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PubMed2004

[Compression vertebral fracture in osteoporosis--prevention and treatment].

Vertebral fractures are the earliest and most common osteoporotic fractures. Usually vertebral fractures are associated with following clinical symptoms: back pain, posture change, loss of height, functional impairment, disability and decreasing quality of life. After 3 years of treatment raloxifene reduced the risk of first vertebral fracture by 55%. The fracture risk within one year was reduced by as much as 68%. The continued observation proved its sustained efficacy in further reduction of the fracture risk by 50% in the fourth year.

Aged↗
PubMed1986

Osteopenia and bone fractures in a man with anorexia nervosa and hypogonadism.

Women with anorexia nervosa have reduced skeletal mass. Both anorexia and osteopenia are less common in men. We describe a 22-year-old man with anorexia nervosa and severe osteopenia involving both cortical and trabecular bone who developed a pelvic fracture and multiple vertebral compression fractures. He was found to have secondary hypogonadotropic hypogonadism that was reversible with weight gain. This case illustrates the need to consider osteopenia as a potential complication of anorexia nervosa in males as well as females.

Adult↗
PubMed1994

[Photoelastic study of fragment compression in fracture of the femoral neck stabilized with the Zespol hip fixator].

The paper presents analysis of the forces within fracture line of femoral neck stabilized with Zespol hip fixator. The investigation has been carried out on specifically designed model of the proximal femur; the forces were measured in photoelastic fashion with the use of epoxy resin cubes as dynamometers. The magnitude of forces within fracture line has been verified and related to the position of the platforms of the screws versus the plate before tightening the nuts.

Biomechanical Phenomena↗
PubMed2000

Treatment of humeral shaft delayed unions and nonunions with humeral locked nails.

OBJECTIVE: To report experience with use of humeral locked nails in treating humeral delayed unions and nonunions. The following techniques yielded encouragingly good results: static locking, short-to-long segment nailing, bone grafting, fracture compression, and minimal surgical trauma. DESIGN AND METHODS: A total of 41 consecutive patients with 13 delayed unions and 28 nonunions were treated with humeral locked nails. Delay from trauma to surgery averaged 4.2 months for delayed union and 15.5 months for nonunion. The average age of patients was 50.2 years; average follow-up time was 23.2 months. There were 7 proximal-third fractures, 21 middle-third fractures, and 13 distal-third fractures. The antegrade approach was used for 13 fractures and retrograde for 28. Open nailing was performed in 39 fractures and closed nailing in 2. If the fracture motion was still present after nail insertion, axial compression of the fracture site was specially applied. Bone grafting was performed in the fractures with open nailing. Thirty-four fractures were nailed with 8-mm nails, and 7 fractures were nailed with 7-mm nails. RESULTS: With a single operation, all but two patients achieved osseous union in, on average, 5.6 months. One of these two patients eventually gained union after another surgery with fracture compression along the original nail and concurrent bone grafting. The second patient, undergoing hemodialysis for chronic renal failure, had persistent nonunion. At follow-up, for patients with antegrade nailing, all but four patients had less than 20 degrees limitation of shoulder abduction. For patients with retrograde nailing, all but two had less than 10 degrees limitation of elbow motion. Only the patient with persistent nonunion had continual pain and significant impairment of arm function. CONCLUSIONS: Humeral locked nailing seems to be effective for humeral delayed unions or nonunions. It may be an acceptable alternative for fractures unsuited for plate fixation, such as those with comminution, osteoporosis, or a severely adhered radial nerve.

Adult↗
PubMed2003

Vertebroplasty and kyphoplasty: new equipment for malignant vertebral fractures treatment.

The Purpose of our study was to assess the effectiveness and safety of Percutaneous Vertebroplasty and Kyphoplasty, in the treatment of pain deriving from neoplastic vertebral compression fractures (VCF). We treated with these new techniques oncologic patients with unremitting pain over spine, refractory to the conventional medical therapy (analgesics, bed-rest, bracing and bisphosphonates), elicited by pressure over spinous process and in absence of neurological signs. Both methods demonstrated a swift pain relief associated with an evident augmentation in vertebral body resistance. Nevertheless only Kyphoplasty revealed itself able to restorate the original somatic morphology and to diminish the spinal kyphosis. Polymethylmethacrylate's leakages (PMMA) not observed in the Kyphoplasty, instead have been found in the Vertebroplasty localized in the intersomatic or perispinal areas. Neither confirmation of epidural or foraminal extravasations, nor complications which pulmonary embolism for the involvement of venous plexus or connected to phenomenon of infection having to do with the procedures. Kyphoplasty and Vertebroplasty are effective alternatives, simple and safe in the treatment of vertebral collapses consequent to aggressive haemangiomas, myelomas and metastases. This entails a complete relief of symptoms and restoration of mobility in 90% of patients within 24 hours from the procedure.

Bone Cements↗
PubMed2005

Detection of vertebral fractures.

Despite the importance of vertebral compression fractures, there is much that remains uncertain. There is no "gold standard" for the definition which has led to epidemiologic and study differences. Height loss is a way to suspect vertebral fractures but it has its own issues. There are multiple radiographic systems for defining vertebral fractures, both prevalent and incident; risk factors for prevalent fractures have already been delineated. Recent studies have elucidated the risk factors for incident vertebral fractures including age, low weight, late menarche, lower bone mineral density, history of vertebral and nonvertebral fractures, smoking, and use of a walking aid. Fan beam densitometers have had improving ability to image the spine, a procedure now known as vertebral fracture assessment (VFA). Recently (in the United States) a CPT code and reimbursement was established. Yet, many vertebral fractures go undiagnosed, diagnosed but unreported, or reported but not utilized in patient care. Because of this, the International Osteoporosis Foundation developed a Vertebral Fracture Initiative for radiologists and the International Society for Clinical Densitometry began a VFA course. Both teaching programs use the semi-quantitative assessment of Genant to aid the radiologists and clinicians in detecting vertebral fractures.

Body Height↗
PubMed1977

[Experiment studies on fractures of the human calcaneus under vertical pressure (author's transl)].

In 60 cases typical compression fractures of the calcaneus were achieved by means of static compression of the test preparation. Afterwards the load bearing capacity of the fractured calcaneus was studied. In case of pure vertical compression the calcaneus does not loose much stability. The load bearing capacity of the studied bones after fracture achieved on an average still 63% of the initial value. In adequate cases of compression fractures, not only the early mobilization but the early weight bearing has to be discussed.

Biomechanical Phenomena↗
PubMed1991

[Compression osteosyntheses with the new AO universal nail. Functional principle and biomechanical prerequisites].

The new AO universal nail, with its special construction, allows extremely stable compression osteosynthesis in correctly selected fractures. Compression osteosynthesis with an intramedullary brace has definite advantages for fracture healing and biomechanics. The basic requirement, especially for the long-term maintenance of pressure, is truly stable anchorage of the locking bolts in the bone. Previous investigations by the author have shown that this is only possible in the shaft of the bone. Anchoring stability is not sufficient in the cancellous juxta-articular bone. Five years of clinical experience fully confirm the theoretical expectations.

Biomechanical Phenomena↗
PubMed1992

Vertebral body fractures in child abuse. Radiologic-histopathologic correlates.

RATIONALE AND OBJECTIVES: Vertebral injuries are rarely reported sequelae of child abuse, and little is known concerning the mechanisms of injury and healing. A preliminary investigation of these issues included correlating radiologic and histologic findings in children with vertebral injuries who died of complications relating to physical abuse. METHODS: Ten vertebral body fractures from four abused infants and young children were studied radiologically and histopathologically. RESULTS: Infants ranged in age from 7 to 36 months (mean, 21 months). Three patients died of associated head injuries. One child died after abandonment. There were three pure vertebral body compression fractures, two superior end-plate fractures without compression deformity, and five anterosuperior end-plate fractures with associated compression deformity. Vertebral compression was generally mild (less than 25%). Typically, end-plate injuries were manifest histologically by extension of the fracture through the medullary trabeculae into the proliferative zone of the superior end plate. The resultant pattern was analogous to that described in a previous study, and could potentially result in a growth disturbance at the vertebral end plate. CONCLUSIONS: Observed radiologic patterns and histologic correlates may help explain previously described findings, such as vertebral notching, in abused infants.

Child Abuse↗
PubMed2006

Preliminary results with modified techniques of balloon kyphoplasty for vertebra plana, traumatic fractures and neoplasms.

Percutaneous vertebroplasty and balloon kyphoplasty are less invasive treatment options than open surgery for patients with vertebral compression fractures. With balloon kyphoplasty, the injection of bone cement is preceded by inflation and removal of bone tamps (balloons) inside the fractured vertebral body. This allows for the creation of a void, where viscous cement is delivered resulting in a lower risk for cement leakage than with vertebroplasty. Another advantage of the balloon inflation is the potential to correct the deformity and restore sagittal alignment. The percutaneous techniques normally require intact pedicles and intact posterior elements. We found that modifying the technique made it suitable for the management of vertebra plana, traumatic fractures, and neoplasms. Our study documents the different modified techniques and the clinical results obtained within the first 21 patients.

Aged↗
PubMed2000

Canal geometry changes associated with axial compressive cervical spine fracture.

STUDY DESIGN: A laboratory study using isolated ligamentous human cadaveric cervical spines to investigate canal occlusion during (transient) and after (steady-state) axial compressive fracture. OBJECTIVES: To determine whether differences exist between transient and postinjury canal occlusion under axial compressive loading, and to examine the effect of loading rate on canal occlusion. SUMMARY OF BACKGROUND DATA: Prior studies have shown no correlation between neurologic deficit and canal occlusion measurements made on radiographs and computed tomography scans. The authors hypothesized that postinjury radiographic assessment does not provide an appreciation for the transient occlusion that occurs during the traumatic fracture event, which may significantly affect the neurologic outcome. METHODS: Twelve human cervical spines were instrumented with a specially designed canal occlusion transducer, which dynamically monitored canal occlusion during axial compressive impact. Six specimens were subjected to a fast-loading rate (time to peak load, approximately 20 msec), and the other six were subjected to a slow-loading rate (time to peak load, approximately 250 msec). After impact, two different postinjury canal occlusion measurements were performed. RESULTS: Each of the six specimens subjected to the fast-loading rate incurred burst fractures, whereas the slow-loading rate produced six wedge-compression fractures. For the fast-rate group, the postinjury occlusion-measurements were significantly smaller than the transient occlusion. In contrast, transient occlusion was not found to be significantly different from postinjury occlusion in the slow-rate group. All of the comparisons between loading rate groups showed significant differences, with the fast-rate fractures producing larger amounts of canal occlusion in every category. CONCLUSIONS: The findings indicate that even if canal occlusion could be measured immediately after axial compressive trauma, the measurement would underestimate the maximal amount of transient canal occlusion. Therefore, postinjury measurement of canal occlusion may indicate a smaller degree of neurologic deficit than what might be expected if the transient occlusion could be measured.

Aged↗
PubMed2006

Coccygeoplasty: treatment for fractures of the coccyx.

Percutaneous vertebroplasty and sacroplasty are becoming common modalities of treatment for vertebral body compression fractures and sacral insufficiency fractures, respectively. The present report describes a case of a coccygeal fracture treated with injection of polymethylmethacrylate cement, which resulted in immediate relief of symptoms. It is suggested that this procedure be called coccygeoplasty.

Aged↗
PubMed2006

[A method to avoid the fixator failure by using pedicle screw combined vertebroplasty for spine fractures].

OBJECTIVE: To study a new implant material (carbonated hydroxyapatite, CHA) united pedicle screw to cure spine fracture. METHODS: Thirty-two cases of spine compressed fracture were used with pedicle screw fixator and vertebroplasty. Before operation, patients' vertebral body were compressed (46 + 21)% (20% approximately 70%) on average. In operation, broken vertebral body was reposition through pedicle screw technique, then used self-made syringe to inject CHA into anterior and central column of broken vertebral body through pedicle. And all of patients were not given any bone-graft. RESULTS: In 6 - 26 months followed-up, no immunologic rejection was found about hydroxyapatite, and no any broken of the screws and shafts was found, no loosing and other complications either. All the patients could move in 3 - 5 days after operation. The height of the broken vertebral body were reduced 97% compared with pre-operation. And CHA in vertebral body was degraded gradually, and at the same time it was replace by new bone in vertebral body. After operation, VAS score was 61 +/- 32, and there was significant difference compared with pre-operation. CONCLUSIONS: The pedicle screw fixation united vertebroplasty is an efficient way to prevent the failure of the treatment of spine fracture.

Adult↗