[A rare atlas fracture (comminuted fracture of the Jefferson type)].
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Adult↗
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Results for “Fractures, Comminuted”
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[Serious injuries of the astragalus. Fracture dislocations, comminuted fractures and total dislocations].
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Adult↗
Factors Associated With Accelerated Fracture Healing in Patients With Traumatic Brain Injury and Extremity Comminuted Fractures: A Retrospective Case-Control Study.
OBJECTIVE: Although traumatic brain injury (TBI) has been clinically associated with accelerated bone healing, the factors that determine which patients experience this phenomenon remain poorly defined, and previous findings are conflicting. This study aimed to investigate the clinical factors associated with accelerated fracture healing in patients with TBI combined with comminuted fractures of the limbs, so as to provide an evidence-based foundation for elucidating the clinical phenomenon of TBI-promoted fracture healing. METHODS: A retrospective case-control study design was employed. Patients between January 2020 and April 2024 with concurrent diagnoses of TBI and comminuted fractures were included. Based on radiographic findings and RUST/mRUST scores, patients were divided into an accelerated healing group (AHG) and a normal/delayed healing group (NDHG). Clinical data including demographics (age, sex, BMI), TBI characteristics (injury site, GCS score), admission laboratory indices (blood count, coagulation function, inflammatory markers), and fracture site/local soft tissue conditions, as well as functional outcomes assessed by the Short Musculoskeletal Function Assessment (SMFA) questionnaire at final follow-up were collected. Univariate analysis and multivariate logistic regression analysis were used to identify independent factors influencing accelerated fracture healing. Receiver operating characteristic (ROC) curves were plotted to evaluate their predictive value. RESULTS: A total of 119 patients were included, with 69 in the AHG and 50 in the NDHG. Significant differences were observed between the two groups in terms of age, BMI, GCS score, and platelet count (p < 0.05). Univariate analysis showed that age, BMI, GCS score, red blood cell count, and platelet count were associated with accelerated fracture healing (p < 0.20). Multivariate logistic regression analysis indicated that younger age (OR = 0.875, 95% CI: 0.821-0.934) and lower GCS score (indicating more severe TBI; OR = 0.490, 95% CI: 0.339-0.707) were independent predictors of accelerated fracture healing. ROC curve analysis showed that the area under the curve (AUC) for age and GCS score in predicting accelerated healing were 0.893 and 0.851, respectively. CONCLUSIONS: In patients with TBI combined with comminuted fractures, younger age and greater TBI severity (lower GCS score) are independent predictors of accelerated fracture healing. These findings assist clinicians in the early identification of patients with high healing potential to optimize treatment strategies, facilitate the early identification of high-risk patients, and provide clinical clues for further exploration of the molecular mechanisms underlying neurohumoral regulation of bone regeneration.
Humans↗
[Elbow dislocation with fracture of the coronoid process and comminuted fracture of the radius head].
In fractures of the elbow with an associated fracture of the coronoid process, the size of the coronoid fragment determines the stability of the joint. A diminution of the arch of the incisura semilunaris by about 30 degrees causes instability of the elbow. We present an alternative way of treating the special case of a fracture of the coronoid process combined with comminuted fracture of the proximal end of the radius. A suitable fragment of the head of the radius is used to reconstruct the coronoid process. The stability achieved allows early functional postoperative treatment with a good range of movement at the elbow joint.
Aged↗
Primary subtalar arthrodesis for the treatment of comminuted fractures of the calcaneus.
Comminuted fractures of the calcaneus are extremely difficult to manage, and the prognosis after this type of injury is particularly poor. The author has approached this problem with precise and anatomic restoration of the height and width of the calcaneus with open reduction and internal fixation followed by primary subtalar arthrodesis. The surgical technique of primary arthrodesis is complex and is described in detail. The rate of arthrodesis and return of function is surprisingly good given the magnitude of comminution present and has given us renewed hope that these injuries should not be abandoned to later salvage attempts at reconstruction.
Arthrodesis↗
[Results of plate osteosynthesis in comminuted fracture of the olecranon].
Comminuted fractures of the olecranon are an absolute indication for operative treatment. Adequate therapy is only possible when open reduction and plating are performed. In the last 20 years, 31 of our patients, i.e. 0.0001% of all patients treated for injuries, had this type of olecranon fracture, and in 25 follow-up examination was possible. The fracture type was classified according to the ASIF system. The range of motion, i.e., extension, flexion, pro- and supination, and pain, physical strength and rehabilitation were classified according to our own system. In cases with concomitant fracture of the radial head, reconstruction is necessary to provide adequate axial movement and strength in the forearm. Brief plaster fixation after the operation makes it possible to restrict the development of ankylosis in the elbow joint. The results were excellent in 10 patients, good in 5 patients, fair in 4 and poor in 6 patients. In 3 patients, i.e. 10% ankylosis was present in the elbow joint; this was considered to constitute an indication for arthroplasty, which gave a better postoperative range of motion.
Adult↗
Stabilization of comminuted fractures of the distal inch of the radius: percutaneous pinning.
Comminuted fractures of the distal inch of the radius have always been difficult to stabilize. Closed reduction and plaster cast fixation frequently result in recurring deformity and some loss of wrist function. A method of closed pinning with proper placement of multiple small Kirschner wires to supplement plaster cast fixation in selected comminuted fractures helps retain anatomical position of the major fragments of the distal end of the radius. This method is sound in principle and we recommend its use in the treatment of severly comminuted fractures of the distal end of the radius.
Adolescent↗
Comminuted fractures of the proximal radius and ulna.
Forty-three comminuted fractures of the proximal radius and ulna in 34 patients were treated with operative stabilization using AO/ASIF techniques. The patients were divided into three groups, according to the type of injury: Group I, isolated comminuted fractures of the olecranon (18 patients); Group II, isolated fractures of the radial head (eight patients); Group III, combined olecranon and radial head fractures (eight patients). All fractures were followed until union. The average follow-up period was 18 months (range, 12-48 months). At the time of this review, the average limits of elbow motion were 20 degrees extension, 118 degrees flexion, 65 degrees pronation, and 62 degrees supination. Two patients were unable to return for follow-up examination. Using the functional classification of Broberg and Morrey, results were rated as excellent in nine cases, good in 15, fair in five, and poor in three. The complication rate in this series was 19%: Two patients developed nonunion, and one patient lost reduction during rehabilitation. All of these patients required reoperation, with eventual satisfactory outcome. Three patients developed heterotopic ossification, two of which were minor and one of which produced ankylosis of the elbow joint. Each of these patients had delayed (more than 72 hours postinjury) stabilization. A functional elbow was achieved in 29 of the 32 patients who returned for follow-up examination. Operative stabilization of comminuted fractures of the proximal radius and ulna provides a stable painless joint with a functional, but not full, range of motion.
Adolescent↗
[Treatment of comminuted fractures of the lower end of the radius with internal osteosynthesis, traction and early mobilization].
Goals for treatment of comminutive fractures of the distal radius include restoration of the articular profile of the proximal part of the joint, while axial loading forces must be avoided as much as possible to prevent secondary displacement. The choice of an internal fixation protected by an external wrist distractor-fixator, with early activo-passive mobilisation, seems to achieve the goal. Twelve patients with a comminuted fracture of the distal radius, including axial articular impigment displacement were reviewed for this study. All fractures were Frykman's type III, IV, VII or VIII. Distraction was done with a specific external apparatus, allowing an internal fixation, using an anterior plate and posterior Kirschner wires for the more complex cases. Distraction was released at the end of the surgical procedure, while the distractor was left in place. The wrist was mobilised early in the post-operative period, and the distractor was removed two months later. At a mean follow-up of 8.5 months, two patients were still painful. Mean motion of the wrist joint was 115 degrees for flexion-extension and 35 degrees for radio-ulnar deviation. Radiological results were good (10 cases), in both planes sagittal and frontal, and stable with time. The radio-ulnar index was correct in 11 cases. Only two cases of Sudeck's atrophy were noted. Authors use a specific external wrist distractor to obtain and maintain reduction in comminuted fractures of the distal end of the radius, using internal fixation in combination. Early motion of the wrist, protected by the wrist distractor seems to lower rates of Sudeck's atrophy.
Biomechanical Phenomena↗
Comminuted fractures of the radial head. Arthroplasty versus internal fixation.
Fractures of the radial head continue to challenge orthopaedic surgeons. Fortunately, most simple uncomplicated fractures treated non-operatively with emphasis on early motion achieve good results. Treatment of more complex fractures remains controversial, however. When simple radial head excision is contraindicated, choosing between open reduction and internal fixation and radial head replacement remains difficult. A review of the literature does not provide definite guidelines, but suggest that fracture complexity and technique are critical for success. This paper is not intended to review the treatment of radial head fractures, but rather to focus on choosing between replacement versus internal fixation when preservation of radial head mechanics is indicated.
Arthroplasty↗
Ligamentotaxis and bone grafting for comminuted fractures of the distal radius.
The conventional treatment of comminuted fractures in the distal radius has been unsatisfactory. We therefore made a prospective study using the principle of ligamentotoxis and primary cancellous bone grafting as the uniform method of treatment. Ligamentotaxis was maintained by using an external fixator for three weeks only, after which a carefully monitored programme of rehabilitation was given. We have reviewed 72 consecutive distal radial fractures after a follow-up of 7 to 40 months (average 11 months). Reduction had been maintained during healing and over 80% of patients regained full range of movement in hands, wrists and forearms with strong and pain-free wrist function. Complications were infrequent and gave no real problems. We conclude that distraction, external fixation and bone grafting appears to be an excellent method of treating comminuted fractures of the distal radius.
Adolescent↗
The value of computed tomography in the early assessment of comminuted fractures of the calcaneus: a review of three patients.
Computed tomography (CT) was performed within 4-8 days of injury in three patients with five fractures of the calcaneus. Three of the fractures were comminuted, and CT gave graphic additional information to the plain radiographs. Three fractures were undisplaced and were managed conservatively. In the other two, there was displacement of bony fragments, and these were treated operatively. In these, CT gave valuable preoperative information regarding the size and location of fracture fragments and helped the surgeon determine the site of incision and type of surgery required. The CT findings were confirmed at operation. CT therefore provides useful information for the management of these difficult fractures.
Adolescent↗
Plaster cast versus percutaneous pin fixation for comminuted fractures of the distal radius in patients between 46 and 65 years of age.
OBJECTIVE: To compare the results of treating unstable distal radius fractures either by percutaneous pinning and casting, or by traditional closed reduction and casting. DESIGN: Prospective, randomized. SETTING: University hospital. PATIENTS: Forty patients with unstable Frykmann III-VIII distal radius fractures resulting from a fall. INTERVENTIONS: Twenty patients were treated with closed reduction, consisting of manipulation, under local anesthesia, followed by casting. Twenty patients were treated with percutaneous fixation using K-wires, followed by casting. MAIN OUTCOME MEASUREMENTS: Initial displacement, quality of reduction, carpal malalignment, articular step-off. Range of motion and grip strength were measured using a scoring system reported by Home et al. (10). RESULTS: Functional results in the pinning group were better (excellent, 12; good, 6; fair, 2) than in the plaster group (excellent, 3; good, 8; fair, 5; poor, 4). Anatomic results also were better in the pinning group. CONCLUSION: The best anatomic and functional results were obtained by percutaneous pinning. Although the cost of pins and plaster treatment is significantly greater than plaster treatment, the author believes that the positive end result justifies the cost.
Aged↗
[Modular construction (2 HS-1 SH), using Cotrel-Dubousset's universal instrumentation for comminuted fractures of the thoracolumbar junction. Comparison with various other constructions].
INTRODUCTION: The authors' objective was to study the anatomical and functional results of an original construct using the Cotrel-Dubousset instrumentation. MATERIAL AND METHODS: This construct is called "Modular construct" or "2 H.S.-1 S.H." fits up two vertebrae above the fracture and a single below. So if the fracture is situated on the L1 level, a supra-laminar hook is set up on each side of T11, and two pedicular screws in T12 (2 H.S.). In the same way, a pedicular screw and an infra-laminar hook are set up on each side of L2 (1.S.H.). Two transverse bars connect together the right and the left rod. This retrospective work is based on the study of 24 patients who had a Thoraco-lumbar burst fracture according to Denis'classification, who were operated on in our Department, and started again to walk without external contention. All the patients had a postero-lateral bone graft. There were no [corrected] anterior arthrodesis performed. The average follow up was 4 years. This series was compared with a concomitant series of miscellaneous constructs realized by the same operators with the C.D. instrumentation. RESULTS: The average regional kyphosis angles went from 16.9 degrees in pre-operative to 3.9 degrees in post-operative, and 8 degrees at the maximum follow up. The average vertebral kyphosis angles went from 18 degrees in pre-operative to 3.8 degrees in post-operative, and 6.3 degrees at the maximum follow up. The miscellaneous constructs had poorer results. There were two severe infections, one early the other late. DISCUSSION: These results compared with the literature show that the 2 H.S.-1 S.H. construct is a competitive one. We think that its mechanical qualities arise from adding systematically hooks at the ends of the construct. These hooks protect the screws during flexion and from pull out constraints.
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Non-operative treatment of comminuted fractures of the proximal humerus in elderly patients.
The purpose of this retrospective study was to assess the clinical and radiographical results of non-operative treatment of displaced multifragmental fractures of the proximal humerus with a minimum follow-up of 10 years. Fifteen patients (one man, 14 women) with 17 injured shoulders were examined. The Neer classification system was used to classify the fractures, and the functional outcome was assessed using the Constant score. At the 10 year review, the mean Constant score for the patients in the three-part fracture group was 59, and 47 in the four-part fracture group. The range of motion was satisfactory with a mean flexion and abduction over 90 degrees. Only four patients reported pain and it was graded as mild. In spite of low functional scoring and poor fracture reduction in many shoulders, the patient's contentment with their injured shoulder after 10 years with high. Radiographical examination revealed severe osteoarthrosis in one shoulder, and humeral head osteonecrosis in two shoulders. Results from this study suggests that non-operative treatment of displaced three-part fractures of the proximal humerus should be considered.
Activities of Daily Living↗
Bridge plating osteosynthesis of 20 comminuted fractures of the femur.
We retrospectively studied the outcome of 20 comminuted fractures (20 patients, 15 men) of the femur treated in accordance with the principles of indirect reduction and biological osteosynthesis technique. The patients were followed for mean 1.5 (1-4.5) years. 11 fractures were subtrochanteric (type C), 6 complex diaphyseal and the remaining 3 were supracondylar (2 type C3 and 1 type A3); 3 fractures were open (type I, II, IIIA). Subtrochanteric fractures were treated with either 95 degrees dynamic condylar screw (DCS; 5 fractures) or with 135 degrees dynamic hip screw (DHS; 6 fractures). Autocompression plates (ACP) implants were chosen for diaphyseal fractures in 4 fractures, and a limited contact dynamic compression plate (LC/DCP) implant in 2. The 3 supracondylar fractures were treated with a 95 degrees DCS implant (1 fracture) and the Condylar Buttress Plate (2 fractures). 11 fractures were bone grafted. There were no immediate postoperative complications. All fractures united on an average of 5 months, irrespective of use of bone grafts. Late complications consisted of mild knee stiffness (4 patients) and 1-2 cm shortening (4 patients).
Adolescent↗
Double-plate fixation of comminuted fractures of the second phalanx in horses: 10 cases (1985-1993).
OBJECTIVE: To determine the technique used, and the outcome for, double-plate fixation of comminuted fractures of the second phalanx of horses. DESIGN: Retrospective analysis of medical records. ANIMALS: 10 horses with comminuted fractures of the second phalanx that were treated by use of double-plate fixation. PROCEDURE: Two 4- to 6-hole dynamic compression plates were abaxially placed to achieve arthrodesis of the proximal interphalangeal joint and fixation of the fracture of the second phalanx. RESULTS: Arthrodesis and fracture healing were detected in all horses. CLINICAL IMPLICATIONS: Horses with comminuted fractures of the second phalanx that are treated with double-plate fixation have an excellent prognosis for survival and use as broodstock, and have an increased potential for return to useful function.
Animals↗
Comminuted fractures of the femoral shaft treated by intramedullary nailing.
We evaluated 245 cases of comminuted femoral fractures treated by intramedullary nailing and graded them by fracture pattern and degree of stability as segmental fractures, and grade I, grade II, grade III, and grade IV comminuted fractures. The infection rate was 0.4 per cent, and the nonunion rate was 0.8 per cent. Shortening of more than 2 cm. was seen in seven cases (3 per cent), and malrotation of more than 20 degrees was noted in four cases (1.7 per cent). These more common problems of shortening and rotation were almost eliminated by the increased use of cerclage wire and postoperative traction and spica casts. Knee range of motion averaged 128 degrees. These fractures provide interesting and difficult challenges. Intramedullary nailing of the segmental fractures is technically demanding but offers excellent results in these otherwise difficult fractures. Patients with grade I and grade II comminuted fractures do well with intramedullary nailing and the bones remain stable. Grade III and grade IV comminuted fractures are unstable and pose the risk of shortening and rotation. Therefore, to gain anatomic restoration in a young person we believe that it is reasonable to perform an open reduction and cerclage wiring of these fractures. The postoperative treatment of the comminuted femoral fracture is determined by both fracture stability and patient reliability, and frequent roentgenograms are indicated. Most importantly, the surgeon should be prepared to apply whatever form of treatment he believes to be necessary to gain optimal results in each individual.
Adolescent↗