pedicle used for needle access was noted in one (1.3%) of 75 injections; this pedicle had been traversed using a 13-gauge needle. Staphylococcus epidermidis infection occurred in one case. No cases of pneumothorax were noted. CONCLUSION: Transpedicular vertebroplasty is readily and safely performed using 11-gauge needles in the mid- and upper thoracic regions, yielding excellent pain relief and low complication rates.

Aged↗
PubMed1986

The plantar ecchymosis sign in fractures of the calcaneus.

The appearance of a central plantar ecchymosis is not an uncommon occurrence 24-48 hours after a compression fracture of the calcaneus. In order to understand the development of this characteristic ecchymosis, the authors studied the anatomy of the fascial compartments in five adult cadaveric feet. The anatomic basis for the plantar ecchymosis sign is demonstrated through dissection of the three osteofascial compartments within the sole of the foot. Dye injected into the central compartment overlying the calcaneal tuberosity reproduces the observed clinical sign. The specificity of this sign for compression fractures of the calcaneus makes it a useful clinical observation in cases where the diagnosis of fracture is uncertain.

Calcaneus↗
PubMed1980

Experimental and clinical studies on differential diagnosis of bone diseases with nucleomedical procedures.

This report is a study of the differential diagnosis of bone diseases using nucleomedical procedures. Experimental and clinical studies on the accumulation of 201Tl and 67Ga in bone inflammation and bone tumors were performed. Also, the degree of deposition of 99mTc-phosphorous compounds represented as a color difference was evaluated for a differentiation between malignant and benign diseases of the spine and shoulder. Uptake of 201Tl in inflammation of the spine and in tumor of the pelvis of rabbits was very low, while that of 67Ga was high. Uptake of 67Ga decreased gradually with lapse of time after the onset of inflammation. These experimental results agreed with clinical studies. The detectability of malignant tumors with 201Tl was inferior to that with 99mTc-label and 67Ga, although osteolytic lesions were occasionally 201Tl-positive. In terms of color range, the difference was 2 or less in spines of normal subjects and 3 or more in the metastatic bone disease and compression fracture. This difference was not statistically significant. Since 67Ga scan was occasionally negative in compression fracture, a differentiation was considered to be possible in such a case. A combined study of bone imaging with 99mTc-phosphorous compound including color difference, 67Ga imaging, bone-marrow imaging and radiography are considered to be helpful for the differentiation.

Animals↗
PubMed2002

How should clinicians manage osteoporosis in ankylosing spondylitis?

Osteoporosis is a common complication of AS, with an incidence between 18.7% and 62%. The prevalence of osteoporosis is greater in males, and increases with increasing patient age and disease duration. Osteoporosis is also more common in patients with syndesmophytes, cervical fusion, and peripheral joint involvement. These variables are not all independent, as they may be indicators of disease duration. Osteoporosis in patients with AS is largely confined to the axial skeleton, in contrast to the pattern of osteoporosis seen in rheumatoid arthritis. BMD at the lumbar spine and femoral neck may be severely reduced, while most studies indicate that carpal and radial BMD remain within normal limits. The development of syndesmophytes in late AS can lead to difficulties in the use of DEXA scanning to determine lumbar BMD, as the extraspinal bone may obscure osteoporotic vertebrae. Under these circumstances more accurate assessment of lumbar BMD, and one that correlates better with femoral neck BMD, may be obtained by quantitative CT scanning or DEXA scanning of the lateral aspect of the L3 vertebra. Osteoporosis in AS significantly increases the risk of vertebral compression fractures within 5 years of the diagnosis of AS. The risk of a vertebral compression fracture occurring over a 30 year period following the diagnosis of AS is 14%, compared to 3.4% for population controls. In patients with vertebral osteoporosis relatively minor trauma, such as slipping, can lead to spinal fracture and dislocatior with subsequent damage to the spinal cord. There is a higher incidence of spinal cord injury following spinal fracture dislocations in patients with AS, and the resulting neurological deficit can range from mild sensory loss to complete paraplegia. Cytokines such as TNF-alpha and IL-6 may play an important part in the pathogenesis of osteoporosis in early AS, and IL-6 levels have been correlated with markers of disease activity and severity. In late AS, mechanical factors such as decreased mobility and the support provided by extraspinal bone may play a role in vertebral osteoporosis. Screening patients with AS for the presence of osteoporosis is an important, but contentious subject. This and subsequent monitoring needs to be considered in all patients, but longterm studies are needed to determine with confidence which patients should undergo screening, by which methods, and how often. The treatment of osteoporosis in AS is at present similar to that used for primary osteoporosis, except that due to the male predominance and a relatively young age of patients, there is a limited role for hormone replacement therapy. Exercise regimens and bisphosphonates are widely used, but a study of the relative efficacy of different bisphosphonate agents in patients with AS is required.

Absorptiometry, Photon↗
PubMed2005

The effect of intermittent pneumatic compression on fracture healing.

OBJECTIVES: Continuously increased venous pressure has been shown to enhance bone growth, stimulate fracture healing, and prevent bone loss, but also causes soft-tissue breakdown as a result of chronic edema. This study was designed to test the hypothesis that intermittently increased venous pressure improves fracture healing without injuring soft tissue. DESIGN: An ostectomy was created in the right radius of 30 skeletally mature male beagles. On postoperative day 7, a pneumatic cuff was placed around the forelimb of each dog. In experimental animals (n = 13), the cuff compressed for 5 minutes followed by no compression for 2.5 minutes. This cycle was repeated 100 times per day for 8 weeks. Control animals (n = 15) wore a nonfunctional cuff. Fracture healing was assessed with dual-energy x-ray absorptiometry, histologic analysis, and biomechanical testing. RESULTS: No soft-tissue complications were noted. Bone mineral content at the ostectomy increased significantly more in the experimental group than in the control group (P < 0.05). Histology revealed that the bone defects in the experimental group were significantly more healed than those in the control group (P < 0.005). No differences were noted between groups in the biomechanical properties of the healing bones. CONCLUSIONS: Intermittently increased venous pressure proximal to a bone defect seems to enhance the formation of new bone without soft-tissue complications. These findings can potentially be applied to the clinical treatment of "difficult to heal" fractures. Further work is necessary to determine the most effective ratio of the presence and absence of pneumatic compression.

Absorptiometry, Photon↗
PubMed1979

A biomechanical comparison of the effects of constant and cyclic compression on fracture healing in rabbit long bones.

In a biomechanical study, the strength of healing experimental fractures in rabbit tibias was compared for two different healing environments. During the healing period large constant compression was applied to one leg, while the other leg was subjected to cyclic compression forces. Rabbits were sacrificed at 3, 4, 5, 6, and 8 weeks after the operation. The healing bones were tested in a dynamic torsion testing machine. Results indicate that on an average basis the cyclic compression treated bones exhibited higher torque and energy absorption to failure, but lower stiffness as compared with the constant compression treated bones, during the 30 to 50 days' healing period. These differences were statistically significant. Additionally, it was estimated that a 27 per cent saving in healing time may be realized for a bone treated with cyclic as compared with constant compression.

Animals↗
PubMed1997

Injury of the posterior ligament complex in patients with acute spinal trauma: evaluation by MR imaging.

OBJECTIVE: We undertook this study to use MR imaging to determine the frequency of injury to the posterior ligament complex of the thoracolumbar spine in patients who have undergone acute thoracolumbar trauma. SUBJECTS AND METHODS: Sixty-eight patients with varying severity of thoracolumbar trauma were examined prospectively. The majority of injuries were related to motor vehicle accidents. The second most common cause was falls. Patients were examined with plain radiography and MR imaging. In addition to conventional MR imaging sequences consisting of T1-weighted and fast spin-echo T2-weighted sagittal and axial images, a fat-suppressed T2-weighted sagittal sequence was performed. The findings were correlated with surgery in six cases and with follow-up clinical examination that included physical examination and conventional anteroposterior and lateral radiographs. RESULTS: Posterior ligament complex injury was detected in 53% (n = 36) of all patients. Such injury was most common in patients with flexion-distraction (n = 15) and patients with dislocation fracture (n = 4). Of the patients with dislocation fracture, all had posterior ligament complex injury. Of the 24 patients with burst fractures, posterior ligament complex tear occurred in 42% (n = 10). Of the 23 patients with compression fractures, 26% (n = 6) had posterior ligament complex tear. Injury to the interspinous ligaments occurred with decreasing frequency in patients with injury to the supraspinous ligament, flaval ligaments, posterior longitudinal ligament, and anterior longitudinal ligament. Surgical findings correlated with MR imaging in all six patients who underwent surgery. CONCLUSION: Injury to the posterior ligament complex, which is often encountered in patients with burst and compression fractures, can be reliably revealed by MR imaging.

Adult↗
PubMed2004

Magnetic resonance imaging characteristics of benign and malignant vertebral fractures.

BACKGROUND: Attempts to differentiate benign and malignant vertebral fractures may be difficult, particularly when there is no obvious evidence of malignancy. Since early diagnosis and appropriate management of malignant vertebral fractures are important, a reliable imaging modality is required. METHODS: From January 1996 to December 2002, 48 patients with malignant vertebral fractures and 50 patients with benign processes were studied. All patients underwent conventional magnetic resonance imaging (MRI) scanning for acute vertebral compression fractures within 2 months of presenting with the complaint. Seven MRI characteristics were used as criteria, including signal intensity, gadolinium enhancement, epidural compression, multiple compression fractures, associated paraspinal soft tissue mass, pedicle involvement, and posterior element involvement. The predictive value of each MRI characteristic for distinguishing malignant from benign osteoporotic vertebral fractures was tested by statistical analysis. RESULTS: Lesions with negative gadolinium enhancement were favored as benign fractures. A uniform signal change in multiple involved vertebra lesions, round, smooth margins with marked epidural compression, a paraspinal soft tissue mass, and pedicle and posterior element involvement were probable malignant characteristics. Among them an associated paraspinal soft tissue mass was found to be significant in predicting the probability of malignancy. CONCLUSIONS: Certain MRI characteristics allow early differentiation of benign and malignant vertebral fractures.

Adult↗
PubMed1987

The posterior vertebral body line: importance in the detection of burst fractures.

A review of the lateral radiographs and CT studies of 114 patients with burst fractures, 46 patients with combined injuries in whom bursting was a major component, and 82 patients with simple anterior compression fractures was performed to evaluate the integrity of the posterior vertebral body margin. This structure normally produces a single or bifid vertical line on the lateral radiograph. Disruption, displacement, or rotation of this line was found in all 114 patients with "pure" burst fractures. These abnormalities were also present in 36 of the 46 patients with combined burst injuries. In all patients with simple compression fracture, flexion, distraction or dislocation, and extension injuries, the line was normal. CT studies showed these abnormalities to be the result of retropulsion of one or more bone fragments from the posterior margin of the vertebral body. Disruptive abnormalities of the posterior vertebral body line are reliable plain-film signs that a burst fracture has occurred and that compromise of the vertebral canal and subarachnoid space is present.

Cervical Vertebrae↗