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PubMed1994

Reversal of severe osteoporosis with vitamin B12 and etidronate therapy in a patient with pernicious anemia.

Pernicious anemia has recently been recognized as a risk factor for osteoporosis and fractures. Although vitamin B12 is important for osteoblast function, the effect of vitamin B12 replacement in states of vitamin B12 deficiency on bone density and fracture incidence is not known. We report 2-year follow-up data from a patient with severe osteoporosis, multiple vertebral compression fractures, and pernicious anemia who exhibited a dramatic response to treatment with vitamin B12 and cyclic etidronate. Serial bone density measurements demonstrated a 15% and 17% increase in the lumbar and greater trochanter regions, respectively, and a 79% increase in the femoral neck region over the 2-year follow-up period. In addition to normalization of bone density compared with age-matched controls, no subsequent vertebral fractures were noted in the 2-year period following initiation of vitamin B12 and etidronate therapy. This case demonstrates that osteoporosis associated with pernicious anemia may be markedly improved by vitamin B12 replacement and cyclic etidronate therapy.

Aged↗

PubMed1986

Clinical course of breast cancer patients with osseous metastasis treated with combination chemotherapy.

Between July 1973 and December 1979, 1171 patients with metastatic breast cancer were treated with doxorubicin-containing chemotherapy. Of those patients, 195 had osseous metastases only. Upon initial diagnosis, 48% had osteolytic metastases; 13% had osteoblastic metastases; 38% had mixed metastases; and 1% had diffuse osteoporosis without any obvious bone destruction. The most common sites of involvement were the dorsal spine (62%), lumbosacral spine (72%), and pelvis (79%). Objective response to chemotherapy was observed in 59% of patients; complete responses were noted in 7%, and partial responses in 52%. The median survival was 28 months (range, 1-118 months). The median time lapse between the start of chemotherapy and disease progression was 14 months (range, 1-109 months). In 32 patients who responded to the treatment, chemotherapy was discontinued after 2 years, and their median duration of continued remission at 39 and 75 months after the completion of therapy. The incidence of pathological fractures was 57%; the most common sites were the spine, which sustained compression fractures, and the ribs. The incidences of hypercalcemia and spinal cord compression due to metastases were 19% and 10%, respectively.

Adult↗

PubMed1992

Fractures and luxations of the vertebral column.

External fixation of the vertebral column is indicated to treat fractures of the caudal lumbar spine, open fractures where vertebral osteomyelitis is present or likely to occur, and vertebral fractures not easily stabilized by internal fixation alone (e.g., compression fractures, fractures including spinous processes, and articular facets). Advantages of external fixation of caudal lumbar fractures, especially in combination with dorsal fixation devices, include the following: Fracture fixation does not preclude dorsal decompression; fixation devices need not be applied directly to the fractured vertebrae; and the combined technique provides dorsal and ventral vertebral fixation, which is more stable than dorsal fixation alone. Although external fixation is not applicable to all vertebral fracture/luxations in small animals, it provides additional points of fixation for rigid stability. Animals with vertebral fracture/luxations treated with an external fixation device have tolerated the external portion well. Development of additional applications for this method of vertebral fracture repair seems warranted.

Animals↗

PubMed1989

Sternal fractures associated with spinal injury.

Twenty-eight cases of sternal fractures and/or dislocations were reviewed for the presence of associated spinal injury. Patient records and radiographs were studied. Sixteen cases had inadequate radiographs to rule out spine fracture. Three cases had known direct injuries to the sternum. Of the remaining nine patients, eight had spine fractures. All of the spine fractures were consistent with a flexion injury mechanism. Three patients had spine fractures at the thoracic level and four at the lumbar level. One patient had lower cervical and thoracic injuries. In the patients with spine injury, the proximal manubrial fragment tended to displace posteriorly. Similarly, the manubrium would move posteriorly in manubriosternal dislocations. A case of spontaneous sternal fracture in a patient with osteoporosis and multiple thoracic compression fractures is described. One patient had open reduction of the manubriosternal joint. Three patients who were admitted for their sternal injuries had spine fractures which were not recognized during the hospitalization. There were no cases of mediastinal injury in the patients with combined sternal and spinal injuries. Flexion injury to the spine may cause buckling of the sternum. However, indirect sternal injury continues to be overlooked. Careful evaluation for spine injuries should be done on all patients with sternal fractures and vice versa.

Adult↗

PubMed2006

Cement augmentation in fracture treatment.

Surgical treatment of fractures close to joints, especially in osteoporotic patients, is often associated with problems to obtain adequate strength of the bone-implant construct as well as sufficient purchase for screws in the weak bone. One way to address this increasing problem is through the development of new metal implants specifically designed for fixation of fractures in osteopenic bone. An alternative strategy is to develop methods for augmentation of the weak bone that surrounds the metal implant. In most instances augmentation is achieved by using injectable cement to reinforce the bone. Conventional PMMA provides good strength but due to several drawbacks it has never gained general acceptance for fracture augmentation. More recently several injectable cements based on calcium-phosphate, calcium-sulphate or bioglass has been developed for augmentation of fractures in the extremities as well as for vertebral compressive fractures in the spine. On the basis of biomechanical studies and the clinical experience so far, cement augmentation will enable faster rehabilitation, as the strength of the cement makes it possible to allow full weight-bearing earlier than conventional metal implants alone. More clinical studies are needed in order to refine the surgical technique, develop cement types aimed for fracture treatment and define the most appropriate indications and limitations of augmentation for fracture repair. The purpose of this article is to review the possible use of augmentation as a technique in the treatment of fractures in the extremities as well as in the spine.

Bone Cements↗

PubMed2000

[The value of bone density measurement--a follow-up of the conclusions in the earlier SBU report].

Osteoporotic fractures are common primarily among elderly Swedish women. Vertebral compression fractures can occur spontaneously without trauma, while wrist and hip fractures are nearly always the result of trauma. The risk of fracture increases in skeletal wasting. If bone density measurement can demonstrate osteoporosis already before fractures occur, then preventive measures could be set in. The present study, which is a systematic review of articles published from 1994 to the spring of 1998, confirms the conclusions of the 1995 report "Bone Density Measurement" from SBU, the Swedish Council on Technology Assessment in Health Care, that the relative risk of fracture can be predicted utilizing bone density measurement. The best risk assessment is achieved by taking into account both clinical risk factors and bone density.

Adult↗

PubMed2001

Thoracic spine fractures.

OBJECTIVE: To investigate the unique characteristics and treatment of thoracic spine fractures. METHODS: Seventy-seven patients with thoracic spine fractures were retrospectively reviewed. Of these, there were 37 compression fractures, 34 fracture-dislocations, 3 burst fractures and 3 burst-dislocations. Twenty-six patients had a complete lesion of the spinal cord, 14 sustained a neurologically incomplete injury, and 37 were neurologically intact. Fifty-three patients were treated nonoperatively and 24 treated operatively. RESULTS: All patients were followed up for 2 approximately 15 years. None of the 26 patients with a complete lesion recovered any significant function. Of 37 neurologically intact patients, 13 had local pain although all of them remained normal function. Two of 14 patients with incomplete paraplegia returned to normal, 7 recovered some function and 5 did not recovered. CONCLUSIONS: Because of the unique anatomy and biomechanics of the thoracic spine, the classification commonly applied to thoracolumbar fractures is not suitable for thoracic fractures. Fusion and instrumentation are indicated when the fractures are unstable, while patients with incomplete lesion of the spinal cord may be the candidates for supplemented decompression.

Adolescent↗

PubMed1990

[Clinical picture of anterior instability of the shoulder joint].

The authors have studied the clinical picture of 360 patients with primary traumatic dislocations and the long-term results have been observed in 286 patients. The analysis of 50 arthrotomies of the shoulder performed in cases of anterior instability has been made. A direct relationship between the clinical course of instability and the severity of the intra-articular lesions appearing during the first traumatic dislocation has been established. Such lesions include ruptures or avulsions of the anterior portion of the cartilage wall, ruptures of the joint capsule, avulsion of the capsule from the neck of the scapula, fractures of the anterior border of the glenoid cavity, compression fracture of the posterior lateral portion of the head of the humerus, etc, Inadequate treatment of traumatic dislocation leads to instability in the form of frequent dislocations or subluxations in the shoulder joint. The surgical treatment of the instability should be directed at the reconstruction of the injured structures of the shoulder joint.

Adult↗

PubMed2003

Vertebroplasty for osteoporotic spine fracture: prevention and treatment.

There is a relatively high prevalence of osteoporotic vertebral compression fractures (VCFs) in the elderly population, especially in women aged 50 or older. The result of these VCFs is increased morbidity and mortality in the short and long term. Medical treatment of these fractures includes bed rest, orthotics, analgesic medication and time. Percutaneous vertebroplasty (PVP) consists of percutaneous injection of biomaterial, such as methylmethacrylate, into the VCF to produce stability and pain relief. Biomechanical testing has shown that PVP can restore strength and stiffness of the vertebral body to the pre-fracture levels. Clinical results show immediate and maintained pain relief in 70-95% of the patients. Possible major complications include cement leakage into the spinal canal or into the venous system. Additionally, percutaneous vertebroplasty may alter the normal loading behavior of the adjacent vertebral body, and there is an increased risk of adjacent segment VCF. Kyphoplasty is a new technique, which introduces a balloon into the vertebral body transpedicularly to reduce the VCF while creating a cavity for the cement injection. This technique has the benefit of kyphosis reduction as well as less cement leakage. Research continues into the development of injectable biomaterials that are resorbable and allow for new bone formation. Vertebroplasty and kyphoplasty are safe and effective in the treatment of osteoporotic VCFs. They may allow for a faster return to function, and thus avoid the morbidity associated with medical treatment.

Administration, Cutaneous↗

PubMed1989

[Treatment of fracture of the thoracolumbar spine using Böhler's method].

The treatment of stable thoracolumbar compressive fractures by the Böhler cast is worth while in cases of kyphosis with integrity of articular apophysis. The best reductions concern T12, L1 and L2. This method, studied on 92 patients, regularly succeeded in reducing and maintaining the kyphosis beneath 20 degrees, provided a complete reduction of the vertebral body and an early and intensive reeducation in the cast, and despite an early, constant but partial loss of reduction. The long term functional results appear to be satisfactory with such a residual deformation. This treatment seems to be particularly indicated in kyphosis of more than 20 degrees.

Adolescent↗

PubMed1987

[Spinal fractures in children and adolescents].

A follow-up study of more than hundred spinal fractures in children and adolescents pointed out that treatment and prognosis depends on the injury involving the growth-plate. In compression fractures without injury of the growth-plate spontaneous correction can be expected during further growth, especially if the wedge-shaped compression was in the sagittal plane alone. Spinal fractures with damage of the growth plate always result from a severe accident. These compound fractures, luxations and luxation-fractures require an exact repositioning and stable fixation to avoid growth disturbances such as progressive scoliosis and kyphosis originating from the unreduced fracture. Reposition and fixation can be managed by modern surgical methods more carefully, more exactly and with greater stability than with conservative methods. Furthermore surgical procedure allows removal of mechanical obstructions within the spinal channel. The origin, clinical appearance and treatment of apophyseal tearing out from the vertebral body are discussed.

Adolescent↗

PubMed1997

[A propos of an unusual case of lumbar-pelvic dislocation in a suicidal jumper].

PURPOSE OF THE STUDY: We report a particular case of lombo-pelvic dislocation in a suicidal jumper, characterized by a distal sacral fracture associated with bilateral fractures of both iliac wings. To our knowledge, it has yet not been described. MATERIAL AND METHODS: The patient was a 27 years old individual. On admission, he sustained the following injuries: hemodynamic shock with intraperitoneal bleeding due to disruption of the triangular ligament of the liver, which resolved with blood transfusions and did not require surgical treatment pelvic fractures initially identified as transverse fractures of both iliac wings, with bilateral avulsions of sciatic spines a compression fracture of the first lumbar vertebra without neurologic complication. In the intensive care unit, evolution was favorable. However, an incomplete cauda equina syndrome was noticed: the anal sphincter was flacid but perianal sensation to pinprick was conserved. An electromyogram showed that the latence of perineal reflexes was increased. The fracture and its displacement were recognized secondarily. A pelvic C.T. exhibited an increases in the antero-posterior dimension of the pelvic ring, due to a distal-displaced transverse sacral fracture. The proximal fragment of the sacrum remained attached to the iliac wing since sacro-iliac joints were intact, iliac wings had tilted forward, and the distal tip of the proximal sacral fragment was driven backward and inferiorly. RESULTS: The patient was maintained in the supine position during 3 months. He then rapidly recovered normal function of his lower limbs. He had normal gait patterns and pelvic static. He did not complain of any pain. Finally, the neurological deficit disappeared and he regained full sexual function and complete control of micturition. DISCUSSION: We think that this fracture should be considered as a variety of suicidal jumper's fracture described by Roy Camille et al. It has the same displacement as type 2 fracture in Roy Camille classification. In the emergency room, diagnosis is difficult, based on usual AP pelvic roentgenograms. A bilateral fracture of iliac wings in a suicidal jumper, especially if associated with bilateral sciatic spine avulsions, is an indication to a pelvic C.T.. A neurological perineal deficit should be ruled out. In our case, the perineal deficit can be attributed to the stretching of sacral roots resulting from a posterior displacement of the sacrum. The favorable evolution suggests that surgery may be not required, and there is no evidence in the literature that it would help neurological recovery. In distal fractures, the sacral canal is not narrowed, and a sacral laminectomy appears therefore not indicated. CONCLUSION: We have described a particular type of transverse fracture of the pelvis, which, in our mind, should be put in the same category as type 2 transverse fractures of the sacrum described by Roy Camille and al, in the suicidal jumper. Since there is no compression of sacral roots into the sacral canal, prolonged bedrest is likely to be the better treatment.

Adult↗

PubMed2003

Osteoporotic vertebral burst fractures with neurologic compromise.

A retrospective study was performed on the operative results following osteoporotic burst fractures with neurologic compromise. We sought to investigate the results of operative decompression and stabilization in patients with neurologic deficit as a result of an osteoporotic burst fractures. We examined the postoperative radiographic outcomes, level of disability, functional outcomes, and complications. Compression fractures of the anterior vertebral column secondary to osteoporosis and minimal trauma are a common clinical entity. These fractures are often effectively treated by nonoperative means. However, compressive failure of the middle vertebral column can lead to retropulsion of vertebral body fragments with significant canal compromise and neurologic injury. Treatment of these more severe injuries becomes more difficult and is less well established. Functional outcomes and disability from pain have not been examined. Previous reports on this subject have documented generally good results but have given few specific data regarding outcomes. We retrospectively report on a series of 10 patients, from 1995 to 1998, with osteoporotic burst fractures, which led to varying degrees of neurologic compromise. There were nine female and one male patient with a mean age of 76 years. Nine of the 10 patients presented more than 1 month following the onset of neurologic symptoms; 70% of the fractures occurred at the thoracolumbar junction (T11-L2). Mean loss of anterior column height was 59%, with significant kyphosis (mean 28 degrees) in nine of the 10 fractures. Mean canal compromise was 41%. At presentation, seven patients were Frankel grade D and three were Frankel grade C. All patients were treated operatively with decompression and arthrodesis. Mean time to follow-up was 16 months. Six of the 10 patients had improvement of their Frankel grade postoperatively and one deteriorated neurologically. Seven of the eight surviving patients completed the Oswestry questionnaire with a mean score of 44%, representing severe disability secondary to low back pain. The Physical Component score of the SF-36 was at or below the national mean for each patient. Complications were present in six of the eight surviving patients. Osteoporotic fractures are not benign. Careful evaluation for neurologic deterioration is warranted. Neurologic recovery occurred in six of the 10 patients; however, significant disability secondary to pain was common.

Aged↗

PubMed2005

[Compound osteosynthesis as treatment for an osteoporotic LWK-1 burst fracture in a 76 year old female patient].

The surgical treatment of osteoporotic vertebral compression fractures is rarely necessary and is mostly done in fractures with neurological deficit. We present a case of compound osteosynthesis in an osteoporotic fracture of the first lumbar vertebra as a "salvage procedure" after a dislocation of a dorsal internal fixator in a 76 year old female sustaining incomplete paraplegia. In this case, an additional ventral stabilization using a vertebral body replacement was not practicable because of old age and previous pneumonia. We performed an additional compound osteosynthesis using bone cement because of insufficient stability when only using cement for augmentation of the pedicle screws.

Aged↗

PubMed2001

Should percutaneous vertebroplasty be used to treat osteoporotic fractures? An update.

Acrylic cement vertebroplasty is being increasingly used to treat osteoporotic vertebral compression fractures (VCFs), although no controlled studies supporting this trend have been published. Vertebroplasty remains controversial as a treatment for osteoporotic fractures because it is a local response to a systemic disease and because the pain caused by osteoporotic fractures usually subsides within a few days or weeks. Current data suggest that pain severity may decrease by half, on average, in 90-100% of patients. Although vertebroplasty is usually well tolerated, serious neurological complications have been reported in a few patients. The most common adverse event is nerve root pain, usually caused by leakage of the cement into the intervertebral foramen. Whether vertebroplasty is followed by an increased risk of osteoporotic fractures in the adjacent vertebras remains unclear. Resorbable cements are being developed and may provide better results than the acrylic cements used today. At present, acrylic cement vertebroplasty to treat osteoporotic VCFs is appropriate in only a minority of patients selected carefully by a multidisciplinary team including a rheumatologist.

Arthroplasty↗

PubMed1988

Insufficiency fractures of the sternum: a consequence of thoracic kyphosis?

Osteoporosis often leads to thoracic compression fractures and progressive thoracic kyphosis. The kyphosis creates a deforming stress on the sternum that may eventuate in an insufficiency-type stress fracture. The findings in four women with osteoporosis, thoracic kyphosis, and insufficiency fractures of the sternum are reported.

Adult↗

PubMed2000

A case report of insufficiency fracture of the Fossa acetabuli in a patient with rheumatoid arthritis.

Aside from vertebral compression fractures, the most common site of insufficiency fractures is the pelvis and lower extremities. In the pelvis, the fractures usually occur in the ilium, the pubis and the ischium, but rarely in the fossa acetabuli. We report a severe insufficiency fracture of the fossa acetabuli in a 78-year-old woman with rheumatoid arthritis (RA). She had associated insufficiency fractures of the rib, the thoracic spine and the sacrum. In our case, senile osteoporosis was present before the onset of the fracture was recognized on radiographs, and RA and corticosteroid therapy might have further aggravated the porosis, resulting in the destruction of the fossa acetabuli. Regarding treatment for the fracture, a cemented total hip replacement without bone graft was attempted for several reasons such as the patient's activities, postoperative rehabilitation and the bone mass of the acetabulum. The postoperative course was satisfactory during study period. However, further follow-up is needed to monitor carefully how the patient will be in the future.

Acetabulum↗

PubMed2004

Percutaneous vertebroplasty for the treatment of burst fractures. Case report.

Percutaneous vertebroplasty is a useful procedure for patients with vertebral osteoporotic compression fractures; however, there has been no mention in the literature of the use of percutaneous vertebroplasty for the treatment of traumatic spinal fractures. The authors report the case of a 33-year-old man who harbored L-1, L-2, and L-5 burst fractures sustained in a work-related accident. The patient was successfully treated by percutaneous vertebroplasty with polymethylmethacrylate. The authors propose this procedure as a useful intervention in selected patients with lumbar burst fractures. The complications associated with major surgical procedures are absent.

Accidents, Occupational↗