[TREATMENT OF ACUTE RENAL FAILURE IN A PATIENT WITH MULTIPLE BONE FRACTURES AND COMPRESSION OF SOFT TISSUES].
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Acute Kidney Injury↗
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Results for “Fractures, Compression”
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[Regeneration of bone tissue in femoral neck fractures with compression metallo-osteosynthesis (experimental study)].
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Animals↗
Associated aortic rupture-pelvic fracture: an alert for orthopedic and general surgeons.
Blunt trauma patients with pelvic fractures have been shown to have a two-fold to five-fold increased risk of aortic rupture compared with the overall blunt trauma population. A retrospective review was performed to determine whether the relationship between aortic rupture and pelvic fracture could be further delineated using a pelvic fracture classification based on mechanism of injury. Of 4,157 consecutive blunt trauma patients, 371 (8.9%) had pelvic fractures, 34 (0.8%) had ruptured thoracic aortas and 12 had both injuries. When pelvic fractures were classified according to vector of force, 10 of 12 (83%) aortic ruptures occurred in patients with an anterior-posterior compression fracture pattern, an incidence of aortic rupture eight times greater than that of the overall blunt trauma population. There was no increased incidence of aortic rupture among patients with any other pelvic fracture pattern. We conclude that the previously reported association between aortic rupture and pelvic fracture can be further specified to include, predominantly, those patients with an anterior-posterior compression fracture pattern.
Adolescent↗
Bone mineral density in ankylosing spondylitis.
Vertebral osteoporosis is a well-recognized feature of ankylosing spondylitis (AS) and also the vertebral compression fractures due to osteoporosis are a common but frequently unrecognized complication of AS. Both may contribute to the pathogenesis of spinal deformity and back pain. The aim of this study was to measure vertebral and femoral neck bone mass in patients with AS by dual photon absorptiometry, to determine the prevalence of compression fractures and to examine the relationship between bone density and disease severity. We found that the bone mass was diminished in the lumbar spine in moderate AS versus mild forms but the patients with advanced disease had the highest BMD values. Examination of spinal radiographs revealed compression and biconcave fractures in 9 (40.9%) cases. Neither the duration of the disease and the degree of sacroiliitis, nor the disease activity assessed by laboratory and clinical parameters was found to significantly affect the results.
Absorptiometry, Photon↗
Vertebrae adjacent to spinal bone lesion are inconsistent reference markers: a magnetic resonance spectroscopic viewpoint.
PURPOSE: To ascertain the suitability of vertebrae adjacent to spinal bone lesions as a signal intensity reference on MRI, and compare the MR spectroscopic appearance of vertebral body compression fractures due to malignant tumor infiltration, bone weakening (e.g., osteoporosis), and/or minor trauma. MATERIALS AND METHODS: Twenty-five patients with spinal compression fractures underwent routine spinal MRI with an additional 1H MRS study protocol to assess the percent fat fraction of the compressed vertebrae as well as the adjacent bony environment. Peak areas for water and total lipid were calculated from short-TE single-voxel 1H MR spectra using the LCModel analyzing tool. RESULTS: There were consistent water-only patterns in the fractured vertebra suggesting either near complete marrow replacement by malignant tissue or local edematous fluid/hemorrhage within the marrow spaces. However, the adjacent vertebrae showed a wide range of patterns from a dominant lipid signal to the inverse of a pronounced water level. These results far exceed the normal variation expected based on age and sex. CONCLUSION: The results suggest that the adjacent vertebrae may not be an accurate reference, especially in diffusion-weighted imaging (DWI), because of the large difference between the two compartments. Furthermore, in the case of gradient-echo measurements, the in-phase vs. opposed-phase effects are significant.
Adult↗
Long-term effects of vertebroplasty: adjacent vertebral fractures.
In today's aging population, osteoporosis-related fractures are an ever-growing concern. Vertebroplasty, a promising yet cost-effective treatment for vertebral compression fractures, has an increasing role. The first vertebroplasty procedures were reported by Deramond and Galibert in France in 1987, and international interest grew with continued development of clinical techniques and augmentation materials in Europe and the United States. Initial publications and presentations at peer review meetings demonstrated 60-90% success rates in providing immediate and significant pain relief. The objective of this review is to assemble experimental and computational biomechanical research whose goal is determining and preventing the negative long-term effects ofvertebroplasty, with a specific focus on adjacent vertebral fractures. Biomechanical studies using isolated cancellous bone cylinders have shown that osteoporotic cancellous bone samples augmented by the rigid bone cement were at least 12 times stiffer and 35 times stronger than the untreated osteoporotic cancellous bone samples. The biomechanical efficacy of the procedure to repair the fractured vertebrae and prevent further collapse is determined using single-vertebra models. The strength or load-bearing capacity of a single vertebra is significantly increased following augmentation when compared to the intact strength. However, there is no dear result regarding the overall stiffness of the single vertebra, with studies reporting contradictorily that the stiffness increases, decreases, or does not significantly alter following augmentation. The effects of vertebroplasty on adjacent structures are studied via multisegment models, whose results plainly oppose the findings of the single-vertebra and intravertebral models. Here, augmentation was shown to decrease the overall segment strength by 19% when compared to the matched controls. As well, there is a significant increase in disc pressure compared to the pre-augmentation measurements. This translates to a high hydrostatic pressure adjacent to the augmented vertebra, representing the first evidence of increased loading. Computational finite element (FE) models have found that the rigid cement augmentation results in an increase in loading in the structures adjacent to the augmented vertebra. The mechanism of the increase of the loading is predicted to be the pillar effect of the rigid cement. The cement inhibits the normal endplate bulge into the augmented vertebra and thus pressurizes the adjacent disc, which subsequently increases the loading of the untreated vertebra. The mechanism for adjacent vertebral fractures is still unclear, but from experimental and computational studies, it appears that the change in mechanical loading following augmentation is responsible. The pillar effect of injected cement is hypothesized to decrease the endplate bulge in the augmented vertebra causing an increase in adjacent disc pressure that is communicated to the adjacent vertebra. To confirm the viability of the pillar effect as the responsible mechanism, endplate bulge and disc pressure should be directly measured before and after augmentation. Future studies should be concerned with quantifying the current and ideal mechanical response of the spine and subsequently developing cements that can achieve this optimum response.
Biomechanical Phenomena↗
The treatment of osteoporotic-posttraumatic vertebral collapse using the Kaneda device and a bioactive ceramic vertebral prosthesis.
Twenty-two patients with neurologic deficit due to delayed posttraumatic vertebral collapse after osteoporotic compression fractures of the thoracolumbar spine underwent anterior decompression and reconstruction with bioactive Apatite-Wollastonite containing glass ceramic vertebral prosthesis and Kaneda instrumentation. Eighteen patients previously had minor trauma that resulted in a mild vertebral compression fracture without any neurologic involvement and were either conservatively treated or not treated at all. Four had no history of back injury. The preoperative neurologic status was incomplete paralysis in all patients. The average age at surgery was 66 (53-79) years. The average follow-up was 34 (20-58) months after surgery. All patients had returned to their daily living with neurologic recovery and stable spine. This type of anterior procedure is effective in the osteoporotic patients and there was a very low incidence of instrumentation failure and very low morbidity.
Aged↗
The healing of experimental fractures by compression osteosynthesis. II. Morphometric and chemical analysis.
The effects of rigid plate fixation on the structure and chemical composition of bones during healing of experimental fractures were studied by morphometric and chemical analysis at intervals of 3 to 24 weeks after attachment of six-hole AO plates to osteotomized rabbit tibiae. After fracture union gradual porotic transformation could be observed from 9 weeks onwards, with rapid excavation and breakdown of the cortical wall. During the study over 24 weeks the degree of porosity increased from 9.0 +/- 4.8 per cent to 37.5 +/- 10.2 per cent (P less than 0.001). This osteoporosis was accompanied by formation of new subperiosteal bone. The changes in the tubular bone led to a progressive increase in overall diameter and in the area occupied by the medullary cavity throughout the experiment. In the osteotomy area increased values were found for the content of hexosamines and the ratio of hexosamines to hydroxyproline at 3 weeks, indicating formation of connective tissue in the fracture area. Later on, no chemical signs of callus formation could be detected. In spite of the slight increase in the content by hydroxyproline, reflecting the formation of new bone subperiosteally, the chemical composition of the unresorbed cortical bone remained unchanged.
Animals↗
Bone mineral density of the lumbar spine by dual photon absorptiometry: age-related regression in normal Japanese subjects and fracture threshold in osteoporotics.
The bone mineral density (BMD) of the lumbar spine was determined by DPA in 280 normal Japanese volunteers and 11 osteoporotic women with compression fractures. In women, bone loss started from the mid thirties and accelerated after the age of 50 years at the rate of 0.75% (0.0074 g/cm2) per year. In men, bone loss started from the mid twenties and occurred linearly at the rate of 0.30% (0.0032 g/cm2). The overall diminutions in vertebral BMD throughout life in men and women were 13.0% and 24.3%, respectively. The mean vertebral BMD of the osteoporotic women with recent compression fractures was 37.5% lower than that of age-matched controls. The 90th percentile for vertebral BMD in this group was 0.584 g/cm2. By the age of 80 years, approximately one-fifth of normal Japanese women have BMD values less than this.
Adult↗
[X-ray characteristics of the union of intra- and periarticular fractures in compression osteosynthesis].
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Animals↗
Value of bone scan imaging in predicting pain relief from percutaneous vertebroplasty in osteoporotic vertebral fractures.
BACKGROUND AND PURPOSE: Patient selection for percutaneous vertebroplasty is often complicated by the presence of multiple fractures or non-localizing pain. Our purpose was to determine whether increased activity revealed by bone scan imaging is predictive of a positive clinical response to percutaneous vertebroplasty. METHODS: A retrospective chart review conducted at our institution yielded 28 vertebroplasty treatment sessions that had been performed after obtaining bone scan imaging for painful, osteoporotic compression fractures in 27 patients. Thirty-five compression fractures were treated during these 28 treatment sessions. In all cases, increased activity was revealed by bone scan imaging before treatment with vertebroplasty. Positive outcome was defined as subjective decrease in pain severity and/or increased level of patient mobility. RESULTS: Subjective pain relief was noted in 26 (93%) of 28 treatment sessions. In 14 (100%) of 14 cases with quantifiable pain levels, pain improved at least 3 points on a 10-point scale (range of improvement, 3-10 points; mean improvement, 7.4 points). Among the remaining 14 treatment sessions in which patients were unable or unwilling to quantify pain severity, the pain relief was described as complete or excellent pain relief in 11 (78%) of 14 cases. In 14 (100%) of 14 cases for which semiquantitative assessment of mobility was available, mobility improved at least one level (5-point graded scale; range of improvement, 1-4 points; mean improvement, 1.7 points). CONCLUSIONS: Increased activity revealed by bone scan imaging is highly predictive of positive clinical response to percutaneous vertebroplasty.
Aged↗
[Osteoporosis and fractures in Parkinson's disease].
We investigated osteoporosis and fractures in Parkinson's disease in stage II to V according to Hoehn and Yahr's disability scale. The bone mineral density (BMD) of the lumbar spine was measured in 82 patients (24 males and 58 females) and in 99 age-matched controls (28 males and 71 females) using dual energy X-ray absorptiometry, and compression fractures of the vertebrae were assessed on X-ray films. BMD decreased with age in females and was lower in females 60 years of age or over than in males at the same age. BMD in the female patients was significantly lower than in the female controls. The female patients in stage III to V had lower BMD than those in stage II. Both male and female patients with a body mass index (BMI) below 21 showed a lower BMD than those with a BMI of 21 or more. Five male (20.8%) and 37 female (63.8%) patients were diagnosed as osteoporosis. In particular 77.8% of the females aged 60 years or older had osteoporosis. Thirty-three patients (7 males and 26 females) had experienced fractures or were found to have vertebral compression fractures on X-ray films. These results suggested that osteoporosis and fractures are common in female patients with Parkinson's disease and that prevention of fractures must be important especially for patients with osteoporosis.
Adult↗
Vertebroplasty in osteoporosis.
Percutaneous vertebroplasty (PV) is a safe and effective treatment for relieving pain in patients complaining of severe back pain induced by osteoporotic compression fractures. The success rate exceeds 90% and the complication rate is lower than 1%. Most of the complications are transient and should be avoided using good technique. The classic indication for PV is severe, persistent, and incapacitating focal back pain not responding to standard medical therapy and related to one or more collapsed vertebral bodies of 4 to 12 weeks duration. PV should be used earlier in patients at risk of immobilization complications and requiring narcotics. PV should be always considered as a good alternative treatment compared with medical therapy in patients with pain and osteoporotic compression fractures.
Bone Cements↗
Anterior spinal column augmentation with injectable bone cements.
A vertebral fracture, whether originating from osteoporosis or trauma, can be the cause of pain, disability, deformation and neurological deficit. The treatment of vertebral compression fractures has, for many years until the advent of vertebroplasty, consisted of bedrest and analgesics. Vertebroplasty is a percutaneous technique during which bone cement is injected in a vertebral body to provide immediate pain relief by stabilization. Inflatable bone tamps can, prior to the injection of cement, be used to create a void in the vertebral body, in which case the technique is known as balloon vertebroplasty (or kyphoplasty). The chance of extracorporal cement leakage is smaller for balloon vertebroplasty than for vertebroplasty. Some authors also claim to have gained some correction in vertebral body height or angulation. Both interventions can be used for several indications, including osteoporotic compression fractures and osteolytic lesions of the vertebral body such as myeloma, hemangioma or metastasis, and also for traumatic burst fractures in combination with pedicle screw instrumentation. Polymethyl methacrylate cement is the bone void filler that is used most frequently, although the application of calcium phosphate cements has been studied widely in vitro, in vivo and also in small-scale clinical series. The clinical results of (balloon-) vertebroplasty are favorable with 85-95% of all patients experiencing immediate and long-lasting relief of pain. Serious complications are relatively rare but include neurological deficit and pulmonary embolism. In this paper, both vertebroplasty and balloon vertebroplasty and their respective indications, techniques and results are described in relation with the application and limitations of permanent and resorbable injectable bone cements.
Absorbable Implants↗
Use of a screw-syringe injector for cement delivery during kyphoplasty: technical report.
OBJECTIVE: Percutaneous kyphoplasty is postulated to have several advantages over percutaneous vertebroplasty for the treatment of vertebral compression fractures and is gaining increased popularity. However, cement delivery with the KyphX kit (Kyphon, Inc., Santa Clara, CA), the only commercially available device for percutaneous kyphoplasty, is relatively problematic. This kit uses a series of "bone filler device" (BFD) tubes. Each BFD must be loaded manually with cement, which is then injected into the kyphoplasty cavity by manually depressing an inner stylet. The high profile of the BFD cannulas and their stylets requires frequent repositioning of the image intensifier tube and table. Because each accommodates only a small volume, the BFDs must be exchanged frequently. This delivery method also places the operator's hands directly in the field of radiation. We sought to overcome these limitations. METHODS: Dissatisfied with the shortcomings of the BFDs, we substituted the EZflow screw-syringe injector (Parallax Medical, Mountain View, CA) we use to deliver cement during conventional percutaneous vertebroplasty. This amalgam of the KyphX kit and the screw-syringe injector has been used for kyphoplasty treatment of 26 thoracolumbar compression fractures in 17 patients. RESULTS: The screw-syringe injector allows controlled volumetric delivery of large boluses of high-viscosity cement without having to refill the reservoir. It minimizes radiation exposure and does not require repositioning of the x-ray tubes. It may theoretically allow decompression should cement extrusion occur. Also, it delivers cement to the interstices of bony trabeculae outside the kyphoplasty cavity, thus combining the mechanical benefits of percutaneous kyphoplasty and percutaneous vertebroplasty. CONCLUSION: The use of a screw-syringe injector has several merits over the customary means of cement delivery during kyphoplasty.
Bone Cements↗
Current concepts and techniques in percutaneous vertebroplasty.
Percutaneous vertebroplasty is a safe and effective alternative for the treatment of many different types of painful vertebral lesions, including osteoporotic compression fractures,hemangiomas, or malignancy-induced pathologic vertebral fractures. Medical therapy often is limited to pain control and immobilization. Because surgery is contraindicated frequently in patients who have osteoporotic compression fractures, and because patients who have widespread metastatic disease often are not surgical candidates, vertebroplasty may be the only practical option. In experienced hands and with appropriately selected patients, percutaneous vertebroplasty is a safe, inexpensive, and highly efficacious procedure; however, because of the potential for devastating complications, all efforts must be made to optimize patient safety.
Antibiotic Prophylaxis↗
Spinal computed tomography and computed tomographic metrizamide myelography in the early diagnosis of metastatic disease.
New lesions were shown by Tc99m bone scans to have developed in sixty patients with known metastatic cancer or high-risk primary cancer and normal neurologic examinations; they were further evaluated with plain radiographs, spinal computed tomography (CT), and CT myelography (CT-M) according to an algorithm. Three groups were identified based on plain radiographs: group 1 (normal radiograph), group 2 (compression fracture as indicated by radiograph), group 3 (evidence of metastasis as indicated by radiograph). In group 1 (n = 18), spinal CT revealed that 33% of the patients had benign disease and 67%, metastases; epidural compression was seen in 25% of the patients with metastasis as indicated by CT-M. In group 2 (n = 26), CT-M disclosed that 38% had a benign compression fracture and 62% had metastases and that 63% of the patients with metastases had an epidural compression. In group 3 (n = 16), spinal CT revealed that 15 patients had metastases (one patient had benign disease). Epidural cord compression was seen in 47% of the patients with metastatic disease. In all groups, the presence of cortical bone discontinuity around the neural canal (seen in 31 patients) was highly associated with epidural compression (seen in 20 patients). Our approach allowed the early and accurate diagnosis of spinal metastasis and epidural tumor as well as the diagnosis of benign disease and was useful in planning optimal local therapy.
Bone and Bones↗
Does vertebroplasty cause incident vertebral fractures? A review of available data.
Vertebroplasty has been in practice in the United States for approximately 10 years and has been described as providing significant benefit to patients with painful vertebral compression fractures. Although the procedure appears to provide dramatic pain relief, it is not without complications. The primary point of discussion in this paper is whether vertebroplasty predisposes patients to the development of additional vertebral fractures, at a rate higher than that seen in the absence of vertebroplasty. To date there remains no definitive answer to this question. There is, however, a significant body of data available in the literature that relates to this issue. This review explores and attempts to synthesize the data both supporting and refuting a relationship between vertebroplasty and the development of subsequent fractures.
Fractures, Compression↗