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PubMed1998

Increased rate of fractures and severe kyphosis: sequelae of living into adulthood with cystic fibrosis.

BACKGROUND: Osteoporosis occurs in patients with cystic fibrosis as they age, but its clinical implications are not well defined. OBJECTIVE: To determine the clinical effect of decreased bone mineral density in adults with cystic fibrosis and to assess possible clinical predictors of osteoporosis. DESIGN: Retrospective cohort study. SETTING: Academic cystic fibrosis center. PATIENTS: 70 adults with late-stage cystic fibrosis who were referred for lung transplantation. MEASUREMENTS: Bone mineral density was measured with dual-energy x-ray absorptiometry, patient-reported fracture events were confirmed by radiography, and kyphosis angles were measured by using the Cobb method. RESULTS: Mean bone mineral densities for the spine, femur, and total body were severely depressed in patients with cystic fibrosis, averaging 2 SDs below those of age-matched normal controls (P < 0.001). Patient interviews showed that 54 fractures had occurred over 1410 patient-years, and chest radiographs showed evidence of 14 additional rib and 62 additional vertebral compression fractures. The database (which covered 1410 patient-years) showed that fracture rates were approximately twofold greater in women with cystic fibrosis aged 16 to 34 years (P = 0.015) and men with cystic fibrosis aged 25 to 45 years (P = 0.04) than in the general population. Vertebral compression and rib fractures were 100- and 10-fold more common than expected, respectively (P < 0.001 for both comparisons). The mean kyphosis angle (+/- SD) for this group was markedly abnormal (44 +/- 14 degrees; 62% > or = 40 degrees) and probably contributed to diminished stature (mean height loss, 5.8 cm in men with cystic fibrosis and 5.9 cm in women with cystic fibrosis). Cumulative prednisone dose, body mass index, and age at puberty were the strongest predictors of bone mineral density. CONCLUSIONS: Osteoporosis is universal in adults with late-stage cystic fibrosis, and its complications include increased fracture rates and severe kyphosis.

Adult↗

PubMed2002

Percutaneous transpedicular vertebroplasty with calcium phosphate cement in the treatment of osteoporotic vertebral compression and burst fractures.

OBJECT: Osteoporotic vertebral fractures occasionally lead to late-onset collapse, kyphosis, persistent back pain, and disability. The authors describe a series of patients in whom they performed percutaneous vertebroplasty by using calcium phosphate cement (CPC) to obtain early pain relief and improve the integrity of the osteoporotic vertebral body (VB). METHODS: Between August 2000 and February 2001, they performed 17 percutaneous transpedicular CPC-assisted vertebroplasty procedures in 16 patients who harbored thoracic or lumbar osteoporotic vertebral fractures. Following repositioning and curettage of the pathological soft tissues, CPC-assisted vertebroplasty was percutaneously performed in four patients with osteoporotic burst fracture and pseudarthrosis (Procedure A). In situ CPC-assisted vertebroplasty was performed in 12 patients with fresh vertebral compression fractures due to osteoporosis (Procedure B). Back pain and low-back pain were evaluated using a visual analog scale (VAS). The deformity index of the VB was measured on a lateral radiograph as the ratio of the VB's height (sum of measurements at anterior, middle, and posterior regions) to its longitudinal diameter. Based on VAS scores, pain was decreased in all patients immediately after surgery, and pain relief was maintained at the last follow up. The mean preoperative deformity index score of the VB was 1.43 in Procedure A and 1.67 in Procedure B; postoperatively scores improved to 1.59 and 1.93, respectively. At the 6-month follow-up examination, the mean deformity index score rebounded to 1.52 in Procedure A and 1.79 in Procedure B. Bone union was documented in all patients. Complications, such as a temporary respiratory insufficiency and a small amount of CPC leakage into the spinal canal, were observed in patients who underwent Procedure B. CONCLUSIONS: Percutaneous transpedicular CPC-assisted vertebroplasty is a minimally invasive procedure that provides early relief of pain and prevents vertebral collapse and pseudarthrosis in patients with osteoporotic vertebral fracture.

Aged↗

PubMed1985

[Indications and results of early functional vertebral fracture treatment].

Early functional treatment was administered to 213 patients with stable compression fractures of thoracic and lumbar vertebrae between 1975 and 1982. Physiotherapy was carried out according to a uniform schedule. The patients were mobilized after an average of 6 days; hospitalization lasted 2 weeks on an average. Control examinations of 82 of these patients revealed only a slight union of compressed vertebral bodies (on an average, 7% of the initial height), which correlated with the primary compression and the patient's age. Remaining functional restriction of the spine and subjective complaints did not correlate significantly with the extent of vertebral compression.

Adult↗

PubMed1977

[Fracture of the vertebrae due to riding accidents].

Fractures of the vertebral column due to riding accidents are frequent. In most of the cases we observe compression fractures of a vertebral body without compression symptoms of the spinal cord. If fractures of the spine heal with a gibbus deformity degenerative changes of the vertebral joints with severe back pains may ensue. Therefore it seems necessary to treat fractures of the vertebral spine with immediate reposition (ventraler Durchhang) and following immobilisation with a plastic corset Lightcast, Hexcelite). Occasionally operative stabilisation is necessary, especially in fractures of the cervical spine.

Athletic Injuries↗

PubMed1976

Articular mass fracture: a neglected cause of post-traumatic neck pain?

Fifty-one compressed distorted cervical articular masses were found in 29 patients seen at this institution over a nine-month period. The significance of these findings is discussed and it is concluded that in most instances these represented compression fractures with deformity of the articular process. Selected signs suggestive of a compressed articular mass are identified on various views. These include (1) neuroforaminal encroachment or narrowing, (2) triangular appearance of the lateral mass in the oblique view, (3) unilateral anterior displacement of the superior facet with respect to the inferior facet, (4) minor anterior subluxation of one vertebral body over another, (5) double outline sign on the lateral view, (6) abnormally visible posterior articulations on the routine AP view. The articular processes are best shown on anteroposterior angled caudad views and lateral tomography. Articular mass deformity frequently appears to be associated with persistent post-traumatic neck pain and a relationship between this deformity and primary or secondary degenerative cervical disc and joint disease is suggested.

Adult↗

PubMed2004

Percutaneous vertebroplasty for treatment of thoracolumbar spine bursting fracture.

OBJECTIVE: Percutaneous vertebroplasty can be very beneficial for patients with vertebral osteoporotic compression fractures. To the best of our knowledge, however, there has been no mention in any literature regarding the use of percutaneous vertebroplasty for the treatment of spinal burst fracture. METHODS: A preliminary study was conducted on 6 patients with traumatic burst fractures of vertebrae treated with percutaneous vertebroplasty starting in June 2000. Fractures involving the anterior and middle columns of the vertebrae and the canal were mildly compressed by the retropulsed bone fragment. However, there was no obvious neurologic deficit in these patients. They initially underwent conservative treatment and thoracolumbar spinal orthosis (TLSO) brace for at least 3 months, but the intractable pain caused patients to be bedridden for prolonged periods of time and limited daily activity. As a result, the patients underwent percutaneous vertebroplasty with polymethylmethacrylate (PMMA) for treatment of spinal burst fractures. RESULTS: Six male patients (mean age: 38.2) who suffered from burst fractures of vertebrae with disabling back pain refractory to analgesic therapy and TLSO brace were treated in this study. The duration of conservation treatment period was 3.5 months to 8 months (mean: 5.2 months). There was no motility. However, 4 vertebrae (66.7%), on radiographs revealed evidence of PMMA leakage through the endplate fracture site into either the disc space or the paravertebral space, without any evident clinical symptoms. No intracanal leakage was seen, and no patient needed a secondary surgical intervention. Pain decreased from 84.3 +/- 5.4 mm at baseline to 34.7 +/- 4.4 mm at the third postoperative day, 30.2 +/- 5.8 at 3 months and 24 +/- 3.5 mm at 12 months. The reduction in pain from baseline to the 3-day and 3 month mark was statistically significant (p < 0.05). The mobility was at least 2 levels of improvement (mean improvement 2.7 points) at 12-months postoperative. CONCLUSION: In highly selective patients, percutaneous vertebroplasty can be an alternative method for the treatment of spinal burst fractures and the prevention of complications from major surgical procedures. However, this procedure still has potential risks and should be employed with extreme caution to prevent extravasation of PMMA into the spinal canal.

Adult↗

PubMed2002

Biomechanical evaluation of an injectable calcium phosphate cement for vertebroplasty.

STUDY DESIGN: Destructive biomechanical tests using fresh cadaveric thoracolumbar vertebral bodies. OBJECTIVES: To evaluate the compression strength of human vertebral bodies injected with a new calcium phosphate (CaP) cement with improved infiltration properties for augmentation of the vertebral bodies before compression fracture and also for vertebroplasty in comparison with polymethylmethacrylate (PMMA) injection. SUMMARY OF BACKGROUND DATA: Vertebroplasty is the percutaneous injection of PMMA cement into the vertebral body. While PMMA has high mechanical strength, it cures fast and thus allows only a short handling time. Other potential problems of using PMMA injection may include damage to surrounding tissues by a high polymerization temperature or by the unreacted toxic monomer, and the lack of long-term biocompatibility. Bone mineral cements, such as calcium carbonate and CaP cements, have longer working time and low thermal effect. They are also biodegradable while having a good mechanical strength. However, the viscosity of injectable mineral cements is high, and the infiltration of these cements into vertebral body has been questioned. Recently, the infiltration properties of a CaP cement have been significantly improved, which is ideal for the transpedicular injection to the vertebral bodies for vertebroplasty or augmentation of osteoporotic vertebral body strength. METHODS: The bone mineral densities of 30 vertebral bodies (T2-L1) were measured using dual-energy x-ray absorptiometry. Ten control specimens were compressed at a loading rate of 15 mm/min to 50% of their original height. The other specimens had 6 mL of PMMA (n = 10) or the new CaP (n = 10) cement injected through the bilateral pedicle approach before being loaded in compression. Additionally, after the control specimens had been compressed, they were injected with either CaP (n = 5) or PMMA (n = 5) cement using the same technique, to simulate vertebroplasty. Loading experiments were repeated with the displacement control of 50% vertebral height. Load to failure was compared among groups and analyzed using analysis of variance. RESULTS: Mean bone mineral densities of all five groups were similar and ranged from 0.56 to 0.89 g/cm2. The size of the vertebral body and the amount of cement injected were similar in all groups. Load to failure values for PMMA, the new CaP, and vertebroplasty PMMA were significantly greater than that of control. Load to failure of the vertebroplasty CaP group was higher than control but not statistically significant. The mean stiffness of the vertebroplasty CaP group was significantly smaller than control, PMMA, and the new CaP groups. The mean height gains after injection of the new CaP and PMMA cements for vertebroplasty were minimal (3.56% and 2.01%, respectively). CONCLUSION: Results of this study demonstrated that the new CaP cement can be injected and infiltrates easily into the vertebral body. It was also found that injection of the new CaP cement can improve the strength of a fractured vertebral body to at least the level of its intact strength. Thus, the new CaP cement may be a good alternative to PMMA cement for vertebroplasty, although further in vivo animal and clinical studies should be done. Furthermore, the new CaP may be more effective in augmenting the strength of osteoporotic vertebral bodies for preventing compression fractures considering our biomechanical testing data and the known potential for biodegradability of the new CaP cement.

Absorptiometry, Photon↗

PubMed2001

Mechanical augmentation of the vertebral body by calcium phosphate cement injection.

The effectiveness of transpedicular calcium phosphate cement (CPC) injection as a new treatment for osteoporotic compression fracture of vertebrae was evaluated by measuring the compressive strength and the mode of failure in vertebrae experimentally injected with CPC. Forty-five human cadaver vertebrae were divided into three groups: a control group; group A, in which CPC was injected into the upper half of the vertebral body; and group B, in which CPC was injected into the whole vertebra. The load-displacement curve characteristically had two peaks in group A, and decreased rapidly after failure in group B. The failure site was the cancellous bone immediately below the cranial endplate in the control group, cancellous bone immediately below the CPC injection area in group A, and in the CPC injection area in group B. Although mechanical strength was greatest in those vertebrae in which the entire cancellous bone was replaced with CPC, the compressive strength of the vertebrae was also increased by partial replacement of cancellous bone with CPC injection. In terms of mode of failure and mechanical gradient with adjacent vertebrae, there were several advantages for those vertebrae in which the cranial half of the cancellous bone was replaced with CPC.

Aged↗

PubMed1997

Bone fractures associated with luteinizing hormone-releasing hormone agonists used in the treatment of prostate carcinoma.

BACKGROUND: Luteinizing hormone-releasing hormone agonists (LHRH-a) have become an established treatment for certain patients with prostate carcinoma. LHRH-a are known to decrease bone mineral density. The purpose of this study was to determine the risk of bone fracture in men receiving LHRH-a for prostate carcinoma. METHODS: A retrospective chart review and phone interviews were conducted to determine the incidence of bone fractures occurring in patients receiving LHRH-a for the treatment of prostate carcinoma. Abstracted data included the number of monthly LHRH-a injections, age, clinical stage of disease, sites of metastases, and bone fracture history. RESULTS: Twenty of the 224 patients (9%) treated with LHRH-a for prostate carcinoma between 1988 and 1995 at 3 teaching hospitals had at least 1 bone fracture during treatment with LHRH-a. The duration of treatment to the time of fracture ranged from 1 to 96 months (mean, 22.2 months). Seven fractures (32%) were osteoporotic in nature (i.e., vertebral compression fractures or hip fractures after a fall from standing), whereas 8 fractures (36%) were associated with a significant traumatic event (i.e., a motor vehicle accident, boxing, etc.) and 5 were of mixed etiology. Two of 22 fractures (9%) were pathologic. CONCLUSIONS: This study demonstrated a 9% fracture incidence in a cohort of patients receiving LHRH-a for prostate carcinoma for up to 96 months. The incidence of osteoporotic fractures was 5%.

Aged↗

PubMed1993

The incidence of hip fracture in Europe.

Fragility fractures are now recognized as a major public health problem. Although the prevalence of all fractures is similar among men and women, the vast majority of osteoporotic fractures occur in elderly women. These comprise vertebral compression fractures, Colles' fracture at the wrist and hip fracture, and to a lesser extent fractures at other sites. The fracture of greatest socioeconomic consequence in Europe is hip fracture, which increases exponentially in incidence with age. The reasons for differences in age- and sex-specific incidence relate in part to the lower bone density of women at the time of maturity (peak bone density) and the accelerated bone loss that occurs after the menopause. Women live significantly longer than men, so that the prevalence of osteoporosis amongst elderly women is six-fold that of men. The age-specific incidence of hip fracture is rising in men and women in many countries, and if the current trends in the United Kingdom continue then the number of hip fractures occurring each year will more than double over the next 20 years. There is a marked geographic distribution in the incidence of hip fractures, even in Europe. Indeed the differences in incidence between communities is greater than the differences in incidence between sexes within communities. This suggests that the importance of gonadal insufficiency in women has been overemphasized and that other factors, probably relating to genetic or lifestyle factors affecting peak bone density, account for ecological differences in incidence of hip fracture between communities.

Adolescent↗

PubMed1992

Epidemiology of osteoporosis.

Fragility fractures are now recognised as a major problem of public health. Although the prevalence of all fractures is similar among men and women, the vast majority of osteoporotic fractures occur in elderly women. These comprise vertebral compression fractures, Colles fractures at the wrist, and hip fracture, and to a lesser extent fractures at other sites. The incidence of vertebral and hip fracture increases exponentially with age. The reasons for this relate in part to the lower bone density of women at the time of maturity (peak bone density), and the accelerated bone loss that occurs after the menopause. Women live significantly longer than men, so that the prevalence of osteoporosis amongst elderly women is six-fold that of men. The age- and sex-specific incidence of osteoporotic fracture is rising in many countries, and if the current trends in the United Kingdom continue, then the number of hip fractures each year will more than double over the next 20 years. There is a marked geographic distribution in the incidence of hip fracture, and probably of other osteoporotic fractures. Indeed, the difference in incidence between communities is greater than the difference in incidence between sexes within communities. This suggests that the importance of gonadal insufficiency in women has been over-emphasised and that other factors, probably relating to life-style factors affecting peak bone density, account for ecological differences in incidence between communities and secular trends within communities.

Colles' Fracture↗

PubMed1989

Epidemiology of vertebral fractures in women.

Vertebral fracture prevalence was assessed in an age-stratified random sample of Rochester, Minnesota women aged 50 years and over. Vertebral fractures, including wedge and concavity as well as compression fractures, were common and increased with age. The estimated incidence of new vertebral fractures also rose with age, reaching 29.6 per 1,000 person-years in women aged greater than or equal to 85 years. The prevalence of one or more vertebral fractures also increased with declining bone mass, reaching 42% in women with spinal bone mineral density less than 0.6 g/cm2 by dual photon absorptiometry. Bone mass and age contributed independently to the risk of vertebral fracture, but "age" may reflect other manifestations of osteoporosis.

Adult↗

PubMed1990

Femoral neck stress fractures.

Femoral neck stress fractures are unusual but not rare athletic injuries. In one large series they accounted for 5% of all stress fractures. Early recognition of the signs and symptoms of this injury is important, as objective findings are often delayed. The potential problems from this fracture are serious. The aetiology includes repeated force above a certain load without internal bone response time. Loss of shock absorption due to muscle fatigue and limitation of ankle motion by boots or splints may also play a role. The diagnosis is based on the finding of groin pain and radiographic testing, which often requires plain films and bone scintigraphy. Regular radiographic findings present in stages progressing from a normal film through sclerosis to a disruption of the cortex and displacement. Bone scintigraphy may be positive 2 or more weeks before plain film changes are present. Classification schemes follow the radiographic changes. A classification system and treatment plan may be based on 3 categories of these fractures--compression side, tension side and displaced femoral neck fracture. Treatment ranges from rest with early symptoms to surgical stabilisation for any widening of cortical cracks and/or displaced fractures. Prompt diagnosis and carefully supervised treatment is the key to preventing displacement. Prolonged disability secondary to pain, nonunion or avascular necrosis is associated with displacement of the femoral neck stress fracture.

Athletic Injuries↗

PubMed1997

Thoracic myelopathy due to intraspinal rheumatoid nodules.

A fifty-six-year-old woman with classical rheumatoid arthritis had subacute onset of paraparesis due to thoracic epidural rheumatoid nodules. Although plain radiograms and computed tomograms of the thoracic spine were negative except for old compression fractures, magnetic resonance imaging revealed thoracic spinal cord compression due to masses at multiple levels. There was a steady recovery after excision surgery.

Female↗

PubMed1987

Assessment of the risk of vertebral fracture in menopausal women.

The decision to institute prophylaxis in women with menopausal osteopenia is hampered by the absence of quantitative criteria for appraising the risk of fracture in the individual. We have developed standards for assessing the risk of fracture by relating the prevalence of atraumatic vertebral compression fractures to bone density in sixty-five menopausal women, forty-nine to ninety-two years old. To define the upper limit of the spectrum of bone density, we also studied thirty-one young women, seventeen to twenty-two years old. The density of trabecular bone in a vertebral body was determined by quantitative computed tomography and expressed in terms of milligrams per milliliter of dipotassium hydrogen phosphate. Twenty-five of the menopausal women exhibited at least one fracture (range, one to six fractures), and forty had no fracture. The bone density ranged from -9 to sixty-nine milligrams per milliliter in those with fractures and from twelve to 122 milligrams per milliliter in those without a fracture. The densities in the young women averaged 173 milligrams per milliliter and ranged from ninety-five to 248 milligrams per milliliter. The percentage of subjects with fractures increased as the bone density decreased. It was zero per cent in women with a density of seventy milligrams per milliliter or more, 38 per cent in women with a density between fifty and less than seventy milligrams per milliliter, 71 per cent in those with a density between thirty and less than fifty milligrams per milliliter, and 82 per cent in women with a density of less than thirty milligrams per milliliter.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1982

[Classification, treatment and results of fractures of the tibial pilon].

Considering the rate of complications and the remaining disability occurring after compression fractures of the distal end of the tibia - the so-called pilon fracture -, this type of fracture is one of the most serious injuries of the lower extremity. Such fractures of the distal end of the tibia can be caused by compressions as well as by direct of indirect traumatic violence, e.g. shearing, bending, or torsion effects. Of 102 patients with pilon fractures, 63 (= 61.8%) suffered this fracture by falling from a great height. When classifying our cases with fracture of the distal end of the tibia, and the diagnosed accompanying injuries, we found a dependence between expected consequences of the lesion and the seriousness of the accident before surgery already. During the treatment of patients suffering from pilon fractures, complications arose in 0% of group I, in 16.1% of group II, and in 27.6% of group III. With respect to the existing possibilities of surgical treatment of fractures, one should always - if possible - reconstruct the joint surfaces in an anatomically correct manner and apply an early functional treatment with late exertion of stress on the injured part.

Adult↗

PubMed1977

Instrumentation of the spine for fracture dislocations in children.

13 children, ages 11-16 years, sustained severe compression fractures or fracture dislocations of the thoracolumbar spine. All cases were treated with Harrington instrumentation with fusion and six also had decompressive laminectomy. All injuries had significant instability and neurologic deficits (nine complete). Follow-up of 2-10 years is provided for analysis of maintenance of reduction and neurologic improvement. This technique appears to offer stability, reduction of orthopedic defects, and assumption of a more aggressive rehabilitation program without introducing significant operative morbidity or neurologic deficit.

Adolescent↗

PubMedDate not supplied

MRI and bone scan imaging in the preoperative evaluation of painful vertebral fractures treated with vertebroplasty and kyphoplasty.

BACKGROUND: This study compared the role and timing of bone scintigraphy and magnetic resonance imaging (MRI) in the evaluation of vertebral compression fractures (VCFs), before treatment with vertebroplasty and kyphoplasty. To our knowledge, no prior articles have described, in osteoporotic and pathological vertebral fractures, the role of MRI and bone scintigraphy as pre-procedural work up in those patients candidated to undergo spinal interventional procedures. MATERIALS AND METHODS: A retrospective chart review was performed of thirty patients treated with interventional procedures for painful vertebral fractures at our institution between January 2002 and July 2003. RESULTS: In patients, selected after evaluation with MRI and bone scan imaging, both procedures demonstrated swift pain relief associated with vertebral resistance augmentation. CONCLUSION: MRI revealed itself to be equivalent to bone scan imaging in selecting patients to be treated with vertebroplasty and kyphoplasty in the first 3/4 months, while bone scintigraphy was more accurate in the evaluation of elderly fractures (> 3/4 months). MRI was superior to bone scintigraphy in vertebral collapses due to multiple myeloma.

Aged↗