SEARCH · PubMed Health

Results for “Fractures, Compression”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 937 records · Page 52Linked to original sources

PubMed2002

Flexion-distraction injuries in the thoracolumbar spine: an in vitro study of the relation between flexion angle and the motion axis of fracture.

A new concept, the motion axis of fracture (MAF), which is defined as the transitional point from anterior compressive to posterior splitting failure on a lateral radiograph, has provided a true understanding of the mechanisms of flexion-distraction injuries in clinical cases. This study was designed to produce in vitro injuries that have MAFs and to clarify the relation between the flexion angle and the MAF location. Adolescent porcine thoracolumbar spines were exposed to a vertical compressive load to failure at three different flexion angles and then examined radiographically. The MAF location was recorded as the distance from the anterior border to the MAF expressed as a percentage of the anteroposterior diameter of the vertebral body. All specimens showed similar injuries, with MAFs consisting of anterior compression fractures in the vertebral bodies and posterior disruptions. A significant negative correlation emerged between the flexion angle and the MAF location (r = -0.890; p < 0.0001). These results suggest that even a vertical compressive load contributes to the production of a flexion-distraction injury with an MAF in the thoracolumbar spine. They also indicate that the flexion angle of the spine at which the vertical compressive load is applied is an important factor in determining the MAF location; that is, the larger the flexion angle, the more anterior the MAF.

Animals↗

PubMed2004

Multiple myeloma: clinical review and diagnostic imaging.

Multiple myeloma (MM) is a malignant clonal neoplasm of plasma cells of B-lymphocyte origin that commonly results in overproduction of large amounts of monoclonal immunoglobulins. Important advances in the therapeutic management of this disease in the past decade have resulted in higher rates of durable complete remission, prolonged event-free survival, and improved overall survival. Clearer understanding of the effects of abnormal plasma cells on bone has led to therapeutic approaches that help prevent vertebral body fractures. Current imaging technologies and, in particular, survey marrow studies with magnetic resonance (MR) imaging have improved detection of the extent and location of disease in MM patients. In newly diagnosed cases, MR surveys of the axial skeleton accurately demonstrate the extent of disease-diffuse or focal involvement-and the presence of associated compression fractures and cord compression. After treatment, MR images show the effects of treatment and the presence of residual disease. Multiple sites of focal bone lesions detected on MR studies allow a more appropriate choice of biopsy site than the usual random iliac marrow biopsy. Use of MR to determine biopsy sites and computed tomographic guidance for biopsy performance have increased the safety and accuracy of sampling. These biopsies have resulted in increased identification of cytogenetic abnormalities, particularly the presence of chromosome 13 deletion, which is a grave prognostic indicator in MM.

B-Lymphocytes↗

PubMed1981

Mechanical bull injuries: the empty saddle syndrome.

We reviewed the cases of 30 patients presenting to the emergency department over a four-month period with a total of 31 injuries suffered while riding a mechanical bull. The majority of injuries were sprains and contusions. The most severe injuries included seven fractures, one dislocation, and one fracture-dislocation. Three patients required hospitalization, including one with a compression fracture of C7. The majority (74%) of injuries involved the upper extremities.

Adult↗

PubMedDate not supplied

From the archives of the AFIP. Child abuse: radiologic-pathologic correlation.

In the United States, roughly one of every 100 children is subjected to some form of neglect or abuse; inflicted injury is responsible for approximately 1,200 deaths per year. Child physical abuse may manifest as virtually any injury pattern known to medicine. Some of the injuries observed in battered children are relatively unique to this population (especially when observed in infants) and therefore are highly suggestive of nonaccidental, or inflicted, injury. Worrisome injuries include rib fracture, metaphyseal fracture, interhemispheric extraaxial hemorrhage, shear-type brain injury, vertebral compression fracture, and small bowel hematoma and laceration. As noted, however, virtually any injury may be inflicted; therefore, careful consideration of the nature of the injury, the developmental capabilities of the child, and the given history are crucial to determine the likelihood that an injury was inflicted. The majority of these injuries are readily detectable at imaging, and radiologic examination forms the mainstay of evaluation of child physical abuse. Detection of metaphyseal fracture (regarded as the most specific radiographically detectable injury in abuse) depends on high-quality, small field-of-view radiographs. The injury manifests radiographically as a lucent area within the subphyseal metaphysis, extending completely or partially across the metaphysis, roughly perpendicular to the long axis of the bone. Acute rib fractures (which in infants are strongly correlated with abuse) appear as linear lucent areas. They may be difficult to discern when acute; thus, follow-up radiography increases detection of these fractures. For skull injuries, radiography is best for detecting fractures, but computed tomography and magnetic resonance imaging best depict intracranial injury.

Archives↗

PubMedDate not supplied

Bone mineral density and fractures in boys with Duchenne muscular dystrophy.

The relationships between bone density, mobility, and fractures were assessed in 41 boys with Duchenne muscular dystrophy. Bone density in the lumbar spine was only slightly decreased while the boys were ambulatory (mean z-score, -0.8), but significantly decreased with loss of ambulation (mean z-score, -1.7). In contrast, bone density in the proximal femur was profoundly diminished even when gait was minimally affected (mean z-score, -1.6), and then progressively decreased to nearly 4 standard deviations below age-matched normals (mean z-score, -3.9). These are consistent with the findings that 18 (44%) of the boys sustained a fracture, 66% of these fractures involved the lower extremities, and there were no spinal compression fractures. Furthermore, four (44%) of nine boys who were walking with aids or support at the time of fracture never resumed walking after the fracture. Osteoporosis is most profound in the lower extremities of boys with Duchenne muscular dystrophy, and begins to develop early while still ambulating. Frequent fractures that may result in loss of ambulation are the clinical consequences.

Adolescent↗

PubMed1996

Quantitation of incident spinal fractures: comparison of visual detection with quantitative morphometry.

The value of quantitative morphometry in detection of new spinal fractures was assessed in serial radiographs from 83 patients with osteoporosis. From vertebral landmarks on lateral spine radiographs, a computer program allowed calculation of vertebral heights and area. By comparing vertebral dimensions in the two sets of films, incident spinal fractures could be quantitated based either on the minimum criteria of 15% reduction in vertebral height (CM2) or a fall in height and area of 20% and 10% (CM1). The results of quantitative morphometry were compared with those of the consensus and individual readings of visual detection by three experienced investigators in the same paired sets of spinal films. For incident new fractures, the visual consensus method (V-C) showed a very good agreement with individual visual detection (kappa of 0.794 to 0.916) as well as with CM1 (kappa of 0.821). However, there was a poor agreement between the results of consensus reading and of detection by CM2 (kappa of 0.341), due to excessive number of fractures identified by CM2, but not by the visual method. For incident recurrent fractures, there was a poor agreement between V-C and individual visual detection, and between V-C and quantitative morphometry (kappa of 0.306 to 0.496). It was due to severe compression fractures at baseline, which caused further changes in vertebral dimensions difficult to measure accurately by either visual or quantitative morphometry. Thus, if the visual detection of fractures by a consensus of experienced investigators is considered as the "gold standard," quantitative morphometry, based on minimum reduction in vertebral height of 20% accompanied by a minimum decline in area of 10%, provides an objective detection of incident new spinal fractures but not of recurrent fractures.

Aged↗

PubMed1988

Changes in incidence and prevalence of vertebral fractures during 30 years.

The age and sex-specific incidence and prevalence of vertebral compression fractures were compared between the 1950s and 1980s in an urban population. In women over 80 years of age the incidence of symptomatic vertebral fractures has increased approximately four times; in elderly men even more. Mainly, low-energy trauma has caused these fractures. Thus, one clinical manifestation of osteoporosis--vertebral fracture--has increased in number, incidence, and prevalence over the last 30 years.

Aged↗

PubMedDate not supplied

Response of fractured osteoporotic bone to polymethylacrylate after vertebroplasty: case report.

BACKGROUND CONTEXT: Polymethylmethacrylate (PMMA) is the most commonly used bone cement for vertebroplasties to treat osteoporotic vertebral compression fractures (VCFs). Several studies have described the reaction of normal bone to PMMA, but it is still unclear how fractured osteoporotic bone responds to PMMA. PURPOSE: To describe the response of fractured osteoporotic bone to PMMA after vertebroplasty. STUDY DESIGN/SETTING: Case report. METHODS: A 69-year-old woman with a previous vertebroplasty at T8 to treat an osteoporotic VCF was admitted to the hospital after she developed lower extremity motor weakness, diffuse hypoesthesia and decreased rectal tone. Magnetic resonance imaging studies of the thoracic spine showed that she had severe spinal cord compression at the level of T8 and T9, as well as akyphotic deformity. A corpectomy of T8 and T9 was performed as part of a spinal cord decompression procedure. Tissue from vertebral body T8, intervertebral discs T7-T8 and T8-T9 and the PMMA implant were then submitted for histologic evaluation. RESULTS: Vertebral body T8 demonstrated viable bone trabeculae, osteoid. fibrosis, granulation tissue and multinucleated giant cells containing PMMA. Scattered necrotic bone fragments were identified throughout the vertebral body, most evident near the PMMA. PMMA leakage into the T7-T8 disc was identified without significant disc inflammation or necrosis. CONCLUSION: Fractured osteoporotic bone is capable of undergoing a reparative healing response after vertebroplasty using PMMA.

Aged↗

PubMed2002

[Pediatric spinal injuries].

Spine injuries during growth are rare, but in comparison to adults they are more often associated with neurologic impairment. They also may occur without visible injuries in X-rays. The problems of conventional radiologic diagnostics include before all the differential diagnosis between synchondrosis, apophysis and fracture lines. MRI is indicated in case of neurologic deficits without radiologic abnormalities. In principle the fracture types correspond to those seen in adults. In addition growth specific injuries of the end-plates (growth plates) or ring apophysis may occur. Stable compression fractures are treated conservatively. The spontaneous remodelling capacity for posttraumatic deformities decreases with age: in children below the age of ten years the remodelling capacity for posttraumatic kyphosis is excellent whereas deformities in the frontal plane show no or only incomplete remodelling. Unstable fractures and injuries with associated compression of neural structures should be treated conservatively.

Accidental Falls↗

PubMed2005

Surgical treatment of bone metastasis: indications and outcomes.

Due to advances in cancer treatment that prolong survival, there has been a noticeable increase in the prevalence of bone metastasis. Consequently, the likelihood of orthopedic surgeons encountering such tumors and the need for effective surgical treatment are also expanding. Although bone metastasis constitutes only one possible type of metastatic lesion, and while local control at a bone metastatic site alone may have little effect on total curability, the quality of life (QOL) of the patient cannot be ensured if local control is ignored. Therefore, it is important to achieve local control through multidisciplinary treatments aimed at both reduced surgery and at conservation of limb function. Surgical treatment may be indicated after a series of more conservative treatments. Among the main indications are pathologic fracture or a high risk of fracture of limb bones. Acute spinal cord injury caused by acute compression fracture from spinal metastasis is a relative indication. The occurrence of a solitary metastasis, for which extended survival may be anticipated, is also an indication for surgery to achieve local control. Appropriate local control is required to realize a predicted survival period. As well, the surgical method, resection margin, and supplementary treatments, and immediately effective reconstruction method should be selected accordingly.

Bone Neoplasms↗

PubMed2004

Therapeutic potential of parathyroid hormone.

Teriparatide, recombinant human parathyroid hormone (1-34) (rhPTH [1-34]), is approved for the treatment of osteoporosis in men and postmenopausal women at high risk for fracture. The best candidates are those who have already had vertebral compression fractures (symptomatic or asymptomatic) or other osteoporosis-related fractures, or those who have very low bone mineral density, in the T score range of -3.5 or below. Teriparatide is the first anabolic drug approved by the US Food and Drug Administration for osteoporosis. It not only dramatically improves bone mass, but also restores bone microarchitecture and increases bone diameter. All of these mechanisms contribute to increasing bone strength and reducing the risk for osteoporosis-related fractures. Although PTH has been used in combination with other agents such as estrogens, calcitonin, and bisphosphonates, the relative benefit of the combined approach versus teriparatide alone for fracture risk reduction has not been shown. In fact, some data suggest that initiating PTH and alendronate together in previously untreated patients or pretreating patients for a short time with alendronate before initiating PTH may somewhat reduce the anabolic response to PTH. There are many unanswered questions regarding PTH, such as the optimal duration of treatment, the optimal sequence of medications for severe osteoporosis, the mechanism of resistance to effect after 18 to 24 months, the effect of subsequent rechallenge with PTH and, most importantly, surrogates to measure PTH effect.

Aged↗

PubMed1997

Skeletal system: biomechanical concepts and relationships to normal and abnormal conditions.

The human skeleton is a remarkable organ that is uniquely designed to provide structural support and to house the body's hematopoietic system and mineral reservoirs. Seven concepts that will assist the clinician in understanding skeletal function are (1) material properties of bone, (2) stress and strain, (3) bending moments and torsional loads, (4) area moments of inertia, (5) fatigue and catastrophic failure, (6) Wolff's law, and (7) stress risers and open section effect. For example, as the modulus of a bone, a measure of stiffness decreases as in Padget's disease or fibrous dysplasia and the same levels of stress will cause greater deformations. The sum of these principles also explains the torus fracture (ductility), fracture of the olecranon by contracting tricep muscle (tensile loading), osteoporotic compression fracture of the spine, and the other biomechanical lesions that are encountered. Understanding these basic biomechanical principles can help physicians comprehend neoplastic processes and fractures that are the metabolic responses of the skeleton to stress and that appear on the radionuclide bone scan.

Biomechanical Phenomena↗

PubMed2000

Upper thoracic spinal fractures in trauma patients - a diagnostic pitfall.

The diagnosis of upper thoracic spinal fractures in multiple-trauma patients remains a challenge. The clinical findings are often difficult to detect, especially in the presence of other (extremity) fractures, head injuries or in patients on respiratory support. The findings of chest radiographs and plain spinal films are described in a series of 23 patients with an upper thoracic spinal fracture. Radiographs were retrospectively reviewed by an orthopaedic surgeon and a skeletal radiologist. Fractures were classified according to Magerl and type A1 and A2 compression fractures were excluded. The neurological outcome was assessed using the Frankel scale.Initially, the fracture was missed in 5 patients (22%), mainly due to concomitant life-threatening injuries. Fractures consisted of type A, B and C in one, 10 and 12 patients, respectively. The main findings were: loss of vertical height of vertebra with or without malalignment (21), widened paraspinal line (21), widened mediastinum (4) and no gross abnormalities (2). Neurological lesions were Frankel A, B, C and E in respectively 14, 1, 1 and 7 patients.Upper thoracic spinal fractures are easily missed in patients with multiple injuries. In patients with neurological symptoms CT and/or MRI is required as soon as the general condition of the patient permits this.

Adolescent↗

PubMed2000

Osteoporosis.

Osteoporosis is a disorder of decreased bone mass, microarchitectural deterioration, and fragility fractures. Osteoporosis is widespread and can affect people of all ethnic backgrounds and many older women and men. An essential element in preventing osteoporosis is the achievement of normal peak bone mass. Adequate nutrition, appropriate calcium and vitamin D intake, regular menstrual cycles and a well balanced exercise program of exercise are essential elements in achieving peak bone mass. At menopause women undergo accelerated bone loss. Thereafter, women and men gradually lose bone mass. A loss of one standard deviation give rise to an enhanced twofold risk of spine fractures or a 2.5 risk of hip fracture. Bone mass is determined by dual energy x-ray absorptiometry, quantitative computed tomography scan, and a peripheral ultrasound. Dual energy x-ray absorptiometry has outstanding precision (within 1% to 2%), and has the ability to show the efficacy of drug intervention. Peripheral measurements may identify osteoporosis but only have a 70% correlation with hip and spine bone mass. Dual energy x-ray absorptiometry determines bone mass in a patient but the bone collagen breakdown products (N-telopeptide crosslinks) establish the current rate of bone loss. Major risk factors leading to fragility fracture include low body weight, history of fracture, family history of osteoporosis, and smoking. All individuals should ingest adequate calcium and vitamin D, exercise, and prevent falls. Women with low bone mass, high urinary bone collagen breakdown products, and/or major risk factors should consider hormone replacement therapy or a selective estrogen receptor modulator (Evista), calcitonin and bisphosphonates (alendronate). These agents successfully increase bone mass and limit fracture risk. Men at risk for fragility fractures respond similarly as women to alendronate and calcitonin. Although vertebral compression fractures can occur spontaneously, hip fractures are attributable to low bone mass coupled with a fall. Hence, fall prevention programs in addition to medical treatment are critical in the prevention of fragility fractures.

Female↗

PubMed1997

[Treatment of pathological fractures caused by metastatic bone cancer].

The diagnosis of metastatic bone cancer is usually easy but in some cases the metastatic lesion is found before primary lesion is diagnosed. In such cases, the diagnosis is essential before treatment is begun. For these cases, bone scintigraphy and MRI are useful. Since curative treatment for metastatic bone cancer is impossible in most cases, it is important to decide the purpose of the treatment before starting. The aims are elongation of the life, decrease of pain, recovery from paralysis, attainment of stability, treatment and prophylaxis of the pathological fracture, and improvement of QOL. As for treatment of the pathological compression fracture of the spine combined with paralysis, the decompression operation should be done as early as possible, because at 48 hours after the paralysis is completed, recovery can not be expected even if complete decompression is performed. The decompression operation is performed with complete resection of the affected vertebrae anteriorly and then by rigid fixation with instrumentation posteriorly. As for the treatment of the pathological fracture of the extremities, in most cases operative treatments are indicated. Most pathological fractures of the extremities occur in the femur and humerus. In case of a proximal femur and humerus, wide excision of the tumor combined with the affected bone is performed, and the defect is then replaced with the prosthesis. When the shaft of the bone is affected, segmental resection of the bone is done in most cases and the defect is then replaced with ceramics and bone cement and fixed with intramedullary nails.

Bone Cements↗

PubMed2002

Evaluation of tension obtained by use of three knots for tying cerclage wires by surgeons of various abilities and experience.

OBJECTIVE: To compare tension of 3 cerclage wire knots tied by surgeons of various abilities and experience. DESIGN: Cross-sectional study. SAMPLE POPULATION: Participants and faculty at a postgraduate course in veterinary orthopedics. PROCEDURE: Subjects tied a cerclage of their choice on an instrumented tying stand that displayed the tension on a computer. Mean tensions in cerclage wires tied with twist, single loop, or double loop knots were compared. The relationship between level of surgeon experience and tension achieved was examined. RESULTS: 29 twist, 30 single loop, and 16 double loop wires were analyzed. Mean +/- SD tension for twist knots was significantly less than for single loop knots (82.3+/-46.1 vs 166.6+/-42.2 N, respectively). Double loop knots achieved significantly greater tension (392.0+/-116.6 N) than twist and single loop knots did, even though few participants had ever tied this knot previously. There was no correlation with experience of the participant. For twist knots, wiggling the wire during cutting and pushing the twist over to flatten it to the bone further reduced tension. CONCLUSIONS AND CLINICAL RELEVANCE: Cerclage applied with a twist knot does not compress fracture fragments as effectively as cerclage applied with single loop or double loop techniques. Because greater compression of fragments will improve the stability of a fracture, a surgeon should strive to maximize the tension in the cerclage that they use. Experience and abilities of the surgeon are not associated with ability to tie cerclage wires tightly.

Animals↗

PubMed1998

Musculoskeletal challenges of osteoporosis.

Reduction in the biomechanical competence of the axial skeleton can result in challenging complications. Osteoporosis consists of a heterogeneous group of syndromes in which bone mass per unit volume is reduced in otherwise normal bone, which results in more fragile bone. The geriatric population has an increased risk for debilitating postural changes because of several factors. The two most apparent factors are involutional loss of functional muscle motor units and the greater prevalence of osteoporosis in this population. Obviously, the main objective of rehabilitation is to prevent fractures rather than to treat the complications. These complications can vary from "silent" compression fractures of vertebral bodies, to sacral insufficiency fractures, to "breath-taking" fractures of the spine or femoral neck. The exponential loss of bone at the postmenopausal stage is not accompanied by an incremental loss of muscle strength. The loss of muscle strength follows a more gradual course and is not affected significantly by a sudden hormonal decline, as is the case with bone loss. This muscle loss may contribute to osteoporosis-related skeletal disfigurations. In men and women, the combination of aging and reduction of physical activity can affect musculoskeletal health, and contribute to the development of bone fragility. The parallel decline in muscle mass and bone mass with age is more than a coincidence, and inactivity may explain some of the bone loss previously associated with aging per se. Kyphotic postural change is the most physically disfiguring and psychologically damaging effect of osteoporosis and can contribute to an increment in vertebral fractures and the risk of falling. Axial skeletal fractures, such as fracture of the sacral alae (sacral insufficiency fracture) and pubic rami, may not be found until radiographic changes are detected. Management of chronic pain should include not only improvement of muscle strength and posture but also, at times, reduction of weight bearing on the painful pelvis with insufficiency fractures. Axial skeletal health can be assisted with improvement of muscular supportive strength. Disproportionate weakness in the back extensor musculature relative to body weight or flexor strength considerably increases the risk of compressing porous vertebrae. A proper exercise program, especially osteogenic exercises, can improve musculoskeletal health in osteoporotic patients. Exercise not only improves musculoskeletal health but also can reduce the chronic pain syndrome and decrease depression. Application of a proper back support can decrease kyphotic posturing and can expedite the patient's return to ambulatory activities. Measures that can increase safety during ambulatory activities can reduce risk of falls and fractures. Managing the musculoskeletal challenges of osteoporosis goes hand in hand with managing the psychological aspects of the disease.

Adult↗

PubMed1996

[Bilateral acetabulum fractures of the anterior column and vertebral body fracture after alcohol-induced seizure].

The case of a 54-year-old male with a compression fracture of the T 12 vertebral body and a bilateral anterior column fracture of the acetabulum is presented. The origin of this rare combination of fractures is explained by the action of the patient's own muscle force on bone of very poor quality. The treatment of these lesions is comparable to the treatment of similar fractures in bone of normal quality.

Acetabulum↗