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Fractures of the shaft of the ulna are described and a simple classification is proposed. Statistics are analysed in respect of mode of treatment and time of healing, and the unique mechanism of direct trauma is discussed. This survey showed that operative treatment has no place whatsoever in the treatment of these fractures.
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A 3 1/2-year-old white girl with neurofibromatosis sustained left radius and ulna fractures. The radius was sclerotic with no medullary canal at the fracture site, and the ulna was hypoplastic distal to the fracture. The fractures failed to unite when immobilized in a long arm plaster cast for 5 months and pseudarthrosis developed. Three subsequent operative attempts to obtain union of the pseudarthrosis by means of internal fixation and bone grafting over the next 30 months were also unsuccessful, and the pseudarthrosis persisted. The forearm was supported in a custom molded leather brace until the child was 13 1/2 years old and had reached skeletal maturity. Osseous union was then operatively obtained using dual onlay tibial cortical and cancellous bone grafts. There has been no recurrence of the pseudarthrosis 3 years and 2 months after bone grafting. The author recommends postponing surgical attempts to achieve union of the forearm bone pseudarthrosis associated with neurofibromatosis until the patient reaches skeletal maturity.
Fractures that can be successfully treated in the office are, in general, those that can be definitively diagnosed, have little or no displacement or can be adequately reduced through closed manipulation with use of local or regional anesthesia, and involve areas that can be securely immobilized for the period needed to achieve healing. X-ray films should be made before any treatment is given and again soon after immobilization to check on the status of reduction, if this was done, or on alignment, if the fracture did not require reduction. After the fracture has healed and the immobilizing device has been removed, convalescence is not considered complete until maximal function of the affected part has been regained. To this end, a vigorous program of reconditioning should be instituted.
Bone status and fracture rates were evaluated in two Yugoslav populations with very different dietary habits. In district A (Podravina) the daily calcium intake was about twice that in district B (Istra). There were similar but smaller differences in the intakes of other nutrients. In district B metacarpal cortical width was reduced in all age groups of both sexes but the difference tended to decrease with age. The proximal femur fracture rate was higher in district B than district A but there was no difference between the forearm fracture rates in the two districts. Our results confirm that bone mass at any age is clearly the result of age and sex and most probably other genetically determined factors but also show that this expression is nutrition related. The data suggest that nutrition (in particular the calcium intake) is an important determinant of bone mass in young adults but seems to have little effect on age-related bone loss in either males or females. The main determinant of cortical bone mass in the elderly seems to be the cortical bone mass in middle life. The proximal femur fractures of old people reflect declining cortical bone mass but the distal forearm fractures of middle-aged women are unrelated to cortical bone mass or nutritional status.
Sixty-two cases of pathologic fractures occurring in 53 patients treated at Scott and White Memorial Hospital from 1966 to 1976 are reviewed and analyzed with regard to type of neoplastic lesion, location, mode of therapy initiated, functional stability of therapy selected, and average length of survival after orthopedic procedure. Pertinent literature is reviewed, and our results are compared with those of other series.
Acute bowing of the bones of the forearm in children following trauma has only recently been recognized as a clinical and radiographic entity. This type of injury has been overlooked in the past because of lack of familiarity with the mechanical properties of curved tubular bones. Absence of a fracture line and the usual findings associated with a healing fracture on radiographs has contributed to the lack of recognition of this condition. The mechanism of injury, clinical and radiographic findings, clinical implications, and classification of these elusive childhood fractures are discussed on the basis of a study of 13 children.
The clinical, laboratory, and radiologic picture of a unique patient with symmetrical fractures of the anterior tibial midshafts, dorsal ulnar cortices, and lateral metatarsals is presented. The findings are not compatible with a diagnosis of osteogenesis imperfecta or osteomalacia despite osseous fragility. The elevated serum pyrophosphate and low urine phosphate content suggest that abnormalities in phosphate metabolism may have contributed to the formation of bone which is biochemically and structurally deficient.
The effect of residual fracture angulation on the distal radial and ulnar epiphyseal plates was studied in children aged 1 to 15 years. Thirty-eight fractures located in the distal fifth of the forearm bones were observed for 1 to 25 months after the fractures had healed. The forearms were examined radiographically on two to five occasions and the inclinations of the epiphyseal plates in relation to the long axis of the proximal fragments were measured. The results showed that an abnormal inclination of the epiphyseal plate after healing of a distal forearm fracture induced an alteration of growth in the epiphyseal plate. The redistribution of growth tended to correct the abnormal inclination. The rate of correction followed an exponential course. The age of the child at the time of the fracture and the distance from the fracture to the epiphyseal plate did not influence the capacity for correction.
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In the operative treatment of fractures there are special principles for plating by support. Osteosynthesis is indicated for comminnuted fractures and bone defects in the metaphysis. Plating for distance also is established for fractures and pseudarthroses with defects in the diaphysis. This method is especially recommended for fractures of the head of the tibia and for reconstructing the pilon tibial.
The serious complications following fractures in the region of the elbow joint are frequently avoidable by selection of adequate methods of treatment. The advantages of operative in comparison with semi-conservative methods of treatment are presented here in relation to our own patients.
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Explore the source record for details and available documents.