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PubMed2006

Ten-year absolute risk of osteoporotic fractures according to BMD T score at menopause: the Danish Osteoporosis Prevention Study.

UNLABELLED: In the non-HRT arms of the DOPS study, 10-year fracture risk was higher at each level of T score than predicted by the Kanis algorithm. Under-reporting of fractures in registers and inclusion of HRT users are probable explanations for inappropriately low fracture risk estimates for younger women. INTRODUCTION: International recommendations highlight the importance of absolute fracture risk in establishing intervention thresholds. The available estimates of long-term risk have been derived by combining relative risks from meta-analyses with U.S. normative BMD data and Swedish fracture incidence records. We validated the 2001 Kanis risk algorithm using incident fractures observed in untreated women in the first 10 years of the Danish Osteoporosis Prevention Study (DOPS). Comparisons were also made with the relative risks derived from a recent meta-analysis of 12 cohort studies. MATERIALS AND METHODS: We analyzed DXA of the spine and hip from 872 women who were enrolled in the non-hormone replacement therapy (HRT) arms of the study and had not received HRT, bisphosphonates, or raloxifene. We collected verified reports of fractures at each visit. We focused on fractures of the hip, spine, shoulder, and forearm to provide risks comparable with the Kanis algorithm. Accordingly, asymptomatic radiographic vertebral fractures were not included. RESULTS: Seventy-eight women (9%) sustained relevant fractures. The risk of fracture increased by 1.32 (95% CI, 1.02; 1.70) for each unit decrease in femoral neck T score and by 1.30 (95% CI, 1.06; 1.58) for each unit decrease in lumbar spine T score at baseline. Absolute fracture risk was higher than expected from the Kanis algorithm at all T score levels. The difference was greatest for participants in the higher range of T scores. At T = -1, the observed risk was 10.9% as opposed to an expected risk of 5.7%. Relative risk gradients were similar to those of the recent meta-analysis. CONCLUSIONS: In healthy women, examined in the first year or two after menopause, 10-year fracture risk was higher at each level of BMD T score than expected from the model by Kanis et al. Inclusion of HRT users in the cohorts used may have led to higher BMD values and lower absolute fracture risk in the Kanis model. These longitudinal data can be used directly in estimating absolute fracture risk in untreated north European women from BMD at menopause.

Absorptiometry, Photon↗
PubMed1987

[Injuries of the brachial plexus and neighboring peripheral nerves in vertebral fractures and other trauma of the cervical spine].

On the one hand, out of 115 patients admitted to hospital with 162 various fractures of the cervical spine without injury to the spinal cord, only 3 (2.6%) had an associated lesion to the brachial plexus or nerves in the vicinity. On the other hand, among 500 consecutive patients with injuries to the brachial plexus, 55 (11%) presented fractures of the cervical spine (including T1 and the 1st rib), whiplash injuries, severe distortions and dislocations, and contusions of that vertebral segment. Five (1% resp. 9%) had spinal cord injuries, including four patients with partial Brown-Sequard's syndrome, which was caused by multilevel root avulsions of the brachial plexus. In rather severe trauma to the lower cervical spine and concomitant brachial plexus lesion, root avulsions must be expected in 83% of cases, and in almost half of these patients three or more roots are avulsed from the spinal cord. Fractures around the shoulder-girdle as well as arterial ruptures are also significant for this severe nerve injury. Of these patients 39 (71%), were victims of motorcycle accidents.

Accidents, Traffic↗
PubMed1993

The anterior acromial approach for antegrade intramedullary nailing of the humeral diaphysis.

At three institutions, 71 humeral intramedullary nails were inserted into the shoulder; 67 were reviewed at 6 months and at completion of treatment. Fifty-one utilized the anterior acromial approach and 16 were inserted lateral to the acromion. Shoulder motion was rated as: excellent (asymptomatic and within 15 degrees of normal); good (normal daily function within normal motion); and poor. Nails were also inserted into the humeral diaphysis of eight cadaver shoulders. Fifty-one nails were inserted via the anterior acromial incision; 48 were graded as excellent, one as good, and two with traumatic axillary neuropathy and reflex sympathetic dystrophy as poor: Sixteen nails were inserted lateral to the acromion; 8 were rated, 7 good, and 1 poor. Motion returned in an average of 17 weeks (range:0-29). The greatest clinical concern is not ultimate shoulder function, but the rate of return. The authors conclude that either the anterior acromial approach or an extraarticular entry portal must be utilized for antegrade humeral diaphyseal nailing.

Acromion↗
PubMed2006

The floating shoulder.

The floating shoulder is an uncommon but important injury pattern. Although it is frequently defined as an ipsilateral fracture of the clavicle and scapular neck, recent studies suggest that ligament disruption associated with a scapular neck fracture contributes to the functional equivalent of this injury pattern, with or without an associated clavicle fracture. Determining the specific injury patterns indicates the potential for significant instability, and correlating these patterns with clinical outcome is a challenge. Because the degree of ligament disruption is difficult to assess on radiographs, indications for nonsurgical and surgical management are not well defined. Minimally displaced fractures typically do well with nonsurgical care. However, the degree of fracture displacement and ligament disruption that results in less predictable outcomes after nonsurgical treatment is uncertain, and the indications for surgery can be controversial. Internal fixation of a displaced clavicle fracture restores the contour of the shoulder, regulates soft-tissue tension, and often indirectly reduces the scapular neck fracture. Fixation of both fractures is recommended in certain fracture patterns. Because these controversies cannot be resolved by current evidence, surgeons must choose an individualized approach based on an understanding of the pathoanatomy and personal experience.

Clavicle↗
PubMed1992

Catheter fracture and embolisation in a totally implanted venous access catheter (TIVAC) following shoulder trauma.

A totally implanted intravenous catheter (TIVAC) was placed via the subclavian vein in a 32-year-old male patient with HIV infection for intermittent drug therapy. 8 months after insertion, a catheter fracture was noted with embolisation of the distal part into the heart. This accident was related to shoulder trauma with a downward movement of the clavicle. In active patients alternatives to the subclavian approach for TIVAC need to be considered.

Journal Article↗
PubMed1986

Pseudarthrosis following proximal humeral fractures: a possible mechanism.

A small series of four patients with pseudarthrosis of the proximal humeral shaft is reported. These patients all had restricted movement of the shoulder joint prior to the trauma, three as a result of rheumatoid arthritis and one due a surgical fusion of the glenohumeral joint. It is suggested that pseudarthrosis is more likely under these circumstances and that pursuit of union of the fracture in such patients may not always be necessary.

Aged↗
PubMed1995

Epidemiology of scapular fractures. Incidence and classification of 338 fractures.

We have studied scapular fractures, with special reference to intraarticular glenoid fractures, during a 10-year period in 2 Swedish counties. There were 338 scapular fractures in 322 patients. The annual incidence was 10/10(5) inhabitants, of which 30 percent affected the glenoid cavity. Out of 100 intraarticular glenoid fractures, 55 occurred in men and 45 in women. The mean age of the women at the time of fracture (64 years) was significantly higher than the mean age of men (49 years). The most common intraarticular glenoid fracture type was the anterior chip fragment fracture which, in about two-thirds of the cases, was associated with shoulder dislocation.

Adult↗
PubMed1989

[Long-term results of conservatively treated fractures of the upper end of the humerus].

The authors have considered 735 fractures of the proximal humerus in 748 patients, with 22% of fractures in 60-70 years old subjects. According to Neer's classification type 3 (surgical neck's fracture) and type 4 (surgical neck's fracture with greater and/or lesser tuberosity fracture) are the most frequent. The Desault bandage and the shoulder spica cast have been the preferred methods of treatment. The follow-up ranged between 12 and 1 year (on the average 5.8 Years). The authors have noted that the good results reduced in proportion to the increasing of the fragments' number and in the four part displacement fractures the bad results were of 55% in this research.

Adolescent↗
PubMed1992

[A modified procedure for repositioning shoulder dislocation].

A new method is presented for the reduction of shoulder dislocations and dislocation fractures, together with the follow-up results. This procedure is a modification of a method for reduction of the hip. Examination of our patients 1-3 years after the accident showed no sign of nerve lesions and little residual discomfort.

Adolescent↗
PubMedDate not supplied

Periprosthetic humeral fractures: management and classification.

Six patients (67 to 94 years of age) sustained a periprosthetic humeral fracture at an average of 43 months after shoulder arthroplasty (range 13 to 85 months). These fractures were classified depending on fracture anatomy and implant stability. Type A fractures occur about the tuberosities. Type B fractures occur about the stem and are subclassified by fracture anatomy and implant stability: B1 fractures are spiral fractures with a stable implant, B2 fractures are transverse or short oblique fractures about the tip of the stem with a stable implant, and B3 fractures are those fractures about the stem with an unstable implant. Type C fractures occur well distal to the tip of the stem. Five of the 6 fractures required surgery, 4 with revision to a long-stemmed component. All fractures united with restoration of range of motion and function. Satisfactory results may be anticipated if these fractures are managed in an appropriate fashion.

Adult↗
PubMed1994

Arthroplasty and acute shoulder trauma. Reasons for success and failure.

Successful treatment of acute fractures of the proximal humerus with prosthetic replacement is a therapeutic challenge to the orthopaedic surgeon, and requires proper elevation of the patient, proper surgical technique, and meticulous rehabilitation. Fractures that require prosthetic replacement as the definitive treatment include 4-part fractures and fracture dislocations, head-split fractures with > 40% articular surface involvement, and selected 3-part fractures. The trauma series of radiographs (including true anteroposterior and lateral views in the scapular plane, and axillary view) is essential for accurate fracture evaluation. Factors important for a successful outcome include gentle soft tissue technique, secure placement of the prosthesis with proper version and height, secure tuberosity reconstruction, meticulous rotator cuff repair, and a motivated patient who is able to understand and perform the rigorous postoperative rehabilitation. Postoperative rehabilitation must be individualized in each case, and the treatment plans should be carefully outlined by the operating surgeon at the completion of the surgical reconstruction. Of 70 cases treated with prosthetic replacement, results were excellent in 31, satisfactory in 22, and unsatisfactory in 17. Unsatisfactory results were associated with tuberosity detachment, prosthetic loosening, inadequate or noncompliant rehabilitation, preoperative nerve injury, humeral malposition, dislocation, deep infection, and ectopic bone formation.

Acute Disease↗
PubMed2005

Fracture of the scapular spine in a patient with a Delta III prosthesis.

Isolated scapular spine fractures are rare and are usually associated with other injuries. We describe a patient with a Delta III shoulder replacement who sustained a displaced ipsilateral fracture of the scapular spine after a fall. Internal fixation of the fracture resulted in excellent pain relief and restoration of the pre-existing shoulder mobility.

Accidental Falls↗
PubMed1999

Active responses decrease impact forces at the hip and shoulder in falls to the side.

Active responses, such as using the arm to break the fall, may be an effective means of decreasing likelihood of injury in a fall and may help explain why only a small percentage of falls result in a fracture. We quantified the impact force at the hip and shoulder in falls to the side from a kneeling position under three conditions: (1) attempting to break the fall by using an arm; (2) falling with the body relaxed; and (3) falling with the body tensed. Subjects fell from a kneeling position onto a force platform array covered with foam padding and impact force data were recorded. The ground reaction force-time curve was generally bimodal due to sequential impacts of the hip and shoulder. Impact forces at the hip and shoulder were 12 and 16% less for the slap condition (p < 0.05) than for the tensed condition. The impact forces for the relaxed and tensed conditions were not significantly different, although impact forces tended to be less in the relaxed condition. We concluded that active responses reduce the impact forces experienced at the hip and shoulder in falls to the side. Decreased effectiveness of protective responses, due to increases in reaction time and decreases in strength with age, may help explain why so many hip fractures occur in the elderly but so few occur in younger people.

Accidental Falls↗