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PubMed1994

Vertebral body index and bone mineral density in women with spinal fractures. 66 probands compared with controls.

The bone mineral density (BMD) was measured in 61 women with compression fractures of the spine and 66 normal pre-menopausal women. Radiographs of the lateral spine were also obtained and the vertebral body index (VBI) was measured in the region L2-L4. Women with spinal fractures had lower BMD and VBI values. Using both BMD and VBI, 3 regions of fracture risk were defined. All but 2 of the fracture patients were in the moderate- or high-risk region for fracture.

Adult↗
PubMed1992

Discriminatory ability of bone mass measurements (SPA and DEXA) for fractures in elderly postmenopausal women.

We investigated the discriminatory ability of forearm bone mineral content (BMCarm) measured by single photon absorptiometry (SPA) and spinal bone mineral density (BMDspine) measured by dual-energy X-ray absorptiometry (DEXA) in 387 elderly postmenopausal women. Of these, 22 had never sustained a fracture (normal), 91 had had less than three vertebral wedge fractures (mild), 51 had experienced a peripheral fracture (moderate), and 24 had had more than three vertebral wedge or compression fractures (severe). BMCarm exceeded BMDspine slightly in the ability to discriminate the mild and moderate groups (P less than 0.01-0.001), whether calculations were performed on raw values or the Z-scores compared with premenopausal women. Receiver operating (ROC) analysis showed that at every cutoff level BMCarm had a similar ability as BMDspine to discriminate between the vertebral fracture (mild and severe) groups and healthy premenopausal and nonfractured postmenopausal women (normal), whereas BMCarm had a significantly higher discriminatory ability of peripheral fractures (P less than 0.05) (moderate) group compared with premenopausal women. We conclude that SPA and DEXA are equally capable as diagnostic procedures in women with established osteoporosis.

Absorptiometry, Photon↗
PubMed1993

The role of arthroscopy in the assessment and treatment of tibial plateau fractures.

This retrospective study compared arthroscopic treatment of certain tibial plateau fractures to traditional open techniques. From January 1989 through August 1992, 40 patients with tibial plateau fractures were evaluated. After reviewing the records and radiologic studies, 23 patients were included in the study based on fracture patterns. Using Hohl's revised classification system, patients with either local compression or split compression fractures were included. Twelve of these patients were treated with arthroscopic reduction and percutaneous fixation (ARPF; group A). The remaining 11 underwent open reduction and internal fixation (ORIF; group B). The results of the ARPF group were superior to those of the ORIF group. In the ARPF group, all reductions were anatomic and remained fixed at least 3 months postoperatively, whereas only six (55%) of the ORIF patients had anatomic reductions initially. Furthermore, one of these patients had further loss of reduction on follow-up radiographs. Iliac crest bone graft was used in two patients in group A and 10 in group B. The use of bone graft in the arthroscopically treated group had no effect on the final outcome. The average length of postoperative hospitalization for the ARPF patients with isolated tibial plateau fractures was 5.36 days compared with 10.27 days for patients who were treated with ORIF. Average time to full weight bearing was 8.95 weeks in the ARPF group and 12.30 weeks in the ORIF group. No patients in either group had medial collateral ligament repairs. No ARPF-treated patients experienced valgus laxity after treatment. One patient in the ORIF group had residual instability and another walked with a cane.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Tibial plateau fractures in alpine skiing.

Tibial plateau fractures are uncommon in sports. Between 1977 and 1986, the authors studied 18 skiers who suffered tibial plateau fractures. Fracture patterns were diverse and displacement minimal. Hyperextension-valgus displacement caused compression fracture of the anterolateral tibial plateau in a characteristic form in 44%. Detection of these fractures is difficult by clinical and plain radiograph assessment, thus diagnosis may require acute awareness and special imaging tests. Although tibial plateau fractures are uncommon in skiers, early detection and treatment is important for best result in this sports population.

Adolescent↗
PubMed1994

Fracture risk in patients with ankylosing spondylitis: a population based study.

OBJECTIVE: To assess the risk of fractures among patients with ankylosing spondylitis (AS). METHODS: A population based cohort study compared fracture incidence in an inception cohort of 158 Rochester, Minnesota residents newly diagnosed with AS between 1935 and 1989 with expected rates from the same community. RESULTS: In 2,398 person-years of observation, there was no increase in the risk of limb fractures, but there was a pronounced increase in the risk of thoracolumbar compression fractures (standardized morbidity ratio = 7.6; 95% CI, 4.3-12.6) among those with AS. CONCLUSION: These data point to the importance of measures aimed at maintaining axial skeletal status in patients with AS.

Adolescent↗
PubMed1980

[Fractures of the axis organ in ankylosing spondylitis (author's transl)].

Fractures of the axis organ in ankylosing spondylitis display special features resulting from the peculiar underlying osteopathy. Depending on the localisation und extent of the vertebral ossification process, the mechanical load situations are different from case to case. Besides the disease-specific metaplastic-productive development, it is also possible that the peculiar destructive-absorptive component dominates in the overall pattern of the fracture, leading to false interpretations such as "non-typical fracture", "persistent pseudoarthrosis", specific spondylitis, stress fracture, suspected tumour, etc. Eight observations by the author demonstrate the risks, problems, differential diagnostic difficulties and the experience collected from observations of the course of the disease: four fractures of the cervical vertebral column (following mild traumas) were mainly flexion, luxation (compression) fractures at C 5/6 with partly extensive spondylodiscitic destruction, conservative treatment being sufficient in the absence of severe neurological symptoms (with one exception). A transvertebral fracture (after trauma) had occurred at the eleventh thoracic vertebral body with extremely protracted healing. Two stress fractures in which healing tendency was absent, were seen in a lumbar vertebral column sigment with spondylo-arthritically stiffened vertebral arch components, being probably a post-traumatic spondylolisthesis in segment L 5/S 1.

Adult↗
PubMed1988

Spontaneous fractures of the hip in the elderly.

The authors found 41 patients with 42 fractures of the hip who had no distinct history of trauma in the total of 1,449 hip fractures treated. They were all women ranging in age from 64 to 91 years. Most of the fractures were of intracapsular type. Three extracapsular fractures, however, were found. Fractures were randomly selected with clear history of trauma, which were matched to the patients with no trauma for age, sex, and type of fracture as a control group. The grades of osteoporosis of the femoral neck, estimated with the Singh index, and of the spine, estimated with the spinal score, were noted statistically significantly higher in the patients than those in the control group. Most of spontaneous fractures of the hip in the elderly are considered similar phenomena to the compression fractures of the dorsolumbar spine.

Aged↗
PubMed2004

[The selection of the surgical approach in the management of fracture and dislocation of lower cervical spine combined spinal cord injury].

OBJECTIVE: To investigate how to select an appropriate surgical approach in the management of fracture and dislocation of lower cervical spine combined spinal cord injury. METHODS: The clinical data of 54 patients of lower cervical spine fracture and dislocation were retrospectively analyzed. There were 29 cases with vertebral body compressive fracture and dislocation, 7 cases with vertebral body bursting fracture and dislocation, 3 cases with unilateral facet dislocation, 15 cases with bilateral facet dislocation. All cases were associated with spinal cord injury. According to American Spinal Injury Association (ASIA) grades, 21 cases were in A grade, 5 cases in B grade, 22 cases in C grade and 6 cases in D grade. All patients had surgical reduction, decompression, stabilization and fusion, 43 cases in anterior approach and 11 cases in posterior approach. RESULTS: All patients were followed up in 12 to 36 months, the mean follow-up time was 18 months. There were no great vessels, trachea, esophagus or spinal cord iatrogenic injury. There were no pull-out and breakage of screws or plates. Fusion was achieved in all patients at an average of 12 weeks postoperatively. There were no pseudarthrosis or bone nonunion. Of all the patients, 96.3% were acquired completely reduction and the normal intervertebral height and lordosis were maintained. Patients with complete spinal cord had no neurologic recovery, but they felt relief from upper limb pain or numb. Incomplete spinal cord lesions improved on average 1-2 Frankel grade after surgery. CONCLUSIONS: For lower cervical spine fracture and dislocation, an ideal anatomy reduction can be obtained with either anterior or posterior approach surgery. It is important to select a suitable surgical approach according to different types of cervical fracture and dislocation.

Adolescent↗
PubMed1998

[Recent progress in orthopaedic managements of osteoporosis-related fractures].

Recent progress in orthopaedic treatment of osteoporosis-related fractures was reviewed. In the femoral neck fractures, the bipolar prosthesis reduces acetabular erosion or central migration, and press-fit stem or cemented stem lowers the incedence of the stem sinking. In thorocanteric fractures, compression hip screws are most commonly used, however, in the cases of unstable fractures with severe osteoporosis, it is difficult to start weight-bearing within a few weeks of surgery because varus deformites or translations at the fracture site sometimes occur. To avoid this disadvantage, the gamma nail has been found to be more effective. In paralysis due to burst fractures of the osteoporotic spine, surgical decompression and spinal instrumentation is the established response. A special orthosis named 'rucksack type orthosis' has been devised and is used for patients who have back pain due to anterior bending posture of the trunk. In distal radius fractures, external fixators are now more frequently used.

Aged↗
PubMed1988

[Management and results of conservative treatment of patients with injuries of the thoracic and lumbar vertebrae].

Conservative treatment of injuries of the thoracic and lumbar spine is indicated in stable fractures without or with an axis angle up to 25 degrees and in children fractures. Stable injuries are compression-wedge-fractures and burst fractures. Severe compression fractures with dorsal ligamentous injuries are regarded being conditional stable. Conservative treatment can be divided into 3 periods: lying period, rising period and stand-walk-sit period. Physiotherapy together with proper nursing is to avoid pulmonary and circulatory complications as well as to support motility of the intestinal tract. After stabilization of the general condition of the patient physiotherapy should furthermore lead to: relaxation of the hypertonic musculature, facilitating and preservation of muscle activities to secure the injured parts of the spine, training and assignment of global, diagonal muscle chains following physiological motions. From 1982-1986 389 patients with fractures of the spine were treated in the Tübingen Accident Hospital (Berufsgenossenschaftliche Unfallklinik Tübingen). An early functional treatment following Bürkle de la Camp was performed in 84%. The follow up examination showed no further displacement in 84%. In 1/3 of the cases a free movement was regarded in the sagittal plane. 2/3 of the cases showed restriction of movement in only one segment. The good functional result is underlined by the subjective impression of the patient themselves: 2/3 were satisfied with the result.

Combined Modality Therapy↗
PubMed1999

[Bilateral posterior fracture-dislocation of the shoulder caused by an epileptic seizure - diagnostic, treatment and result].

The case of an 39-year-old man is presented, who sustained a bilateral locked fracture dislocation of the shoulders occurring during an epileptic seizure. Radiographs demonstrated a compression-fracture of the anteromedial aspect of the humeral head bilaterally (reversed Hill-Sachs-lesions). Additionally, fractures of the lesser and greater tuberosity were diagnosed at the right site. Open reduction and internal fixation was performed in both shoulders within 12 hours. 6 months later the patient has no complaints with a free range of motion. Diagnostics, treatment and result are discussed in context with the literature.

Adult↗
PubMed2003

Intra-individual variation in lumbar bone mineral density as a measure of spondylotic deformity in the elderly.

In an attempt at quantitative assessment of spondylotic deformity, the intra-individual variation in L(1)-L(4) bone mineral density (BMD) was calculated, as the standard deviation (SD) and coefficient of variation (CV), obtained by dividing the SD by mean L(1)-L(4) BMD, in 463 subjects. The subjects ranged in age from their second to tenth decades. Dual-energy X-ray absorptiometry (DXA), using the Lunar DPX-L, was employed to assess the BMD. The SD of lumbar (L)BMD increased with advancing age in males, but not in females, whereas the CV of LBMD increased with age in both males and females, along with the radiographically assessed degree of severity of spondylosis deformans. Both the intra-individual SD and CV of L(1)-L(4) BMD showed a highly significant correlation with the radiological degree of severity of spondylosis deformans, and SD, but not CV, showed a strong dependence on the mean L(1)-L(4) BMD on a multiple regression test. Multiple regression test revealed no significant correlation between on body height, weight, fracture, and intra-individual variation in L(1)-L(4) projected area, reflecting compression fracture, one hand and SD or CV of L(1)-L(4) BMD on the other. Intra-individual variation in lumbar bone mineral density, expressed as a coefficient of variation, is suggested as an index of spondylotic deformity.

Adult↗
PubMed2005

Camel-related injuries in the pediatric age group.

BACKGROUND: Road traffic accidents continue to be a major cause of morbidity and mortality among children. Domestic animal-related injuries in general, camel-related in particular, have not been given much attention, and very little is written about them. METHODS: The medical records of all children admitted to our hospital with camel-related injuries were retrospectively reviewed for age, sex, mechanism of injury, type of injuries, treatment, and outcome. RESULTS: Seventy-eight children with camel-related injuries were seen at our hospital. Most of them were camel jockeys. All were males, and their ages ranged from 4 to 15 years (mean, 8.6 years). In 74, the cause of injury was a fall from a racing camel, 2 were kicked by a camel, and 1 had a camel bite. Forty-four (56.4%) had head injury, which was moderate to severe in 17, and 6 of them had associated skull fractures, whereas 3 had intracranial hematomas. Twenty-five (32.1%) had fractures of various bones, and 14 of them had fracture of the tibia. One child had L2 and L3 dislocation, with displacement and compression fracture of L2. Two sustained thoracic injuries, whereas 9 had intraabdominal injuries, including liver injury (3), splenic injury (1), renal injury (3), and bowel injury (2). One had a camel bite leading to a fractured mandible, injury to his ear, and intimal tear of the left common carotid artery. CONCLUSIONS: Camels are a potential cause of serious injuries and a major public health problem for children in this part of the world. This is especially so for camel jockeys. Every effort should be made to prevent such injuries, including limiting camel racing to older children as well as providing adequate protective measures and public education about the proper and compassionate handling of domestic animals.

Accidental Falls↗
PubMed1976

Discontinuity of the spinous process on standard roentgenographs as an aid in the diagnosis of unstable fractures of the spine.

It has been observed that discontinuity in the outline of the spinous process on standard anteroposterior radiographs is a characteristic finding in some unstable spine fractures. Since the spinous processes are often not depicted clearly on lateral views of the trauma victim's spine, these are less reliable; however, if a transverse fracture through the spinous process at the level of, or adjacent to, an anterior compression fracture is demonstrable, this confirms the unstable nature of the injury. Recognition of this sign, when present, may eliminate excessive pretreatment manipulations in some patients who have sustained major trauma and are suspected of having unstable spine fractures.

Accidents, Traffic↗
PubMedDate not supplied

Fractures of the calcaneus: a review with emphasis on CT.

The calcaneus is the most commonly fractured tarsal bone and accounts for about 2% of all fractures. Advances in cross-sectional imaging, particularly in computed tomography (CT), have given this modality an important role in identifying and characterizing calcaneal fractures. Fracture characterization is essential to guide the management of these injuries. Calcaneal fractures have characteristic appearances based on the mechanism of injury and are divided into two major groups, intraarticular and extraarticular. Most calcaneal fractures (70%-75%) are intraarticular and result from axial loading that produces shear and compression fracture lines. Of the two major systems for classifying intraarticular fractures-Hannover and Sanders-the latter is used most often and is helpful in treatment planning and determining prognosis. Extraarticular fractures account for about 25%-30% of calcaneal fractures and include all fractures that do not involve the posterior facet. The article describes in detail calcaneal anatomy, mechanism of calcaneal injuries and their associated fracture patterns, CT features of intra- and extraarticular fractures, and management implications. Familiarity with calcaneal anatomy and fracture patterns is essential for radiologists to guide the treating physicians.

Calcaneus↗
PubMed2001

"General surgical pearls" for the anterior exposure of vertebral fractures.

Recently interest has been increasing in the anterior surgical approach for spinal cord decompression and bony stabilization of vertebral compression fractures. Our neurosurgical spine service routinely consults us to provide anterior operative exposure and wound closure for all levels of the thoracic and lumbar vertebral spine. Averaging about 30 exposures per year we have developed an excellent operative experience with these vertebral exposures. With no complete general surgery reference on anterior vertebral identified this summary of our "general surgical pearls" that we have learned and/or have developed should significantly aid other general and trauma surgeons who may be asked by their neurosurgical and/or orthopedic surgical colleagues for assistance with these operations.

Humans↗
PubMed2003

[QOL and ADL assessement for patients with osteoporotic fractures].

Osteoporosis is characterized by fragile bone with decreased bone mass, resulting in fractures of vertebra, hip, distal radius and proximal humerus. Spinal deformities caused by multiple compression fractures and walking disability after hip fracture induce decreased QOL and limited ADL in elderly patients with osteoporosis. The goal of treatment for patients with osteoporosis is to improve ADL and QOL.

English Abstract↗