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PubMed1987

Unusual complications of temporal bone fractures.

Eighty-two temporal bone fractures were diagnosed in 75 patients with high-resolution computed tomographic scanning. Excluding six gunshot injuries, 55 (72%) of the fractures were oblique, 11 (15%) were longitudinal, and ten (13%) were transverse. Facial paresis or paralysis occurred in 45 patients (60%), hemotympanum occurred in 67 (89%), and cerebrospinal fluid otorrhea occurred in 19 (25%). Among 66 patients in whom audiometry was performed, 20 (30%) had conductive hearing loss, nine (14%) had sensorineural loss, and 36 (55%) had mixed hearing loss. Vestibular symptoms were present in 23 patients (30%). Other unusual complications of temporal bone fractures were observed: bilateral abducens paralysis, three patients (4%); unilateral abducens paralysis, two (2.67%); trigeminal paralysis, one (1.33%); and aseptic sigmoid sinus thrombosis, one (1.33%).

Abducens Nerve Injury↗
PubMedDate not supplied

Temporal bone fractures.

High-resolution technique is essential to the evolution of temporal bone fractures. Axial and coronal scan planes are optimal but may not be possible in acutely traumatized patients. A knowledge of normal temporal bone anatomy is important and can be obtained from standard texts, so it will not be considered in detail in this article. Classically, petrous temporal bone fractures have been classified as longitudinal, transverse, or mixed. Recent publications have emphasized the importance of describing fractures in terms of planes rather than lines. According to this concept, most temporal bone fractures are actually oblique, and true longitudinal fractures are rare. Petrous temporal bone fractures may be associated with cranial nerve or vascular injuries when the fracture extends to the skull base. This is particularly true of the oblique fracture, which characteristically extends anteromedially to the skull base through weak places in that area, thus avoiding the compact bone of the otic capsule surrounding the labyrinth. The most common associated injury is to the facial nerve in its geniculate or proximal tympanic segment. Transverse fractures frequently involve the labyrinth. A careful search for various types of ossicular dislocation should be performed in association with temporal bone fractures, because this may result in conductive hearing loss. The site of cerebrospinal fluid otorhinorrhea resulting from temporal bone fractures can usually be defined on plain high-resolution temporal bone images, but intrathecal contrast may be helpful. Temporal bone fractures caused by gunshot wounds are frequently complex and may be limited by metallic streak artifacts. Pediatric patients have different proportions of facial nerve injury and types of hearing loss as compared with adults.

Adult↗
PubMed1984

Management of proximal sesamoid bone fractures in the horse.

The case records of 49 horses with proximal sesamoid bone fracture were studied. The population consisted of 20 Thoroughbreds, 20 Standardbreds, 5 Quarter Horses, 2 Arabians, and 2 grade horses. The fractured bones were classified into 5 categories: apical fractures, basilar fractures, abaxial fractures, middle one-third fractures, and bilateral comminuted-distracted fractures. Apical fractures occurred most frequently in the Standardbred, with the prevalence of medial fracture being equal to that of lateral fracture. Basilar fractures occurred predominantly in the Thoroughbred, with the highest prevalence in the lateral sesamoid bone of the right front fetlock. Bilateral comminuted-distracted fractures also occurred primarily in the right front fetlock. The prognosis following surgical removal of apical fractures appeared to be superior to that for stall rest alone. The prognosis for basilar fractures was poor.

Age Factors↗
PubMedDate not supplied

Epidemiology of bone fractures occurring during hospitalization.

OBJECTIVE: To investigate the incidence and epidemiology of nosocomial bone fractures. DESIGN: Observational, case series. SETTING: Tertiary care center. PATIENTS: All patients sustaining a fracture during hospitalization during the 18-month study period from July 1989 through December 1990. RESULTS: Twenty nosocomial fractures were identified. Twelve of these resulted from falls (3.5 fractures from falls/100,000 patient days). Fracture rates were higher on the neurology service than on other services. Patients who fell and sustained a fracture were significantly older than patients who fell but did not sustain a fracture (74 versus 58 years, respectively, p < .05). Falls occurring on weekends and holidays were approximately three times more likely to result in fracture than falls occurring on other days (p = .06). CONCLUSIONS: Nosocomial fractures were infrequent events but were more common in the elderly and in persons with significant neuropsychological impairment. Persons who sustained fractures during hospitalization were similar to those who fell and fractured bones in a community setting.

Accidental Falls↗
PubMed1991

Ten-year statistics and observation of facial bone fracture.

Six hundred and seventy-four cases of facial bone fracture in the past 10 years were studied with respect to age and sex, region, cause, classification, and treatment at our clinic. About half of the cases of the single fractures of nasal bones were caused by sports and fights. Of the other cases of facial bone fracture, about 40% were caused by traffic accidents. Reduction of facial bone fracture should be performed as soon as possible from a functional as well as cosmetic point of view. Hence precise diagnosis and refined techniques of repairing are mandatory to avoid postoperative complications.

Adolescent↗
PubMed2004

A retrospective analysis of health care costs for bone fractures in women with early-stage breast carcinoma.

BACKGROUND: In this retrospective data base study, the authors sought to estimate direct costs for bone fractures in women age > or =65 years with early-stage breast carcinoma and to compare those costs with treatment costs for bone fractures in older women without early-stage breast carcinoma. METHODS: Direct costs for bone fractures in patients with early-stage breast carcinoma, which consist of excess treatment costs for bone fracture and excess costs of long-term care for bone fracture, were evaluated by using the 1997-1998 Standard Analytical File. The statistical significance of the difference in inpatient costs, medical treatment costs, and long-term care admission rates were determined with the t test and the Fisher chi-square test, respectively. RESULTS: For older women with early-stage breast carcinoma, the direct costs for bone fracture were estimated at $45,579, and 57% of those costs came from treating the bone fracture (32% came from inpatient hospital costs, and 25% came from noninpatient hospital costs), 25% came from other excess treatment costs, and 18% came from excess long-term care costs. The women who had early-stage breast carcinoma and sustained bone fracture did not differ significantly from the women without early-stage breast carcinoma who sustained a bone fracture. CONCLUSIONS: Bone fracture was associated with high direct costs in older women with early-stage breast carcinoma. Additional research should include appropriate, incidence-based studies to investigate the potential benefit of an intervention for preventing bone fracture in this increasingly large patient population.

Age Distribution↗
PubMed2006

Analysis of nasal bone fractures; a six-year study of 503 patients.

The aim of this study is to classify the nasal bone fractures based on computed tomography (CT) analysis and patterns of the nasal bone fractures, and review 503 cases treated between 1998-2004 at the Department of Plastic Surgery, Inha University Hospital, Incheon, South Korea. The age, sex, etiology, associated injuries, pattern of fractures and treatments were reviewed and a radiographic study was analyzed. Plain simple radiographs of lateral and Waters view of the nasal bones combined with computed tomography scans were done. Nasal bone fractures were classified into six types: Type I) Simple without displacement; Type II) Simple with displacement/without telescoping; IIA; Unilateral; IIAs) Unilateral with septal fracture; IIB) Bilateral; IIBs) Bilateral with septal fracture; Type III) Comminuted with telescoping or depression. Diagnosis of nasal bone fractures were made positively by plain x-ray films in 82% of cases, negative finding was 9.5% and 8.5% of cases were suspicious of the fractures. Reliability of the plain film radiographs of the nasal bone fracture was 82% in this study. In the most of the fractured nasal bones (93%) the closed reduction was done, open reduction in 4% and no surgical intervention in 3%. Nasal reduction was carried out in average 6.5 days post the injury. The patterns of the nasal bones fractures classified by CT findings were type IIA (182 cases, 36%), IIBs (105 cases, 21%), IIB (90 cases, 18%), IIAs (66 cases, 13%), I (39 cases, 8%) and III (21 cases, 4.3%). We think the CT is necessary for diagnosing nasal bone fracture because the reliability of the plain film was only 82%.

Adolescent↗
PubMed1979

Clinical and experimental correlations in temporal bone fracture: the facial nerve.

In this review of 50 patients with fracture of the temporal bone, 11 patients had ipsilateral facial paralysis, three of immediate and eight of delayed onset. Eight patients with complete paralysis of the facial nerve had facial nerve decompression; six of these had incomplete return of function. Only one patient with a delayed complete facial paralysis had complete return of function. The poor functional results in patients with delayed complete facial paralysis due to temporal bone fracture encourage facial nerve decompression in all stable patients with the complete facial paralysis of temporal bone fracture.

Adult↗
PubMed2006

Radiographic classification of temporal bone fractures: clinical predictability using a new system.

OBJECTIVE: To compare the traditional system of radiographic classification of temporal bone fractures (transverse vs longitudinal vs oblique) with a newer system (otic capsule violating vs otic capsule sparing) with respect to their ability to predict sequelae of temporal bone trauma. DESIGN: Retrospective chart and radiology review. SETTING: University trauma center and Department of Otolaryngology-Head and Neck Surgery. PATIENTS: Patients with temporal bone fractures. INTERVENTIONS: Clinic records and computed tomographic scans were reviewed to evaluate the clinical predictability of complications of temporal bone fractures. MAIN OUTCOME MEASURES: Complications of temporal bone fractures (ie, sensorineural hearing loss, conductive hearing loss, cerebrospinal fluid leakage, and facial nerve weakness) were recorded. Two classification schemes for temporal bone fractures were statistically analyzed and compared as to their ability to predict each complication. RESULTS: A total of 234 temporal bone fractures were identified; 30 cases met our strict criteria for inclusion. The traditional classification system of temporal bone fractures did not significantly predict temporal bone complications (P = .71). On the other hand, the otic capsule-based system did demonstrate statistically significant predictive ability (P < .001). Patients with otic capsule-violating fractures were 5 times more likely to have facial nerve injury, 25 times more likely to have sensorineural hearing loss, and 8 times more likely to have cerebrospinal fluid otorrhea than those with otic capsule-sparing fractures. CONCLUSIONS: The traditional radiographic classification system failed to demonstrate clinical predictability in our series. Furthermore, the newer system of classification (otic capsule sparing vs otic capsule violating) demonstrated statistically significant predictive ability for serious clinical outcomes associated with temporal bone fractures.

Accidental Falls↗
PubMed1998

[Contribution of soft tissue trauma and/or bone fracture to immune suppression after hemorrhagic shock in the animal experiment].

Bone fracture, soft-tissue trauma and hemorrhagic shock are frequent complications in trauma patients, and these patients are known to be immunocompromised. Nonetheless, it is difficult to differentiate the effect of soft-tissue trauma plus hemorrhage from that of bone fracture and hemorrhage on host immune function in the clinical setting. To determine this experimentally, closed bone fracture (right lower leg) and/or soft-tissue trauma (2.5 cm midline laparotomy) were induced prior to hemorrhagic shock (mean arterial BP of 35 +/- 5 mm Hg for 90 min) in male C3H/HeN mice. All animals were killed at 72 h after initiation of the experiment and the spleens were collected aseptically. More significant depression of splenocyte IL-2 and IL-3 release occurred with the combined insult than after bony injury or tissue trauma alone with hemorrhage. The present study suggests that different traumatic insults, i.e. bone fracture as well as soft-tissue trauma in conjunction with hemorrhagic shock, produce comparable depression of host immune function. Moreover, combination of closed bone fracture and soft-tissue trauma prior to hemorrhagic shock leads to even more compromised immunity. This indicates that different mechanisms of immune depression may be involved following soft-tissue trauma or bony injury coupled with hemorrhage. The markedly depressed immune function following bony injury, soft-tissue trauma and hemorrhagic shock may contribute to the increased susceptibility of severely injured patients to sepsis and the ensuing multiple organ failure in the clinical situation.

Animals↗
PubMed1978

Functional fracture-bracing of long-bone fractures of the lower extremity in children.

Fifty-six tibial fractures in fifty-five children, sixteen years old or younger, and seventeen femoral fractures in seventeen children in the same age group, seven of them with associated tibial fractures, were treated by fracture-bracing. The tibial fractures healed in an average of 13.2 weeks with no complications that could be attributed to failure of the method. The femoral fractures healed in an average of seventeen weeks. There was an angular femoral deformity of more than 5 degrees in seven of seventeen patients, all but one in fractures of the middle third of the femoral shaft. Of nine distal fractures, only one had angulation of more than 5 degrees. Therefore, the method should be restricted to fractures in the distal third of the femoral shaft. Fracture-bracing gave more freedom to the child and was eminently satisfactory to the parents.

Adolescent↗
PubMed1998

Twenty years of statistics and observation of facial bone fracture.

We analyse the details of patients with facial bone fractures who visited us from 1993 to 1997, and compare past cases treated from 1978 to 1992. From 1993 to 1997, the total numbers of patients and fractures were 633 and 697, respectively. Thus, we had 127 patients and 139 fractures annually. The number of patients has increased over the years. The highest occurrence rate of facial bone fracture was in the nasal bone (half of all), followed by the malar bone, blowout fractures and the mandibular bone. The rate was the lowest in the maxillary bone. The ratio of males to females was 7:3. Facial bone fractures were most often seen in the 10-29 age group.

Adolescent↗
PubMed2001

Temporal bone fracture and its complications.

OBJECTIVE: To explore the characteristics and treatment of temporal bone fractures and injuries in the medial-inner ear. METHODS: The clinical data of 48 cases of temporal bone fractures admitted to our hospital from January 1989 to November 1999 were retrospectively analyzed. RESULTS: Forty-eight patients with temporal bone fractures accounted for 17.00% of the homochronous craniofacial fractures. Of the 48 cases, temporal bone fractures induced by traffic accidents accounted for 66.67%, capillary fractures for 93.75%, medial inner ear injuries or craniocerebral injuries for 77.08% and hearing loss or tinnitus for 48.00%. The cerebrospinal fluid (CSF) otorrhea and facioplegia accounted for 36.70% and 3.00%, respectively, in the longitudinal fractures, while they were 25.00% and 37.50%, respectively, in the transversal fractures. Primary emergent operations were performed on 46 cases and neurosurgery accounted for 46.00%. Secondary procedures accounted for 16.70%. As a result, 43 cases survived (89.58%) and 5 died (10.41%). CONCLUSIONS: Traffic injury is the first high-dangerous factor for temporal bone fractures, which are often complicated with medial-inner ear or craniocerebral injury. The CSF otorrhea is common in the longitudinal fractures and facioplegia is common in the transversal fractures. The key step is to rescue the life, keep the airway unobstructed and maintain the circulation in the primary emergency treatment.

Adolescent↗
PubMed2004

Growth factors--importance and possibilities for enhancement of the healing process in bone fractures.

UNLABELLED: The healing process after bone fractures is subject to complex regulation. A major part in it is played by biologically active molecules, called growth factors. The most important of these are the bone morphogenetic proteins (BMPs), transforming growth factor--beta (TGF-beta), platelet-derived growth factor (PDGF), fibroblast growth factor (FGF), insulin-like growth factor (IGF), vascular endothelial growth factor (VEGF), and epidermal growth factor (EGF). AIM: The aim of the present study was to do a short review of data in the scientific literature about the specific role of each factor in reparative osteogenesis in relation to the healing of bone fractures, as well as the possibilities for enhancement of this process by growth factors. MATERIAL AND METHODS: A detailed Medline search was conducted with emphasis on reports from the last ten years. CONCLUSION: The information gathered demonstrated the key role of growth factors and their potential for stimulation of healing of fractures and their complications. This conclusion is supported by results from numerous animal experiments.

Animals↗
PubMed1980

Hyoid bone fracture with pharyngeal lacerations.

Four cases of hyoid bone fracture with laceration of the pharynx are presented. The emergency treatment must aim at an exploration of the neck in an attempt to suture the lacerations of the pharyngeal mucosa. The fractured hyoid bone may be left untouched in most cases. The most common causes of fractures of the hyoid bone were previously considered to be violent strangulation and hanging. In the last two decades, however, road accidents seem to have become the most important cause in patients who survive the initial impact of collision. The biodynamics of injury to the pharynx and larynx in road accidents have been adequately described by Nahum and Siegel (1967). The concluded that the driver was the most frequent victim and the steering wheel was the object with which the neck most commonly collides. It is very easy to miss a fractured hyoid bone during the urgent admission of a patient injured in a traffic accident, since the more dramatic injuries are treated first and a treacheostomy is often performed to provide an airway.

Adult↗
PubMed1998

Facial reanimation after temporal bone fracture.

Fracture of the temporal bone is usually associated with skull injury and the patient is initially seen in the emergency room. As a result the diagnosis of facial paralysis may be delayed. The aim of this study is to emphasize the importance of early diagnosis and treatment of facial paralysis in such cases. Between 1990 and 1996, sixteen patients with facial paralysis due to temporal bone fracture were operated on within one month of trauma. The surgical technique was selected on the basis of the location of fallopian canal involvement and the patients hearing status. Six patients had grade VI, 7 had grade V and 3 had grade IV facial weakness preoperatively. Twelve patients had serviceable hearing. 9 of them underwent facial decompression through the transmastoid approach and 3 were operated on via the middle fossa approach. Four patients with unserviceable hearing had the operation through the translabyrinthine route. Postoperatively, 15 out of sixteen patients gained normal facial function while one had grade III facial weakness. Severe grade and sudden onset facial paralysis after temporal bone fracture should be surgically corrected as early as possible. The site of involvement of the facial canal and patient's hearing status should be considered in deciding the type of surgery to be applied.

Adolescent↗