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PubMed1994

ABC of emergency radiology. The ankle.

The os trigonum is a common normal variant of the talus and is due to a separate ossification centre arising from the posterior tubercle. The appearance may resemble an old ununited fracture fragment. However, it is triangular, well corticated, in a classic location, and usually bilateral, which enables it to be distinguished from a fracture. Transverse, sclerotic, linear lines located at the metaphysis of growing long bones are due to short periods of growth arrest and have no clinical importance (fig 5). They may be confused with compression fractures, but again these lines are usually bilateral. Fibrous cortical defects are the most commonly seen benign lesions of long bones and are usually identified incidentally in radiographs taken for another reason. The defect is limited to the cortex, commonly found at the metaphysis, but may be located in the diaphysis as the bone grows. The lesion is well corticated (sclerotic margins) and usually does not produce signs or symptoms.

Ankle Injuries↗

PubMed2006

Significantly reduced radiation exposure to operators during kyphoplasty and vertebroplasty procedures: methods and techniques.

BACKGROUND AND PURPOSE: Vertebroplasty and kyphoplasty can be associated with significant radiation exposure to the operator. We compared the exposure levels to an operator performing vertebral fracture augmentation with vertebroplasty and kyphoplasty, to assess a cement injection and a monitoring technique designed to reduce this exposure. METHODS: A neuroradiologist performed 189 consecutive vertebral augmentation procedures in 135 patients with osteoporotic compression fractures by using a bilateral approach with biplane pulse fluoroscopy at 7.5 pulses/second. Cement delivery was performed with intermittent fluoroscopy with kyphoplasty and vertebroplasty by using syringes or continuous fluoroscopic monitoring with a cement delivery system (CDS). Data collection included time and operator exposure parameters. RESULTS: A total of 87 kyphoplasty procedures, 82 vertebroplasty procedures with a CDS (VP-CDS), and 20 vertebroplasty procedures with syringes (VP-S) were safely performed. Mean fluoroscopy time for device positioning was 4.3 minutes for each procedure type. Mean fluoroscopy time (minutes) for cement delivery was significantly different for the 3 procedure types; 2.1 for kyphoplasty, 3.7 for VP-CDS, and 1.5 for VP-S (P < .0001). Comparable mean radiation exposure rates (microsieverts/minute) were 0.8 for kyphoplasty, 1.1 for VP-CDS, and 0.3 for VP-S during device-positioning and 1.7 for kyphoplasty, 2.9 for VP-CDS, and 0.2 for VP-S during cement injection (P < .002). CONCLUSION: Use of the modified cement injection technique and intermittent fluoroscopy with kyphoplasty and vertebroplasty with syringes results in a significantly lower operator exposure rate compared with vertebroplasty with a CDS.

Adult↗

PubMed1988

[Principles of primary functional fracture treatment].

The main characteristic feature of primary functional treatment of fractures is that all parts of the affected segment of the locomotor apparatus are essentially functional again within a week after the trauma has been sustained, even without any internal splinting. Stable cancellous bone compression, fractures that are stabilized by a pronounced muscular sheath and certain fractures affecting the shafts of the long tubular bones are all indications for application of this method, providing there is no concomitant high-grade soft tissue damage. Adjuvant analgesia is an important basis of the therapy; others are exercises under the supervision of a physiotherapist and the adaptation of supporting splints and cuffs. The primary functional treatment regimen has few complications, and when it is applied only in situations where it is genuinely indicated and is competently supervised, the clinical results are excellent.

Braces↗

PubMed1997

Classification and acute management of thoracolumbar fractures.

Successful management of traumatic injuries of the thoracolumbar spine requires understanding of the concepts of spinal stability and instability. There are numerous classifications of injury patterns based on fracture type and the probable forces involved. This article focuses on Denis's three-column theory of spinal stability and its utility in categorizing five injury patterns and the forces involved: specifically, wedge compression fractures, burst fractures, flexion distraction injuries, fracture dislocations, and miscellaneous injuries. The authors also highlight the acute management and evaluation of patients suspected to have these types of injuries.

Acute Disease↗

PubMed1999

In vitro fracture strength of endodontically treated premolars.

The recent introduction of new bonding agents has led some authors to suggest that certain endodontically treated posterior teeth could be restored with a bonded restoration instead of a full-coverage crown or onlay. To test the fracture resistance of endodontically treated premolars restored with and without bonding agents, we randomly divided 56 intact and caries-free maxillary premolars into seven groups as follows: unaltered teeth; access only; MOD prep and RCT; MOD prep, RCT, and amalgam restoration; MOD prep, RCT, and amalgam with 4-META bonding agent; MOD prep, RCT, and composite resin restoration; and MOD prep, RCT, and composite resin with 4-META bonding agent. The teeth were subjected to compressive fracture tests in a Zwick 1435 Universal Testing Machine. Unaltered teeth and those with access only demonstrated similar fracture strengths. Under the conditions of this study, there was no significant difference in fracture strength between the experimental groups.

Acrylic Resins↗

PubMed1992

Fracture thresholds in osteoporosis: implications for hormone replacement treatment.

The bone mineral densities of the lumbar spine and femoral neck were determined by dual energy chi ray absorptiometry in 110 women aged 40-82 years (average 65 years) with spinal osteoporosis who had had at least one atraumatic vertebral compression fracture and in 1026 normal women aged 40-79 years (average 52 years). The women with osteoporosis showed a significant decrease in bone mineral density (BMD) at the lumbar spine and femoral neck compared with age matched normal women (sixth decade of life -26% spine, -23% femoral neck; seventh decade -26% spine, -16% femoral neck). The fracture threshold, defined as the 90th centile of spinal BMD for women with osteoporosis, was 0.81 g/cm2 at the lumbar spine and 0.656 g/cm2 at the femoral neck. Five per cent of normal women aged 40-49 years, 20% aged 50-59 years, and 45% aged 60-69 years had a BMD below this threshold. To maintain the bones of women above the fracture threshold until the age of 70 years about 50% of postmenopausal women need hormone replacement therapy. However, if the BMD is to be kept above the fracture threshold for a women's lifetime, e.g. until the age of 80-90 years, then most women will need treatment, though for various lengths of time depending on their initial BMD. Measurements of BMD in postmenopausal women currently help in identifying the risk of osteoporotic fractures but in the lifetime assessment of risk in a single subject they may have a more important role in deciding the duration of hormone replacement therapy.

Absorptiometry, Photon↗

PubMed1985

Vertebral fracture, extensor hypertonia of thoracic limbs, and paralysis of pelvic limbs (Schiff-Sherrington syndrome) in an Arabian foal.

An Arabian foal, which was recumbent for 4 days, had signs of extensor rigidity of the thoracic limbs and hypotonic paralysis of the pelvic limbs. Survey radiography revealed a lesion at T15, with radiographic impression of a compression fracture or a hemivertebra. Postmortem examination revealed a fracture at T15. Clinical and pathologic findings in this case were compatible with the Schiff-Sherrington syndrome, which is characterized by thoracic limb extensor hypertonia associated with paraplegia from acute thoracolumbar trauma.

Animals↗

PubMed1999

Intravertebral body reconstruction with an injectable in situ-setting carbonated apatite: biomechanical evaluation of a minimally invasive technique.

The ability to mechanically reinforce an osteoporotic vertebral body could impede spinal compression fracture and the associated pain and complications. Previous studies have shown that reinforcement of fractured vertebrae with conventional acrylic cement can relieve symptoms and avoid further collapse. In this study, we explored the use of a carbonated apatite cement combined with a minimally invasive injection technique to improve the compressive mechanical properties of cadaveric vertebral bodies. After establishing the biomechanical characteristics of cement formulations intended to have appropriate viscosities, we evaluated the infiltration of the cements into thoracic vertebral bodies using a combined suction-injection technique. The energy-absorption capabilities of the reinforced vertebral bodies were then measured during axial compressive tests and compared with those of nonreinforced vertebrae. The ultimate compressive strength of the cement formulations averaged from 11.6 to 17.7 MPa, depending on curing conditions. The suction-injection technique allowed from one-half to two-thirds of each vertebral body to be infiltrated with cement. Energy absorption was significantly higher (p < 0.05) between 25 and 70% collapse of the vertebral body in the specimens that received the apatite injection as compared with the controls. These results suggest that osteoporotic vertebral-body augmentation with the injection of apatite cement could prevent further collapse after initial failure has occurred. The osteoconductive nature of the cement and its ability to be remodeled by bone, together with its compressive strength, which is higher than that of cancellous bone, could provide better clinical results than those of current treatments with acrylic cement.

Aged↗

PubMed2003

Quantitative computed tomography-based finite element models of the human lumbar vertebral body: effect of element size on stiffness, damage, and fracture strength predictions.

This study investigated the numerical convergence characteristics of specimen-specific "voxel-based" finite element models of 14 excised human cadaveric lumbar vertebral bodies (age: 37-87; M = 6, F = 8) that were generated automatically from clinical-type CT scans. With eventual clinical applications in mind, the ability of the model stiffness to predict the experimentally measured compressive fracture strength of the vertebral bodies was also assessed. The stiffness of "low"-resolution models (3 x 3 x 3 mm element size) was on average only 4% greater (p = 0.03) than for "high"-resolution models (1 x 1 x 1.5 mm) despite interspecimen variations that varied over four-fold. Damage predictions using low- vs high-resolution models were significantly different (p = 0.01) at loads corresponding to an overall strain of 0.5%. Both the high (r2 = 0.94) and low (r2 = 0.92) resolution model stiffness values were highly correlated with the experimentally measured ultimate strength values. Because vertebral stiffness variations in the population are much greater than those that arise from differences in voxel size, these results indicate that imaging resolution is not critical in cross-sectional studies of this parameter. However, longitudinal studies that seek to track more subtle changes in stiffness over time should account for the small but highly significant effects of voxel size. These results also demonstrate that an automated voxel-based finite element modeling technique may provide an excellent noninvasive assessment of vertebral strength.

Adult↗

PubMed2004

Percutaneous vertebroplasty: technique and results in 192 procedures.

Percutaneous vertebroplasty with acrylic cement (usually polymethylmethacrylate) consists of injecting cement into vertebral bodies weakened by osseous lesions. The objective of this procedure is to obtain an analgesic effect by mechanical stabilization in destructive lesions of the spine. The three major indications are aggressive vertebral hemangiomas, severe or refractory pain related to osteoporotic vertebral fractures, and malignant vertebral tumors. Complications are infrequent, but occur essentially in patients with vertebral malignant tumors. We present our experience with 148 patients that underwent 192 percutaneous PMMA vertebroplasties for the treatment of painful osteoporotic compression fractures (76 patients, 105 vertebral levels), hemangiomas (31 patients, 43 vertebral levels) and neoplasms (31 patients, 43 vertebral levels). In a vast majority of appropriately selected cases and especially in osteoporotic cases, vertebroplasty constitutes a relatively simple procedure with a very high rate of success.

Adult↗

PubMed2001

Apparent diffusion coefficients and T2 relaxation time measurements to evaluate disc degeneration. A quantitative MR study of young patients with previous vertebral fracture.

PURPOSE: To assess the suitability of apparent diffusion coefficient (ADC) measurements to evaluate degeneration processes of the vertebral disc and to compare the results with T2 relaxation time measurements in both degenerated and normal intervertebral discs. MATERIAL AND METHODS: Fourteen young patients (8.8-20.8 years old) who had had a vertebral compression fracture at least 1 year earlier, underwent MR studies with diffusion imaging in three orthogonal directions and T2 relaxation time measurements. ADC values and T2 relaxation times of both degenerated and normal intervertebral discs were compared to the values of 20 healthy young asymptomatic control subjects. RESULTS: In the degenerated discs of patients, the ADCx and ADCy values were decreased compared to earlier determined values of healthy controls. ADC values in the z-direction in degenerated discs did not differ significantly from the values of controls. T2 relaxation times were shorter in the degenerated discs of patients compared to the values of controls. The greatest changes in both these values were observed in degenerated discs followed by discs with normal signal intensity adjacent to primary trauma area and secondary trauma area. CONCLUSION: We suggest that decreased ADC values reflect the lost integrity of the intervertebral disc. ADC measurements at MR may prove sensitive depicting of early degenerative changes in vertebral discs.

Adolescent↗

PubMed2005

Real-time CT fluoroscopy (CTF)-guided vertebroplasty in osteoporotic spine fractures.

The purpose of this study was to evaluate the clinical feasibility, benefits, and limitations of CT fluoroscopy (CTF)-guided percutaneous vertebroplasty (PVP). PVP under the guidance of CTF without additional guidance by conventional C-arm fluoroscopy was performed in a total of 29 vertebral bodies in 21 patients with vertebral compression fractures. While monitoring sectional CTF images, the needle was advanced from the skin to the target vertebra. Contrast media and polymethylmethacrylate (PMMA) were injected into the target vertebra with careful monitoring of their distribution. After the procedure, an evaluation was conducted to determine whether extraosseous leakage of PMMA occurred and whether sufficient filling of PMMA had been achieved. Needle placement into the target vertebra was easily achieved with both the transpedicular and posterolateral approaches. Injection of PMMA and venous leakage of contrast media were carefully monitored in all patients, and early detection of PMMA leaking was achieved in 5 patients. Extraosseous leakage that had not been detected during the procedure was not found upon postoperative evaluation. Pain scales were significantly decreased after the procedure, and no obvious complications occurred following the procedure. CTF-guided PVP without the combined use of C- arm fluoroscopy was feasible and showed definite benefits. We believe that, in spite of some limitations, CTF-guided PVP provides an alternative technique appropriate in certain situations.

Aged↗

PubMed2002

Measurement of canal occlusion during the thoracolumbar burst fracture process.

Post-injury CT scans are often used following burst fracture trauma as an indication for decompressive surgery. Literature suggests, however, that there is little correlation between the observed fragment position and the level of neurological injury or recovery. Several studies have aimed to establish the processes that occur during the fracture using indirect methods such as pressure measurements and pre/post impact CT scans. The purpose of this study was to develop a direct method of measuring spinal canal occlusion during a simulated burst fracture by using a high-speed video technique. The fractures were produced by dropping a mass from a measured height onto three-vertebra bovine specimens in a custom-built rig. The specimens were constrained to deform only in the impact direction such that pure compression fractures were generated. The spinal cord was removed prior to testing and the video system set up to film the inside of the spinal canal during the impact. A second camera was used to film the outside of the specimen to observe possible buckling during impact. The video images were analysed to determine how the cross-sectional area of the spinal canal changed during the event. The images clearly showed a fragment of bone being projected from the vertebral body into the spinal canal and recoiling to the final resting position. To validate the results, CT scans were taken pre- and post-impact and the percentage canal occlusion was calculated. There was good agreement between the final canal occlusion measured from the video images and the CT scans.

Animals↗

PubMed2006

[Advancement in the repair and reconstruction of the injured spine and spinal cord].

OBJECTIVE: To investigate the latest research and the therapeutic development in the injuries to the spine and spinal cord. METHODS: Literature concerned was reviewed, combined with our own research and clinical experience, to summarize the trend of the researches and their clinical application in the treatment of the injured spine and spinal cord. RESULTS: The posterior approach atlantoaxial stabilization technique changed the conventional wiring technique into the transarticular screw fixation to the plate and pedicle or the lateral mass screw fixation technique. The clinical application of the transoralpharyngeal atlantoaxial reduction plate fixation technique showed a good effect on the reduction of atlantoaxial dislocation. However, there were no unified criteria for selection of the surgical approach, fixation level, and fusion mode in the treatment of thoracolumbar spinal fractures. Under optimal conditions, both the anterior and the posterior approaches could achieve good clinical effects on decompression and spinal reconstruction. The single level fixation technique showed some advantages in treating certain types of thoracolumbar spinal fractures when compared with the traditional cross-sectional fixation. The endoscopy-assistant and image-guiding spinal intervention techniques were evolved in China during these years. In the treatment of the obstinate painful osteoporotic vertebral compressive fracture, percutaneous vertebroplasty and kyphoplasty achieved good results in the pain relief and spinal reconstruction. Numerous basic and clinical researches have given us a further understanding of the medical protection of acute spinal cord injury, and biological treatments have given us new ideas on neural reparation and regeneration. Cell transplantation and gene therapy have become the most promising treatment strategies in this field. CONCLUSION: With the rapid development of spine surgery, the repair and reconstruction of the injured spine and spinal cord made a great stride in the recent years.

Cell Transplantation↗

PubMed2004

Diagnosis and management of thoracolumbar spine fractures.

The lack of robust clinical studies has contributed to controversy regarding optimal treatment for patients with injuries to the thoracolumbar spine. The transitional anatomy of the thoracolumbar spine makes it vulnerable to injury resulting from high-energy motor vehicle collisions and falls; osteoporosis is an underlying factor in most of the compression fractures identified in elderly patients. The formulation of a treatment plan for patients with injuries to the thoracolumbar spine depends on the presence and extent of neurologic injury and deformity and an estimate concerning spinal stability. Both nonsurgical and surgical treatment options are available to achieve the goals of preservation of neurologic function and restoration of spinal stability.

Decompression, Surgical↗

PubMed2002

Percutaneous pinning of talar neck fractures.

In this article, we describe a technique for percutaneous pinning of talar neck fractures. This technique, which uses 2 partially threaded cannulated screws placed in opposite directions and parallel to each other, minimizes soft-tissue injury and blood-supply disruption and can shorten surgery. In addition, it allows for fracture compression and optimal positioning of screws, which increase the biomechanical stability of the fixation.

Bone Screws↗

PubMed2000

Minimally invasive retroperitoneal approach for lumbar corpectomy and anterior reconstruction. Technical note.

The anterior decompressive procedure in which spinal fusion is performed is considered an effective treatment for thoracolumbar fractures and tumors. However, it is also known to be associated with considerable surgery-related trauma. The purpose of this study was to show that lumbar corpectomy and anterior reconstruction can be performed via a minimally invasive retroperitoneal approach (MIRA) and therefore the surgical approach-related trauma can be reduced. The authors studied retrospectively the hospital records and radiological studies obtained in five patients (mean age 67.4 years, range 59-76 years) who underwent lumbar corpectomy and spinal fusion via an MIRA followed by posterior fixation. Four patients presented with osteoporotic compression fractures at L-2 and L-3, and one patient presented with metastatic disease in L-4 from prostate cancer. Neurological deficits due to cauda equina compression were demonstrated in all patients. The MIRA provided excellent exposure to facilitate complete decompression and anterior reconstruction in all patients, as verified on follow-up radiographic studies. All patients improved clinically. A 1-year follow-up record is available for four patients and a 6-month follow-up record for the fifth patient; continuing clinical improvement has been observed in all. Radiography demonstrated anatomically correct reconstruction in all patients, as well as a solid fusion or a stable compound union in the four patients for whom 1-year follow-up records were available. The MIRA allows the surgeon to perform anterior lumbar spine surgery via a less invasive approach. The efficacy and safety of this technique and its potential to reduce perioperative morbidity compared with conventional retroperitoneal lumbar spine surgery should be further investigated in a larger series.

Aged↗

PubMedDate not supplied

[Kyphoplasty - a new minimally invasive treatment for repositioning and stabilising vertebral bodies].

AIM OF THE STUDY: Osteoporotic vertebral fractures are an ailment of the aging population of increasing incidence and high socioeconomic impact. Intractable pain causing significant morbidity leads to long-term hospitalisation. Kyphoplasty offers a new minimal invasive operative stabilisation procedure for these vertebral compression fractures. This study is conducted to investigate whether this procedure significantly reduces both pain and the duration of hospital stay in comparison to conservative treatment modalities. METHOD: From January until July 2002 a total of 22 patients had undergone kyphoplasty in 37 vertebral bodies. Osteoporotic vertebral fractures were treated in 18 cases, while in another 4 cases prophylactic stabilisation for osteolytic lesions was performed. Both the duration of hospital stay and the reduction of pain symptoms were determined and compared to a conservatively treated control group of 20 patients suffering from 35 fractured vertebral bodies. Pre- and postoperative endplate angles were measured to assess the restoration of the sagittal alignment. The effects on pain symptoms were measured on a self-reported Visual Analogue Score Scale. RESULTS: The mean pain relief for the patients undergoing kyphoplasty was 82 %, which was significantly higher (p < 0.0001) compared to the group of the conservatively treated patients (42 %). Reduction of the kyphotic deformity was achieved in 4 cases (average 8.5 degrees ). The average in-patient treatment duration for the surgical treated patients was 10 days as opposed to a significantly longer mean hospitalisation of 20 days (p = 0.003). Cement extravasation was observed in 5 out of 37 treated vertebral bodies without clinical sequelae. CONCLUSION: Kyphoplasty is a safe minimal invasive procedure for the stabilisation of osteoporotic vertebral fractures leading to a statistically significant reduction both of pain status and duration of hospitalisation.

Aged↗