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PubMed1989

Closed rereduction of axial compression in Colles' fracture is hardly possible.

Totally, 146 Colles' fractures that were displaced after the primary reduction were treated by closed rereduction and plaster immobilization. A permanently acceptable position was achieved in 11 of 27 cases, where dorsal angulation was the only malalignment. In fractures with both axial compression and dorsal angulation, both displacements improved to a permanently acceptable position in only 7 of 105 cases, and only the dorsal angle improved to an acceptable position in 26 cases. The axial compression was most difficult to correct. The chances of achieving a permanently acceptable position by rereduction are rather small in Colles' fracture with axial compression alone or combined with deviation of the dorsal angle. High age and the presence of dorsal comminution are further factors likely to worsen the prognosis.

Adult↗

PubMed1989

[Fractures of the thoracic spine (T1-T10). Apropos of 105 cases].

Thoracic spine (T1-T10) fractures can be considered a specific entity owing to the anatomic features of the rib cage and the spinal canal. During a nine year period, the authors treated 105 such fractures. The thoracic spine fractures included 57 (54.2 per cent) compression fractures, 21 (20 per cent) comminuted (burst) fractures, 3 (2.8 per cent) flexion-distraction fractures, and 24 (23 per cent) fracture-dislocations. Five lesions, termed "fracture-dislocations by an oblique shearing force", were characterized by considerable displacement and the absence of neurologic injury. 35.2 per cent of the patients had injuries at multiple levels. The frequency of associated thoracic (26.5 per cent) and scapular injuries (20 per cent) reflected involvement of the entire thoracic cage. The frequency of neurologic impairment (30.4 per cent including 20 per cent complete paraplegia) reflects the particular vulnerability of the dorsal spinal cord. 32 per cent of the patients presented one or more thoracic effusions (hemomediastinum, hemothorax) related to parietal hematoma and/or hematoma at the fracture site. Functional management of 47 patients led to recovery of a painless spine without kyphotic deformity. Conservative treatment was often difficult because of associated parietal lesions; the 10 patients treated in this manner had only moderate reductions that maintained poorly in time, but had no major painful sequellae. A posterior approach was used for 42 patients with unstable or neurotoxic fractures because this permitted a complete decompression down to the posterior wall, when necessary by a "wide laminectomy". The anterior approach was reserved for purely anterior compression (3 cases) or residual compression after an initial posterior procedure (2 cases). Cotrel-Dubousset instrumentation (used in 7 cases) was particularly indicated because it offers the advantages of Harrington rods (31 cases) while providing better stabilization. This prevented later loss of reduction and obviated the need for a postoperative brace.

Adolescent↗

PubMedDate not supplied

Thoracic spine fracture in a football player. A case report.

Compression fractures of the thoracic spine are less common than injuries to the cervical, thoracolumbar, or lumbar regions because of the inherent stability and geometry of the thoracic spinal region. This injury may be difficult to detect acutely because of the lack of localizing symptoms. An appropriate index of suspicion should be present when examining a player experiencing acute back pain associated with localized spinal tenderness. Early recognition and appropriate treatment are needed to maximize the patient's chances of return to normal function while avoiding further injury from lack of recognition of the injury or too early return to play.

Adult↗

PubMed1986

[Concomitant osseous and ligamentous injuries of traumatic shoulder dislocation and its significance for the pathogenesis of habitual dislocation].

161 consecutive patients with traumatic shoulder luxation between 1975 and 1983 are followed, concerning their evolution to recurrent shoulder dislocation. In 26 patients there was a recurrent shoulder dislocation in a mean time of 19 months after the first luxation. In literature the common level of recurrent dislocation is higher than our 16.1%, despite of the shorter immobilising time after the first shoulder luxation in our center. When there is no evolution to recurrent dislocation, a stable shoulder and a normal shoulder function without pain can be expected in 95%. The compression fracture of the humeral head and the avulsion of the glenoid margin were made responsible for the recurrent dislocation, mostly appearing in adult men, younger than 35 (55% of all recurrent dislocations). Because avulsion fractures of the tuberculum majus don't lead to an unstable fracture neither the existence of a compression defect in the humeral head is pathognomonic for an unstable shoulder, nor a lack of such radiological appearance excludes a recurrent dislocation. In first instance rotatory cuff injuries could be responsible for the instability of the shoulder joint. All patients with this invalidating injuries should be stimulated to an operative procedure, because after correction of an unstable shoulder by a derotation osteotomy of Weber or the elevation of the anterior margin of glenoid in the technique of Trillat good results with normal functional capacities of the shoulder can be expected.

Adolescent↗

PubMed2006

Percutaneous sacroplasty using CT fluoroscopy.

Sacral insufficiency fractures frequently cause significant pain and limit activities of daily living in patients with osteoporosis. Percutaneous vertebroplasty is a common procedure to alleviate the pain associated with thoracic and lumbar vertebral compression fractures. The sacral percutaneous vertebroplasty procedure (sacroplasty) has recently been introduced as an alternative to medical management of osteoporotic sacral insufficiency fractures. We describe our CT fluoroscopy technique in performing percutaneous sacroplasty.

Administration, Cutaneous↗

PubMed2005

Vertebroplasty in osteoporotic spine fractures: a quality of life assessment.

OBJECTIVE: Our goal was to perform a quantitative evaluation of the improvement in functional capacity, quality of life, mental function, reduction in drug intake and impact on hospital admissions after vertebroplasty in the treatment of osteoporotic compression fractures. The efficacy of vertebroplasty in relief of pain has been addressed in previous publications but the quantitative evaluation of improvement in quality of life has not been addressed before. METHODS: This is a prospective study of 42 patients with 83 symptomatic vertebral fractures treated by vertebroplasty with a mean follow-up of 9.1 months. The outcome was measured by pre and postoperatively utilizing the Visual Analogue Scale, the Oswestry Disability Index, the Rolland Morris Scale for Back Pain and EuroQol-5D questionnaire (EQ-5D). The postoperative evaluations were performed at one week, one month, three month, and six month intervals thereafter. RESULTS: In 34 out of 39 active patients, marked pain relief was noted (87%). The Visual Analogue Scale score improved from a mean preoperative score of 8.2 to a mean postoperative score of 2.9 (p=0.0000003) at one week follow up and 3.9 at the last follow-up. The Rolland Morris Scale for Back Pain showed a drop from a mean preoperative rating of 13 to a mean postoperative rating of 10, showing a 25% improvement (p= 0.0207). The Oswestry Disability Index preoperatively was 64.4 which improved to 43.8 postoperatively, showing a 32% improvement (p= 0.0207). The EQ-5D showed a mean preoperative index value of 0.097 and mean postoperative index value of 0.592 (p = 0.0000003). All p-values were determined by the Willcoxin sign-ranked test. CONCLUSION: Vertebroplasty is a safe and efficacious procedure with a resulting improvement in pain and quality of life.

Adult↗

PubMed1998

Changes of biochemical markers during fracture healing.

The aim of this study was to evaluate the changes of biochemical markers during fracture healing in patients with osteoporosis. The study included 26 patients; 9 underwent hip hemiarthroplasty (mean age +/- SD: 71.0 +/- 10.2 years, group EN) for femoral neck fractures. 7 underwent osteosynthesis (75.3 +/- 8.2 years, group OS) for trochanteric fractures, and 10 subjects had spinal compression fractures (68.2 +/- 12.0 years, group CO). No operative procedures were performed in group CO. Urinary pyridinoline (Pyr), deoxypyridinoline (Dpyr) by high performance liquid chromatography (HPLC), Crosslaps by both enzyme-linked immunosorbent assay (ELISA) and radioimmunoassay (RIA) (CTx-ELISA and CTx-RIA) and serum N-terminal mid-fragment osteocalcin (OCN-Mid) by ELISA were analyzed at the time of admission and at weeks 1, 2, 4, 8 and 24 after operation or, in the case of group CO, after admission. As a whole, bone resorption markers started to increase from week 1, with various peak values between weeks 4 and 8 depending upon the particular marker, but returned to the initial vales at week 24. OCN-Mid started to increase from week 8 and remained at elevated levels at week 24. In groups EN and OS, bone resorption markers changed in the same manner as they did as a whole group. OCN-Mid did not change in group EN, although it increased significantly from week 8 in group OS. No biochemical markers changed significantly in group CO. In conclusion, bone resorption was accelerated at an early stage due to acute osteonecrosis or bed rest, followed by bone formation due to callus or mechanical stress later on. As far as bone resorption markers are concerned, 24 weeks are enough to eliminate the effect of fracture.

Aged↗

PubMed2003

Delayed blow-out type rupture of the right ventricle following blunt chest trauma.

A 36-year-old man suffered multiple traumatic injuries when he fell from a crane. Fractures of both lower extremities, a compression fracture of the fourth lumbar vertebra, and bilateral hemopneumothoraxes were identified. The sternum was not fractured, but was tender. The day after admission, the right ventricular free wall ruptured and was diagnosed by echocardiography. An emergency operation was performed. A Gore-tex sheet was sutured from inside the ventricle, and a Hemashield graft was sutured over the tear. The risk of hemorrhage is high in the patient with multiple traumatic injuries when heparin is required. Mechanical ventilation was required until the 13th postoperative day because persistent hemothorax. After an operation to reduce a leg fracture, the patient was discharged from the hospital on the 66th postoperative day.

Adult↗

PubMed2003

[Percutaneous vertebroplasty: technique and early results in 25 procedures].

Vertebroplasty procedure which involves percutaneous injection of bone cement into a collapsed vertebra using fluoroscopic guidance, has been introduced not only for treatment of osteoporotic patients, who have prolonged long lasting pain following vertebral fracture, but also for osteolytic vertebral compression fractures, to restore its loadbearing capacity and stiffness. Our result suggest that vertebroplasty is associated with pain relief in almost 100% of cases. Proper patient selection and a good technique should minimize complications.

Diskectomy, Percutaneous↗

PubMed2006

A new modification of corrective osteotomy for treatment of distal radius malunion.

A new modification of corrective osteotomy for distal radius malunion, which minimizes the need for bone grafting and addresses the constraining aspect of the extensor retinaculum, is described. This new modification uses a volar and dorsal approach to perform an angled step-cut osteotomy, release of the extensor retinaculum, and volar plating. The typically dorsally extruded comminuted fracture fragments from the distal, dorsal compression fracture component of the distal radius fracture is mobilized with the distal fragment and acts as a dorsal strut graft to span the opening wedge, corrective osteotomy. Therefore, this new modification facilitates and improves the realignment of the malunited radius, while minimizing or eliminating the need for bone grafting.

Biomechanical Phenomena↗

PubMed2006

Bone health in autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED): findings in 25 adults.

OBJECTIVE: Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) is characterized by chronic mucocutaneous candidiasis and autoimmune destruction of endocrine organs. The resulting endocrinopathies and their treatment may impact bone health. The purpose of our study was to assess bone health and its correlates in adult patients with APECED. PATIENTS AND METHODS: Twenty-five adults (12 males) with APECED were prospectively assessed. Data on their previous medical history were collected from hospital records. Areal bone mineral density (aBMD) for the lumbar spine (L1-L4), femoral neck and whole body as well as volumetric BMD (vBMD) for the lumbar spine (L2-L4) were measured with dual-energy X-ray absorptiometry (DXA). RESULTS: Mean age was 34 years (range 21-59 years). All patients had 1-4 autoimmune endocrinopathies, the most common being adrenocortical failure (20 patients) and hypoparathyroidism (18 patients). Osteopaenia or osteoporosis was present in 28%. The median (range) aBMD Z-scores were for the lumbar spine -0.3 (-2.3 to +3.3) and for the femoral neck, -0.1 (-2.2 to +2.0). The BMD Z-scores tended to be higher in patients with hypoparathyroidism than in patients with normal parathyroid function (at the lumbar spine +0.4 vs.-1.2, P = 0.016, and at the femoral neck +0.3 vs.-0.4, P = 0.090). Adrenocortical failure had a negative impact on BMD. Six patients had had low-impact fractures and three were diagnosed with compression fractures. CONCLUSIONS: Despite the complex endocrine problems, the overall prevalence of symptomatic osteoporosis is low in adults treated for APECED. Osteopaenia is frequently observed and warrants follow-up. Treated hypoparathyroidism may have a positive, and adrenocortical failure a negative, impact on bone health.

Absorptiometry, Photon↗

PubMed1995

Subclavian crush syndrome complicating transvenous cardioverter defibrillator systems.

UNLABELLED: Subclavian crush syndrome, described with pacemaker leads implanted via subclavian puncture, may occur when conductor fractures and insulation breaches develop by compression of a lead between the first rib and clavicle. We reviewed our experience in 164 patients who underwent intended implantation of transvenous defibrillator systems to determine the clinical relevance of subclavian crush syndrome in defibrillator patients. Venous access was obtained via subclavian puncture in 114 patients (70%) and via cephalic cut-down in 50 patients (30%). Nonthoracotomy lead systems, with or without subcutaneous patch, were successfully implanted in 131 of 164 patients (79.9%). Thoracotomy was required in 32 patients (19.5%) and subxiphoid patch in 1 patient (0.6%). Over a mean of 12.9 months (range 1-62 months), 3 patients (1.8%) required revision of the rate sensing lead/coil or superior vena cava coil after development of lead compression fractures in the region of the clavicle and first rib. In all 3 patients the leads had been implanted via subclavian puncture (2.6% of patients in whom the subclavian technique was utilized). Two patients presented with spurious shocks. One patient was asymptomatic. CONCLUSIONS: When venous access is obtained via subclavian puncture, subclavian crush syndrome may develop in patients with transvenous defibrillator systems. Patients may be asymptomatic and lead fractures may go unrecognized. When implanting transvenous defibrillator systems, strong consideration should be given to obtaining venous access primarily via the cephalic cut-down technique.

Aged↗

PubMed1997

Hip fracture and osteoporosis in a XIIth Dynasty female skeleton from Lisht, upper Egypt.

Osteoporosis and complications arising from loss of bone mass have been present in human populations for thousands of years. However, reports of this disease in antiquity remain uncommon. The purpose of this report is to describe an important case of osteoporosis in ancient Egypt because of its intrinsic interest and to provide perspectives on factors contributing to this condition today. The case providing the focus for this report is from Lisht, Upper Egypt and is dated to the XIIth Dynasty (1990-1786 B.C.). Methods used to characterize the pathology include gross anatomical study, radiology, and radiographic measurements. Observations, measurements, and indices all indicate osteoporosis complicated by fracture of the femoral neck and compression fractures of some vertebrae. The Lisht case adds to a small corpus of reports on osteoporosis and complicating factors of this disease in antiquity. Long-term survival of an extracapsular fracture of the femoral neck in this case is remarkable and may reflect supportive social conditions.

Egypt, Ancient↗

PubMed1999

Monkeybar injuries: complications of play.

BACKGROUND: Playground equipment resulted in >200 000 injuries from 1990 to 1994, according to the Consumer Product Safety Commission; 88% were attributable to climbers (monkeybars/jungle gyms [MB/JGs]), swings, and slides. Equipment-specific injury requiring emergency department (ED) evaluation has not been reported previously. OBJECTIVE: To describe the spectrum of significant MB/JG-related injuries. METHODS: A 2-year retrospective chart review was performed using the computerized charting system at a large urban Children's Hospital/Regional Pediatric Trauma Center with 50 000 ED visits per year. A telephone survey also was conducted after the chart review to obtain additional information concerning the injury location, the surface type below the equipment, and the presence of adult supervision. RESULTS: A total of 204 patients were identified. Mean age was 6.2 years (range, 20 months to 12 years); 114 (56%) were male. A seasonal variation was noted with June to August accounting for 43% of visits. Injuries included fractures in 124 (61%), contusions in 20 (10%), neck and back strains in 17 (8%), lacerations in 16 (8%), closed head injuries in 10 (5%), abdominal trauma in 5 (3%), genitourinary injuries in 5 (3%), and miscellaneous injuries in the remainder. Among fractures, 90% were fractures of the upper extremity; 48 (40%) were supracondylar fractures. One child sustained a C7 compression fracture. Abdominal injuries included 1 child who sustained a splenic laceration. All genitourinary injuries (2 vaginal hematomas, 1 vaginal contusion, 1 penile laceration, and 1 urethral injury) were from straddle-type injuries. Fifty-one (25%) patients were admitted to the hospital. Of these, 47 (92%) required an operative procedure (orthopedic reduction or vaginal examination under anesthesia). Analysis of the telephone data revealed that the surface did not influence the injury type. Of the 79 fractures, 30 occurred on "soft surfaces." Injury type was associated significantly with chronologic age. Younger children (1 to 4 years of age) sustained more long-bone fractures than did older children. The presence of adult (at least 18 years of age) supervision, did not influence the occurrence of fractures. CONCLUSIONS: These data suggest that 1) a significant proportion (25%) of MB/JG-related injuries that are evaluated in the ED require hospitalization; 2) most of the injuries resulting in admission will require operative intervention (92%); 3) the surface below the equipment has no influence on the type or severity of the injury; 4) younger children are more likely to sustain long-bone fractures than are older children; and 5) adult supervision does not influence the injury pattern. These data identify the need for additional investigation of means of making MB/JGs safer for child use.

Age Distribution↗

PubMed2001

[Results of conservative treatment for solid abdominal organ trauma].

We analyzed 59 cases of intraabdominal solid organ injury treated at the Surgical Emergency Service of Istanbul Medical School between January 1996 and January 2001. Fifty-six of these cases suffered blunt and 3 penetrating trauma. Twenty-three cases had injuries involving the liver, 14 spleen, 5 kidney, 6 liver and spleen, 6 liver and kidney, 6 spleen and kidney and four liver and kidney. In 4 of splenic and 5 of hepatic injuries Grade IV injuries were detected. Among the cases, 21% were Grade I, 45% were Grade II, 19% were Grade III, and 15% were Grade IV. Associated injuries were: head trauma in 34 cases (57.6%--Glasgow Coma Score under 7 in 6 cases), thoracic trauma in 19 cases (32%), pelvic fracture in 6 cases (10%), vertebral compression fracture in 3 cases (5%). One patient with splenic (Grade III) and hepatic (Grade II) injury, and one patient with Grade IV splenic injury required surgery during close follow-up due to hemodynamic instability. Our failure rate for conservative treatment of solid organ injuries is 3.3%. Three patients with polytrauma in the ICU died (5% mortality rate). Conservative management in solid organ injuries is gaining more popularity every day. Our work, and current studies accept physiologic parameters in the follow-up of solid organ injuries. Conservative treatment guided with hemodynamic stability, accounts almost a 98% success rate.

Abdominal Injuries↗

PubMed1985

[Bilateral shoulder dislocation fractures, femoral neck and vertebral fractures: a remarkable combination of injuries during an epileptic seizure].

Fracture complications of convulsions are reported occasionally, e.g.: mono- or bilateral posterior shoulder luxations and luxation fractures, central dislocations of the hip as well as fractures of the femoral neck or compression fractures of vertebrae. A case is reported where the patient sustained four such lesions simultaneously. The epileptic seizure occurred following the sudden interruption of a neurotropic therapy with Carbamazepin (Tegretal). A general osteodystrophy was not found. The simultaneous presence of four such lesions following one convulsion has never before been reported and appears to be very uncommon. The frequency and problems of post-epileptic fractures are discussed and the operative treatment of the lesions briefly described.

Adult↗

PubMed1979

The Roger Anderson device in the treatment of fractures of the distal end of the radius.

One of the more common as well as difficult fractures to manage is the extension compression fracture of the distal end of the radius. In the physiologically younger patient we believe that every effort should be made to preserve the integrity of the radiocarpal joint and maintain motion of the hand. We have used the technique described by Anderson and O'Neil to treat comminuted, displaced fractures of the distal end of the radius in twenty-five patients from April 1972 through April 1978. Twenty-one of these patients were available for follow-up examination at an average of nineteen months (range, six to forty months) following injury. There were sixteen satisfactory and five unsatisfactory functional results, and three complications. This form of external fixation should be avoided in the older, obese, and osteoporotic patient as well as in the unreliable and uncooperative patient. If these guidelines are followed, we believe that the Roger Anderson device provides satisfactory immobilization and functional results in the treatment of comminuted fractures of the distal end of the radius in the physiologically younger patient, who may be expected to place heavy demands on the wrist.

Adult↗

PubMed1984

[Allogeneic bone transplantation. Indications--preservation--results].

For 15 years the University Department of Traumatology Freiburg i.Br. is using deep frozen preserved allogenous bone grafts. Organization and service of the "bone bank" are standardized and simple. Basing on long experience the following indications for this technique have been developed: fresh fractures à deux étages, comminuted and compression fractures of long tubular bones that were stabilized operatively by plate-osteosynthesis showing smaller or bigger osseous defects, furthermore basic defects of the acetabulum with total hip replacement. Suppositions for the transplantation of allogenous cancellous bone are: well vascularized bed without infect, sufficient amount of cancellous bone and no disturbing movement of the bone at the place of transplantation. The results are excellent if one pays attention to these suppositions. Open fractures and local infections are absolute contraindications. As deep frozen preserved cancellous bone is always and sufficient available it is a precious help especially in polytraumatized patients. So the deposits of autogenous cancellous bone can be reserved for special problems. The little prolonged time of consolidation is only observed in the first phase until about the 20th week, after that time there are no significant differences to autogenous cancellous bone.

Bone Diseases↗