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PubMed2003

Defining regional variation in the material properties of human rib cortical bone and its effect on fracture prediction.

This paper presents the results of dynamic material tests and computational modeling that elucidate the effects of regional rib mechanical properties on thoracic fracture patterns. First, a total of 80 experiments were performed using small cortical bone samples from 23 separate locations on the rib cages of four cadavers (2 male, 2 female). Each specimen was subjected to dynamic three-point bending resulting in an average strain rate of 5 +/- 1.5 strain/s. Test coupon modeling was used to verify the test setup. Regional variation was defined by location as anterior, lateral, or posterior as well as by rib level 1 through 12. The specimen stiffness and ultimate stress and strain were analyzed by location and rib level. Second, these material properties were incorporated into a human body computational model. The rib cage was partitioned into anterior, lateral, and posterior segments and the material properties were varied by location using an elastic-plastic material model. A total of 12 simulations with a rigid impactor were performed including 2 separate material assumptions, original and modified rib properties for regional variations, 3 separate impactor velocities, and 2 directions, anterior and lateral. The data from the material tests for all subjects indicate a statistically significant increase in the average stiffness and average ultimate stress for the cortical bone specimens located in the lateral (11.9 GPa modulus, 153.5 MPa ultimate stress) portion of the ribs versus the anterior (7.51 GPa, 116.7 MPa) and posterior (10.7 GPa, 127.7 MPa) rib locations. In addition, the stiffness, ultimate stress, and ultimate strain for all subjects are significantly different by rib level with each variable generally increasing with increasing rib number. The results from the computational modeling for both frontal and lateral impacts illustrate that the location and number of rib fractures are altered by the inclusion of rib material properties that vary by region.

Journal Article↗
PubMed2003

Bone mineral density, biochemical markers and skeletal fractures in haemodialysis patients.

BACKGROUND: End-stage renal disease is often associated with altered bone metabolism. METHODS: In order to investigate the determinant factors of bone mineral density (BMD) and the risk factors of fractures, we studied 70 patients; 26 women (23 post-menopausal) and 44 men, (mean+/-SD) aged 60.5+/-14.3 years, treated by standard haemodialysis (HD) for 6.4+/-6.8 years. Main circulating bone biochemical markers were assessed and BMD was measured with a Lunar DPX densitometer at five sites. BMD results are expressed as a function of age and gender (Z-score). RESULTS: Mean Z-score was markedly decreased at the mid-radius (-2.75+/-1.23) whereas it was normal at the femoral neck (-0.42+/-1.13) and lumbar spine (0.02+/-2.13), and total body (-0.62+/-1.53). Time on HD was negatively correlated to the Z-score at the mid-radius and total body but not at the other sites. Serum intact parathyroid hormone (iPTH), whole PTH or cyclase activating PTH (CAP) and bone-specific alkaline phosphatase concentrations were negatively correlated with Z-scores at all sites. Twenty-one out of 70 patients had sustained a total of 27 fractures since the beginning of dialysis therapy (seven ribs, seven ankles, six vertebrae, three humerus, two wrists and two hips). They had a total body Z-score significantly lower than that of patients without fractures, -1.34+/-1.54 vs -0.37+/-1.46, respectively (P<0.031); however, their Z-scores at the other sites were not different. They were on HD for longer time, 10.4+/-9.5 vs 5.0+/-5.1, respectively (P<0.003), and the relative risk of skeletal fractures was 6.4 times greater after 10 years of HD. The seven patients with rib fractures had a decreased Z-score at most of the sites but not at the mid-radius. Rib fractures but no other fractures were associated with markedly decreased body weight, fat mass and serum leptin levels. CONCLUSIONS: In conclusion, the Z-score at the mid-radius was decreased in HD patients and correlated with high serum PTH but not with fractures. Bone fractures were associated with the time passed on HD and with a low total body Z-score. Rib fractures were frequent and associated with a poor nutritional state.

Adult↗
PubMed2004

Predictive value of low BMD for 1-year fracture outcomes is similar for postmenopausal women ages 50-64 and 65 and Older: results from the National Osteoporosis Risk Assessment (NORA).

UNLABELLED: The relationship of low bone mass and fracture in younger postmenopausal women has not been extensively studied. In a large cohort of postmenopausal women > or =50 years of age, we found the relationship of BMD measured at peripheral sites and subsequent 1-year fracture risk to be similar between women <65 and those > or =65 years of age. INTRODUCTION: Low bone mass and fractures are prevalent in older postmenopausal women. However, the frequency of low bone mass and fracture in younger postmenopausal women has not been studied extensively. There are very limited data regarding the association between BMD measurements and fractures in postmenopausal women who are between the ages of 50 and 64. MATERIALS AND METHODS: In the National Osteoporosis Risk Assessment (NORA) we studied the frequency of low bone mass and its association with fracture in women 50-64 years of age in comparison with women > or =65 of age. NORA enrolled 200,160 postmenopausal women > or =50 years of age who had no prior diagnosis of osteoporosis. Baseline BMD was measured at the heel, forearm, or finger. A 1-year follow-up survey requesting incident fractures since baseline was completed by 163,935 women, 87,594 (53%) of whom were 50-64 years of age. The association between BMD and fracture was assessed using logistic regression, adjusted for important covariates. RESULTS: Thirty-one percent of women 50-64 years of age had low bone mass (T scores < or = -1.0) compared to 62% of women > or =65 years of age. During the first year of follow-up, 2440 women reported fractures of wrist/forearm, rib, spine, or hip, including 440 hip fractures. Nine hundred four women 50-64 years of age reported fractures, including 86 hip fractures, accounting for 37% of fractures and 20% of hip fractures reported in the entire NORA cohort. Relative risk for osteoporotic fracture was 1.5 for each SD decrease in BMD for both the younger and older groups of women. CONCLUSION: Low BMD in younger postmenopausal women 50-64 years of age showed a 1-year relative risk of fracture similar to that found in women > or =65 years of age.

Age Factors↗
PubMed2000

An in vitro study of the effect of bony buttressing on fixation strength of a fractured atrophic edentulous mandible model.

PURPOSE: The purpose of this study was to measure the resistance to displacement in an adult bovine rib mandible model as the vertical dimension of the bone decreases, and to compare the fixation strength of titanium miniplates and reconstruction plates. MATERIALS AND METHODS: Five groups of 6 ribs each were tested based on the vertical dimension of the rib and method of fixation (group 1, 40 mm, miniplate), (group 2, 30 mm, miniplate), (group 3, 20 mm, miniplate), (group 4, 10 mm, miniplate), (group 5, 10 mm, reconstruction plate). In the 4 groups stabilized with a miniplate, a 3-hole-per-segment, 2.0-mm titanium miniplate and 6.0-mm monocortical titanium screws were used. In group 5, a 3-screw-per-segment, 2.4-mm titanium reconstruction plate and 2.4-mm bicortical titanium screws were used for fixation. A 2-dimensional beam model (Class III lever) was established, and an Instron machine was used initially to develop a load-displacement curve to 100 N for each specimen. An osteotomy was then created, and the segments were reduced without preload. The ribs were then loaded to failure in the Instron machine. The load-displacement curve and failure load were recorded. RESULTS: There was no significant difference (P < or = .05) between any of the groups before the osteotomy. At 75 N, groups 1 and 2 were superior to group 5 in resistance to displacement. Group 4 showed significantly less (P < or = .05) resistance to displacement than the other experimental miniplated subgroups. As loads increased, groups 1 and 2 continued to show increased resistance to displacement when compared with groups 3, 4, and 5. Loads to failure for groups 1 and 2 were comparable to group 5. CONCLUSIONS: Decreased resistance to displacement occurs with decreasing vertical dimension of the bovine rib. In fractures of the edentulous mandible, a miniplate is more likely to provide adequate fixation if the mandible is 30 to 40 mm in height (nonatrophic). At higher loads, groups with greater vertical height (30 mm and 40 mm) provided resistance to displacement equivalent to the 10-mm group repaired with a reconstruction plate. Therefore, fractures of the atrophic mandible may be better treated with more rigid techniques.

Alveolar Bone Loss↗
PubMed1983

Osteopetrosis in trauma.

A 19-year-old male with a bone disease that predisposes to pathological fractures was involved in an automobile accident. Although the physician must always look for multiple injuries in any trauma patient, this case illustrates that in the patient with bone disease, the probability of multiple fractures is extremely high. The differential diagnosis of dense-bone disease is discussed as are considerations relevant to caring for the trauma patient with bone disease.

Accidents, Traffic↗
PubMed1975

[Fatigue fractures of the leg bones. Apropos of 19 cases].

The authors report non-traumatic fracture occurring in healthy bond, fatigue fractures of the leg, much less common than fatigue of the metatarsal bones. The authors report here 19 cases, characterised by periosteal apposition and a limited bony fissure which could only be demonstrated towards the second or third week. Its radiological appearance consisted of peri-osteal apposition and bony fissure, and is quite characteristic. However, it is not always obvious and, in some cases, a misdiagnosis of reticulosarcoma was made. It is treated by plaster immobilisation or simple rest and this leads to a cure without sequelae. Progressive and sufficiently prolonged physiotherapy permits recovery of the normal bony structure submitted to new stresses in intensity and duration and should prevent further fractures.

Calcaneus↗
PubMed1998

[The experimental research of transforming growth factor-beta 1 expression during fracture healing].

OBJECTIVE: To observe the effect of TGF-beta 1 in the regulation of fracture healing. METHOD: The expression of transforming growth factor-beta 1 (TGF-beta 1) in different period of fracture healing was investigated by immunohistochemistry. RESULTS: It was found that the expression of TGF-beta 1 changed in different period. The cells in the cambial layer of the periostlum showed low or negative signal in the immediate injury response period. The osteoblasts differentiated from the periosteum cells stained strongly in the intramembranous ossification period, and the differentiated chondrocytes stained most strongly in the chondrogenesis period. The hypertrophic chondrocytes showed negative signal and the osteoblasts stained strongly in the endochondral ossification period. These results suggested that the expression of TGF-beta 1 was closely related to the proliferation and differentiation state of repair cells. CONCLUSION: TGF-beta 1 is intimately involved in the control of fracture healing.

Animals↗
PubMed1987

Correlations of injury, toxicology, and cause of death to Galaxy Flight 203 crash site.

This report details the medical investigation of the crash of Galaxy Flight 203, on 21 Jan. 1985, near Reno, Nevada. Sixty-eight persons died at the scene, two died during hospitalization, and one victim survived. After completion of autopsies on all victims, pathologists determined causes of death based upon injuries, evidence of smoke inhalation, and toxicologic results. Our research shows that the majority of victims survived the impact only to succumb to toxic gas and fire. We correlated the causes of death, various injuries, and toxicologic findings to body location at the crash site to aid in reconstructing the events surrounding the accident and to address medicolegal problems and safety considerations. Our experience clearly supports the need for thorough medical investigation, including autopsy of each victim and determination of the precise cause of death for all fatalities.

Abdominal Injuries↗