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PubMed2004

[Superior sagittal sinus occlusion caused by a compound depressed skull fracture: a case treated by emergency surgery].

Depressed skull fractures compressing major venous sinuses are rare, and the treatment is a matter of controversy. The majority of depressed fractures are treated conservatively for fear of bleeding from venous sinuses, but surgical intervention was conducted in a few cases. We report a case of a 59-year-old man with a compound depressed fracture occluding the superior sagittal sinus (SSS). The patient was struck on the head by a heavy iron bar and admitted to our emergency center because of deterioration of consciousness. A computed tomographic scan showed depressed skull fracture overlying the SSS with hemorrhagic lesions in the bilateral parietal lobes and an acute epidural hematoma at the right temporoparietal convexity. Digital subtraction angiography (DSA) showed an occlusion of the SSS and compensatory venous drainage associated with poor capillary filling in the left parietal lobe. On an emergency basis, bone fragments compressing the SSS were surgically removed piece-by-piece to resolve severe venous congestion and to avoid infection. A small tear in the SSS was treated by head elevation and compressing the SSS with Gelfoam. Postoperative DSA confirmed the patency of the SSS and normal blood flow in the left parietal lobe. The patient exhibited slight disorientation and was transferred to another hospital for further rehabilitation. Because of symptomatic severe venous congestion, we had to perform emergency surgical decompression and removal of bone fragments. Treatment strategy for depressed skull fracture with SSS involvement was discussed with review of the literature.

Decompression, Surgical↗

PubMed2003

Osteopenia and osteoporosis in patients with end-stage liver disease caused by hepatitis C and alcoholic liver disease: not just a cholestatic problem.

Although best characterized in chronic cholestatic liver disease, osteopenic bone disease and fracturing are well-recognized complications of cirrhosis, particularly after liver transplantation. We sought to compare the prevalence of osteopenia and osteoporosis, to assess the effect of orthotopic liver transplantation (OLT) on bone density, and to determine fracture rates before and after OLT in three groups of patients with advanced cirrhosis: patients with cirrhosis from hepatitis C virus (HCV) alone, from alcohol abuse (ALD), and from HCV in conjunction with alcohol abuse (HCV+ALD). Between 1991 and 2001, 207 consecutive patients who underwent OLT for HCV (68 patients), ALD (66), and HCV+ALD (73) were assessed clinically, biochemically, radiologically, and by bone densitometry. The baseline mean T score was lower in the HCV group than in the ALD group (-1.43 versus -0.87, P =.048) despite ALD patients having more advanced liver disease; patients with HCV+ALD had intermediate T scores. The pattern of significant bone loss at 4 months and 12 months was similar for all three groups. The baseline fracture rate was lowest in the HCV group and highest in the ALD group, despite the latter having the highest bone density. Fractures occurred in 17% of patients in the first year after transplantation, the majority being vertebral compression fractures. Patients with cirrhosis caused by HCV, ALD, or a combination of both should be screened for osteopenia, especially before OLT.

Adult↗

PubMed2005

[Selectivity and individualization of transpedicular balloon kyphoplasty for aged osteoporotic spinal fractures].

OBJECTIVE: To investigate the selectivity and individualization of transpedicular balloon kyphoplasty for aged osteoporotic spinal fracture. METHODS: Twenty-two consecutive procedures were performed in 17 aged patients with osteoporotic spinal compression fractures from April 2002 to June 2004. The signal changes in different sequences were confirmed by magnetic resonance imaging before the procedures. This operation involved the percutaneous insertion of two inflatable bone tamps into a fractured vertebral body transpedicularly under fluoroscopic guidance. Every patient was treated individually, according to the results of radiography and CT scan before operation. Preoperative and postoperative complications, visual analogue scale, and radiographic findings such as vertebral height and Cobb angle were recorded and analyzed. RESULTS: All patients tolerated the procedure well with immediate relief of their back pain in 24 hours. There was no leakage of cement into the epidura. The mean loss percent of the anterior and middle vertebral heights were (35.32 +/- 13.15)% and (27.53 +/- 12.61)% before operation, and (14.21 +/- 12.43)% and (16.2 +/- 7.5)% after operation. The height restoration of vertebra was confirmed by X-ray after the procedure (P < 0.01). The mean kyphosis was improved from (25.3 +/- 4.2) degrees to (8.6 +/- 5.1) degrees. No complications occurred. No patient had nerve injury. The patients were allowed to walk next day after the procedure. CONCLUSION: The selectivity and individualization of transpedicular balloon kyphoplasty for aged osteoporotic spinal fractures has satisfactory short-term clinical efficacy. It is also an effective way to prevent complications.

Aged↗

PubMedDate not supplied

Nutcracker fractures of the cuboid.

A case report is presented involving a nutcracker fracture of the cuboid and concomitant fractures of the navicular and calcaneus. A literature review of the mechanism and treatments of the nutcracker fracture is discussed. Also presented are the methods used to radiographically evaluate and surgically correct the compression fracture of the cuboid and its associated fractures.

Female↗

PubMed1978

Repair of physeal fractures of the tuber olecranon in the horse, using a tension band method.

Physeal fractures of the tuber olecranon of 4 horses were treated, using the tension band method of compression fracture repair. A cortical bone screw and Steinmann pin were placed through the proximal fragment into the distal parent bone parallel to the palmar border of the olecranon. The tension band was placed dorsal to the Steinmann pin and anchored in a hole through the shaft of the ulna 10 cm distal to the tuber olecranon. Of the 4 foals, 2 became pasture sound, 1 is now being worked under saddle, and the 4th showed no signs of lameness 5 months after surgery.

Animals↗

PubMed1994

[Involutional osteoporosis].

Involutional osteoporosis has been divided into two types. Type-1 osteoporosis, known as postmenopausal osteoporosis, occurs in women after menopause. Type-2 osteoporosis, known as senile osteoporosis, occurs in men and women over 70 years of age. The general symptoms are back pain in patients with Type-1 osteoporosis and back pain with spinal deformity in Type-2. Vertebral fractures occur in Type-1 and fractures of the femoral neck are common in Type-2. Post-traumatic vertebral collapse following compression fractures is recently recognized as one of the important and serious complications in osteoporotic fractures. Other fractures such as femoral neck, wrist (distal radius) and proximal humerus are common in this disease. Study of bone metabolism and its pharmaceutical reaction has advanced, but the treatment of osteoporosis is still not satisfactory.

Aged↗

PubMed2004

Kyphoplasty for treatment of osteoporotic vertebral fractures: a prospective non-randomized study.

BACKGROUND: Minimally invasive augmentation techniques of vertebral bodies have been advocated to treat osteoporotic vertebral body compression fractures (VBCFs). Kyphoplasty is designed to address both fracture-related pain as well as kyphotic deformity usually associated with fracture. Previous studies have indicated the potential of this technique for reduction of vertebral body height, but there has been little investigation into whether this has a lasting effect. The current study reports on our experience and the one-year results in 27 kyphoplasty procedures (24 patients) for osteoporotic VBCFs. RESULTS: All but one patient experienced pain relief following the procedure (on VAS 1-10)--with a lasting effect over the follow-up period in 25 cases. An average vertebral kyphosis reduction of 47.7% was achieved with no loss of reduction after one year. The potential for reduction was statistically related to the pre-operative amount of kyphosis, the level treated, and the age of the fracture, but not to the age of the patient. During follow-up, one fracture adjacent to a treated level was observed. Pain relief was not related to the amount of reduction. CONCLUSION: Kyphoplasty is an effective treatment of VBCFs in terms of pain relief and durable reduction of deformity. Whether spinal realignment results in an improved long-term clinical outcome remains to be investigated.

Adult↗

PubMed1989

[Diagnosis of spinal fractures using optical processing of the roentgenologic image].

X-ray examinations by a traditional method in 694 patients with non-complicated compression fractures in the thoraco-lumbar part of the vertebral column do not always give the exact picture of the character of fractures of the vertebral column. The method of optic processing the roentgen picture was used in 30 patients for more detailed analysis of structural changes in the vertebrae bodies. The method allowed to specify structural changes in the vertebra bodies, including the detection of the fracture plane, abruption of a body portion, detection of an additional contour of the limiting plate in its pressing into the vertebra body and the zone of infiltration in the upper portions of the body.

Absorptiometry, Photon↗

PubMed1984

[Stabilization of proximal femoral fractures using the compression and sliding screw].

Between 1979 and 1983 we treated 169 fractures with a sliding compression hip screw out of 402 operated fractures of the upper femur. The indication for this method included all types of proximal femoral fractures. In case of instable trochanteric fractures convincing results of treatment could be achieved because of early weight bearing. As complications could be found in two cases loss of fixation. The mortality rate was 17.8 per cent. Still 2/3 of the injured with an average age of 76.2 years could leave the hospital walking on their own after an average stay of 37.6 days.

Adolescent↗

PubMed1994

Seizure-induced thoracic burst fractures. A case report.

Musculoskeletal injuries can arise from muscle contraction during generalized seizure activity. The most frequently documented injuries are thoracic vertebral body compression fractures, proximal femur fractures, and proximal humerus fractures occasionally accompanied by dislocation. A case is presented of a thoracic burst fracture and bilateral proximal humerus fractures secondary to a seizure.

Adult↗

PubMed1995

Schmorl's nodes and low-back pain. Analysis of magnetic resonance imaging findings in symptomatic and asymptomatic individuals.

Magnetic resonance imaging (MRI) findings in cases with symptomatic and asymptomatic Schmorl's nodes have been analysed. In all symptomatic cases, the vertebral body marrow surrounding the Schmorl's node was seen as low signal intensity on T1-weighted images and as high signal intensity on T2-weighted images. It was confirmed by histological examination that the MRI findings indicated the presence of inflammation and oedema in the vertebral bone marrow. These MRI findings were not seen in asymptomatic individuals. Inflammatory changes in the vertebral body marrow induced by intraosseous fracture and biological reactions to intraspongious disc materials might cause pain. We postulate that after fracture healing and subsidence of inflammation, the Schmorl's nodes become asymptomatic, in analogy with old vertebral compression fractures. MRI is not only useful in detecting the recently developed Schmorl's nodes but also in differentiating between symptomatic and asymptomatic Schmorl's nodes.

Adolescent↗

PubMed1993

The epidemiology of fragility fractures: is there a role for bone quality?

Fragility fractures, particularly those of the hip, vertebrae, and distal forearm, constitute a major public health problem. The two ultimate determinants of fracture are bone strength and propensity to trauma. Bone strength depends not only upon bone mass but also upon a variety of qualitative aspects of bone structure. These include its architecture, the amount of fatigue damage it has sustained, and changes in its bulk material properties, indices that are collectively subsumed into the term "bone quality." Fragility fractures show differences in their patterns of incidence by age, sex, ethnic group, geographic area, and season. Many of these differences are currently unexplained, and disorders of bone quality might contribute to them. There are two fracture sites at which evidence implicates bone quality more directly--the spine and proximal femur. Many vertebral compression fractures follow minimal trauma, and controlled studies suggest that vertebral microarchitecture contributes to fracture risk independently of vertebral bone mass. At the hip, observational studies have pointed to a role for disordered trabecular architecture, accumulation of microfractures (fatigue damage), and the accumulation of osteoid. The extent to which these phenomena act independently of bone mass, however, remains uncertain.

Adult↗

PubMed1994

Ultrasound transmission as a sensitive indicator of bone change in Japanese women in the perimenopausal period.

Apparent velocity of ultrasound (AVU) through the patella was measured in 160 Japanese women without specific diseases affecting the skeletal system. AVU averaged 1955 +/- 64 m/s (mean +/- S.D.) in healthy premenopausal women. Twenty patients with postmenopausal osteoporosis over the age of 50 years with at least one atraumatic vertebral fracture had significantly lower average AVU (1757 +/- 89.6 m/s) than that of the same age group without compression fracture (1838 +/- 78.0 m/s, P < 0.05). Perimenopausal women without vertebral fracture in their 50s were divided into two groups, premenopausal (n = 11) and postmenopausal (n = 28), and both AVU through the patella and spinal BMD (L-2-4) using DXA were measured. A significant difference was found in AVU between the two groups (premenopausal, 1953 +/- 58 m/s; postmenopausal, 1885 +/- 73 m/s, P < 0.01), in the absence of a difference either in the mean age (premenopausal, 52.7 +/- 2.0; menopausal, 54.2 +/- 2.4) or in the spinal BMD as assessed by DXA (premenopausal, 0.930 +/- 0.080 g/cm2; postmenopausal, 0.851 +/- 0.148 g/cm2). The apparent difference in AVU without corresponding difference in BMD suggests that perhaps AVU measures something about the bone that is not reflected in BMD in women in their 50s in the immediate postmenopausal period. When AVU of our test subjects was compared with that in Caucasians reported by Heaney RP et al. (Osteoporotic bone fragility: detection by ultrasound transmission velocity. J Am Med Assoc 1989;261:2986-2990) no difference was found in AVU between Japanese and Caucasians.(ABSTRACT TRUNCATED AT 250 WORDS)

Absorptiometry, Photon↗

PubMed1982

Bone mass of the axial and the appendicular skeleton in women with Colles' fracture: its relation to physical activity.

The aim of this investigation was to elucidate whether Colles' fractures in middle-aged women were indicative of generalized bone loss (osteopenia) and whether bone mass of the axial and the appendicular skeleton was related to the extent of daily physical activity. Thirty-six patients (aged 50-73 years) with previous Colles' fracture were studied. The median time elapse after the injury was 18 months (range 9-20.5 months). Bone mineral content of the 2nd, 3rd, and 4th lumbar vertebrae (lumbar BMC) and both distal forearms (forearm BMC) were determined to dual-photon (153Gd) absorptiometry. The physical activity level was graded according to a standard interview and a bicycle ergometer test. Mean lumbar BMC was reduced by 9% compared to age-matched normal women (p less than 0.05), mean forearm BMC was reduced by 5% (NS). Twenty patients showed spinal osteopenia by either conventional radiography or absorptiometry (95% confidence limits 38-72%). The fracture-related bone loss from the forearms was most prominent when the fracture had occurred in the dominant forearm, suggesting that the loss of 'dominant' forearm activity per se results in bone loss. No relation between working capacity and forearm BMC was found. However, the working capacity was positively related to lumbar BMC (P less than 0.01), even if the common relationship to age was eliminated (P less than 0.05). The data suggest that the bone mass of the axial skeleton reflects the extent of daily physical activity. Patients with Colles' fractures represent an easily definable population which might benefit from prophylactic measures against vertebral bone loss and compression fractures. One of these could be physical exercise.

Aged↗

PubMed2004

The nutcracker fracture of the cuboid in children: a case report.

The fracture of the cuboid in children is rarely diagnosed and has probably been underreported for nondisplaced fractures. The diagnosis is often missed, and overlooked cuboid fracture can lead to severe alterations in foot mechanics and function. This case report involves a displaced compression fracture of the left cuboid in a 9-year-old girl after a fall from a height, which was treated by open reduction, bone graft, internal fixation with pins, and plaster splint immobilization. Follow-up examination 2 years after the injury revealed good bone union and a very good functional result.

Child↗

PubMed1992

[Reconstruction of the function and shape of the middle region of the face].

The anatomical structures and biomechanical features of the middle third of the face require various methods of osteosynthesis in case of fracture. Compression osteosynthesis is mainly confined to the lateral margin of the orbits, where the transverse section of the bone is made so as to resist the force applied to attach the osteosynthetic material. If thin bone blades are fractured, as is often observed in the middle level of the face, adapting osteosynthesis is a method operating without compression. It can be regarded as the method of choice for this type of fracture.

Bone Plates↗

PubMed2005

[Vertebroplasty and kyphoplasty in osteoporotic fractures of vertebral bodies -- a prospective 1-year follow-up analysis].

PURPOSE: Kyphoplasty and vertebroplasty offer two minimally invasive operative stabilization procedures for vertebral compression fractures. The purpose of this prospective study was to investigate whether both procedures are able to reduce pain and to preserve postoperative vertebral height during a 1-year follow up. MATERIALS AND METHODS: Osteoporotic vertebral fractures were treated in 42 cases, 20 patients (15 female, 5 male) underwent vertebroplasty, 22 patients (14 female, 8 male) underwent kyphoplasty. 32 vertebral fractures were treated with vertebroplasty and 35 vertebral fractures were treated with kyphoplasty. Symptomatic levels were identified by correlating the clinical presentation with conventional radiographs, CT or/and MRI. During the follow up reduction of pain was determined. Radiographic scans were performed pre- and postoperatively and after 3, 6 and 12 months. The vertebral height and endplate angles were measured to assess the restoration of the sagittal alignment. The effects on pain symptoms were measured on a self-reported Visual Analog Scale (VAS) and the Oswestry score was documented. RESULTS: The median pain scores (VAS) decreased significantly for kyphoplasty and vertebroplasty from pre- to post-treatment, as did the Oswestry score (p < 0.05). No significant differences could be found between both groups for the median pain score (VAS) and the Oswestry score. Kyphoplsty led to a significant restoration of the vertebral height and reduction of kyphosis (p < 0.05). During the 1-year follow up both operation techniques were able to stabilize the height of the vertebral body. CONCLUSION: Kyphoplasty and vertebroplasty are effective minimally invasive procedures for the stabilization of osteoporotic vertebral fractures leading to a statistically significant reduction in pain. Kyphoplasty restores significantly vertebral body height in fresh fractures. The restoration of vertebral height and reduction of kyphosis may have an influence on the long term clinical outcome. This has to be evaluated in a long term prospective study.

Aged↗

PubMed2003

Percutaneous vertebroplasty and kyphoplasty for painful vertebral body fractures in cancer patients.

OBJECT: The current North American experience with minimally invasive vertebro- and kyphoplasty is largely limited to the treatment of benign osteoporotic compression fractures. The objective of this study was to assess the safety and efficacy of these procedures for painful vertebral body (VB) fractures in cancer patients. METHODS: The authors reviewed a consecutive group of cancer patients (21 with myeloma and 35 with other primary malignancies) undergoing vertebro- and kyphoplasty at their institution. Ninety-seven (65 vertebro- and 32 kyphoplasty) procedures were performed in 56 patients during 58 treatment sessions. The mean patient age was 62 years (+/- 13 years [standard deviation]) and the median duration of symptoms was 3.2 months. All patients suffered intractable spinal pain secondary to VB fractures. Patients noted marked or complete pain relief after 49 procedures (84%), and no change after five procedures (9%); early postoperative Visual Analog Scale (VAS) pain scores were unavailable in four patients (7%). No patient was worse after treatment. Reductions in VAS pain scores remained significant up to 1 year (p = 0.02, Wilcoxon signed-rank test). Analgesic consumption was reduced at 1 month (p = 0.03, Wilcoxon signed-rank test). Median follow-up length was 4.5 months (range 1 day-19.7 months). Asymptomatic cement leakage occurred during vertebroplasty at six (9.2%) of 65 levels; no cement extravasation was seen during kyphoplasty. There were no deaths or complications related to the procedures. The mean percentage of restored VB height by kyphoplasty was 42 +/- 21%. CONCLUSIONS: Percutaneous vertebro- and kyphoplasty provided significant pain relief in a high percentage of patients, and this appeared durable over time. The absence of cement leakage-related complications may reflect the use of 1) high-viscosity cement; 2) kyphoplasty in selected cases; and 3) relatively small volume injection. Precise indications for these techniques are evolving; however, they are safe and feasible in well-selected patients with refractory spinal pain due to myeloma bone disease or metastases.

Adult↗