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[Osteosynthesis of crural bone fractures using bone plates with pegs].

A metal plate with pegs for osteosynthesis was designed and introduced into practice for the treatment of diaphyseal fractures of the leg bones. Studies for appraising the tension-deformity condition proved that installation of 20 cone-shaped pegs on the inner surface of the plate increases the stability of fixation 3.6-fold. Besides, the cone-shaped pegs facilitate maintenance of intactness of the vessels of the periosteum and soft tissues as a result of which the conditions for healing of the fractures improve. Operations were carried out on 43 patients, in 41 with good outcomes. External immobilization was not applied in the postoperative period, early restorative treatment was conducted.

Adolescent

The effect of haemorrhage and bone fracture on bone marrow circulation.

Blood flow was measured in the bone marrow and trabecular bone of the dog using 133Xe and hydrogen clearance technique. Estimated from hydrogen wash-out curves, flow in the marrow of the femoral diaphysis was 0.207 ml.min(-1).g(-1), in the marrow of the humerus 0.123ml.min(-1).g(-1) and in the trabecular bone of femoral metaphysis 0.173ml.min(-1).g(-1). Haemorrhagic hypotension and fracture reduced the medullary flow. After haemorrhage an exponential relationship was found between blood pressure and effective bone marrow and muscle blood flow. The correlation between systemic arterial and intramedullary pressures was found to be exponential and between intramedullary pressure and flow linear.

Animals

Air in the temporomandibular joint fossa: CT sign of temporal bone fracture.

Temporal bone fractures can be difficult to detect clinically and radiographically. Air is sometimes present in the glenoid fossa of the temporomandibular joint (TMJ) at computed tomography (CT) of acute basilar skull fractures. This study evaluated TMJ fossa air as a sign of temporal bone fracture. Initial CT scans of the head in 114 patients with a diagnosis of basilar skull fracture at discharge were retrospectively reviewed. TMJ fossa air was present in 23 of 114 patients (20.2%) and was bilateral in three patients. Only temporal bone fractures were significantly (P less than .001) associated with TMJ fossa air. Temporal bone fractures were observed at CT in 23 of 26 cases of TMJ fossa air, but in three of 26 cases, TMJ fossa air was the only CT sign of clinically apparent temporal bone fractures. TMJ fossa air is associated with acute temporal bone fracture and may be the only CT sign of an otherwise inconspicuous temporal bone fracture.

Adolescent

[The biology of bones and of bone fracture healing].

For the treatment of fractures several systems are available. Biological and biomechanical aspects have to be considered in order to obtain an optimal final result. The vascular supply of the intact and of the fractured bone is reviewed. The role of the fracture hematoma with a low pO2 and a pH below the physiological range are discussed. In bone remodelling tension forces and cyclic loading are important factors in resorption and regeneration. The influence of the periosteum in bone healing after internal fixation is described.

Bone Regeneration

Temporal bone fractures: longitudinal or oblique? The case for oblique temporal bone fractures.

Classical descriptions and illustrations of temporal bone fractures are misleading. Both oblique and longitudinal fractures produce a similar fracture line in the middle cranial fossa; however, externally, they are different. Oblique fractures cross the petrotympanic fissure while longitudinal fractures run within it. In a study of 150 temporal bone fractures, the majority were oblique. An array of fracture planes accounts for most of the fractures observed. Depending on the direction of trauma, fracture planes rotate around an anteroposterior axis. When they approach the horizontal (axial) plane, they result in oblique fractures. True longitudinal fractures are rare. They are vertical and perpendicular to the oblique planes.

Adolescent

[The healing of bone fractures in rats during the readaptation after a 14-day head-down suspension].

Histological, histochemical and histomorphometric methods have been used to study an effect of a 14-day head-down suspension on healing the fractured fibular diaphysis in the rats traumatized immediately after suspension. The study of the fibulae on Days 11 and 17 following an operative fracture indicated that both in control and experimental rats the ends of fractured bones were tightly interconnected by the calluses. A comparative study of the calluses and their structural components as well as detailed investigation of histological structure of calluses on the 11th and 17th post-traumatic days did not reveal significant differences between control and experimental animals. Furthermore, the rate of cartilage replacement by spongy bone tissue in calluses of experimental animals was even somewhat higher than that in control rats. Thus the data obtained give ground to believe that in a readaptation period after 14-day suspension resulting in the osteoporotic changes of weight-bearing bones a repair process in the bones is rapidly normalized and in some parameters exceeds it in control animals.

Adaptation, Physiological

Temporal bone fractures.

Temporal bone fractures represent a frequent source of morbidity and are often associated with fatal injuries in the head trauma patient. The initial care of these patients may be the responsibility of the emergency room physician or the neurosurgeon. The treatment of temporal bone fractures is often postponed because more pressing injuries may exist. However, it should be stressed that an otolaryngologist be consulted as soon as feasible because future rehabilitation is dependent on the initial examination.

Humans

[An experimental study on the effects of the plating method for bone fractures--with reference to bone union and bone strength (author's transl)].

The plating method for bone fractures is in wide use. The author studied both new bone formation and bone atrophy of the cortex of fracture site after long periods of plating. This study is concerned with the bone strength of the fracture site as influenced by rigid plate fixation, and also with bone union after the removal of the plate. The experimental results, using mature rabbits as subjects, showed the following: X-rays of the bone union at the fracture site treated by the plating method confirmed evident union at 8 weeks after surgery. The bone strength at the region of this union, as tested by the bending method (an Instron Type Testing Machine was used), showed its highest values at 28 weeks after surgery. Yet, this was only 60% of the bone strength as measured at a non-fracture site; it then gradually declined in strength. On the other hand, in the case where the plate had been removed 8 weeks after surgery, bone strength was recovered to the same level as that of non-fracture sites 16 weeks after surgery. In conclusion, rigid plate fixation for a long period may result not only in progressive bone atrophy of the cortex but also in a delayed remodeling of the bone at the region of the bone union. It is, therefore, very important to remove the plate as early as possible once union has been achieved. Careful observation, however, is necessary during the short time between plate removal and the period when bone strength becomes again normal.

Animals

Changes in connective tissue metabolism due to bone fractures in children aged 10--14 years. III. Urinary hydroxyproline and glycosaminoglycan excretion following bone fractures treated in different ways.

Urinary hydroxyproline and glycosaminoglycan excretion was studied in the course of fracture healing in twenty 10--14-year-old children with fracture of the femur or of the tibia and fibula. In 11 children reduction and plaster cast were used, in 5 osteosynthesis, and in 4 extension of 6--21 days duration combined with immobilization by plaster cast. In the state of resorption, an increase was observed in the urinary excretion of hydroxyproline and total glycosaminoglycans and in the six glycosaminoglycan fractions studied. As a result of the soft tissue damage accompanying the fracture, the excretion of hyaluronic acid, heparan sulphate, and dermatan sulphate showed the most marked increase. No statistically significant relationship could be demonstrated between the mode of treatment and the amounts of urinary hydroxyproline and glycosaminoglycan, but the stage of resorption was prolonged in the case of treatment with traction. At the beginning of regeneration, a decrease in hydroxyproline excretion and then an increase corresponding to the intensive synthesis of collagen were demonstrated. Glycosaminoglycan excretion during the development of fibrous callus was considerably below the control value. Excretion of the metabolites decreased markedly in the five operated patients. in the case of extension, the stage of regeneration prolonged by 4 to 10 days. In the stage of calcification, urinary hydroxyproline excretion was increased while the excretion of glycosaminoglycan and its fractions was the same as in the controls except in the patients treated with traction. No statistically significant relationship was found between the urinary amounts of hydroxyproline and glycosaminoglycan and the mode of treatment. In the case of traction, fracture repair and the formation of connective tissue callus were prolonged.

Adolescent

Floating petrous bone fracture.

Floating petrous bone fracture appears to occur when the elastic pediatric skull is subjected to large compressive forces. Unlike a longitudinal fracture, a floating petrous bone fracture does not involve the ear canal and squamous cortex. Rather, the fracture line runs through the middle ear, separating the petrous apex from its lateral and inferior bony attachments. Characteristic clinical findings include immediate onset of conductive hearing loss, with ipsilateral sixth and seventh cranial nerve paralysis. This article details the third known occurrence of this type of fracture, and includes a discussion of the pathophysiologic mechanism and treatment rationale.

Child

Strain rate dependence of the mechanical properties of reindeer antler and the cumulative damage model of bone fracture.

Carter and Caler have produced a 'cumulative damage' model for the fracture of bone, based on creep experiments on human bone, which has been corroborated by monotonic tensile tests on bone, loaded at various strain rates. Monotonic tensile tests on reindeer's antler, which has a lower modulus of elasticity than human bone, produce very similar results. Unlike human bone, reindeer antler always shows a large post-yield strain, and it is possible to distinguish pre-yield and post-yield behaviour. The 'final stiffness' (ultimate stress/ultimate strain) is invariant with strain rate. This is confirmation that bone fractures when a certain amount of damage has accumulated. However, reindeer antler shows a considerable post-yield increase in stress. This is difficult to accommodate in a cumulative damage model.

Animals

[Pathologic bone fractures: definition and classification].

A bone fracture is a complete or incomplete discontinuity of bone caused by a direct or indirect force. A pathological bone fracture is a bone fracture which occurs without adequate trauma and is caused by a preexistent pathological bone lesion. Causes include resorption of bone mass (osteoporosis), reduction of bone quality (osteomalacia, osteonecrosis), insufficient bone production (osteogenesis imperfecta, fibrous dysplasia), augmented bone resorption (giant cell granulomas, aneurysmal bone cyst), pathological bone remodelling (Paget's disease), or local bone destruction due to tumorous growths. A pathological bone fracture has to be detected clinically as well as radiologically and its cause diagnosed histologically in order to ensure adequate therapy.

Bone and Bones

Use of the dynamic compression plate for treatment of equine long-bone fractures.

Long-bone fractures of 6 foals admitted consecutively to the Ohio State University Veterinary Hospital were treated successfully with ASIF dynamic compression plating. The cases included 2 foals with closed fracture of the metacarpus, and 1 foal each with open nonunion of the metatarsus, closed fracture of the radius, open fracture of the tibia, and open fracture of the ulna. Five of these foals became sound, with no deformity, so they could be trained for racing or showing. The 6th foal, a filly with nonunion, became "pasture-sound" and was scheduled for breeding. It was concluded that the dynamic compression plates have many advantages over conventional ASIF plates. These advantages include: the plates can be put near the end of bones; screws can be put at an angle other than 90 degrees to the plate; cancellous screws can be used in any hole; plates can be shaped and the screw heads will still fit the holes; less exposure is required; and operating time is shorter.

Animals

Distribution of physeal and nonphyseal fractures in 2,650 long-bone fractures in children aged 0-16 years.

The distribution of 2,650 long-bone fractures in children is presented. Fractures involving the humerus, radius, ulna, femur, tibia, and fibula were classified according to Salter and Harris. Growth plate injuries accounted for 30% of fractures. Nonphyseal fractures occurred twice as often in the upper extremity as in the lower extremity. Girls with physeal fractures on the average were 1.5 years younger than boys with the same type of fracture in the same location.

Adolescent

[Bioabsorbable poly(L-lactide) osteosynthesis plates and screws for the fixation of zygomatic bone fractures].

Ten unstable zygomatic bone fractures were treated with osteosynthesis plates and screws made of bioabsorbable poly(l-lactide) (PLLA). This study has shown that our PLLA plates and screws guarantee stable osteosynthesis of zygomatic bone fractures for an adequate period of time and allow undisturbed healing of the fracture. Bioabsorption takes more or less 18 months. Thus, a second operation for removal of the osteosynthesis material is avoided.

Biodegradation, Environmental

Bilateral longitudinal temporal bone fractures: a retrospective review of seventeen cases.

The types of temporal bone fractures, longitudinal and transverse, are reviewed. All cases of bilateral temporal bone fractures at Parkland Memorial Hospital in Dallas over a 10-year period from 1968 to 1978 are reivewed and discussed by the authors. One hundred sixty patients with the diagnosis of base of skull fractures were studied. Fifty-nine of these were temporal bone fractures and 17 of the 59 were bilateral. Of all the base of skull fractures, 10% were bilateral temporal bone fractures and 29% of all temporal bone fractures were bilateral. For each case the method of injury, the extent of damage to hearing and facial nerve function, presence of CSF otorrhea, X-ray findings, and additional complications are summarized and the results discussed. The operative findings of facial nerve decompressions are carefully reviewed. The authors' method of caring for temporal bone fractures is presented.

Facial Paralysis

Role of natural frequency of bone as a guide for detection of bone fracture healing.

The natural frequency of bone is studied in normal and fractured bones, in vitro as well as in vivo, by recording the outputs of microphone pick-ups, attached at proximal and distal ends to the bone defect. Natural frequency of bone is determined for an optimum output displayed on a cathode ray oscilloscope with respect to different stress wave frequencies. A comparative study of normal and fractured bone in vivo in 25 patients was made to diagnose the size of the fracture and its rate of healing. The natural frequency and intensity of sound in the injured bone was reduced while the output voltage increased with respect to the normal bone. The investigation reports a simple, reliable and rapid technique for the assessment of bone fracture.

Animals

[Diagnosis of carpal bone fractures].

The diagnosis of carpal bone fractures has been facilitated by new radiological projections and by the advent of modern imaging methods. Fractures of the scaphoid bone still account for 75% of carpal fractures with their complications (pseudarthrosis, malunion) and their sequelae of arthrosis. However, the frequency of other fractures appears to be increasing due to a better knowledge of their mechanism and to the possibilities of the new imaging methods.

Carpal Bones