WorldWideScience

Sample records for bone fractures

  1. Fractures (Broken Bones): First Aid

    Science.gov (United States)

    First aid Fractures (broken bones) Fractures (broken bones): First aid By Mayo Clinic Staff A fracture is a ... 10, 2018 Original article: http://www.mayoclinic.org/first-aid/first-aid-fractures/basics/ART-20056641 . Mayo Clinic ...

  2. Stress fractures and bone pain

    International Nuclear Information System (INIS)

    Groshar, D.; Even-Sapir, E.; Lam, M.; Israel, O.; Front, D.

    1984-01-01

    Stress fractures result from an unusual repetitive physical activity causing absorption of bone in excess of repair and bone formation. This leads to the weakening of the bone and subsequently to a fracture. It is a benign condition that if recognized in time does not need any treatment besides rest. However, if diagnosis is not made and physical activity continues it may result in severe injury to the bone and a frank fracture may result. Pain is the typical clinical feature and bone scintigraphy, being more sensitive than radiography, is done to establish early diagnosis. The presence of asymptomatic sites of abnormal bone uptake typical of stress fracture in which pain appeared only about 2 weeks after scintigraphy, drew the authors' attention to the question of how close is the relationship between stress fractures and bone pain. Sixty-four military recruits diagnosed as suffering from stress fracture were investigated in order to correlate sites with abnormal uptake of Tc-99m MDP on bone scintigraphy with sites of local pain. In 37 (58%) subjects multiple sites of abnormal uptake were recognised. Of 123 sites of abnormal uptake, 31 (25%) were asymptomatic. In three patients bone pain appeared at the site of the abnormal uptake two weeks after scintigraphy. Bone scintigraphy appears to be more sensitive than bone pain in the diagnosis of stress fractures. The osteoblastic activity which manifests itself by abnormal uptake appears in some cases earlier than the pain caused by the fracture. Present findings may suggest that under certain circumstances, in a population prone to stress fracture, bone scan should be considered as a screening method

  3. Treatment of Temporal Bone Fractures

    Science.gov (United States)

    Diaz, Rodney C.; Cervenka, Brian; Brodie, Hilary A.

    2016-01-01

    Traumatic injury to the temporal bone can lead to significant morbidity or mortality and knowledge of the pertinent anatomy, pathophysiology of injury, and appropriate management strategies is critical for successful recovery and rehabilitation of such injured patients. Most temporal bone fractures are caused by motor vehicle accidents. Temporal bone fractures are best classified as either otic capsule sparing or otic capsule disrupting-type fractures, as such classification correlates well with risk of concomitant functional complications. The most common complications of temporal bone fractures are facial nerve injury, cerebrospinal fluid (CSF) leak, and hearing loss. Assessment of facial nerve function as soon as possible following injury greatly facilitates clinical decision making. Use of prophylactic antibiotics in the setting of CSF leak is controversial; however, following critical analysis and interpretation of the existing classic and contemporary literature, we believe its use is absolutely warranted. PMID:27648399

  4. Image diagnosis of nasal bone fracture

    International Nuclear Information System (INIS)

    Hirota, Yoshiharu; Shimizu, Yayoi; Iinuma, Toshitaka.

    1988-01-01

    Twenty cases of nasal bone fractures were evaluated as to the types of fractures based upon HRCT findings. Conventional X-Ray films for nasal bones were analyzed and compared with HRCT findings. Nasal bone fractures were classified into lateral and frontal fractures. HRCT images were evaluated in three planes including upper, middle and lower portions of the nasal bone. Fractures favored males of teens. Lateral fracture gave rise to the fractures of the nasal bone opposite to the external force, loosening of the ipsilateral nasomaxillary sutures and fractures of the frontal process of the maxilla. Conventional X-Ray films were reevaluated after HRCT evaluation and indications of nasal bone fractures were determined. In addition to the discontinuity of the nasal dorsum, fracture lines parallel to and beneath the nasal dorsum and indistinct fracture lines along the nasomaxillary sutures are the indication of nasal bone fractures by conventional X-Ray films. (author)

  5. The healing of fractured bones

    Energy Technology Data Exchange (ETDEWEB)

    Bacon, G.E. [Central Electricity Generating Board, Cheltenham (United Kingdom)

    1997-04-01

    A method utilising neutron beams of width 1 mm, used on D1B (2.4 A) and D20 (1.3 A) to study the healing of fractured bones is presented. It is found that the callus bone uniting the fractured tibia of a sheep, whose healing had been encouraged by daily mechanical vibration over a period of three months, showed no trace of the large preferential vertical orientation of the apatite crystals which is characteristic of the normal bone. Nevertheless the bone had regained about 60% of its mechanical strength and the callus bone, although not oriented, was well crystallized. It is considered that the new monochromator for D20, expected to give increased intensity at 2.5 A, will be of considerable advantage. (author). 2 refs.

  6. Fracture healing in osteoporotic bone.

    Science.gov (United States)

    Cheung, Wing Hoi; Miclau, Theodore; Chow, Simon Kwoon-Ho; Yang, Frank F; Alt, Volker

    2016-06-01

    As the world population rises, osteoporotic fracture is an emerging global threat to the well-being of elderly patients. The process of fracture healing by intramembranous ossification or/and endochondral ossification involve many well-orchestrated events including the signaling, recruitment and differentiation of mesenchymal stem cells (MSCs) during the early phase; formation of a hard callus and extracellular matrix, angiogenesis and revascularization during the mid-phase; and finally callus remodeling at the late phase of fracture healing. Through clinical and animal research, many of these factors are shown to be impaired in osteoporotic bone. Animal studies related to post-menopausal estrogen deficient osteoporosis (type I) have shown healing to be prolonged with decreased levels of MSCs and decreased levels of angiogenesis. Moreover, the expression of estrogen receptor (ER) was shown to be delayed in ovariectomy-induced osteoporotic fracture. This might be related to the observed difference in mechanical sensitivity between normal and osteoporotic bones, which requires further experiments to elucidate. In mice fracture models related to senile osteoporosis (type II), it was observed that chondrocyte and osteoblast differentiation were impaired; and that transplantation of juvenile bone marrow would result in enhanced callus formation. Other factors related to angiogenesis and vasculogenesis have also been noted to be impaired in aged models, affecting the degradation of cartilaginous matrixes and vascular invasion; the result is changes in matrix composition and growth factors concentrations that ultimately impairs healing during age-related osteoporosis. Most osteoporotic related fractures occur at metaphyseal sites clinically, and reports have indicated that differences exist between diaphyseal and metaphyseal fractures. An animal model that satisfies three main criteria (metaphyseal region, plate fixation, osteoporosis) is suggested for future research for

  7. Bone fractures: assessment and management.

    Science.gov (United States)

    Lim, L; Sirichai, P

    2016-03-01

    Severe dental traumatic injuries often involve the supporting bone and soft tissues. This article outlines the current concepts in the management of dentoalveolar fractures for the general dental practitioner with case reports to illustrate management principles and techniques. © 2016 Australian Dental Association.

  8. A Rare Nasal Bone Fracture: Anterior Nasal Spine Fracture

    Directory of Open Access Journals (Sweden)

    Egemen Kucuk

    2014-04-01

    Full Text Available Anterior nasal spine fractures are a quite rare type of nasal bone fractures. Associated cervical spine injuries are more dangerous than the nasal bone fracture. A case of the anterior nasal spine fracture, in a 18-year-old male was presented. Fracture of the anterior nasal spine, should be considered in the differential diagnosis of the midface injuries and also accompanying cervical spine injury should not be ignored.

  9. [Management of facial bone fractures].

    Science.gov (United States)

    Oikarinen, Kyösti; Korpi, Jarkko

    2010-01-01

    Although the number of patients suffering from facial bone fractures has decreased more resources due to complexity of the fractures are needed. The initial treatment and reconstruction phase require hospitalisation and close collaboration between several medical and dental specialists. Fractures cause alterations in occlusion and masticatory functions and are frequently associated with soft tissue injuries. The primary radiographic examination is panoramic radiography in mandibular and computed tomography in maxillary and mid face fractures. The treatment principles have changed during the last three decades. Long-term maxillomandibular immobilisation has given way to internal fixation and direct osteosynthesis. The greatest innovations of the treatment have taken place in materials. Steel has been replaced by Titanium or resorbable plates, screws and meshes.

  10. Complications of Nasal Bone Fractures.

    Science.gov (United States)

    Hwang, Kun; Yeom, Seung Han; Hwang, Suk Hyun

    2017-05-01

    The aim of this study was to perform a systematic review of the treatment of nasal bone fractures. The search terms ("nasal bone fracture" AND complication) and ("nasal bone fracture" AND [anosmia OR olfaction OR olfactory nerve OR smell]) and (anosmia AND ["nasal preparation" OR "nasal antiseptics"]) were used to search PubMed and SCOPUS. Of the 500 titles, 40 full papers were reviewed. One paper was excluded, and 3 mined papers were added. Ultimately, 12 papers were analyzed. The overall deformity rate was 10.4% ± 4.8%. No significant differences were found between patients who underwent closed reduction (14.7% ± 7.3%) and those who underwent open reduction (9.4% ± 4.4%), between those who underwent local anesthesia (5.8% ± 4.5%), and those who underwent general anesthesia (8.8% ± 3.8%), or between those who received timely treatment (5.7%) and those whose treatment was delayed (9.0%). Septal deviation occurred in 10.0% of patients as a sequela of nasal bone fracture. The nasal obstruction rate was 10.5% ± 5.3%. Fewer patients of nasal obstruction occurred in the open reduction patients (6.9% ± 4.4%) than in the closed reduction patients (15.2%). One patient of epiphora and 1 patient of diplopia were reportedAmong the 77 patients with nasal bone fractures, 29 (37.7% ± 11.3%) complained of olfactory disturbances. No significant associations were found between the type of fracture and the presence of olfactory disturbances. It is recommended for providers to explain to patients that approximately one-tenth of nasal bone fractures exhibit deformity, septal deviation, or nasal obstruction after surgery. Surgeons should take considerable care to avoid the olfactory mucosa during reduction surgery.

  11. Bone shortening of clavicular fractures

    DEFF Research Database (Denmark)

    Thorsmark, A. H.; Muhareb Udby, P.; Ban, I.

    2017-01-01

    Background: The indication for operative treatment of clavicular fractures with bone shortening over 2 cm is much debated. Correct measurement of clavicular length is essential, and reliable measures of clavicular length are therefore highly requested by clinical decision-makers. The aim of this ......Background: The indication for operative treatment of clavicular fractures with bone shortening over 2 cm is much debated. Correct measurement of clavicular length is essential, and reliable measures of clavicular length are therefore highly requested by clinical decision-makers. The aim...... of this study was to investigate if three commonly scientifically used measurement methods were interchangeable to each other. Methods: A retrospective study using radiographs collected as part of a previous study on clavicular fractures. Two independent raters measured clavicle shortening on 60 patients using......, Weir's protocol for Standard error of measurement (SEM) and minimal detectable change (MDC), and Bland-Altman plots. Results: None of the methods were directly interchangeable. The side difference method by Lazarides et al. was the most reliable of the three methods, but had a high proportion of post-fracture...

  12. Petrous bone fracture: a virtual trauma analysis.

    Science.gov (United States)

    Montava, Marion; Deveze, Arnaud; Arnoux, Pierre-Jean; Bidal, Samuel; Brunet, Christian; Lavieille, Jean-Pierre

    2012-06-01

    The temporal bone shields sensorineural, nervous, and vascular structures explaining the potential severity and complications of trauma related to road and sport accidents. So far, no clear data are available on the exact mechanisms involved for fracture processes. Modelization of structures helps to answer these concerns. Our objective was to design a finite element model of the petrous bone structure to modelize temporal bone fracture propagation in a scenario of lateral impact. A finite element model of the petrous bone structure was designed based on computed tomography data. A 7-m/s lateral impact was simulated to reproduce a typical lateral trauma. Results of model analysis was based on force recorded, stress level on bone structure up to induce a solution of continuity of the bony structure. Model simulation showed that bone fractures follow the main axes of the petrous bone and occurred in a 2-step process: first, a crush, and second, a massive fissuration of the petrous bone. The lines of fracture obtained by simulation of a lateral impact converge toward the middle ear region. This longitudinal fracture is located at the mastoid-petrous pyramid junction. Using this model, it was possible to map petrous bone fractures including fracture chronology and areas of fusion of the middle ear region. This technique may represent a first step to investigate the pathophysiology of the petrous bone fractures, aiming to define prognostic criteria for patients' care.

  13. Corrective Septorhinoplasty in Acute Nasal Bone Fractures.

    Science.gov (United States)

    Kim, Jisung; Jung, Hahn Jin; Shim, Woo Sub

    2018-03-01

    Closed reduction is generally recommended for acute nasal bone fractures, and rhinoplasty is considered in cases with an unsatisfactory outcome. However, concomitant rhinoplasty with fracture reduction might achieve better surgical outcomes. This study investigated the surgical techniques and outcomes in patients who underwent rhinoplasty and fracture reduction concomitantly, during the acute stage of nasal bone fracture. Forty-five patients who underwent concomitant rhinoplasty and fracture reduction were enrolled. Nasal bone fractures were classified into three major types (type I, simple fracture; type II, fracture line that mimics nasal osteotomy; and type III, comminuted fracture) based on computed tomography images and preoperative facial images. Two independent otolaryngology-head and neck surgeons evaluated the surgical outcomes and telephone based survey were made to evaluate patients satisfaction. Among 45 patients, there were 39 males and 6 females. Type I was the commonest type of fracture with 18 patients (40%), while the most frequently used surgical technique for corrective surgery was dorsal augmentation with 44 patients (97.8%). The mean visual analogue scale satisfaction score of the surgeons and patients were 7.62 and 8, respectively, with no significant differences between fracture types. Concomitant rhinoplasty with fracture reduction can be performed for acute nasal bone fracture patients, and it might lead to better aesthetic outcomes.

  14. Birth-associated long-bone fractures.

    Science.gov (United States)

    Basha, Asma; Amarin, Zouhair; Abu-Hassan, Freih

    2013-11-01

    To assess the incidence and outcome of neonatal long-bone fractures at a tertiary teaching hospital. A retrospective study of all neonates with long-bone fractures delivered at Jordan University Hospital between January 1, 2000, and December 31, 2010. Among a total of 34 519 live births, 8 neonates had a long-bone fracture (incidence 0.23/1000 live births); of these, 6 had a femur fracture (0.17/1000 live births) and 2 had a humerus fracture (0.05/1000 live births). The route of delivery was emergency cesarean delivery for 6 infants, elective cesarean delivery for 1 infant, and the vaginal route for 1 infant. The mean birth weight was 2723g. All neonates weighed more than 2200g and their gestational age was more than 35weeks, with the exception of 1 neonate born at 31weeks weighing 1500g. The mean time interval from birth to fracture diagnosis was 1.5days. All fractures healed with no residual deformity. Emergency cesarean delivery carries a higher risk of long-bone fracture than vaginal delivery. Prematurity, malpresentation, abnormal lie, and multiple pregnancies may predispose to long-bone fractures. The prognosis of birth-associated long-bone fractures is good. © 2013.

  15. The Ameloblastin extracellular matrix molecule enhances bone fracture resistance and promotes rapid bone fracture healing

    Science.gov (United States)

    Lu, Xuanyu; Li, Wenjin; Fukumoto, Satoshi; Yamada, Yoshihiko; Evans, Carla; Diekwisch, Thomas G.H.; Luan, Xianghong

    2016-01-01

    The extracellular matrix (ECM) provides structural support, cell migration anchorage, cell differentiation cues, and fine-tuned cell proliferation signals during all stages of bone fracture healing, including cartilaginous callus formation, callus remodeling, and bony bridging of the fracture gap. In the present study we have defined the role of the extracellular matrix protein ameloblastin (AMBN) in fracture resistance and fracture healing of mouse long bones. To this end, long bones from WT and AMBNΔ5-6 truncation model mice were subjected to biomechanical analysis, fracture healing assays, and stem cell colony formation comparisons. The effect of exogenous AMBN addition to fracture sites was also determined. Our data indicate that lack of a functional AMBN in the bone matrix resulted in 31% decreased femur bone mass and 40% reduced energy to failure. On a cellular level, AMBN function inhibition diminished the proliferative capacity of fracture repair callus cells, as evidenced by a 58% reduction in PCNA and a 40% reduction in Cyclin D1 gene expression, as well as PCNA immunohistochemistry. In terms of fracture healing, AMBN truncation was associated with an enhanced and prolonged chondrogenic phase, resulting in delayed mineralized tissue gene expression and delayed ossification of the fracture repair callus. Underscoring a role of AMBN in fracture healing, there was a 6.9-fold increase in AMBN expression at the fracture site one week after fracture, and distinct AMBN immunolabeling in the fracture gap. Finally, application of exogenous AMBN protein to bone fracture sites accelerated callus formation and bone fracture healing (33% increase in bone volume and 19% increase in bone mineral density), validating the findings of our AMBN loss of function studies. Together, these data demonstrate the functional importance of the AMBN extracellular matrix protein in bone fracture prevention and rapid fracture healing. PMID:26899203

  16. Delayed Reduction of Nasal Bone Fractures.

    Science.gov (United States)

    Yoon, Han Young; Han, Dong Gil

    2016-06-01

    Nasal bone fractures are managed by closed reduction within the 2-week period, and are managed by secondary correction after this time. There is little literature on the delayed reduction for nasal bone fractures beyond the 2-week duration. We report our experience with nasal fractures, which were reduced beyond this period. A retrospective review was performed for all patients who had undergone closed reduction of isolated nasal bone fracture. Patients were included for having undergone reduction of nasal bone fractures at or more than 2 weeks after the injury. Medical records were reviewed for demographic information, injury mechanism, fracture type, delay in treatment, and cause for delay. Postoperative outcomes were evaluated using computed tomography images. The review identified 10 patients. The average reduction time was 22.1 days. Five of patients underwent reduction between days 15 and 20, and the remaining five patients underwent reduction between days 21 and 41. The postoperative outcomes were excellent in 8 patients and good in 2 patients. Outcomes were superior for nasal fractures with displaced end plates and multiple fracture segments. Our study results appears to support delayed reduction of isolated nasal fractures in the presence of factors that delay bony reunion.

  17. Foal Fractures: Osteochondral Fragmentation, Proximal Sesamoid Bone Fractures/Sesamoiditis, and Distal Phalanx Fractures.

    Science.gov (United States)

    Reesink, Heidi L

    2017-08-01

    Foals are susceptible to many of the same types of fractures as adult horses, often secondary to external sources of trauma. In addition, some types of fractures are specific to foals and occur routinely in horses under 1 year of age. These foal-specific fractures may be due to the unique musculoskeletal properties of the developing animal and may present with distinct clinical signs. Treatment plans and prognoses are tailored specifically to young animals. Common fractures not affecting the long bones in foals are discussed in this article, including osteochondral fragmentation, proximal sesamoid bone fractures/sesamoiditis, and distal phalanx fractures. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Navicular bone fracture in the pelvic limb in two horses

    International Nuclear Information System (INIS)

    Kaser-Hotz, B.; Ueltschi, G.; Hess, N.

    1991-01-01

    The case history, radiographic and scintigraphic findings of two horses with pelvic limb navicular bone fractures are presented. In both cases the fractures were of traumatic origin. One horse had a bilateral fracture of the navicular bone, distal border, the other horse had a fracture of the proximal articular border in one pelvic limb navicular bone

  19. Ulnar nerve paralysis after forearm bone fracture

    Directory of Open Access Journals (Sweden)

    Carlos Roberto Schwartsmann

    2016-08-01

    Full Text Available ABSTRACT Paralysis or nerve injury associated with fractures of forearm bones fracture is rare and is more common in exposed fractures with large soft-tissue injuries. Ulnar nerve paralysis is a rare condition associated with closed fractures of the forearm. In most cases, the cause of paralysis is nerve contusion, which evolves with neuropraxia. However, nerve lacerations and entrapment at the fracture site always need to be borne in mind. This becomes more important when neuropraxia appears or worsens after reduction of a closed fracture of the forearm has been completed. The importance of diagnosing this injury and differentiating its features lies in the fact that, depending on the type of lesion, different types of management will be chosen.

  20. Structural bone allograft fractures in oncological procedures.

    Science.gov (United States)

    Garcia-Coiradas, Javier; Garcia-Maroto, Roberto; Cebrian, Juan Luis; Lopez-Duran, Luis

    2015-11-01

    We report our experience analysing the risk of fracture amongst allografts in limb-preserving surgery for bone tumours. We retrospectively reviewed our experience with bone allograft and its major complications when used for limb -preserving operations for bone tumours. Forty-one structural allografts were performed in 39 patients between 1992 and 2012. Minimum follow-up was 20 months. Massive allografts have a high complication rate. Excluding infection and nonunion, five acute fractures were found. All fractures occurred after the graft-host junction was united. Local factors-such as graft preservation, weight bearing, fixation to the host or systemic factors such as adjuvant treatments (chemotherapy or radiotherapy)-influence fracture rate. In our study, four patients achieved consolidation with internal fixation and autologous iliac-crest graft, whilst only one required graft exchange. There is no general consensus as to when to treat fractures using open reduction and internal fixation or by exchanging the allograft. Higher fracture rate in relation to systemic treatment was found. Massive structural allograft reconstruction still has a place in limb-preserving surgery, with an acceptable fracture rate and a durable solution.

  1. Comparison of temporal bone fractures in children and adults.

    Science.gov (United States)

    Kang, Ho Min; Kim, Myung Gu; Hong, Seok Min; Lee, Ho Yun; Kim, Tae Hyun; Yeo, Seung Geun

    2013-05-01

    Contrary to our expectation, that the clinical characteristics of temporal bone fracture would differ in children and adults, we found that the two groups were similar. Most studies of temporal bone fractures have been performed in adults. To our knowledge, no study has investigated differences in temporal bone fractures in children and adults. We therefore investigated differences in temporal bone fractures in adults and children by examining the manifestations and clinical symptoms of temporal bone fractures in pediatric patients. The demographic and clinical characteristics were assessed in 32 children and 186 adults with temporal bone fractures. All patients underwent computed tomography of the temporal bone. Causes of fracture, gender distribution, manifestations of temporal bone fracture, and clinical symptoms were similar in adults and children (p > 0.05 each). Petrous fracture, ear fullness, dizziness, and tinnitus were significantly more frequent in adults than in children (p < 0.05 each).

  2. Fracture, aging and disease in bone

    Energy Technology Data Exchange (ETDEWEB)

    Ager, J.W.; Balooch, G.; Ritchie, R.O.

    2006-02-01

    From a public health perspective, developing a detailed mechanistic understanding of the well-known increase in fracture risk of human bone with age is essential. This also represents a challenge from materials science and fracture mechanics viewpoints. Bone has a complex, hierarchical structure with characteristic features ranging from nanometer to macroscopic dimensions; it is therefore significantly more complex than most engineering materials. Nevertheless, by examining the micro-/nano-structural changes accompanying the process of aging using appropriate multiscale experimental methods and relating them to fracture mechanics data, it is possible to obtain a quantitative picture of how bone resists fracture. As human cortical bone exhibits rising ex vivo crack-growth resistance with crack extension, its fracture toughness must be evaluated in terms of resistance-curve (R-curve) behavior. While the crack initiation toughness declines with age, the more striking finding is that the crack-growth toughness declines even more significantly and is essentially absent in bone from donors exceeding 85 years in age. To explain such an age-induced deterioration in the toughness of bone, we evaluate its fracture properties at multiple length scales, specifically at the molecular and nanodimensions using pico-force atomic-force microscopy, nanoindentation and vibrational spectroscopies, at the microscale using electron microscopy and hard/soft x-ray computed tomography, and at the macroscale using R-curve measurements. We show that the reduction in crack-growth toughness is associated primarily with a degradation in the degree of extrinsic toughening, in particular involving crack bridging, and that this occurs at relatively coarse size-scales in the range of tens to hundreds of micrometers. Finally, we briefly describe how specific clinical treatments, e.g., with steroid hormones to treat various inflammatory conditions, can prematurely damage bone, thereby reducing its

  3. Mechanistic fracture criteria for the failure of human cortical bone

    Energy Technology Data Exchange (ETDEWEB)

    Nalla, Ravi K.; Kinney, John H.; Ritchie, Robert O.

    2002-12-13

    A mechanistic understanding of fracture in human bone is critical to predicting fracture risk associated with age and disease. Despite extensive work, a mechanistic framework for describing how the underlying microstructure affects the failure mode in bone is lacking.

  4. Phalangeal bone mineral density predicts incident fractures

    DEFF Research Database (Denmark)

    Friis-Holmberg, Teresa; Brixen, Kim; Rubin, Katrine Hass

    2012-01-01

    This prospective study investigates the use of phalangeal bone mineral density (BMD) in predicting fractures in a cohort (15,542) who underwent a BMD scan. In both women and men, a decrease in BMD was associated with an increased risk of fracture when adjusted for age and prevalent fractures....... PURPOSE: The aim of this study was to evaluate the ability of a compact and portable scanner using radiographic absorptiometry (RA) to predict major osteoporotic fractures. METHODS: This prospective study included a cohort of 15,542 men and women aged 18-95 years, who underwent a BMD scan in Danish Health...... Examination Survey 2007-2008. BMD at the middle phalanges of the second, third and fourth digits of the non-dominant hand was measured using RA (Alara MetriScan®). These data were merged with information on incident fractures retrieved from the Danish National Patient Registry comprising the International...

  5. Impact sports and bone fractures among adolescents.

    Science.gov (United States)

    Lynch, Kyle R; Kemper, Han C G; Turi-Lynch, Bruna; Agostinete, Ricardo R; Ito, Igor H; Luiz-De-Marco, Rafael; Rodrigues-Junior, Mario A; Fernandes, Rômulo A

    2017-12-01

    The objective of the present study was to investigate the effects of different sports on stress fractures among adolescents during a 9-month follow-up period. The sample was composed of 184 adolescents divided into three groups (impact sports [n = 102]; swimming [n = 35]; non-sports [n = 47]). The occurrence of stress fracture was reported by participants and coaches. As potential confounders we considered age, sex, resistance training, body composition variables and age at peak of height velocity. There were 13 adolescents who reported fractures during the 9-month period. Bone mineral density values were higher in adolescents engaged in impact sports (P-value = 0.002). Independently of confounders, the risk of stress fracture was lower in adolescents engaged in impact sports than in non-active adolescents (hazard ratio [HR] = 0.23 [95% confidence interval (CI) = 0.05 to 0.98]), while swimming practice was not associated to lower risk of fracture (HR = 0.49 [95% CI = 0.09 to 2.55]). In conclusion, the findings from this study indicate the importance of sports participation among adolescents in the reduction of stress fracture risk, especially with impact sports. More importantly, these results could be relevant for recognising adolescents in danger of not reaching their potential for peak bone mass and later an increased risk of fractures.

  6. Alveolar Bone Fracture: Pathognomonic Sign for Clinical Diagnosis

    OpenAIRE

    Gutmacher, Zvi; Peled, Eli; Norman, Doron; Lin, Shaul

    2017-01-01

    Aim: Dental injuries, especially luxation and avulsion, are common. Dental trauma can cause alveolar bone fracture that can lead to tooth loss and malocclusion. Single tooth alveolar bone fractures are difficult to identify unless it protrudes through the overlying mucosa and can be visualized. Pain, malocclusion, and tooth mobility provide signs of suspected alveolar bone fractures. Integrity of the proximate alveolar bone should be examined for fractures where avulsion, luxation, or other t...

  7. Computed tomography evaluation of petrous bone fractures ...

    African Journals Online (AJOL)

    Background: Petrous bone trauma is the sequel of blunt head injury and can have life threatening complications resulting in immediate mortality. Early detection and good knowledge of the Computed Tomography (CT) findings ensure prompt treatment of both fractures and complications. Objective: To document the ...

  8. Central tarsal bone fracture in a cat.

    Science.gov (United States)

    Cinti, Filippo; Pisani, Guido; Penazzi, Claudio; Carusi, Umberto; Vezzoni, Luca; Vezzoni, Aldo

    2016-01-01

    Fracture of the central tarsal bone is an uncommon injury in dogs and occurs predominantly in racing Greyhounds. To the authors' knowledge, this type of fracture has not been described previously in cats. This case report describes a five-year-old Domestic Shorthair cat referred to the Centro Veterinario Luni Mare because of lameness, swelling and signs of pain in the right hindlimb caused by trauma. Clinical examination and diagnostic imaging revealed a right central tarsal bone fracture. Open reduction and internal fixation with a 2.0 mm position screw and two 0.8 mm Kirschner wires were carried out. The last follow-up examination three years postoperatively found the cat in good health with normal range of motion and function, and no signs of lameness in the right hindlimb.

  9. Prevalence of Temporal Bone Fractures in Patients with Mandibular Fractures Using Multidetector-Row CT.

    Science.gov (United States)

    Ogura, I; Kaneda, T; Sasaki, Y; Buch, K; Sakai, O

    2015-06-01

    Temporal bone fracture after mandibular trauma is thought to be rare, and its prevalence has not been reported in the literature. The purpose of this study was to investigate the prevalence of temporal bone fractures in patients with mandibular fractures and the relationship between temporal bone fractures and the mandibular fracture location using multidetector-row computed tomography (MDCT). A prospective study was performed in 201 patients with mandibular fractures who underwent 64-MDCT scans. The mandibular fracture locations were classified as median, paramedian, angle, and condylar types. Statistical analysis for the relationship between prevalence of temporal bone fractures and mandibular fracture locations was performed using χ(2) test with Fisher's exact test. A P-value fracture was 3.0 % of all patients with mandibular fractures and 19.0 % of those with multiple mandibular fractures of paramedian and condylar type. There was a significant relationship between the incidence of temporal bone fracture and the paramedian- and condylar-type mandibular fracture (P = 0.001). Multiple mandibular fractures of paramedian and condylar type may be a stronger indicator for temporal bone fractures. This study suggests that patients with mandibular fracture, especially the paramedian and condylar type, should be examined for coexisting temporal bone fracture using MDCT.

  10. Alveolar Bone Fracture: Pathognomonic Sign for Clinical Diagnosis.

    Science.gov (United States)

    Gutmacher, Zvi; Peled, Eli; Norman, Doron; Lin, Shaul

    2017-01-01

    Dental injuries, especially luxation and avulsion, are common. Dental trauma can cause alveolar bone fracture that can lead to tooth loss and malocclusion. Single tooth alveolar bone fractures are difficult to identify unless it protrudes through the overlying mucosa and can be visualized. Pain, malocclusion, and tooth mobility provide signs of suspected alveolar bone fractures. Integrity of the proximate alveolar bone should be examined for fractures where avulsion, luxation, or other tooth trauma is detected. Any suggestion of alveolar fractures should be further investigated with an appropriate radiograph. This case report shows a pathognomonic sign that detects and diagnosis single tooth alveolar bone fractures, i.e. , a localized hematoma crossing the attached gingiva from the free gingival margin to the vestibular mucosa. This should serve as a warning for localized alveolar bone fracture. A visualized hematoma and gentle, careful palpation may help detect covered fractures when the overlying mucosa is not perforated.

  11. Bone graft substitutes and bone morphogenetic proteins for osteoporotic fractures: What is the evidence?

    NARCIS (Netherlands)

    E.M.M. van Lieshout (Esther); V. Alt (Volker)

    2016-01-01

    textabstractDespite improvements in implants and surgical techniques, osteoporotic fractures remain challenging to treat. Among other major risk factors, decreased expression of morphogenetic proteins has been identified for impaired fracture healing in osteoporosis. Bone grafts or bone graft

  12. Fracture of nasal bones: an epidemiologic analysis

    Directory of Open Access Journals (Sweden)

    Fornazieri, Marco Aurélio

    2008-12-01

    Full Text Available Introduction: One of the most common diseases in the otorhinolaryngology emergency room is the nasal bones fracture. The peak of incidence is between 15 and 25 years of age. Generally men are more affected. Objective: To analyze the age, gender and the most frequent causes of nasal fractures evaluated in the otorhinolaryngology service of a tertiary hospital. Method: Retrospective study of records of the patients with nasal fracture diagnosis treated between July 1st, 2003 and July 1st, 2007. Results: 167 patients with nasal bones fracture were included in the study, including 134 men and 33 women. Violence was the most frequent cause, with 55 cases (32.9%, followed by fall from their own height, with 33 cases (19.7%, and motorcycle accident, 14 cases (8.4%. The most common age was between 21 and 39 years (46.1%. Conclusion: Male, age between 21 and 39 years and violence are the most common characteristics found in our service. Motorcycle accidents also play an important role in this affection.

  13. Early Onset of Laying and Bumblefoot Favor Keel Bone Fractures

    Science.gov (United States)

    Gebhardt-Henrich, Sabine G.; Fröhlich, Ernst K. F.

    2015-01-01

    Simple Summary Numerous studies have documented a high prevalence of keel bone fractures in laying hens. In this longitudinal study, 80 white and brown laying hens were regularly checked for keel bone deviations and fractures while egg production was individually monitored. About 62% of the hens had broken keel bones at depopulation. More new fractures occurred during the time when laying rates were highest. Hens with broken keel bones at depopulation had laid their first egg earlier than hens with intact keel bones. All birds with bumblefoot on both feet had a fracture at depopulation. Abstract Numerous studies have demonstrated influences of hybrid, feed, and housing on prevalence of keel bone fractures, but influences of behavior and production on an individual level are less known. In this longitudinal study, 80 white and brown laying hens were regularly checked for keel bone deviations and fractures while egg production was individually monitored using Radio Frequency Identification (RFID) from production until depopulation at 65 weeks of age. These focal birds were kept in eight pens with 20 hens per pen in total. About 62% of the hens had broken keel bones at depopulation. The occurrence of new fractures was temporally linked to egg laying: more new fractures occurred during the time when laying rates were highest. Hens with fractured keel bones at depopulation had laid their first egg earlier than hens with intact keel bones. However, the total number of eggs was neither correlated with the onset of egg laying nor with keel bone fractures. All birds with bumblefoot on both feet had a fracture at depopulation. Hens stayed in the nest for a longer time during egg laying during the ten days after the fracture than during the ten days before the fracture. In conclusion, a relationship between laying rates and keel bone fractures seems likely. PMID:26633520

  14. Probabilistic Risk Assessment for Bone Fracture - Bone Fracture Risk Module (BFxRM)

    Science.gov (United States)

    Licata, Angelo; Myers, Jerry G.; Lewandowski, Beth

    2013-01-01

    This presentation summarizes the concepts, development, and application of NASA's Bone Fracture Risk Module (BFxRM). The overview includes an assessmnet of strenghts and limitations of the BFxRM and proposes a numebr of discussion questions to the panel regarding future development avenues for this simulation system.

  15. Central tarsal bone fracture in the border collie.

    Science.gov (United States)

    Guilliard, M

    2007-07-01

    Fracture of the plantar process of the central tarsal bone together with a dorsomedial displacement of the body of the bone was seen in six border collies. All injuries occurred during free exercise, with no extrinsic trauma. Three dogs had concomitant tarsal fractures. Primary treatment was by lag screwing the central tarsal bone to the fourth tarsal bone. All cases eventually made an excellent recovery. The superficial radiographic appearance was of a luxation of the bone as reported in a previous series, but appraisal of the radiographs showed evidence of fracture in all cases. A cadaver study to assess the mechanism of luxation showed that it is unlikely to occur naturally.

  16. Early Onset of Laying and Bumblefoot Favor Keel Bone Fractures

    Directory of Open Access Journals (Sweden)

    Sabine G. Gebhardt-Henrich

    2015-11-01

    Full Text Available Numerous studies have demonstrated influences of hybrid, feed, and housing on prevalence of keel bone fractures, but influences of behavior and production on an individual level are less known. In this longitudinal study, 80 white and brown laying hens were regularly checked for keel bone deviations and fractures while egg production was individually monitored using Radio Frequency Identification (RFID from production until depopulation at 65 weeks of age. These focal birds were kept in eight pens with 20 hens per pen in total. About 62% of the hens had broken keel bones at depopulation. The occurrence of new fractures was temporally linked to egg laying: more new fractures occurred during the time when laying rates were highest. Hens with fractured keel bones at depopulation had laid their first egg earlier than hens with intact keel bones. However, the total number of eggs was neither correlated with the onset of egg laying nor with keel bone fractures. All birds with bumblefoot on both feet had a fracture at depopulation. Hens stayed in the nest for a longer time during egg laying during the ten days after the fracture than during the ten days before the fracture. In conclusion, a relationship between laying rates and keel bone fractures seems likely.

  17. Osteoporosis in clinical practice – bone densitometry and fracture risk

    African Journals Online (AJOL)

    Osteoporosis is a condition of decreased bone mass and bone density associated with an increase in fracture risk. Bone mineral density (BMD) of the lumbar spine and femur can be reliably measured by double-beam X-ray absorptiometry (DEXA), which provides a measure of bone strength. Reduction in BMD is a ...

  18. Stress fracture development classified by bone scintigraphy

    International Nuclear Information System (INIS)

    Zwas, S.T.; Elkanovich, R.; Frank, G.; Aharonson, Z.

    1985-01-01

    There is no consensus on classifying stress fractures (SF) appearing on bone scans. The authors present a system of classification based on grading the severity and development of bone lesions by visual inspection, according to three main scintigraphic criteria: focality and size, intensity of uptake compare to adjacent bone, and local medular extension. Four grades of development (I-IV) were ranked, ranging from ill defined slightly increased cortical uptake to well defined regions with markedly increased uptake extending transversely bicortically. 310 male subjects aged 19-2, suffering several weeks from leg pains occurring during intensive physical training underwent bone scans of the pelvis and lower extremities using Tc-99-m-MDP. 76% of the scans were positive with 354 lesions, of which 88% were in th4e mild (I-II) grades and 12% in the moderate (III) and severe (IV) grades. Post-treatment scans were obtained in 65 cases having 78 lesions during 1- to 6-month intervals. Complete resolution was found after 1-2 months in 36% of the mild lesions but in only 12% of the moderate and severe ones, and after 3-6 months in 55% of the mild lesions and 15% of the severe ones. 75% of the moderate and severe lesions showed residual uptake in various stages throughout the follow-up period. Early recognition and treatment of mild SF lesions in this study prevented protracted disability and progression of the lesions and facilitated complete healing

  19. Petrous bone fractures violating otic capsule.

    Science.gov (United States)

    Magliulo, Giuseppe; Ciniglio Appiani, Mario; Iannella, Giannicola; Artico, Marco

    2012-12-01

    This study presents our experience with a series of patients suffering from petrous bone fractures violating the otic capsule who underwent subtotal petrosectomy combined with eustachian tube, middle ear, and mastoid obliteration, with the goal of preventing cerebrospinal fluid (CSF) leak and meningitis. This study enrolled 26 patients between 1997 and 2011. The clinical symptoms, otoscopy, and preoperative and postoperative audiometry and facial function, as well as CSF leak or meningitis, were evaluated in each patient. The entire group underwent a subtotal petrosectomy using the technique described in detail by Fisch. In addition, each patient was interviewed using a questionnaire to evaluate the impact on quality of life. Intraoperatively, we found significant CSF leaks in 14 patients (42.5%). No patient reported other episodes of CSF leak or meningitis after the surgery. The patients' responses of facial nerve function were slightly worse than the House-Brackmann evaluation (50% versus 42.3%; p < 0.05). The vast majority (88.5%) of the patients experienced no social impact. Our findings suggest the importance of not underestimating the risk for CSF leak in the petrous bone fractures violating the otic capsule. Preoperative counseling regarding the various troublesome complications must adequately motivate candidates to undergo surgery by pointing out the positive impact of the proposed treatment.

  20. Usefulness of MR imaging in pathologic fracture of long bone

    International Nuclear Information System (INIS)

    Lim, Hyo Soon; Park, Jin Gyoon; Song, Jae Min; Chung, Tae Woong; Yoon, Woong; Kang, Heoung Kyun

    2002-01-01

    The purpose of this study was to evaluate the usefulness of MR imaging of pathologic fractures of the long bones. In 18 patients aged between four and 75 (mean, 25.8) years with histologically confirmed pathologic fractures of the long bones, plain radiographs and MR images were retrospectively analyzed. The former were examined with regard to location and type of fracture, and the presence or absence of underlying disease causing fracture; and the latter in terms of underlying disease, extraosseous mass formation, and soft tissue change. The long bones involved were the femur in nine patients, the humerus in six, and the tibia in three. Underlying diseases were metastatic tumor (n=6), benign bone tumor (n=5), primary malignant bone tumor (n=4), osteomyelitis (n=2), and eosinophilic granuloma (n=1). Plain radiographs showed the fracture site as the metaphysis in ten cases, the disphysis in five, and the metadisphysis in one. Fractures were either transverse (n=10), oblique (n=3), spiral (n=1), vertical (n=1), or telescopic (n=1). In two cases, the fracture line was not visible. MR images revealed underlying diseases in all cases. Two benign bone tumors took the form of a cystic mass, hematoma was seen in three cases. Where pathologic fracture of a long bone had occurred, or a pathologic fracture in which the findings of plain radiography were equivocal, MR imaging was useful for evaluating the pattern and extent of an underlying lesion

  1. Possible benefits of strontium ranelate in complicated long bone fractures.

    Science.gov (United States)

    Alegre, Duarte Nuno; Ribeiro, Costa; Sousa, Carlos; Correia, João; Silva, Luís; de Almeida, Luís

    2012-02-01

    Osteoporosis drugs are prescribed to prevent fragility fractures, which is the principal aim of the management of osteoporosis. However, if fracture does occur, then it is also important to promote a fast and uneventful healing process. Despite this, little is known about the effect of osteoporosis drugs on bone healing in humans. Strontium ranelate is an osteoporosis agent that increases bone formation and reduces bone resorption and may therefore be beneficial in fracture healing. We report four cases of fracture non-union for up to 20 months. Treatment with strontium ranelate (2 g/day) for between 6 weeks and 6 months appeared to contribute to bone consolidation in the four cases. Animal studies support beneficial effects of strontium ranelate on bone healing via improvement of bone material properties and microarchitecture in the vicinity of the fracture. The clinical cases described herein provide new information on these effects, in the absence of randomized controlled studies on the clinical efficacy of pharmacological treatments in osteoporosis in fracture repair. Further studies are necessary. Fracture healing is an important topic in orthopedic research and is also a concern for patients with postmenopausal osteoporosis. Evidence from case reports and animal studies suggests that strontium ranelate improves bone microarchitecture and accelerates fracture healing. A positive effect of osteoporosis treatments on bone healing is an interesting possibility and merits further clinical research.

  2. Implant failure in osteosynthesis of fractures of long bones ...

    African Journals Online (AJOL)

    Patients who had open operative treatment of fractures of long bones were reviewed retrospectively to identify the incidence of and risk factors for implant failure. One hundred and five patients had open reduction and internal fixation of 117 fractures of long bones, out of which four patients suffered implant failure.

  3. Isolated bone infarct of the calcaneus after fracture.

    Science.gov (United States)

    Bui-Mansfield, Liem T; Clayton, Trevor L

    2010-01-01

    The calcaneus has a rich vascular supply; therefore, avascular necrosis of the calcaneus is extremely rare. We report the first case of bone infarct of the calcaneus 9 months after a fracture. We also review the literature on osteonecrosis of the calcaneus to offer potential mechanisms for bone infarction in the calcaneus after a fracture.

  4. FRACTURE OF THE CENTRAL TARSAL BONE IN NONRACEHORSES: FOUR CASES.

    Science.gov (United States)

    Knuchell, Jeannie A; Spriet, Mathieu; Galuppo, Larry D; Katzman, Scott A

    2016-07-01

    Fractures of the central tarsal bone are a rarely recognized cause of acute severe hind limb lameness in nonracehorses. Diagnosis of these fractures can be challenging and little is known about their configuration or outcome. The objectives of this retrospective case series study were to describe the clinical features, imaging findings, and outcomes of fractures of the central tarsal bone in a sample of nonracehorses. Medical records from 2001 to 2014 were searched for cases of central tarsal bone fractures in nonracehorses. All available imaging findings including radiography, ultrasound, computed tomography (CT), and/or nuclear scintigraphy were reviewed. History, clinical presentation, and outcome were collected from the records. Four horses met the inclusion criteria. All had a similar configuration as a simple nondisplaced slab fracture in a dorsomedial to plantarolateral orientation. Initial radiographs failed to reveal the fracture in three of four cases. When additional plantarolateral-dorsomedial oblique radiographic views were obtained, the fracture could be identified in all cases. Fractures of the central tarsal bone seemed to occur in a consistent dorsomedial to plantarolateral orientation in this sample of nonracehorses, which is different from the configuration previously reported in racehorses. While CT can be used for detection and assessment of these fractures, authors propose that radiography can also identify these fractures with the appropriate view. Authors recommend the use of several plantarolateral to dorsomedial radiographic projections at varying degrees of obliquity for horses with a suspected central tarsal bone fracture. © 2016 American College of Veterinary Radiology.

  5. The AO Pediatric Comprehensive Classification of Long Bone Fractures (PCCF).

    Science.gov (United States)

    Joeris, Alexander; Lutz, Nicolas; Blumenthal, Andrea; Slongo, Theddy; Audigé, Laurent

    2017-04-01

    Background and purpose - To achieve a common understanding when dealing with long bone fractures in children, the AO Pediatric Comprehensive Classification of Long Bone Fractures (AO PCCF) was introduced in 2007. As part of its final validation, we present the most relevant fracture patterns in the lower extremities of a representative population of children classified according to the PCCF. Patients and methods - We included patients up to the age of 17 who were diagnosed with 1 or more long bone fractures between January 2009 and December 2011 at either of 2 tertiary care university hospitals in Switzerland. Patient charts were retrospectively reviewed. Results - More lower extremity fractures occurred in boys (62%, n = 341). Of 548 fractured long bones in the lower extremity, 25% involved the femur and 75% the lower leg. The older the patients, the more combined fractures of the tibia and fibula were sustained (adolescents: 50%, 61 of 123). Salter-Harris (SH) fracture patterns represented 66% of single epiphyseal fractures (83 of 126). Overall, 74 of the 83 SH patterns occurred in the distal epiphysis. Of all the metaphyseal fractures, 74 of 79 were classified as incomplete or complete. Complete oblique spiral fractures accounted for 57% of diaphyseal fractures (120 of 211). Of all fractures, 7% (40 of 548) were classified in the category "other", including 29 fractures that were identified as toddler's fractures. 5 combined lower leg fractures were reported in the proximal metaphysis, 40 in the diaphysis, 26 in the distal metaphysis, and 8 in the distal epiphysis. Interpretation - The PCCF allows classification of lower extremity fracture patterns in the clinical setting. Re-introduction of a specific code for toddler's fractures in the PCCF should be considered.

  6. Solitary, spontaneous cervical and large bone fractures in aluminium osteodystrophy

    International Nuclear Information System (INIS)

    Sundaram, M.; Dessner, D.; Ballal, S.

    1991-01-01

    Aluminum-induced bone disease in uremic patients receiving dialysis was first described a little more than 10 years ago. The epidemic form of the disease was seen in centers where there was a high aluminum content in the water dialysate. Although this problem has been corrected, sporadic forms of the disease continue to be noted in dialyzed and nondialyzed patients. Multiple fractures are a radiological feature of aluminum-related bone disease. We present four patients whose nontraumatic fractures involved large bones, without evidence of multiple fractures. Healing was not seen in any of the fractures. In patients receiving dialysis the presence of spontaneous fractures of large bones or cervical vertebrae, which may be clinically silent or vaguely symptomatic, should raise the possibility of aluminum-induced osteomalacia even if these fractures are solitary. (orig./GDG)

  7. Percutaneous treatment of calcaneus fractures associated with underlying bone cysts.

    Science.gov (United States)

    Chen, Linwei; Zhang, Guoyou; Li, Shi; Wu, Zhipeng; Yuan, Wen; Hong, Jianjun

    2012-05-01

    Calcaneal bone cysts with pathological fractures are rare. There is no clear consensus on their management with a few reports of open curettage, bone grafting and internal fixation in the treatment of pathological calcaneal fractures. No minimally invasive management has been reported before. We reviewed our experience in treating five patients with pathologic calcaneus fractures associated with pre-existing bone cysts who underwent percutaneous cyst curettage, fracture reduction, screw fixation and calcium sulfate cement injection between 2004 and 2009. All of the pathologic fractures healed with satisfactory radiological results. There were no soft tissue complications or cyst recurrences. Partial weightbearing with plaster cast immobilization was allowed at 4 weeks postoperatively and full weightbearing was allowed at 6 weeks postoperatively. This percutaneous technique provided a minimally invasive option for treatment of a calcaneal bone cyst with pathologic fracture.

  8. Temporal Bone Fracture Causing Superior Semicircular Canal Dehiscence

    Directory of Open Access Journals (Sweden)

    Kevin A. Peng

    2014-01-01

    Full Text Available Importance. Superior semicircular canal dehiscence (SCD is a third window lesion of the inner ear causing symptoms of vertigo, autophony, tinnitus, and hearing loss. A “two-hit” hypothesis has traditionally been proposed, whereby thinly developed bone overlying the superior canal is disrupted by a sudden change in intracranial pressure. Although the symptoms of SCD may be precipitated by head injury, no previous reports have described a temporal bone fracture directly causing SCD. Observations. Two patients sustained temporal bone fractures after closed head trauma, and developed unilateral otologic symptoms consistent with SCD. In each instance, computed tomography imaging revealed fractures extending through the bony roof of the superior semicircular canal. Conclusions and Relevance. Temporal bone fractures, which are largely treated nonoperatively, have not previously been reported to cause SCD. As it is a potentially treatable entity, SCD resulting from temporal bone fracture must be recognized as a possibility and diagnosed promptly if present.

  9. Management of long bone fractures using SIGN nail: experience ...

    African Journals Online (AJOL)

    ... bone fractures. The major challenges were seen in multiply injured patients with multiple fractures. Also patients that present after several years of injury with malunion and\\or non-union may pose some challenges in treatment using SIGN nail. Keywords: Sign, Intramedullary Nail, Image Intensifier, External Jig, Fractures ...

  10. Local drug delivery for enhancing fracture healing in osteoporotic bone.

    Science.gov (United States)

    Kyllönen, Laura; D'Este, Matteo; Alini, Mauro; Eglin, David

    2015-01-01

    Fragility fractures can cause significant morbidity and mortality in patients with osteoporosis and inflict a considerable medical and socioeconomic burden. Moreover, treatment of an osteoporotic fracture is challenging due to the decreased strength of the surrounding bone and suboptimal healing capacity, predisposing both to fixation failure and non-union. Whereas a systemic osteoporosis treatment acts slowly, local release of osteogenic agents in osteoporotic fracture would act rapidly to increase bone strength and quality, as well as to reduce the bone healing period and prevent development of a problematic non-union. The identification of agents with potential to stimulate bone formation and improve implant fixation strength in osteoporotic bone has raised hope for the fast augmentation of osteoporotic fractures. Stimulation of bone formation by local delivery of growth factors is an approach already in clinical use for the treatment of non-unions, and could be utilized for osteoporotic fractures as well. Small molecules have also gained ground as stable and inexpensive compounds to enhance bone formation and tackle osteoporosis. The aim of this paper is to present the state of the art on local drug delivery in osteoporotic fractures. Advantages, disadvantages and underlying molecular mechanisms of different active species for local bone healing in osteoporotic bone are discussed. This review also identifies promising new candidate molecules and innovative approaches for the local drug delivery in osteoporotic bone. Copyright © 2014 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

  11. Characteristics of bone biochemical indices in predicting secondary osteoporotic fracture after intertrochanteric fracture in elderly women

    Directory of Open Access Journals (Sweden)

    Shaofeng Yang

    2018-01-01

    The Translational Potential of this Article: Besides BMD, bone microstructure and remodeling levels can be accurately measured by bone biochemical indices. The main objective of this research is to explore the change of BMD and the serum level of bone biochemical indices of elderly women who suffered unilateral intertrochanteric fracture within 12 months. Simultaneously, with aim to better obtain bone remodeling level and predict more accurately the risk of a secondary osteoporotic fracture, bone biochemical indices of these patients, who undergo secondary osteoporotic fracture or not, are collected during follow-up and compared respectively.

  12. Probabilistic Risk Assessment for Astronaut Post Flight Bone Fracture

    Science.gov (United States)

    Lewandowski, Beth; Myers, Jerry; Licata, Angelo

    2015-01-01

    Introduction: Space flight potentially reduces the loading that bone can resist before fracture. This reduction in bone integrity may result from a combination of factors, the most common reported as reduction in astronaut BMD. Although evaluating the condition of bones continues to be a critical aspect of understanding space flight fracture risk, defining the loading regime, whether on earth, in microgravity, or in reduced gravity on a planetary surface, remains a significant component of estimating the fracture risks to astronauts. This presentation summarizes the concepts, development, and application of NASA's Bone Fracture Risk Module (BFxRM) to understanding pre-, post, and in mission astronaut bone fracture risk. The overview includes an assessment of contributing factors utilized in the BFxRM and illustrates how new information, such as biomechanics of space suit design or better understanding of post flight activities may influence astronaut fracture risk. Opportunities for the bone mineral research community to contribute to future model development are also discussed. Methods: To investigate the conditions in which spaceflight induced changes to bone plays a critical role in post-flight fracture probability, we implement a modified version of the NASA Bone Fracture Risk Model (BFxRM). Modifications included incorporation of variations in physiological characteristics, post-flight recovery rate, and variations in lateral fall conditions within the probabilistic simulation parameter space. The modeled fracture probability estimates for different loading scenarios at preflight and at 0 and 365 days post-flight time periods are compared. Results: For simple lateral side falls, mean post-flight fracture probability is elevated over mean preflight fracture probability due to spaceflight induced BMD loss and is not fully recovered at 365 days post-flight. In the case of more energetic falls, such as from elevated heights or with the addition of lateral movement

  13. Surgical management of proximal splint bone fractures in the horse

    International Nuclear Information System (INIS)

    Peterson, P.R.; Pascoe, J.R.; Wheat, J.D.

    1987-01-01

    Fractures of Metacarpal and Metatarsal II and IV (the splint bones) were treated in 283 horses over an 11 year period. In 21 cases the proximal portion of the fractured bone was stabilized with metallic implants. One or more cortical bone screws were used in 11 horses, and bone plates were applied in 11 horses. One horse received both treatments. Complications of screw fixation included bone failure, implant failure, radiographic lucency around the screws, and proliferative new bone at the ostectomy site. Only two of the horses treated with screw fixation returned to their intended use. Complications of plate fixation included partial fixation failure (backing out of screws), wound drainage, and proliferative bony response around the plate. Six of the 11 horses treated by plate fixation returned to their intended use. The authors recommend consideration of plate fixation techniques for repair of fractures in the proximal third of the splint bone

  14. Fixation of tibial plateau fractures with synthetic bone graft versus natural bone graft: a comparison study.

    LENUS (Irish Health Repository)

    Ong, J C Y

    2012-06-01

    The goal of this study was to determine differences in fracture stability and functional outcome between synthetic bone graft and natural bone graft with internal fixation of tibia plateau metaphyseal defects.

  15. Long-bone fractures in persons with spinal cord injury.

    Science.gov (United States)

    Frotzler, A; Cheikh-Sarraf, B; Pourtehrani, M; Krebs, J; Lippuner, K

    2015-09-01

    Retrospective data analysis. To document fracture characteristics, management and related complications in individuals with traumatic spinal cord injury (SCI). Rehabilitation centre for SCI individuals. Patients' records were reviewed. Patients with traumatic SCI and extremity fractures that had occurred after SCI were included. Patient characteristics, fractured bone, fracture localisation, severity and management (operative/conservative), and fracture-related complications were extracted. A total of 156 long-bone fractures in 107 SCI patients (34 women and 73 men) were identified. The majority of patients were paraplegics (77.6%) and classified as American Spinal Injury Association Impairment Scale A (86.0%). Only the lower extremities were affected, whereby the femur (60.9% of all fractures) was fractured more frequently than the lower leg (39.1%). A total of 70 patients (65.4%) had one fracture, whereas 37 patients (34.6%) had two or more fractures. Simple or extraarticular fractures were most common (75.0%). Overall, 130 (83.3%) fractures were managed operatively. Approximately half of the femur fractures (48.2%) were treated with locking compression plates. In the lower leg, fractures were mainly managed with external fixation (48.8%). Conservative fracture management was applied in 16.7% of the cases and consisted of braces or a well-padded soft cast. Fracture-associated complications were present in 13.5% of the cases but did not differ significantly between operative (13.1%) and conservative (15.4%) fracture management. SCI was associated with simple or extraarticular fractures of the distal femur and the lower leg. Fractures were mainly managed operatively with a low complication rate.

  16. Bone and bone marrow pro-osteoclastogenic cytokines are up-regulated in osteoporosis fragility fractures.

    Science.gov (United States)

    D'Amelio, P; Roato, I; D'Amico, L; Veneziano, L; Suman, E; Sassi, F; Bisignano, G; Ferracini, R; Gargiulo, G; Castoldi, F; Pescarmona, G P; Isaia, G C

    2011-11-01

    This study evaluates cytokines production in bone and bone marrow of patients with an osteoporotic fracture or with osteoarthritis by real time PCR, Western blot and immunohistochemistry. We demonstrate that the cytokine pattern is shifted towards osteoclast activation and osteoblast inhibition in patients with osteoporotic fractures. Fragility fractures are the resultant of low bone mass and poor bone architecture typical of osteoporosis. Cytokines involved in the control of bone cell maturation and function are produced by both bone itself and bone marrow cells, but the roles of these two sources in its control and the amounts they produce are not clear. This study compares their production in patients with an osteoporotic fracture and those with osteoarthritis. We evaluated 52 femoral heads from women subjected to hip-joint replacement surgery for femoral neck fractures due to low-energy trauma (37), or for osteoarthritis (15). Total RNA was extracted from both bone and bone marrow, and quantitative PCR was used to identify the receptor activator of nuclear factor kB Ligand (RANKL), osteoprotegerin (OPG), macrophage colony stimulating factor (M-CSF), transforming growth factor β (TGFβ), Dickoppf-1 (DKK-1) and sclerostin (SOST) expression. Immunohistochemistry and Western blot were performed in order to quantify and localize in bone and bone marrow the cytokines. We found an increase of RANKL/OPG ratio, M-CSF, SOST and DKK-1 in fractured patients, whereas TGFβ was increased in osteoarthritic bone. Bone marrow produced greater amounts of RANKL, M-CSF and TGFβ compared to bone, whereas the production of DKK-1 and SOST was higher in bone. We show that bone marrow cells produced the greater amount of pro-osteoclastogenic cytokines, whereas bone cells produced higher amount of osteoblast inhibitors in patients with fragility fracture, thus the cytokine pattern is shifted towards osteoclast activation and osteoblast inhibition in these patients.

  17. Clinical evaluation of stress fractures using bone scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Furuta, Atsuhiko; Tanohata, Kazunori; Otake, Toru; Hashizume, Toshiyuki (Kanto Rosai Hospital, Kawasaki, Kanagawa (Japan)); Kobayashi, Yozi; Nakazima, Hiroyuki

    1984-05-01

    Clinical evaluation of stress fractures were performed in 58 athletes using bone scintigraphy with sup(99m)Tc-MDP. Stress fractures of the tibia were most often seen in the males with running type sports. They occurred more often in the proximal tibia and on the right side. Stress fractures of the fibula were most often seen in females with jumping type sports, such as volley ball. They occurred more often in the distal fibula and on the right side. Tarsal bone fractures were seen most often rugby players. Metatarsal fractures occurred in the third fourth and fifth metatarsals. No lesion was seen in the first and second metatarsals. We feel that stress fractures of the femur can be differentiated from osteosarcoma by small loculated radionuclide accumulation as well as symptoms, course and tomographic and CT findings. Bilateral involvement was seen in two cases in patellae and calcanei. Most of the other fractures were seen on the right side. Negative radiographs were seen in 36% of the patients and occurred most commonly in the tarsal bones excluding calcaneus. Bone scintigrams were positive in all cases and were most useful in fractures of the tarsal bones excluding calcaneus.

  18. Clinical evaluation of stress fractures using bone scintigraphy

    International Nuclear Information System (INIS)

    Furuta, Atsuhiko; Tanohata, Kazunori; Otake, Toru; Hashizume, Toshiyuki; Kobayashi, Yozi; Nakazima, Hiroyuki.

    1984-01-01

    Clinical evaluation of stress fractures were performed in 58 athletes using bone scintigraphy with sup(99m)Tc-MDP. Stress fractures of the tibia were most often seen in the males with running type sports. They occurred more often in the proximal tibia and on the right side. Stress fractures of the fibula were most often seen in females with jumping type sports, such as volley ball. They occurred more often in the distal fibula and on the right side. Tarsal bone fractures were seen most often rugby players. Metatarsal fractures occurred in the third fourth and fifth metatarsals. No lesion was seen in the first and second metatarsals. We feel that stress fractures of the femur can be differentiated from osteosarcoma by small loculated radionuclide accumulation as well as symptome, course and tomographic and CT finding. Bilateral involvement was seen in two cases in patellae and calcanei. Most of the other fractures were seen on the right side. Negative radiographs were seen in 36% of the patients and occurred most commonly in the tarsal bones excluding calcaneus. Bone scintigrams were positive in all cases and were most useful in fractures of the tarsal bones excluding calcaneus. (author)

  19. Cost effective use of audiograms after pediatric temporal bone fractures.

    Science.gov (United States)

    Frisenda, Julia L; Schroeder, James W; Ryan, Maura E; Valika, Taher S; Billings, Kathleen R

    2015-11-01

    To identify the relationship of pediatric temporal fractures to the incidence and type of hearing loss present. To analyze the timing and utility of audiometric testing in children with temporal bone fractures. Retrospective case series of 50 pediatric patients with temporal bone fractures who were treated at an urban, tertiary care children's hospital from 2008 to 2014. A statistical analysis of predictors of hearing loss after temporal bone fracture was performed. Fifty-three fractures (69.7%) in 50 patients involved the petrous portion of the temporal bone. The mean age of patients was 7.13 years, and 39 (73.6%) were male. A fall was the most common mechanism of injury in 28 (52.8%) patients, followed by crush injury (n=14, 26.2%), and vehicular trauma (n=10, 18.9%). All otic capsule violating fractures were associated with a sensorineural hearing loss (n=4, 7.5%, p=0.002). Three of four otic capsule sparing fractures were associated with ossicular dislocation, with a corresponding mixed or conductive hearing loss on follow up audiometric testing. The majority of otic capsule sparing fracture patients (n=19/43, 44.2%) who had follow up audiograms had normal hearing, and those with otic capsule violating fractures were statistically more likely to have persistent hearing loss than those with otic capsule sparing fractures (p=0.01). Patients with otic capsule violating fractures or those with ossicular disruption are at higher risk for persistent hearing loss. Cost-saving may be accrued by selecting only those patients at high risk for persistent hearing loss for audiometric testing after temporal bone fractures. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  20. Biomechanical analysis on fracture risk associated with bone deformity

    Science.gov (United States)

    Kamal, Nur Amalina Nadiah Mustafa; Som, Mohd Hanafi Mat; Basaruddin, Khairul Salleh; Daud, Ruslizam

    2017-09-01

    Osteogenesis Imperfecta (OI) is a disease related to bone deformity and is also known as `brittle bone' disease. Currently, medical personnel predict the bone fracture solely based on their experience. In this study, the prediction for risk of fracture was carried out by using finite element analysis on the simulated OI bone of femur. The main objective of this research was to analyze the fracture risk of OI-affected bone with respect to various loadings. A total of 12 models of OI bone were developed by applying four load cases and the angle of deformation for each of the models was calculated. The models were differentiated into four groups, namely standard, light, mild and severe. The results show that only a small amount of load is required to increase the fracture risk of the bone when the model is tested with hopping conditions. The analysis also shows that the torsional load gives a small effect to the increase of the fracture risk of the bone.

  1. Orthodontic treatment for oral rehabilitation after multiple maxillofacial bone fractures.

    Science.gov (United States)

    Nakamura, Yoshiki; Ogino, Tomoko Kuroiwa; Hirashita, Ayao

    2008-09-01

    We present the orthodontic treatment of a patient with occlusal dysfunction after plastic surgery for multiple maxillofacial bone fractures caused by a traffic accident. The patient had mandibular deviation to the right because of inappropriate repositioning and fixation of the fractured bone and complete avulsion of both mandibular central incisors. The bilateral mandibular incisors, canines, and premolars were also suspected of partial avulsion or alveolar bone fracture. Several tests, including percussion and dental computed tomography, were performed on these teeth to rule out ankylosis and confirm tooth movement. Camouflage orthodontic treatment was carried out with expansion of the maxillary arch, alignment of both arches, and space closure between the mandibular lateral incisors to improve the occlusion. Good occlusion and interdigitation were obtained. Orthodontic treatment is useful for the rehabilitation of occlusal dysfunction caused by multiple maxillofacial bone fractures.

  2. [Parathyroid hormone injection to counteract delayed bone fractures].

    Science.gov (United States)

    Brunnemann, C E; Reisinger, E C; Ganzer, D; Schober, H C

    2010-08-01

    Two women, aged 71 and 53 years with periprosthetic fractures of the left femur and an 18 year old man with a non-union of fracture of the left radius presented for assessment and treatment. Serial radiographs showed that osteosynthesis and/or autogenous bone-grafting and multiple revisions had not resulted in healing of the fractures. In all three patients parathyroid hormone (teriparatide), 20 to 60 microg, was injected subcutaneously once daily for 6 - 10 weeks. Subsequently a stable consolidation of the bone occurred in all of them. Administration of parathyroid hormone can induce stable consolidation of the bone in non-unions and delayed healing of bone fractures. Georg Thieme Verlag KG Stuttgart, New York.

  3. Quantification of guided mode propagation in fractured long bones.

    Science.gov (United States)

    Xu, Kailiang; Liu, Dan; Ta, Dean; Hu, Bo; Wang, Weiqi

    2014-07-01

    Guided modes propagation in intact, fractured and healing long bone has drawn significant research interests. However, mode quantifications for the direct comparison are still necessary to address. The aim of the study is to analyze the mode interaction with a notch-fracture in the long bone and find quantitative ultrasound parameters sensitive to depth and width variation of the fracture. We analyzed the impacts of the partially and completely diaphyseal osteotomy on fundamental guided modes propagation using the two-dimension finite-difference time-domain (2D-FDTD) simulations. The long bones were built as three layer models by a cortical plate embedded between overlying soft tissue and inner-coated marrow. Narrowband low-frequency sinusoids (100 kHz) were employed to only excite two fundamental guided modes. The mode amplitude variations were investigated as functions of the gap-breakage width and depth. It is found that the transverse fractures have strong influences on the anti-symmetric mode A0 transmission and reflection, whereas amplitudes of the symmetric mode S0 are not sensitive to the fracture degree. The quantitative results consistently indicate that reflection energy and transmission coefficients of the S0 and A0 modes can be used to quantify the mode interaction in the fractured long bone and further to evaluate long bone fracture status. Future study is needed to investigate the physical experiments on realistic fractured long bone and to insure that the proposed ultrasound parameters can be used to quantitatively evaluate the long bone fracture in clinical application. Copyright © 2013 Elsevier B.V. All rights reserved.

  4. [Clinal analysis of 202 nasal bone fractures cases].

    Science.gov (United States)

    Zhong, Zhenhua; Fan, Xihui; Lian, Zhuang; Cheng, Zexing; Zhuang, Yuanling

    2014-12-01

    To evaluate the age, sex, etiology, diagnosis and treatment time of nasal bone fractures. Clinical data of 202 cases with nasal bone fractures treated in the hospital were retrospectively analysed. A total of 202 cases,163 men (80. 7%) and 39 women (19. 3%). Fifty-two patients had a relationship with alcohol consumption, and all of them were males. The most frequent reasons of the injury were fight 46. 5% (94 cases) followed by falling-down 21. 3% (43 cases), traffic accidents 19. 3% (39 cases), works related 6. 5% (13 cases), sport injuries 5. 9% (12 cases) and others 0. 5% (1 cases). Patients distribution in seasons were: spring 54 cases (26.7%), summer 42 cases (20.8%), autumn 58 cases (28.7%), winter 48 cases (23. 8%). Diagnosis of nasal bone fractures were made positively by x-ray films in 79. 7% of cases, but 100% by CT. Positive predictive value of CT was superior to that of X-ray films in the diagnosis of nasal bone fracture. High morbidity of nasal bone fracture was seen in the age group of 20-29 years, and predominantly in male. Fight was found to be the main etiologic factor. We think that CT is necessary for diagnosing nasal bone fracture.

  5. Open intramedullary nailing for segmental long bone fractures: an ...

    African Journals Online (AJOL)

    Background: Closed, locked intramedullary nailing has been accepted as the gold standard in the care of femoral fractures, with reported union rates as high as 98–100%. Closed, locked intramedullary nailing often requires expensive equipment which is a challenge in developing countries. Segmental long bone fractures ...

  6. Operative stabilization of open long bone fractures: A tropical tertiary ...

    African Journals Online (AJOL)

    Background: Operative treatment of open fractures in our environment is fraught with problems of availability of theater space, appropriate hardware, and instrumentation such that high complication rates may be expected. Materials and Methods: We evaluated all open long bone fractures operatively stabilized at our center ...

  7. Mortality associated with bone fractures in COPD patients

    Science.gov (United States)

    Yamauchi, Yasuhiro; Yasunaga, Hideo; Sakamoto, Yukiyo; Hasegawa, Wakae; Takeshima, Hideyuki; Urushiyama, Hirokazu; Jo, Taisuke; Matsui, Hiroki; Fushimi, Kiyohide; Nagase, Takahide

    2016-01-01

    Background and objective COPD is well known to frequently coexist with osteoporosis. Bone fractures often occur and may affect mortality in COPD patients. However, in-hospital mortality related to bone fractures in COPD patients has been poorly studied. This retrospective study investigated in-hospital mortality of COPD patients with bone fractures using a national inpatient database in Japan. Methods Data of COPD patients admitted with bone fractures, including hip, vertebra, shoulder, and forearm fractures to 1,165 hospitals in Japan between July 2010 and March 2013, were extracted from the Diagnosis Procedure Combination database. The clinical characteristics and mortalities of the patients were determined. Multivariable logistic regression analysis was also performed to determine the factors associated with in-hospital mortality of COPD patients with hip fractures. Results Among 5,975 eligible patients, those with hip fractures (n=4,059) were older, had lower body mass index (BMI), and had poorer general condition than those with vertebral (n=1,477), shoulder (n=281), or forearm (n=158) fractures. In-hospital mortality was 7.4%, 5.2%, 3.9%, and 1.3%, respectively. Among the hip fracture group, surgical treatment was significantly associated with lower mortality (adjusted odds ratio, 0.43; 95% confidence interval, 0.32–0.56) after adjustment for patient backgrounds. Higher in-hospital mortality was associated with male sex, lower BMI, lower level of consciousness, and having several comorbidities, including pneumonia, lung cancer, congestive heart failure, chronic liver disease, and chronic renal failure. Conclusion COPD patients with hip fractures had higher mortality than COPD patients with other types of fracture. Surgery for hip fracture was associated with lower mortality than conservative treatment. PMID:27703343

  8. Mortality associated with bone fractures in COPD patients.

    Science.gov (United States)

    Yamauchi, Yasuhiro; Yasunaga, Hideo; Sakamoto, Yukiyo; Hasegawa, Wakae; Takeshima, Hideyuki; Urushiyama, Hirokazu; Jo, Taisuke; Matsui, Hiroki; Fushimi, Kiyohide; Nagase, Takahide

    2016-01-01

    COPD is well known to frequently coexist with osteoporosis. Bone fractures often occur and may affect mortality in COPD patients. However, in-hospital mortality related to bone fractures in COPD patients has been poorly studied. This retrospective study investigated in-hospital mortality of COPD patients with bone fractures using a national inpatient database in Japan. Data of COPD patients admitted with bone fractures, including hip, vertebra, shoulder, and forearm fractures to 1,165 hospitals in Japan between July 2010 and March 2013, were extracted from the Diagnosis Procedure Combination database. The clinical characteristics and mortalities of the patients were determined. Multivariable logistic regression analysis was also performed to determine the factors associated with in-hospital mortality of COPD patients with hip fractures. Among 5,975 eligible patients, those with hip fractures (n=4,059) were older, had lower body mass index (BMI), and had poorer general condition than those with vertebral (n=1,477), shoulder (n=281), or forearm (n=158) fractures. In-hospital mortality was 7.4%, 5.2%, 3.9%, and 1.3%, respectively. Among the hip fracture group, surgical treatment was significantly associated with lower mortality (adjusted odds ratio, 0.43; 95% confidence interval, 0.32-0.56) after adjustment for patient backgrounds. Higher in-hospital mortality was associated with male sex, lower BMI, lower level of consciousness, and having several comorbidities, including pneumonia, lung cancer, congestive heart failure, chronic liver disease, and chronic renal failure. COPD patients with hip fractures had higher mortality than COPD patients with other types of fracture. Surgery for hip fracture was associated with lower mortality than conservative treatment.

  9. Identifying Novel Clinical Surrogates to Assess Human Bone Fracture Toughness.

    Science.gov (United States)

    Granke, Mathilde; Makowski, Alexander J; Uppuganti, Sasidhar; Does, Mark D; Nyman, Jeffry S

    2015-07-01

    Fracture risk does not solely depend on strength but also on fracture toughness; ie, the ability of bone material to resist crack initiation and propagation. Because resistance to crack growth largely depends on bone properties at the tissue level, including collagen characteristics, current X-ray based assessment tools may not be suitable to identify age-related, disease-related, or treatment-related changes in fracture toughness. To identify useful clinical surrogates that could improve the assessment of fracture resistance, we investigated the potential of (1)H nuclear magnetic resonance spectroscopy (NMR) and reference point indentation (RPI) to explain age-related variance in fracture toughness. Harvested from cadaveric femurs (62 human donors), single-edge notched beam (SENB) specimens of cortical bone underwent fracture toughness testing (R-curve method). NMR-derived bound water showed the strongest correlation with fracture toughness properties (r = 0.63 for crack initiation, r = 0.35 for crack growth, and r = 0.45 for overall fracture toughness; p toughness properties were best explained by a combination of NMR properties including pore water and RPI-derived tissue stiffness with age as a significant covariate (adjusted R(2)  = 53.3%, 23.9%, and 35.2% for crack initiation, crack growth, and overall toughness, respectively; p toughness and emphasize the utility of a multimodal assessment of fracture resistance. Exploring the mechanistic origin of fracture toughness, glycation-mediated nonenzymatic collagen crosslinks and intracortical porosity are possible determinants of bone fracture toughness and could explain the sensitivity of NMR to changes in fracture toughness. Assuming fracture toughness is clinically important to the ability of bone to resist fracture, our results suggest that improvements in fracture risk assessment could potentially be achieved by accounting for water distribution (quantitative ultrashort echo time magnetic

  10. Hearing and Mortality Outcomes following Temporal Bone Fractures.

    Science.gov (United States)

    Honeybrook, Adam; Patki, Aniruddha; Chapurin, Nikita; Woodard, Charles

    2017-12-01

    The aim of this article is to determine hearing and mortality outcomes following temporal bone fractures. Retrospective chart review was performed of 152 patients diagnosed with a temporal bone fracture presenting to the emergency room at a tertiary care referral center over a 10-year period. Utilizing Patients' previously obtained temporal bone computed tomographic scans and audiograms, fractures were classified based on several classification schemes. Correlations between fracture patterns, mortality, and hearing outcomes were analyzed using χ 2 tests. Ossicular chain disruption was seen in 11.8% of patients, and otic capsule violation was seen in 5.9%; 22.7% of patients presented for audiologic follow-up. Seventeen patients with conductive hearing loss had air-bone gaps of 26 ± 7.5 dB (500 Hz), 27 ± 6.8 dB (1,000 Hz), 18 ± 6.2 dB (2,000 Hz), and 32 ± 7.7 dB (4,000 Hz). Two cases of profound sensorineural hearing loss were associated with otic capsule violation. No fracture classification scheme was predictive of hearing loss, although longitudinal fractures were statistically associated with ossicular chain disruption ( p  fractures in patients older than 60 years carried a relative risk of death of 3.15 compared with those younger than 60 years. The average magnitude of conductive hearing loss resulting from temporal bone fracture ranged from 18 to 32 dB in this cohort. Classification of fracture type was not predictive of hearing loss, despite the statistical association between ossicular chain disruption and longitudinal fractures. This finding may be due to the low follow-up rates of this patient population. Physicians should make a concerted effort to ensure that audiological monitoring is executed to prevent and manage long-term hearing impairment.

  11. Muscle-bone Interactions During Fracture Healing

    Science.gov (United States)

    2015-03-01

    fracture heal - ing. The rate of delayed union or non-union in tibial fractures with associated compartment syndrome was 55...complications of open tibial shaft fractures stratified as per the Gustilo–Ander- son classification. Injury 2011;42:1408-15. 121. Giannoudis PV, Harwood PJ...Kontakis G, et al. Long- term quality of life in trauma patients following the full spectrum of tibial injury (fasciotomy, closed fracture , grade

  12. The Value of Radionuclide Bone Imaging in Defining Fresh Fractures Among Osteoporotic Vertebral Compression Fractures.

    Science.gov (United States)

    Zhao, Quan-Ming; Gu, Xiao-Feng; Liu, Zhong-Tang; Cheng, Li

    2016-05-01

    Vertebral fractures are the most common osteoporotic fractures. To perform percutaneous vertebral body cement augmentation, it is essential to accurately identify the affected vertebrae. The study evaluated the role of radionuclide bone imaging in identifying fresh osteoporotic vertebral compression fractures. A prospective study of 39 patients with acute osteoporotic vertebral compression fractures was carried out. All patients underwent magnetic resonance imaging (MRI) and radionuclide bone imaging to determine if the fractures were fresh, followed by percutaneous kyphoplasty for the fresh fractures. The positive rate on radionuclide bone imaging was 92.1% (82/89), and the positive rate on MRI was 93.3% (83/89), with no statistically significant difference (P > 0.05). Eighty-one vertebrae had the same positive identification by both radionuclide bone imaging and MRI, and 5 of the same vertebrae were diagnosed negative by both techniques. One patient with positive radionuclide bone imaging was negative according to MRI, and 2 patients were entirely positive by MRI but negative by radionuclide bone imaging. A kappa test showed good consistency between the 2 methods for detecting the affected vertebrae (Kappa = 0.751, P osteoporotic vertebral compression fracture, making it an effective method for detecting affected vertebrae for percutaneous vertebroplasty.

  13. The fracture properties and toughening mechanisms of bone and dentin

    Science.gov (United States)

    Koester, Kurt John

    The mechanical properties of bone and dentin and in particular their fracture properties, are the subject of intense research. The relevance of these properties is increasing as our population ages and fracture incidence impacts the lives of a greater portion of the population. A robust framework is needed to understand the fracture properties of bone and dentin to guide researchers as they attempt to characterize the effects of aging, disease, and pharmaceutical treatments on the properties of these mineralized tissues. In the present work, this framework is provided and applied to human bone, human dentin, and animal bone. In situ electron microscopy was also used to identify the salient toughening mechanisms in bone and dentin. It was found that bone and dentin are extrinsically toughened materials and consequently their fracture properties are best characterized utilizing a crack-growth resistance approach. A description of the different mechanical measurements commonly employed when using small animal models (rats and mice) to evaluate the influence of drug therapies on bone fragility is provided. A study where these properties were measured for a large population of wild-type rats and mice was also conducted. Given my findings, it was determined that for the most complete understanding of small animal bone it was necessary to measure strength and toughness. Strength measurements probe the flaw distribution and toughness measurements to evaluate the resistance to facture in the presence of a single dominant worst-case flaw.

  14. Sensitivity Analysis of the Bone Fracture Risk Model

    Science.gov (United States)

    Lewandowski, Beth; Myers, Jerry; Sibonga, Jean Diane

    2017-01-01

    Introduction: The probability of bone fracture during and after spaceflight is quantified to aid in mission planning, to determine required astronaut fitness standards and training requirements and to inform countermeasure research and design. Probability is quantified with a probabilistic modeling approach where distributions of model parameter values, instead of single deterministic values, capture the parameter variability within the astronaut population and fracture predictions are probability distributions with a mean value and an associated uncertainty. Because of this uncertainty, the model in its current state cannot discern an effect of countermeasures on fracture probability, for example between use and non-use of bisphosphonates or between spaceflight exercise performed with the Advanced Resistive Exercise Device (ARED) or on devices prior to installation of ARED on the International Space Station. This is thought to be due to the inability to measure key contributors to bone strength, for example, geometry and volumetric distributions of bone mass, with areal bone mineral density (BMD) measurement techniques. To further the applicability of model, we performed a parameter sensitivity study aimed at identifying those parameter uncertainties that most effect the model forecasts in order to determine what areas of the model needed enhancements for reducing uncertainty. Methods: The bone fracture risk model (BFxRM), originally published in (Nelson et al) is a probabilistic model that can assess the risk of astronaut bone fracture. This is accomplished by utilizing biomechanical models to assess the applied loads; utilizing models of spaceflight BMD loss in at-risk skeletal locations; quantifying bone strength through a relationship between areal BMD and bone failure load; and relating fracture risk index (FRI), the ratio of applied load to bone strength, to fracture probability. There are many factors associated with these calculations including

  15. Increased bone fractures among elderly United States hemodialysis patients.

    Science.gov (United States)

    Wagner, John; Jhaveri, Kenar D; Rosen, Lisa; Sunday, Suzanne; Mathew, Anna T; Fishbane, Steven

    2014-01-01

    Fractures are an important cause of morbidity in hemodialysis patients. Multiple advances in the treatment of mineral and bone disease in hemodialysis patients have occurred. The purpose of this study was to determine whether the rate of fractures in hemodialysis patients has changed over time. We studied US Renal Data System (USRDS) datasets to determine the rates of hospitalized fractures among hemodialysis patients. The primary outcome was incidence of fractures requiring hospitalization. The fracture rate per 1000 person-years was calculated by year from 1992 to 2009. The first 90 days after initiating dialysis were excluded from analysis. The incidence of hip and vertebral fractures increased from 12.5 fractures per 1000 patient-years in 1992 to 25.3 per 1000 patient-years in 2004 (P fractures increased from 3.2 per 1000 patient-years in 1992 to 7.7 per 1000 patient-years in 2009 (P fracture rate was seen in white patients >65 years of age. After 2004, the incidence rate of these fractures stabilized and subtly declined, but did not decrease significantly. Fracture rates increased significantly in hemodialysis patients from 1992 to 2004, with most of the increase occurring in elderly white patients. Assessment of fracture risk and management in dialysis patients at greatest risk requires greater emphasis and further study.

  16. Bone biology in the elderly: clinical importance for fracture treatment

    Directory of Open Access Journals (Sweden)

    Rolvien Tim

    2016-12-01

    Full Text Available Age-related bone impairment often leads to fragility fractures in the elderly. Although excellent surgical care is widely provided, diagnosis and treatment of the underlying bone disorder are often not kept in mind. The interplay of the three major bone cells – osteoblasts, osteoclasts, and osteocytes – is normally well regulated via the secretion of messengers to control bone remodeling. Possible imbalances that might occur in the elderly are partly due to age, genetic risk factors, and adverse lifestyle factors but importantly also due to imbalances in calcium homeostasis (mostly due to vitamin D deficiency or hypochlorhydria, which have to be eliminated. Therefore, the cooperation between the trauma surgeon and the osteologist is of major importance to diagnose and treat the respective patients at risk. We propose that any patient suffering from fragility fractures is rigorously screened for osteoporosis and metabolic bone diseases. This includes bone density measurement by dual-energy X-ray absorptiometry, laboratory tests for calcium, phosphate, vitamin D, and bone turnover markers, as well as additional diagnostic modalities if needed. Thereby, most risk factors, including vitamin D deficiency, can be identified and treated while patients who meet the criteria for a specific therapy (i.e. antiresorptive and osteoanabolic receive such. If local health systems succeed to manage this process of secondary fracture prevention, morbidity and mortality of fragility fractures will decline to a minimum level.

  17. Development of an injectable pseudo-bone thermo-gel for application in small bone fractures.

    Science.gov (United States)

    Kondiah, Pariksha J; Choonara, Yahya E; Kondiah, Pierre P D; Kumar, Pradeep; Marimuthu, Thashree; du Toit, Lisa C; Pillay, Viness

    2017-03-30

    A pseudo-bone thermo-gel was synthesized and evaluated for its physicochemical, mechanical and rheological properties, with its application to treat small bone fractures. The pseudo-bone thermo-gel was proven to have thermo-responsive properties, behaving as a solution in temperatures below 25°C, and forming a gelling technology when maintained at physiological conditions. Poly propylene fumerate (PPF), Pluronic F127 and PEG-PCL-PEG were strategically blended, obtaining a thermo-responsive delivery system, to mimic the mechanical properties of bone with sufficient matrix hardness and resilience. A Biopharmaceutics Classification System (BCS) class II drug, simvastatin, was loaded in the pseudo-bone thermo-gel, selected for its bone healing properties. In vitro release analysis was undertaken on a series of experimental formulations, with the ideal formulations obtaining its maximum controlled drug release profile up to 14days. Ex vivo studies were undertaken on an induced 4mm diameter butterfly-fractured osteoporotic human clavicle bone samples. X-ray, ultrasound as well as textural analysis, undertaken on the fractured bones before and after treatment displayed significant bone filling, matrix hardening and matrix resilience properties. These characteristics of the pseudo-bone thermo-gel thus proved significant potential for application in small bone fractures. Copyright © 2017 Elsevier B.V. All rights reserved.

  18. Biophysical stimulation of bone fracture repair, regeneration and remodelling

    Directory of Open Access Journals (Sweden)

    Chao E. Y.S.

    2003-12-01

    Full Text Available Biophysical stimulation to enhance bone fracture repair and bone regenerate maturation to restore its structural strength must rely on both the biological and biomechanical principle according to the local tissue environment and the type of mechanical stress to be born by the skeletal joint system. This paper reviews the possible interactions between biophysical stimuli and cellular responses in healing bone fractures and proceeds to speculate the prospects and limitations of different experimental models in evaluating and optimising such non-invasive interventions. It is important to realize that bone fracture repair has several pathways with various combinations of bone formation mechanisms, but there may only be one bone remodeling principle regulated by the hypothesis proposed by Wolff. There are different mechanical and biophysical stimuli that could provide effective augmentation of fracture healing and bone regenerate maturation. The key requirements of establishing these positive interactions are to define the precise cellular response to the stimulation signal in an in vitro environment and to use well-established animal models to quantify and optimise the therapeutic regimen in a time-dependent manner. This can only be achieved through research collaboration among different disciplines using scientific methodologies. In addition, the specific forms of biophysical stimulation and its dose effect and application timing must be carefully determined and validated. Technological advances in achieving focalized stimulus delivery with adjustable signal type and intensity, in the ability to monitor healing callus mechanical property non-invasively, and in the establishment of a robust knowledgebase to develop effective and reliable treatment protocols are the essential pre-requisites to make biophysical stimulation acceptable in the main arena of health care. Finally, it is important to bear in mind that successful fracture repair or bone

  19. New regenerative treatment for tooth and periodontal bone defect associated with posttraumatic alveolar bone crush fracture.

    Science.gov (United States)

    Kiyokawa, Kensuke; Kiyokawa, Munekatsu; Takagi, Mikako; Rikimaru, Hideaki; Fukaya, Takuji

    2009-05-01

    We developed a new regenerative treatment of tooth and periodontal defect and tooth dislocation associated with posttraumatic alveolar bone crush fracture in the region of the maxillary anterior teeth. Using this method, dislocated teeth are first extracted and crushed alveolar bone is debrided. The dislocated teeth are then reimplanted, and cancellous iliac bone (bone marrow) is grafted to the area surrounding the teeth to regenerate periodontal bone. Tooth reimplantation was completely successful in 2 cases, and periodontal bone regenerated to a sufficient height with the iliac bone graft. Compared with the general method of treatment with a prosthesis (bridge), when using this method to treat cases such as these, there is no sacrifice of healthy teeth adjacent to the defect, and sufficient esthetic and functional recovery is possible. It is thought that this method could be applied as a new treatment of alveolar bone fracture in the future.

  20. Comparison of ultrasonography with computed tomography in the diagnosis of nasal bone fractures.

    Science.gov (United States)

    Javadrashid, R; Khatoonabad, M; Shams, N; Esmaeili, F; Jabbari Khamnei, H

    2011-12-01

    The aim of this study is to compare ultrasonography with CT in the diagnosis of nasal bone fractures. 40 patients (9 female and 31 male) with mid-facial fractures, which were suspected nasal bone fractures, were included. All of the patients had mid-facial CT images. Ultrasonography with a 7.5 MHz transducer (Aloka 3500, Tokyo, Japan) was used to evaluate the nasal bone fractures. All of the sonograms were compared with CT findings for sensitivity, specificity and predictive values. A χ(2) test was applied to the data to assess statistical significance. CT diagnosed nasal bone fractures in 24 of the 40 patients (9 unilateral fractures and 15 bilateral fractures) while ultrasonography diagnosed the fractured bones in 23 patients (9 unilateral fractures and 14 bilateral fractures). Ultrasonography missed one fractured bone in a bilateral fractured case and a unilateral fracture was also missed (two false-negative results). The sensitivity and specificity of ultrasonography in assessing nasal bone fracture in comparison with CT were 94.9% and 100%, respectively. The positive predictive value (PPV) and the negative predictive value (NPV) of ultrasonographic evaluation of the nasal bone fractures were 100% and 95.3%, respectively. The χ(2) test did not show any significant difference between CT and ultrasonography in diagnosis of nasal bone fractures (P = 0.819). Ultrasonography can be used as a first line of diagnostic imaging for evaluating nasal bone fractures, especially in children and pregnant women.

  1. Axial and appendicular bone density predict fractures in older women

    Science.gov (United States)

    Black, D. M.; Cummings, S. R.; Genant, H. K.; Nevitt, M. C.; Palermo, L.; Browner, W.

    1992-01-01

    To determine whether measurement of hip and spine bone mass by dual-energy x-ray absorptiometry (DEXA) predicts fractures in women and to compare the predictive value of DEXA with that of single-photon absorptiometry (SPA) of appendicular sites, we prospectively studied 8134 nonblack women age 65 years and older who had both DEXA and SPA measurements of bone mass. A total of 208 nonspine fractures, including 37 wrist fractures, occurred during the follow-up period, which averaged 0.7 years. The risk of fracture was inversely related to bone density at all measurement sites. After adjusting for age, the relative risks per decrease of 1 standard deviation in bone density for the occurrence of any fracture was 1.40 for measurement at the proximal femur (95% confidence interval 1.20-1.63) and 1.35 (1.15-1.58) for measurement at the spine. Results were similar for all regions of the proximal femur as well as SPA measurements at the calcaneus, distal radius, and proximal radius. None of these measurements was a significantly better predictor of fractures than the others. Furthermore, measurement of the distal radius was not a better predictor of wrist fracture (relative risk 1.64: 95% CI 1.13-2.37) than other sites, such as the lumbar spine (RR 1.56; CI 1.07-2.26), the femoral neck (RR 1.65; CI 1.12-2.41), or the calcaneus (RR 1.83; CI 1.26-2.64). We conclude that the inverse relationship between bone mass and risk of fracture in older women is similar for absorptiometric measurements made at the hip, spine, and appendicular sites.

  2. Magnetic resonance imaging versus bone scintigraphy in suspected scaphoid fracture

    Energy Technology Data Exchange (ETDEWEB)

    Tiel-van Buul, M.M.C. [Dept. of Nuclear Medicine, Academic Medical Center, Univ. of Amsterdam (Netherlands); Roolker, W. [Dept. of Nuclear Medicine, Academic Medical Center, Univ. of Amsterdam (Netherlands); Verbeeten, B.W.B. Jr. [Dept. of Radiology, Academic Medical Center, Univ. of Amsterdam (Netherlands); Broekhuizen, A.H. [Dept. of Traumatology, Academic Medical Center, Univ. of Amsredam (Netherlands)

    1996-08-01

    Magnetic resonance imaging (MRI) has become increasingly useful in the evaluation of musculoskeletal problems, including those of the wrist. In patients with a wrist injury, MRI is used mainly to assess vascularity of scaphoid non-union. However, the use of MRI in patients in the acute phase following carpal injury is not common. Three-phase bone scintigraphy is routinely performed from at least 72 h after injury in patients with suspected scaphoid fracture and negative initial radiographs. We evaluated MRI in this patient group. The bone scan was used as the reference method. Nineteen patients were included. Bone scintigraphy was performed in all 19 patients, but MRI could be obtained in only 16 (in three patients, MRI was stopped owing to claustrophobia). In five patients, MRI confirmed a scintigraphically suspected scaphoid fracture. In one patient, a perilunar luxation, without a fracture, was seen on MRI, while bone scintigraphy showed a hot spot in the region of the lunate bone, suspected for fracture. This was confirmed by surgery. In two patients, a hot spot in the scaphoid region was suspected for scaphoid fracture, and immobilization and employed for a period of 12 weeks. MRI was negative in both cases; in one of them a scaphoid fracture was retrospectively proven on the initial X-ray series. In another two patients, a hot spot in the region of MCP I was found with a negative MRI. In both, the therapy was adjusted. In the remaining six patients, both modalities were negative. We conclude that in the diagnostic management of patients with suspected scaphoid fracture and negative initial radiographs, the use of MRI may be promising, but is not superior to three-phase bone scintigraphy. (orig.)

  3. The Impact of Type 2 Diabetes on Bone Fracture Healing

    Directory of Open Access Journals (Sweden)

    Carlos Marin

    2018-01-01

    Full Text Available Type 2 diabetes mellitus (T2DM is a chronic metabolic disease known by the presence of elevated blood glucose levels. Nowadays, it is perceived as a worldwide epidemic, with a very high socioeconomic impact on public health. Many are the complications caused by this chronic disorder, including a negative impact on the cardiovascular system, kidneys, eyes, muscle, blood vessels, and nervous system. Recently, there has been increasing evidence suggesting that T2DM also adversely affects the skeletal system, causing detrimental bone effects such as bone quality deterioration, loss of bone strength, increased fracture risk, and impaired bone healing. Nevertheless, the precise mechanisms by which T2DM causes detrimental effects on bone tissue are still elusive and remain poorly studied. The aim of this review was to synthesize current knowledge on the different factors influencing the impairment of bone fracture healing under T2DM conditions. Here, we discuss new approaches used in recent studies to unveil the mechanisms and fill the existing gaps in the scientific understanding of the relationship between T2DM, bone tissue, and bone fracture healing.

  4. Pediatric Temporal Bone Fractures: A 10-Year Experience.

    Science.gov (United States)

    Wexler, Sonya; Poletto, Erica; Chennupati, Sri Kiran

    2017-11-01

    The aim of the study was to compare the traditional and newer temporal bone fracture classification systems and their reliability in predicting serious outcomes of hearing loss and facial nerve (FN) injury. We queried the medical record database for hospital visits from 2002 to 2013 related to the search term temporal. A total of 1144 records were identified, and of these, 46 records with documented temporal bone fractures were reviewed for patient age, etiology and classification of the temporal bone fracture, FN examination, and hearing status. Of these records, radiology images were available for 38 patients and 40 fractures. Thirty-eight patients with accessible radiologic studies, aged 10 months to 16 years, were identified as having 40 temporal bone fractures for which the otolaryngology service was consulted. Twenty fractures (50.0%) were classified as longitudinal, 5 (12.5%) as transverse, and 15 (37.5%) as mixed. Using the otic capsule sparing (OCS)/violating nomenclature, 32 (80.0%) of fractures were classified as OCS, 2 (5.0%) otic capsule violating (OCV), and 6 (15.0%) could not be classified using this system. The otic capsule was involved in 1 (5%) of the longitudinal fractures, none of the transverse fractures, and 1 (6.7%) of the mixed fractures. Sensorineural hearing loss was found in only 2 fractures (5.0%) and conductive hearing loss (CHL) in 6 fractures (15.0%). Two fractures (5.0%) had ipsilateral facial palsy but no visualized fracture through the course of the FN canal. Neither the longitudinal/transverse/mixed nor OCS/OCV classifications were predictors of sensorineural hearing loss (SNHL), CHL, or FN involvement by Fisher exact statistical analysis (for SNHL: P = 0.37 vs 0.16; for CHL: P = 0.71 vs 0.33; for FN: P = 0.62 vs 0.94, respectively). In this large pediatric series, neither classification system of longitudinal/transverse/mixed nor OCS/OCV was predictive of SNHL, CHL, or FN palsy. A more robust database of audiologic results would

  5. Mandibular bone changes in 24 years and skeletal fracture prediction.

    Science.gov (United States)

    Jonasson, G; Sundh, V; Hakeberg, M; Hassani-Nejad, A; Lissner, L; Ahlqwist, M

    2013-03-01

    The objectives of the investigation were to describe changes in mandibular bone structure with aging and to compare the usefulness of cortical and trabecular bone for fracture prediction. From 1968 to 1993, 1,003 women were examined. With the help of panoramic radiographs, cortex thickness was measured and cortex was categorized as: normal, moderately, or severely eroded. The trabeculation was assessed as sparse, mixed, or dense. Visually, the mandibular compact and trabecular bone transformed gradually during the 24 years. The compact bone became more porous, the intertrabecular spaces increased, and the radiographic image of the trabeculae seemed less mineralized. Cortex thickness increased up to the age of 50 and decreased significantly thereafter. At all examinations, the sparse trabeculation group had more fractures (71-78 %) than the non-sparse group (27-31 %), whereas the severely eroded compact group showed more fractures than the less eroded groups only in 1992/1993, 24 years later. Sparse trabecular pattern was associated with future fractures both in perimenopausal and older women (relative risk (RR), 1.47-4.37) and cortical erosion in older women (RR, 1.35-1.55). RR for future fracture associated with a severely eroded cortex increased to 4.98 for cohort 1930 in 1992/1993. RR for future fracture associated with sparse trabeculation increased to 11.43 for cohort 1922 in 1992/1993. Dental radiographs contain enough information to identify women most at risk of future fracture. When observing sparse mandibular trabeculation, dentists can identify 40-69 % of women at risk for future fractures, depending on participant age at examination.

  6. Exercise in youth: High bone mass, large bone size, and low fracture risk in old age.

    Science.gov (United States)

    Tveit, M; Rosengren, B E; Nilsson, J Å; Karlsson, M K

    2015-08-01

    Physical activity is favorable for peak bone mass but if the skeletal benefits remain and influence fracture risk in old age is debated. In a cross-sectional controlled mixed model design, we compared dual X-ray absorptiometry-derived bone mineral density (BMD) and bone size in 193 active and retired male elite soccer players and 280 controls, with duplicate measurements of the same individual done a mean 5 years apart. To evaluate lifetime fractures, we used a retrospective controlled study design in 397 retired male elite soccer players and 1368 controls. Differences in bone traits were evaluated by Student's t-test and fracture risk assessments by Poisson regression and Cox regression. More than 30 years after retirement from sports, the soccer players had a Z-score for total body BMD of 0.4 (0.1 to 0.6), leg BMD of 0.5 (0.2 to 0.8), and femoral neck area of 0.3 (0.0 to 0.5). The rate ratio for fracture after career end was 0.6 (0.4 to 0.9) and for any fragility fracture 0.4 (0.2 to 0.9). Exercise-associated bone trait benefits are found long term after retirement from sports together with a lower fracture risk. This indicates that physical activity in youth could reduce the burden of fragility fractures. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  7. Identification tibia and fibula bone fracture location using scanline algorithm

    Science.gov (United States)

    Muchtar, M. A.; Simanjuntak, S. E.; Rahmat, R. F.; Mawengkang, H.; Zarlis, M.; Sitompul, O. S.; Winanto, I. D.; Andayani, U.; Syahputra, M. F.; Siregar, I.; Nasution, T. H.

    2018-03-01

    Fracture is a condition that there is a damage in the continuity of the bone, usually caused by stress, trauma or weak bones. The tibia and fibula are two separated-long bones in the lower leg, closely linked at the knee and ankle. Tibia/fibula fracture often happen when there is too much force applied to the bone that it can withstand. One of the way to identify the location of tibia/fibula fracture is to read X-ray image manually. Visual examination requires more time and allows for errors in identification due to the noise in image. In addition, reading X-ray needs highlighting background to make the objects in X-ray image appear more clearly. Therefore, a method is required to help radiologist to identify the location of tibia/fibula fracture. We propose some image-processing techniques for processing cruris image and Scan line algorithm for the identification of fracture location. The result shows that our proposed method is able to identify it and reach up to 87.5% of accuracy.

  8. A comparison of bone density and bone morphology between patients presenting with hip fractures, spinal fractures or a combination of the two

    Science.gov (United States)

    2013-01-01

    Background Currently it is uncertain how to define osteoporosis and who to treat after a hip fracture. There is little to support the universal treatment of all such patients but how to select those most in need of treatment is not clear. In this study we have compared cortical and trabecular bone status between patients with spinal fractures and those with hip fracture with or without spinal fracture with the aim to begin to identify, by a simple clinical method (spine x-ray), a group of hip fracture patients likely to be more responsive to treatment with current antiresorptive agents. Methods Comparison of convenience samples of three groups of 50 patients, one with spinal fractures, one with a hip fracture, and one with both. Measurements consist of bone mineral density at the lumbar spine, at the four standard hip sites, number, distribution and severity of spinal fractures by the method of Genant, cortical bone thickness at the infero-medial femoral neck site, femoral neck and axis length and femoral neck width. Results Patients with spinal fractures alone have the most deficient bones at both trabecular and cortical sites: those with hip fracture and no spinal fractures the best at trabecular bone and most cortical bone sites: and those with both hip and spinal fractures intermediate in most measurements. Hip axis length and neck width did not differ between groups. Conclusion The presence of the spinal fracture indicates poor trabecular bone status in hip fracture patients. Hip fracture patients without spinal fractures have a bone mass similar to the reference range for their age and gender. Poor trabecular bone in hip fracture patients may point to a category of patient more likely to benefit from therapy and may be indicated by the presence of spinal fractures. PMID:23432767

  9. Comparison in bone turnover markers during early healing of femoral neck fracture and trochanteric fracture in elderly patients

    Directory of Open Access Journals (Sweden)

    Shota Ikegami

    2009-10-01

    Full Text Available Healing of fractures is different for each bone and bone turnover markers may reflect the fracture healing process. The purpose of this study was to determine the characteristic changes in bone turnover markers during the fracture healing process. The subjects were consecutive patients with femoral neck or trochanteric fracture who underwent surgery and achieved bone union. There were a total of 39 patients, including 33 women and 6 men. There were 18 patients (16 women and 2 men with femoral neck fracture and 21 patients (17 women and 4 men with trochanteric fracture. Serum bone-specific alkaline phosphatase (BAP was measured as a bone formation marker. Urine and serum levels of N-terminal telopeptide of type I collagen (NTX, as well as urine levels of C-terminal telopeptide of type I collagen (CTX and deoxypyridinoline (DPD, were measured as markers of bone resorption. All bone turnover markers showed similar changes in patients with either type of fracture, but significantly higher levels of both bone formation and resorption markers were observed in trochanteric fracture patients than in neck fracture patients. BAP showed similar levels at one week after surgery and then increased. Bone resorption markers were increased after surgery in patients with either fracture. The markers reached their peak values at three weeks (BAP and urinary NTX, five weeks (serum NTX and DPD, and 2-3 weeks (CTX after surgery. The increase in bone turnover markers after hip fracture surgery and the subsequent decrease may reflect increased bone formation and remodeling during the healing process. Both fractures had a similar bone turnover marker profile, but the extent of the changes differed between femoral neck and trochanteric fractures.

  10. Comparison in bone turnover markers during early healing of femoral neck fracture and trochanteric fracture in elderly patients.

    Science.gov (United States)

    Ikegami, Shota; Kamimura, Mikio; Nakagawa, Hiroyuki; Takahara, Kenji; Hashidate, Hiroyuki; Uchiyama, Shigeharu; Kato, Hiroyuki

    2009-10-10

    Healing of fractures is different for each bone and bone turnover markers may reflect the fracture healing process. The purpose of this study was to determine the characteristic changes in bone turnover markers during the fracture healing process. The subjects were consecutive patients with femoral neck or trochanteric fracture who underwent surgery and achieved bone union. There were a total of 39 patients, including 33 women and 6 men. There were 18 patients (16 women and 2 men) with femoral neck fracture and 21 patients (17 women and 4 men) with trochanteric fracture. Serum bone-specific alkaline phosphatase (BAP) was measured as a bone formation marker. Urine and serum levels of N-terminal telopeptide of type I collagen (NTX), as well as urine levels of C-terminal telopeptide of type I collagen (CTX) and deoxypyridinoline (DPD), were measured as markers of bone resorption. All bone turnover markers showed similar changes in patients with either type of fracture, but significantly higher levels of both bone formation and resorption markers were observed in trochanteric fracture patients than in neck fracture patients. BAP showed similar levels at one week after surgery and then increased. Bone resorption markers were increased after surgery in patients with either fracture. The markers reached their peak values at three weeks (BAP and urinary NTX), five weeks (serum NTX and DPD), and 2-3 weeks (CTX) after surgery. The increase in bone turnover markers after hip fracture surgery and the subsequent decrease may reflect increased bone formation and remodeling during the healing process. Both fractures had a similar bone turnover marker profile, but the extent of the changes differed between femoral neck and trochanteric fractures.

  11. Roles of Chondrocytes in Endochondral Bone Formation and Fracture Repair.

    Science.gov (United States)

    Hinton, R J; Jing, Y; Jing, J; Feng, J Q

    2017-01-01

    The formation of the mandibular condylar cartilage (MCC) and its subchondral bone is an important but understudied topic in dental research. The current concept regarding endochondral bone formation postulates that most hypertrophic chondrocytes undergo programmed cell death prior to bone formation. Under this paradigm, the MCC and its underlying bone are thought to result from 2 closely linked but separate processes: chondrogenesis and osteogenesis. However, recent investigations using cell lineage tracing techniques have demonstrated that many, perhaps the majority, of bone cells are derived via direct transformation from chondrocytes. In this review, the authors will briefly discuss the history of this idea and describe recent studies that clearly demonstrate that the direct transformation of chondrocytes into bone cells is common in both long bone and mandibular condyle development and during bone fracture repair. The authors will also provide new evidence of a distinct difference in ossification orientation in the condylar ramus (1 ossification center) versus long bone ossification formation (2 ossification centers). Based on our recent findings and those of other laboratories, we propose a new model that contrasts the mode of bone formation in much of the mandibular ramus (chondrocyte-derived) with intramembranous bone formation of the mandibular body (non-chondrocyte-derived).

  12. The point of view of the veterinary surgeon: bone and fracture.

    Science.gov (United States)

    Autefage, A

    2000-09-01

    It is important to understand the biomechanics of fractures if the morphological characteristics of fracture, fracture treatment and fracture healing are to be understood. Because of the mechanical properties of bone, which is stronger in compression than in tension, a fracture line is initiated perpendicular to the direction of tension or in shear. The mechanical properties of bone are also time-dependent (viscoelasticity). Subsequently, when the load is applied at a higher load range, a greater amount of energy is stored within the bone, resulting in a more severe fracture (high energy fractures). There are five types of fracture: tension, compression, torque, bending, and shear, with typical morphologies: transverse fractures in tension, fracture line at 45 degrees to the long axis of the bone in compression, spiral fracture in torsion, combined transverse and butterfly fracture in bending, shear line when the overload is applied eccentrically. These different morphological types are shown on radiographs.

  13. Staged subtalar fusion for severe calcaneus fractures with bone loss.

    Science.gov (United States)

    Williams, Chad G; Coffey, Michael J; Shorten, Peter; Lyions, James D; Laughlin, Richard T

    2013-01-01

    With high energy fractures to the calcaneus there is the potential for significant bone loss. The loss of bone can make it difficult to fully regain calcaneal alignment. In addition these fractures are often associated with significant soft tissue injury. These two factors make it difficult to address this injury in a single stage, and can have significant complications. To address these issues our initial goal in treatment has been restoration of calcaneal alignment and stabilization of the surrounding soft tissue, followed by delayed/staged subtalar arthrodesis. Patients with calcaneus fractures treated by a single surgeon from 2002 to 2012 were reviewed. Injuries which were found to have medial extrusion of the posterior facet and bone loss, and subsequently underwent a staged protocol involving early provisional fixation and late subtalar fusion were included. We treated 6 calcaneus fractures with bone loss. All patients were treated with staged subtalar fusion after initial irrigation and debridement and provisional fixation. No soft-tissue complications were noted after the fusion procedure in any of the six cases. Fusion occurred in all six patients at an average of 20.6 weeks (range, 13-23 weeks). All patients were able to ambulate and wear a regular shoe by one year following the initial injury. It is important in the high energy calcaneus fracture to assess for both soft tissue integrity and bone loss. A thorough debridement of both the soft tissues and any devitalized bone should be performed as well as provisional fixation which attempts to restore near normal calcaneal anatomy. Definitive fusion should not be performed until the soft tissues have fully recovered.

  14. A case of cuboid bone stress fracture in a senior high school rugby athlete

    OpenAIRE

    Tetsuo Hagino; Satoshi Ochiai; Yoshiyuki Watanabe; Shinya Senga; Yoshihiro Takayama; Hirotaka Haro

    2014-01-01

    We report a case of cuboid bone stress fracture in a 17-year-old rugby athlete. Cuboid bone stress fractures are rare in athletes. When an athlete with no history of trauma presents with pain on the lateral side of the foot and no abnormality on plain radiograph, cuboid bone stress fracture should be suspected and magnetic resonance imaging should be conducted.

  15. Modeling the effects of inflammation in bone fracture healing

    Science.gov (United States)

    Kojouharov, H. V.; Trejo, I.; Chen-Charpentier, B. M.

    2017-10-01

    A new mathematical model is presented to study the early inflammatory effects in bone healing. It consists of a system of nonlinear ordinary differential equations that represents the interactions among macrophages, mesenchymal stem cells, and osteoblasts. A qualitative analysis of the model is performed to determine the equilibria and their corresponding stability properties. A set of numerical simulations is performed to support the theoretical results. The model is also used to numerically monitor the evolution of a broken bone for different types of fractures and to explore possible treatments to accelerate bone healing by administrating anti-inflammatory drugs.

  16. Long Bone Fracture And Ilizarov Techniques: A Nigerian Experience ...

    African Journals Online (AJOL)

    17 (41.5%) patients reported within the first week of trauma while 24 (58.5%) others presented between 2 weeks and 26 months with complications, effectively managed with Ilizarov apparatus and techniques. All fractures united, soft tissue infections controlled, osteomyelitis liquidated, missing bones replaced and limb ...

  17. Pattern and Trauma Mechanisms of Paediatric Long Bone Fractures ...

    African Journals Online (AJOL)

    Background: There are few reports on trauma mechanisms in children in Nigeria. Knowledge of the pattern of injuries and trauma mechanisms should help formulate injury prevention measures. The objective of this study was to determine the pattern and trauma mechanisms in children with long bone fractures managed in ...

  18. Repairing Fractured Bones by Use of Bioabsorbable Composites

    Science.gov (United States)

    Farley, Gary L.

    2006-01-01

    A proposed method of surgical repair of fractured bones would incorporate recent and future advances in the art of composite materials. The composite materials used in this method would be biocompatible and at least partly bioabsorbable: that is, during the healing process following surgery, they would be wholly or at least partly absorbed into the bones and other tissues in which they were implanted. Relative to the traditional method, the proposed method would involve less surgery, pose less of a risk of infection, provide for better transfer of loads across fracture sites, and thereby promote better healing while reducing the need for immobilization by casts and other external devices. One requirement that both the traditional and proposed methods must satisfy is to fix the multiple segments of a broken bone in the correct relative positions. Mechanical fixing techniques used in the traditional method include the use of plates spanning the fracture site and secured to the bone by screws, serving of wire along the bone across the fracture site, insertion of metallic intramedullary rods through the hollow portion of the fractured bone, and/or inserting transverse rods through the bone, muscle, and skin to stabilize the fractured members. After the bone heals, a second surgical operation is needed to remove the mechanical fixture(s). In the proposed method, there would be no need for a second surgical operation. The proposed method is based partly on the observation that in the fabrication of a structural member, it is generally more efficient and reliable to use multiple small fasteners to transfer load across a joint than to use a single or smaller number of larger fasteners, provided that the stress fields of neighboring small fasteners do not overlap or interact. Also, multiple smaller fasteners are more reliable than are larger and fewer fasteners. However, there is a trade-off between structural efficiency and the cost of insertion time and materials. The

  19. 99mTc-MDP bone scintigraphy in the diagnosis of stress fracture of the metatarsal bones mimicking oligoarthritis

    Directory of Open Access Journals (Sweden)

    Jauković Ljiljana

    2008-01-01

    Full Text Available Background. Stress fractures are the injuries of soft tissues and bones caused by intensive and repeated stress on a bone. Repeated submaximal stress disturbs the balance between the processes of bone production and resorption that results in fracture. Case report. We presented a case of a patient with stress fracture of metatarsal bone. The patient was diagnosed and treated as having reactive oligoarthritis caused by Chlamydia trachomatis and administered antibiotics. Initial plain radiography was negative for bone fracture. Tc-99m bone scintigraphy suggested stress fracture of the second metatarsal. Plain radiography was became positive three weeks later, showing callus formation in the proximal part of the second metatarsal. Conclusion. Bone scintigraphy is a diagnostic test of choice in early diagnosis of stress fracture, and it is important to apply it timely in order to include the entire therapy and prevent complications, as well as to let a patient return to previous daily activites.

  20. Preexisting lesions associated with complete diaphyseal fractures of the third metacarpal bone in 12 Thoroughbred racehorses.

    Science.gov (United States)

    Gray, Sarah N; Spriet, Mathieu; Garcia, Tanya C; Uzal, Francisco A; Stover, Susan M

    2017-07-01

    We characterized features of complete diaphyseal fractures of third metacarpal bones in Thoroughbred racehorses. Given that stress fractures are known to occur in the third metacarpal bone, an additional aim was to determine if complete fractures are associated with signs of a preexisting incomplete stress fracture. Bilateral metacarpi from 12 Thoroughbred racehorses euthanized because of complete unilateral metacarpal diaphyseal fracture were examined visually and radiographically. Open, comminuted, transverse or short oblique fractures occurred in the middle of the diaphysis or supracondylar region. Periosteal surface discoloration and bone callus formation contiguous with the fracture line were present in fractured bones. All contralateral intact metacarpi had gross anatomic lesions, and 10 had radiographic abnormalities similar to those observed on fractured metacarpi. Catastrophic metacarpal fractures occurred in racehorses with bilateral evidence of preexisting bone injury.

  1. Calcaneal quantitative ultrasound-bone mineral density value for evaluating bone metabolism and bone turnover in patients with osteoporotic fracture

    Directory of Open Access Journals (Sweden)

    Hong-Wei Yan

    2017-09-01

    Full Text Available Objective: To study the calcaneal quantitative ultrasound-bone mineral density (QUS-BMD value for evaluating bone metabolism and bone turnover in patients with osteoporotic fracture. Methods: A total of 150 patients who were diagnosed with osteoporotic fracture in Nuclear Industry 417 Hospital between January 2010 and March 2017 were selected as the fracture group of the research, and 70 subjects with normal bone mineral density confirmed by physical examination during the same period were selected as the control group of the research. QUSBMD apparatus was used to measure bone mineral density of calcaneus, and the serum was collected to determine the biochemical indexes of bone metabolism and bone turnover. Results: QUS-BMD value as well as serum BALP, OC, OPG levels of fracture group was significantly lower than those of control group while serum TRACP5b, RANKL, PINP, PICP, CTX and NTX levels were significantly higher than those of control group; serum BALP, OC, OPG levels of patients with osteoporosis and osteopenia were significantly lower than those of subjects with normal bone mass while TRACP5b, RANKL, PINP, PICP, CTX and NTX levels were significantly higher than those of subjects with normal bone mass; serum BALP, OC, OPG levels of patients with osteoporosis was significantly lower than those of patients with osteoporosis while TRACP5b, RANKL, PINP, PICP, CTX and NTX levels were significantly higher than those of patients with osteoporosis. Conclusion: Calcaneal QUS-BMD is valuable for evaluating the bone metabolism activity and bone turnover process in patients with osteoporotic fracture.

  2. Cortical bone fracture analysis using XFEM - case study.

    Science.gov (United States)

    Idkaidek, Ashraf; Jasiuk, Iwona

    2017-04-01

    We aim to achieve an accurate simulation of human cortical bone fracture using the extended finite element method within a commercial finite element software abaqus. A two-dimensional unit cell model of cortical bone is built based on a microscopy image of the mid-diaphysis of tibia of a 70-year-old human male donor. Each phase of this model, an interstitial bone, a cement line, and an osteon, are considered linear elastic and isotropic with material properties obtained by nanoindentation, taken from literature. The effect of using fracture analysis methods (cohesive segment approach versus linear elastic fracture mechanics approach), finite element type, and boundary conditions (traction, displacement, and mixed) on cortical bone crack initiation and propagation are studied. In this study cohesive segment damage evolution for a traction separation law based on energy and displacement is used. In addition, effects of the increment size and mesh density on analysis results are investigated. We find that both cohesive segment and linear elastic fracture mechanics approaches within the extended finite element method can effectively simulate cortical bone fracture. Mesh density and simulation increment size can influence analysis results when employing either approach, and using finer mesh and/or smaller increment size does not always provide more accurate results. Both approaches provide close but not identical results, and crack propagation speed is found to be slower when using the cohesive segment approach. Also, using reduced integration elements along with the cohesive segment approach decreases crack propagation speed compared with using full integration elements. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  3. Treatment of proximal fifth metatarsal bone fractures in athletes.

    Science.gov (United States)

    Japjec, M; Starešinić, M; Starjački, M; Žgaljardić, I; Štivičić, J; Šebečić, B

    2015-11-01

    Proximal fifth metatarsal (V MT) bone fractures are common injuries that are a major diagnostic and therapeutic challenge. Lawrence and Botte considered different treatment options and the possibility of recovery and divided these fractures into three different regions: tuberosity avulsion fractures (zone I), acute fractures of the metaphysis at the level of the intermetatarsal junction (zone II) and proximal diaphysis stress fracture (zone III). A total of 42 athletes with fracture of the V MT bone in zone II and III were treated in our institution during a 6-year period. All patients were offered surgical treatment, but nine patients refused surgery. Thus, the patients were divided into two groups: group 1 comprised 33 patients who underwent an intramedullary screw fixation operation under regional anaesthesia immediately after the fracture was diagnosed; group 2 contained the remaining nine patients who had refused surgery and received conservative therapy with non-weight-bearing short-leg casts or orthosis. Follow-up ranged from 6 to 24 months. All fractures healed in group 1: healing occurred within 8 weeks in 26 patients and was prolonged to 16 to 18 weeks in four patients. In group 2, fractures healed in four patients but did not heal in five patients even after 6 months. Four of the five patients in whom the fracture did not heal required subsequent osteosynthesis because they had constant problems that caused absence from sport. After the operation, their fractures healed in an average of 10 weeks. One patient decided not to undergo the operation due to the absence of subjective symptoms. Three patients in group 1 who started intensive training sustained a refracture and underwent re-operation in which osteosynthesis was performed with a stronger screw. The fractures then healed again. Treatment results were evaluated radiologically and clinically using the Modified Foot Score. Results in group 1 were significantly better than those in group 2 and there

  4. Fracture of the radial sesamoid bone of the thumb: an unusual fracture

    Directory of Open Access Journals (Sweden)

    Deabate Luca

    2012-02-01

    Full Text Available 【Abstract】The hand consists of five sesamoids. Two of them are present at the metacarpophalangeal (MCP joint of the thumb. Fracture of the sesamoid bones of the thumb is a rare injury and the literature on the radial side is seldom reported. We reported a case of a patient with a fracture of the radial sesamoid at the MCP joint of the thumb in order to increase attention regarding this type of injuries. A 44-year-old male, high level gymnastic trainer, was helping one of his athletes during an exercise while he reported a hyperextension trauma to the MCP joint of the right thumb. One week after trauma, he presented to the hand surgeon complaining of a painful thumb at the MCP joint level on its palmar aspect. Standard A-P and lateral X-rays revealed a fracture of the radial sesamoid and the fracture was treated with a splint for 3 weeks. He was able to resumed his entire work 6 weeks after the injury. The sesamoid fractures is an indicator of the magnitude of the hyperextension injury and sometimes associated with tears of the volar plate ligament of the MCP joint. And a failure to recognize the ligament injury may lead to a long-term hyperextension instability on pinching. Key words: Fracture, bone; Sesamoid bones; Thumb

  5. Do Laying Hens with Keel Bone Fractures Experience Pain?

    Science.gov (United States)

    Nasr, Mohammed A. F.; Nicol, Christine J.; Murrell, Joanna C.

    2012-01-01

    The European ban on battery cages has forced a change towards the use of non-cage or furnished cage systems, but unexpectedly this has been associated with an increased prevalence of keel bone fractures in laying hens. Bone fractures are acutely painful in mammals, but the effect of fractures on bird welfare is unclear. We recently reported that keel bone fractures have an effect on bird mobility. One possible explanation for this is that flying becomes mechanically impaired. However it is also possible that if birds have a capacity to feel pain, then ongoing pain resulting from the fracture could contribute to decreased mobility. The aim was to provide proof of concept that administration of appropriate analgesic drugs improves mobility in birds with keel fracture; thereby contributing to the debate about the capacity of birds to experience pain and whether fractures are associated with pain in laying hens. In hens with keel fractures, butorphanol decreased the latency to land from perches compared with latencies recorded for these hens following saline (mean (SEM) landing time (seconds) birds with keel fractures treated with butorphanol and saline from the 50, 100 and 150 cm perch heights respectively 1.7 (0.3), 2.2 (0.3), p = 0.05, 50 cm; 12.5 (6.6), 16.9 (6.7), p = 0.03, 100 cm; 20.6 (7.4), 26.3 (7.6), p = 0.02 150 cm). Mobility indices were largely unchanged in birds without keel fractures following butorphanol. Critically, butorphanol can be considered analgesic in our study because it improved the ability of birds to perform a complex behaviour that requires both motivation and higher cognitive processing. This is the first study to provide a solid evidential base that birds with keel fractures experience pain, a finding that has significant implications for the welfare of laying hens that are housed in non-cage or furnished caged systems. PMID:22927930

  6. Do laying hens with keel bone fractures experience pain?

    Directory of Open Access Journals (Sweden)

    Mohammed A F Nasr

    Full Text Available The European ban on battery cages has forced a change towards the use of non-cage or furnished cage systems, but unexpectedly this has been associated with an increased prevalence of keel bone fractures in laying hens. Bone fractures are acutely painful in mammals, but the effect of fractures on bird welfare is unclear. We recently reported that keel bone fractures have an effect on bird mobility. One possible explanation for this is that flying becomes mechanically impaired. However it is also possible that if birds have a capacity to feel pain, then ongoing pain resulting from the fracture could contribute to decreased mobility. The aim was to provide proof of concept that administration of appropriate analgesic drugs improves mobility in birds with keel fracture; thereby contributing to the debate about the capacity of birds to experience pain and whether fractures are associated with pain in laying hens. In hens with keel fractures, butorphanol decreased the latency to land from perches compared with latencies recorded for these hens following saline (mean (SEM landing time (seconds birds with keel fractures treated with butorphanol and saline from the 50, 100 and 150 cm perch heights respectively 1.7 (0.3, 2.2 (0.3, p = 0.05, 50 cm; 12.5 (6.6, 16.9 (6.7, p = 0.03, 100 cm; 20.6 (7.4, 26.3 (7.6, p = 0.02 150 cm. Mobility indices were largely unchanged in birds without keel fractures following butorphanol. Critically, butorphanol can be considered analgesic in our study because it improved the ability of birds to perform a complex behaviour that requires both motivation and higher cognitive processing. This is the first study to provide a solid evidential base that birds with keel fractures experience pain, a finding that has significant implications for the welfare of laying hens that are housed in non-cage or furnished caged systems.

  7. Association of Obesity with Forearm Fractures, Bone Mineral Density and Fracture Risk (FRAX® During Postmenopausal Period

    Directory of Open Access Journals (Sweden)

    Erkan Mesci

    2016-08-01

    Full Text Available Objective: The aim of this study was to investigate the association among obesity with bone mineral density (BMD and subsequent fracture risk among postmenopausal women with a previous forearm fracture. Materials and Methods: The study enrolled obese (n=40 and normal-weight (n=40 postmenopausal women who had a previous forearm fracture. BMD measurements were obtained using a GE-LUNAR DPX dual energy X-ray absorptiometry scan for all subjects. FRAX® fracture risk scores were calculated taking into account former fractures and current risk factors of the subjects. Both groups were compared with respect to their BMD values, T scores, FRAX® risk scores and frequency of previous fractures. Results: No difference was observed between groups with regard to mean age, mean age of menopause onset and mean serum calcium, phosphorus and alkaline phosphatase levels (p>0.05 for all. Statistically, obese patients showed highly significantly greater mean BMD values at lumbar spine (L1-L4 and femoral neck in comparison to subjects with normal body weight (p=0.000 for all. Obese patients had a lower 10-year probability of a major osteoporotic fracture on average as determined by FRAX® fracture risk score compared to that in normal-weight subjects (p<0.05. Also, obese group had a lower 10-year probability of a hip fracture versus normal-weight subjects (p<0.01. Both groups were found to have a similar frequency of previous fractures. Conclusion: Although obese patients in this study had greater BMD values and lower FRAX® risk scores, the probability of subsequent fractures predicted for the obese group was not lower when compared to that predicted for normal-weight group. It should be kept in mind that obesity may not necessarily be protective against fractures and treatment algorithms based solely on BMD might be inadequate to predict future fracture risk.

  8. Imaging and treatment of a fracture of the hamate bone

    International Nuclear Information System (INIS)

    Andresen, R.; Radmer, S.; Scheufler, O.; Banzer, D.

    2001-01-01

    The relatively rare fractures of the hamate bone are the most common osseous injuries of the distal carpal row, whereby fractures of both the body and the hook of the hamate occur. We present a hamulus ossis hamati fracture that was caused by direct trauma in a high-level game of underwater rugby. Although this was diagnosed by conventional X-ray, the precise position of the fracture was clearly imaged using thin-layer CT, while additional multiplanar MRT revealed further sequelae of the trauma. A CT follow-up after 10 weeks of conservative therapy did not show any osseous consolidation, which indicated the need for surgical revision with exstirpation of the hamulus. (orig.) [de

  9. Clinical observation of biomimetic mineralized collagen artificial bone putty for bone reconstruction of calcaneus fracture

    Science.gov (United States)

    Pan, Yong-Xiong; Yang, Guang-Gang; Li, Zhong-Wan; Shi, Zhong-Min; Sun, Zhan-Dong

    2018-01-01

    Abstract This study investigated clinical outcomes of biomimetic mineralized collagen artificial bone putty for bone reconstruction in the treatment of calcaneus fracture. Sixty cases of calcaneal fractures surgically treated with open reduction and internal fixation in our hospital from June 2014–2015 were chosen and randomly divided into two groups, including 30 cases treated with biomimetic mineralized collagen artificial bone putty as treatment group, and 30 cases treated with autogenous ilia as control group. The average follow-up time was 17.2 ± 3.0 months. The results showed that the surgery duration and postoperative drainage volume of treatment group were significantly lower than control group; there were no statistically significant differences in the fracture healing time, American Orthopaedic Foot and Ankle Society scores at 3 and 12 months after surgery, Böhler’s angle, Gissane’s angle and height of calcaneus between the two groups. There were no significant differences in wound complication and reject reaction between the two groups, while significant difference in donor site complication. As a conclusion, the implantation of biomimetic mineralized collagen artificial bone putty in the open reduction of calcaneal fracture resulted in reliable effect and less complications, which is suitable for clinical applications in the treatment of bone defect in calcaneal fractures.

  10. Is Surgical Navigation Useful During Closed Reduction of Nasal Bone Fractures?

    Science.gov (United States)

    Kim, Seon Tae; Jung, Joo Hyun; Kang, Il Gyu

    2017-05-01

    To report the case of a 42-year-old woman with a nasal bone fracture that was easily treated using a surgical navigation system. In this clinical report, the authors suggest that intraoperative surgical navigation systems are useful diagnostically and for localizing sites of nasal bone fractures exactly. The patient underwent successful closed reduction of the nasal bone fracture. Surgical navigation is a useful tool for identifying nasal bone fracture locations and for guiding closed reduction. Surgical navigation is recommended when nasal bone fractures are complicated or not well reduced using the ordinary method.

  11. The Proprioceptive System Regulates Morphologic Restoration of Fractured Bones

    Directory of Open Access Journals (Sweden)

    Ronen Blecher

    2017-08-01

    Full Text Available Successful fracture repair requires restoration of bone morphology and mechanical integrity. Recent evidence shows that fractured bones of neonatal mice undergo spontaneous realignment, dubbed “natural reduction.” Here, we show that natural reduction is regulated by the proprioceptive system and improves with age. Comparison among mice of different ages revealed, surprisingly, that 3-month-old mice exhibited more rapid and effective natural reduction than newborns. Fractured bones of null mutants for transcription factor Runx3, lacking functional proprioceptors, failed to realign properly. Blocking Runx3 expression in the peripheral nervous system, but not in limb mesenchyme, recapitulated the null phenotype, as did inactivation of muscles flanking the fracture site. Egr3 knockout mice, which lack muscle spindles but not Golgi tendon organs, displayed a less severe phenotype, suggesting that both receptor types, as well as muscle contraction, are required for this regulatory mechanism. These findings uncover a physiological role for proprioception in non-autonomous regulation of skeletal integrity.

  12. Aging and Fracture of Human Cortical Bone and Tooth Dentin

    Energy Technology Data Exchange (ETDEWEB)

    Ager, Joel; Koester, Kurt J.; Ager III, Joel W.; Ritchie, Robert O.

    2008-05-07

    Mineralized tissues, such as bone and tooth dentin, serve as structural materials in the human body and, as such, have evolved to resist fracture. In assessing their quantitative fracture resistance or toughness, it is important to distinguish between intrinsic toughening mechanisms which function ahead of the crack tip, such as plasticity in metals, and extrinsic mechanisms which function primarily behind the tip, such as crack bridging in ceramics. Bone and dentin derive their resistance to fracture principally from extrinsic toughening mechanisms which have their origins in the hierarchical microstructure of these mineralized tissues. Experimentally, quantification of these toughening mechanisms requires a crack-growth resistance approach, which can be achieved by measuring the crack-driving force, e.g., the stress intensity, as a function of crack extension ("R-curve approach"). Here this methodology is used to study of the effect of aging on the fracture properties of human cortical bone and human dentin in order to discern the microstructural origins of toughness in these materials.

  13. Finite element analysis of functionally graded bone plate at femur bone fracture site

    Science.gov (United States)

    Satapathy, Pravat Kumar; Sahoo, Bamadev; Panda, L. N.; Das, S.

    2018-03-01

    This paper focuses on the analysis of fractured Femur bone with functionally graded bone plate. The Femur bone is modeled by using the data from the CT (Computerized Tomography) scan and the material properties are assigned using Mimics software. The fracture fixation plate used here is composed of Functionally Graded Material (FGM). The functionally graded bone plate is considered to be composed of different layers of homogeneous materials. Finite element method approach is adopted for analysis. The volume fraction of the material is calculated by considering its variation along the thickness direction (z) according to a power law and the effective properties of the homogeneous layers are estimated. The model developed is validated by comparing numerical results available in the literature. Static analysis has been performed for the bone plate system by considering both axial compressive load and torsional load. The investigation shows that by introducing FG bone plate instead of titanium, the stress at the fracture site increases by 63 percentage and the deformation decreases by 15 percentage, especially when torsional load is taken into consideration. The present model yields better results in comparison with the commercially available bone plates.

  14. Comparison of femoral morphology and bone mineral density between femoral neck fractures and trochanteric fractures.

    Science.gov (United States)

    Maeda, Yuki; Sugano, Nobuhiko; Saito, Masanobu; Yonenobu, Kazuo

    2011-03-01

    Many studies that analyzed bone mineral density (BMD) and skeletal factors of hip fractures were based on uncalibrated radiographs or dual-energy xray absorptiometry (DXA). Spatial accuracy in measuring BMD and morphologic features of the femur with DXA is limited. This study investigated differences in BMD and morphologic features of the femur between two types of hip fractures using quantitative computed tomography (QCT). Forty patients with hip fractures with normal contralateral hips were selected for this study between 2003 and 2007 (trochanteric fracture, n=18; femoral neck fracture, n=22). Each patient underwent QCT of the bilateral femora using a calibration phantom. Using images of the intact contralateral femur, BMD measurements were made at the point of minimum femoral-neck cross-sectional area, middle of the intertrochanteric region, and center of the femoral head. QCT images also were used to measure morphologic features of the hip, including hip axis length, femoral neck axis length, neck-shaft angle, neck width, head offset, anteversion of the femoral neck, and cortical index at the femoral isthmus. No significant differences were found in trabecular BMD between groups in those three regions. Patients with trochanteric fractures showed a smaller neck shaft angle and smaller cortical index at the femoral canal isthmus compared with patients with femoral neck fractures. We conclude that severe osteoporosis with thinner cortical bone of the femoral diaphysis is seen more often in patients with trochanteric fracture than in patients with femoral neck fracture. Level IV, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

  15. The Photodynamic Bone Stabilization System: a minimally invasive, percutaneous intramedullary polymeric osteosynthesis for simple and complex long bone fractures.

    Science.gov (United States)

    Vegt, Paul; Muir, Jeffrey M; Block, Jon E

    2014-01-01

    The treatment of osteoporotic long bone fractures is difficult due to diminished bone density and compromised biomechanical integrity. The majority of osteoporotic long bone fractures occur in the metaphyseal region, which poses additional problems for surgical repair due to increased intramedullary volume. Treatment with internal fixation using intramedullary nails or plating is associated with poor clinical outcomes in this patient population. Subsequent fractures and complications such as screw pull-out necessitate additional interventions, prolonging recovery and increasing health care costs. The Photodynamic Bone Stabilization System (PBSS) is a minimally invasive surgical technique that allows clinicians to repair bone fractures using a light-curable polymer contained within an inflatable balloon catheter, offering a new treatment option for osteoporotic long bone fractures. The unique polymer compound and catheter application provides a customizable solution for long bone fractures that produces internal stability while maintaining bone length, rotational alignment, and postsurgical mobility. The PBSS has been utilized in a case series of 41 fractures in 33 patients suffering osteoporotic long bone fractures. The initial results indicate that the use of the light-cured polymeric rod for this patient population provides excellent fixation and stability in compromised bone, with a superior complication profile. This paper describes the clinical uses, procedural details, indications for use, and the initial clinical findings of the PBSS.

  16. A novel classification of frontal bone fractures: The prognostic significance of vertical fracture trajectory and skull base extension.

    Science.gov (United States)

    Garg, Ravi K; Afifi, Ahmed M; Gassner, Jennifer; Hartman, Michael J; Leverson, Glen; King, Timothy W; Bentz, Michael L; Gentry, Lindell R

    2015-05-01

    The broad spectrum of frontal bone fractures, including those with orbital and skull base extension, is poorly understood. We propose a novel classification scheme for frontal bone fractures. Maxillofacial CT scans of trauma patients were reviewed over a five year period, and frontal bone fractures were classified: Type 1: Frontal sinus fracture without vertical extension. Type 2: Vertical fracture through the orbit without frontal sinus involvement. Type 3: Vertical fracture through the frontal sinus without orbit involvement. Type 4: Vertical fracture through the frontal sinus and ipsilateral orbit. Type 5: Vertical fracture through the frontal sinus and contralateral or bilateral orbits. We also identified the depth of skull base extension, and performed a chart review to identify associated complications. 149 frontal bone fractures, including 51 non-vertical frontal sinus (Type 1, 34.2%) and 98 vertical (Types 2-5, 65.8%) fractures were identified. Vertical fractures penetrated the middle or posterior cranial fossa significantly more often than non-vertical fractures (62.2 v. 15.7%, p = 0.0001) and had a significantly higher mortality rate (18.4 v. 0%, p fractures with frontal sinus and orbital extension, and fractures that penetrated the middle or posterior cranial fossa had the strongest association with intracranial injuries, optic neuropathy, disability, and death (p fractures carry a worse prognosis than frontal bone fractures without a vertical pattern. In addition, vertical fractures with extension into the frontal sinus and orbit, or with extension into the middle or posterior cranial fossa have the highest complication rate and mortality. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  17. Bone graft substitutes and bone morphogenetic proteins for osteoporotic fractures: what is the evidence?

    Science.gov (United States)

    Van Lieshout, Esther M M; Alt, Volker

    2016-01-01

    Despite improvements in implants and surgical techniques, osteoporotic fractures remain challenging to treat. Among other major risk factors, decreased expression of morphogenetic proteins has been identified for impaired fracture healing in osteoporosis. Bone grafts or bone graft substitutes are often used for stabilizing the implant and for providing a scaffold for ingrowth of new bone. Both synthetic and naturally occurring biomaterials are available. Products generally contain hydroxyapatite, tricalcium phosphate, dicalcium phosphate, calcium phosphate cement, calcium sulfate (plaster of Paris), or combinations of the above. Products have been used for the treatment of osteoporotic fractures of the proximal humerus, distal radius, vertebra, hip, and tibia plateau. Although there is generally consensus that screw augmentation increased the biomechanical properties and implant stability, the results of using these products for void filling are not unequivocal. In osteoporotic patients, Bone Morphogenetic Proteins (BMPs) have the potential impact to improve fracture healing by augmenting the impaired molecular and cellular mechanisms. However, the clinical evidence on the use of BMPs in patients with osteoporotic fractures is poor as there are no published clinical trials, case series or case studies. Even pre-clinical literature on in vitro and in vivo data is weak as most articles focus on the beneficial role for BMPs for restoration of the underlying pathophysiological factors of osteoporosis but do not look at the specific effects on osteoporotic fracture healing. Limited data on animal experiments suggest stimulation of fracture healing in ovariectomized rats by the use of BMPs. In conclusion, there is only limited data on the clinical relevance and optimal indications for the use of bone graft substitute materials and BMPs on the treatment of osteoporotic fractures despite the clinical benefits of these materials in other clinical indications. Given the

  18. Radiodiagnosis of closed fractures of 2-5 metacarpal bones

    International Nuclear Information System (INIS)

    Fastykovskaya, E.D.; Kopysova, V.A.; Kuzina, I.R.

    1986-01-01

    A unified method of radiodiagnosis of angular deformities in subcapital fractures of 2-5 metacarpal bones was proposed. It was based on the standardization of the wrist laying for roentgenography of the oblique view strictly at the angle of 45 deg. The projection angle of deformity of the metacarpal bone was measured on a radiogram obtained and then a true value of the angular displacement of the bone fragments to the palm was determined on a nomogram (i.e. on a chart of the ratio of values of the true and projection angles). The healthy metacarpal bone heads were inclined to the palm at the angle of 13-33 deg. It was found that in subcapital fractures of 2-5 metacarpal bones certain self-correction (varying from 10 to 15 deg) of angular deformities was possible in children and adolescents only. Owing to such radiodiagnosis and a differentiated choice of therapeutic methods (in 48.8% of the patients indications for reposition were determined) good anatomical and functional results were obtained in most of the patients (96.9%)

  19. Are bi-axial proximal sesamoid bone fractures in the British Thoroughbred racehorse a bone fatigue related fracture? A histological study.

    Science.gov (United States)

    Kristoffersen, M; Hetzel, U; Parkin, T D H; Singer, E R

    2010-01-01

    To investigate whether microfractures and alterations in the trabecular bone area are associated with catastrophic bi-axial proximal sesamoid bone fractures (PSBF). Proximal sesamoid bones (PSB) from 10 racehorses with PSBF and from 10 control racehorses without musculoskeletal injury were examined using the bulk basic fuchsin method. Bone histomorphometric and microfracture analysis was performed, and cases and controls compared using two-sample t-test, paired t-test, and Mann-Whitney U test. There was no significant difference in the microfracture density and the trabecular bone area between bones from case and control horses, and between fractured and non-fractured bones in case horses. Microfracture density was low in the areas of the PSB examined. Microfracture density was not significantly different between groups, indicating that propagation of micro-cracks is an unlikely predisposing pathologic alteration in PSBF in British racehorses. There was no significant difference in the bone surface area between groups, which one would expect if modelling, adaptation and an increase in bone density were associated with PSBF fracture in the case horses. Therefore, PSBF in the British racehorse does not appear to be associated with microfractures of the trabecular bone of the PSB. The PSB fractures might represent an acute monotonic fracture; however, the aetiology of the fractures remains unknown with additional research required.

  20. BIOMATERIAL IMPLANTS IN BONE FRACTURES PRODUCED IN RATS FIBULAS

    Science.gov (United States)

    Shirane, Henrique Yassuhiro; Oda, Diogo Yochizumi; Pinheiro, Thiago Cerizza; Cunha, Marcelo Rodrigues da

    2015-01-01

    To evaluate the importance of collagen and hydroxyapatite in the regeneration of fractures experimentally induced in the fibulas of rats. Method: 15 rats were used. These were subjected to surgery to remove a fragment from the fibula. This site then received a graft consisting of a silicone tubes filled with hydroxyapatite and collagen. Results: Little bone neoformation occurred inside the tubes filled with the biomaterials. There was more neoformation in the tubes with collagen. Conclusion: The biomaterials used demonstrated biocompatibility and osteoconductive capacity that was capable of stimulating osteogenesis, even in bones with secondary mechanical and morphological functions such as the fibula of rats. PMID:27047813

  1. [Intramedullary stabilisation of metastatic fractures of long bones].

    Science.gov (United States)

    Piatek, S; Westphal, T; Bischoff, J; Schubert, S; Holmenschlager, F; Winckler, S

    2003-02-01

    Surgical treatment of metastatic fractures of long bones is mostly a palliative one. Intramedullary stabilisation without resection of metastases follows the aim of the palliative therapy concept. From 01.01.1995 to 30.08.2001 36 manifest and 4 impending long bone fractures were registered in 22 female and 16 male patients, with a mean age of 63 years. In addition, one revision was necessary due to persisting instability after humeral intramedullary bundle nailing. Pathological fractures were found in the humerus (n=11), femoral neck (n=6), per- and subtrochanteric region (n=12), femoral shaft (n=10) and tibia (n=2). Most of them were malignancies of the kidneys (n=13), bronchi (n=7) and breast (n=6). One patient with a solitary metastasis in the humerus received curative treatment by resection, open reduction and internal fixation. All other cases underwent palliative stabilisation. Metastatic lesions of the femoral neck were treated by resection and prosthetic replacement. The remaining fractures were stabilized intramedullarily without resection of metastases or use of bone cement. In 9 cases, a locking nail was implanted in the humerus, and one patient received humeral bundle nailing. In the lower extremities, we used a classic-nail or gamma-nail in 15 and a locking nail in 8 cases. Two moribund patients did not undergo surgery. No intraoperative complications occurred. 63 % of the patients with stabilisation of the leg were able to walk at the time of discharge. The mean survival time (Kaplan-Meier) of patients after palliative operation amounted to 161.5 days (95 % CI 92.7; 230.3). We found 6 postoperative complications: temporary palsy of the radial nerve (n=1), soft tissue infection (n=1), dislocation of the nail (n=2), loosening of the distal locking screw (n=1), proceeding osteolysis with high fracture risk (n=1). Intramedullary stabilisation without resection of metastases using locking nails meets the requirements of palliative therapy. This procedure

  2. Sacral Stress Fracture following the Bone Union of Lumbar Spondylolysis

    Directory of Open Access Journals (Sweden)

    Tatsuro Sasaji

    2016-01-01

    Full Text Available While 22 articles have reported on sacral stress fractures, it is a rare injury and its etiology is not well known. We present the case of a 16-year-old male who presented with low back pain in 2015. He was a high school soccer player with a previous history of a bilateral L5 lumbar spondylolysis in 2014. The patient refrained from soccer and wore a brace for six months. Two months after restarting soccer, he again complained of low back pain. After 1 year, a lumbar spine computed tomography revealed the bone union of the spondylolysis. At his first visit to our hospital, his general and neurological conditions were normal and laboratory data were within the normal range. Sacral coronal magnetic resonance imaging (MRI of the left sacral ala revealed an oblique lineal signal void surrounding bone marrow edema. Based on his symptoms, sports history, and MRI, he was diagnosed with a sacral stress fracture. He again refrained from soccer; his low back pain soon improved, and, after 1 year, the abnormal signal change had disappeared on sacral MRI. Recurrent low back pain case caused by a sacral stress fracture occurring after the bone union of lumbar spondylolysis is uncommon.

  3. Survival times of patients with a first hip fracture with and without subsequent major long-bone fractures.

    Science.gov (United States)

    Angthong, Chayanin; Angthong, Wirana; Harnroongroj, Thos; Naito, Masatoshi; Harnroongroj, Thossart

    2013-01-01

    Survival rates are poorer after a second hip fracture than after a first hip fracture. Previous survival studies have included in-hospital mortality. Excluding in-hospital deaths from the analysis allows survival times to be evaluated in community-based patients. There is still a lack of data regarding the effects of subsequent fractures on survival times after hospital discharge following an initial hip fracture. This study compared the survival times of community-dwelling patients with hip fracture who had or did not have a subsequent major long-bone fracture. Hazard ratios and risk factors for subsequent fractures and mortality rates with and without subsequent fractures were calculated. Of 844 patients with hip fracture from 2000 through 2008, 71 had a subsequent major long-bone fracture and 773 did not. Patients who died of other causes, such as perioperative complications, during hospitalization were excluded. Such exclusion allowed us to determine the effect of subsequent fracture on the survival of community-dwelling individuals after hospital discharge or after the time of the fracture if they did not need hospitalization. Demographic data, causes of death, and mortality rates were recorded. Differences in mortality rates between the patient groups and hazard ratios were calculated. Mortality rates during the first year and from 1 to 5 years after the most recent fracture were 5.6% and 1.4%, respectively, in patients with subsequent fractures, and 4.7% and 1.4%, respectively, in patients without subsequent fractures. These rates did not differ significantly between the groups. Cox regression analysis and calculation of hazard ratios did not show significant differences between patients with subsequent fractures and those without. On univariate and multivariate analyses, age fracture. This study found that survival times did not differ significantly between patients with and without subsequent major long-bone fractures after hip fracture. Therefore, all

  4. Elastoplasticity analysis of the nails used in long bone fractures

    International Nuclear Information System (INIS)

    Paterson, R; Paterson, A; Miralles, M T; Del Sel, G; Del Sel, N

    2011-01-01

    Elastoplastic endomedullary nail-insertion system in long bone fractures is a method which allows generating forces, moments, frictions and stress states in parts of the bone previously selected. Adding previous knowledge on the distribution of forces and acting moments over the bone fragments to be threaded, as well as on the elastoplastic and mechanical properties of the nails to be inserted (designing a special, specific structure for each case), the results, coming from 26 years of applying this technique, have been promising. It is from this perspective that we call this threading and anchoring procedure 'Selective Tension System' (STS). Physicochemical analyses and mechanical trials on elastoplastic nails used in the osteosynthesis in long bone fractures are presented. The magnitude of the forces produced by flattening the nails and the reacting forces at both ends are measured. It is expected that the evidence provided on the elastic variability of these nails will be useful as guidance on the availability and choice of the elastoplastic combinations that best fit each patient.

  5. Biological methods to enhance bone healing and fracture repair.

    Science.gov (United States)

    Verdonk, René; Goubau, Yannick; Almqvist, Fredrik K; Verdonk, Peter

    2015-04-01

    This article looks into normal physiological fracture healing with special emphasis on the diamond concept. A precise definition of nonunion of long bones is described. Most often inadequate fixation (too rigid or too loose) is the reason for nonunion in long bone fractures. Because a critical bone defect cannot be bridged, it may lead directly or indirectly (lack of fixation) to nonunion. Individual inadequate local biological characteristics are also often found to be the cause; poor soft tissue coverage as well as a lack of periosteum and muscle or fascia or skin defects can lead to compromised vascularity in situ. Systemic factors are now much more recognized, e.g., smoking, diabetes, and cachexia, as well as the limited impact of some medications, e.g., nonsteroidal anti-inflammatory drugs and steroids. Today's mode of treatment for nonunion is approached in this article, and suggestions for appropriate treatment of long bone nonunion is presented. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  6. Unsuspected costo-vertebral fractures demonstrated by bone scanning in the child abuse syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Smith, F.W.; Gilday, D.L.; Ash, J.M.; Green, M.D.

    1980-01-01

    Many patterns of injury have been described in the child abuse syndrome. Until recently, all the bone manifestations of this syndrome have been diagnosed radiologically. Four cases of multiple costovertebral fracture diagnosed by bone scan are described and their etiology discussed. The use of bone scanning in identifying fractures which previously would have been missed is advocated.

  7. Unsuspected costo-vertebral fractures demonstrated by bone scanning in the child abuse syndrome

    International Nuclear Information System (INIS)

    Smith, F.W.; Gilday, D.L.; Ash, J.M.; Green, M.D.

    1980-01-01

    Many patterns of injury have been described in the child abuse syndrome. Until recently, all the bone manifestations of this syndrome have been diagnosed radiologically. Four cases of multiple costovertebral fracture diagnosed by bone scan are described and their etiology discussed. The use of bone scanning in identifying fractures which previously would have been missed is advocated. (orig.) [de

  8. Hereditary bone dysplasia with pathological fractures and nodal osteoarthropathy

    Energy Technology Data Exchange (ETDEWEB)

    Arendse, Regan [University of Stellenbosch, Department of Medicine, Tygerberg Hospital, Stellenbosch (South Africa); University of Cape Town, Division of Rheumatology, Groote Schuur Hospital, Cape Town (South Africa); Brink, Paul [University of Stellenbosch, Department of Medicine, Tygerberg Hospital, Stellenbosch (South Africa); Beighton, Peter [University of Cape Town, Division of Human Genetics, Faculty of Health Sciences, Cape Town (South Africa)

    2009-12-15

    A father and daughter both had multiple pathological fractures and nodal osteoarthropathy. The father, aged 50 years, had at least 20 healed fractures of the axial and appendicular skeleton, sustained by minor trauma over his 50-year lifespan, many of which had been surgically fixed prior to his first presentation to us. Fractures of the clavicles, thoracic cage and long bones of the arms and legs, had healed with malalignment and deformity. Healed fractures were complicated by ankylosis of the cervical vertebrae and both elbows. He also had osteoarthritis of the hands, with exuberant osteophytosis, and profound perceptive deafness. His general health was good, his intellect and facies were normal, and his sclerae were white. The daughter, aged 27 years, had sustained at least seven fractures of the axial and appendicular skeleton following trivial injuries, in distribution similar to those of the father. She had also experienced painful swelling of the fingers, which preceded progressive development of nodal osteoarthropathy. Her hearing was normal. In both individuals, biochemical and immunological investigations yielded normal results. It was not possible for molecular studies to be undertaken. Pedigree data were consistent with autosomal dominant transmission, and this disorder appeared to be a previously undocumented heritable skeletal dysplasia. (orig.)

  9. Capture the fracture - use of bone turnover markers in clinical practice

    Directory of Open Access Journals (Sweden)

    Vuksanović Miljanka

    2016-01-01

    Full Text Available Bone is a living tissue, metabolically very active, with the level of turnover of about 10% per year. Bone remodeling is a well-balanced process of bone resorption, induced by osteoclasts and bone formation maintained osteoblasts. Loss of bone remodeling balance, with increased bone resorption, leads to osteoporosis. Bone turnover markers are classified as markers of bone formation and of bone resorption. During the growth and development of skeleton, bone turnover markers show higher levels of activity than in the adult period. The increase in biochemical markers peaks again in the postmenopausal period, indicating accelerated bone remodeling. Bone mineral density is an important predictor of an osteoporotic fracture. Timely assessment of risk factors of osteoporosis and bone markers can detect subjects with accelerated bone remodeling and osteoporosis. This may introduce adequate therapy and prevent fracture.

  10. A roentgenographic study of the posterior urethral injury associated with pelvic bone fracture in male

    International Nuclear Information System (INIS)

    Han, Sang Suk; Sol, Chang Hyo; Kim, Byung Soo

    1983-01-01

    The author analyzed detailed pattern of pelvic bone fracture in 52 cases of posterior urethral injury associated with pelvic bone fracture in male. The relationship between fracture and urethral injury was reviewed in 38 cases who received retrograde urethography at the time of injury. The pattern of urethral injury due to pelvic bone fracture was newly classified. The results were as follows: 1. In age distribution, the most common was 5th decade (26.9%). 2 . The most frequent type of pelvic rami fracture was two rami fracture (52%). 3. There was no case with only the superior ramus fracture, and all cases were associated with inferior ramus fracture with or without superior ramus fracture. 4. In inferior ramus fracture, the ratio of ischial ramus fracture to pubic ramus fracture was 46.1 : 17.4. 5. In cases with only the ischial ramus or pubic ramus fracture, unilateral fracture exceed bilateral fracture (44.2 : 19.3). 6. The bladder rupture was found in 10 among the total 52 cases, 9 of which were associated with superior ramus fracture, and 8 were extraperitoneal type. 7. The most common type of urethral injury was Tpye III (73.7%), and followed by Type II (10.5%), Type I (7.9%), and Type IV (7.9%). 8. These results strongly suggested that the superior ramus fracture was related to bladder rapture, and inferior ramus fracture to urethal injury

  11. Allelic determinants of vitamin d insufficiency, bone mineral density, and bone fractures.

    Science.gov (United States)

    Trummer, Olivia; Schwetz, Verena; Walter-Finell, Daniela; Lerchbaum, Elisabeth; Renner, Wilfried; Gugatschka, Markus; Dobnig, Harald; Pieber, Thomas R; Obermayer-Pietsch, Barbara

    2012-07-01

    Low 25-hydroxycholecalciferol [25(OH) vitamin D] status is known to play an important role in many diseases with focus on bone health. Based on recently reported genetic determinants of vitamin D insufficiency, we aimed to analyze genetic variants of group-specific component (GC), 7-dehydrocholesterol reductase (DHCR7), and cytochrome P450IIR-1 (CYP2R1) for association with vitamin D levels, bone mineral density (BMD), and bone fractures. We conducted a cross-sectional BMD and fracture study and a prospective cohort study. The cross-sectional study comprised participants of a BMD screening study, and the prospective cohort study comprised nursing home subjects. The cross-sectional study included 342 subjects (mean age, 55.3 ± 12.0 yr), and the prospective study included 1093 subjects (mean age, 84.0 ± 6.0 yr). Patients were stratified by GC, DHCR7, and CYP2R1 genotypes. For each gene, the allele associated with lower 25(OH) vitamin D levels was designated as "risk allele." The potential role of these risk alleles in fracture risk was analyzed by logistic regression analysis including age and sex as confounders. We measured BMD and fractures. GC genotypes were significantly associated with lower mean 25(OH) vitamin D levels in both cohorts (P = 0.001 and P = 0.048, respectively). There was no significant association of BMD with any of the genotypes. None of the alleles was associated with past fractures, whereas the DHCR7 G-allele was significantly associated with prospective fractures (odds ratio, 0.68; 95% confidence interval, 0.51-0.92; P = 0.011). The DHCR7 gene polymorphism may be a predictor for fracture risk.

  12. A case of cuboid bone stress fracture in a senior high school rugby athlete

    Directory of Open Access Journals (Sweden)

    Tetsuo Hagino

    2014-10-01

    Full Text Available We report a case of cuboid bone stress fracture in a 17-year-old rugby athlete. Cuboid bone stress fractures are rare in athletes. When an athlete with no history of trauma presents with pain on the lateral side of the foot and no abnormality on plain radiograph, cuboid bone stress fracture should be suspected and magnetic resonance imaging should be conducted.

  13. Automatic retrieval of bone fracture knowledge using natural language processing.

    Science.gov (United States)

    Do, Bao H; Wu, Andrew S; Maley, Joan; Biswal, Sandip

    2013-08-01

    Natural language processing (NLP) techniques to extract data from unstructured text into formal computer representations are valuable for creating robust, scalable methods to mine data in medical documents and radiology reports. As voice recognition (VR) becomes more prevalent in radiology practice, there is opportunity for implementing NLP in real time for decision-support applications such as context-aware information retrieval. For example, as the radiologist dictates a report, an NLP algorithm can extract concepts from the text and retrieve relevant classification or diagnosis criteria or calculate disease probability. NLP can work in parallel with VR to potentially facilitate evidence-based reporting (for example, automatically retrieving the Bosniak classification when the radiologist describes a kidney cyst). For these reasons, we developed and validated an NLP system which extracts fracture and anatomy concepts from unstructured text and retrieves relevant bone fracture knowledge. We implement our NLP in an HTML5 web application to demonstrate a proof-of-concept feedback NLP system which retrieves bone fracture knowledge in real time.

  14. Propagation of a dorsal cortical fracture of the third metacarpal bone in two horses

    International Nuclear Information System (INIS)

    Spurlock, G.H.

    1988-01-01

    Seemingly, propagation of a dorsal cortical fracture in the third metacarpal bone developed after continued race performance in 2 horses. Historically, both horses had intermittent lameness that had responded to nonsteroidal anti-inflammatory drugs and brief rest periods. However, lameness in both horses had increased in severity. Radiography revealed a dorsal cortical fracture of the third metacarpal bone, with propagation of the fracture plane proximally. Fractures were incomplete and healed with stall rest in both horses

  15. Computed tomography of temporal bone fractures and temporal region anatomy in horses.

    Science.gov (United States)

    Pownder, S; Scrivani, P V; Bezuidenhout, A; Divers, T J; Ducharme, N G

    2010-01-01

    In people, specific classifications of temporal bone fractures are associated with clinical signs and prognosis. In horses, similar classifications have not been evaluated and might be useful establishing prognosis or understanding pathogenesis of certain types of trauma. We hypothesized associations between temporal bone fracture location and orientation in horses detected during computed tomography (CT) and frequency of facial nerve (CN7) deficit, vestibulocochlear nerve (CN8) deficit, or temporohyoid osteoarthropathy (THO). Complex temporal region anatomy may confound fracture identification, and consequently a description of normal anatomy was included. All horses undergoing temporal region CT at our hospital between July 1998 and May 2008. Data were collected retrospectively, examiners were blinded, and relationships were investigated among temporal bone fractures, ipsilateral THO, ipsilateral CN7, or ipsilateral CN8 deficits by Chi-square or Fischer's exact tests. Seventy-nine horses had CT examinations of the temporal region (158 temporal bones). Sixteen temporal bone fractures were detected in 14 horses. Cranial nerve deficits were seen with fractures in all parts of the temporal bone (petrosal, squamous, and temporal) and, temporal bone fractures were associated with CN7 and CN8 deficits and THO. No investigated fracture classification scheme, however, was associated with specific cranial nerve deficits. Without knowledge of the regional anatomy, normal structures may be mistaken for a temporal bone fracture or vice versa. Although no fracture classification scheme was associated with the assessed clinical signs, simple descriptive terminology (location and orientation) is recommended for reporting and facilitating future comparisons.

  16. Comparison of macrostructural and microstructural bone features in Thoroughbred racehorses with and without midbody fracture of the proximal sesamoid bone.

    Science.gov (United States)

    Anthenill, Lucy A; Gardner, Ian A; Pool, Roy R; Garcia, Tanya C; Stover, Susan M

    2010-07-01

    To compare macrostructural and microstructural features of proximal sesamoid bones (PSBs) from horses with and without PSB midbody fracture to gain insight into the pathogenesis of PSB fracture. PSBs from 16 Thoroughbred racehorses (8 with and 8 without a PSB midbody fracture). Parasagittal sections of fractured and contralateral intact PSBs from horses with a PSB fracture and an intact PSB from age- and sex-matched control horses without a PSB fracture were evaluated for visual, radiographic, microradiographic, histologic, and his-tomorphometric differences in bone porosity, vascular channels, heme pigment, trabecular anisotropy, and pathological findings. Fractured PSBs and their contralateral intact PSBs had more compacted trabecular bone than did control PSBs. Focal repair or remodeling was evident in the palmar aspect of many fractured and contralateral intact PSBs. Fracture coincided with microstructural features and propagated from the flexor to the articular surface. Fractured PSBs had adapted to high loading but had focal evidence of excessive remodeling and porosity that likely predisposed the horses to complete fracture and catastrophic injury. Detection of focal injury before complete fracture provides an opportunity for prevention of catastrophic injury. Development of diagnostic imaging methods to assess porosity of PSBs may help to identify at-risk horses and allow for modifications of training and racing schedules to reduce the incidence of PSB fracture in Thoroughbred racehorses.

  17. Experimental study on healing process of rat mandibular bone fracture examined by radiological procedures

    Energy Technology Data Exchange (ETDEWEB)

    Iuchi, Yukio; Furumoto, Keiichi (Nippon Dental Univ., Tokyo (Japan))

    1994-06-01

    The healing process of rat mandibular fractures was stereoscopically observed daily, using plain roentgenography in the lateral-oblique and tooth axis directions and bone scintigraphy using 99m-Tc-methylene diphosphoric acid (Tc-99m-MDP). The findings were compared with microradiograms of regional polished specimens. X-ray findings included the following. Up to 3 days after bone fracture, the fracture mesiodistally showed distinct radiolucency, with sharp and irregular fracture stump. Radiopacity of the fracture site gradually increased 7 days or later, and bone trabecular formation by callus and stump bridging started to occur at 14 days. Findings similar to those in the control group were observed 49 days or later. The inside was difficult to differentiate, irrespective of the observation time. Bone scans in the mesiodistal and buccolingual planes revealed tracer uptake in the areas of mandibular and soft tissue damage one day after bone fracture. Tracer uptake began to be seen in the fracture site 3 days later, and became marked at 14 days. Then Tc-99m DMP began to be localized and returned to the findings similar to those at 49 days. Bone scanning tended to show wider areas earlier than roentgenography. Microradiographic mesiodistal examination revealed distinct radiopacy of the fracture line for 3 days after bone fracture. Seven days later, bone resorption cavity occurred in the cortical bone around the fracture stump, along with neogenesis of callus. Neogenesis and calcification began to occur gradually, and 14 days later, the fracture osteoremodeling of the internal bone trabeculae was observed. Bone trabecular formation within the bone, however, occurred later. (N.K.).

  18. ß-TCP bone substitutes in tibial plateau depression fractures.

    Science.gov (United States)

    Rolvien, Tim; Barvencik, Florian; Klatte, Till Orla; Busse, Björn; Hahn, Michael; Rueger, Johannes Maria; Rupprecht, Martin

    2017-10-01

    The use of beta-tricalciumphospate (ß-TCP, Cerasorb®) ceramics as an alternative for autologous bone-grafting has been outlined previously, however with no study focusing on both clinical and histological outcomes of ß-TCP application in patients with multi-fragment tibial plateau fractures. The aim of this study was to analyze the long-term results of ß-TCP in patients with tibial plateau fractures. 52 patients were included in this study. All patients underwent open surgery with ß-TCP block or granulate application. After a mean follow-up of 36months (14-64months), the patients were reviewed. Radiography and computed-tomography were performed, while the Rasmussen score was obtained for clinical outcome. Furthermore, seven patients underwent biopsy during hardware removal, which was subsequently analyzed by histology and backscattered electron microscopy (BSEM). An excellent reduction with two millimeters or less of residual incongruity was achieved in 83% of the patients. At follow-up, no further changes occurred and no nonunions were observed. Functional outcome was good to excellent in 82%. Four patients underwent revision surgery due to reasons unrelated to the bone substitute material. Histologic analyses indicated that new bone was built around the ß-TCP-grafts, however a complete resorption of ß-TCP was not observed. ß-TCP combined with internal fixation represents an effective and safe treatment of tibial plateau depression fractures with good functional recovery. While its osteoconductivity seems to be successful, the biological degradation and replacement of ß-TCP is less pronounced in humans than previous animal studies have indicated. Copyright © 2017 Elsevier B.V. All rights reserved.

  19. Zygomaticomaxillary complex fracture in a zygomatic bone affected by monostotic fibrous dysplasia: a very rare association.

    Science.gov (United States)

    Pinto, Lara Carolina D'Araújo; Ribeiro, André Luis Ribeiro; Aquime, João Rafael Habib Souza; Carreira, Aline Semblano Dias; Alves-Junior, Sérgio M; Pinheiro, João J V

    2013-05-01

    The association between fibrous dysplasia (FD) and fractures is very rare. This paper reports the case of a zygomaticomaxillary complex fracture in a bone affected by FD, a 29-year-old man who was involved in a bicycle accident and who subsequently presented with a zygomaticomaxillary complex fracture. Computed tomography revealed multiple fractures of the left zygomaticomaxillary complex with dysplastic bone alterations. Fracture lines occurred near transitional areas between the lesion and healthy bone. The patient was treated through an intraoral approach by an open reduction and internal fixation procedure, using a titanium miniplate and screws. An incisional biopsy was performed through the maxillary sinus to confirm the diagnosis of FD. After 12 months of follow-up, there were no postoperative complications. This paper reports a rare association thought to be caused by irregular trabecular bone deposition, which increases bone thickness/resiliency and thus increases its clinical fracture resistance.

  20. Use of Porcine Cancellous Bone Graft of Radial Nonunion Fracture in a Dog

    Directory of Open Access Journals (Sweden)

    S. Y. Heo, H. B. Lee, M. S. Kim and N. S. Kim*

    2012-06-01

    Full Text Available A 6-month, 1.3 kg, Yorkshire terrier was referred for treatment of a radial nonunion fracture. The nonunion fracture site had a 40 mm-long defect between both fracture ends, where a porcine cancellous bone graft was implanted. The surgical treatment of the nonunion fracture was accomplished using an external fixator and polymethylmethacrylate (PMMA. The dog had a successful clinical outcome, and a radiographic examination conducted at post-surgery week 16 revealed the incorporation of the porcine cancellous bone graft and the nonunion fracture site by newly formed bone, resulting in a complete union. Porcine cancellous bone graft should be considered as an alternative option to autografts when treating nonunion fractures with segment bones defects.

  1. Bone growth stimulators. New tools for treating bone loss and mending fractures.

    Science.gov (United States)

    Whitfield, James F; Morley, Paul; Willick, Gordon E

    2002-01-01

    In the new millennium, humans will be traveling to Mars and eventually beyond with skeletons that respond to microgravity by self-destructing. Meanwhile in Earth's aging populations growing numbers of men and many more women are suffering from crippling bone loss. During the first decade after menopause all women suffer an accelerating loss of bone, which in some of them is severe enough to result in "spontaneous" crushing of vertebrae and fracturing of hips by ordinary body movements. This is osteoporosis, which all too often requires prolonged and expensive care, the physical and mental stress of which may even kill the patient. Osteoporosis in postmenopausal women is caused by the loss of estrogen. The slower development of osteoporosis in aging men is also due at least in part to a loss of the estrogen made in ever smaller amounts in bone cells from the declining level of circulating testosterone and is needed for bone maintenance as it is in women. The loss of estrogen increases the generation, longevity, and activity of bone-resorbing osteoclasts. The destructive osteoclast surge can be blocked by estrogens and selective estrogen receptor modulators (SERMs) as well as antiosteoclast agents such as bisphosphonates and calcitonin. But these agents stimulate only a limited amount of bone growth as the unaffected osteoblasts fill in the holes that were dug by the now suppressed osteoclasts. They do not stimulate osteoblasts to make bone--they are antiresorptives not bone anabolic agents. (However, certain estrogen analogs and bisphosphates may stimulate bone growth to some extent by lengthening osteoblast working lives.) To grow new bone and restore bone strength lost in space and on Earth we must know what controls bone growth and destruction. Here we discuss the newest bone controllers and how they might operate. These include leptin from adipocytes and osteoblasts and the statins that are widely used to reduce blood cholesterol and cardiovascular damage. But

  2. Sphenoid Sinus and Sphenoid Bone Fractures in Patients with Craniomaxillofacial Trauma

    Science.gov (United States)

    Cantini Ardila, Jorge Ernesto; Mendoza, Miguel Ángel Rivera; Ortega, Viviana Gómez

    2013-01-01

    Background and Purpose Sphenoid bone fractures and sphenoid sinus fractures have a high morbidity due to its association with high-energy trauma. The purpose of this study is to describe individuals with traumatic injuries from different mechanisms and attempt to determine if there is any relationship between various isolated or combined fractures of facial skeleton and sphenoid bone and sphenoid sinus fractures. Methods We retrospectively studied hospital charts of all patients who reported to the trauma center at Hospital de San José with facial fractures from December 2009 to August 2011. All patients were evaluated by computed tomography scan and classified into low-, medium-, and high-energy trauma fractures, according to the classification described by Manson. Design This is a retrospective descriptive study. Results The study data were collected as part of retrospective analysis. A total of 250 patients reported to the trauma center of the study hospital with facial trauma. Thirty-eight patients were excluded. A total of 212 patients had facial fractures; 33 had a combination of sphenoid sinus and sphenoid bone fractures, and facial fractures were identified within this group (15.5%). Gender predilection was seen to favor males (77.3%) more than females (22.7%). The mean age of the patients was 37 years. Orbital fractures (78.8%) and maxillary fractures (57.5%) were found more commonly associated with sphenoid sinus and sphenoid bone fractures. Conclusions High-energy trauma is more frequently associated with sphenoid fractures when compared with medium- and low-energy trauma. There is a correlation between facial fractures and sphenoid sinus and sphenoid bone fractures. A more exhaustive multicentric case-control study with a larger sample and additional parameters will be essential to reach definite conclusions regarding the spectrum of fractures of the sphenoid bone associated with facial fractures. PMID:24436756

  3. Chemotherapy decreases epiphyseal strength and increases bone fracture risk.

    Science.gov (United States)

    Van Leeuwen, Barbara L; Verkerke, Gerard J; Hartel, Rene M; Sluiter, Willem J; Kamps, Willem A; Jansen, Henk W B; Hoekstra, Harald J

    2003-08-01

    To establish the effect of three frequently used chemotherapeutic agents in childhood cancer on the skeleton, growing male Wistar rats were studied. Treatment with doxorubicin, methotrexate, and cisplatin reduces the proximal tibial growth plate shear strength because of a decreased surface area and maximum shear stress. After treatment the bone fracture risk of the tibia and femur is increased because of decreased bending resistance. Doxorubicin and cisplatin reduce the maximum shear stress of the proximal tibial growth plate, none of the chemotherapeutic agents inhibit bone mineralization. These effects are caused by treatment-induced malnutrition and the accompanying weight reduction and a direct effect of the chemotherapeutic agents on the skeleton. The current study confirmed the importance of preventing malnutrition during chemotherapeutic treatment in view of possible skeletal complications. During followup of children treated with chemotherapy, attention should be given to signs and symptoms suggestive of such complications.

  4. Reliable classification of children's fractures according to the comprehensive classification of long bone fractures by Müller.

    Science.gov (United States)

    Meling, Terje; Harboe, Knut; Enoksen, Cathrine H; Aarflot, Morten; Arthursson, Astvaldur J; Søreide, Kjetil

    2013-04-01

    Guidelines for fracture treatment and evaluation require a valid classification. Classifications especially designed for children are available, but they might lead to reduced accuracy, considering the relative infrequency of childhood fractures in a general orthopedic department. We tested the reliability and accuracy of the Müller classification when used for long bone fractures in children. We included all long bone fractures in children aged fractures. Datasets were generated for intra- and inter-rater analysis, as well as a reference dataset for accuracy calculations. We present proportion of agreement (PA) and kappa (K) statistics. For intra-rater analysis, overall agreement (κ) was 0.75 (95% CI: 0.68-0.81) and PA was 79%. For inter-rater assessment, K was 0.71 (95% CI: 0.61-0.80) and PA was 77%. Accuracy was estimated: κ = 0.72 (95% CI: 0.64-0.79) and PA = 76%. The Müller classification (slightly adjusted for pediatric fractures) showed substantial to excellent accuracy among general orthopedic surgeons when applied to long bone fractures in children. However, separate knowledge about the child-specific fracture pattern, the maturity of the bone, and the degree of displacement must be considered when the treatment and the prognosis of the fractures are evaluated.

  5. Reliable classification of children’s fractures according to the comprehensive classification of long bone fractures by Müller

    Science.gov (United States)

    2013-01-01

    Background and purpose Guidelines for fracture treatment and evaluation require a valid classification. Classifications especially designed for children are available, but they might lead to reduced accuracy, considering the relative infrequency of childhood fractures in a general orthopedic department. We tested the reliability and accuracy of the Müller classification when used for long bone fractures in children. Methods We included all long bone fractures in children aged fractures. Datasets were generated for intra- and inter-rater analysis, as well as a reference dataset for accuracy calculations. We present proportion of agreement (PA) and kappa (K) statistics. Results For intra-rater analysis, overall agreement (κ) was 0.75 (95% CI: 0.68–0.81) and PA was 79%. For inter-rater assessment, K was 0.71 (95% CI: 0.61–0.80) and PA was 77%. Accuracy was estimated: κ = 0.72 (95% CI: 0.64–0.79) and PA = 76%. Interpretation The Müller classification (slightly adjusted for pediatric fractures) showed substantial to excellent accuracy among general orthopedic surgeons when applied to long bone fractures in children. However, separate knowledge about the child-specific fracture pattern, the maturity of the bone, and the degree of displacement must be considered when the treatment and the prognosis of the fractures are evaluated. PMID:23245225

  6. Sagittal fractures of the third carpal bone in horses: 12 cases (1977-1985)

    International Nuclear Information System (INIS)

    Fischer, A.T. Jr.; Stover, S.M.

    1987-01-01

    Third carpal sagittal fractures were found to be related to racing injuries in 10 of 12 horses. These fractures occurred most commonly on the medial aspect of the bone. A dorsoproximal-dorsodistal view of the carpus was required to visualize the fracture in all cases. Healing of the fracture required periods of rest of up to one year. Conservative management of these fractures resulted in return to function in 7 of 12 horses

  7. Spatial Differences in the Distribution of Bone Between Femoral Neck and Trochanteric Fractures.

    Science.gov (United States)

    Yu, Aihong; Carballido-Gamio, Julio; Wang, Ling; Lang, Thomas F; Su, Yongbin; Wu, Xinbao; Wang, Manyi; Wei, Jie; Yi, Chen; Cheng, Xiaoguang

    2017-08-01

    There is little knowledge about the spatial distribution differences in volumetric bone mineral density and cortical bone structure at the proximal femur between femoral neck fractures and trochanteric fractures. In this case-control study, a total of 93 women with fragility hip fractures, 72 with femoral neck fractures (mean ± SD age: 70.6 ± 12.7 years) and 21 with trochanteric fractures (75.6 ± 9.3 years), and 50 control subjects (63.7 ± 7.0 years) were included for the comparisons. Differences in the spatial distributions of volumetric bone mineral density, cortical bone thickness, cortical volumetric bone mineral density, and volumetric bone mineral density in a layer adjacent to the endosteal surface were investigated using voxel-based morphometry (VBM) and surface-based statistical parametric mapping (SPM). We compared these spatial distributions between controls and both types of fracture, and between the two types of fracture. Using VBM, we found spatially heterogeneous volumetric bone mineral density differences between control subjects and subjects with hip fracture that varied by fracture type. Interestingly, femoral neck fracture subjects, but not subjects with trochanteric fracture, showed significantly lower volumetric bone mineral density in the superior aspect of the femoral neck compared with controls. Using surface-based SPM, we found that compared with controls, both fracture types showed thinner cortices in regions in agreement with the type of fracture. Most outcomes of cortical and endocortical volumetric bone mineral density comparisons were consistent with VBM results. Our results suggest: 1) that the spatial distribution of trabecular volumetric bone mineral density might play a significant role in hip fracture; 2) that focal cortical bone thinning might be more relevant in femoral neck fractures; and 3) that areas of reduced cortical and endocortical volumetric bone mineral density might be more relevant for

  8. Inadvertent Screw Stripping During Ankle Fracture Fixation in Elderly Bone

    Science.gov (United States)

    Dinah, A. Feroz; Mears, Simon C.; Knight, Trevor A.; Soin, Sandeep P.; Campbell, John T.; Belkoff, Stephen M.

    2011-01-01

    Poor screw purchase because of osteoporosis presents difficulties in ankle fracture fixation. The aim of our study was to determine if cortical thickness, unicortical versus bicortical purchase, and bone mineral density are predictors of inadvertent screw stripping and overtightening. Ten paired cadaver ankles (average donor age, 81.7 years; range, 50-97 years) were used for the study. Computed tomography scanning with phantoms of known density was used to determine the bone density along the distal fibula. A standard small-fragment, 7-hole, one-third tubular plate was applied to the lateral surface of the fibula, with 3 proximal bicortical cortical screws and 2 distal unicortical cancellous screws. A posterior plate, in which all 5 screws were cortical and achieved bicortical purchase, was subsequently applied to the same bones and positioned so that the screw holes did not overlap. A torque sensor was used to measure the torque of each screw during insertion (Ti) and then stripping (Ts). The effect of bone density, screw location, cortical thickness, and unicortical versus bicortical purchase on Ti and Ts was checked for significance (P screws were inadvertently stripped and 12% were overtightened. Despite 21% of the screws being stripped or being at risk for stripping, we found no significant predictors to warn of impending screw stripping. Additional work is needed to identify clinically useful predictors of screw stripping. PMID:23569675

  9. Combined fracture dislocation of the navicular bone along with cuboid, cuneiform and longitudinal split fracture of the lateral malleolus: a rare combination of fractures

    Directory of Open Access Journals (Sweden)

    Khatri Chhetri*, Kapil Mani

    2014-12-01

    Full Text Available Fracture dislocation of the navicular bone, fracture of the cuboid, cuneiform, and longitudinal split fracture of the lateral malleolus is a rare combination of fractures. This is a high velocity injury fracture and can be caused by forcible plantar flexion and inversion of the foot at the time of impact onto the ground. Here we reported such a case in a 35-year-old male patient who was treated by open reduction and fixation with a partially threaded screw and two K-wires for the navicular bone, and two interfragmentary screws with a one third tubular plate for the lateral malleolus. K-wires were removed 6 weeks after surgery followed by partial weight bearing. After 6 months, the patient can walk normally with minimal pain and swelling of the foot. Key words: Arthritis; Navicular fracture dislocation; Split fracture of lateral malleolus

  10. X-ray picture of unstable bone fractures and closed comporession-distraction osteosynthesis

    International Nuclear Information System (INIS)

    Onoprienko, G.A.; Morozova, T.D.

    1981-01-01

    Roentgenologic pictures of unstable bone fractures and the consolidation dynamics after closed compression-distraction osteosynthesis are analyzed. It is established that studying roentgenologic pictures of fractured bones in the early terms after the trauma permit to state unfavourable consolidation conditions and to predict the result of the treatment [ru

  11. Significant forefoot varus deformity resulting in progressive stress fractures of all lesser metatarsal bones

    NARCIS (Netherlands)

    van der Vlies, Cornelis H.; Ponsen, Kees J.; Besselaar, Philip P.; Goslings, J. Carel

    2008-01-01

    Stress fractures may occur in any bone, but appear most frequently in the metatarsal bones. Consecutive stress fractures of all lesser metatarsals in a short period are rare, and only a few cases have been described in the literature. We report an unusual case of a young man with consecutive stress

  12. Mechanical test and fractal analysis on anisotropic fracture of cortical bone

    Energy Technology Data Exchange (ETDEWEB)

    Yin, Dagang [State Key Laboratory of Coal Mine Disaster Dynamics and Control, Chongqing University, Chongqing 400044 (China); College of Aerospace Engineering, Chongqing University, Chongqing 400044 (China); Chen, Bin, E-mail: bchen@cqu.edu.cn [State Key Laboratory of Coal Mine Disaster Dynamics and Control, Chongqing University, Chongqing 400044 (China); College of Aerospace Engineering, Chongqing University, Chongqing 400044 (China); Ye, Wei [College of Aerospace Engineering, Chongqing University, Chongqing 400044 (China); Gou, Jihua [Department of Mechanical and Aerospace Engineering, University of Central Florida, Orlando, FL 32816 (United States); Fan, Jinghong [Division of Mechanical Engineering, Alfred University, Alfred, NY 14802 (United States)

    2015-12-01

    Highlights: • The mechanical properties of the cortical bone of fresh bovine femora along three different directions are tested through four-point bending experiments. • SEM observation shows that the roughness of the fracture surfaces of the three different directions of the bone are remarkably different. • The fractal dimensions of the different fracture surfaces of the bone are calculated by box-counting method in MATLAB. • The fracture energies of the different fracture directions are calculated based on their fractal models. - Abstract: The mechanical properties of the cortical bone of fresh bovine femora along three different directions are tested through four-point bending experiments. It is indicated that the fracture energy along the transversal direction of the bone is distinctly larger than those of the longitudinal and radial directions. The fracture surfaces of the three different directions are observed by scanning electron microscope (SEM). It is shown that the roughness of the fracture surface of the transversal direction is obviously larger than those of the fracture surfaces of the longitudinal and radial directions. It is also revealed that the osteons in the bone are perpendicular to the fracture surface of the transversal direction and parallel to the fracture surfaces of the longitudinal and radial directions. Based on these experimental results, the fractal dimensions of the fracture surfaces of different directions are calculated by box-counting method in MATLAB. The calculated results show that the fractal dimension of the fracture surface of the transversal direction is remarkably larger than those of the fracture surfaces of the longitudinal and radial directions. The fracture energies of different directions are also calculated based on their fractal models. It is denoted that the fracture energy of the transversal direction is remarkably larger than those of the longitudinal and radial directions. The calculated results are in

  13. Mechanical test and fractal analysis on anisotropic fracture of cortical bone

    International Nuclear Information System (INIS)

    Yin, Dagang; Chen, Bin; Ye, Wei; Gou, Jihua; Fan, Jinghong

    2015-01-01

    Highlights: • The mechanical properties of the cortical bone of fresh bovine femora along three different directions are tested through four-point bending experiments. • SEM observation shows that the roughness of the fracture surfaces of the three different directions of the bone are remarkably different. • The fractal dimensions of the different fracture surfaces of the bone are calculated by box-counting method in MATLAB. • The fracture energies of the different fracture directions are calculated based on their fractal models. - Abstract: The mechanical properties of the cortical bone of fresh bovine femora along three different directions are tested through four-point bending experiments. It is indicated that the fracture energy along the transversal direction of the bone is distinctly larger than those of the longitudinal and radial directions. The fracture surfaces of the three different directions are observed by scanning electron microscope (SEM). It is shown that the roughness of the fracture surface of the transversal direction is obviously larger than those of the fracture surfaces of the longitudinal and radial directions. It is also revealed that the osteons in the bone are perpendicular to the fracture surface of the transversal direction and parallel to the fracture surfaces of the longitudinal and radial directions. Based on these experimental results, the fractal dimensions of the fracture surfaces of different directions are calculated by box-counting method in MATLAB. The calculated results show that the fractal dimension of the fracture surface of the transversal direction is remarkably larger than those of the fracture surfaces of the longitudinal and radial directions. The fracture energies of different directions are also calculated based on their fractal models. It is denoted that the fracture energy of the transversal direction is remarkably larger than those of the longitudinal and radial directions. The calculated results are in

  14. Mandibular trabecular bone as fracture indicator in 80-year-old men and women.

    Science.gov (United States)

    Hassani-Nejad, Azar; Ahlqwist, Margareta; Hakeberg, Magnus; Jonasson, Grethe

    2013-12-01

    The objective of the present study was to compare assessments of the mandibular bone as fracture risk indicators for 277 men and women. The mandibular trabecular bone was evaluated in periapical radiographs, using a visual index, as dense, mixed dense and sparse, or sparse. Bone texture was analysed using a computer-based method in which the number of transitions from trabeculae to intertrabecular spaces was calculated. The sum of the sizes and intensities of the spaces between the trabeculae was calculated using Jaw-X software. Women had a statistically significantly greater number of fractures and a higher frequency of sparse mandibular bone. The OR for having suffered a fracture with visually sparse trabecular bone was highest for the male group (OR = 5.55) and lowest for the female group (OR = 3.35). For bone texture as an indicator of previous fracture, the OR was significant for the female group (OR = 2.61) but not for the male group, whereas the Jaw-X calculations did not differentiate between fractured and non-fractured groups. In conclusion, all bone-quality assessments showed that women had a higher incidence of sparse trabecular bone than did men. Only the methods of visual assessment and trabecular texture were significantly correlated with previous bone fractures. © 2013 Eur J Oral Sci.

  15. [The laboratory evaluation of pathogenic factors under retarded consolidation of fractures of bones of lower extremities].

    Science.gov (United States)

    Stogov, V M; Kireeva, E A; Karasev, A G

    2014-12-01

    The study was carried out to comparatively analyze metabolic profile and content of growth factors in blood serum of patients with retarded consolidation of fractures of bones of lower extremities. The evaluation was applied to concentration of metabolites, growth factors and enzyme activity of blood serum in 13 patients with retarded consolidation of fractures of thigh and shank bones (main group). The comparative group included 14 patients with solid fractures of thigh and shank bones. The analysis established that as compared to patients with solid fractures of bones, in patients with retarded consolidation of fractures blood serum contained reliably higher concentration of triglycerides, products of glycolysis, epidermal growth factor and transforming growth factors TGF-α and TGF-β2. The content of vitamin E and insullin-like growth factor (IGF-1) was decreased The given markers can be labeled as potential markers of diagnostic and prognosis of development of retarded consolidation of fractures.

  16. Bone morphometry and mineral contents of the distal part of the fractured third metacarpal bone in thoroughbred racehorses

    International Nuclear Information System (INIS)

    Yoshihara, T.; Oikawa, M.; Wada, R.; Hasegawa, M.; Kaneko, M.

    1990-01-01

    Most of the bone fractures in racehorses occur in the fore limb, especially in the metacarpal joint during the racing and training. The longitudinal fracture of the third metacarpal bone (Mc III) often occurs in the osteosclerotic and/or necrotic lesions in the distal part of the bone. To elucidate the endogenous factors of its fracture, soft radiograms of 4 fractured and 4 non-fractured control cases have been investigated morphometrically by a image analyzer. In addition, to analyze the quality of these bones, 20 elements of mineral contents in the crashed bones have been measured using a fluorescent X-ray analyzer. As the results, the osteosclerotic change was observed in both groups in the plantar side of the distal part of Mc III, however, no significant differences were found in the bone morphometry. No significant differences in the 19 elements of bone mineral were found except Fe. From these findings, the mechanism of the occurrence of the longitudinal fracture in the Mc III remains to be elucidated. In future, further work needs to be done with regard to the mechanical intensity and collagen disposition of the distal part of the Mc III

  17. Development and validation of a predictive bone fracture risk model for astronauts.

    Science.gov (United States)

    Nelson, Emily S; Lewandowski, Beth; Licata, Angelo; Myers, Jerry G

    2009-11-01

    There are still many unknowns in the physiological response of human beings to space, but compelling evidence indicates that accelerated bone loss will be a consequence of long-duration spaceflight. Lacking phenomenological data on fracture risk in space, we have developed a predictive tool based on biomechanical and bone loading models at any gravitational level of interest. The tool is a statistical model that forecasts fracture risk, bounds the associated uncertainties, and performs sensitivity analysis. In this paper, we focused on events that represent severe consequences for an exploration mission, specifically that of spinal fracture resulting from a routine task (lifting a heavy object up to 60 kg), or a spinal, femoral or wrist fracture due to an accidental fall or an intentional jump from 1 to 2 m. We validated the biomechanical and bone fracture models against terrestrial studies of ground reaction forces, skeletal loading, fracture risk, and fracture incidence. Finally, we predicted fracture risk associated with reference missions to the moon and Mars that represented crew activities on the surface. Fracture was much more likely on Mars due to compromised bone integrity. No statistically significant gender-dependent differences emerged. Wrist fracture was the most likely type of fracture, followed by spinal and hip fracture.

  18. Nose fracture

    Science.gov (United States)

    Fracture of the nose; Broken nose; Nasal fracture; Nasal bone fracture; Nasal septal fracture ... A fractured nose is the most common fracture of the face. It most ... occurs with other fractures of the face. Nose injuries and neck ...

  19. Bone three-dimensional microstructural features of the common osteoporotic fracture sites

    Science.gov (United States)

    Chen, Huayue; Kubo, Kin-ya

    2014-01-01

    Osteoporosis is a common metabolic skeletal disorder characterized by decreased bone mass and deteriorated bone structure, leading to increased susceptibility to fractures. With aging population, osteoporotic fractures are of global health and socioeconomic importance. The three-dimensional microstructural information of the common osteoporosis-related fracture sites, including vertebra, femoral neck and distal radius, is a key for fully understanding osteoporosis pathogenesis and predicting the fracture risk. Low vertebral bone mineral density (BMD) is correlated with increased fracture of the spine. Vertebral BMD decreases from cervical to lumbar spine, with the lowest BMD at the third lumbar vertebra. Trabecular bone mass of the vertebrae is much lower than that of the peripheral bone. Cancellous bone of the vertebral body has a complex heterogeneous three-dimensional microstructure, with lower bone volume in the central and anterior superior regions. Trabecular bone quality is a key element to maintain the vertebral strength. The increased fragility of osteoporotic femoral neck is attributed to low cancellous bone volume and high compact porosity. Compared with age-matched controls, increased cortical porosity is observed at the femoral neck in osteoporotic fracture patients. Distal radius demonstrates spatial inhomogeneous characteristic in cortical microstructure. The medial region of the distal radius displays the highest cortical porosity compared with the lateral, anterior and posterior regions. Bone strength of the distal radius is mainly determined by cortical porosity, which deteriorates with advancing age. PMID:25232524

  20. Targeting Transforming Growth Factor Beta to Enhance the Fracture Resistance of Bone

    Science.gov (United States)

    2013-01-01

    solely explained by an age- or menopausal - related decrease in bone mass [2,3], new anti-fracture therapies should also address other determinants of...to postmenopausal osteoporosis , certain diseases such as diabetes [1] and chronic kidney disease [2] also increase fracture risk. While an age- related ...fractures and bone mineral density in post- menopausal women with osteoporosis . N Engl J Med. 2001;344 (19):1434–41. 6. Shane E, Burr D, Ebeling PR, et

  1. Celiac disease and bone fractures: a systematic review and meta-analysis.

    Science.gov (United States)

    Heikkilä, Katriina; Pearce, Jo; Mäki, Markku; Kaukinen, Katri

    2015-01-01

    Celiac disease, an autoimmune disease induced by dietary gluten, is associated with metabolic bone disorders, such as low bone mineral density. However, it is unclear whether this translates into an association between celiac disease and such hard clinical outcomes as bone fractures. To systematically review and pool the evidence for the relationship of celiac disease with prevalence and incidence of bone fractures. We systematically searched Pubmed, Scopus, Web of Science, and Cochrane Library in January 2014 for studies of celiac disease and bone fractures. Observational studies of any design, in which bone fracture outcomes were compared in individuals with and without celiac disease were included. Two investigators independently extracted results from eligible studies. In the meta-analyses of case-control and cross-sectional studies, bone fractures were almost twice as common in individuals with a clinically diagnosed celiac disease as in those without the disease. In the meta-analyses of prospective studies, celiac disease at baseline was associated with a 30% increase (95% confidence interval [CI]: 1.14, 1.50) in the risk of any fracture and a 69% increase in the risk of hip fracture (95% CI: 1.10, 2.59). The two studies of unrecognized celiac disease (elevated circulating concentrations of celiac disease-specific autoantibodies but no celiac disease diagnosis) had contradicting findings. Our findings suggest that clinically diagnosed celiac disease and bone fractures co-occur and that celiac disease was associated with an increased risk of hip fractures as well as fractures in general. Further research would be needed to determine whether unrecognized celiac disease is associated with the risk of bone fractures.

  2. Increased sclerostin associated with stress fracture of the third metacarpal bone in the Thoroughbred racehorse

    Science.gov (United States)

    Singer, E.; Henson, F.

    2018-01-01

    Objectives The exact aetiology and pathogenesis of microdamage-induced long bone fractures remain unknown. These fractures are likely to be the result of inadequate bone remodelling in response to damage. This study aims to identify an association of osteocyte apoptosis, the presence of osteocytic osteolysis, and any alterations in sclerostin expression with a fracture of the third metacarpal (Mc-III) bone of Thoroughbred racehorses. Methods A total of 30 Mc-III bones were obtained; ten bones were fractured during racing, ten were from the contralateral limb, and ten were from control horses. Each Mc-III bone was divided into a fracture site, condyle, condylar groove, and sagittal ridge. Microcracks and diffuse microdamage were quantified. Apoptotic osteocytes were measured using TUNEL staining. Cathepsin K, matrix metalloproteinase-13 (MMP-13), HtrA1, and sclerostin expression were analyzed. Results In the fracture group, microdamage was elevated 38.9% (sd 2.6) compared with controls. There was no difference in the osteocyte number and the percentage of apoptotic cells between contralateral limb and unraced control; however, there were significantly fewer apoptotic cells in fractured samples (p fractured samples, sclerostin expression was significantly higher (p fractured during racing. In this study, this is not associated with osteocyte apoptosis or osteocytic osteolysis. The finding of increased sclerostin in the region of the fracture suggests that this protein may be playing a key role in the regulation of bone microdamage during stress adaptation. Cite this article: N. Hopper, E. Singer, F. Henson. Increased sclerostin associated with stress fracture of the third metacarpal bone in the Thoroughbred racehorse. Bone Joint Res 2018;7:94–102. DOI: 10.1302/2046-3758.71.BJR-2016-0202.R4. PMID:29363519

  3. Proton pump inhibitors increase the incidence of bone fractures in hepatitis C patients.

    Science.gov (United States)

    Mello, Michael; Weideman, Rick A; Little, Bertis B; Weideman, Mark W; Cryer, Byron; Brown, Geri R

    2012-09-01

    While proton pump inhibitors (PPI) may increase the risk of bone fractures, the incidence of new bone fractures in a chronic hepatitis C virus (HCV) infected cohort, with or without PPI exposure, has not been explored. A retrospective cohort study of the incidence of bone fractures over 10 years in 9,437 HCV antibody positive patients in the Dallas VA Hepatitis C Registry was performed. The study endpoint was the incidence of verified new bone fractures per patient-years (pt-yrs) in PPI users compared to non-PPI users. PPI use was defined as those taking a PPI for ≥360 days. Pt-yrs of exposure for PPI users began on the first PPI prescription date, and pt-yrs of exposure for non-PPI users began with first date of any non-PPI prescription. For both HCV groups, the final date of patients' study duration was defined by end of PPI exposure, bone fracture occurrence, death or end of study evaluation period. Exclusion criteria included use of bone health modifying medications ≥30 days. Statistical differences in fracture incidence between groups were determined by multivariate regression analysis. Among the total study population analyzed (n = 2,573), 109 bone fractures occurred. Unadjusted bone fracture incidences were 13.99/1,000 pt-yrs vs. 5.86/1,000 pt-yrs in PPI and non-PPI users, respectively. The adjusted hazard ratio for new bone fractures was 3.87 (95 % CI 2.46-6.08) (p 1 year increased the risk of new bone fractures by more than threefold.

  4. Integrity of the osteocyte bone cell network in osteoporotic fracture: Implications for mechanical load adaptation

    International Nuclear Information System (INIS)

    Kuliwaba, J S; Truong, L; Codrington, J D; Fazzalari, N L

    2010-01-01

    The human skeleton has the ability to modify its material composition and structure to accommodate loads through adaptive modelling and remodelling. The osteocyte cell network is now considered to be central to the regulation of skeletal homeostasis; however, very little is known of the integrity of the osteocyte cell network in osteoporotic fragility fracture. This study was designed to characterise osteocyte morphology, the extent of osteocyte cell apoptosis and expression of sclerostin protein (a negative regulator of bone formation) in trabecular bone from the intertrochanteric region of the proximal femur, for postmenopausal women with fragility hip fracture compared to age-matched women who had not sustained fragility fracture. Osteocyte morphology (osteocyte, empty lacunar, and total lacunar densities) and the degree of osteocyte apoptosis (percent caspase-3 positive osteocyte lacunae) were similar between the fracture patients and non-fracture women. The fragility hip fracture patients had a lower proportion of sclerostin-positive osteocyte lacunae in comparison to sclerostin-negative osteocyte lacunae, in contrast to similar percent sclerostin-positive/sclerostin-negative lacunae for non-fracture women. The unexpected finding of decreased sclerostin expression in trabecular bone osteocytes from fracture cases may be indicative of elevated bone turnover and under-mineralisation, characteristic of postmenopausal osteoporosis. Further, altered osteocytic expression of sclerostin may be involved in the mechano-responsiveness of bone. Optimal function of the osteocyte cell network is likely to be a critical determinant of bone strength, acting via mechanical load adaptation, and thus contributing to osteoporotic fracture risk.

  5. Integrity of the osteocyte bone cell network in osteoporotic fracture: Implications for mechanical load adaptation

    Science.gov (United States)

    Kuliwaba, J. S.; Truong, L.; Codrington, J. D.; Fazzalari, N. L.

    2010-06-01

    The human skeleton has the ability to modify its material composition and structure to accommodate loads through adaptive modelling and remodelling. The osteocyte cell network is now considered to be central to the regulation of skeletal homeostasis; however, very little is known of the integrity of the osteocyte cell network in osteoporotic fragility fracture. This study was designed to characterise osteocyte morphology, the extent of osteocyte cell apoptosis and expression of sclerostin protein (a negative regulator of bone formation) in trabecular bone from the intertrochanteric region of the proximal femur, for postmenopausal women with fragility hip fracture compared to age-matched women who had not sustained fragility fracture. Osteocyte morphology (osteocyte, empty lacunar, and total lacunar densities) and the degree of osteocyte apoptosis (percent caspase-3 positive osteocyte lacunae) were similar between the fracture patients and non-fracture women. The fragility hip fracture patients had a lower proportion of sclerostin-positive osteocyte lacunae in comparison to sclerostin-negative osteocyte lacunae, in contrast to similar percent sclerostin-positive/sclerostin-negative lacunae for non-fracture women. The unexpected finding of decreased sclerostin expression in trabecular bone osteocytes from fracture cases may be indicative of elevated bone turnover and under-mineralisation, characteristic of postmenopausal osteoporosis. Further, altered osteocytic expression of sclerostin may be involved in the mechano-responsiveness of bone. Optimal function of the osteocyte cell network is likely to be a critical determinant of bone strength, acting via mechanical load adaptation, and thus contributing to osteoporotic fracture risk.

  6. Bone Repair on Fractures Treated with Osteosynthesis, ir Laser, Bone Graft and Guided Bone Regeneration: Histomorfometric Study

    Science.gov (United States)

    dos Santos Aciole, Jouber Mateus; dos Santos Aciole, Gilberth Tadeu; Soares, Luiz Guilherme Pinheiro; Barbosa, Artur Felipe Santos; Santos, Jean Nunes; Pinheiro, Antonio Luiz Barbosa

    2011-08-01

    The aim of this study was to evaluate, through the analysis of histomorfometric, the repair of complete tibial fracture in rabbits fixed with osteosynthesis, treated or not with infrared laser light (λ780 nm, 50 mW, CW) associated or not to the use of hydroxyapatite and guided bone regeneration (GBR). Surgical fractures were created, under general anesthesia (Ketamina 0,4 ml/Kg IP and Xilazina 0,2 ml/Kg IP), on the dorsum of 15 Oryctolagus rabbits that were divided into 5 groups and maintained on individual cages, at day/night cycle, fed with solid laboratory pelted diet and had water ad libidum. On groups II, III, IV and V the fracture was fixed with wire osteosynthesis. Animals of groups III and V were grafted with hydroxyapatite and GBR technique used. Animals of groups IV and V were irradiated at every other day during two weeks (16 J/cm2, 4×4 J/cm2). Observation time was that of 30 days. After animal death (overdose of general anesthetics) the specimes were routinely processed to wax and underwent histological analysis by light microscopy. The histomorfometric analysis showed an increased bone neoformation, increased collagen deposition, less reabsorption and inflammation when laser was associated to the HATCP. It is concluded that IR laser light was able to accelerate fracture healing and the association with HATCP and GBR resulted on increased deposition of CHA.

  7. [Diagnosis and treatment of tubular bone fractures complicated by defective consolidation of bone fragments in children and adolescents].

    Science.gov (United States)

    Merkulov, V N; Dorokhin, A I; Sokolov, O G; Mininkov, D S

    2008-01-01

    Over 3500 cases of long bone fracture in children and adolescents were analysed by objective methods including USG, CT, osteodensitometry, thermography, polarography, and radionuclide studies. A group of patients with delayed consolidation of bone fragments was distinguished based on the results of clinical and instrumental investigations. Diagnostic criteria and early signs of delayed consolidation were established. Methods for the treatment of such children were improved taking into account localization of the fracture, clinical signs of delayed consolidation and its underlying causes.

  8. Proximal Tibia Fracture After Anterior Cruciate Ligament Reconstruction Using Bone-Patellar Tendon-Bone Autograft: A Case Report

    OpenAIRE

    Voos, James E.; Drakos, Mark C.; Lorich, Dean G.; Fealy, Stephen

    2007-01-01

    The optimal operative management of anterior cruciate ligament (ACL) injury continues to be debated. Many complications can occur, but fracture is often not routinely discussed. We present a complex intra-articular tibia fracture in a patient who had an autologous, ipsilateral bone-patellar-bone ACL reconstruction. While still advocating early, aggressive physical therapy, this case reminds us of the inherent susceptibility to injury in the immediate post-operative period.

  9. Sensitivities of biomechanical assessment methods for fracture healing of long bones.

    Science.gov (United States)

    Chen, G; Wu, F Y; Zhang, J Q; Zhong, G Q; Liu, F

    2015-07-01

    There is a controversy as to whether the biomechanical methods are feasible to assess fracture healing of long bones. This paper investigated the sensitivities of two biomechanical methods, torsion and bending, for assessing fracture healing of long bones; both a simplified beam model and finite element model of an artificial femur were employed. The results demonstrated that, in the initial healing stage, the whole-bone stiffness of the fractured bone is extremely sensitive to the variation of the callus stiffness at the fracture site; when the shear (or Young's) modulus of the callus reaches 15% that of the intact bone, the whole-bone stiffness rises up to 90% that of the intact bone. After that, the whole-bone torsional (or bending) stiffness increases slowly; it becomes less sensitive to the variation of the callus stiffness. These results imply that the whole-bone stiffness is of limited reliability to assess the healing quality particular at late stages of the healing process. The simplified model in this paper provided a theoretical framework to explain why the whole-bone stiffness is insensitive to the healing process of fractured long bones in the late stage of healing. The conclusions obtained from the simplified model were verified with the finite element simulations of the artificial femur. Copyright © 2015 IPEM. Published by Elsevier Ltd. All rights reserved.

  10. Recreational football training decreases risk factors for bone fractures in untrained premenopausal women

    DEFF Research Database (Denmark)

    Helge, Eva Wulff; Aagaard, Per; Jakobsen, Markus D.

    2010-01-01

    The present intervention was designed to investigate whether a 14-week period of regular recreational association football (F) or endurance running (R) has an effect on the risk of falls and bone fractures due to gains in muscle function and volumetric bone mineral density (vBMD). Fifty healthy...... improved peak jump power, maximal hamstring strength and vBMD in the distal tibia, suggesting a decreased fracture risk due to stronger bones and a reduced risk of falling....

  11. Rotary self-locking intramedullary nail for long tubular bone fractures.

    Science.gov (United States)

    Huang, Zhong-lian; Yang, Hai-long; Xu, Jian-kun; Xia, Xue; Wang, Xin-jia; Song, Jian-xin; Hu, Jun

    2013-10-01

    Intramedullary nails had been widely used in the treatment of long-bone fractures because of less interference of fractures and center bearing biomechanical advantage. However, it had been also found many shortcomings such as broken nails, delayed healing and was modified in order to achieve better efficacy and reduce complications. The aim of the present study is to compare the efficacy of rotary self-locking intramedullary nails (RSIN) with that of interlocking intramedullary nails (IIN) in the treatment of long-bone fractures. A retrospective study investigated 129 cases with long-bone fractures (36 with femoral fracture, 81 with tibial fracture, and 12 with humeral fracture). The fractures were fixed using either an RSIN or IIN. All patients underwent followup for 12-30 months. All patients in both groups achieved a clinical fracture healing standard and the postoperative affected limb muscle strength and joint function were well restored. The RSIN group required a shorter operative time and the fracture healed faster. There was no significant difference in the hospital stay, intraoperative blood loss or postoperative complications between the two groups. RSIN is used to treat long-bone fractures. Its healing efficacy is equivalent to the IIN. Moreover, the RSIN method is simpler and causes less tissue damage than the IIN, therefore having the advantage of accelerated healing.

  12. Increased sclerostin associated with stress fracture of the third metacarpal bone in the Thoroughbred racehorse.

    Science.gov (United States)

    Hopper, N; Singer, E; Henson, F

    2018-01-01

    The exact aetiology and pathogenesis of microdamage-induced long bone fractures remain unknown. These fractures are likely to be the result of inadequate bone remodelling in response to damage. This study aims to identify an association of osteocyte apoptosis, the presence of osteocytic osteolysis, and any alterations in sclerostin expression with a fracture of the third metacarpal (Mc-III) bone of Thoroughbred racehorses. A total of 30 Mc-III bones were obtained; ten bones were fractured during racing, ten were from the contralateral limb, and ten were from control horses. Each Mc-III bone was divided into a fracture site, condyle, condylar groove, and sagittal ridge. Microcracks and diffuse microdamage were quantified. Apoptotic osteocytes were measured using TUNEL staining. Cathepsin K, matrix metalloproteinase-13 (MMP-13), HtrA1, and sclerostin expression were analyzed. In the fracture group, microdamage was elevated 38.9% (sd 2.6) compared with controls. There was no difference in the osteocyte number and the percentage of apoptotic cells between contralateral limb and unraced control; however, there were significantly fewer apoptotic cells in fractured samples (p fractured samples, sclerostin expression was significantly higher (p bones that have fractured during racing. In this study, this is not associated with osteocyte apoptosis or osteocytic osteolysis. The finding of increased sclerostin in the region of the fracture suggests that this protein may be playing a key role in the regulation of bone microdamage during stress adaptation. Cite this article: Bone Joint Res 2018;7:94-102. © 2018 Hopper et al.

  13. Fracture Risk Prediction Using Phalangeal Bone Mineral Density or FRAX(®)?

    DEFF Research Database (Denmark)

    Friis-Holmberg, Teresa; Rubin, Katrine Hass; Brixen, Kim

    2014-01-01

    In this prospective study, we investigated the ability of Fracture Risk Assessment Tool (FRAX), phalangeal bone mineral density (BMD), and age alone to predict fractures using data from a Danish cohort study, Danish Health Examination Survey 2007-2008, including men (n = 5206) and women (n = 7552...... variables performed overall best in the prediction of major osteoporotic fractures. In predicting hip fractures, there was a tendency of T-score performing worse than the other methods....

  14. Allogenic bone rods with freeze drying and gamma rays irradiation for treatment of fracture

    International Nuclear Information System (INIS)

    Zhou Zhenbin

    1999-01-01

    Opened reduction and internal fixation are the usual treatment of fracture, but both methods need a second operation for removal implants. The benefits of the bone rods are that they can avoid the removement of internal fixation and will be absorbed spontaneously. The bone rods are made of allogeneic compact bones with freeze-drying and gamma rays irradiation supplied by Shanxi Provincial Tissue Bank. The purpose of this study is to evaluate allograft reaction, the stability of the internal fixation, osteoinduction in the treatment of fracture using allogeneic bone rods with freeze drying and gamma rays irradiation. From May 1997 to May 1998, fourteen cases (male 12, female 2) of treatment were reviewed. The mean age was 37.3 (21-5 1). There were 3 medial malleolus fractures, 7 tibia and fibula fractures, 1 ulna and radius fracture, 1 lateral condyle of humerus fracture. The clinical results were satisfactory. Because the strength of the bone rods are weaker than that of screws, the bone rods are only indicated in the fixation of cancellous bones fracture and unloaded bone fracture. It can be used as a supplementary fixation of loaded bone. It is not indicated for fixation of comminuted fracture. More than two bone rods may be used in the fixation of fracture in order to get stability of the fracture and decrease stress between rods which will prevent the break of the bone rods. Allogeneic bone rods with freeze-drying and gamma rays irradiation can be used as implants of non-immunogenicity. There are no allograft reactions in all cases (including fever, leukocytosis, exudation or swelling in the wound). Although plenty of experimental studies have showed that freeze drying with gamma rays irradiation (below 50 KGy) would not destroy BMP of bone allograft, but there is no osteoinduction in our cases. The healing of a fracture and bridging external callus are similar as other operations. This new technique may have the following advantages compare with the screws: 1

  15. Impact of degenerative radiographic abnormalities and vertebral fractures on spinal bone density of women with osteoporosis

    Directory of Open Access Journals (Sweden)

    Lúcia Costa Paiva

    2002-01-01

    Full Text Available CONTEXT: Measurements of bone density taken by dual-energy x-ray absorptiometry are the most accurate procedure for the diagnosis of osteoporosis. This procedure has the disadvantage of measuring the density of all mineral components, including osteophytes, vascular and extra vertebral calcifications. These alterations can influence bone density results and densitometry interpretation. OBJECTIVE: To correlate radiography and densitometry findings from women with osteoporosis, analyzing the influence of degenerative processes and vertebral fractures on the evaluation of bone density. DESIGN: Retrospective study. SETTING: Osteoporosis outpatients' clinic at Hospital das Clínicas, Universidade Estadual de Campinas. PARTICIPANTS: Ninety-six postmenopausal women presenting osteoporosis diagnosed by bone density. MAIN MEASUREMENTS: Bone mineral density of the lumbar spine and femoral neck were measured by the technique of dual-energy x-ray absorptiometry, using a LUNAR-DPX densitometer. Fractures, osteophytes and aortic calcifications were evaluated by simple x-rays of the thoracic and lumbar spine. RESULTS: The x-rays confirmed vertebral fractures in 41.6%, osteophytes in 33.3% and calcifications of the aorta in 30.2%. The prevalence of fractures and aortic calcifications increased with age. The mean bone mineral density was 0.783g/cm² and the mean T-score was --3.47 DP. Neither fractures nor aortic calcifications had significant influence on bone mineral density (P = 0.36 and P = 0.09, respectively, despite the fractured vertebrae having greater bone mineral density (P < 0.02. Patients with lumbar spine osteophytes showed greater bone mineral density (P = 0.04. Osteophytosis was associated with lumbar spine bone mineral density after adjustment for fractures and aortic calcifications by multiple regression (P = 0.01. CONCLUSION: Osteophytes and lumbar spine fractures can overestimate bone density interpretation. The interpretation of densitometry

  16. Surgical repair of skull fractures in four horses using cuttable bone plates.

    Science.gov (United States)

    Dowling, B A; Dart, A J; Trope, G

    2001-05-01

    Three horses with severely comminuted, open facial bone fractures and one horse with a comminuted, open orbital rim fracture were referred for treatment. Severe facial bone asymmetry and epistaxis were apparent in all cases and subcutaneous emphysema was present in two, however physical and neurological examinations were otherwise normal. Radiography and endoscopy were of some use in assessing the degree of damage, although the true extent of the damage was more apparent at surgery. Surgical reduction of the fractures was recommended to maximise cosmetic and functional outcome. After surgical debridement and reduction of the fractures the bone fragments remained unstable and were not amenable to stabilisation with interfragmentary wires alone, so 2 mm cuttable bone plates were used to maintain fracture alignment. Screw migration occurred in three horses and in one of these horses the plate had to be removed. Other complications were minor and in all horses the fractures healed with good cosmetic and functional outcome. The use of cuttable bone plates should be considered as a reasonable alternative to inter-fragmentary wiring for unstable, comminuted fractures of the facial bones, even where fractures are open.

  17. Fracture healing: Quantitative three-phase bone scintigraphy as a prognostic factor

    International Nuclear Information System (INIS)

    Dodig, D.; Kasal, B.; Kragic-Pranic, A.; Predic, P.

    2002-01-01

    Aim: Careful clinical examination and conventional radiography, together with other standard methods for evaluation of bone fracture healing, are frequently inconclusive. Furthermore, it is difficult to predict the complications of healing on the basis of clinical and radiographic findings only. Bone scintigraphy plays an important role in detecting bone fractures. This method is very sensitive, but not enough specific. The aim of this work was to evaluate the role of three-phase bone scintigraphy in the healing prognosis of long bone fractures. Material and Methods: We evaluated the three elements (perfusion, blood pool and static image) of three-phase bone scintigraphy in early prognosis of the course of fracture healing in patients with fractures of femur or tibia. Three-phase bone scintigraphy was performed in 73 patients. The patients were divided into 4 groups according to X-ray and clinical examination: 1) Non operated patients with stable fracture, 2) Operated patients with unstable fracture (infection), 3) Fractures with delayed union, 4) Patients with pseudoarthrosis. Using region of interest (ROI) method we compared the activity on the site of fracture with the activity on the symmetrical place in the healthy bone. The relative indices for each group of patients and for each element of three-bone scintigraphy were calculated in order to make possible the follow up of the fracture healing and to obtain data for prognosis and evaluation of possible complications. Results: The most valuable results were obtained by quantitative analysis of perfusion data immediately after trauma and 2-3 weeks later. Our results show a high diagnostic accuracy in identifying infection by perfusion scintigrams immediately after trauma. The perfusion indices obtained immediately and after 2-3 weeks could predict delayed union after the trauma. Quantitative analysis of blood pool phase gave no data of clinical significance in distinguishing various pathologies. Conclusion: Our

  18. Predicting Hip Fracture Type With Cortical Bone Mapping (CBM) in the Osteoporotic Fractures in Men (MrOS) Study.

    Science.gov (United States)

    Treece, Graham M; Gee, Andrew H; Tonkin, Carol; Ewing, Susan K; Cawthon, Peggy M; Black, Dennis M; Poole, Kenneth E S

    2015-11-01

    Hip fracture risk is known to be related to material properties of the proximal femur, but fracture prediction studies adding richer quantitative computed tomography (QCT) measures to dual-energy X-ray (DXA)-based methods have shown limited improvement. Fracture types have distinct relationships to predictors, but few studies have subdivided fracture into types, because this necessitates regional measurements and more fracture cases. This work makes use of cortical bone mapping (CBM) to accurately assess, with no prior anatomical presumptions, the distribution of properties related to fracture type. CBM uses QCT data to measure the cortical and trabecular properties, accurate even for thin cortices below the imaging resolution. The Osteoporotic Fractures in Men (MrOS) study is a predictive case-cohort study of men over 65 years old: we analyze 99 fracture cases (44 trochanteric and 55 femoral neck) compared to a cohort of 308, randomly selected from 5994. To our knowledge, this is the largest QCT-based predictive hip fracture study to date, and the first to incorporate CBM analysis into fracture prediction. We show that both cortical mass surface density and endocortical trabecular BMD are significantly different in fracture cases versus cohort, in regions appropriate to fracture type. We incorporate these regions into predictive models using Cox proportional hazards regression to estimate hazard ratios, and logistic regression to estimate area under the receiver operating characteristic curve (AUC). Adding CBM to DXA-based BMD leads to a small but significant (p fracture, with AUC increasing from 0.78 to 0.79, assessed using leave-one-out cross-validation. For specific fracture types, the improvement is more significant (p trochanteric fractures and 0.76 to 0.82 for femoral neck fractures. In contrast, adding DXA-based BMD to a CBM-based predictive model does not result in any significant improvement. © 2015 The Authors. Journal of Bone and Mineral Research

  19. Characteristics of bone fractures and usefulness of micro-computed tomography for fracture detection in rabbits: 210 cases (2007-2013).

    Science.gov (United States)

    Sasai, Hiroshi; Fujita, Daisuke; Tagami, Yukari; Seto, Eiko; Denda, Yuki; Hamakita, Hideaki; Ichihashi, Tomonori; Okamura, Kensaku; Furuya, Masaru; Tani, Hiroyuki; Sasai, Kazumi; Yamate, Jyoji

    2015-06-15

    To characterize bone fractures and the usefulness of micro-CT for imaging fractures in pet rabbits. Retrospective case series. 210 client-owned rabbits with bone fractures. Medical records of rabbits evaluated for bone fractures from 2007 through 2013 were examined. Information was collected on signalment and nature of fractures, and radiographic and micro-CT images of fractures were reviewed. Almost half (n = 95 [47.7%]) of fractures were in rabbits fracture was the most common type of fracture with a nonneoplastic cause (n = 46 [23.2%]) and was most common in the L4-L7 region. The tibia was the most common site for limb fracture among all fractures with a nonneoplastic cause (45 [22.7%]). Twelve (5.7%) fractures had a neoplastic cause, and 7 of these were associated with metastatic uterine adenocarcinoma. Females were significantly more likely to have a fracture caused by neoplasia than were males. Compared with radiography, micro-CT provided more detailed fracture information, particularly for complicated fractures or structures (eg, skull, pelvic, vertebral, and comminuted limb fractures). Findings were useful for understanding the nature of fractures in pet rabbits and supported the use of micro-CT versus radiography for fracture detection and evaluation.

  20. Use of bone marrow derived stem cells in a fracture non-union

    Directory of Open Access Journals (Sweden)

    Binod C. Raulo

    2012-01-01

    Full Text Available This is an attempt of using in vitro cultured mesenchymal stem cells (MSCs from bone marrow in joining of a fracture non-union. Bone marrow cells were obtained and differentially centrifuged for MSCs that were grown in vitro in mesenchymal stem cell basal medium aseptically, for 10 d. The cell mass was injected around the fracture non-union. Healthy conditions of development of tissue regeneration at the trauma site and due bone joining were recorded. It is concluded that in vitro cultured MSCs had a blithesome effect on the fracture non-union.

  1. The role of bone marrow-derived cells in bone fracture repair in a green fluorescent protein chimeric mouse model

    International Nuclear Information System (INIS)

    Taguchi, Kazuhiro; Ogawa, Rei; Migita, Makoto; Hanawa, Hideki; Ito, Hiromoto; Orimo, Hideo

    2005-01-01

    We investigated the role of bone marrow cells in bone fracture repair using green fluorescent protein (GFP) chimeric model mice. First, the chimeric model mice were created: bone marrow cells from GFP-transgenic C57BL/6 mice were injected into the tail veins of recipient wild-type C57BL/6 mice that had been irradiated with a lethal dose of 10 Gy from a cesium source. Next, bone fracture models were created from these mice: closed transverse fractures of the left femur were produced using a specially designed device. One, three, and five weeks later, fracture lesions were extirpated for histological and immunohistochemical analyses. In the specimens collected 3 and 5 weeks after operation, we confirmed calluses showing intramembranous ossification peripheral to the fracture site. The calluses consisted of GFP- and osteocalcin-positive cells at the same site, although the femur consisted of only osteocalcin-positive cells. We suggest that bone marrow cells migrated outside of the bone marrow and differentiated into osteoblasts to make up the calluses

  2. Bone bruise, lipohemarthrosis, and joint effusion in CT of non-displaced hip fracture

    International Nuclear Information System (INIS)

    Geijer, Mats; Dunker, Dennis; Collin, David; Goethlin, Jan H.

    2012-01-01

    Background. A suspected occult hip fracture after normal radiography is not uncommon in an elderly person after a fall. Despite a lack of robust validation in the literature, computed tomography (CT) is often used as secondary imaging. Purpose. To assess the frequency and clinical utility of non-cortical skeletal and soft tissue lesions as ancillary fracture signs in CT diagnosis of occult hip fractures. Material and Methods. All fracture signs (cortical and trabecular fractures, bone bruise, joint effusion, and lipohemarthrosis) were recorded in 231 hip low-energy trauma cases with CT performed after normal or equivocal radiography in two trauma centers. Results. There were no fracture signs in 110 patients. Twelve of these had a joint effusion. In 121 patients with 46 cervical hip fractures and 75 trochanteric fractures one or more fracture signs were present. Cortical fractures were found in 115 patients. Bone bruise was found in 119 patients, joint effusion in 35, and lipohemarthrosis in 20 patients. Conclusion. Ancillary signs such as bone bruise and lipohemarthrosis can strengthen and sometimes indicate the diagnosis in CT of occult hip fractures. Joint effusion is a non-specific sign

  3. Bone bruise, lipohemarthrosis, and joint effusion in CT of non-displaced hip fracture

    Energy Technology Data Exchange (ETDEWEB)

    Geijer, Mats (Center for Medical Imaging and Physiology, Skaane University Hospital, Lund University, Lund (Sweden)), Email: mats@geijer.info; Dunker, Dennis; Collin, David; Goethlin, Jan H. (Department of Radiology, Sahlgrenska University Hospital, Moelndal (Sweden))

    2012-03-15

    Background. A suspected occult hip fracture after normal radiography is not uncommon in an elderly person after a fall. Despite a lack of robust validation in the literature, computed tomography (CT) is often used as secondary imaging. Purpose. To assess the frequency and clinical utility of non-cortical skeletal and soft tissue lesions as ancillary fracture signs in CT diagnosis of occult hip fractures. Material and Methods. All fracture signs (cortical and trabecular fractures, bone bruise, joint effusion, and lipohemarthrosis) were recorded in 231 hip low-energy trauma cases with CT performed after normal or equivocal radiography in two trauma centers. Results. There were no fracture signs in 110 patients. Twelve of these had a joint effusion. In 121 patients with 46 cervical hip fractures and 75 trochanteric fractures one or more fracture signs were present. Cortical fractures were found in 115 patients. Bone bruise was found in 119 patients, joint effusion in 35, and lipohemarthrosis in 20 patients. Conclusion. Ancillary signs such as bone bruise and lipohemarthrosis can strengthen and sometimes indicate the diagnosis in CT of occult hip fractures. Joint effusion is a non-specific sign

  4. Bone graft substitutes for the treatment of traumatic fractures of the extremities.

    Science.gov (United States)

    Hagen, Anja; Gorenoi, Vitali; Schönermark, Matthias P

    2012-01-01

    HEALTH POLITICAL AND SCIENTIFIC BACKGROUND: Bone graft substitutes are increasingly being used as supplements to standard care or as alternative to bone grafts in the treatment of traumatic fractures. The efficacy and cost-effectiveness of bone graft substitutes for the treatment of traumatic fractures as well as the ethical, social and legal implications of their use are the main research questions addressed. A systematic literature search was conducted in electronic medical databases (MEDLINE, EMBASE etc.) in December 2009. Randomised controlled trials (RCT), where applicable also containing relevant health economic evaluations and publications addressing the ethical, social and legal aspects of using bone graft substitutes for fracture treatment were included in the analysis. After assessment of study quality the information synthesis of the medical data was performed using metaanalysis, the synthesis of the health economic data was performed descriptively. 14 RCT were included in the medical analysis, and two in the heath economic evaluation. No relevant publications on the ethical, social and legal implications of the bone graft substitute use were found. In the RCT on fracture treatment with bone morphogenetic protein-2 (BMP-2) versus standard care without bone grafting (RCT with an elevated high risk of bias) there was a significant difference in favour of BMP-2 for several outcome measures. The RCT of calcium phosphate (CaP) cement and bone marrow-based composite materials versus autogenous bone grafts (RCT with a high risk of bias) revealed significant differences in favour of bone graft substitutes for some outcome measures. Regarding the other bone graft substitutes, almost all comparisons demonstrated no significant difference. The use of BMP-2 in addition to standard care without bone grafting led in the study to increased treatment costs considering all patients with traumatic open fractures. However, cost savings through the additional use of BMP-2

  5. [Our first experiences with autologous transplantation of bone marrow stem cells to treat pseudarthrosis, delayed fracture healing and long bone defects fracture].

    Science.gov (United States)

    Sír, M; Procházka, V; Gumulec, J; Pleva, L

    2009-03-01

    Traumatology and orthopaedics have undergone substantial progress in the use of new, sophisticated techniques, implants and navigation methods. Nevertheless, these new methods continue to fail in some instances. Regenerative medicine using the growth potential of stem cells that posses the ability to regenerate damaged tissues represent one of the possible ways forward. There is a potential for more comprehensive utilization of bone marrow stem cells that had for many years been used in transplant medicine. Traumatology and orthopaedics could utilise stem cells in the treatment of bone defects, i.e. in the treatment of pseudarthrosis, delayed fracture healing, defect fractures and aseptic bone necroses. Bone formation and growth is a complex, predominantly anabolic, process with a range of feedbacks. Nevertheless, it is the bone marrow where the necessary progenitors of bone growth are located. These are mesenchymal stem cells (MSCs), haematopoietic stem cells (HSCs) as well as thrombocytes containing a range of necessary growth factors. A number of studies showed positive results for stem cells treatment of pseudarthrosis, with only a fraction, however, being statistically significant in human medicine. This method was used in 11 patients of the Traumatology Centre of the Faculty Hospital in Ostrava, Czech Republic in 2008. The researched patients were treated for pseudarthrosis of long bones, delayed multifragmentary fracture haling and defect fractures of long bones. Autologous concentrate of bone marrow stem cells was applied in one session into the area of bone defect in a patient lightly anaesthetised with propofol. The results from this small sample of patients are not yet available. However, we are sharing our first experiences with this treatment option.

  6. Susceptibility to keel bone fractures in laying hens and the role of genetic variation.

    Science.gov (United States)

    Candelotto, Laura; Stratmann, Ariane; Gebhardt-Henrich, Sabine G; Rufener, Christina; van de Braak, Teun; Toscano, Michael J

    2017-10-01

    Keel bone fractures are a well-known welfare problem in modern commercial laying hen systems. The present study sought to identify genetic variation in relation to keel bone fracture susceptibility of 4 distinct crossbred and one pure line, and by extension, possible breeding traits. Susceptibility to fractures were assessed using an ex vivo impact testing protocol in combination with a study design that minimized environmental variation to focus on genetic differences. The 5 crossbred/pure lines differed in their susceptibility to keel bone fractures with the greatest likelihood of fracture in one of the 3 commercial lines and the lowest susceptibility to fractures in one of the experimental lines. Egg production at the hen-level did not differ between the crossbred/pure lines (P > 0.05), though an increased susceptibility to keel bone fractures was associated with thinner eggshells and reduced egg breaking strength, a pattern consistent among all tested crossbred/pure lines. Our findings suggest an association between egg quality and bone strength which appeared to be independent of crossbred/pure line. The findings indicate the benefit of the impact methodology to identify potential breeding characteristics to reduce incidence of keel fracture as well as the potential relationship with eggshell quality. © 2017 Poultry Science Association Inc.

  7. Risk Assessment of Bone Fracture During Space Exploration Missions to the Moon and Mars

    Science.gov (United States)

    Lewandowski, Beth E.; Myers, Jerry G.; Nelson, Emily S.; Griffin, Devon

    2008-01-01

    The possibility of a traumatic bone fracture in space is a concern due to the observed decrease in astronaut bone mineral density (BMD) during spaceflight and because of the physical demands of the mission. The Bone Fracture Risk Module (BFxRM) was developed to quantify the probability of fracture at the femoral neck and lumbar spine during space exploration missions. The BFxRM is scenario-based, providing predictions for specific activities or events during a particular space mission. The key elements of the BFxRM are the mission parameters, the biomechanical loading models, the bone loss and fracture models and the incidence rate of the activity or event. Uncertainties in the model parameters arise due to variations within the population and unknowns associated with the effects of the space environment. Consequently, parameter distributions were used in Monte Carlo simulations to obtain an estimate of fracture probability under real mission scenarios. The model predicts an increase in the probability of fracture as the mission length increases and fracture is more likely in the higher gravitational field of Mars than on the moon. The resulting probability predictions and sensitivity analyses of the BFxRM can be used as an engineering tool for mission operation and resource planning in order to mitigate the risk of bone fracture in space.

  8. Reference point indentation is not indicative of whole mouse bone measures of stress intensity fracture toughness.

    Science.gov (United States)

    Carriero, Alessandra; Bruse, Jan L; Oldknow, Karla J; Millán, José Luis; Farquharson, Colin; Shefelbine, Sandra J

    2014-12-01

    Bone fragility is a concern for aged and diseased bone. Measuring bone toughness and understanding fracture properties of the bone are critical for predicting fracture risk associated with age and disease and for preclinical testing of therapies. A reference point indentation technique (BioDent) has recently been developed to determine bone's resistance to fracture in a minimally invasive way by measuring the indentation distance increase (IDI) between the first and last indentations over cyclic indentations in the same position. In this study, we investigate the relationship between fracture toughness KC and reference point indentation parameters (i.e. IDI, total indentation distance (TID) and creep indentation distance (CID)) in bones from 38 mice from six types (C57Bl/6, Balb, oim/oim, oim/+, Phospho1(-/-) and Phospho1 wild type counterpart). These mice bone are models of healthy and diseased bone spanning a range of fracture toughness from very brittle (oim/oim) to ductile (Phospho1(-/-)). Left femora were dissected, notched and tested in 3-point bending until complete failure. Contralateral femora were dissected and indented in 10 sites of their anterior and posterior shaft surface over 10 indentation cycles. IDI, TID and CID were measured. Results from this study suggest that reference point indentation parameters are not indicative of stress intensity fracture toughness in mouse bone. In particular, the IDI values at the anterior mid-diaphysis across mouse types overlapped, making it difficult to discern differences between mouse types, despite having extreme differences in stress intensity based toughness measures. When more locations of indentation were considered, the normalised IDIs could distinguish between mouse types. Future studies should investigate the relationship of the reference point indentation parameters for mouse bone in other material properties of the bone tissue in order to determine their use for measuring bone quality. Copyright © 2014

  9. Callus formation in bone fractures combined with brain injury in rat

    Directory of Open Access Journals (Sweden)

    Yu-Ping Chen

    2017-01-01

    Full Text Available Objective: The objective of this study was to determine the speed of bony union and the serum levels of biomarkers in the setting of bone fractures combined with brain injury. Materials and Methods: In this study, Sprague–Dawley rats were randomized into four groups: sham, brain injury, bone fracture, and bone fracture plus brain injury groups. The serum levels of biochemical markers, namely, nerve growth factor (NGF, Wnt-3a, Dickkopf-related protein-1, receptor-activator of NF-κB ligand, and adrenocorticotropic hormone (ACTH, were measured on the days 1, 3, 7, and 14 following injury. Bony union was evaluated using radiographs every week for 6 weeks. Results: Compared with the brain injury group and bone fracture group, the radiographs of the bone fracture plus brain injury group revealed enhanced callus formations in week 2. From week 3, the callus formation did not differ significantly among the groups. The serum levels of the biomarkers varied at different time points. The serum levels of NGF on days 1 and 3, Wnt-3a on days 3 and 14, and ACTH on days 1, 3, and 7 were significantly higher in the bone fracture plus brain injury group than in the bone fracture group. Conclusions: Brain injury increases callus formation in simultaneous bone fracture. Considering the time point, early NGF, Wnt-3a, and ACTH elevation might be associated with early callus formation enhancement. The results indicate that these brain injury-induced biomarkers might play crucial role in accelerating bone healing.

  10. The associations between QCT-based vertebral bone measurements and prevalent vertebral fractures depend on the spinal locations of both bone measurement and fracture

    Science.gov (United States)

    Anderson, D. E.; Demissie, S.; Allaire, B. T.; Bruno, A. G.; Kopperdahl, D. L.; Keaveny, T. M.; Kiel, D. P.

    2013-01-01

    Summary We examined how spinal location affects the relationships between quantitative computed tomography (QCT)-based bone measurements and prevalent vertebral fractures. Upper spine (T4–T10) fractures appear to be more strongly related to bone measures than lower spine (T11–L4) fractures, while lower spine measurements are at least as strongly related to fractures as upper spine measurements. Introduction Vertebral fracture (VF), a common injury in older adults, is most prevalent in the mid-thoracic (T7–T8) and thoracolumbar (T12–L1) areas of the spine. However, measurements of bone mineral density (BMD) are typically made in the lumbar spine. It is not clear how the associations between bone measurements and VFs are affected by the spinal locations of both bone measurements and VF. Methods A community-based case–control study includes 40 cases with moderate or severe prevalent VF and 80 age- and sex-matched controls. Measures of vertebral BMD, strength (estimated by finite element analysis), and factor of risk (load:strength ratio) were determined based on QCT scans at the L3 and T10 vertebrae. Associations were determined between bone measures and prevalent VF occurring at any location, in the upper spine (T4–T10), or in the lower spine (T11–L4). Results Prevalent VF at any location was significantly associated with bone measures, with odds ratios (ORs) generally higher for measurements made at L3 (ORs=1.9–3.9) than at T10 (ORs=1.5–2.4). Upper spine fracture was associated with these measures at both T10 and L3 (ORs=1.9–8.2), while lower spine fracture was less strongly associated (ORs=1.0–2.4) and only reached significance for volumetric BMD measures at L3. Conclusions Closer proximity between the locations of bone measures and prevalent VF does not strengthen associations between bone measures and fracture. Furthermore, VF etiology may vary by region, with VFs in the upper spine more strongly related to skeletal fragility. PMID:23925651

  11. Sacral Fracture Nonunion Treated by Bone Grafting through a Posterior Approach

    Directory of Open Access Journals (Sweden)

    Sang Yang Lee

    2013-01-01

    Full Text Available Nonunion of a sacral fracture is a rare but serious clinical condition which can cause severe chronic pain, discomfort while sitting, and significant restriction of the level of activities. Fracture nonunions reportedly occur most often after nonoperative initial treatment or inappropriate operative treatment. We report a case of fracture nonunion of the sacrum and pubic rami that resulted from non-operative initial treatment, which was treated successfully using bone grafting through a posterior approach and CT-guided percutaneous iliosacral screw fixation combined with anterior external fixation. Although autologous bone grafting has been the gold standard for the treatment of pelvic fracture nonunions, little has been written describing the approach. We utilized a posterior approach for bone grafting, which could allow direct visualization of the nonunion site and preclude nerve root injury. By this procedure, we were able to obtain the healing of fracture nonunion, leading to pain relief and functional recovery.

  12. Minimally Invasive Plate Osteosynthesis In The Treatment Of Isolated Ulnar Bone Fractures

    Directory of Open Access Journals (Sweden)

    Suman K Shrestha

    2012-11-01

    Full Text Available BACKGROUND: Minimally invasive internal fixation is also called “biological internal fixation”. This concept is used widely in the treatment of various fractures but to date, there have been no report about such application in the repair of isolated ulnar bone fractures. METHODS: Eleven patients with fracture of isolated ulnar bone (four AO type 22A11 and seven AO type 22A12, mean age 43.16 (range, 24- 59y, were treated using closed reduction and locking compression plate with minimally invasive plate osteosynthesis (MIPO with the aim of minimising soft tissue damage. RESULTS: Fractures healed at an average of 7.8 weeks with good to excellent clinical outcomes. There were no complications such as nonunion, implant failure or neurovascular injuries. CONCLUSIONS: MIPO seems to be advantageous for soft tissue and bone biology. Good union was seen and fracture complications were also prevented by early mobilisation.

  13. Incomplete oblique sagittal fractures of the dorsal cortex of the third metacarpal bone in six horses

    International Nuclear Information System (INIS)

    Watt, B.C.; Foerner, J.J.; Haines, G.R.

    1998-01-01

    To describe incomplete oblique sagittal dorsal cortical fractures of the equine third metacarpal bone, their surgical repair, and subsequent performance of the horses. Retrospective examination of medical records and racing performance. Six Thoroughbred race horses, 2 to 4 years of age. Radiographic confirmation of all fractures preceded general anesthesia and surgical correction. Three fractures were treated by intracortical compression using screws placed in lag fashion, and five fractures were treated by osteostixis. Race records were reviewed for each horse to determine performance after surgery. Fractures were best observed on palmarodorsal radiographic projections. Three horses treated by intracortical compression returned to racing, but fracture recurred in one horse and was treated by osteostixis. This horse and the other three horses treated by osteostixis raced after surgery. Horses with incomplete oblique sagittal fractures of the dorsal cortex of the third metacarpal bone can race after surgical management of the fracture by screws placed in lag fashion or osteostixis. The authors' preferred surgical procedure for managing this fracture is osteostixis. Palmarodorsal radiographic projections of the third metacarpal bone are recommended in young Thoroughbred race horses suspected of having dorsal metacarpal stress fractures

  14. Bone mineral density and fractures after surgical menopause : systematic review and meta-analysis

    NARCIS (Netherlands)

    Fakkert, I. E.; Teixeira, N.; Abma, E. M.; Slart, R. H. J. A.; Mourits, M. J. E.; de Bock, G. H.

    Background Oophorectomy is recommended for women at increased risk for ovarian cancer. When performed at premenopausal age oophorectomy induces acute surgical menopause, with unwanted consequences. Objective To investigate bone mineral density (BMD) and fracture prevalence after surgical menopause.

  15. On the multiscale origins of fracture resistance in human bone and its biological degradation

    Energy Technology Data Exchange (ETDEWEB)

    Zimmermann, Elizabeth A.; Barth, Holly D.; Ritchie, Robert O.

    2012-03-09

    Akin to other mineralized tissues, human cortical bone can resist deformation and fracture due to the nature of its hierarchical structure, which spans the molecular to macroscopic length-scales. Deformation at the smallest scales, mainly through the composite action of the mineral and collagen, contributes to bone?s strength or intrinsic fracture resistance, while crack-tip shielding mechanisms active on the microstructural scale contribute to the extrinsic fracture resistance once cracking begins. The efficiency with which these structural features can resist fracture at both small and large length-scales becomes severely degraded with such factors as aging, irradiation and disease. Indeed aging and irradiation can cause changes to the cross-link profile at fibrillar length-scales as well as changes at the three orders of magnitude larger scale of the osteonal structures, both of which combine to inhibit the bone's overall resistance to the initiation and growth of cracks.

  16. Influence of Bone Remodeling Inhibition on the Development of Experimental Stress Fractures

    National Research Council Canada - National Science Library

    Schaffler, Mitchell B; Boyd, Robert D

    2004-01-01

    .... These experiments tested the hypothesis by pharmacological inhibition of bone remodeling will diminish the severity of the stress fracture and slow the accumulation of microdamage with resulting from chronic loading. Bisphosphonate (BIS...

  17. Determinants of Stress Fracture and Bone Mass in Elite Military Cadets

    National Research Council Canada - National Science Library

    Cosman, Felicia

    2002-01-01

    The aim of this 4-year prospective cohort study of 891 cadets at the United States Military Academy at West Point was to examine the determinants of stress fractures and the acquisition of peak bone...

  18. Photoacoustic and SEM analysis of fracture bone callus to different consolidation times

    Science.gov (United States)

    Lomelí Mejia, P. A.; Urriolagoitia, G.; Jiménez Pérez, J. L.; Cruz Orea, A.; Lecona Butron, H.; Villegas Castrejón, H.

    2005-06-01

    The Photoacoustic Spectroscopy (PA) and Scanning Electron Microscopy (SEM) were used to perform a study of fractured bone callus to different consolidation times. From these techniques we obtained optical absorption spectra and pictures of male rat fractured bones at different consolidation times. From these spectra it was possible to observe the presence of p-Nitrophenylphosphatase, characteristic phosphatase in rat fractured bones through their absorption peaks which were compared with characteristic reported peaks in the literature for this phosphatase. In this study we showed that p-Nitrophenylphosphatase could be considered as an indicator of the repair process of bone fractures. Through the complementary SEM analysis it was possible to obtain different pictures as the callus grows in the time.

  19. Diagnosis and Treatment Considerations for Nonphyseal Long Bone Fractures in the Foal.

    Science.gov (United States)

    Glass, Kati; Watts, Ashlee E

    2017-08-01

    Many long bone fractures that are not considered repairable in the adult horse are repairable in the foal. This is largely because of reduced patient size and more rapid healing in the foal. When there is no articular communication, the long-term prognosis for athletic function can be very good. Emergency care and transport of the foal with a long bone fracture is different than the adult. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Bone Scan in Detection of Biological Activity in Nonhypertrophic Fracture Nonunion

    OpenAIRE

    Gandhi, Sunny J.; Rabadiya, Bhavdeep

    2017-01-01

    Biological activity of the fracture site is very important factor in treatment planning of fracture nonunion. If no biological activity is detected, then an autologous bone graft can be supplemented or osteogenic supplementations, such as bone morphogenetic protein is given. If biological activity is present, then secure fixation is sufficient to achieve bony union. Biological activity of nonunions is usually assessed by conventional radiographs. The presence of callus formation is usually as...

  1. Multiple Low Energy Long Bone Fractures in the Setting of Rothmund-Thomson Syndrome

    Directory of Open Access Journals (Sweden)

    Nicholas Beckmann

    2015-01-01

    Full Text Available Rothmund-Thomson syndrome is a rare autosomal recessive genodermatosis characterized by a poikilodermatous rash starting in infancy as well as various skeletal anomalies, juvenile cataracts, and predisposition to certain cancers. Although Rothmund-Thomson syndrome is associated with diminished bone mineral density in addition to multiple skeletal abnormalities, there are few reports of the association with stress fractures or pathologic fractures in low energy trauma or delayed healing of fractures. Presented is a case of a young adult male with Rothmund-Thomson syndrome presenting with multiple episodes of long bone fractures caused by low energy trauma with one of the fractures exhibiting significantly delayed healing. The patient was also found to have an asymptomatic stress fracture of the lower extremity, another finding of Rothmund-Thomson syndrome rarely reported in the literature. A thorough review of the literature and comprehensive presentation of Rothmund-Thomson syndrome is provided in conjunction with our case.

  2. The timing of bone SPECT to predict osteonecrosis after internal fixation of femur neck fractures.

    Science.gov (United States)

    Kim, Ji Wan; Ryu, Jin-Sook; Baek, Sora; Byun, Seong-Eun; Chang, Jae Suk

    2017-05-01

    Bone SPECT can be used after a femur neck fracture to assess the circulation of the femoral head in the immediate postoperative period because the blood supply is one of the major factors affecting bone uptake of radiotracer on bone scintigraphy. The purpose of our present study was to investigate whether osteonecrosis of the femoral head (OFH) after internal fixation of femoral neck fracture could be predicted by early and late bone SPECT. This retrospective cohort study enrolled 44 patients (33 women; mean age, 66.9 years) who underwent surgical fixation for femoral neck fractures. Early and late bone SPECT images were obtained within 2 weeks postoperatively and at 3 months postoperatively. Patients were followed up for a minimum of 24 months (average, 34 months). OFH developed in 9 out of 44 patients but no patient showed nonunion. Seventeen patients with normal femoral head uptake on early bone SPECT were healed. Of 27 patients with decreased femoral head uptake on early bone SPECT, 2 patients developed OFH on radiography before 3 months postoperatively, 18 patients recovered to normal uptake on the late SPECT, and the remaining 7 patients still showed decreased uptake on the late SPECT at 3 months postoperatively. All of these 7 cases finally developed OFH on radiography. Bone SPECT can reliably predict the possibility of OFH with after femoral neck fracture at least 3 months after surgery, while early bone SPECT showed low specificity. Clinical. Copyright © 2016 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

  3. Free vascularized fibula grafts for salvage of failed oncologic long bone reconstruction and pathologic fractures.

    Science.gov (United States)

    Friedrich, Jeffrey B; Moran, Stephen L; Bishop, Allen T; Shin, Alexander Y

    2009-01-01

    Vascularized bone grafts, particularly the free fibula transfer, have incited revolutionary changes in the field of skeletal reconstruction. In no place has this been more evident than in oncologic reconstruction. The free vascularized fibula graft has been used to good effect for primary long-bone reconstruction, long-bone allograft complication salvage, and pathologic fracture salvage of the long bones. Although many of these procedures often entail significant complications, limb salvage has been made possible in a majority of patients using transfers of free vascularized fibula grafts. The purpose of this review is to critically evaluate the technique of onlay free vascularized fibula grafts for salvage of allograft complications and pathologic fractures of the long bones. This will be accomplished by reviewing the problem of allograft complications and pathologic fractures, the current treatment modalities available, the outcomes of these treatments, and future directions of treatment for this particular problem.

  4. Diagnostic approach to reflex sympathetic dystrophy after fracture: radiography or bone scintigraphy?

    Energy Technology Data Exchange (ETDEWEB)

    Todorovic-Tirnanic, M. [Clinical Center of Serbia, Belgrade (Yugoslavia); Obradovic, V. [Clinical Center of Serbia, Belgrade (Yugoslavia); Han, R. [Clinical Center of Serbia, Belgrade (Yugoslavia); Goldner, B. [Clinical Center of Serbia, Belgrade (Yugoslavia); Stankovic, D. [Medical Center, Smederevo (Yugoslavia); Sekulic, D. [Medical Center, Smederevo (Yugoslavia); Lazic, T. [Medical Center, Smederevo (Yugoslavia); Djordjevic, B.

    1995-10-01

    The aim of this paper was to compare the value of bone scintigraphy and radiography in the early diagnosis of post-fracture reflex sympathetic dystrophy (RSD). Thirty-seven adult patients with post-fracture RSD (28 in the first and nine in the second clinical stage of RSD), as well as seven patients with fracture but without RSD (control group), were investigated by radiography and bone scintigraphy. All of them were immobilized (duration of immobilization: 4-22 weeks). In 21 persons three phase bone scintigraphy was performed. The best distinction between the control group and the RSD patients was achieved by delayed bone scintigrams. The sensitivity (97%), positive predictive value (97%) and accuracy (95%) of delayed bone scintigraphy were very high compared to the values for radiography, which were 73%, 90% and 70% respectively. Bone scintigraphy also displayed higher specificity (86%) and negative predictive value (86%) than radiography (57% and 29% respectively). In the first clinical stage the difference between the accuracy of bone scintigraphy (97%) and radiography (63%) was greater than for the whole group. In the second stage of RSD the accuracy of bone scintigraphy (86%) and radiography (81%) was similar. Three-phase bone scintigraphy is not necessary for the diagnosis of post-fracture RSD: it is sufficient to perform delayed bone scintigraphy. It is concluded that bone scintigraphy is to be preferred to radiography for the early diagnosis of post-fracture RSD in the first clinical stage. In the second stage the diagnostic capabilities of bone scintigraphy and radiography are more comparable. (orig.)

  5. Are the High Hip Fracture Rates Among Norwegian Women Explained by Impaired Bone Material Properties?

    Science.gov (United States)

    Duarte Sosa, Daysi; Vilaplana, Laila; Güerri, Roberto; Nogués, Xavier; Wang-Fagerland, Morten; Diez-Perez, Adolfo; F Eriksen, Erik

    2015-10-01

    Hip fracture rates in Norway rank among the highest in the world, more than double that of Spanish women. Previous studies were unable to demonstrate significant differences between the two populations with respect to bone mass or calcium metabolism. In order to test whether the difference in fracture propensity between both populations could be explained by differences in bone material quality we assessed bone material strength using microindentation in 42 Norwegian and 46 Spanish women with normal BMD values, without clinical or morphometric vertebral fractures, no clinical or laboratory signs of secondary osteoporosis, and without use of drugs with known influence on bone metabolism. Bone material properties were assessed by microindentation of the thick cortex of the mid tibia following local anesthesia of the area using the Osteoprobe device (Active Life Scientific, Santa Barbara, CA, USA). Indentation distance was standardized against a calibration phantom of methylmethacrylate and results, as percentage of this reference value, expressed as bone material strength index units (BMSi). We found that the bone material properties reflected in the BMSi value of Norwegian women was significantly inferior when compared to Spanish women (77 ± 7.1 versus 80.7 ± 7.8, p material properties, higher bone mass, and were taller than Spanish women. The increased height will increase the impact on bone after falls, and impaired bone material properties may further enhance the risk fracture after such falls. These ethnic differences in bone material properties may partly explain the higher propensity for fracture in Norwegian women. © 2015 American Society for Bone and Mineral Research.

  6. Serum nickel level in patients with facial bone fractures treated with ...

    African Journals Online (AJOL)

    McRoy

    2014-07-26

    Jul 26, 2014 ... industrial workers with nickel exposure. All patients involved in any form of maxillofacial trauma resulting in maxillofacial fractures were selected by careful clinical examination. The patients were treated at the same department for facial bone fractures using transosseous wires. Injuries sustained involving ...

  7. Design of a Model of Forearm Bone Fractures for Educational Purposes

    Science.gov (United States)

    Jastaniah, Saddig; Hamdan, Abdulrahman; Alhadrami, Abdullah; Almatrafi, Talal; Arif, Ahmed; Almalki, Hassan

    2016-01-01

    This work explores a new approach to demonstrate possible forearm fractures in humans as an educating means for student radiographers. The Design of abnormal bones are not normally available as phantoms; the manufacturer usually produces normal human musculoskeletal models for educational purposes. Hence fractures and abnormalities are usually…

  8. Brief Report: Bone Fractures in Children and Adults with Autism Spectrum Disorders

    Science.gov (United States)

    Neumeyer, Ann M.; O'Rourke, Julia A.; Massa, Alexandra; Lee, Hang; Lawson, Elizabeth A.; McDougle, Christopher J.; Misra, Madhusmita

    2015-01-01

    Peripubertal boys with autism spectrum disorder (ASD) have lower bone mineral density (BMD) than typically developing controls. However, it is not clear whether lower BMD in ASD results in an increased fracture rate. This study examined the rate of fractures in children and adults with and without ASD using a national database of emergency room…

  9. Influence of bone mineral density and hip geometry on the different types of hip fracture.

    Science.gov (United States)

    Li, Yizhong; Lin, Jinkuang; Cai, Siqing; Yan, Lisheng; Pan, Yuancheng; Yao, Xuedong; Zhuang, Huafeng; Wang, Peiwen; Zeng, Yanjun

    2016-01-01

    The aim of this study was to assess the influence of bone mineral density and hip geometry on the fragility fracture of femoral neck and trochanteric region. There were 95 menopausal females of age ≥ 50 years with fragility fracture of hip, including 55 cases of femoral neck fracture and 40 cases of trochanteric fracture. Another 63 non-fractured females with normal bone mineral density (BMD) were chosen as control. BMD, hip axis length, neck-shaft angle and structural parameters including cross surface area, cortical thickness and buckling ratio were detected and compared. Compared with control group, the patients with femoral neck fracture or trochanteric fractures had significantly lower BMD of femoral neck, as well as lower cross surface area and cortical thickness and higher buckling ratio in femoral neck and trochanteric region. There were no significant differences of BMD and structural parameters in the femoral neck fracture group and intertrochanteric fracture group. Hip axis length and neck-shaft angle were not significantly different among three groups. The significant changes of BMD and proximal femur geometry were present in the fragility fracture of femoral neck and trochanteric region. The different types of hip fractures cannot be explained by these changes.

  10. Influence of bone mineral density and hip geometry on the different types of hip fracture

    Directory of Open Access Journals (Sweden)

    Yizhong Li

    2016-01-01

    Full Text Available The aim of this study was to assess the influence of bone mineral density and hip geometry on the fragility fracture of femoral neck and trochanteric region. There were 95 menopausal females of age ≥ 50 years with fragility fracture of hip, including 55 cases of femoral neck fracture and 40 cases of trochanteric fracture. Another 63 non-fractured females with normal bone mineral density (BMD were chosen as control. BMD, hip axis length, neck-shaft angle and structural parameters including cross surface area, cortical thickness and buckling ratio were detected and compared. Compared with control group, the patients with femoral neck fracture or trochanteric fractures had significantly lower BMD of femoral neck, as well as lower cross surface area and cortical thickness and higher buckling ratio in femoral neck and trochanteric region. There were no significant differences of BMD and structural parameters in the femoral neck fracture group and intertrochanteric fracture group. Hip axis length and neck-shaft angle were not significantly different among three groups. The significant changes of BMD and proximal femur geometry were present in the fragility fracture of femoral neck and trochanteric region. The different types of hip fractures cannot be explained by these changes.

  11. Osteoporotic Fracture: 2015 Position Statement of the Korean Society for Bone and Mineral Research.

    Science.gov (United States)

    Yoo, Je-Hyun; Moon, Seong-Hwan; Ha, Yong-Chan; Lee, Dong Yeon; Gong, Hyun Sik; Park, Si Young; Yang, Kyu Hyun

    2015-11-01

    Osteoporotic fractures are one of the most common causes of disability and a major contributor to medical care costs worldwide. Prior osteoporotic fracture at any site is one of the strongest risk factors for a new fracture, which occurs very soon after the first fracture. Bone mineral density (BMD) scan, a conventional diagnostic tool for osteoporosis, has clear limitations in diagnosing osteoporotic fractures and identifying the risk of subsequent fractures. Therefore, early and accurate diagnosis of osteoporotic fractures using the clinical definition which is applicable practically and independent of BMD, is essential for preventing subsequent fractures and reducing the socioeconomic burden of these fractures. Fractures caused by low-level trauma equivalent to a fall from a standing height or less at major (hip, spine, distal radius, and proximal humerus) or minor (pelvis, sacrum, ribs, distal femur and humerus, and ankle) sites in adults over age 50, should be first regarded as osteoporotic. In addition, if osteoporotic fractures are strongly suspected on history and physical examination even though there are no positive findings on conventional X-rays, more advanced imaging techniques such as computed tomography, bone scan, and magnetic resonance imaging are necessary as soon as possible.

  12. Evaluation of perfusion of the femoral head after femoral neck fracture using bone scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Yamaguchi, Satoshi; Ishido, Yasuhiro [Saiseikai Sendai Hospital, Kagoshima (Japan); Okano, Toshihiro [Ibusuki National Hospital, Kagoshima (Japan); Komiya, Setsuro [Kagoshima Univ. (Japan). Faculty of Medicine

    2002-09-01

    We treated 13 patients for femoral neck fracture. They consisted of 2 males and 11 females, and were classified according to Garden stage classification; Stage I, 3 cases; Stage II, 2 cases; Stage III, 2 cases; Stage IV, 4 cases. Two trochanteric fracture cases were used by control. We evaluated perfusion of the femoral head after femoral neck fracture using bone scintigraphy, which is considered useful for evaluation of perfusion of the femoral neck before operation. (author)

  13. Evaluation of perfusion of the femoral head after femoral neck fracture using bone scintigraphy

    International Nuclear Information System (INIS)

    Yamaguchi, Satoshi; Ishido, Yasuhiro; Okano, Toshihiro; Komiya, Setsuro

    2002-01-01

    We treated 13 patients for femoral neck fracture. They consisted of 2 males and 11 females, and were classified according to Garden stage classification; Stage I, 3 cases; Stage II, 2 cases; Stage III, 2 cases; Stage IV, 4 cases. Two trochanteric fracture cases were used by control. We evaluated perfusion of the femoral head after femoral neck fracture using bone scintigraphy, which is considered useful for evaluation of perfusion of the femoral neck before operation. (author)

  14. Vitamin D and nutritional status are related to bone fractures in alcoholics.

    Science.gov (United States)

    González-Reimers, Emilio; Alvisa-Negrín, Julio; Santolaria-Fernández, Francisco; Candelaria Martín-González, M; Hernández-Betancor, Iván; Fernández-Rodríguez, Camino M; Viña-Rodríguez, J; González-Díaz, Antonieta

    2011-01-01

    Bone fractures are common in alcoholics. To analyse which factors (ethanol consumption; liver function impairment; bone densitometry; hormone changes; nutritional status, and disrupted social links and altered eating habits) are related to bone fractures in 90 alcoholic men admitted to our hospitalization unit because of organic problems. Bone homoeostasis-related hormones were measured in patients and age- and sex-matched controls. Whole-body densitometry was performed by a Hologic QDR-2000 (Waltham, MA, USA) densitometer, recording bone mineral density (BMD) and fat and lean mass; nutritional status and liver function were assessed. The presence of prevalent fractures was assessed by anamnesis and chest X-ray film. Forty-nine patients presented at least one fracture. We failed to find differences between patients with and without fractures regarding BMD parameters. Differences regarding fat mass were absent, but lean mass was lower among patients with bone fracture. The presence of fracture was significantly associated with impaired subjective nutritional evaluation (χ² = 5.79, P = 0.016), lower vitamin D levels (Z = 2.98, P = 0.003) and irregular eating habits (χ² = 5.32, P = 0.02). Reduced lean mass and fat mass, and altered eating habits were more prevalent among patients with only rib fractures (n = 36) than in patients with multiple fractures and/or fractures affecting other bones (n = 13). These last were more closely related to decompensated liver disease. Serum vitamin D levels showed a significant relationship with handgrip strength (ρ = 0.26, P = 0.023) and lean mass at different parts of the body, but not with fat mass. By logistic regression analysis, only vitamin D and subjective nutritional evaluation were significantly, independently related with fractures. Prevalent fractures are common among heavy alcoholics. Their presence is related more closely to nutritional status, lean mass and vitamin D levels than to BMD. Lean mass is more reduced

  15. An interface finite element model can be used to predict healing outcome of bone fractures.

    Science.gov (United States)

    Alierta, J A; Pérez, M A; García-Aznar, J M

    2014-01-01

    After fractures, bone can experience different potential outcomes: successful bone consolidation, non-union and bone failure. Although, there are a lot of factors that influence fracture healing, experimental studies have shown that the interfragmentary movement (IFM) is one of the main regulators for the course of bone healing. In this sense, computational models may help to improve the development of mechanical-based treatments for bone fracture healing. Hence, based on this fact, we propose a combined repair-failure mechanistic computational model to describe bone fracture healing. Despite being a simple model, it is able to correctly estimate the time course evolution of the IFM compared to in vivo measurements under different mechanical conditions. Therefore, this mathematical approach is especially suitable for modeling the healing response of bone to fractures treated with different mechanical fixators, simulating realistic clinical conditions. This model will be a useful tool to identify factors and define targets for patient specific therapeutics interventions. © 2013 Published by Elsevier Ltd.

  16. Effect of regular anti-osteoporosis treatment on bone mineral density and bone metabolism in patients with primary osteoporosis and its relationship with bone fractures

    Directory of Open Access Journals (Sweden)

    Xue-Feng Qian

    2016-12-01

    Full Text Available Objective: To analyze the effect of regular anti-osteoporosis treatment on bone mineral density and bone metabolism in patients with primary osteoporosis and its relationship with bone fractures. Methods: A total of 120 patients with primary osteoporosis were included in this study and randomly divided into observation group and control group (n=60. Control group received consistent treatment, observation group received individualized regular antiosteoporosis treatment, and then the differences in bone mineral density, bone metabolism, trace elements, oxidative stress, fracture incidence, and so on were compared between two groups of patients 1 year after treatment. Results: Absolute BMD value of observation group after treatment was higher than that of control group; serum bone formation indexes ALP, BGP, PⅠNP and PⅠCP content were higher than those of control group; serum bone resorption indexes β-CTX, sRANKL, TRACP, BAP and DPD content were lower than those of control group; serum trace elements iron and zinc content were higher than those of control group while calcium content was lower than that of control group; serum AOPP and MAOA content of observation group were significantly lower than those of control group while SOD and T-AOC content were significantly higher than those of control group;fracture incidence was significantly lower than that of control group during treatment. Conclusions: The regular antiosteoporosis treatment can increase bone mineral density, optimize the overall condition and reduce the incidence of long-term fracture in patients with primary osteoporosis.

  17. Transverse and Oblique Long Bone Fracture Evaluation by Low Order Ultrasonic Guided Waves: A Simulation Study.

    Science.gov (United States)

    Li, Ying; Liu, Dan; Xu, Kailiang; Ta, Dean; Le, Lawrence H; Wang, Weiqi

    2017-01-01

    Ultrasonic guided waves have recently been used in fracture evaluation and fracture healing monitoring. An axial transmission technique has been used to quantify the impact of the gap breakage width and fracture angle on the amplitudes of low order guided wave modes S 0 and A 0 under a 100 kHz narrowband excitation. In our two dimensional finite-difference time-domain (2D-FDTD) simulation, the long bones are modeled as three layers with a soft tissue overlay and marrow underlay. The simulations of the transversely and obliquely fractured long bones show that the amplitudes of both S 0 and A 0 decrease as the gap breakage widens. Fixing the crack width, the increase of the fracture angle relative to the cross section perpendicular to the long axis enhances the amplitude of A 0, while the amplitude of S 0 shows a nonmonotonic trend with the decrease of the fracture angle. The amplitude ratio between the S 0 and A 0 modes is used to quantitatively evaluate the fracture width and angles. The study suggests that the low order guided wave modes S 0 and A 0 have potentials for transverse and oblique bone fracture evaluation and fracture healing monitoring.

  18. Vertebral fractures and role of low bone mineral density in Crohn's disease.

    Science.gov (United States)

    Siffledeen, Jesse S; Siminoski, Kerry; Jen, Ho; Fedorak, Richard N

    2007-06-01

    Vertebral fractures in Crohn's (CD) patients with low bone mineral density (BMD) have been documented as between 14%-22%. Vertebral fractures in CD patients with normal BMD have not been reported. The objectives were to identify the prevalence of vertebral fractures in CD patients and associated predictive factors. Two hundred twenty-four CD patients underwent vertebral BMD analysis and radiographs. Fractures were identified by using quantitative height reduction morphometry, and severity was assessed by spinal fracture index. Mean age was 40.6 +/- 11.0 years. Sixty percent reported corticosteroid use during the preceding year. Forty-five of 224 (20.0%) patients had 88 vertebral fractures. Sixteen of 45 patients with vertebral fractures had normal BMD (19.0% of all patients with normal BMD). Analysis of patients with or without vertebral fractures did not demonstrate significant differences in BMD or in corticosteroid use. Linear regression analysis demonstrated that elevations in body mass index, C-reactive protein, and parathyroid hormone were significantly predictive of vertebral fractures (r = 0.415, P 20% (r = 0.417, P < .05). This study demonstrates that vertebral fractures in CD patients occur with an equal frequency in those with low and with normal BMD, regardless of corticosteroid use. The mean age of CD patients with vertebral fractures was much lower than that reported in the general population for these fractures. Elevations in body mass index and C-reactive protein and parathyroid hormone levels were predictive of vertebral fractures.

  19. [Reconstruction of periprosthetic fractures of hip with cortical bone plates allografts].

    Science.gov (United States)

    Zhou, Zong-ke; Pei, Fu-xing; Tu, Chong-qi; Yang, Jing; Shen, Bin; Liu, Lei; Fatou, Camara-yagouba

    2004-12-22

    To observe clinical results for reconstruction of periprosthetic fractures of hip with cortical bone plates allografts by deep-freezing and ethylene oxide treatment. Seven patients with periprosthetic fractures of hip underwent cortical bone plates allografts by deep-freezing at -70 degrees C after being treatment of 48 degrees C ethylene oxide. And evaluate clinical outcome by examining T lymphocytes, Harris scores, X-rays photograph, and bone scintigraphy. There were not activity of immune rejection and infection in all patients. Harris scores of patients increased 21, 32, 40, 40 scores at 3, 6, 12, 24 months after surgery. T-lymphocytes, antibody and immunocomplex in blood was normal postoperation. X-ray film indicated that fracture was healed at 3 months and there was partially bone conjunction between allograft strut and host bone. There was incorporation of 85% allograft strut to host bone, and 15% allograft strut was partially absorbed at 12 months after surgery. The size of femur of host was added 3 mm to 5 mm, averaged 4.3 mm at 12 months postoperation. Density of 80% allograft plates was as same as host bone after remodeling and the absorbtion of 10% allograft plates stopped at 24 months after surgery. There was thick of nuclein in the area of allograft cortical bone plates by bone scintigraphy examination at 3 months postoperation, and the thick of nuclein was stronger at 6, and 12 months after surgery. Allograft cortical bone plates by deep frozen at -70 degrees C after being treatment of 48 degrees C ethylene oxide is suitable for mechanical fixation and biological bone transplantation, and it can increase bone reservation, augment strength of femur once the allograft strut incorporates to host bone, and avoid removing metal implant in second operation when being applied into reconstruction femoral fracture in joint replacement.

  20. Open Intramedullary Nailing for Segmental Long Bone Fractures: An ...

    African Journals Online (AJOL)

    as the gold standard in the care of femoral shaft fractures, with high union ... shaft fractures as compared with open nailing.[19] Other ..... alignment. To achieve these, all except one of our fractures were statically locked using 3 or 4 interlocking screws. Despite the open method of reduction, our overall union rate of 91.7% at ...

  1. Acute postoperative osteomyelitis in femur fracture: contribution of bone scintilography (case report)

    International Nuclear Information System (INIS)

    Borges, Natalie Ferreira; Rezende, Cleuza Maria de Faria; Sanchez-Ucros, Natalia; Laguardia, Priscilla; Diniz, Simone Odilia Fernandes; Cardoso, Valbert Nascimento; Rodrigues, Carlos Jorge Simal; Santos, Raquel Gouvea dos

    2009-01-01

    The treatment of bone fractures is aimed at consolidating and returns of function as soon as possible and can be performed by different methods. Treatment with the plate in fractures of the femur in bridge aims not to address the location of fracture and stabilize it, maintaining the anatomical axis by the fixation of proximal and distal segments. Postoperative follow-up of the fracture is necessary to evaluate the irrigation of the bone structure and the effect of the method. The scintigraphy is a method capable of assessing the degree of bone remodeling and the presence or absence of local bone homeostasis. The objective of this report is to present the case of a rabbit, male, which was subjected to osteotomy and fixation of the femoral diaphysis by means of the plate in the bridge. After 10 days the animal was subjected to scintigraphic and radiographic evaluations. The animal came to death and an autopsy was performed on the same when it was observed macroscopy consistent with acute osteomyelitis due to contamination postoperative time. Radiographic evaluation in acute osteomyelitis is unclear. The methods assist in the scintigraphic diagnosis of osteomyelitis by allowing the detection of functional changes in this infectious process. The bone scintigraphy with diphosphonates labeled with technetium-99m shows increased bone turnover in the infected area and its high sensitivity, even in an early stage makes it the method of choice in the diagnosis of acute osteomyelitis in patients without prior bone disease and bone radiologically normal. (author)

  2. Acute postoperative osteomyelitis in femur fracture: contribution of bone scintilography (case report)

    Energy Technology Data Exchange (ETDEWEB)

    Borges, Natalie Ferreira; Rezende, Cleuza Maria de Faria; Sanchez-Ucros, Natalia; Laguardia, Priscilla [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Escola de Veterinaria; Diniz, Simone Odilia Fernandes; Cardoso, Valbert Nascimento [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Faculdade de Farmacia; Rodrigues, Carlos Jorge Simal [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Faculdade de Medicina; Santos, Raquel Gouvea dos [Centro de Desenvolcimento da Tecnologia Nuclear (CDTN/CNEN-MG), Belo Horizonte, MG (Brazil). Lab. de Radiobiologia

    2009-07-01

    The treatment of bone fractures is aimed at consolidating and returns of function as soon as possible and can be performed by different methods. Treatment with the plate in fractures of the femur in bridge aims not to address the location of fracture and stabilize it, maintaining the anatomical axis by the fixation of proximal and distal segments. Postoperative follow-up of the fracture is necessary to evaluate the irrigation of the bone structure and the effect of the method. The scintigraphy is a method capable of assessing the degree of bone remodeling and the presence or absence of local bone homeostasis. The objective of this report is to present the case of a rabbit, male, which was subjected to osteotomy and fixation of the femoral diaphysis by means of the plate in the bridge. After 10 days the animal was subjected to scintigraphic and radiographic evaluations. The animal came to death and an autopsy was performed on the same when it was observed macroscopy consistent with acute osteomyelitis due to contamination postoperative time. Radiographic evaluation in acute osteomyelitis is unclear. The methods assist in the scintigraphic diagnosis of osteomyelitis by allowing the detection of functional changes in this infectious process. The bone scintigraphy with diphosphonates labeled with technetium-99m shows increased bone turnover in the infected area and its high sensitivity, even in an early stage makes it the method of choice in the diagnosis of acute osteomyelitis in patients without prior bone disease and bone radiologically normal. (author)

  3. Means of enhancing bone fracture healing : Optimal cell source, isolation methods and acoustic stimulation

    NARCIS (Netherlands)

    Ghebes, Corina Adriana; Braham, Maaike Vera Jasmijn; Zeegers, Adelgunde Veronica Clemens Maria; Renard, Auke Jan Sijbe; Fernandes, Hugo; Saris, Daniel B F

    2016-01-01

    Background: The human body has an extensive capacity to regenerate bone tissue after trauma. However large defects such as long bone fractures of the lower limbs cannot be restored without intervention and often lead to nonunion. Therefore, the aim of the present study was to assess the pool and

  4. Plastic Fibula Bone Deformity with Ipsilateral Fracture of Tibiain Adults: A Case Report

    OpenAIRE

    Abbas Abdoli Tafti; Sanazsadat Sajadi; Maryam Shahmoradi

    2015-01-01

    Plastic bowing is a constant deformation of long bones occurring after a long standing force to bone. This type of fracture is seen in children and is uncommon in the adults. In this paper we report a case of fibular plastic deformity with ipsilateral tibia fracture in a 20 years old man that occurred after a direct hit. At the initial examination vital signs were stable and radiography of tibia and fibula fracture with plastic deformation were clear. In order to treat him we performed fib...

  5. Risk factors for proximal sesamoid bone fractures associated with exercise history and horseshoe characteristics in Thoroughbred racehorses.

    Science.gov (United States)

    Anthenill, Lucy A; Stover, Susan M; Gardner, Ian A; Hill, Ashley E

    2007-07-01

    To assess individual and combined associations of high-speed exercise and horseshoe characteristics with risk of forelimb proximal sesamoid bone fractures and proximal sesamoid bone midbody fractures in Thoroughbred racehorses. 269 deceased Thoroughbred racehorses. A case-control study design was used to compare 121 horses with a fracture of at least 1 of 4 forelimb proximal sesamoid bones (75 horses had a midbody fracture) and 148 horses without a forelimb proximal sesamoid bone fracture. Univariable and multivariable logistic regression analyses were used to evaluate potential risk factors for association with proximal sesamoid bone fracture. Compared with horses that died without proximal sesamoid bone fractures, horses that died with proximal sesamoid bone fractures were more likely to be sexually intact males, spend more time in active trainingand racing, complete more events, train and race longer since their last layup, have higher exercise intensities during the 12 months prior to death, and have greater cumulative distances for their career. Horses with proximal sesamoid bone midbody fractures were more likely to be sexually intact males, train and race longer since their last layup, and have higher exercise intensities during the 12 months prior to death. Limitingexercise intensity and the continuous time spent in activity duringa horse's career may decrease the frequency of forelimb proximal sesamoid bone fractures in Thoroughbred horses.

  6. Multiple long bone cysts revealed by MRI in trichorhinophalangeal syndrome type II predisposing to pathological fractures

    Energy Technology Data Exchange (ETDEWEB)

    Konala, Praveen; Cassar-Pullicino, Victor N. [The Robert Jones and Agnes Hunt Orthopaedic Hospital, Department of Radiology, Oswestry (United Kingdom); Kiely, Nigel [The Robert Jones and Agnes Hunt Orthopaedic Hospital, Department of Orthopaedic Surgery, Oswestry (United Kingdom); Noakes, Charlotte [Oxford University Hospital, The Oxford Genetics Laboratories, Oxford (United Kingdom); Blair, Edward [Oxford University Hospital, Department of Clinical Genetics, Oxford (United Kingdom)

    2017-07-15

    Trichorhinophalangeal syndrome type II is a rare genetic disorder with the few published case reports mainly reporting the radiographic skeletal manifestations. There are no published imaging reports of long bone cysts involving multiple bones in this condition. We report a unique case of bone cysts involving multiple long bones detected with MRI in a patient with trichorhinophalangeal syndrome type II complicated by a subsequent pathological fracture. It is possible that the bone cysts are a previously undescribed feature of this syndrome; however, the evidence is insufficient to establish a definite association. Chromosomal abnormality identified in this patient is consistent with trichorhinophalangeal syndrome type II with no unusual features. Although the nature of these bone cysts is unclear, they are one of the causes of the known increased fracture risk observed in this syndrome. (orig.)

  7. Facial Bone Fracture Patients Visiting Pusan National University Hospital in Busan and Yangsan: Trends and Risks.

    Science.gov (United States)

    Kim, Hyo-Geon; Son, Yong-Hyun; Chung, In-Kyo

    2014-07-01

    This study examined patients with facial bone fracture visiting Pusan National University Dental Hospital to understand the trends, and to enhance appropriate care and treatment for patients with facial bone fracture. We investigated 531 patients presenting with facial bone fracture in Yangsan and 802 patients in Busan from January 2010 to December 2013. We divided the patients by year, month, gender, age, site, and cause to compare with historic data and other studies. The gender ratio was 3.58:1 in Yangsan and 4.31:1 in Busan. Patients aged in their 20s had the highest number of facial bone fractures in both Yangsan and Busan. The most frequent fracture site was the mandible, and the most frequent cause was slip down in both Yangsan and Busan. The investigation and comparison of patients with facial bone fracture who visited Pusan National University Hospital located at Yangsan and Busan from 2010 to 2013 found a difference in the total number of patients at each hospital, but the trends were not significantly different.

  8. Can mouthguards prevent mandibular bone fractures and concussions? A laboratory study with an artificial skull model.

    Science.gov (United States)

    Takeda, Tomotaka; Ishigami, Keiichi; Hoshina, Sanae; Ogawa, Toru; Handa, Jun; Nakajima, Kazunori; Shimada, Atsushi; Nakajima, Tsuneya; Regner, Connell Wayne

    2005-06-01

    Some sports' accidents are responsible for inflicting traumatic brain injuries and mandibular bone fractures when impacts occur to the chin. It is often thought that mouth guards can prevent many of these injuries. However, such assertions may be insufficient without adequate research. It is therefore necessary to establish a systematic method of investigation to solve this problem. In the present laboratory study, tests were performed using pendulum impact equipment and an artificial skull model connected to strain gages and accelerometers to simulate and measure the surface distortions related to bone deformation or fractures and the acceleration of the head related to concussions. As impacts, direct blows to the mandibular undersurface were applied. As a result, wearing a mouth guard decreased (P fractures and concussions. However, further well-designed and exhaustive studies are vital to show that mouth guards reduce the incidence of concussions and mandibular bone fractures.

  9. [Stress fractures of the tarsal navicular bone. Causality, diagnosis, therapy, prophylaxis].

    Science.gov (United States)

    Ivanic, G M; Juranitsch, T; Myerson, M S; Trnka, H J

    2003-12-01

    Stress fractures of the tarsal navicular bone are a challenge in diagnosis and therapy. First and foremost you have to think about this fracture. The origin of the injury can be detected in a wrong or too heavy strain of the bone especially in long distance runners and recruits. The MRI is the diagnostic tool of first choice. Therapy of displaced or comminuted fractures as well as pseudarthrosis is best done with surgical procedures like direct screw fixation or interposition of autologous bone depending on the circumstances and the age of injury. Conservative treatment with a plaster of Paris is useful in non-displaced and non-comminuted fractures. Prophylaxis with technical aids and a changing habits is recommended.

  10. [Calcium and bone metabolism across women's life stages. Stress fracture in female athletes.

    Science.gov (United States)

    Yagishita, Kazuyoshi

    Stress fractures are common overuse injuries in athletes, especially in long-distance runner, jumping sports and gymnastics in female athletes. The pathology of stress fracture mainly includes repeated biomechanical loading, which leads to bone micro-damage and failure of bone structure. Female athlete triad(FAT), which includes low energy availability with or without an eating disorder, functional hypothalamic amenorrhea, and osteoporosis, is a serious healthcare concern in female athletes. For prevention and treatment of stress fracture, management of biomechanical factors modifying the load applied to a bone is important, and especially in female athletes, management for FAT is one of the important factors. This report outlines the current knowledge on the epidemiology, diagnosis, treatment and prevention of stress fracture, relating to FAT in female athletes.

  11. Bisphosphonate-related atypical femoral fracture with bone metastasis of breast cancer: case report and review.

    Science.gov (United States)

    Hayashi, Kazunori; Aono, Masanari; Shintani, Kousuke; Kazuki, Kenichi

    2014-03-01

    Intravenous bisphosphonates (BPs) have been used to reduce the frequency of skeletal-related events due to bone metastases of several kinds of cancers. Although many studies on BP-related atypical fractures (BRAFs) due to the use of BP for osteoporosis treatment have been reported, few reports on BRAFs arising as a complication of long-term BP use for bone metastasis of cancer are available. A 62-year-old woman with a history of breast cancer presented with right thigh pain after she had a fall. Radiographs indicated a transverse fracture in the shaft of the right femur. She had been on zoledronate treatment for six years. Based on radiographic and histopathological findings, we concluded that the fracture was not a pathological fracture associated with metastasis but was a complication of long-term BP treatment. Clinical oncologists should consider the possibility of BRAFs in patients on long-term zoledronate treatment for bone metastases.

  12. Emergency ultrasound in the detection of pediatric long-bone fractures.

    Science.gov (United States)

    Barata, Isabel; Spencer, Robert; Suppiah, Ara; Raio, Christopher; Ward, Mary Frances; Sama, Andrew

    2012-11-01

    Long-bone fractures represent one of the most commonly sustained injuries following trauma and account for nearly 4% of emergency department visits in the United States each year. These fractures are associated with a significant risk of bleeding and neurovascular compromise. Delays in their identification and treatment can lead to loss of limb and even death. Although emergency physicians currently rely predominantly on radiography for the examination of long-bone injuries, emergency ultrasound has several advantages over radiography and may be useful in the identification of long-bone fractures. Ultrasound is rapid, noninvasive, and cost-effective. Unlike radiography, ultrasound does not expose children to ionizing radiation, which has been linked to cancer. The goal of this study was to assess the agreement between emergency physicians' and radiologists' final assessments of suspected long-bone fractures using emergency ultrasound and radiography, respectively, in the pediatric population. This is a prospective study involving a convenience sample of pediatric patients (fracture. Suspected fractures were characterized by swelling, erythema, and localized pain. Patients who had a history of fracture, extremity deformity, orthopedic hardware in the traumatized area, or an open fracture were excluded from this study. Each investigator received limited, focused training in the use of ultrasonography for fracture identification and localization. This training consisted of a brief didactic session and video review of normal and fractured long-bones. A total of 53 subjects (mean age, 10.2 [SD, 3.8] years; 56.6% were male) were enrolled, which corresponded to 98 ultrasound examinations. Sixty-nine scans (70.4%) involved bones of the upper extremity, and 29 (29.6%) the lower extremity. Radiography identified a total of 43 fractures. The sensitivity and specificity of ultrasound in the detection of long-bone fractures were 95.3% (95% confidence interval [CI], 82

  13. Effects of COLIA1 polymorphisms and haplotypes on perimenopausal bone mass, postmenopausal bone loss and fracture risk

    DEFF Research Database (Denmark)

    González-Bofill, N; Husted, Camilla L.; Harsløf, Torben

    2011-01-01

    mineral density (BMD) and increased bone turnover at menopause and after 10 years of follow-up. Introduction We wanted to investigate whether the -1997G/T, -1663indelT and +1245G/T polymorphisms in the COLIA1 gene are associated with perimenopausal bone mass, early postmenopausal bone loss and interact.......015±0.006 g/cm2 and 0.017±0.006 g/cm2, respectively (pchanges in bone mass and fracture risk and no overall interaction with the effects of hormone therapy could be demonstrated for any of the polymorphisms in COLIA1. Conclusions The -1997G/T polymorphism...... and haplotype 3 are significantly associated with perimenopausal bone mass, and these effects were sustained up to 10 years after menopause. No association between the -1663indelT or +1245G/T polymorphisms and peri- or postmenopausal bone mass could be demonstrated....

  14. Roentgenofunctional investigation of the ankle joint in a long-term period after crural bone fracture

    International Nuclear Information System (INIS)

    Ignat'ev, Yu.T.; Novikov, V.P.

    1989-01-01

    On the basis of the results of clinicoroentgenological and tensographic investigations of 119 patients after traumas of the crural bones and ankle joint (2-36 yrs. ago) the authors showed the importance of roentgenofunctional investigation of the ankle joint. A specially designed footing was proposed. Of 77 patients after intra-articular fractures of the ankle bones various disorders in articular proportions, undetectable on routine roengenography, were diagnosed in 29 by functional roentgenography. Articular changes on roentgenofunctional investigation were revealed in one patient only out of 42 patients with extra-articular fractures of the crural bones. Tensography showed disorders of foot biomechanics in all patients with subluxations in the ankle

  15. The loss of activating transcription factor 4 (ATF4) reduces bone toughness and fracture toughness.

    Science.gov (United States)

    Makowski, Alexander J; Uppuganti, Sasidhar; Wadeer, Sandra A; Whitehead, Jack M; Rowland, Barbara J; Granke, Mathilde; Mahadevan-Jansen, Anita; Yang, Xiangli; Nyman, Jeffry S

    2014-05-01

    Even though age-related changes to bone tissue affecting fracture risk are well characterized, only a few matrix-related factors have been identified as important to maintaining fracture resistance. As a gene critical to osteoblast differentiation, activating transcription factor 4 (ATF4) is possibly one of these important factors. To test the hypothesis that the loss of ATF4 affects the fracture resistance of bone beyond bone mass and structure, we harvested bones from Atf4+/+ and Atf4-/- littermates at 8 and 20 weeks of age (n≥9 per group) for bone assessment across several length scales. From whole bone mechanical tests in bending, femurs from Atf4-/- mice were found to be brittle with reduced toughness and fracture toughness compared to femurs from Atf4+/+ mice. However, there were no differences in material strength and in tissue hardness, as determined by nanoindentation, between the genotypes, irrespective of age. Tissue mineral density of the cortex at the point of loading as determined by micro-computed tomography was also not significantly different. However, by analyzing local composition by Raman Spectroscopy (RS), bone tissue of Atf4-/- mice was found to have higher mineral to collagen ratio compared to wild-type tissue, primarily at 20 weeks of age. From RS analysis of intact femurs at 2 orthogonal orientations relative to the polarization axis of the laser, we also found that the organizational-sensitive peak ratio, ν1Phosphate per Amide I, changed to a greater extent upon bone rotation for Atf4-deficient tissue, implying bone matrix organization may contribute to the brittleness phenotype. Target genes of ATF4 activity are not only important to osteoblast differentiation but also in maintaining bone toughness and fracture toughness. Published by Elsevier Inc.

  16. Nuclear scintigraphic evaluation of third metacarpal and metatarsal bone fractures in three horses

    International Nuclear Information System (INIS)

    Markel, M.D.; Snyder, J.R.; Hornof, W.J.; Meagher, D.M.

    1987-01-01

    Nuclear scintigraphy was used to evaluate healing of third metacarpal bone (MC III) fractures in 2 horses (horses 1 and 2) and a third metatarsal bone fracture in 1 horse (horse 3) after stabilization of each fracture with 2 broad dynamic compression plates. In horse 1, the fracture had uniform uptake of 99mTc methylene diphosphonate on days 1, 15, and 30 after surgery. The fracture healed, and the horse was discharged from the clinic on day 52. In horse 2, a 6-cm photopenic region (ie, area of low radioactivity) was seen over the diaphysis of MC III on day 3. The region persisted and became more distinct by day 32. The diaphysis of MC III sequestered, and horse 2 was euthanatized on day 44. In horse 3, vascularity was seen bridging the fracture on day 5, with a 3-cm photopenic region over the dorsal diaphysis of the third metatarsal bone. By days 18 and 32, uptake of 99mTc methylene diphosphonate in the region had increased, indicating vascularization of the site. the fracture healed, and horse 3 was discharged from the clinic on day 47. Our findings indicated that serial nuclear scintigraphy can be used to evaluate fracture vascularization after surgery in horses

  17. Exercise-induced rib stress fractures: influence of reduced bone mineral density

    DEFF Research Database (Denmark)

    Vinther, Anders; Kanstrup, Inge-Lis; Christiansen, Erik

    2005-01-01

    Exercise-induced rib stress fractures have been reported frequently in elite rowers during the past decade. The etiology of rib stress fractures is unclear, but low bone mineral density (BMD) has been suggested to be a potential risk factor for stress fractures in weight-bearing bones. The present...... study investigated BMD in seven Danish national team rowers with previous rib stress fracture (RSF) and 7 controls (C) matched for gender, age, height, weight and training experience. Total body scan and specific scans of the lumbar spine (L2-L4), femoral neck and distal radius were performed using...... density may be a potential risk factor for the development of exercise-induced rib stress fractures in elite rowers....

  18. Death due to fracture of thin calvarial bones after a fall: A forensic approach

    Directory of Open Access Journals (Sweden)

    Georgios Sioutas

    2017-06-01

    Full Text Available A 45-year-old male was autopsied. He had fallen backwards from a two-stairs height to the ground and passed away. A skull fracture was detected in the left occipital area, extending up to the left side of the skull base. The patient's death occurred due to the very low thickness of the calvarial bones, which led to the aforementioned fracture, and in turn resulted in subarachnoid hemorrhage and death. The cortical thickness was measured and compared with average values at standardized points. Uniform bone thinning was confirmed rather than localized. Calvarial thinning may result from various conditions. In the present case study, however, the exact mechanism which led to the low thickness of the calvarial bones of the patient is undetermined. Death due to the susceptible structure and fracture of calvarial bones has rarely been reported throughout relevant literature.

  19. Pneumolabyrinth secondary to temporal bone fracture: a case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Bacciu A

    2014-09-01

    Full Text Available Andrea Bacciu,1 Vincenzo Vincenti,1 Sampath Chandra Prasad,1 Daniela Tonni,1 Elisa Ventura,2 Salvatore Bacciu,1 Enrico Pasanisi1 1Department of Clinical and Experimental Medicine, Unit of Audiology and Paediatric Otolaryngology, 2Department of Neuroradiology, University Hospital of Parma, Parma, Italy Abstract: Pneumolabyrinth following temporal bone fracture is an extremely rare condition. It results from air entering the inner ear when a communication between the air-filled middle ear spaces and inner ear is established. The imaging modality of choice for pneumolabyrinth is high-resolution computed tomography of the temporal bone. Treatment options include conservative management (bed rest, antibiotics, corticosteroids or surgery (exploratory tympanotomy. We present the case of a 31-year-old female who had pneumolabyrinth secondary to a temporal bone fracture. The patient was treated surgically and made a full clinical recovery. Keywords: pneumolabyrinth, temporal bone fractures, head trauma

  20. Third metacarpal condylar fatigue fractures in equine athletes occur within previously modelled subchondral bone.

    Science.gov (United States)

    Whitton, R Christopher; Trope, Gareth D; Ghasem-Zadeh, Ali; Anderson, Garry A; Parkin, Timothy D H; Mackie, Eleanor J; Seeman, Ego

    2010-10-01

    Bone modelling and remodelling reduce the risk of fatigue fractures; the former by adapting bone to its loading circumstances, the latter by replacing fatigued bone. Remodelling transiently increases porosity because of the normal delay in onset of the formation phase of the remodelling sequence. Protracted intense loading suppresses remodelling leaving modelling as the only means of maintaining bone strength. We therefore hypothesized that race horses with fatigue fractures of the distal third metacarpal bone (MC3) will have reduced porosity associated with suppressed remodelling while continued adaptive modelling will result in higher volume fraction (BV/TV) at this site. Using high resolution peripheral quantitative computed tomography (HR-pQCT), we measured the distal aspect of the MC3 obtained at postmortem from 13 thoroughbred race horses with condylar fractures of the MC3 (cases), 8 horses without fractures (training controls), 14 horses with a fracture at another site (fractured controls) and 9 horses resting from training (resting controls). Porosity of the subchondral bone of MC3 was lower in cases than resting controls (12±1.4% vs. 18±1.6%, P=0.017) although areas of focal porosity were observed adjacent to fractures in 6/13 horses. BV/TV of the distal metacarpal epiphysis tended to be higher in horses with condylar fractures (0.79±0.015) than training controls (0.74±0.019, P=0.070), but also higher in controls with a fracture elsewhere (0.79±0.014) than the training controls (0.74±0.019, P=0.040). BV/TV was higher in horses over three years of age than those aged two or three years (0.79±0.01 vs. 0.74±0.01, P=0.016). All metacarpal condylar fractures occurred within focal areas of high BV/TV. We infer that intense training in equine athletes suppresses remodelling of third metacarpal subchondral bone limiting damage repair while modelling increases regional bone volume in an attempt to minimise local stresses but may fail to offset bone

  1. In situ observation of fracture behavior of canine cortical bone under bending

    Energy Technology Data Exchange (ETDEWEB)

    Lin, Zilan X. [Department of Orthopaedics, Medical University of South Carolina, 96 Jonathan Lucas Street Suite 708 MSC 622, Charleston, SC 29425 (United States); Department of Mechanical Engineering, University of South Carolina, 300 Main Street, Columbia, SC 29208 (United States); Xu, Zhi-Hui [Department of Mechanical Engineering, University of South Carolina, 300 Main Street, Columbia, SC 29208 (United States); An, Yuehuei H. [Department of Orthopaedics, Medical University of South Carolina, 96 Jonathan Lucas Street Suite 708 MSC 622, Charleston, SC 29425 (United States); Department of Orthopaedic Surgery, Southside Hospital, North Shore-LIJ Health System, 217 East Main Street, Bay Shore, NY 11706 (United States); Li, Xiaodong, E-mail: xl3p@virginia.edu [Department of Mechanical Engineering, University of South Carolina, 300 Main Street, Columbia, SC 29208 (United States); Department of Mechanical and Aerospace Engineering, University of Virginia, 122 Engineer' s Way, Charlottesville, VA 22904 (United States)

    2016-05-01

    Cortical bone provides many important body functions and maintains the rigidness and elasticity of bone. A common failure mode for bone structure is fracture under a bending force. In the current study, the fracture behavior of canine cortical bone under three-point bending was observed in situ using an atomic force microscope (AFM), a scanning electron microscope (SEM), and an optical microscope to examine the fracture process in detail. Nanoindentation was carried out to determine the elastic modulus and hardness of different building blocks of the canine cortical bone. The results have shown that the special structure of Haversian systems has significant effects on directing crack propagation. Although Haversian systems contain previously believed weak points, and micro-cracks initiate within Haversian systems, our findings have demonstrated that macro-cracks typically form around the boundaries of Haversian systems, i.e. the cement lines. Micro-cracks that developed inside Haversian systems have the functions of absorbing and dissipating energy and slow down on expanding when interstitial tissue cannot hold any more pressure, then plastic deformation and fracture occur. - Highlights: • Macro- and micro-cracks occur in unique patterns in the bone fracturing process under a bending force. • Early developed micro-cracks inside Haversian systems absorb and dissipate energy in order to delay fracture initiation. • The mechanical properties of Haverisan systems and its surrounding structures influence the developments of macro- and micro-crack formation. • Previously believed weak spots in the bone matrix are not necessarily the origins of fracture development.

  2. Repair of long-bone fractures in cats and small dogs with the Unilock mandible locking plate system

    OpenAIRE

    Voss, K; Kull, M A; Haessig, M; Montavon, P M

    2009-01-01

    Objectives: To retrospectively evaluate stabilisation of long-bone fractures in cats and small dogs using the Unilock system. Methods: Medical histories and radiographs of consecutive patients with long-bone fractures stabilised with the Unilock system were reviewed. Cases with follow-up radiographs taken at least four weeks postoperatively were included. Signalment of the patient, fracture localisation and type, primary fracture repair or revision surgery, single or double plating, and compl...

  3. THE EFFECT OF STRAIN RATE ON FRACTURE TOUGHNESS OF HUMAN CORTICAL BONE: A FINITE ELEMENT STUDY

    Science.gov (United States)

    Ural, Ani; Zioupos, Peter; Buchanan, Drew; Vashishth, Deepak

    2011-01-01

    Evaluating the mechanical response of bone under high loading rates is crucial to understanding fractures in traumatic accidents or falls. In the current study, a computational approach based on cohesive finite element modeling was employed to evaluate the effect of strain rate on fracture toughness of human cortical bone. Two-dimensional compact tension specimen models were simulated to evaluate the change in initiation and propagation fracture toughness with increasing strain rate (range: 0.08 to 18 s−1). In addition, the effect of porosity in combination with strain rate was assessed using three-dimensional models of microcomputed tomography-based compact tension specimens. The simulation results showed that bone’s resistance against the propagation of fracture decreased sharply with increase in strain rates up to 1 s−1 and attained an almost constant value for strain rates larger than 1 s−1. On the other hand, initiation fracture toughness exhibited a more gradual decrease throughout the strain rates. There was a significant positive correlation between the experimentally measured number of microcracks and the fracture toughness found in the simulations. Furthermore, the simulation results showed that the amount of porosity did not affect the way initiation fracture toughness decreased with increasing strain rates, whereas it exacerbated the same strain rate effect when propagation fracture toughness was considered. These results suggest that strain rates associated with falls lead to a dramatic reduction in bone’s resistance against crack propagation. The compromised fracture resistance of bone at loads exceeding normal activities indicates a sharp reduction and/or absence of toughening mechanisms in bone during high strain conditions associated with traumatic fracture. PMID:21783112

  4. Vitamin E and the Healing of Bone Fracture: The Current State of Evidence

    Directory of Open Access Journals (Sweden)

    Boekhtiar Borhanuddin

    2012-01-01

    Full Text Available Background. The effect of vitamin E on health-related conditions has been extensively researched, with varied results. However, to date, there was no published review of the effect of vitamin E on bone fracture healing. Purpose. This paper systematically audited past studies of the effect of vitamin E on bone fracture healing. Methods. Related articles were identified from Medline, CINAHL, and Scopus databases. Screenings were performed based on the criteria that the study must be an original study that investigated the independent effect of vitamin E on bone fracture healing. Data were extracted using standardised forms, followed by evaluation of quality of reporting using ARRIVE Guidelines, plus recalculation procedure for the effect size and statistical power of the results. Results. Six animal studies fulfilled the selection criteria. The study methods were heterogeneous with mediocre reporting quality and focused on the antioxidant-related mechanism of vitamin E. The metasynthesis showed α-tocopherol may have a significant effect on bone formation during the normal bone remodeling phase of secondary bone healing. Conclusion. In general, the effect of vitamin E on bone fracture healing remained inconclusive due to the small number of heterogeneous and mediocre studies included in this paper.

  5. Assessment of alveolar bone mineral density as a predictor of lumbar fracture probability.

    Science.gov (United States)

    Takaishi, Yoshitomo; Arita, Seizaburo; Honda, Mitsugi; Sugishita, Takeshi; Kamada, Aiko; Ikeo, Takashi; Miki, Takami; Fujita, Takuo

    2013-05-01

    Osteoporosis and tooth loss have been linked with advancing age, but no clear relationship between these conditions has been proven. Several studies of bone mineral density measurements of the jaw and spine have shown similarities in their rate of age-related deterioration. Thus, measurements of jawbone density may predict lumbar vertebral bone density. Using jawbone density as a proxy marker would circumvent the need for lumbar bone measurements and facilitate prediction of osteoporotic spinal fracture susceptibility at dental clinics. We aimed to characterize the correlation between bone density in the jaw and spine and the incidence of osteoporotic spinal fractures. We used computerized radiogrammetry to measure alveolar bone mineral density (al-BMD) and dual-energy X-ray absorptiometry to measure lumbar bone mineral density (L-BMD). L-BMD and al-BMD in 30 female patients (average age: 59 ± 5 years) were correlated with various patient attributes. Statistical analysis included area under the curve (AUC) and probability of asymptomatic significance (PAS) in a receiver operating characteristic curve. The predictive strength of L-BMD T-scores (L-BMD[T]) and al-BMD measurements for fracture occurrence was then compared using multivariate analysis with category weight scoring. L-BMD and al-BMD were significantly correlated with age, years since menopause, and alveolar bone thickness. Both were also negatively correlated with fracture incidence. Category weight scores were -0.275 for a L-BMD(T) fracture occurrence than L-BMD. Our results suggest the possible association between al-BMD and vertebral fracture risk. Assessment of alveolar bone density may be useful in patients receiving routine dental exams to monitor the clinical picture and the potential course of osteoporosis in patients who may be at a higher risk of developing osteoporosis.

  6. Effect of autologous platelet-rich plasma on bone regeneration in mandibular fractures.

    Science.gov (United States)

    Daif, Emad T

    2013-10-01

    The aim of this study was to assess the effect of autologous platelet-rich plasma (PRP) on bone regeneration in mandibular fractures via a cone beam computed tomography (CBCT). Twenty-four patients having parasymphyseal fractures participated in this study. They were randomly divided into two equal groups. Group A was treated by two titanium miniplates and screws plus local application of activated PRP along the fracture line, whereas group B was treated by the same bone plates and screws without application of PRP. The patients were recalled at 1 week, 3 and 6 months after surgery for clinical assessment and measuring the bone density via CBCT at a region of interest (ROI) including the fracture line. The mean values of the bone density measurements, in both groups, were higher at 3 and 6 months than 1 week after surgery. At 1 week after surgery, the values were 542 ± 93 HU and 515 ± 81 HU in group A and B, respectively. In group A, the mean value of bone density measurements was 728 ± 58 HU (range 620-796 HU) at 3 months after surgery and it was 1024 ± 188 HU (range 825-1490 HU) 6 months later. While in group B, the mean values of the bone density measurements at the ROI were 600 ± 78 HU (range 520-790 HU) and 756 ± 53 HU (range 710-890 HU) at 3 and 6 months after surgery, respectively. The increase in the bone density measurements at 3 and 6 months after surgery was statistically significant only in group A (P = 0.0002 and P = 0.0001, respectively). It can be concluded that direct application of the PRP along the fracture lines may enhance the bone regeneration in mandibular fractures. © 2012 John Wiley & Sons A/S.

  7. Catastrophic scapular fractures in Californian racehorses: pathology, morphometry and bone density.

    Science.gov (United States)

    Vallance, S A; Spriet, M; Stover, S M

    2011-11-01

    To enhance understanding of the nature and pathogenesis of scapular fractures in racehorses. Scapular fractures in racehorses have a consistent configuration related to sites of pre-existing stress modelling and remodelling. Fractured and intact scapulae collected post mortem were examined visually and with computed tomography (CT). Scapular fracture configuration, bone modelling changes and standardised CT morphometry and density measurements were recorded. Statistical comparisons were made between fractured, nonfractured contralateral and control scapulae. Thirty-nine scapulae from 10 Thoroughbred (TB) and 10 Quarter Horse (QH) racehorses were obtained. All 14 fractured scapulae (from 12 horses) had a consistent comminuted fracture configuration. A complete fracture coursed transversely through the neck of the scapula at the level of the distal aspect of the spine (8.9 ± 0.9 cm proximal to the lateral articular margin of the glenoid cavity). The distal fragment of 13 fractured scapulae was split into 2 major fragments by a fracture in the frontal plane that entered the glenoid cavity (2.8 ± 0.4 cm caudal to the cranial articular margin). Focal areas of periosteal proliferation and/or radiolucency were present in the distal aspect of the scapular spine of all fractured and intact contralateral scapulae, but less commonly (Phorses without a scapular fracture. Fractured scapulae had 7-10% lower mean density and 46-104% greater density heterogeneity in the spine adjacent to the transverse fracture compared to control scapulae (Pfracture configuration that is associated with pre-existing pathology of the distal aspect of the spine. This location is consistent with scapular stress fractures diagnosed in lame TB racehorses. Catastrophic fracture is the acute manifestation of a more chronic process. Consequently, there are opportunities for early detection and prevention of fatalities. © 2010 EVJ Ltd.

  8. Osteoclast abnormalities in fractured bone during bisphosphonate treatment for osteoporosis: a case report.

    Science.gov (United States)

    Vigorita, V J V; Silver, J S; Eisemon, E O E

    2012-07-01

    Bisphosphonates have been widely used in the treatment of an array of bone disorders. Recent complications have included unusual femoral fractures in patients who have received long term bisphosphonate treatment for osteoporosis. Although it has been shown that bisphosphonates are effective by blunting osteoclast resorption, there has been little morphologic description of the local tissue activity at the site of these unusual fractures. To evaluate for local changes to bone morphology at the fracture site in patients presenting with a bisphosphonate-related femur fracture, a sample of cortical bone was obtained at the site of a bisphosphonate fracture and was processed in a nondecalcified manner. The specimen was evaluated for potential cellular changes consistent with bisphosphonate treatment. Significant osteoclast abnormalities at the fracture site were found in a 69-year-old woman treated for 2 years with Fosamax substantiating that bone remodeling at this site is distinctly abnormal. Addressing the osteoclast dysfunction should be a focus of future therapeutic attention and intervention.

  9. [Ultrasound monitoring of consolidation processes in fractures of long tubular bones in osteosynthesis using bioactive implants].

    Science.gov (United States)

    Zavadovskaia, V D; Popov, V P; Akbasheva, O E; Grigor'ev, E G; Druzhinina, T V

    2014-01-01

    To show the capabilities of ultrasound monitoring to assess consolidation processes in fractures of long tubular bones in the use of bioactive material-containing implants. Eighty-two (45.1%) patients whose bone fragments had been fixed with bioactive material-coated plates and 100 (54.9%) patients with bioinert material-coated ones were examined. Consolidation changes were estimated by ultrasound and X-ray studies 2, 4, 6, and 12 months after surgery. Bone metabolic changes were determined by US osteometry 2 months following surgery. Ultrasound data were compared with the biochemical markers: C-terminal telopeptide (CrossLaps) and osteocalcin. Ultrasound monitoring of the rates of consolidation and the time course of changes in bone strength versus the biochemical markers established the positive effect of bioactiveplates on the process of consolidation in fractures of tubular bones and made it possible to consider local osteopenic syndrome to be a prognostically favorable sign of timely callus formation.

  10. Macrophages in bone fracture healing: Their essential role in endochondral ossification.

    Science.gov (United States)

    Schlundt, Claudia; El Khassawna, Thaqif; Serra, Alessandro; Dienelt, Anke; Wendler, Sebastian; Schell, Hanna; van Rooijen, Nico; Radbruch, Andreas; Lucius, Richard; Hartmann, Susanne; Duda, Georg N; Schmidt-Bleek, Katharina

    2018-01-01

    In fracture healing, skeletal and immune system are closely interacting through common cell precursors and molecular mediators. It is thought that the initial inflammatory reaction, which involves migration of macrophages into the fracture area, has a major impact on the long term outcome of bone repair. Interestingly, macrophages reside during all stages of fracture healing. Thus, we hypothesized a critical role for macrophages in the subsequent phases of bone regeneration. This study examined the impact of in vivo induced macrophage reduction, using clodronate liposomes, on the different healing phases of bone repair in a murine model of a standard closed femoral fracture. A reduction in macrophages had no obvious effect on the early fracture healing phase, but resulted in a delayed hard callus formation, thus severely altering endochondral ossification. Clodronate treated animals clearly showed delayed bony consolidation of cartilage and enhanced periosteal bone formation. Therefore, we decided to backtrack macrophage distribution during fracture healing in non-treated mice, focusing on the identification of the M1 and M2 subsets. We observed that M2 macrophages were clearly prevalent during the ossification phase. Therefore enhancement of M2 phenotype in macrophages was investigated as a way to further bone healing. Induction of M2 macrophages through interleukin 4 and 13 significantly enhanced bone formation during the 3week investigation period. These cumulative data illustrate their so far unreported highly important role in endochondral ossification and the necessity of a fine balance in M1/M2 macrophage function, which appears mandatory to fracture healing and successful regeneration. Copyright © 2016. Published by Elsevier Inc.

  11. Analysis of facial bone fractures: An 11-year study of 2,094 patients

    Directory of Open Access Journals (Sweden)

    Hwang Kun

    2010-01-01

    Full Text Available Purpose: The medical records of these patients were reviewed and analysed to determine the clinical characteristics and treatment of facial bone fractures. Patients and Methods: This is a retrospective study of 2,094 patients with facial bone fractures from various accidents that were treated at the Inha University Hospital from 1996 to 2007. Results: The most common age group was the third decade of life (29%. Males were more common than females (3.98:1. The most common aetiology was violent assault or nonviolent traumatic injury (49.4%. The most common isolated fracture site was the nasal bone (37.7%, followed by the mandible (30%, orbital bones (7.6%, zygoma (5.7%, maxilla (1.3% and the frontal bone (0.3%. The largest group with complex fractures included the inferior region of the orbital floor and zygomaticomaxilla (14%. Closed reduction was performed in 46.3% of the cases while 39.7% of the cases required open reduction. For open reductions, the most commonly used soft-tissue approach was the intraoral approach (32.3%. The complication rate was 6.4% and the most common complication was hypoesthesia (68.4% followed by diplopia (25.6%. Conclusion: Long-term collection of epidemiological data regarding facial fractures and concomitant injuries is important for the evaluation of existing preventive measures and useful in the development of new methods of injury prevention and treatment.

  12. Osteoporosis and bone fractures in alcoholic liver disease: a meta-analysis.

    Science.gov (United States)

    Bang, Chang Seok; Shin, In Soo; Lee, Sung Wha; Kim, Jin Bong; Baik, Gwang Ho; Suk, Ki Tae; Yoon, Jai Hoon; Kim, Yeon Soo; Kim, Dong Joon

    2015-04-07

    To evaluate the association between alcoholic liver disease (ALD) and bone fractures or osteoporosis. Non-randomized studies were identified from databases (PubMed, EMBASE, and the Cochrane Library). The search was conducted using Boolean operators and keywords, which included "alcoholic liver diseases", "osteoporosis", or "bone fractures". The prevalence of any fractures or osteoporosis, and bone mineral density (BMD) were extracted and analyzed using risk ratios and standardized mean difference (SMD). A random effects model was applied. In total, 15 studies were identified and analyzed. Overall, ALD demonstrated a RR of 1.944 (95%CI: 1.354-2.791) for the development of bone fractures. However, ALD showed a RR of 0.849 (95%CI: 0.523-1.380) for the development of osteoporosis. BMD was not significantly different between the ALD and control groups, although there was a trend toward lower BMD in patients with ALD (SMD in femur-BMD: -0.172, 95%CI: -0.453-0.110; SMD in spine-BMD: -0.169, 95%CI: -0.476-0.138). Sensitivity analyses showed consistent results. Current publications indicate significant associations between bone fractures and ALD, independent of BMD or the presence of osteoporosis.

  13. Analysis of facial bone fractures: An 11-year study of 2,094 patients

    Science.gov (United States)

    Hwang, Kun; You, Sun Hye

    2010-01-01

    Purpose: The medical records of these patients were reviewed and analysed to determine the clinical characteristics and treatment of facial bone fractures. Patients and Methods: This is a retrospective study of 2,094 patients with facial bone fractures from various accidents that were treated at the Inha University Hospital from 1996 to 2007. Results: The most common age group was the third decade of life (29%). Males were more common than females (3.98:1). The most common aetiology was violent assault or nonviolent traumatic injury (49.4%). The most common isolated fracture site was the nasal bone (37.7%), followed by the mandible (30%), orbital bones (7.6%), zygoma (5.7%), maxilla (1.3%) and the frontal bone (0.3%). The largest group with complex fractures included the inferior region of the orbital floor and zygomaticomaxilla (14%). Closed reduction was performed in 46.3% of the cases while 39.7% of the cases required open reduction. For open reductions, the most commonly used soft-tissue approach was the intraoral approach (32.3%). The complication rate was 6.4% and the most common complication was hypoesthesia (68.4%) followed by diplopia (25.6%). Conclusion: Long-term collection of epidemiological data regarding facial fractures and concomitant injuries is important for the evaluation of existing preventive measures and useful in the development of new methods of injury prevention and treatment. PMID:20924449

  14. Common Polymorphism in the LRP5 Gene May Increase the Risk of Bone Fracture and Osteoporosis

    Directory of Open Access Journals (Sweden)

    Guang-Yue Xu

    2014-01-01

    Full Text Available The low-density lipoprotein receptor-related protein 5 gene (LRP5 was identified to be linked to the variation in bone mineral density and types of bone diseases. The present study was aimed at examining the association of LRP5 rs3736228 C>T gene with bone fracture and osteoporosis by meta-analysis. A systematic electronic search of literature was conducted to identify all published studies in English or Chinese on the association of the LRP5 gene with bone fracture and osteoporosis risks. All analyses were calculated using the Version 12.0 STATA software. Odds ratios (ORs and their corresponding 95% confidence interval (95% CI were calculated. An updated meta-analysis was currently performed, including seven independent case-control studies. Results identified that carriers of rs3736228 C>T variant in the LRP5 gene were associated with an increased risk of developing osteoporosis and fractures under 4 genetic models but not under the dominant model (OR = 1.19, 95% CI = 0.97~1.46, and P=0.103. Ethnicity-subgroup analysis implied that LRP5 rs3736228 C>T mutation was more likely to develop osteoporosis and fractures among Asians and Caucasians in majority of subgroups. These results suggest that there is a modest effect of the LRP5 rs3736228 C>T on the increased susceptibility of bone fracture and osteoporosis.

  15. Common polymorphism in the LRP5 gene may increase the risk of bone fracture and osteoporosis.

    Science.gov (United States)

    Xu, Guang-Yue; Qiu, Yong; Mao, Hai-Jun

    2014-01-01

    The low-density lipoprotein receptor-related protein 5 gene (LRP5) was identified to be linked to the variation in bone mineral density and types of bone diseases. The present study was aimed at examining the association of LRP5 rs3736228 C>T gene with bone fracture and osteoporosis by meta-analysis. A systematic electronic search of literature was conducted to identify all published studies in English or Chinese on the association of the LRP5 gene with bone fracture and osteoporosis risks. All analyses were calculated using the Version 12.0 STATA software. Odds ratios (ORs) and their corresponding 95% confidence interval (95% CI) were calculated. An updated meta-analysis was currently performed, including seven independent case-control studies. Results identified that carriers of rs3736228 C>T variant in the LRP5 gene were associated with an increased risk of developing osteoporosis and fractures under 4 genetic models but not under the dominant model (OR = 1.19, 95% CI = 0.97~1.46, and P = 0.103). Ethnicity-subgroup analysis implied that LRP5 rs3736228 C>T mutation was more likely to develop osteoporosis and fractures among Asians and Caucasians in majority of subgroups. These results suggest that there is a modest effect of the LRP5 rs3736228 C>T on the increased susceptibility of bone fracture and osteoporosis.

  16. Subradiographic Foot and Ankle Fractures and Bone Contusions Detected by MRI in Elite Ice Hockey Players.

    Science.gov (United States)

    Baker, Jonathan C; Hoover, Eric G; Hillen, Travis J; Smith, Matthew V; Wright, Rick W; Rubin, David A

    2016-05-01

    In ice hockey players, serious bone injuries in the foot and ankle, especially those attributed to impact from the moving puck, may be radiographically occult and underrecognized. The purpose of this research was to study foot and ankle bone injuries detected with magnetic resonance imaging (MRI) that occurred in elite hockey players. The hypothesis was that these injuries predominate medially, especially when caused by the impact from the puck, and are associated with prolonged lost playing time. Case series; Level of evidence, 4. Three independent observers, blinded to the mechanism of injury, retrospectively reviewed foot and ankle MRI examinations acquired after 31 acute injuries that occurred in 27 elite ice hockey players who had no radiographically visible fractures. Bone abnormalities were classified as fractures or varying degrees of contusion based on predetermined definitions. Interobserver agreement was analyzed with kappa statistics. The association between the injury mechanism and the bones involved was examined with the Fisher exact test. A t test was applied to determine if MRI evidence of a severe bone injury (defined as either a fracture or a high-grade bone contusion) was associated with longer recovery times, when return-to-play information was available. The observers identified at least 1 bone injury in 27 of the 31 MRI examinations, including 10 with radiographically occult fractures. Agreement among the 3 observers for injury categorization was substantial (κ = 0.76). Seventeen injuries were caused by a direct blow (15 from a moving puck, 2 from an uncertain source), resulting in 6 fractures and 6 high-grade bone contusions, with 14 of the 17 involving a medial bone (medial malleolus, navicular, or first metatarsal base). Compared with other mechanisms, direct impaction was statistically more likely to result in a severe bone injury and to involve the medial foot and ankle. In 20 injuries where return-to-play information was available

  17. EVALUATION OF RESULTS IN FRACTURES OF BOTH BONES FOREARM TREATED WITH DYNAMIC COMPRESSION PLATING

    Directory of Open Access Journals (Sweden)

    Sindhuja G

    2017-06-01

    Full Text Available BACKGROUND The anatomical alignment of the bones, the length, the radial bow, and axis should be restored for a good functional outcome. Conservative treatment has resulted in malunion, non-union, synostosis and ultimately poor functional outcome. Internal fixation helps in perfect reduction of fracture fragments in anatomical position by rigid fixation and early mobilisation, the normal functions of the hand can be re-achieved at the earliest. This study has been taken up to evaluate the results of open reduction and internal fixation of the fractures of BBFA with DCP in adults and its advantages and complications. In this study, the rate and time taken for union, the complication, the functional results in terms of forearm rotation and wrist and elbow movements are evaluated. MATERIALS AND METHODS This study includes treatment of 20 cases of fracture of both bones of forearm by open reduction and internal fixation with 3.5 mm DCP from August 2013 to August 2015 at Department of Orthopaedics at Konaseema Institute of Medical Sciences, Amalapuram. Follow-up was done up to September 2015. This is a prospective time bound study. Sample size - 20 patients. Inclusion Criteria- 1. Simple fractures. 2. Open fractures-Gustilo and Anderson type I and type II. 3. Age criteria = 15 to 70 years, both males and females. Exclusion Criteria- 1. Age criteria 0 to 14 years & > 70 years. 2. Radiologically proven segmental fractures and isolated forearm bone fractures. 3. Pathological fracture. 4. Gustilo and Anderson type III. 5. Patient not willing for surgery. 6. Patient unfit for surgery. RESULTS The present study consists of 20 cases of fracture both bones of the forearm. All the cases were openly reduced and internally fixed with 3.5 mm DCP. The study period was from August 2013 to September 2015. The age of these patients ranged from 15-70 years with fracture being most common in 3 rd decade and an average age of 31 years. CONCLUSION Use of separate

  18. Scintigraphic control of bone-fracture healing under ultrasonic stimulation: An animal experimental study

    International Nuclear Information System (INIS)

    Klug, W.; Franke, W.G.; Knoch, H.G.

    1986-01-01

    In a model of closed lower-leg fracture in rabbits and of secondary bone-fracture healing, scintigraphic control until biological healing was performed. Biological fracture healing was assumed for a region of interest (ROI)-activity ratio close to 1.0. After application of sup(99m)Tc-HEDP, 151 examinations were performed. ROI activity increased significantly until day 14 p.i. and reached the maximum value (Q=6.44) on day 14 postfracture. Sixty-one lower leg fractures were treated by ultrasound from days 14-28 postfractures. These stimulated fractures were biologically healed on day 168 postfracture. The fractures that were not treated by ultrasound could not be detected by scanning after day 203 postfracture. (orig.)

  19. Intramedullary bone fragment obstructing passage of reaming guide wire with iatrogenic fractured tibia.

    Science.gov (United States)

    Nag, Suman; Lall, Hitesh; Jain, Vijay Kumar; Bansal, Pankaj; Khare, Rahul; Mittal, Deepak

    2010-02-01

    Reamed interlocking intramedullary fixation is the treatment of choice for displaced tibial shaft fractures in adults. In most cases it can be performed without difficulty; however, technical difficulties may be encountered during nailing in some cases. This article describes a case of closed nailing for a tibial shaft fracture in which intramedullary guide wire was obstructed by a small intramedullary bone fragment in the distal fracture segment. Forceful reaming and insertion of the nail led to a break in the cortex of the distal fragment and bending of guide wire. Finally, open reduction and intramedullary nailing was performed to retrieve the guide wire and intramedullary bone fragment and fix the tibia.A comminuted fracture with multiple close fragments in proximity to the fracture site should be preoperatively scrutinized to look for intramedullary bone fragment or a fragment that could be pushed in the intramedullary canal during the intramedullary nailing. The surgeon can then anticipate the potential operative difficulty that may be encountered during closed nailing of such a fracture; and the patient can be counseled, as open nailing is a safer and viable option. Finally it is pertinent that even if this fracture type is overlooked, catastrophe can be avoided by properly following all the steps of intramedullary nailing. Copyright 2010, SLACK Incorporated.

  20. The value of spiral CT scan on fracture of ankle joint and tarsal bones

    International Nuclear Information System (INIS)

    Li Zhaoli; Liang Jingyin; Pan Zhifeng

    2009-01-01

    Objective: To study the value of spiral CT scan on the fracture of ankle joint and tarsal bones. Methods: 43 cases with the fracture of ankle joint and tarsal bones were collected and analyzed. All the cases were examined by plain film radiography and spiral CT thin slice scan. Multi-planar reformation (MPR), surface shaded display (SSD) and other techniques of image post-processing were performed in 35 cases of them. Results: Spiral CT scan could demonstrate more fractures than plain film radiography in 28 cases(65.1%). There are 15 cases (34.9%) which are normal in plain film radiography but abnormal in Spiral CT scan. Spiral CT could demonstrate the different length, width, direction and number of linear low density shadow. SSD and MPR were performed again in the cases with avulsion fracture and fragmental fracture to demonstrate the fracture direction and the shape, size and location of fragments more clearly. Conclusion: Spiral CT thin slice scan with image post-processing techniques can play an important role in fracture of ankle joint and tarsal bones. (authors)

  1. Malunion of Long-Bone Fractures in a Conflict Zone in the Democratic Republic of Congo.

    Science.gov (United States)

    Bauhahn, Grace; Veen, Harald; Hoencamp, Rigo; Olim, Nelson; Tan, Edward C T H

    2017-09-01

    Malunion is a well-recognized complication of long-bone fractures which accounts for more than 25% of injuries in conflict zones. The aim of this study was to investigate the rate of malunion sustained by casualties with penetrating gunshot wounds in an International Committee of the Red Cross (ICRC) surgical substitution project in the Democratic Republic of Congo (DRC) and compare these results with current literature. A retrospective cohort study was performed. All patients admitted to the ICRC facility between the periods of 01.10.2014 and 31.12.2015 with long-bone fractures caused by gunshot wound were included, and data were collected retrospectively from the patient's hospital notes. A total of 191 fractures caused by gunshot were treated in the DRC at the ICRC surgical substitution project during the study period. On average, the fractures were 3 days old on admission and were all open, with 62% also being comminuted. The ICRC management protocol, which emphasizes debridement, antibiotic prophylaxis and conservative fracture stabilization, was followed in all cases. Forty-eight percentage of the fractures were finally classified as 'union without complication'; however, 17% were classified as 'malunion'. This study indicates that open long-bone fractures that are managed by the ICRC surgical substitution project in DRC may have an increased likelihood of malunion as compared to long-bone fractures treated in developed countries. Patient delay and mechanism of injury may have caused increased rates of infection which are likely behind these increased rates of malunion, alongside the lack of definitive fracture treatment options made available to the surgical team.

  2. Vascularized fibula flap onlay for salvage of pathologic fracture of the long bones.

    Science.gov (United States)

    Friedrich, Jeffrey B; Moran, Steven L; Bishop, Allen T; Wood, Christina M; Shin, Alexander Y

    2008-06-01

    Long bone pathologic fractures, especially when radiation-induced, represent a significant and difficult-to-treat entity. The ultimate goal of treatment is limb salvage; however, there are no treatment methods that guarantee bony healing. The vascularized fibula flap has revolutionized bone reconstruction, including that of the long bones. The authors report the results of onlay vascularized fibula flaps for pathologic long bone fractures and the outcomes and complications of this reconstruction method. Records of patients who underwent long bone pathologic fracture reconstruction with the vascularized fibula onlay flap were reviewed retrospectively. Records were analyzed for reconstruction details, time to bony union, subsequent operations, clinical and functional outcomes, and complications associated with harvest and reconstruction. Twenty-five patients met the study criteria. Twenty-one patients demonstrated bony fracture union at an average of 11 months after fibular flap onlay grafting. Two patients who had experienced bony union ultimately required amputations for reasons unrelated to reconstruction. All four patients whose fibular flap failed later obtained limb salvage after further procedures. Thirteen of 25 patients achieved a good or excellent functional outcome as judged by a common oncologic reconstruction functional outcome scale. Postsurgical complications were common in this patient group, with a total of 22 distinct complications (88 percent incidence). Despite a high complication rate, this study demonstrates that pathologic long bone fracture salvage with an onlay fibula flap achieves relatively good clinical and functional outcomes. Limb salvage was made possible in a majority of patients, all of whom experienced a difficult problem in the form of long bone pathologic fractures.

  3. Bone mineral density, bone turnover markers and fractures in patients with systemic sclerosis: a case control study.

    Directory of Open Access Journals (Sweden)

    Marco Atteritano

    Full Text Available OBJECTIVE: The aim of our study was to elucidate the pathophysiology of systemic sclerosis-related osteoporosis and the prevalence of vertebral fragility fracture in postmenopausal women with systemic sclerosis (SSc. METHODOLOGY: Fifty-four postmenopausal women with scleroderma and 54 postmenopausal controls matched for age, BMI, and smoking habits were studied. BMD was measured by dual energy-x-ray absorptiometry at spine and femur, and by ultrasonography at calcaneus The markers of bone turnover included serum osteocalcin and urinary deoxypyridinoline. All subjects had a spine X-ray to ascertain the presence of vertebral fractures. RESULTS: bone mineral density at lumbar spine (BMD 0.78±0.08 vs 0.88±0.07; p<0,001, femoral neck (BMD: 0.56±0.04 vs 0.72±0.07; p<0,001 and total femur (BMD: 0.57±0.04 vs 0.71±0.06; p<0,001 and ultrasound parameter at calcaneus (SI: 80.10±5.10 vs 94.80±6.10 p<0,001 were significantly lower in scleroderma compared with controls; bone turnover markers and parathyroid hormone level were significantly higher in scleroderma compared with controls, while serum of 25(OHD3 was significantly lower. In scleroderma group the serum levels of 25(OHD3 significantly correlated with PTH levels, BMD, stiffness index and bone turnover markers. One or more moderate or severe vertebral fractures were found in 13 patients with scleroderma, wherease in control group only one patient had a mild vertebral fracture. CONCLUSION: Our data shows, for the first time, that vertebral fractures are frequent in subjects with scleroderma, and suggest that lower levels of 25(OHD3 may play a role in the risk of osteoporosis and vertebral fractures.

  4. Repair of long-bone fractures in cats and small dogs with the Unilock mandible locking plate system.

    Science.gov (United States)

    Voss, K; Kull, M; Hässig, M; Montavon, P

    2009-01-01

    To retrospectively evaluate stabilisation of long-bone fractures in cats and small dogs using the Unilock system. Medical histories and radiographs of consecutive patients with long-bone fractures stabilised with the Unilock system were reviewed. Cases with follow-up radiographs taken at least four weeks postoperatively were included. Signalment of the patient, fracture localisation and type, primary fracture repair or revision surgery, single or double plating, and complications for each patient were noted. Additionally, implant size, number of screws, number of cortices engaged with screws, and number of empty holes across the fracture were evaluated in fractures where a single plate had been applied. Eighteen humeral, 18 radial, 20 femoral, and 10 tibial fractures were treated. The Unilock system was used for primary repair in 44 fractures and for revision surgery in 22 fractures. Two plates were applied in 17 fractures, and a single plate was applied in 49 fractures. Follow-up radiographs were taken four to 109 weeks postoperatively. Complications were seen in 12 animals and 13 fractures (19.7%). Fixation failure occurred in seven fractures (10.6%). Cases with a single plate that suffered fixation failure had thinner screws in relation to bone diameter than cases with double plates, and more screws in a main fragment than those without fixation failure. The Unilock system is a suitable implant for fracture fixation of long bones in cats and small dogs.

  5. Bone strength estimates relative to vertical ground reaction force discriminates women runners with stress fracture history.

    Science.gov (United States)

    Popp, Kristin L; McDermott, William; Hughes, Julie M; Baxter, Stephanie A; Stovitz, Steven D; Petit, Moira A

    2017-01-01

    To determine differences in bone geometry, estimates of bone strength, muscle size and bone strength relative to load, in women runners with and without a history of stress fracture. We recruited 32 competitive distance runners aged 18-35, with (SFX, n=16) or without (NSFX, n=16) a history of stress fracture for this case-control study. Peripheral quantitative computed tomography (pQCT) was used to assess volumetric bone mineral density (vBMD, mg/mm 3 ), total (ToA) and cortical (CtA) bone areas (mm 2 ), and estimated compressive bone strength (bone strength index; BSI, mg/mm 4 ) at the distal tibia. ToA, CtA, cortical vBMD, and estimated strength (section modulus; Zp, mm 3 and strength strain index; SSIp, mm 3 ) were measured at six cortical sites along the tibia. Mean active peak vertical (pkZ) ground reaction forces (GRFs), assessed from a fatigue run on an instrumented treadmill, were used in conjunction with pQCT measurements to estimate bone strength relative to load (mm 2 /N∗kg -1 ) at all cortical sites. SSIp and Zp were 9-11% lower in the SFX group at mid-shaft of the tibia, while ToA and vBMD did not differ between groups at any measurement site. The SFX group had 11-17% lower bone strength relative to mean pkZ GRFs (phistory of stress fracture. Bone strength relative to load is also lower in this same region suggesting that strength deficits in the middle 1/3 of the tibia and altered gait biomechanics may predispose an individual to stress fracture. Copyright © 2016. Published by Elsevier Inc.

  6. The challenge of fracture management in osteoporotic bones

    African Journals Online (AJOL)

    like diphosphonates to assist in fracture healing and use of augmentation techniques is worthwhile considering. Kenya Orthopaedic Association (K.O.A) formulate a policy for management of osteoporotic fractures in our local set up. InTRoduCTIon. Osteoporosis is defined as a systemic skeletal disease characterised by low ...

  7. Bone fragility beyond strength and mineral density: Raman spectroscopy predicts femoral fracture toughness in a murine model of rheumatoid arthritis.

    Science.gov (United States)

    Inzana, Jason A; Maher, Jason R; Takahata, Masahiko; Schwarz, Edward M; Berger, Andrew J; Awad, Hani A

    2013-02-22

    Clinical prediction of bone fracture risk primarily relies on measures of bone mineral density (BMD). BMD is strongly correlated with bone strength, but strength is independent of fracture toughness, which refers to the bone's resistance to crack initiation and propagation. In that sense, fracture toughness is more relevant to assessing fragility-related fracture risk, independent of trauma. We hypothesized that bone biochemistry, determined by Raman spectroscopy, predicts bone fracture toughness better than BMD. This hypothesis was tested in tumor necrosis factor-transgenic mice (TNF-tg), which develop inflammatory-erosive arthritis and osteoporosis. The left femurs of TNF-tg and wild type (WT) littermates were measured with Raman spectroscopy and micro-computed tomography. Fracture toughness was assessed by cutting a sharp notch into the anterior surface of the femoral mid-diaphysis and propagating the crack under 3 point bending. Femoral fracture toughness of TNF-tg mice was significantly reduced compared to WT controls (p=0.04). A Raman spectrum-based prediction model of fracture toughness was generated by partial least squares regression (PLSR). Raman spectrum PLSR analysis produced strong predictions of fracture toughness, while BMD was not significantly correlated and produced very weak predictions. Raman spectral components associated with mineralization quality and bone collagen were strongly leveraged in predicting fracture toughness, reiterating the limitations of mineralization density alone. Copyright © 2012 Elsevier Ltd. All rights reserved.

  8. Evaluation of several pre-clinical tools for identifying characteristics associated with limb bone fracture in thoroughbred racehorses

    OpenAIRE

    Corsten, Anthony Nicholas

    2016-01-01

    Catastrophic skeletal fractures in racehorses are devastating not only to the animals, owners and trainers, but also to the perception of the sport in the public eye. The majority of these fatal accidents are unlikely to be due to chance, but are rather an end result failure from stress fractures. Stress fractures are overuse injuries resulting from an accumulation of bone tissue damage over time. Because stress fractures are pathological, it is possible that overt fractures can be predicted ...

  9. Impact of Maternal Diet on Offspring Bone Fracture Risk During Childhood

    DEFF Research Database (Denmark)

    Petersen, Sesilje Elise Bondo

    Fetal programming is an emerging concept that links environmental conditions during embryonic and fetal development with risk of diseases later in life. A hypothesis for fetal programming of bone health state that peak bone mass may be modified by environmental influences during fetal life...... and dietary patterns in two prospective pregnancy cohorts, were associated with offspring risk of bone fractures in childhood. Overall, our studies provided limited support to the hypothesis that fetal bone health is programmed by the maternal vitamin D status and overall diet during pregnancy. However...

  10. Teriparatide treatment of femoral fracture nonunion that autogenous bone grafting failed to heal: a case report.

    Science.gov (United States)

    Yu, Wei; Guo, Xiaodong

    2017-12-01

    Management of fracture nonunion is challenging as another surgical intervention for the patient is often a necessity, which has a huge impact on both quality of life and economic burden of the patient. Thus, a less aggressive and better accepted treatment for nonunion is required. We gave teriparatide to a 45-year-old man with femoral fracture nonunion 1 year after he underwent surgery with autogenous bone grafting that failed to heal his initial nonunion. Successful union was obtained after once-daily administration of teriparatide for 9 months. Our case showed teriparatide could successfully treat a femoral fracture nonunion that autogenous bone grafting failed to heal. Teriparatide may provide an alternative treatment for fracture nonunion.

  11. LRP5 gene polymorphisms predict bone mass and incident fractures in elderly Australian women.

    Science.gov (United States)

    Bollerslev, J; Wilson, S G; Dick, I M; Islam, F M A; Ueland, T; Palmer, L; Devine, A; Prince, R L

    2005-04-01

    Postmenopausal osteoporosis and bone mass are influenced by multiple factors including genetic variation. The importance of LDL receptor-related protein 5 (LRP5) for the regulation of bone mass has recently been established, where loss of function mutations is followed by severe osteoporosis and gain of function is related to increased bone mass. The aim of this study was to evaluate the role of polymorphisms in the LRP5 gene in regulating bone mass and influencing prospective fracture frequency in a well-described, large cohort of normal, ambulatory Australian women. A total of 1301 women were genotyped for seven different single nucleotide polymorphisms (SNPs) within the LRP5 gene of which five were potentially informative. The effects of these gene polymorphisms on calcaneal quantitative ultrasound measurements (QUS), osteodensitometry of the hip and bone-related biochemistry was examined. One SNP located in exon 15 was found to be associated with fracture rate and bone mineral density. Homozygosity for the less frequent allele of c.3357 A > G was associated with significant reduction in bone mass at most femoral sites. The subjects with the GG genotype, compared to the AA/AG genotypes showed a significant reduction in BUA and total hip, femoral neck and trochanter BMD (1.5% P = 0.032; 2.7% P = 0.047; 3.6% P = 0.008; 3.1% P = 0.050, respectively). In the 5-year follow-up period, 227 subjects experienced a total of 290 radiologically confirmed fractures. The incident fracture rate was significantly increased in subjects homozygous for the GG polymorphism (RR of fracture = 1.61, 95% CI [1.06-2.45], P = 0.027). After adjusting for total hip BMD, the fracture rate was still increased (RR = 1.67 [1.02-2.78], P = 0.045), indicating factors other than bone mass are of importance for bone strength. In conclusion, genetic variation in LRP5 seems to be of importance for regulation of bone mass and osteoporotic fractures.

  12. Osteopenia and bone fractures in a man with anorexia nervosa and hypogonadism

    International Nuclear Information System (INIS)

    Rigotti, N.A.; Neer, R.M.; Jameson, L.

    1986-01-01

    Women with anorexia nervosa have reduced skeletal mass. Both anorexia and osteopenia are less common in men. We describe a 22-year-old man with anorexia nervosa and severe osteopenia involving both cortical and trabecular bone who developed a pelvic fracture and multiple vertebral compression fractures. He was found to have secondary hypogonadotropic hypogonadism that was reversible with weight gain. This case illustrates the need to consider osteopenia as a potential complication of anorexia nervosa in males as well as females

  13. Osteopenia and bone fractures in a man with anorexia nervosa and hypogonadism

    Energy Technology Data Exchange (ETDEWEB)

    Rigotti, N.A.; Neer, R.M.; Jameson, L.

    1986-07-18

    Women with anorexia nervosa have reduced skeletal mass. Both anorexia and osteopenia are less common in men. We describe a 22-year-old man with anorexia nervosa and severe osteopenia involving both cortical and trabecular bone who developed a pelvic fracture and multiple vertebral compression fractures. He was found to have secondary hypogonadotropic hypogonadism that was reversible with weight gain. This case illustrates the need to consider osteopenia as a potential complication of anorexia nervosa in males as well as females.

  14. Choice of operative method for management of isolated zygomatic bone fractures; evidence based study.

    Science.gov (United States)

    Iqbal, Hafiz Aamer; Chaudhry, Saima

    2009-09-01

    To evaluate the treatment outcome of different methods for reduction and fixation of isolated zygomatic bone fractures using degree of displacement as a guide to classify patients into closed and open reduction groups. This Clinical Trial was conducted at de' Montmorency College of Dentistry/Punjab Dental Hospital, Lahore between 21st July 2000 and 30th June 2003. Sixty patients with isolated zygomatic bone fractures were assigned to open and closed reduction groups of treatment depending on the degree of fracture displacement. Adequacy of reduction was evaluated by comparing pre and post operative radiographs. Aesthetic outcome was assessed by biometric evaluation. Reduction was adequate in all patients except four. In two of four no facial deformity was apparent. No patient showed post surgical change in position of reduced zygomatic bone. Biometric evaluation revealed acceptable aesthetics and adequate mouth opening in all except two patients. Our study indicates that displacement of 2 mm at any of the fractured site on occipitomental radiographs can be successfully used as a criterion to assign patients into open and closed reduction groups, for treatment of isolated zygomatic bone fractures.

  15. A comparison of bone mineral density in osteoporotic fracture of the proximal femur using dual energy X-ray absorptiometry

    International Nuclear Information System (INIS)

    Lee, Jong Seok; Yoo, Beong Gyu; Kim, Keung Sik

    2000-01-01

    There were some controversies about direct cause of hip fracture. We attempted to look at 40 osteoporotic proximal femur fractures in women over 50 years between March in 1999 and February in 2000. The bone density of the fracture group and the healthy 85 control group was measured by Dual Energy X-ray absorptiometry (DEXA). The result was compared using age matched paired T test. The results were as follows: The femoral neck fractures were 14 cases and the trochanteric fractures were 26 cases. Mean age at a fracture was 67.1 years in neck fracture group and 76.5 years in trochanteric fracture. In the control group, the bone density of both side of the proximal femur was measured and it showed statistically no difference between both sides in same person. The bone density of neck, Ward's triangle, trochanter (P<0.05) and lumbar spine (P<0.001) was significantly reduced in the proximal femoral fracture group comparing with the control group. The bone density of neck, Ward's triangle, trochanter (P<0.05) was significantly reduced in the proximal femoral neck fracture group comparing with the control group, but there was no statistical difference in lumbar spine comparing with the control group. The bone density of neck, Ward's triangle, trochanter and lumbar spine (P<0.001) was significantly reduced in the proximal femoral neck fracture group comparing with the control group. We concluded that the bone mineral densities (BMD) of proximal femur and lumbar spine had decreased in hip fractures but that the bone mineral density and T-score % of the proximal femur were statistically lower than that of the lumbar spine. We suggest that measuring the bone mineral density of the proximal femur may reflect the weakness of the proximal femur more precisely than measuring the bone mineral density of the lumbar spine

  16. A comparison of bone mineral density in osteoporotic fracture of the proximal femur using dual energy X-ray absorptiometry

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jong Seok; Yoo, Beong Gyu [Wonkwang Health Science College, Iksan (Korea, Republic of); Kim, Keung Sik [Yonsei University Yong Dong Severance Hospital, Seoul (Korea, Republic of)

    2000-04-15

    There were some controversies about direct cause of hip fracture. We attempted to look at 40 osteoporotic proximal femur fractures in women over 50 years between March in 1999 and February in 2000. The bone density of the fracture group and the healthy 85 control group was measured by Dual Energy X-ray absorptiometry (DEXA). The result was compared using age matched paired T test. The results were as follows: The femoral neck fractures were 14 cases and the trochanteric fractures were 26 cases. Mean age at a fracture was 67.1 years in neck fracture group and 76.5 years in trochanteric fracture. In the control group, the bone density of both side of the proximal femur was measured and it showed statistically no difference between both sides in same person. The bone density of neck, Ward's triangle, trochanter (P<0.05) and lumbar spine (P<0.001) was significantly reduced in the proximal femoral fracture group comparing with the control group. The bone density of neck, Ward's triangle, trochanter (P<0.05) was significantly reduced in the proximal femoral neck fracture group comparing with the control group, but there was no statistical difference in lumbar spine comparing with the control group. The bone density of neck, Ward's triangle, trochanter and lumbar spine (P<0.001) was significantly reduced in the proximal femoral neck fracture group comparing with the control group. We concluded that the bone mineral densities (BMD) of proximal femur and lumbar spine had decreased in hip fractures but that the bone mineral density and T-score % of the proximal femur were statistically lower than that of the lumbar spine. We suggest that measuring the bone mineral density of the proximal femur may reflect the weakness of the proximal femur more precisely than measuring the bone mineral density of the lumbar spine.

  17. Comminuted fracture of the accessory carpal bone removed via an arthroscopic-assisted arthrotomy.

    Science.gov (United States)

    Bonilla, Alvaro G; Santschi, Elizabeth M

    2015-02-01

    A 16-year-old American paint horse gelding was presented for evaluation of a left forelimb lameness grade III/V. Radiographs and computed tomography revealed a comminuted fracture of the accessory carpal bone involving the entire articulation with the distal radius and the proximal aspect of the articulation with the ulnar carpal bone. Multiple fragments were present in the palmar pouch of the antebrachiocarpal joint. An arthroscopic-assisted open approach was necessary to remove all fractured fragments. Subsequently the horse was re-admitted for lameness and was treated successfully with antibiotics and long-term supportive bandaging.

  18. Comminuted fracture of the accessory carpal bone removed via an arthroscopic-assisted arthrotomy

    Science.gov (United States)

    Bonilla, Alvaro G.; Santschi, Elizabeth M.

    2015-01-01

    A 16-year-old American paint horse gelding was presented for evaluation of a left forelimb lameness grade III/V. Radiographs and computed tomography revealed a comminuted fracture of the accessory carpal bone involving the entire articulation with the distal radius and the proximal aspect of the articulation with the ulnar carpal bone. Multiple fragments were present in the palmar pouch of the antebrachiocarpal joint. An arthroscopic-assisted open approach was necessary to remove all fractured fragments. Subsequently the horse was re-admitted for lameness and was treated successfully with antibiotics and long-term supportive bandaging. PMID:25694665

  19. Minimal packing duration in close reduction for nasal bone fracture treatment.

    Science.gov (United States)

    Choi, Dong Sik; Lee, Jeong Woo; Yang, Jung Dug; Chung, Ho Yun; Cho, Byung Chae; Choi, Kang Young

    2015-04-15

    Nasal bone fracture is the most common type of facial bone fracture. The optimal duration of the packing after closed reduction has been a controversial issue. The packing has several disadvantages such as blocking the nasal airway, causing infection and a headache, which is the most common immediate complication. The present study investigated the minimal and optimal duration of the nasal packing following reduction surgery of nasal bone fracture. A prospective study was performed for the patients undergoing reduction surgery following nasal bone fracture between July 2010 and June 2012. The patients were categorised into three groups according to the duration of nasal packing. For the patients treated between July 2010 and June 2011, nasal packing was maintained for 5 days. For those between July 2011 and December 2011, packing was maintained for 3 days. For those between January 2012 and June 2012, the packing was removed after 1 day. The computed tomography scan and the cephalolateral X-ray were checked at immediate postoperative period after packing removal and 6 months postoperatively. The alteration of heights, deviations, and nasal bone contours with time passage were compared among three groups. The patient satisfaction survey was also performed and compared. A total of 530 patients including 322 of the 5-days packing group, 102 of the 3-days group, and 106 of the 1-day group were enrolled. There was no statistically significant difference between the groups in terms of heights, deviations, and nasal bone contours (p-value ≥ 0.05). In the patient satisfaction survey, the 1-day packing group complained of discomfort related to nasal packing and headache symptoms much less, compared to the other two groups. The present study demonstrated that 1-day packing had comparable postoperative outcome with reducing the patients' discomfort. As such, a longer packing duration was not needed to achieve stable results one day is a reasonable packing time for most

  20. Multiple fractures and impaired bone metabolism in Wolfram syndrome: a case report.

    Science.gov (United States)

    Catalano, Antonino; Bellone, Federica; Cicala, Giuseppe; Giandalia, Annalisa; Morabito, Nunziata; Cucinotta, Domenico; Russo, Giuseppina Tiziana

    2017-01-01

    Wolfram Syndrome (WS) is a rare and lethal disease characterized by optic atrophy, diabetes mellitus, diabetes insipidus, and hearing loss. To date, osteoporotic related fractures have not been reported in affected patients. Here, we describe the case of a man affected by WS complicated by several bone fragility fractures. A 50-year-old Caucasian man was hospitalized because of tibia and fibula fractures. His clinical features included diabetes mellitus, diabetes insipidus, optic atrophy and deafness that were consistent with an unrecognized WS diagnosis, which was confirmed by the identification of a specific mutation in gene WFS1 encoding wolframin. Bone mineral density by phalangeal quantitative ultrasound demonstrated severe osteoporosis, with high serum levels of surrogate markers of bone turn-over. Previously unidentified rib fractures were also detected. To the best of our knowledge, this is the first report of osteoporotic related fractures in a patient affected by WS. Although no effective treatments are currently available to delay the progression of the disease, this case report suggests to evaluate fracture risk in the diagnostic work-up of WS.

  1. Patella fracture during rehabilitation after bone-patellar tendon-bone anterior cruciate ligament reconstruction: 2 case reports.

    Science.gov (United States)

    Piva, Sara R; Childs, John D; Klucinec, Brian M; Irrgang, James J; Almeida, Gustavo J M; Fitzgerald, G Kelley

    2009-04-01

    Case report. Patellar fracture is a rare but significant complication following anterior cruciate ligament (ACL) reconstruction when using a bone-patellar tendon-bone (BPTB) autograft. The purpose of these case reports is to describe 2 cases in which patellar fracture occurred during rehabilitation after ACL reconstruction using a BPTB. Both patients were 23-year-old males referred for rehabilitation after ACL reconstruction using a BPTB autograft. They were both progressing satisfactorily in rehabilitation until sustaining a fracture of the patella. One fracture occurred during the performance of the eccentric phase of a knee extension exercise during the sixth week of rehabilitation (7 weeks postsurgery), whereas the other fracture occurred during testing of the patient is quadriceps maximum voluntary isometric contraction in the ninth week of rehabilitation (10 weeks postsurgery). Both patients were subsequently treated with open reduction and internal fixation of the patella. During rehabilitation following ACL reconstruction using BPTB autograft, clinicians should consider the need to balance the sometimes-competing goals of improving quadriceps strength while providing protection to the healing graft, minimization of patellofemoral pain, and protection of the patellar donor site.

  2. New quantitative ultrasound techniques for bone analysis at the distal radius in hip fracture cases: differences between femoral neck and trochanteric fractures.

    Science.gov (United States)

    Horii, Motoyuki; Fujiwara, Hiroyoshi; Sakai, Ryo; Sawada, Koshiro; Mikami, Yasuo; Toyama, Syogo; Ozaki, Etsuko; Kuriyama, Nagato; Kurokawa, Masao; Kubo, Toshikazu

    2017-01-01

    Ample evidence on etiological and pathological differences between femoral neck and trochanteric fracture cases suggests the possibility of individualized treatment. There are many issues related to areal bone mineral density and other quantitative computed tomography parameters of the proximal femur. Although osteoporosis is a systemic problem, little has been reported regarding differences in bone structural parameters, including bone mineral density, between them in regions other than the proximal femur. Participants were consecutive female patients >50 years of age admitted to the Saiseikai Suita Hospital (Osaka prefecture, Japan) for their first hip fracture between January 2012 and September 2014. Cortical thickness (CoTh, mm), volumetric trabecular bone mineral density (TBD, mg/cm 3 ), and elastic modulus of trabecular bone (EMTb, GPa) were obtained as the new QUS parameters using the LD-100 system (Oyo Electric, Kyoto, Japan). The mean values of these parameters were compared between femoral neck and trochanteric fracture cases. In addition, correlations between age and each QUS parameter were investigated for each fracture type. A receiver operating characteristic (ROC) curve analysis was performed to examine the degree of effect each parameter on the fracture types. The area under the curve (AUC) for each parameter was compared to the AUC for age. There were 63 cases of femoral neck fracture (mean age, 78.2 years) and 37 cases of trochanteric fracture (mean age, 85.9 years). Mean TBD and EMTb were significantly higher for femoral neck fractures. There were significant negative correlations between QUS parameters and age for femoral neck fractures (P fractures were above those for trochanteric fractures for TBD and EMTb. AUCs were 0.72 for age, and 0.61, 0.65, and 0.65 for CoTh, TBD, and EMTb, respectively. The new QUS parameters indicated that TR fracture cases were more osteoporotic than were FN fracture cases, even at the distal radius. There might be

  3. Open Fracture of the Forearm Bones due to Horse Bite

    OpenAIRE

    Santoshi, John Ashutosh; Leshem, Lall

    2014-01-01

    Introduction: Fractures have been described mainly following falling accidents in horse-related injuries. Horse bites are uncommon accidents. We present a case of open fracture of the forearm due to horse bite. Case Report: A 35-year-old male farm-worker presented to the emergency room with alleged history of horse bite to the right forearm about 2 hours prior to presentation while feeding the horse. There was deformity of the forearm with multiple puncture wounds, deep abrasions and small...

  4. Post-traumatic bone mineral loss in tibial shaft fractures treated with a weight-bearing brace.

    Science.gov (United States)

    Andersson, S M; Nilsson, B E

    1979-12-01

    The bone mineral content in the upper ends of the tibia and the fibula was measured in 27 patients with tibial shaft fracture. The loss of bone mineral associated with the fracture did not differ between patients who were allowed weight-bearing in a functional below-knee brace and patients treated with a long leg plaster cast without weight-bearing.

  5. Peak bone mineral density, lean body mass and fractures

    NARCIS (Netherlands)

    Boot, Annemieke M.; de Ridder, Maria A. J.; van der Sluis, Inge M.; van Slobbe, Ingrid; Krenning, Eric P.; Keizer-Schrama, Sabine M. P. F. de Muinck

    Background: During childhood and adolescence, bone mass and lean body mass (LBM) increase till a plateau is reached. In this longitudinal and cross-sectional study, the age of reaching the plateau was evaluated for lumbar spine and total body bone mass measurements and lean body mass. The

  6. Multiple fracture of medullary tube during intramedullary nailing of long bone fractures.

    Science.gov (United States)

    Vakharia, M R; Lehto, S A; Mohler, D G

    2000-01-01

    Intramedullary nailing is an accepted treatment for the fixation of femoral and tibial shaft fractures. There is a low but significant incidence of intraoperative complications during intramedullary nailing. During this procedure, a medullary tube may be used to exchange the bent olive-tipped reaming guidewire for the straight guidewire. A review of the literature found only one report of a fracture of the medullary tube. Two cases in which the medullary tube fractured into multiple pieces are presented.

  7. Bone morphogenetic protein-7: Review of signalling and efficacy in fracture healing

    Directory of Open Access Journals (Sweden)

    Steven Cecchi

    2016-01-01

    Full Text Available Bone morphogenetic proteins (BMPs are a group of signalling molecules that belong to the transforming growth factor-β superfamily of proteins. Initially identified for their ability to induce bone formation, recent advances in the understanding of cellular and molecular mechanisms regarding BMPs have led to the use of the growth factor to accelerate bone healing. Recent clinical trials have demonstrated that BMPs, BMP-7 in particular, may present an alternative line of treatment other than the gold standard, autogenous bone grafting, in the treatment of fracture nonunion. We performed a literature search in September 2014 of PubMed and Embase using search terms, including “bone morphogenetic proteins”, “BMP-7”, “non-union”, “fracture healing” and “cost-effectiveness”, reviewing the efficacy, safety, and cost of treatment of nonunions with BMP-7. The authors further canvassed the reference lists of selected articles and used online search tools, such as Google Scholar. BMP-7 uses both the canonical and noncanonical signalling pathways. The treatment of fracture nonunion with recombinant human BMP-7 (rhBMP-7 has a comparable efficacy with that of autogenous bone grafting with an average union rate of 87% compared with 93% for bone grafting. Furthermore, fewer complications have been described with the use of rhBMP-7 compared with traditional bone grafting. We describe the signalling pathways that BMP-7 uses to exert its effect on bone. In nonunions, rhBMP-7 has been shown to have a similar efficacy to bone grafting with fewer complications.

  8. THE RESULT OF INTRAMEDULLARY NAILING WITH BONE GRAFTING OF TIBIA'S PATHOLOGIC FRACTURE

    Directory of Open Access Journals (Sweden)

    V. M. Shapovalov

    2010-01-01

    Full Text Available The authors give the clinical case of successful surgical treatment of patient with tibia's pathologic fracture by intramedullary nailing with bone grafting. The disadvantages of such patients' treatment by plaster immobilization and by some invasive methods like vascular autografting by Ilizarov's method and bone plating were also discussed. The obvious benefits of proposed surgical treatment technique of observed patient category are shown.

  9. Echinococcal disease of the bone: An unusual cause of a pathological fracture

    Directory of Open Access Journals (Sweden)

    Matthew Goodier

    2010-12-01

    Full Text Available Echinococcosis is caused by the larva of the tapeworm, Echinococcus granulosus or Echinococcus multiloccularis and is endemic in many rural areas of Southern Africa. Echinococcosis of the bone is an unusual manifestation of echinococcal disease and a rare cause of a lytic lesion of bone. This report describes a 30-yr old female who presented with an Echinococcal cyst of the right radius complicated by a pathological fracture.

  10. Evaluation of the lateral orbital approach in management of zygomatic bone fractures.

    Science.gov (United States)

    Thangavelu, K; Ganesh, N Sayee; Kumar, J Arun; Sabitha, S; Nikil

    2013-01-01

    Zygomatic maxillary fractures, also known as tripod fractures, are usually the result of a direct blow to the body of the zygoma. Tripod fracture consists of (a) zygomatic arch fracture, (b) fracture of the lateral orbital wall, and (c) fracture of the inferior orbital floor. The purpose of this study is to evaluate the functional and esthetic outcome following this lateral orbital approach in the management of zygoma fracture. This study was carried out in VMS Dental College, Salem, and in a private hospital. This study was based on the experience gained from a retrospective study of the 30 lateral orbital approaches that were used in 30 patients with fractures of the zygomatic complex, which were conducted for a period of 8 years between January 2003 and January 2011. In the retrospective study, all the 30 patients were able to open the mouth completely; eyeball movements were normal; esthetically, all patients appeared normal. There were no sinusitis or visual problems in any of the studied patients. We conclude that the lateral orbital approach is an ideal option in reduction and treatment of zygomatic bone and arch fractures.

  11. Osteoporotic Fracture Risk Assessment Using Bone Mineral Density in Korean: A Community-based Cohort Study.

    Science.gov (United States)

    Jang, Eun Jin; Lee, Young-Kyun; Choi, Hyung Jin; Ha, Yong-Chan; Jang, Sunmee; Shin, Chan Soo; Cho, Nam Han

    2016-02-01

    Fracture-risk assessment tool (FRAX) using just clinical risk factors of osteoporosis has been developed to estimate individual risk of osteoporotic fractures. We developed prediction model of fracture risk using bone mineral density (BMD) as well as clinical risk factors in Korean, and assessed the validity of the final model. To develop and validate an osteoporotic FRAX, a total of 768 Korean men and women aged 50 to 90 years were followed for 7 years in a community-based cohort study. BMD as well as clinical risk factors for osteoporotic fracture including age, sex, body mass index, history of fragility fracture, family history of fracture, smoking status, alcohol intake, use of oral glucocorticoid, rheumatoid arthritis, and other causes of secondary osteoporosis were assessed biannually. During the follow-up period, 86 osteoporotic fractures identified (36 in men and 50 in women). The developed prediction models showed high discriminatory power and had goodness of fit. The developed a Korean specific prediction model for osteoporotic fractures can be easily used as a screening tool to identify individual with high risk of osteoporotic fracture. Further studies for validation are required to confirm the clinical feasibility in general Korean population.

  12. Intrinsic material property differences in bone tissue from patients suffering low-trauma osteoporotic fractures, compared to matched non-fracturing women.

    Science.gov (United States)

    Vennin, S; Desyatova, A; Turner, J A; Watson, P A; Lappe, J M; Recker, R R; Akhter, M P

    2017-04-01

    Osteoporotic (low-trauma) fractures are a significant public health problem. Over 50% of women over 50yrs. of age will suffer an osteoporotic fracture in their remaining lifetimes. While current therapies reduce skeletal fracture risk by maintaining or increasing bone density, additional information is needed that includes the intrinsic material strength properties of bone tissue to help develop better treatments, since measurements of bone density account for no more than ~50% of fracture risk. The hypothesis tested here is that postmenopausal women who have sustained osteoporotic fractures have reduced bone quality, as indicated with measures of intrinsic material properties compared to those who have not fractured. Transiliac biopsies (N=120) were collected from fracturing (N=60, Cases) and non-fracturing postmenopausal women (N=60, age- and BMD-matched Controls) to measure intrinsic material properties using the nano-indentation technique. Each biopsy specimen was embedded in epoxy resin and then ground, polished and used for the nano-indentation testing. After calibration, multiple indentations were made using quasi-static (hardness, modulus) and dynamic (storage and loss moduli) testing protocols. Multiple indentations allowed the median and variance to be computed for each type of measurement for each specimen. Cases were found to have significantly lower median values for cortical hardness and indentation modulus. In addition, cases showed significantly less within-specimen variability in cortical modulus, cortical hardness, cortical storage modulus and trabecular hardness, and more within-specimen variability in trabecular loss modulus. Multivariate modeling indicated the presence of significant independent mechanical effects of cortical loss modulus, along with variability of cortical storage modulus, cortical loss modulus, and trabecular hardness. These results suggest mechanical heterogeneity of bone tissue may contribute to fracture resistance

  13. Role of mesenchymal stem cells in bone regeneration and fracture repair: a review.

    Science.gov (United States)

    Wang, Xin; Wang, Yu; Gou, Wenlong; Lu, Qiang; Peng, Jiang; Lu, Shibi

    2013-12-01

    Mesenchymal stem cells (MSCs) are non-haematopoietic stromal stem cells that have many sources, such as bone marrow, periosteum, vessel walls, adipose, muscle, tendon, peripheral circulation, umbilical cord blood, skin and dental tissues. They are capable of self-replication and of differentiating into, and contributing to the regeneration of, mesenchymal tissues, such as bone, cartilage, ligament, tendon, muscle and adipose tissue. The homing of MSCs may play an important role in the repair of bone fractures. As a composite material, the formation and growth of bone tissue is a complex process, including molecular, cell and biochemical metabolic changes. The recruitment of factors with an adequate number of MSCs and the micro-environment around the fracture are effective for fracture repair. Several studies have investigated the functional expression of various chemokine receptors, trophic factors and adhesion molecules in human MSCs. Many external factors affect MSC homing. MSCs have been used as seed cells in building tissue-engineered bone grafts. Scaffolds seeded with MSCs are most often used in tissue engineering and include biotic and abiotic materials. This knowledge provides a platform for the development of novel therapies for bone regeneration with endogenous MSCs.

  14. Ergotropic effect of bone cement on pedicle screw fixation in treatment of osteoporotic thoracolumbar fracture

    Directory of Open Access Journals (Sweden)

    Da LIU

    2017-02-01

    Full Text Available Objective To evaluate the ergotropic effect of bone cement on pedicle screw fixation in treatment of osteopo¬rotic thoracolumbar fracture. Methods Fifty-three patients with osteoporotic thoracolumbar fracture, admitted from Jun. 2013 to Dec. 2014, were included for treatment by augmentation of pedicle screw fixation with bone cement. All patients underwent pre-operative examination of bone mineral density with T-score ≤-2.5 and augmentation of pedicle screw fixation with injection of 1.5 ml bone cement in adjacent to fractured vertebra. All patients were treated with anti-osteoporosis therapy pre- and post-operation, ob¬served and recorded with basic conditions and complications. At pre-operation, one-week post-operation and last follow-up, pain vi¬sual analogue scale (VAS and neurological function score (ASIA of all patients were recorded, and the compression rats of anterior and posterior edge of fractured vertebra, and compression rats of spinal canal and Cobb angel of all patients were measured. Results All the 53 patients were successfully undergone operation in about 90-140 min with blood loss of about 150-350 ml. No spinal cord or nerve injury, dural tear and obvious leakage of bone cement and screw loosening occurred during operation. All patients were followed up for 12 to 36 months and the neurological function obviously recovered contrasted with pre-operation. X-ray and CT examination at last follow-up showed good fractures healing, good position and non-loosening of internal fixation device and non-leakage of bone cement. At one week post-operation and last follow-up, VAS, compression rats of anterior edge and posterior edge of fractured vertebra, compression rats of spinal canal and Cobb angel were significantly lower than those at pre-operation (P0.05. Conclusions Augmentation of pedicle screw fixation with bone cement can effectively strengthen the initial stability of pedicle screw in osteo¬porosis, restore the

  15. Alzheimer's Disease Increases the Incidence of Hospitalization Due to Fall-related Bone Fracture in Elderly Chinese

    Directory of Open Access Journals (Sweden)

    Fang Li

    2016-12-01

    Conclusion: On the basis of our findings, we conclude that AD may increase the incidence of hospitalization due to falls and bone fracture. We also found that AD has no effect on fracture location, but larger studies are needed to confirm this finding. Physicians and family members should emphasize the possibility of falls and bone fracture in patients with AD. Our findings suggest that preventing falls in AD patients may reduce the number of hospitalized AD patients.

  16. Osteosynthesis of ununited femoral neck fracture by internal fixation combined with iliac crest bone chips and muscle pedicle bone grafting

    Directory of Open Access Journals (Sweden)

    D D Baksi

    2016-01-01

    Full Text Available Background: Ununited femoral neck fracture is seen commonly in developing countries due to delayed presentation or failure of primary internal fixation. Such fractures, commonly present with partial or total absorption of femoral neck, osteonecrosis of femoral head in 8-30% cases with upward migration of trochanter posing problem for osteosynthesis, especially in younger individuals. Several techniques for treatment of such conditions are described like osteotomies or nonvascularied cortical or cancellous bone grafting provided varying degrees of success in terms of fracture union but unsatisfactory long term results occurred due to varying incidence of avascular necrosis (AVN of femoral head. Moreover, in presence of AVN of femoral head neither free fibular graft nor cancellous bone graft is satisfactory. The vascularied bone grafting by deep circumflex iliac artery based on iliac crest bone grafting, free vascularied fibular grafting and muscle pedicle periosteal grafting showed high incidence of success rate. Osteosynthesis is the preferred treatment of choice in ununited femoral neck fracture in younger individuals. Materials and Methods: Of the 293 patients operated during the period from June 1977 to June 2009, 42 were lost to followup. Seven patients with gluteus medius muscle pedicle bone grafting (MPBG were excluded. Thus, out of 244 patients, 208 (85.3% untreated nonunion and 36 (14.7% following failure of primary internal fixation were available for studies. Time interval between the date of injury and operation in untreated nonunion cases was mean 6.5 months and in failed internal fixation cases was mean 11.2 months. Ages of the patients varied from 16 to 55 years. Seventy patients had partial and 174 had subtotal absorption of the femoral neck. Evidence of avascular necrosis (AVN femoral head was found histologically in 135 (54.3% and radiologically in 48 (19.7% patients. The patients were operated by open reduction of fracture

  17. Open Fracture of the Forearm Bones due to Horse Bite

    Directory of Open Access Journals (Sweden)

    John Ashutosh Santoshi

    2014-01-01

    Full Text Available Introduction: Fractures have been described mainly following falling accidents in horse-related injuries. Horse bites are uncommon accidents. We present a case of open fracture of the forearm due to horse bite. Case Report: A 35-year-old male farm-worker presented to the emergency room with alleged history of horse bite to the right forearm about 2 hours prior to presentation while feeding the horse. There was deformity of the forearm with multiple puncture wounds, deep abrasions and small lacerations on the distal-third of the forearm. Copious irrigation with normal saline was done and he was administered anti-tetanus and post-exposure rabies prophylaxis. Prophylactic antibiotic therapy was commenced. Radiographs revealed fracture of radius and ulna in the mid-shaft region. He underwent emergency wound debridement, and the ulna was stabilised with an intra-medullary square nail. Seventy-two hours later, he underwent re-debridement and conversion osteosynthesis. He had an uneventful recovery and at three-month follow-up, the fractures had healed radiographically in anatomic alignment. At two-year follow-up, he is doing well, is pain free and has a normal range of motion compared to the contralateral side. Conclusion: Horse bites behave as compound fractures however rabies prophylaxis will be needed and careful observation is needed. Early radical debridement, preliminary skeletal stabilisation, re-debridement and conversion osteosynthesis to plate, and antibiotic prophylaxis were the key to the successful management of our patient. Keywords: Horse; animal bite; forearm; open fracture

  18. Bone lesions from overload: shin splint and stress fracture

    International Nuclear Information System (INIS)

    Una Gorospe; Jon Andoni; Isla Gallego, Concepcion; Santana Borbones, Aranzazu; Perera Romero, Carmen; Allende Riera, Ana J

    2005-01-01

    There are many stress injuries in the lower extremities due to exercise, and the case we present is an example of two injuries which may present in children or young adults who train excessively. The patient complains of pain and tightness on exercise. The underlying pathology is probably rupture of insertion fibres of the tibial and soleus (Sharpey's fibres) muscles. Probably, there is also periostitis and myositis. Stress fractures and shin splints are often present at the same time in different stages, and both are typical pathologies due to excessive training. Scintigraphy allows identification and early management of shin splints and stress fractures (au)

  19. A 5-year exercise program in pre- and peripubertal children improves bone mass and bone size without affecting fracture risk.

    Science.gov (United States)

    Detter, Fredrik T L; Rosengren, Björn E; Dencker, Magnus; Nilsson, J-Å; Karlsson, Magnus K

    2013-04-01

    We studied the effect in children of an exercise intervention program on fracture rates and skeletal traits. Fractures were registered for 5 years in a population-based prospective controlled exercise intervention study that included children aged 6-9 years at study start, 446 boys and 362 girls in the intervention group and 807 boys and 780 girls in the control group. Intervention subjects received 40 min/school day of physical education and controls, 60 min/week. In 73 boys and 48 girls in the intervention group and 52 boys and 48 girls in the control group, bone mineral density (BMD, g/cm(2)) and bone area (mm(2)) were followed annually by dual-energy X-ray absorptiometry, after which annual changes were calculated. At follow-up we also assessed trabecular and cortical volumetric BMD (g/cm(3)) and bone structure by peripheral computed tomography in the tibia and radius. There were 20.0 fractures/1,000 person-years in the intervention group and 18.5 fractures/1,000 person-years in the control group, resulting in a rate ratio of 1.08 (0.79-1.47) (mean and 95 % CI). The gain in spine BMD was higher in both girls (difference 0.01 g/cm(2), 0.005-0.019) and boys (difference 0.01 g/cm(2), 0.001-0.008) in the intervention group. Intervention girls also had higher gain in femoral neck area (difference 0.04 mm(2), 0.005-0.083) and at follow-up larger tibial bone mineral content (difference 0.18 g, 0.015-0.35), larger tibial cortical area (difference 17 mm(2), 2.4-31.3), and larger radial cross-sectional area (difference 11.0 mm(2), 0.63-21.40). As increased exercise improves bone mass and in girls bone size without affecting fracture risk, society ought to encourage exercise during growth.

  20. Prediction of Incident Major Osteoporotic and Hip Fractures by Trabecular Bone Score (TBS) and Prevalent Radiographic Vertebral Fracture in Older Men.

    Science.gov (United States)

    Schousboe, John T; Vo, Tien; Taylor, Brent C; Cawthon, Peggy M; Schwartz, Ann V; Bauer, Douglas C; Orwoll, Eric S; Lane, Nancy E; Barrett-Connor, Elizabeth; Ensrud, Kristine E

    2016-03-01

    Trabecular bone score (TBS) has been shown to predict major osteoporotic (clinical vertebral, hip, humerus, and wrist) and hip fractures in postmenopausal women and older men, but the association of TBS with these incident fractures in men independent of prevalent radiographic vertebral fracture is unknown. TBS was estimated on anteroposterior (AP) spine dual-energy X-ray absorptiometry (DXA) scans obtained at the baseline visit for 5979 men aged ≥65 years enrolled in the Osteoporotic Fractures in Men (MrOS) Study and its association with incident major osteoporotic and hip fractures estimated with proportional hazards models. Model discrimination was tested with Harrell's C-statistic and with a categorical net reclassification improvement index, using 10-year risk cutpoints of 20% for major osteoporotic and 3% for hip fractures. For each standard deviation decrease in TBS, there were hazard ratios of 1.27 (95% confidence interval [CI] 1.17 to 1.39) for major osteoporotic fracture, and 1.20 (95% CI 1.05 to 1.39) for hip fracture, adjusted for FRAX with bone mineral density (BMD) 10-year fracture risks and prevalent radiographic vertebral fracture. In the same model, those with prevalent radiographic vertebral fracture compared with those without prevalent radiographic vertebral fracture had hazard ratios of 1.92 (95% CI 1.49 to 2.48) for major osteoporotic fracture and 1.86 (95% CI 1.26 to 2.74) for hip fracture. There were improvements of 3.3%, 5.2%, and 6.2%, respectively, of classification of major osteoporotic fracture cases when TBS, prevalent radiographic vertebral fracture status, or both were added to FRAX with BMD and age, with minimal loss of correct classification of non-cases. Neither TBS nor prevalent radiographic vertebral fracture improved discrimination of hip fracture cases or non-cases. In conclusion, TBS and prevalent radiographic vertebral fracture are associated with incident major osteoporotic fractures in older men independent of each other

  1. Deformation and Fracture Mechanisms of Bone and Nacre

    Science.gov (United States)

    Wang, Rizhi; Gupta, Himadri S.

    2011-08-01

    Bone and nacre are the most-known biological hard tissues to materials researchers. Although highly mineralized, both bone and nacre are amazingly tough and exhibit remarkable inelasticity, properties that are still beyond the reach of many modern ceramic materials. Very interestingly, the two hard tissues seem to have adopted totally different structural strategies for achieving mechanical robustness. Starting from a true nanocomposite of the mineralized collagen fibril and following up to seven levels of hierarchical organization, bone is built on a structure with extreme complexity. In contrast, nacre possesses a structure of surprising simplicity. Polygonal mineral tablets of micrometer size are carefully cemented together into a macroscopic wonder. A comparative analysis of the structure-property relations in bone and nacre helps us to unveil the underlying mechanisms of this puzzling phenomenon. In this review, we critically compare the various levels of structures and their mechanical contributions between bone and nacre, with a focus on inelasticity and the toughening process. We demonstrate that, although nacre and bone differ from each other in many aspects, they have adopted very similar deformation and toughening mechanisms.

  2. Effects of local vibration and pulsed electromagnetic field on bone fracture: A comparative study.

    Science.gov (United States)

    Bilgin, Hakkı Murat; Çelik, Ferhat; Gem, Mehmet; Akpolat, Veysi; Yıldız, İsmail; Ekinci, Aysun; Özerdem, Mehmet Siraç; Tunik, Selçuk

    2017-07-01

    The effectiveness of various therapeutic methods on bone fracture has been demonstrated in several studies. In the present study, we tried to evaluate the effect of local low-magnitude, high-frequency vibration (LMHFV) on rat tibia fracture in comparison with pulsed electromagnetic fields (PEMF) during the healing process. Mid-diaphysis tibiae fractures were induced in 30 Sprague-Dawley rats. The rats were assigned into groups such as control (CONT), LMHFV (15 min/day, 7 days/week), and PEMF (3.5 h/day, 7 days/week) for a three-week treatment. Nothing was applied to control group. Radiographs, serum osteocalcin levels, and stereological bone analyses of the three groups were compared. The X-rays of tibiae were taken 21 days after the end of the healing process. PEMF and LMHFV groups had more callus formation when compared to CONT group; however, the difference was not statistically significant (P = 0.375). Serum osteocalcin levels were elevated in the experimental groups compared to CONT (P ≤ 0.001). Stereological tests also showed higher osteogenic results in experimental groups, especially in LMHFV group. The results of the present study suggest that application of direct local LMHFV on fracture has promoted bone formation, showing great potential in improving fracture outcome. Bioelectromagnetics. 38:339-348, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  3. [Combined treatment of long tubular bone fractures and false joints using the bioplastic material collapan (Russia)].

    Science.gov (United States)

    Kesian, G A; Berchenko, G N; Urazgil'deev, R Z; Arsen'ev, I G; Mikelaishvili, D S; Karapetian, G S

    2008-01-01

    This experimental morphological study on 32 dogs was designed to evaluate the efficiency of hydroxyapatite containing preparation collapan used to promote healing of segmented femur defects. Implantation of collapan was shown to greatly contribute to the formation, maturation and remodelling of bone callus. Combined treatment of 165 patients with comminuted fractures and 148 ones with false joints of long tubular bones using collapan implants proved to efficaciously promote bone consolidation in 99.4% of the total 313 subjects. Collapan activated reparative osteogenesis, reduced the duration of hospitalization, the frequency of inflammatory complications, and the requirement of secondary inpatient care.

  4. An unusual case of hypercortisolism with multiple weight-bearing bone fractures.

    Science.gov (United States)

    Papadakis, Georgios; Uebelhart, Brigitte; Goumaz, Michel; Zawadynski, Sophie; Rizzoli, Rene

    2013-09-01

    Glucocorticoid excess, either from exogenous exposure or through endogenous overproduction, is a common cause of secondary osteoporosis. We report a 52-year-old woman presenting with multiple stress fractures of the lower extremities, despite various osteoporosis therapeutic regimens. Investigations led to the diagnosis of hypercortisolism of pituitary origin. Pituitary surgery was unsuccessful, justifying a treatment of ketoconazole. In the absence of densitometric osteoporosis, assessment of bone microstructure using high resolution peripheral quantitative computed tomography revealed alterations of both the cortical and trabecular compartments. This case illustrates that hypercortisolism may cause bone fragility in the absence of marked changes in areal bone mineral density.

  5. Elbow arthrodesis following a pathological fracture in a dog with bilateral humeral bone cysts.

    Science.gov (United States)

    Choate, C J; Arnold, G A

    2011-01-01

    A 10-month-old Yorkshire Terrier was referred for evaluation of an intermittent right thoracic limb lameness that acutely progressed to non-weight-bearing. A diagnosis of bilateral bone cysts of the humeral condyles with a pathologic fracture of the lateral aspect of the right humeral condyle was given following radiographic and histopathologic examination. Bilateral pathology necessitated consideration of treatment modalities other than amputation of the limb, as previously reported. Arthrodesis of the right elbow using a 2.0 mm locking bone plate was performed. The dog did not experience any complications associated with the procedure or the contralateral bone cyst.

  6. Malunion of Long-Bone Fractures in a Conflict Zone in the Democratic Republic of Congo

    NARCIS (Netherlands)

    Bauhahn, G.; Veen, H. in 't; Hoencamp, R.; Olim, N.; Tan, E.C.T.H.

    2017-01-01

    INTRODUCTION: Malunion is a well-recognized complication of long-bone fractures which accounts for more than 25% of injuries in conflict zones. The aim of this study was to investigate the rate of malunion sustained by casualties with penetrating gunshot wounds in an International Committee of the

  7. Surgical treatment of a comminuted articular fracture of the accessory carpal bone in a thoroughbred horse

    International Nuclear Information System (INIS)

    Munroe, G.A.; Cauvin, E.

    1997-01-01

    The clinical, radiographic and ultrasonographic findings in a case ofa comminuted articular fracture of the accessory carpal bone of a thoroughbred chaser are described, and its surgical treatment and aftercare are detailed. The horse made an uneventful recovery and successfully returned to racing

  8. pattern of long bone fractures in a paediatric population at kenyatta ...

    African Journals Online (AJOL)

    Objective: This study aimed to determine the pattern of long bone fractures, common mechanisms of injury, severity and location at time of injury in the paediatric age group. Design: This was a cross-sectional study setting: The study was conducted at the Accident and Emergency department, Paediatric Orthopaedic ward.

  9. Mandibular fracture caused by peri-implant bone loss : Report of a case

    NARCIS (Netherlands)

    Meijer, Henny J. A.; Raghoebar, Gerry M.; Visser, Anita

    Background: A major complication related to excessive bone loss around implants is fracture of the mandible. This complication is most likely to occur in a very atrophic mandible. A 57-year-old woman presented with progressive pain and swelling that had been present for 5 days in the right frontal

  10. Hindfoot arthrodesis for management of bone loss following calcaneus fractures and nonunions.

    Science.gov (United States)

    Molloy, Andy P; Lipscombe, Stephen J

    2011-03-01

    Massive bone loss following calcaneal fractures is a challenging condition to treat, especially if nonunion is present. Meticulous preoperative examination and imaging are crucial for accurate preoperative planning. If performed, successful outcomes can be achieved with the strategies outlined in this article. Copyright © 2011 Elsevier Inc. All rights reserved.

  11. Hedgehog signaling mediates woven bone formation and vascularization during stress fracture healing.

    Science.gov (United States)

    Kazmers, Nikolas H; McKenzie, Jennifer A; Shen, Tony S; Long, Fanxin; Silva, Matthew J

    2015-12-01

    Hedgehog (Hh) signaling is critical in developmental osteogenesis, and recent studies suggest it may also play a role in regulating osteogenic gene expression in the post-natal setting. However, there is a void of studies directly assessing the effect of Hh inhibition on post-natal osteogenesis. This study utilized a cyclic loading-induced ulnar stress fracture model to evaluate the hypothesis that Hh signaling contributes to osteogenesis and angiogenesis during stress fracture healing. Immediately prior to loading, adult rats were given GDC-0449 (Vismodegib - a selective Hh pathway inhibitor; 50mg/kg orally twice daily), or vehicle. Hh signaling was upregulated in response to stress fracture at 3 days (Ptch1, Gli1 expression), and was markedly inhibited by GDC-0449 at 1 day and 3 days in the loaded and non-loaded ulnae. GDC-0449 did not affect Hh ligand expression (Shh, Ihh, Dhh) at 1 day, but decreased Shh expression by 37% at 3 days. GDC-0449 decreased woven bone volume (-37%) and mineral density (-17%) at 7 days. Dynamic histomorphometry revealed that the 7 day callus was composed predominantly of woven bone in both groups. The observed reduction in woven bone occurred concomitantly with decreased expression of Alpl and Ibsp, but was not associated with differences in early cellular proliferation (as determined by callus PCNA staining at 3 days), osteoblastic differentiation (Osx expression at 1 day and 3 days), chondrogenic gene expression (Acan, Sox9, and Col2α1 expression at 1 day and 3 days), or bone resorption metrics (callus TRAP staining at 3 days, Rankl and Opg expression at 1 day and 3 days). To evaluate angiogenesis, vWF immunohistochemistry showed that GDC-0449 reduced fracture callus blood vessel density by 55% at 3 days, which was associated with increased Hif1α gene expression (+30%). Dynamic histomorphometric analysis demonstrated that GDC-0449 also inhibited lamellar bone formation. Lamellar bone analysis of the loaded limb (directly adjacent

  12. Stress analysis of implant-bone fixation at different fracture angle

    Science.gov (United States)

    Izzawati, B.; Daud, R.; Afendi, M.; Majid, MS Abdul; Zain, N. A. M.; Bajuri, Y.

    2017-10-01

    Internal fixation is a mechanism purposed to maintain and protect the reduction of a fracture. Understanding of the fixation stability is necessary to determine parameters influence the mechanical stability and the risk of implant failure. A static structural analysis on a bone fracture fixation was developed to simulate and analyse the biomechanics of a diaphysis shaft fracture with a compression plate and conventional screws. This study aims to determine a critical area of the implant to be fractured based on different implant material and angle of fracture (i.e. 0°, 30° and 45°). Several factors were shown to influence stability to implant after surgical. The stainless steel, (S. S) and Titanium, (Ti) screws experienced the highest stress at 30° fracture angle. The fracture angle had a most significant effect on the conventional screw as compared to the compression plate. The stress was significantly higher in S.S material as compared to Ti material, with concentrated on the 4th screw for all range of fracture angle. It was also noted that the screws closest to the intense concentration stress areas on the compression plate experienced increasing amounts of stress. The highest was observed at the screw thread-head junction.

  13. The challenge of fracture management in osteoporotic bones ...

    African Journals Online (AJOL)

    Patients and methods: Consecutive files of traceable patients who were treated for osteoporotic fractures from January 1998 to December 2007. The demographic data, investigations, management methods and functional outcomes of the treatment were determined. The data collected was analysed using SPSS 17.0 ...

  14. Impaction bone grafting and a cemented cup after acetabular fracture

    NARCIS (Netherlands)

    Bronsema, E.; Stroet, M.A. Te; Zengerink, M.; Kampen, A. van; Schreurs, B.W.

    2014-01-01

    PURPOSE: Patients suffering from post traumatic osteoarthritis of the acetabulum often require a total hip arthroplasty at a relatively young age. Long-term data outcome studies for this population are lacking. We report on the long-term outcome of 20 acetabular fractures in 20 patients treated with

  15. Large bone distractor for open reconstruction of articular fractures of the calcaneus

    Science.gov (United States)

    Twardosz, Wojciech; Tondel, Wieslaw; Olewicz-Gawlik, Anna; Hrycaj, Pawel

    2009-01-01

    The results of operative treatment of two groups of patients with articular fractures of the calcaneus were evaluated. Twenty-three cases were treated surgically using a standard reconstruction procedure. In the second group of 19 patients a large bone distractor was used; it held the soft tissue flap retracted, while aiding in articular and tuberosity fragment reduction and increasing visualisation by distraction of the posterior talocalcaneal joint. After a year, the anatomical and functional results, together with the operative time, were evaluated. All fractures healed with good or very good anatomical results. All cases, except those with complications (n = 3), achieved good (n = 28) or very good (n = 11) functional scoring. The distractor group had significantly shorter operative times, and less manpower was needed during surgery. We conclude that the large bone distractor is a useful tool in open reconstruction of articular calcaneal fractures. PMID:19404639

  16. A simplified application (APP) for the parametric design of screw-plate fixation of bone fractures.

    Science.gov (United States)

    Chung, Chen-Yuan

    2018-01-01

    Screw and plate fixation is commonly used to treat bone fractures. A prototype application (APP) for presurgical simulation was developed and validated by comparing it with current analytical approach and other models. In this APP, alternative plate designs and materials to limit the effects of stress shielding could be tested. In addition, the number and position of screws and the gap between bone and plate that achieved acceptable stability were predicted. The fixation stability providing a situation of interfragmentary strain between 2% and 10% is necessary for callus formation. However, improving the fixation stability leads to a stress shielding effect. The simultaneous alleviation of stress shielding and maintenance of stability are important in fracture healing. In this study, the feasibility of creating a specialized APP to evaluate different screw-plate configurations for diaphyseal femoral fractures was investigated. The ultimate goal is to extend this technique to computer-assisted preoperative planning for orthopedic surgery. Copyright © 2017 Elsevier Ltd. All rights reserved.

  17. Mechanistic aspects of fracture and R-curve behavior in elk antler bone

    Energy Technology Data Exchange (ETDEWEB)

    Launey, Maximilien E.; Chen, Po-Yu; McKittrick, Joanna; Ritchie, Robert O.

    2009-11-23

    Bone is an adaptative material that is designed for different functional requirements; indeed, bones have a variety of properties depending on their role in the body. To understand the mechanical response of bone requires the elucidation of its structure-function relationships. Here, we examine the fracture toughness of compact bone of elk antler which is an extremely fast growing primary bone designed for a totally different function than human (secondary) bone. We find that antler in the transverse (breaking) orientation is one of the toughest biological materials known. Its resistance to fracture is achieved during crack growth (extrinsically) by a combination of gross crack deflection/twisting and crack bridging via uncracked 'ligaments' in the crack wake, both mechanisms activated by microcracking primarily at lamellar boundaries. We present an assessment of the toughening mechanisms acting in antler as compared to human cortical bone, and identify an enhanced role of inelastic deformation in antler which further contributes to its (intrinsic) toughness.

  18. Osteoblast-derived WNT16 represses osteoclastogenesis and prevents cortical bone fragility fractures

    Science.gov (United States)

    Movérare-Skrtic, Sofia; Henning, Petra; Liu, Xianwen; Nagano, Kenichi; Saito, Hiroaki; Börjesson, Anna E; Sjögren, Klara; Windahl, Sara H; Farman, Helen; Kindlund, Bert; Engdahl, Cecilia; Koskela, Antti; Zhang, Fu-Ping; Eriksson, Emma E; Zaman, Farasat; Hammarstedt, Ann; Isaksson, Hanna; Bally, Marta; Kassem, Ali; Lindholm, Catharina; Sandberg, Olof; Aspenberg, Per; Sävendahl, Lars; Feng, Jian Q; Tuckermann, Jan; Tuukkanen, Juha; Poutanen, Matti; Baron, Roland; Lerner, Ulf H; Gori, Francesca; Ohlsson, Claes

    2015-01-01

    The WNT16 locus is a major determinant of cortical bone thickness and nonvertebral fracture risk in humans. The disability, mortality and costs caused by osteoporosis-induced nonvertebral fractures are enormous. We demonstrate here that Wnt16-deficient mice develop spontaneous fractures as a result of low cortical thickness and high cortical porosity. In contrast, trabecular bone volume is not altered in these mice. Mechanistic studies revealed that WNT16 is osteoblast derived and inhibits human and mouse osteoclastogenesis both directly by acting on osteoclast progenitors and indirectly by increasing expression of osteoprotegerin (Opg) in osteoblasts. The signaling pathway activated by WNT16 in osteoclast progenitors is noncanonical, whereas the pathway activated in osteoblasts is both canonical and noncanonical. Conditional Wnt16 inactivation revealed that osteoblast-lineage cells are the principal source of WNT16, and its targeted deletion in osteoblasts increases fracture susceptibility. Thus, osteoblast-derived WNT16 is a previously unreported key regulator of osteoclastogenesis and fracture susceptibility. These findings open new avenues for the specific prevention or treatment of nonvertebral fractures, a substantial unmet medical need. PMID:25306233

  19. Insufficiency Fracture in the Para-Acetabulum, with Features Mimicking Those of a Malignant Bone Tumor

    Science.gov (United States)

    Sakamoto, Akio; Yamamoto, Takuaki; Tanaka, Kazuhiro; Matsuda, Shuichi; Yoshida, Tatsuya; Iwamoto, Yukihide

    2008-01-01

    Para-acetabular insufficiency fractures are rare and exceedingly difficult to diagnose without a high index of suspicion, since the images mimic those of bone tumors. We herein present the case of a 55-year-old woman who suffered from hip pain with subacute onset. She had undergone a hysterectomy-ovariectomy due to endometriosis when she was 41 years old. Her bone mineral density was normal due to supplemental treatment with female hormones. About 3 months after onset, she was referred to our institute with a diagnosis of pelvic bone tumor. Plain radiographs and computed tomography showed irregular osteosclerosis in the para-acetabulum. Bone scintigraphy demonstrated uptake in the para-acetabulum. Magnetic resonance imaging showed abnormal signal with low-signal intensity on T1-weighted images and high-signal intensity on T2-weighted images throughout the entire hemipelvic bone. Since the pain continued for more than 3 months, open biopsy was undertaken and the lesion was found to be non-neoplastic. Six months after onset, the pain disappeared. The clinical course suggested a diagnosis of insufficiency fracture in the para-acetabulum. Para-acetabular insufficiency fractures should always be considered in cases of hip pain, even in patients with prolonged symptoms. PMID:24179350

  20. Analysis of orbital bone fractures: a 12-year study of 391 patients.

    Science.gov (United States)

    Hwang, Kun; You, Sun Hye; Sohn, In Ah

    2009-07-01

    This retrospective study evaluates 391 patients with orbital bone fractures from a variety of accidents that were treated at the department of Plastic and Reconstructive Surgery, Inha University Hospital, Incheon, South Korea, between February 1996 and April 2008. The medical records of these patients were reviewed and analyzed to determine the clinical characteristics and treatment of the orbital bone fractures.The following results were obtained. The mean age of the patients was 31.1 years, and the age range was 4 to 78 years. The most common age group was the third decade of life (32.5%). There was a significant male predominance in all age groups, with a ratio of 4.43:1. The most common etiology was violent (assault) or nonviolent traumatic injury (57.5%) followed by traffic accidents (15.6%) and sports injuries (10.7%).The most common isolated orbital bone fracture site was the orbital floor (26.9%). The largest group of complex fractures included the inferior region of the orbital floor and zygomaticomaxilla (18.9%). Open reduction was performed in 63.2% of the cases, and the most common fracture reconstruction material was MEDPOR (56.4%) followed by a resorbable sheet (41.1%). The postoperative complication rate was 17.9%, and there were no statistically significant differences among the reconstruction materials with regard to complications. During follow-up, diplopia, hypoesthesia, and enophthalmos occurred as complications; however, there was no significant difference between porous polyethylene sheet (MEDPOR) and resorbable sheet groups.Long-term epidemiological data regarding the natural history of orbital bone fractures are important for the evaluation of existing preventative measures and for the development of new methods of injury prevention and treatment.

  1. Fracture of the temporal bone in patients with traumatic brain injury

    Directory of Open Access Journals (Sweden)

    Secchi, Myrian Marajó Dal

    2012-01-01

    Full Text Available Introduction: The fractures in the temporal bone are lesions that are observed in patients with traumatic brain injury (TBI. The computed tomography of high-resolution (CT allows evaluating the fracture and the complications. Objective: Evaluate patients with TBI and temporal bone fracture. Way of study: Retrospective study. Method: Were evaluated 28 patients interned by TBI with clinical evidence and/or radiologic from temporal bone fractures. Results: The age ranged from 3 to 75 years. The most affected side was the right side 50% (n=14, left side 36% (n=10 and both sides 14% (n=4. The etiology of the trauma was the falling 25% (n=7, accidents with motorcycles and bicycles 21% (n=6, physical aggression 14% (n=4, running over 11% (n=3, fall of object 4% (n=1 and other causes 25% (n=7. The clinical signs were: Otorrhagia 78%, otalgia 11% (n=3, otorrhea 7% (n=2, facial paralysis 7% (n=2 and hearing loss 7% (n=2. The otoscopic findings: otorrhagia 57% (n=16, laceration of external auditory canal 36% (n=10, hemotympanum 11% (n=3, normal 7% (n=2 and Battle signal 7% (n=2. The findings for CT of skull were: with no alterations 54% (n=15 and temporal fracture 7% (n=2 and the CT of temporal bones were: line of fracture 71% (n=20, opacification of the mastoid 25% (n=7, glenoid cavity air 14% (n=1, dislocation of the ossicular chain 7% (n=2 and veiling of the middle ear 4% (n=1. Conclusion: Patients with TBI must be submitted to the otorhinolaryngological evaluation and imaging, for the early diagnosis of the complications and treatment.

  2. Microdamage detection and repair in bone: fracture mechanics, histology, cell biology.

    Science.gov (United States)

    Hazenberg, Jan G; Hentunen, Teuvo A; Heino, Terhi J; Kurata, Kosaku; Lee, Thomas C; Taylor, David

    2009-01-01

    Bone is an elementary component in the human skeleton. It protects vital organs, regulates calcium levels and allows mobility. As a result of daily activities, bones are cyclically strained causing microdamage. This damage, in the form of numerous microcracks, can cause bones to fracture and therefore poses a threat to mechanical integrity. Bone is able to repair the microcracks through a process called remodelling which is tightly regulated by bone forming and resorbing cells. However, the manner by which microcracks are detected, and repair initiated, has not been elucidated until now. Here we show that microcrack accumulation causes damage to the network of cellular processes, resulting in the release of RANKL which stimulates the differentiation of cells specialising in repair.

  3. Impact of Maternal Diet on Offspring Bone Fracture Risk During Childhood

    DEFF Research Database (Denmark)

    Petersen, Sesilje Elise Bondo

    Fetal programming is an emerging concept that links environmental conditions during embryonic and fetal development with risk of diseases later in life. A hypothesis for fetal programming of bone health state that peak bone mass may be modified by environmental influences during fetal life......, including maternal diet and vitamin D status. However, few studies have investigated whether these factors during pregnancy impact offspring bone health in short as well as in the long term. The overall objective of this thesis was to investigate epidemiologically whether maternal vitamin D status...... and dietary patterns in two prospective pregnancy cohorts, were associated with offspring risk of bone fractures in childhood. Overall, our studies provided limited support to the hypothesis that fetal bone health is programmed by the maternal vitamin D status and overall diet during pregnancy. However...

  4. Reimplantation of a Large Extruded Segment of Bone in an Open Fracture.

    Science.gov (United States)

    Afshar, Ahmadreza

    2017-02-01

    Replacing an extruded segment of bone in an open fracture imposes a challenging decision concerning the best and safest patient management. There are numerous advantages to restoring the patient's own extruded bone segment to its original location, particularly when the bone segment is of structural importance. However, reimplantation of contaminated and avascular extruded bone segments can potentially result in serious infection or nonunion. There is no conclusive evidence regarding the best decontamination protocol for the safest use of the recovered bone segment as an autologous graft. Among the different chemical sterilization solutions 10% povidone-iodine and chlorhexidine gluconate solutions are the author's most preferred solutions. Regarding cellular toxicity, 10% povidone-iodine has been found to be the most favorable among the readily available solutions. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  5. Usefulness of the Trabecular Bone Score for assessing the risk of osteoporotic fracture.

    Science.gov (United States)

    Redondo, L; Puigoriol, E; Rodríguez, J R; Peris, P; Kanterewicz, E

    2018-04-01

    The trabecular bone score (TBS) is an imaging technique that assesses the condition of the trabecular microarchitecture. Preliminary results suggest that TBS, along with the bone mineral density assessment, could improve the calculation of the osteoporotic fracture risk. The aim of this study was to analyse TBS values and their relationship with the clinical characteristics, bone mineral density and history of fractures of a cohort of posmenopausal women. We analysed 2,257 posmenopausal women from the FRODOS cohort, which was created to determine the risk factors for osteoporotic fracture through a clinical survey and bone densitometry with vertebral morphometry. TBS was applied to the densitometry images. TBS values ≤1230 were considered indicative of degraded microarchitecture. We performed a simple and multiple linear regression to determine the factors associated with this index. The mean TBS value in L1-L4 was 1.203±0.121. Some 55.3% of the women showed values indicating degraded microarchitecture. In the multiple linear regression analysis, the factors associated with low TBS values were age, weight, height, spinal T-score, glucocorticoid treatment, presence of type 2 diabetes and a history of fractures due to frailty. TBS showed microarchitecture degradation values in the participants of the FRODOS cohort and was associated with anthropometric factors, low bone mineral density values, the presence of fractures, a history of type 2 diabetes mellitus and the use of glucocorticoids. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  6. Bilateral Facial Paralysis Caused by Bilateral Temporal Bone Fracture: A Case Report and a Literature Review

    Directory of Open Access Journals (Sweden)

    Sultan Şevik Eliçora

    2015-01-01

    Full Text Available Bilateral facial paralysis caused by bilateral temporal bone fracture is a rare clinical entity, with seven cases reported in the literature to date. In this paper, we describe a 40-year-old male patient with bilateral facial paralysis and hearing loss that developed after an occupational accident. On physical examination, House-Brackmann (HB facial paralysis of grade 6 was observed on the right side and HB grade 5 paralysis on the left. Upon temporal bone computed tomography (CT examination, a fracture line exhibiting transverse progression was observed in both petrous temporal bones. Our patient underwent transmastoid facial decompression surgery of the right ear. The patient refused a left-side operation. Such patients require extensive monitoring in intensive care units because the presence of multiple injuries means that facial functions are often very difficult to evaluate. Therefore, delays may ensue in both diagnosis and treatment of bilateral facial paralysis.

  7. Management of Lower Extremity Long-bone Fractures in Spinal Cord Injury Patients.

    Science.gov (United States)

    Schulte, Leah M; Scully, Ryan D; Kappa, Jason E

    2017-09-01

    The AO classification system, used as a guide for modern fracture care and fixation, follows a basic philosophy of care that emphasizes early mobility and return to function. Lower extremity long-bone fractures in patients with spinal cord injury often are pathologic injuries that present unique challenges, to which the AO principles may not be entirely applicable. Optimal treatment achieves healing without affecting the functional level of the patient. These injuries often result from low-energy mechanisms in nonambulatory patients with osteopenic bone and a thin, insensate soft-tissue envelope. The complication rate can be high, and the outcomes can be catastrophic without proper care. Satisfactory results can be obtained through various methods of immobilization. Less frequently, internal fixation is applied. In certain cases, after discussion with the patient, amputation may be suitable. Prevention strategies aim to minimize bone loss and muscle atrophy.

  8. Femoral head viability following hip fracture. Prognostic role of radionuclide bone imaging

    International Nuclear Information System (INIS)

    Drane, W.E.; Rudd, T.G.

    1985-01-01

    A retrospective study was made of all radionuclide (RN) bone images performed at our institution over a two-year period to evaluate femoral head viability after nonpathologic fracture of the femoral neck. Twelve patients had avascular femoral heads during the perioperative period, of which nine had adequate follow-up. Seven of these nine patients had follow-up bone images. Revascularization occurred in four patients, while three had persistent absence of femoral head uptake. With clinical follow-up ranging from four to 29 months (median: 14 months), only two of these nine patients developed clinical or radiographic evidence of osteonecrosis. RN bone imaging performed in the perioperative period does not reliably predict the development of post-traumatic osteonecrosis of the femoral head and, at present, should not be used to determine prospectively method of treatment of femoral neck fracture

  9. Femoral head viability following hip fracture. Prognostic role of radionuclide bone imaging

    Energy Technology Data Exchange (ETDEWEB)

    Drane, W.E.; Rudd, T.G.

    1985-03-01

    A retrospective study was made of all radionuclide (RN) bone images performed at our institution over a two-year period to evaluate femoral head viability after nonpathologic fracture of the femoral neck. Twelve patients had avascular femoral heads during the perioperative period, of which nine had adequate follow-up. Seven of these nine patients had follow-up bone images. Revascularization occurred in four patients, while three had persistent absence of femoral head uptake. With clinical follow-up ranging from four to 29 months (median: 14 months), only two of these nine patients developed clinical or radiographic evidence of osteonecrosis. RN bone imaging performed in the perioperative period does not reliably predict the development of post-traumatic osteonecrosis of the femoral head and, at present, should not be used to determine prospectively method of treatment of femoral neck fracture.

  10. The Usefulness of the Endonasal Incisional Approach for the Treatment of Nasal Bone Fracture

    Directory of Open Access Journals (Sweden)

    Hyo Seong Kim

    2012-05-01

    Full Text Available BackgroundAmong all facial fractures, nasal bone fractures are the most common, and they have been reduced by closed reduction (CR for a long time. But several authors have reported suboptimal results when using CR, and the best method of nasal bone reduction is still being debated. We have found that indirect open reduction (IOR through an endonasal incisional approach is a useful method for more accurate reduction of the nasal bone.MethodsA retrospective chart review was performed of 356 patients who underwent reduction of a nasal bone fracture in our department from January, 2006, to July, 2011. We treated 263 patients with IOR. We assessed patients' and doctors' satisfaction with surgical outcomes after IOR or CR. We evaluated the frequency of nasal bleeding owing to mucosal injury, and followed the surgical outcomes of patients who had simultaneous dorsal augmentation rhinoplasty.ResultsAccording to the analysis of the satisfaction scores, both patients and doctors were significantly more satisfied in the IOR group than the CR group (P<0.05. Mucosal injury with nasal bleeding occurred much less in the IOR group (5.3% than the CR group (12.9%. Dorsal augmentation rhinoplasty with IOR was performed simultaneously in 34 cases. Most of them (31/34 showed satisfaction with the outcomes.ConclusionsIOR enables surgeons to manipulate the bony fragment directly through the endonasal incisional approach. However, we propose that CR is the proper technique for patients under 16 and for those with comminuted nasal bone fractures because submucosal dissection in IOR can damage the growth or circulation of nasal bone.

  11. Complications of Elastic Stable Intramedullary Nailing for treating paediatric long bone fractures

    Science.gov (United States)

    Nisar, Aamer; Bhosale, Abhijit; Madan, Sanjeev S.; Flowers, Mark J.; Fernandes, James A.; Jones, Stanley

    2013-01-01

    This study reports the complications observed in children with long bone fractures treated using Elastic Stable Intramedullary Nailing (ESIN). One hundred and sixty-four (n = 164) fractures in 160 patients under the age of 16 years formed the basis of our review. This included 108 boys and 52 girls with the median age of 11 years and median follow up of 7.5 months. The analysis included fractures of the radius/ulna, humerus, femur and tibia. All pathological fractures were excluded. In this series 54 patients (34%) had complications however majority of these were minor complications with irritation due to prominent nail ends being the commonest complication. No long-term sequelae were encountered in our patients. PMID:24403743

  12. The influence of orientation and practical size on the interface fracture of a bone-nano composite cement

    International Nuclear Information System (INIS)

    Ilik, Igor; Khandaker, Morshed

    2010-01-01

    Clinical follow-up studies in cemented total hip arthroplasties found that femoral prosthesis loosening is caused by the fracture of the bone-cement interfaces. The research objectives were to determine whether orientation of the bone has any influence on the interface fracture strength, and to determine whether inclusion of micro/nano sizes MgO particles on Cobalt HV bone cement has any influence on the interface fracture strength. Flexural tests were conducted on five groups of specimens to find Young Modulus and bending strength: (1) longitudinal bone, (2) transverse bone, (3) pure cement particles, (4) cement with 36 im and 27 nm MgO particles, and (5) cement with 27nm MgO particles. Also, fracture tests were conducted on six groups of bone-cement specimen to find interface fracture toughness: (1) longitudinal bone-cement without MgO particles, (2) transverse bone-cement without MgO particles, (3) longitudinal bone-cement with 36 im MgO particles, (4) transverse bone-cement with 36 im MgO particles, (5) , longitudinal bone-cement with 27 nm MgO particles, and (6) transverse bone-cement with 27 nm MgO particles. Transverse bone specimen was 14% stiffer than longitudinal specimen, while bending strength and fracture toughness of longitudinal specimen was 29% and 2.6 times lower than the transverse specimen, respectively. Reduction of Young's modulus (7.3%), bending strength (27%) and fracture toughness (16%) was observed by the inclusion of microsize MgO particles, and a reduction of the Young's Modulus (19%), bending strength (21%),and fracture toughness (19%) for nanosize MgO particles. The interface toughness of the transverse bone infused with 27nm MgO was about 6 times higher than transverse bone infused with 36 im particles of MgO. Preliminary studies show that orientation of the bone has significant influence on the interface fracture. MgO particles size have a significant effect on the strength of the bone - cement interface.(Author)

  13. The frequency of bone fractures among patients with chronic kidney disease not on dialysis: two-year follow-up.

    Science.gov (United States)

    Figurek, Andreja; Vlatkovic, Vlastimir; Vojvodic, Dragan; Gasic, Branislav; Grujicic, Milorad

    2017-12-01

    Renal osteodystrophy is a severe complication of chronic kidney disease (CKD) that increases morbidity and mortality in these patients. Mineral and bone disorder starts early in CKD and affects the incidence of bone fractures. The aim of this study was to observe the frequency of diverse bone fractures in patients with CKD not on dialysis. This cohort study included 68 patients that were followed during the two-year period. The patients were divided into two cohorts: one that developed bone fractures and the other that did not. There were 35 (51.5%) men and 33 (48.5%) women. The mean age of patients ranged 62.88±11.60 years. During follow-up serum values of chronic kidney disease - mineral and bone indicators were measured. The methods of descriptive and analytical statistics were used in order to analyze obtained data. During this two-year follow-up seven patients developed bone fractures. Among them, females dominated (6 patients) compared to males (only 1 patient). The most common were fractures of forearm. The mean level of parathyroid hormone (PTH) at the beginning of the monitoring was higher in the group of patients with bone fractures (165.25 ± 47.69 pg/mL) in regard to another group (103.96 ± 81.55 pg/mL). After two-year follow-up, this difference became statistically significant at the level p fractures had higher FRAX (Fracture Risk Assessment) score compared to another group. In our study, about 10% of patients had bone fractures in the two-year follow-up period. Patients who developed fractures had a higher PTH level and FRAX score.

  14. Novel intramedullary-fixation technique for long bone fragility fractures using bioresorbable materials.

    Directory of Open Access Journals (Sweden)

    Takanobu Nishizuka

    Full Text Available Almost all of the currently available fracture fixation devices for metaphyseal fragility fractures are made of hard metals, which carry a high risk of implant-related complications such as implant cutout in severely osteoporotic patients. We developed a novel fracture fixation technique (intramedullary-fixation with biodegradable materials; IM-BM for severely weakened long bones using three different non-metallic biomaterials, a poly(l-lactide (PLLA woven tube, a nonwoven polyhydroxyalkanoates (PHA fiber mat, and an injectable calcium phosphate cement (CPC. The purpose of this work was to evaluate the feasibility of IM-BM with mechanical testing as well as with an animal experiment. To perform mechanical testing, we fixed two longitudinal acrylic pipes with four different methods, and used them for a three-point bending test (N = 5. The three-point bending test revealed that the average fracture energy for the IM-BM group (PLLA + CPC + PHA was 3 times greater than that of PLLA + CPC group, and 60 to 200 times greater than that of CPC + PHA group and CPC group. Using an osteoporotic rabbit distal femur incomplete fracture model, sixteen rabbits were randomly allocated into four experimental groups (IM-BM group, PLLA + CPC group, CPC group, Kirschner wire (K-wire group. No rabbit in the IM-BM group suffered fracture displacement even under full weight bearing. In contrast, two rabbits in the PLLA + CPC group, three rabbits in the CPC group, and three rabbits in the K-wire group suffered fracture displacement within the first postoperative week. The present work demonstrated that IM-BM was strong enough to reinforce and stabilize incomplete fractures with both mechanical testing and an animal experiment even in the distal thigh, where bone is exposed to the highest bending and torsional stresses in the body. IM-BM can be one treatment option for those with severe osteoporosis.

  15. The management of unstable oblique infected mandibular fractures with a 2.3 mm mandibular osteosynthesis reconstruction bone plate.

    Science.gov (United States)

    Ghanem, Walid A; Elhayes, Khaled A; Saad, Khalid

    2011-12-01

    This study is aimed to evaluate the efficacy of 2.3mm reconstruction bone plates in the treatment of unstable infected mandibular fractures. The study included 32 patients with unstable oblique infected mandibular fractures (23 males and 9 females), with a mean age of 33 years. The patients were divided into two groups. Group 1 were treated with an osteosynthesis plate (with at least 3 screws on each side of fracture sites) applied to the mandibular fracture site, while in group 2 the bone plate was applied (2 screws on each side of fracture sites) with maxillomandibular fixation (MMF). Clinical and radiographic examinations were carefully assessed preoperatively and postoperatively at follow-up intervals of 1, 2, 6, 12 months. Postoperative complications in terms of dysocclusion, wound dehiscence and neurosensory disturbances were examined. Postoperative clinical and radiographic results showed that group 1 had quicker bone generation and more precise anatomical alignment of fracture sites than with those in group 2. All patients showed no evidence of infection, plate fracture or exposure, malunion, osteomyelitis, neurosensory disturbances, or dental injury. The 2.3mm reconstruction bone plates provide excellent stability and healing of the unstable infected mandibular fractures provided that the fracture site is fixed by at least 3 screws on each side of the fracture sites. Copyright © 2010 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  16. Osteoimmune Mechanisms of Segmental Bone Fracture Healing and Therapy

    Science.gov (United States)

    2016-09-01

    abrogating conventional routes of intracellular protein degradation can enhance the BMP precursor protein level...repair cascade. Growth factors such as vascular endothelial growth factor (VEGF), bone morphogenetic proteins (BMP), transforming growth factor (TGF...summarized in Table 1. The alterations are classified as persistent (observed at all-time points), local vs. systemic (occurring only in segmental defect

  17. Maternal vitamin D status and offspring bone fractures

    DEFF Research Database (Denmark)

    Petersen, Sesilje Bondo; Olsen, Sjurdur Frodi; Mølgaard, Christian

    2014-01-01

    offspring bone mass and related that to maternal vitamin D status. METHODS: The Danish Fetal Origins 1988 Cohort recruited 965 pregnant women during 1988-89 at their 30th gestation week antenatal midwife visit. A blood sample was drawn and serum was stored, which later was analyzed for the concentration...

  18. Bone mineral density and bone markers in patients with a recent low-energy fracture: effect of 1 y of treatment with calcium and vitamin D

    DEFF Research Database (Denmark)

    Hitz, Mette F; Jensen, Jens-Erik B; Eskildsen, Peter C

    2007-01-01

    BACKGROUND: Low-energy fractures of the hip, forearm, shoulder, and spine are known consequences of osteoporosis. OBJECTIVE: We evaluated the effect of 1 y of treatment with calcium and vitamin D on bone mineral density (BMD) and bone markers in patients with a recent low-energy fracture. DESIGN...... significantly related to physical performance. CONCLUSIONS: A 1-y intervention with calcium and vitamin D reduced bone turnover, significantly increased BMD in patients younger than 70 y, and decreased bone loss in older patients. The effect of treatment was related to physical performance.......: In a double-blinded design, patients with fracture of the hip (lower-extremity fracture, or LEF) or upper extremity (UEF) were randomly assigned to receive 3000 mg calcium carbonate + 1400 IU cholecalciferol or placebo (200 IU cholecalciferol). BMD of the hip (HBMD) and lumbar spine (LBMD) were evaluated...

  19. Bone mineral density and bone markers in patients with a recent low-energy fracture: effect of 1 y of treatment with calcium and vitamin D

    DEFF Research Database (Denmark)

    Hitz, Mette F; Jensen, Jens-Erik B; Eskildsen, Peter C

    2007-01-01

    : In a double-blinded design, patients with fracture of the hip (lower-extremity fracture, or LEF) or upper extremity (UEF) were randomly assigned to receive 3000 mg calcium carbonate + 1400 IU cholecalciferol or placebo (200 IU cholecalciferol). BMD of the hip (HBMD) and lumbar spine (LBMD) were evaluated......BACKGROUND: Low-energy fractures of the hip, forearm, shoulder, and spine are known consequences of osteoporosis. OBJECTIVE: We evaluated the effect of 1 y of treatment with calcium and vitamin D on bone mineral density (BMD) and bone markers in patients with a recent low-energy fracture. DESIGN...... significantly related to physical performance. CONCLUSIONS: A 1-y intervention with calcium and vitamin D reduced bone turnover, significantly increased BMD in patients younger than 70 y, and decreased bone loss in older patients. The effect of treatment was related to physical performance....

  20. Surgical repair of mid-body proximal sesamoid bone fractures in 25 horses.

    Science.gov (United States)

    Busschers, Evita; Richardson, Dean W; Hogan, Patricia M; Leitch, Midge

    2008-12-01

    To describe the characteristics of unilateral mid-body proximal sesamoid bone (PSB) fractures, to determine factors associated with the outcome of horses after surgical repair, and to describe a technique for arthroscopically assisted screw fixation in lag fashion. Retrospective case series. Horses (n=25) with unilateral mid-body PSB fracture. Medical records (1996-2006), radiographs, and arthroscopic videos of horses with surgically repaired unilateral mid-body PSB fractures were reviewed. Retrieved data included signalment, affected limb and PSB, fracture characteristics, and surgical technique. Outcome was established by radiographic assessment of healing and race records; categorical data were analyzed using Fisher's Exact test. Medial forelimb PSBs were most commonly affected (80%). Surgical technique and degree of reduction were significantly associated with outcome; 44% of horses with screw repair and none of the horses with wire fixation raced (P=.047). Factors that may have influenced this outcome were differences in fracture reduction (improved reduction in 22% wire repairs and 88% screw repairs, P=.002) and use of external coaptation (22% wire repair and 88% lag screw repair, P=.002). None of the horses with unimproved reduction raced after surgery. Only 28% of horses with mid-body PSB fractures raced after surgery. Compared with wire fixation, screw fixation in lag fashion resulted in good reduction and is seemingly a superior repair technique. For mid-body PSB fractures, arthroscopically assisted screw fixation in lag fashion and external coaptation for anesthesia recovery and initial support provides the best likelihood of return to athletic use.

  1. Lower trabecular volumetric BMD at metaphyseal regions of weight-bearing bones is associated with prior fracture in young girls.

    Science.gov (United States)

    Farr, Joshua N; Tomás, Rita; Chen, Zhao; Lisse, Jeffrey R; Lohman, Timothy G; Going, Scott B

    2011-02-01

    Understanding the etiology of skeletal fragility during growth is critical for the development of treatments and prevention strategies aimed at reducing the burden of childhood fractures. Thus we evaluated the relationship between prior fracture and bone parameters in young girls. Data from 465 girls aged 8 to 13 years from the Jump-In: Building Better Bones study were analyzed. Bone parameters were assessed at metaphyseal and diaphyseal sites of the nondominant femur and tibia using peripheral quantitative computed tomography (pQCT). Dual-energy X-ray absorptiometry (DXA) was used to assess femur, tibia, lumbar spine, and total body less head bone mineral content. Binary logistic regression was used to evaluate the relationship between prior fracture and bone parameters, controlling for maturity, body mass, leg length, ethnicity, and physical activity. Associations between prior fracture and all DXA and pQCT bone parameters at diaphyseal sites were nonsignificant. In contrast, lower trabecular volumetric BMD (vBMD) at distal metaphyseal sites of the femur and tibia was significantly associated with prior fracture. After adjustment for covariates, every SD decrease in trabecular vBMD at metaphyseal sites of the distal femur and tibia was associated with 1.4 (1.1-1.9) and 1.3 (1.0-1.7) times higher fracture prevalence, respectively. Prior fracture was not associated with metaphyseal bone size (ie, periosteal circumference). In conclusion, fractures in girls are associated with lower trabecular vBMD, but not bone size, at metaphyseal sites of the femur and tibia. Lower trabecular vBMD at metaphyseal sites of long bones may be an early marker of skeletal fragility in girls. Copyright © 2011 American Society for Bone and Mineral Research.

  2. Accurate in vitro identification of fracture onset in bones: failure mechanism of the proximal human femur.

    Science.gov (United States)

    Juszczyk, Mateusz Maria; Cristofolini, Luca; Salvà, Marco; Zani, Lorenzo; Schileo, Enrico; Viceconti, Marco

    2013-01-04

    Bone fractures have extensively been investigated, especially for the proximal femur. While failure load can easily be recorded, and the fracture surface is readily accessible, identification of the point of fracture initiation is difficult. Accurate location of fracture initiation is extremely important to understand the multi-scale determinants of bone fracture. In this study, a recently developed technique based on electro-conductive lines was applied to the proximal femoral metaphysis to elucidate the fracture mechanism. Eight cadaveric femurs were prepared with 15-20 electro-conductive lines (crack-grid) covering the proximal region. The crack-grid was connected to a dedicated data-logger that monitored electrical continuity of each line at 700 kHz. High-speed videos (12,000 frames/s, 0.1-0.2 mm pixel size) of the destructive tests were acquired. Most crack-grid-lines failed in a time-span of 0.08-0.50 ms, which was comparable to that identified in the high-speed videos, and consistent with previous video recordings. However, on all specimens 1-3 crack-grid-lines failed significantly earlier (2-200 ms) than the majority of the crack-grid-lines. The first crack-grid-line to fail was always the closest one to the point of fracture initiation identified in the high-speed videos (superior-lateral neck region). Then the crack propagated simultaneously, at comparable velocity on the anterior and posterior sides of the neck. Such a failure pattern has never been observed before, as spatial resolution of the high-speed videos prevented from observing the initial opening of a crack. This mechanism (fracture onset, time-lag, followed by catastrophic failure) can be explained with a transfer of load to the internal trabecular structure caused by the initial fracture of the thin cortical shell. This study proves the suitability of the crack-grid method to investigate bone fractures associated to tensile stress. The crack-grid method enables significantly faster sampling

  3. Conventional bone plate fixation of distal radius and ulna fractures in toy breed dogs.

    Science.gov (United States)

    Ramírez, J M; Macías, C

    2016-03-01

    To describe the outcome of bone plate fixation of distal radius and ulna fractures in toy breed dogs treated with conventional bone plates. Records of 15 toy breed dogs with distal radius and ulna fractures were retrospectively reviewed for signalment, method of fixation, complications and clinical and radiographic assessments. A telephone-based owner questionnaire was conducted to determine long-term function and client satisfaction. Age ranged from 4 months to 6 years. Body weight ranged from 1 to 4 kg. Dynamic compression plates were used in 13 dogs and veterinary cuttable plates were used in 2 dogs as the means of fixation. Full radiographic and clinical follow-up data were available for 10 dogs and follow-up was performed between 6 and 8 weeks postoperatively. At that time, all fractures had healed and return to function was considered excellent in all 10 dogs. Five dogs did not return for hospital evaluation because they were judged by their owners to be free of lameness. In two cases, owners could not be contacted by telephone, but the referring veterinarians reported the dogs to be asymptomatic. No major complications occurred. Conventional bone plates are suitable choices for stabilisation of distal radius and ulna fractures in toy breed dogs and are not necessarily correlated with high rates of complication. © 2016 Australian Veterinary Association.

  4. Cognitive plasticity as a moderator of functional dependency in elderly patients hospitalized for bone fractures.

    Science.gov (United States)

    Calero-García, M J; Calero, M D; Navarro, E; Ortega, A R

    2015-01-01

    Bone fractures in older adults involve hospitalization and surgical intervention, aspects that have been related to loss of autonomy and independence. Several variables have been studied as moderators of how these patients recover. However, the implications of cognitive plasticity for functional recovery have not been studied to date. The present study analyzes the relationship between cognitive plasticity--defined as the capacity for learning or improved performance under conditions of training or performance optimization--and functional recovery in older adults hospitalized following a bone fracture. The study comprised 165 older adults who underwent surgery for bone fractures at a hospital in southern Spain. Participants were evaluated at different time points thereafter, with instruments that measure activities of daily life (ADL), namely the Barthel Index (BI) and the Lawton Index, as well as with a learning potential (cognitive plasticity) assessment test (Auditory Verbal Learning Test of Learning Potential, AVLT-LP). Results show that most of the participants have improved their level of independence 3 months after the intervention. However, some patients continue to have medium to high levels of dependency and this dependency is related to cognitive plasticity. The results of this study reveal the importance of the cognitive plasticity variable for evaluating older adults hospitalized for a fracture. They indicate a possible benefit to be obtained by implementing programs that reduce the degree of long-term dependency or decrease the likelihood of it arising.

  5. Comparative Study Between Coaptive Film Versus Suture For Wound Closure After Long Bone Fracture Fixation

    Directory of Open Access Journals (Sweden)

    IM Anuar Ramdhan

    2013-03-01

    Full Text Available INTRODUCTION: Coaptive film (i.e., Steri-StripsTM is an adhesive tape used to replace sutures in wound closure. The use of coaptive film for wound closure after long bone fracture fixation has not been well documented in the literature. METHODS: The aim of this prospective, randomized controlled trial comparing coaptive film with sutures for wound closure after long bone fracture fixation was skin closure time, incidence of wound complications and scar width at 12 week follow-up. Forty-five patients underwent femur fracture fixation (22 patients’ wound closed with sutures, 23 with coaptive film. RESULTS: The mean time for skin closure using coaptive film was 171.13 seconds compared to 437.27 seconds using suture. The mean wound lengths in the coaptive film group and suture group were 187.65 mm and 196.73 mm, respectively. One patient in each group had wound complications. CONCLUSION: Coaptive film is a time-saving procedure for skin closure following long bone fracture fixation. There is no difference in the incidence of wound complications and scar width between these two methods of skin closure.

  6. Histomorphometric study of trabecular bone remodeling during condylar process fracture healing in the growing period: experimental study.

    Science.gov (United States)

    Yasuoka, T; Oka, N

    1991-09-01

    Trabecular bone remodeling during condylar fracture healing in the growing period was analyzed by histomorphometry with a synchronous system. Data from the study showed displacement of the fractured condyle was compensated by the changes in remodeling ascribed to the pubertal spurt of growth, and that such remodeling still continued even after clinical healing. The regional acceleratory phenomenon, evolved to potentiate tissue healing, was observed 1 week after induction of the fracture. Mesenchymal cells were presumably modulated into chondroblasts that promoted endochondral ossification. It was concluded that trabecular bone remodeling plays an important role in healing of condylar fractures during the growth period.

  7. Fracture generation in human vertebrae under compression loading: The influence of pedicle preservation and bone mineral density on in vitro fracture behavior.

    Science.gov (United States)

    Kraxenberger, Michael; Schröder, Christian; Geith, Tobias; Büttner, Andreas; von Schulze-Pellengahr, Christoph; Birkenmaier, Christof; Müller, Peter E; Jansson, Volkmar; Wegener, Bernd

    2018-01-01

    Fractured vertebral bodies are a common and wide spread health issue. The purpose of this study was to develop a standardized method to experimentally generate compression fractures in vertebral bodies. The influence of the pedicles has been investigated with regards to the fracture behavior. The correlation between bone mineral density (BMD), the cause of fractures and the fracture behavior was investigated. Twenty-one fresh frozen human lumbar spines were examined for bone mineral density (BMD) by means of quantitative computed tomography (qCT). All soft tissue was removed, vertebrae were carefully separated from each other and the exposed cranial and caudal endplates were covered with a thin layer of resin to generate a plane and homogeneous surface. A total of 80 vertebral bodies were tested until fracture. A good positive correlation was found between BMD, fracture compression force and stiffness of the vertebral body. No significant differences were found between the fractures generated in vertebral bodies with and without pedicles, respectively. Our model represents a consolidation of already existing testing devices. The comparative measurement of the BMD and the fracture behavior shows validity. In contrast to other authors, the force was applied to the whole vertebral body. Furthermore the upper and lower plates were not parallelized and therefore the natural anatomic shape was imitated. Fracture behavior was not altered by removing the pedicles.

  8. Applying Full Spectrum Analysis to a Raman Spectroscopic Assessment of Fracture Toughness of Human Cortical Bone.

    Science.gov (United States)

    Makowski, Alexander J; Granke, Mathilde; Ayala, Oscar D; Uppuganti, Sasidhar; Mahadevan-Jansen, Anita; Nyman, Jeffry S

    2017-10-01

    A decline in the inherent quality of bone tissue is a † Equal contributors contributor to the age-related increase in fracture risk. Although this is well-known, the important biochemical factors of bone quality have yet to be identified using Raman spectroscopy (RS), a nondestructive, inelastic light-scattering technique. To identify potential RS predictors of fracture risk, we applied principal component analysis (PCA) to 558 Raman spectra (370-1720 cm -1 ) of human cortical bone acquired from 62 female and male donors (nine spectra each) spanning adulthood (age range = 21-101 years). Spectra were analyzed prior to R-curve, nonlinear fracture mechanics that delineate crack initiation (K init ) from crack growth toughness (K grow ). The traditional ν 1 phosphate peak per amide I peak (mineral-to-matrix ratio) weakly correlated with K init (r = 0.341, p = 0.0067) and overall crack growth toughness (J-int: r = 0.331, p = 0.0086). Sub-peak ratios of the amide I band that are related to the secondary structure of type 1 collagen did not correlate with the fracture toughness properties. In the full spectrum analysis, one principal component (PC5) correlated with all of the mechanical properties (K init : r = - 0.467, K grow : r = - 0.375, and J-int: r = - 0.428; p toughness, namely age and/or volumetric bone mineral density (vBMD), were included in general linear models as covariates, several PCs helped explain 45.0% (PC5) to 48.5% (PC7), 31.4% (PC6), and 25.8% (PC7) of the variance in K init , K grow , and J-int, respectively. Deriving spectral features from full spectrum analysis may improve the ability of RS, a clinically viable technology, to assess fracture risk.

  9. Effect of Gukang capsule-assisted surgical treatment on fracture healing, microcirculation and bone metabolism in elder patients with fracture of distal radius

    Directory of Open Access Journals (Sweden)

    Jian-Nian Wang

    2016-10-01

    Full Text Available Objective: To analyze the effect of Gukang capsule-assisted surgical treatment on fracture healing, microcirculation and bone metabolism in elder patients with fracture of distal radius. Methods: A total of 200 elderly patients with fracture of distal radius treated from September 2010 to September 2015 were randomly divided into observation group and control group (n=100. Control group received routine surgical treatment, and observation group underwent Gukang capsule-assisted surgical treatment. Fracture healing was compared between two groups, serum microcirculation and bone metabolism indexes were detected 1 week after operation, X-ray examination was performed 6 months after operation and imaging parameters were measured. Results: Regression time of postoperative affected-side limb swelling and radiographic healing time of broken ends of fractured bone of observation group were significantly shorter than those of control group; 1 week after operation, serum TXB2, CTX-I, CTX-II, RANK, RANKL and TRACP5b levels as well as TXB-2/6-Keto-PGF1α ratio of observation group were significantly lower than those of control group, and 6-Keto-PGF1α, ALP, OPG, PICP, BGP and 1,25(OH2D3 levels were significantly higher than those of control group. Conclusions: Gukang capsule-assisted surgery helps promote the fracture healing in elderly patients with fracture of distal radius and can improve microcirculation and bone metabolism.

  10. Statistical analysis of the behavior of fracture toughness of compound bioceramic artificial bone.

    Science.gov (United States)

    Xu, Shilian; Xu, Renping; Li, Ruoqi

    2011-12-01

    We show the manufacturing procedure of the test specimen of the compound bioceramic artificial bone, conduct experiments to measure its fracture toughness, and conclude that the experiment data conform to the two-parameter Weibull distribution with scale parameter β = 0.527369 and form parameter α = 5.24317. Furthermore, compound bioceramic artificial bone is of a high level of crack sensitivity and its data for the fracture toughness is has a high dispersion. We also analyze the evolution of the confidence level of the reliability of its fracture toughness. With the increase of the confidence level γ, the crack sensitivity increases, but the median, the discreteness, and the confidence intervals decrease. The size of the test specimen influences the experiment for the fracture toughness, the measured values and their dispersion, and there exists the conversion between size of the test specimen and that of the real device. We extend the results to introduce the statistic model of the size effect of the fracture toughness. © 2011, Copyright the Authors. Artificial Organs © 2011, International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  11. Long-bone fractures in llamas and alpacas: 28 cases (1998–2008)

    Science.gov (United States)

    Knafo, S. Emmanuelle; Getman, Liberty M.; Richardson, Dean W.; Fecteau, Marie-Eve

    2012-01-01

    Treatment and outcome of camelids with long-bone fractures are described. Medical records (1998–2008) of camelids (n = 28) with long-bone fractures were reviewed for signalment, time to presentation, fracture type, method of repair, duration of hospitalization, and post-operative complications. Follow-up information was obtained via telephone interviews with owners. Mean age and weight at presentation were 3.4 years and 56.3 kg, respectively. Twenty-six fractures were treated with internal fixation (n = 11), external fixation (n = 10), combination of internal and external fixation (n = 3), amputation (n = 1), and external fixation followed by amputation (n = 1). Long-term follow-up information was obtained for 19 of the 26 animals. The post-operative complication rate was 23% and owner satisfaction was high. Animals with open fractures were more likely to experience complications. Internal fixation was associated with superior alignment and outcome. Internal fixation techniques should be recommended for camelids. PMID:23277645

  12. Assessment of cortical bone fracture resistance curves by fusing artificial neural networks and linear regression.

    Science.gov (United States)

    Vukicevic, Arso M; Jovicic, Gordana R; Jovicic, Milos N; Milicevic, Vladimir L; Filipovic, Nenad D

    2018-02-01

    Bone injures (BI) represents one of the major health problems, together with cancer and cardiovascular diseases. Assessment of the risks associated with BI is nontrivial since fragility of human cortical bone is varying with age. Due to restrictions for performing experiments on humans, only a limited number of fracture resistance curves (R-curves) for particular ages have been reported in the literature. This study proposes a novel decision support system for the assessment of bone fracture resistance by fusing various artificial intelligence algorithms. The aim was to estimate the R-curve slope, toughness threshold and stress intensity factor using the two input parameters commonly available during a routine clinical examination: patients age and crack length. Using the data from the literature, the evolutionary assembled Artificial Neural Network was developed and used for the derivation of Linear regression (LR) models of R-curves for arbitrary age. Finally, by using the patient (age)-specific LR models and diagnosed crack size one could estimate the risk of bone fracture under given physiological conditions. Compared to the literature, we demonstrated improved performances for estimating nonlinear changes of R-curve slope (R 2 = 0.82 vs. R 2 = 0.76) and Toughness threshold with ageing (R 2 = 0.73 vs. R 2 = 0.66).

  13. Death due to fracture of thin calvarial bones after a fall: A forensic approach.

    Science.gov (United States)

    Sioutas, Georgios; Karakasi, Maria-Valeria; Kapetanakis, Stylianos; Pavlidis, Pavlos

    2017-06-01

    A 45-year-old male was autopsied. He had fallen backwards from a two-stairs height to the ground and passed away. A skull fracture was detected in the left occipital area, extending up to the left side of the skull base. The patient's death occurred due to the very low thickness of the calvarial bones, which led to the aforementioned fracture, and in turn resulted in subarachnoid hemorrhage and death. The cortical thickness was measured and compared with average values at standardized points. Uniform bone thinning was confirmed rather than localized. Calvarial thinning may result from various conditions. In the present case study, however, the exact mechanism which led to the low thickness of the calvarial bones of the patient is undetermined. Death due to the susceptible structure and fracture of calvarial bones has rarely been reported throughout relevant literature. Copyright © 2017 Daping Hospital and the Research Institute of Surgery of the Third Military Medical University. Production and hosting by Elsevier B.V. All rights reserved.

  14. Novel Therapeutic Strategy for the Prevention of Bone Fractures

    Science.gov (United States)

    2013-06-01

    including reproduction and distribution, or selling or licensing copies, or posting to personal, institutional or third party websites are...in mice, dogs, cows, sheep and humans, and mice lacking myostatin have been observed to show increased bone density in the limb, spine, and jaw...displacement speed of 10 µm/sec using a Transducer Techniques 5 kg load cell. Structural, or extrinsic, properties including ultimate force (Fu; height of

  15. Vertical fracture and marginal bone loss of internal-connection implants: a finite element analysis.

    Science.gov (United States)

    Jimbo, Ryo; Halldin, Anders; Janda, Martin; Wennerberg, Ann; Vandeweghe, Stefan

    2013-01-01

    Marginal bone loss around implants is of great concern, and its cause may be multifactorial. Recently, clinical cases presenting marginal bone loss, in most cases accompanied by vertical fracture of internal-connection implants in the buccolingual direction, have been reported, in which unfavorable stress distribution is one possible cause of marginal bone resorption. The purpose of the current study was to characterize this type of marginal bone loss and implant fracture by conducting a finite element analysis (FEA). Clinical and radiographic evaluations showed that the prostheses of all reported cases had implant-level setups and were directly screwed to the internal implants. Intriguingly, all vertical fractures reported were in the buccolingual direction. Therefore, to characterize the specific implant fractures, FEA was conducted with misfit models created for two different setups, abutment-level and implant-level, both with screw-retained prostheses. The models were subjected to initial misfits of 0 μm (representing perfect fit), 50 μm, 100 μm, 150 μm, or 200 μm, and vertical loading was then applied. FEA revealed that, for the implant-level setup, excessive stress at the neck of the implant gradually increased in the buccolingual direction as the misfit increased. This result was not seen for the abutment-level setup. A broad maximum stress distribution was evident for the implant-level setup but not for the abutment-level setup. Broad distribution of excessive stress in the FEA correlated to the clinical cases, and marginal bone loss in these cases may be associated with mechanical alterations. To avoid unnecessary complications, selection of an abutment-level setup is strongly suggested.

  16. Mandibular bone structure, bone mineral density, and clinical variables as fracture predictors: a 15-year follow-up of female patients in a dental clinic.

    Science.gov (United States)

    Jonasson, Grethe; Billhult, Annika

    2013-09-01

    To compare three mandibular trabeculation evaluation methods, clinical variables, and osteoporosis as fracture predictors in women. One hundred and thirty-six female dental patients (35-94 years) answered a questionnaire in 1996 and 2011. Using intra-oral radiographs from 1996, five methods were compared as fracture predictors: (1) mandibular bone structure evaluated with a visual radiographic index, (2) bone texture, (3) size and number of intertrabecular spaces calculated with Jaw-X software, (4) fracture probability calculated with a fracture risk assessment tool (FRAX), and (5) osteoporosis diagnosis based on dual-energy-X-ray absorptiometry. Differences were assessed with the Mann-Whitney test and relative risk calculated. Previous fracture, gluco-corticoid medication, and bone texture were significant indicators of future and total (previous plus future) fracture. Osteoporosis diagnosis, sparse trabeculation, Jaw-X, and FRAX were significant predictors of total but not future fracture. Clinical and oral bone variables may identify individuals at greatest risk of fracture. Copyright © 2013 Elsevier Inc. All rights reserved.

  17. Bone strength and muscle properties in postmenopausal women with and without a recent distal radius fracture.

    Science.gov (United States)

    Crockett, K; Arnold, C M; Farthing, J P; Chilibeck, P D; Johnston, J D; Bath, B; Baxter-Jones, A D G; Kontulainen, S A

    2015-10-01

    Distal radius (wrist) fracture (DRF) in women over age 50 years is an early sign of bone fragility. Women with a recent DRF compared to women without DRF demonstrated lower bone strength, muscle density, and strength, but no difference in dual-energy x-ray absorptiometry (DXA) measures, suggesting DXA alone may not be a sufficient predictor for DRF risk. The objective of this study was to investigate differences in bone and muscle properties between women with and without a recent DRF. One hundred sixty-six postmenopausal women (50-78 years) were recruited. Participants were excluded if they had taken bone-altering medications in the past 6 months or had medical conditions that severely affected daily living or the upper extremity. Seventy-seven age-matched women with a fracture in the past 6-24 months (Fx, n = 32) and without fracture (NFx, n = 45) were measured for bone and muscle properties using the nondominant (NFx) or non-fractured limb (Fx). Peripheral quantitative computed tomography (pQCT) was used to estimate bone strength in compression (BSIc) at the distal radius and tibia, bone strength in torsion (SSIp) at the shaft sites, muscle density, and area at the forearm and lower leg. Areal bone mineral density at the ultradistal forearm, spine, and femoral neck was measured by DXA. Grip strength and the 30-s chair stand test were used as estimates of upper and lower extremity muscle strength. Limb-specific between-group differences were compared using multivariate analysis of variance (MANOVA). There was a significant group difference (p lower leg, with the Fx group demonstrating 16 and 19% lower BSIc, 3 and 6% lower muscle density, and 20 and 21% lower muscle strength at the upper and lower extremities, respectively. There were no differences between groups for DXA measures. Women with recent DRF had lower pQCT-derived estimated bone strength at the distal radius and tibia and lower muscle density and strength at both extremities.

  18. Effect of Diabetes Mellitus Type II on Long Bones Fractures Healing

    Directory of Open Access Journals (Sweden)

    Ali Sadighi

    2015-07-01

    Full Text Available Introduction: Fracture healing is a complex process where synthesis and activation of a cascade of cells and molecules collaborate and participate in regeneration of the fractured bones. There are several factors involved in nonunion of fractured bones. Endocrine and metabolic diseases are regarded as factors causing nonunion of fractured bones. The present study aims at evaluating effect of diabetes type II, as an important and prevalent metabolic disease, on results of surgical treatment of long bones fractures. Method: This case-control study was conducted on 74 patients with isolated fracture of tibia and femur shafts resulting from low-energy trauma. In this study, 50 patients with definite diagnosis of diabetes were compared with 24 metabolically health persons considering age, gender, type of fracture, and treatment method. The diabetic patients were classified in two groups considering their insulin or oral agent. Level of hs-CRP inflammatory marker was also determined in these patients. Union rate and duration as well as relation between inflammatory marker and union rate were studied. Results: Prevalence of nonunion and delayed union were seen in 8 (32% and 2 (8% patients with orally-treated diabetes, respectively. It was 3 (12% in diabetes patients treated with insulin. However, there was not any case of nonunion in the health group. There was a statistically significant difference between these groups. According to the regression model, hs-CRP level played a significant role considering nonunion prediction (P=0.001, Odd’s Ratio=3.4, CI95%:1.4-4.8. Also, type of diabetes treatment had a significant role in predicting nonunion (P=0.04, Odd’s Ratio=0.6, CI95%:0.3-1.4. Duration of being affected by diabetes did not play any important role in nonunion prediction. Conclusion: Prevalence of nonunion in patients with diabetes suffering from fracture and undergoing orthopedic surgery is higher than healthy people. It seems that increase

  19. Differential diagnosis of trampoline fracture from osteomyelitis by bone scan with pinhole collimator.

    Science.gov (United States)

    Gauthé, Mathieu; Mestas, Danielle; Canavese, Federico; Samba, Antoine; Cachin, Florent

    2014-02-01

    A 2-year-old girl with recent history of trampoline fall presented to the A&E Department for complete functional impairment of the left lower extremity and fever. Blood examination revealed an inflammatory syndrome, while plain radiographs were normal. As magnetic resonance imaging was unavailable, a bone scintigraphy was performed. While standard acquisition found an intense uptake focused on the left proximal tibial metaphysis whose appearance was suggestive of acute hematogenous osteomyelitis, complementary acquisition with the pinhole collimator demonstrated that this abnormal uptake was clearly distinct from the cartilage growth plate. One month follow-up radiographs showed a fracture that confirmed the diagnosis of trampoline fracture.

  20. Orthopedic surgery and bone fracture pain are both significantly attenuated by sustained blockade of nerve growth factor.

    Science.gov (United States)

    Majuta, Lisa A; Longo, Geraldine; Fealk, Michelle N; McCaffrey, Gwen; Mantyh, Patrick W

    2015-01-01

    The number of patients suffering from postoperative pain due to orthopedic surgery and bone fracture is projected to dramatically increase because the human life span, weight, and involvement in high-activity sports continue to rise worldwide. Joint replacement or bone fracture frequently results in skeletal pain that needs to be adequately controlled for the patient to fully participate in needed physical rehabilitation. Currently, the 2 major therapies used to control skeletal pain are nonsteroidal anti-inflammatory drugs and opiates, both of which have significant unwanted side effects. To assess the efficacy of novel therapies, mouse models of orthopedic and fracture pain were developed and evaluated here. These models, orthopedic surgery pain and bone fracture pain, resulted in skeletal pain-related behaviors that lasted 3 weeks and 8 to 10 weeks, respectively. These skeletal pain behaviors included spontaneous and palpation-induced nocifensive behaviors, dynamic weight bearing, limb use, and voluntary mechanical loading of the injured hind limb. Administration of anti-nerve growth factor before orthopedic surgery or after bone fracture attenuated skeletal pain behaviors by 40% to 70% depending on the end point being assessed. These data suggest that nerve growth factor is involved in driving pain due to orthopedic surgery or bone fracture. These animal models may be useful in developing an understanding of the mechanisms that drive postoperative orthopedic and bone fracture pain and the development of novel therapies to treat these skeletal pains.

  1. Male Astronauts Have Greater Bone Loss and Risk of Hip Fracture Following Long Duration Spaceflights than Females

    Science.gov (United States)

    Ellman, Rachel; Sibonga, Jean; Bouxsein, Mary

    2010-01-01

    This slide presentation reviews bone loss in males and compares it to female bone loss during long duration spaceflight. The study indicates that males suffer greater bone loss than females and have a greater risk of hip fracture. Two possible reason for the greater male bone loss are that the pre-menopausal females have the estrogen protection and the greater strength of men max out the exercise equipment that provide a limited resistance to 135 kg.

  2. Diagnostic accuracy of ultrasound in upper and lower extremity long bone fractures of emergency department trauma patients.

    Science.gov (United States)

    Frouzan, Arash; Masoumi, Kambiz; Delirroyfard, Ali; Mazdaie, Behnaz; Bagherzadegan, Elnaz

    2017-08-01

    Long bone fractures are common injuries caused by trauma. Some studies have demonstrated that ultrasound has a high sensitivity and specificity in the diagnosis of upper and lower extremity long bone fractures. The aim of this study was to determine the accuracy of ultrasound compared with plain radiography in diagnosis of upper and lower extremity long bone fractures in traumatic patients. This cross-sectional study assessed 100 patients admitted to the emergency department of Imam Khomeini Hospital, Ahvaz, Iran with trauma to the upper and lower extremities, from September 2014 through October 2015. In all patients, first ultrasound and then standard plain radiography for the upper and lower limb was performed. Data were analyzed by SPSS version 21 to determine the specificity and sensitivity. The mean age of patients with upper and lower limb trauma were 31.43±12.32 years and 29.63±5.89 years, respectively. Radius fracture was the most frequent compared to other fractures (27%). Sensitivity, specificity, positive predicted value, and negative predicted value of ultrasound compared with plain radiography in the diagnosis of upper extremity long bones were 95.3%, 87.7%, 87.2% and 96.2%, respectively, and the highest accuracy was observed in left arm fractures (100%). Tibia and fibula fractures were the most frequent types compared to other fractures (89.2%). Sensitivity, specificity, PPV and NPV of ultrasound compared with plain radiography in the diagnosis of upper extremity long bone fractures were 98.6%, 83%, 65.4% and 87.1%, respectively, and the highest accuracy was observed in men, lower ages and femoral fractures. The results of this study showed that ultrasound compared with plain radiography has a high accuracy in the diagnosis of upper and lower extremity long bone fractures.

  3. Location of Vertebral Fractures is Associated with Bone Mineral Density and History of Traumatic Injury.

    Science.gov (United States)

    Watt, Jennifer; Crilly, Richard

    2017-04-01

    The upper and lower thoracolumbar spine have been associated with different biomechanical outcomes. This concept, as it applies to osteoporotic fracture risk, has not been well documented. This was a case-control study of 120 patients seen in an osteoporosis clinic. Vertebral fractures were identified from lateral radiographs using Genant's semi-quantitative assessment method. An association between bone mineral density (BMD) T-scores and vertebral fracture location was assessed. In an additional analysis, the association between a history of any traumatic injury and possible predictor variables was also explored. The median age of patients was 75 (IQR 67-80), and 84.2% of patients were female. A history of trauma was reported by 46.7% of patients. A vertebral fracture in the lower thoracolumbar spine (T11-L4) was associated with significantly higher femoral neck (p trochanteric (p = 0.002), intertrochanteric (p fractures in the lower thoracolumbar spine. A fracture in the upper thoracolumbar spine (T4-T10) decreased the odds of having a history of traumatic injury (OR 0.32, 95% CI 0.14-0.76, p = 0.01), while a non-vertebral fracture increased the odds of such an injury (OR 2.41, 95% CI 1.10-5.32, p = 0.03). Vertebral fractures in the lower thoracolumbar spine are associated with higher BMD T-scores. This should be studied further to understand possible correlations with patients' future fracture risk.

  4. Magnesium intake, bone mineral density, and fractures: results from the Women's Health Initiative Observational Study1234

    Science.gov (United States)

    Orchard, Tonya S; Larson, Joseph C; Alghothani, Nora; Bout-Tabaku, Sharon; Cauley, Jane A; Chen, Zhao; LaCroix, Andrea Z; Wactawski-Wende, Jean; Jackson, Rebecca D

    2014-01-01

    Background: Magnesium is a necessary component of bone, but its relation to osteoporotic fractures is unclear. Objective: We examined magnesium intake as a risk factor for osteoporotic fractures and altered bone mineral density (BMD). Design: This prospective cohort study included 73,684 postmenopausal women enrolled in the Women's Health Initiative Observational Study. Total daily magnesium intake was estimated from baseline food-frequency questionnaires plus supplements. Hip fractures were confirmed by a medical record review; other fractures were identified by self-report. A baseline BMD analysis was performed in 4778 participants. Results: Baseline hip BMD was 3% higher (P 422.5 compared with magnesium. In contrast, risk of lower-arm or wrist fractures increased with higher magnesium intake [multivariate-adjusted HRs of 1.15 (95% CI: 1.01, 1.32) and 1.23 (95% CI: 1.07, 1.42) for quintiles 4 and 5, respectively, compared with quintile 1; P-trend = 0.002]. In addition, women with the highest magnesium intakes were more physically active and at increased risk of falls [HR for quintile 4: 1.11 (95% CI: 1.06, 1.16); HR for quintile 5: 1.15 (95% CI: 1.10, 1.20); P-trend magnesium intake is associated with lower BMD of the hip and whole body, but this result does not translate into increased risk of fractures. A magnesium consumption slightly greater than the Recommended Dietary Allowance is associated with increased lower-arm and wrist fractures that are possibly related to more physical activity and falls. This trial was registered at clinicaltrials.gov as NCT00000611. PMID:24500155

  5. In vitro evaluation of allogeneic bone screws for use in internal fixation of transverse fractures created in proximal sesamoid bones obtained from equine cadavers.

    Science.gov (United States)

    Sasaki, Naoki; Takakuwa, Jun; Yamada, Haruo; Mori, Ryuji

    2010-04-01

    To evaluate effectiveness of allogeneic bone screws and pins for internal fixation of midbody transverse fractures of equine proximal sesamoid bones (PSBs) in vitro. 14 forelimbs from cadavers of 3-year-old Thoroughbreds. Allogeneic cortical bone fragments were collected from the limbs of a male Thoroughbred, and cortical bone screws were prepared from the tissue by use of a precision desktop microlathe programmed with the dimensions of a metal cortical bone screw. A midbody transverse osteotomy of each PSB was performed by use of a bone-shaping oscillating saw and repaired via 1 of 3 internal fixation techniques: 1 allogeneic bone screw with 1 allogeneic bone pin (type I; n = 6 PSBs), 2 allogeneic bone screws (type II; 8), or 1 stainless steel cortical bone screw (control repair; 6). Mechanical tension measurements were obtained by use of a commercially available materials testing system. Mean +/- SD tensile strength (TS) was 668.3 +/- 216.6 N for type I repairs, 854.4 +/- 253.2 N for type II repairs, and 1,150.0 +/- 451.7 N for control repairs. Internal fixation of PSB fractures by the use of allogeneic bone screws and bone pins was successful. Although mean TS of control repairs with stainless steel cortical bone screws was greater than the mean TS of type I and type II repairs, the difference between type II and control repairs was not significant. Allogeneic screws may advance healing and result in fewer complications in a clinical setting.

  6. Fabrication of a customized bone scaffold using a homemade medical 3D printer for comminuted fractures

    Science.gov (United States)

    Yoon, Do-Kun; Jung, Joo-Young; Shin, Han-Back; Kim, Moo-Sub; Choe, Bo-Young; Kim, Sunmi; Suh, Tae Suk; Lee, Keum Sil; Xing, Lei

    2016-09-01

    The purpose of this study was to show a 3D printed reconstruction model of a bone destroyed by a comminuted fracture. After a thoracic limb of a cow with a comminuted fracture was scanned by using computed tomography, a scaffold was designed by using a 3D modeling tool for its reconstruction and fabricated by using a homemade medical 3D printer. The homemade medical 3D printer was designed for medical use. In order to reconstruct the geometry of the destroyed bone, we use the geometry of a similar section (reference geometry) of normal bone in the 3D modeling process. The missing part between the destroyed ridge and the reference geometry was filled with an effective space by using a manual interpolation. Inexpensive materials and free software were used to construct the medical 3D printer system. The fabrication of the scaffold progressed according to the design of reconstructed bone by using this medical 3D printer. The material of the scaffold was biodegradable material, and could be transplanted into the human body. The fabricated scaffold was correctly inserted into the fractured bone in place of the destroyed portion, with good agreement. According to physical stress test results, the performance of printing resolution was 0.1 mm. The average geometrical error of the scaffold was below 0.3 mm. The reconstructed bone by using the fabricated scaffold was able to support the weight of the human body. No process used to obtain the result was complex or required many resources. The methods and results in this study show several possible clinical applications in fields such as orthopedics or oncology without a need to purchase high-price instruments for 3D printing.

  7. Pathologic mandibular fracture after biting crab shells following ramal bone graft.

    Science.gov (United States)

    Kwon, Ik Jae; Lee, Byung Ho; Eo, Mi Young; Kim, Soung Min; Lee, Jong Ho; Lee, Suk Keun

    2016-10-01

    The mandibular ramus is considered an appropriate choice for reconstruction of maxillofacial defects because of sufficient amounts of material and fewer donor site complications. Although bone harvesting from the mandibular ramus has many advantages, in rare cases it can result in pathologic fracture of the mandible. Here, we present a case of 59-year-old man who suffered a pathologic mandible fracture related to biting hard foods, such as crab shells, after a sinus bone lifting with ramal bone graft procedure performed 2 weeks prior. He underwent closed reduction by intermaxillary fixation with an arch bar over the course of 4 weeks. Three months later, the patients had a stable occlusion with normal mouth opening and sensation. To prevent this complication, the osteotomy should be performed in such a way that it is not too vertical during ramal bone harvesting. Furthermore, we wish to emphasize the importance of patients being instructed to avoid chewing hard foods for at least 4 weeks after ramal bone harvesting. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  8. Treatment of Atypical Ulnar Fractures Associated with Long-Term Bisphosphonate Therapy for Osteoporosis: Autogenous Bone Graft with Internal Fixation

    Directory of Open Access Journals (Sweden)

    Yohei Shimada

    2017-01-01

    Full Text Available Long-term bisphosphonate use has been suggested to result in decreased bone remodelling and an increased risk of atypical fractures. Fractures of this nature commonly occur in the femur, and relatively few reports exist to show that they occur in other bones. Among eight previous reports of atypical ulnar fractures associated with bisphosphonate use, one report described nonunion in a patient who was treated with cast immobilization and another described ulna nonunion in one of three patients, all of whom were treated surgically with a locking plate. The remaining two surgical patients achieved bone union uneventfully following resection of the osteosclerotic lesion and iliac bone grafting before rigid fixation. We hypothesized that the discontinuation of bisphosphonate therapy, the use of teriparatide treatment, and low-intensity pulsed ultrasound (LIPUS might have been associated with fracture healing.

  9. Procedural Sedation With Ketamine Versus Propofol for Closed Reduction of Pediatric Both Bone Forearm Fractures.

    Science.gov (United States)

    Morrison, Todd; Carender, Chris; Kilbane, Brendan; Liu, Raymond W

    2017-09-01

    Effective treatment of pediatric both bone forearm fractures consists of timely restoration of anatomic alignment with manipulation and immobilization, often accomplished with the aid of procedural sedation in the emergency department setting. The current lack of consensus regarding a safe and optimal regimen may result in inadequate sedation, compromised quality of reduction, or patient harm. The current study was conducted to answer the following questions for pediatric both bone forearm fractures treated with closed reduction with either ketamine or propofol procedural sedation: (1) Is there a difference in the rate of unacceptable alignment 4 weeks after reduction? (2) Is there a difference in the rates of major sedation-related complications? Medical records, data on procedural sedation, and radiographs of 74 skeletally immature patients with diaphyseal or distal metaphyseal both bone forearm fractures treated with manipulation were reviewed (ketamine sedation, 26; propofol sedation, 48). Rates of unacceptable alignment for the 2 cohorts were similar both immediately after reduction and at 4 weeks. Rates of complications of procedural sedation did not differ between cohorts. The duration of procedural sedation was longer and the padding index was greater with ketamine. Malalignment after reduction was more likely in older patients and those with a higher padding index. Although no difference was found in the rates of malalignment or sedation-related complications between fractures reduced with ketamine or propofol sedation, the sedation regimens differ in both procedural duration and padding index. Careful consideration of the risks and benefits of procedural sedation for closed reduction of pediatric forearm fractures is warranted. [Orthopedics. 2017; 40(5):288-294.]. Copyright 2017, SLACK Incorporated.

  10. Surgical management of complete diaphyseal third metacarpal and metatarsal bone fractures: Clinical outcome in 10 mature horses and 11 foals

    OpenAIRE

    Bischofberger, Andrea S; Fürst, Anton; Auer, Jörg A; Lischer, Christoph J

    2009-01-01

    Reasons for performing study: Osteosynthesis of third metacarpal (McIII) and third metatarsal (MtIII) bone fractures in horses is a surgical challenge and complications surrounding the repair are common. Retrospective studies evaluating surgical repair, complications and outcome are necessary to increase knowledge and improve success of long bone fracture repair in the horse. Objectives: To evaluate clinical findings, surgical repair, post operative complications and outcome of 10 mature h...

  11. Use of a bone plate for treatment of middle phalangeal fractures in horses: seven cases (1979-1984)

    International Nuclear Information System (INIS)

    Doran, R.E.; White, N.A. II; Allen, D.

    1987-01-01

    Four adult horses and 3 foals with middle phalangeal fractures were treated by arthrodesis of the proximal interphalangeal joint, using a bone plate. Six of the 7 horses survived greater than 2 years; 2 of the 6 horses had intermittent lameness after hard work, and 4 horses didn't have evidence of lameness. The use of a bone plate for arthrodesis of the proximal interphalangeal joint was a successful treatment alternative for middle phalangeal fractures in horses

  12. Combined nanoindentation testing and scanning electron microscopy of bone and articular calcified cartilage in an equine fracture predilection site

    OpenAIRE

    M Doube; EC Firth; A Boyde; AJ Bushby

    2010-01-01

    Condylar fracture of the third metacarpal bone (Mc3) is the commonest cause of racetrack fatality in Thoroughbred horses. Linear defects involving hyaline articular cartilage, articular calcified cartilage (ACC) and subchondral bone (SCB) have been associated with the fracture initiation site, which lies in the sagittal grooves of the Mc3 condyle. We discovered areas of thickened and abnormally-mineralised ACC in the sagittal grooves of several normal 18-month-old horses, at the same site tha...

  13. Comparison of fracture site callus with iliac crest bone marrow as the source of plastic-adherent cells

    Directory of Open Access Journals (Sweden)

    Achmad Zaki

    2013-05-01

    Full Text Available Background: Red marrow has been described as the main source of mesenchymal stem cells although its aspiration and isolation from bone marrow was reported to have significant donor site morbidity. Since secondary bone healing occurs through formation of callus as the result of proliferation and differentiation of mesenchymal stem cells, callus may become alternative source for mesenchymal stem cells. In this study, we compared the number of plastic-adherent cells from fracture site callus and bone marrow of iliac crest after two and four weeks of culture.Methods: Sixteen New Zealand rabbits were fracturized at the femoral shaft. Then, these rabbits were taken care. After two weeks of fracturization, 3 mL iliac crest bone marrow aspiration and callus extraction of eight rabbits were cultured (group I. The other eight rabbits were treated equally after four weeks of fracturization (group II. Simultaneously, the cultures were observed after one and two weeks. Four weeks later, they were harvested. Cells were counted using Neubauer hemocytometer. The average number of cells between the sources and groups were statistically analyzed using the unpaired t-test. Results: In group I, there were 2.6 ± 0.1 x 104 cells in the culture of iliac crest bone marrow aspirate and 2.5 ± 0.1 x 104 cells in culture of callus extract from fracture site (p = 0.34. In group II, there were 2.7 ± 0.1 x 104 cells and 2.1 ± 0.1 x 104 cells, respectively (p < 0.001.Conclusion: Fracture site callus at the second week post-fracturization may be potential as source of plastic-adherent cells compared with iliac crest bone marrow. (Med J Indones. 2013;22:70-5Keywords: Bone marrow, fracture site callus, iliac crest, long bone, mesenchymal stem cell, plastic-adherent cells

  14. Outcome of Distal Both Bone Leg Fractures Fixed by Intramedulary Nail for Fibula & MIPPO in Tibia.

    Science.gov (United States)

    Gupta, Anil; Anjum, Rashid; Singh, Navdeep; Hackla, Shafiq

    2015-04-01

    Fractures of the distal third of the tibia are mostly associated with a fibular fracture that often requires fixation. The preferred treatment of distal tibial fracture is the minimally invasive percutaneous plate osteosynthesis (MIPPO) procedure. However, there are no clear cut guidelines on fixation of the fibular fracture and currently most orthopedic surgeons use a plate osteosynthesis for the fibula as well. A common complication associated with dual plating is an increased chance of soft tissue necrosis, infection, and in some cases resulting in an exposed implant. We conducted a prospective study to analyze the results of fractures of the distal in both leg bones managed by the MIPPO procedure for tibial fractures and a rush nail for fibular fractures. The study was conducted in a tertiary care hospital from November 2012 to May 2014, a total of 30 fractures in 30 patients (18 males, 12 females) with a mean age of 42.4 years (26-60 years) were treated in our institution in the aforesaid time period with MIPPO for tibia and rush nail for fibular fractures. All the cases were operated on by a single surgeon in emergency within 24 hours. The patients with skin blistering and compound fractures were excluded from this study. Rehabilitative measures were proceeded as per patient's pain profile, isometric and isotonic exercises were started on the first post-operative day, with full weight bearing at 10-12 weeks after assessing clinical and radiological union. Regular follow up of patients was done, radiographs were taken at the immediate post-operative period and at 3, 6, 12 and 24 weeks. All the patients were available for regular follow up. Radiological and clinical union proceeded normally in all the patients, no patients had signs of any deep infection, delayed union or nonunion, three patients had a superficial infection of the tibial incision that healed with a change in antibiotic. The use of dual plating for fixation of the lower tibia and fibula

  15. Quantitative comparison of bone mineral density characteristics of the distal epiphysis of third metacarpal bones from Thoroughbred racehorses with or without condylar fracture.

    Science.gov (United States)

    Bogers, Sophie H; Rogers, Chris W; Bolwell, Charlotte; Roe, Wendi; Gee, Erica; McIlwraith, C Wayne

    2016-01-01

    To compare regional proportions and spatial distributions of volumetric bone mineral density (BMDv) of the palmar aspect of the distal epiphysis of the third metacarpal bone (McIII) in limbs with or without a condylar fracture from Thoroughbred racehorses. McIIIs from cadavers of Thoroughbred racehorses with (n = 6 bones) and without (8) a condylar fracture. BMDv and spatial distributions of BMDv in peripheral quantitative CT images of the distal epiphysis of McIIIs were quantitatively assessed with spatial analysis software. Relative proportions of voxels within 9 threshold categories of BMDv and spatial statistics for BMDv distribution were compared between fractured and nonfractured limbs. No significant differences in BMDv characteristics were identified between fractured and nonfractured limbs, although fractured limbs had a lower proportion of voxels in the BMDv thresholds 700 to bone to race training rather than differences between fractured and nonfractured limbs. In both limb groups, uniform clusters of low BMDv with areas of high BMDv were identified. BMDv characteristics of the distal epiphysis of McIII reflected training load, and fracture characteristics were subtle. Serial imaging techniques in conjunction with detailed training data are required to elucidate the onset of the pathological response to load in horses.

  16. Fracture line index of fibular stalk and the ankle joint bone in the classification of the ankle joint trauma

    International Nuclear Information System (INIS)

    Wu Jun; Zhang Qiang

    2003-01-01

    Objective: To evaluate the fracture line index of fibular stalk and the ankle joint bone in the classification of the ankle joint trauma. Methods: Measure fracture line index of fibular stalk and the ankle joint in 217 adult cases of fracture and dislocation of ankle joint. And the cases were classified by the results of the measurement. Results: Measurement was unavailable in 9 cases of tearing fracture. In 31 cases, the lesions could not be particularly classified. And in the rest 176 cases the trauma were precisely classified. The over all successful rate was 81.6%. Conclusion: Fracture line index of fibular stalk and the ankle joint bone are valuable in classification of the trauma of the angle joint. While the specificity of this method is low in differentiating the adducting and abducting fracture of the medial angle, in which a combined investigation is recommended

  17. [Osteogenon in therapy of distal radial bone fractures in patients with secondary osteoporosis].

    Science.gov (United States)

    Varga, O Iu; Vezikova, N N; Marusenko, I M; Kheĭfets, L M

    2007-01-01

    To assess efficacy of osteogenon in consolidation of solitary fractures of distal part of the radial bone (RB) in patients with secondary osteoporosis (SO) due to rheumatoid arthritis (RA) and chronic renal failure (CRF). The study group consisted of 7 patients with documented RA and 8 patients with CRF caused by chronic glomerulonephritis or chronic pyelonephritis in the predialysis period. The control group comprised 13 patients (6 and 7 patients, respectively). The patients were matched by clinico-demographic and therapy characteristics. Patients of the study group received osteogen from the fracture diagnosis to its consolidation. Osteogenon has an analgetic effect, improves well being, raises physical activity, reduces duration of fracture consolidation in patients with SO.

  18. Catestatin, vasostatin, cortisol, and pain assessments in dogs suffering from traumatic bone fractures.

    Science.gov (United States)

    Srithunyarat, Thanikul; Hagman, Ragnvi; Höglund, Odd V; Stridsberg, Mats; Olsson, Ulf; Hanson, Jeanette; Nonthakotr, Chalermkwan; Lagerstedt, Anne-Sofie; Pettersson, Ann

    2017-03-21

    Traumatic bone fractures cause moderate to severe pain, which needs to be minimized for optimal recovery and animal welfare, illustrating the need for reliable objective pain biomarkers for use in a clinical setting. The objectives of this study were to investigate catestatin (CST) and vasostatin (VS) concentrations as two new potential biomarkers, and cortisol concentrations, scores of the short form of the Glasgow composite measure pain scale (CMPS-SF), and visual analog scale (VAS) in dogs suffering from traumatic bone fractures before and after morphine administration in comparison with healthy dogs. Fourteen dogs with hind limb or pelvic fractures and thirty healthy dogs were included. Dogs with fractures were divided into four groups according to analgesia received before participation. Physical examination, CMPS-SF, pain and stress behavior VAS scores were recorded in all dogs. Saliva and blood were collected once in healthy dogs and in dogs with fractures before and 35-70 min after morphine administration. Blood samples were analyzed for CST, VS, and cortisol. Saliva volumes, however, were insufficient for analysis. Catestatin and cortisol concentrations, and CMPS-SF, and VAS scores differed significantly between dogs with fractures prior to morphine administration and healthy dogs. After morphine administration, dogs with fractures had significantly decreased CMPS-SF and VAS scores and, compared to healthy dogs, CST concentrations, CMPS-SF, and VAS scores still differed significantly. However, CST concentrations remained largely within the normal range. Absolute delta values for CST significantly correlated with delta values for CMPS-SF. Catestatin and cortisol did not differ significantly before and after morphine administration. Vasostatin concentrations did not differ significantly between groups. Catestatin and cortisol concentrations, CMPS-SF, and VAS scores differed significantly in the dogs with traumatic bone fractures compared to the healthy dogs

  19. Outcomes and complication rates of different bone grafting modalities in long bone fracture nonunions: a retrospective cohort study in 182 patients.

    Science.gov (United States)

    Flierl, Michael A; Smith, Wade R; Mauffrey, Cyril; Irgit, Kaan; Williams, Allison E; Ross, Erin; Peacher, Gabrielle; Hak, David J; Stahel, Philip F

    2013-09-09

    Novel bone substitutes have challenged the notion of autologous bone grafting as the 'gold standard' for the surgical treatment of fracture nonunions. The present study was designed to test the hypothesis that autologous bone grafting is equivalent to other bone grafting modalities in the management of fracture nonunions of the long bones. A retrospective review of patients with fracture nonunions included in two prospective databases was performed at two US level 1 trauma centers from January 1, 1998 (center 1) or January 1, 2004 (center 2), respectively, until December 31, 2010 (n = 574). Of these, 182 patients required adjunctive bone grafting and were stratified into the following cohorts: autograft (n = 105), allograft (n = 38), allograft and autograft combined (n = 16), and recombinant human bone morphogenetic protein-2 (rhBMP-2) with or without adjunctive bone grafting (n = 23). The primary outcome parameter was time to union. Secondary outcome parameters consisted of complication rates and the rate of revision procedures and revision bone grafting. The autograft cohort had a statistically significant shorter time to union (198 ± 172-225 days) compared to allograft (416 ± 290-543 days) and exhibited a trend towards earlier union when compared to allograft/autograft combined (389 ± 159-619 days) or rhBMP-2 (217 ± 158-277 days). Furthermore, the autograft cohort had the lowest rate of surgical revisions (17%) and revision bone grafting (9%), compared to allograft (47% and 32%), allograft/autograft combined (25% and 31%), or rhBMP-2 (27% and 17%). The overall new-onset postoperative infection rate was significantly lower in the autograft group (12.4%), compared to the allograft cohort (26.3%) (P grafting appears to represent the bone grafting modality of choice with regard to safety and efficiency in the surgical management of long bone fracture nonunions.

  20. Larynx Trauma and Hyoid Bone Fracture after Bite Injury in Dog: Case Report

    Science.gov (United States)

    Manchi, George; Brunnberg, Mathias M.; Shahid, Muhammad; Al Aiyan, Ahmad; Brunnberg, Leo; Stein, Silke

    2016-01-01

    An 8-year-old male Jack Russell crossbreed dog was admitted to our hospital with dyspnea and shock following a dog-bite injury on the ventral neck. Radiographs revealed subcutaneous emphysema and bilateral thyrohyoid bone fractures. Intraoperatively, rupture of both sternohyoid muscles, both hyoepiglotticus muscles, both thyrohyoid muscles, and a partial cranial rupture of the superficial sphincter colli muscle were detected. Part of the epiglottis was detached from the thyroid cartilage. The patient’s severed muscles and torn epiglottis were reattached using a simple interrupted suture pattern. Hyoepiglotticus muscles could not be identified. The bilateral thyrohyoid bone fractures were repaired with intraosseous wire suture. A temporary tracheostomy tube and an esophageal feeding tube were placed postoperatively. The dog was discharged after 8 days, re-examined at 2 and 6 months and laryngeal and pharyngeal function were evaluated as normal. To the authors’ knowledge, this is the first report of a dog that presented with laryngeal trauma with hyoid bone fracture and acute dyspnea that underwent surgical treatment resulting in an acceptable outcome. PMID:27579303

  1. Larynx trauma and hyoid bone fracture after bite injury in dog: case report

    Directory of Open Access Journals (Sweden)

    George Manchi

    2016-08-01

    Full Text Available An 8-year-old male Jack Russell crossbreed dog was admitted to our hospital with dyspnoea and shock following a dog-bite injury on the ventral neck. Radiographs revealed subcutaneous emphysema and bilateral thyrohyoid bone fractures. Intra-operatively, rupture of both sternohyoid muscles, both hyoepiglotticus muscles, both thyrohyoid muscles and a partial cranial rupture of the superficial sphincter colli muscle were detected. Part of the epiglottis was detached from the thyroid cartilage. The patient’s severed muscles and torn epiglottis were reattached using a simple interrupted suture pattern. Hyoepiglotticus muscles could not be identified. The bilateral thyrohyoid bone fractures were repaired with intraosseous wire suture. A temporary tracheostomy tube and an esophageal feeding tube were placed postoperatively. The dog was discharged after 8 days, re-examined at 2 and 6 months and laryngeal and pharyngeal function were evaluated as normal. To the authors’ knowledge, this is the first report of a dog that presented with laryngeal trauma with hyoid bone fracture and acute dyspnea who underwent surgical treatment resulting in an acceptable outcome.

  2. The role of impairment of mesenchymal stem cell function in osteoporotic bone fracture healing.

    Science.gov (United States)

    Zhang, Lihai; Miramini, Saeed; Richardson, Martin; Mendis, Priyan; Ebeling, Peter

    2017-09-01

    With demographic change and increasing life expectancy, osteoporotic fractures have become one of the most prevalent trauma conditions seen in daily clinical practice. A variety of factors are known to affect the rate of healing in osteoporotic conditions (e.g. both biochemical and biomechanical environment of callus cells). However, the influence of impairment of mesenchymal stem cell function in the osteoporotic condition on bone fracture healing has not been fully understood. In the present study, we develop a mathematical model that quantifies the change in biological processes within the fracture callus as a result of osteoporosis. The model includes special features of osteoporosis such as reduction in mesenchymal stem cell (MSC) number in osteoporotic bone, impaired response of osteoporotic MSCs to their biomechanical microenvironment and the effects of configuration of locking compression plate (LCP) system on healing in this context. The results presented here suggest that mechanically-mediated MSCs differentiation at early stages of healing are significantly affected under osteoporotic conditions, while it is predicted that the flexible fixation achieved by increasing bone-plate distance of LCP could alleviate the negative effects of osteoporosis on healing. The outcomes of this study could potentially lead to patient specific surgical solutions, and thus achieve optimal healing outcomes in osteoporotic conditions.

  3. The clinical application of radionuclide bone scan in patients with femoral neck fracture

    International Nuclear Information System (INIS)

    Sun Yongming; Dong Qirong; Liu Zengli; Yang Yi; Tang Jun; Wu Jingchang

    2004-01-01

    Objective: To investigate the clinical value of bone scan for evaluation of patients with femoral neck fracture. Methods: The data of bone scan, surgical operation, and osteonecrosis of the femoral head after operation of 420 patients were statistically analyzed. The region of interest (ROI) ratios of the fractured head of femur to contralateral counterpart, head to shaft of femur and head to anterior superior iliac spine were calculated and compared with those of controls. Results: The rate of internal fixation operation performed on the patients without femoral head ischemia was higher than those with femoral head ischemia, and the rate of hip arthroplasty was lower. In patients with femoral head ischemia prior to operation, more patients suffered osteonecrosis of the femoral head after operation compared with the patients without femoral head ischemia. The ROI ratio of patients with femoral head ischemia was significantly lower than that of controls. Conclusion: For fractured femoral neck, bone scan prior to the operation has certain significance for selecting surgical program in clinical practice, and also has important value in predicting prognosis. (authors)

  4. Need for Bone Grafts in the Surgical Treatment of Displaced Intra-Articular Calcaneal Fractures.

    Science.gov (United States)

    Duymus, Tahir Mutlu; Mutlu, Serhat; Mutlu, Harun; Ozel, Omer; Guler, Olcay; Mahirogullari, Mahir

    Controversy is ongoing regarding the use of bone grafts to fill cavities that occur with collapse of the posterior facet in the joint and for repair of the calcaneal height with plating. The present study included 40 patients with 43 displaced intra-articular calcaneal fractures treated with open reduction and internal fixation from March 2009 to November 2013. In the present case-control study, the patients were separated into 2 groups: group A received an allograft (20 patients, 22 calcaneal fractures) and group B did not (20 patients, 21 calcaneal fractures). The calcaneal height and Böhler's angle were compared between the 2 groups. The final outcomes for all patients were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle hindfoot scale score and compared between the 2 groups. No significant differences were observed between the groups with regard to the basic demographic variables (p > .05). Using Sanders classification, 8 (18%) were type 2, 19 (44%) were type 3, and 16 (37%) were type 4 fractures. The comparisons between the 2 groups showed a loss of Böhler's angle and loss of calcaneal height that was significantly greater in group B (p  .05). In conclusion, although no differences were found in the clinical results between the 2 groups, more satisfactory radiologic results were obtained in group A, in which bone grafts were used. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  5. [Application of bone flap pedicled on retrograde branch of radial artery for treatment of old scaphoid bone fractures of type AO-B].

    Science.gov (United States)

    Sun, Qing-peng

    2015-05-01

    To investigate application of the bone flap pedicled on the retrograde branch of radial artery for treatment of old scaphoid bone fractures of type AO-B. From October 2007 to October 2011,41 patients with old scaphoid bone fractures of type AO-B were treated by transplantation of the bone flap pedicled on the retrograde branch of radial artery including 26 males and 15 females with an average of (27.3±4.5) years old ranging from 16 to 43 years old. The courses before operation ranged from 6 to 22 months with an average of 11 months. All fractures belonged to the type B of AO classification, that is old wrist fracture of scaphoid bone. All patients' wrist function (pain, function, motion, grip strength) were evaluated by Cooney's modifiedwrist scoring system before and 6 months after operation,and the conditions of bone healing were observed during the follow-up time. Among them, 36 patients were followed up from 4 to 15 months with an average of 8.3 months. The wounds were healed well without other complications as infection appearing. X-rays or CT confirmed that all fractures were healed completely. The Cooney wrist score was improved from preoperative 53.61±13.97 to postoperative 81.81±8.71 (Pfractures,which is scientific and has curative effects, and valuable for clinical application.

  6. Plasma B vitamins, homocysteine and their relation with bone loss and hip fracture in elderly men and women

    Science.gov (United States)

    Elevated homocysteine is a strong risk factor for osteoporotic fractures among elders, yet it may be a marker for low B vitamin status. Objective: To examine the associations of plasma concentrations of folate, vitamin B12, vitamin B6 and homocysteine with bone loss and hip fracture risk in elderly...

  7. Histopathological examination of bone debris from reaming of interlocking intra-medullary nail fixation of long bone fractures with concomitant head injury.

    Science.gov (United States)

    Khallaf, Fathy G; Kehinde, Elijah O

    2015-12-01

    The aim of study was to test, for the presence of osteoblasts in the reaming debris of intramedullary nailing of femoral and tibial fracture in patients with and without severe head injury. Two groups of patients were studied. Group A (n = 32) had long bone fractures in addition to having head injuries. Group B (n = 35) had only long bone fractures. The fractures in the 2 groups of patients was treated by inter medullary nailing. Osteoblasts in the debris of the inter medullary nailing was compared between the 2 groups of patients. The results demonstrated that histopathological specimens from reaming debris of fractured femur and tibia in patients with head injury showed osteoblasts in (82.9%) and in (27.5%) of patients with isolated long bone fractures (p fractures and concomitant head injury confirm fast and adequate healing in these patients and the presence of plenty of osteoblasts in their reaming debris may reflect a proof of accelerated fracture healing environment.

  8. Open Intramedullary Nailing for Segmental Long Bone Fractures: An Effective Alternative in a Resource-restricted Environment

    Science.gov (United States)

    Babalola, Olasunkanmi M; Ibraheem, Gbadebo Hakeem; Ahmed, Bola A; Olawepo, Ayokunle; Agaja, Samuel B; Adeniyi, Adebowale

    2016-01-01

    Background: Closed, locked intramedullary nailing has been accepted as the gold standard in the care of femoral fractures, with reported union rates as high as 98–100%. Closed, locked intramedullary nailing often requires expensive equipment which is a challenge in developing countries. Segmental long bone fractures are often a result of high-energy trauma and hence often associated with a lot of injuries to the surrounding soft tissues. This consequently results in higher rates of delayed or nonunion. This study was proposed to review the outcome of management of segmental fractures with locked intramedullary nails, using an open method of reduction. Methods: A retrospective analysis was made of data obtained from all segmental long bone fractures treated with intramedullary nailing over a 1-year period. Records were retrieved from the folders of patients operated on from January 2011 to December 2011. Patients were followed up for a minimum of 1 year after the surgery. Results: We managed a total of 12 segmental long bone fractures in 11 patients. Eight of the 12 fractures were femoral fractures and 10 of the fractures were closed fractures. All but one fracture (91.7%) achieved union within 4 months with no major complications. Conclusions: Open method of locked intramedullary nailing achieves satisfactory results when used for the management of long bone fractures. The method can be used for segmental fractures of the humerus, femur, and tibia, with high union rates. This is particularly useful in low-income societies where the use of intraoperative imaging may be unavailable or unaffordable. It gives patients in such societies, a chance for comparable outcomes in terms of union rates as well as avoidance of major complications. Larger prospective studies will be necessary to conclusively validate the efficacy of this fixation method in this environment. PMID:27843272

  9. An ultrasound wearable system for the monitoring and acceleration of fracture healing in long bones.

    Science.gov (United States)

    Protopappas, Vasilios C; Baga, Dina A; Fotiadis, Dimitrios I; Likas, Aristidis C; Papachristos, Athanasios A; Malizos, Konstantinos N

    2005-09-01

    An ultrasound wearable system for remote monitoring and acceleration of the healing process in fractured long bones is presented. The so-called USBone system consists of a pair of ultrasound transducers, implanted into the fracture region, a wearable device and a centralized unit. The wearable device is responsible to carry out ultrasound measurements using the axial-transmission technique and initiate therapy sessions of low-intensity pulsed ultrasound. The acquired measurements and other data are wirelessly transferred from the patient-site to the centralized unit, which is located in a clinical setting. The evaluation of the system on an animal tibial osteotomy model is also presented. A dataset was constructed for monitoring purposes consisting of serial ultrasound measurements, follow-up radiographs, quantitative computed tomography-based densitometry and biomechanical data. The animal study demonstrated the ability of the system to collect ultrasound measurements in an effective and reliable fashion and participating orthopaedic surgeons accepted the system for future clinical application. Analysis of the acquired measurements showed that the pattern of evolution of the ultrasound velocity through healing bones over the postoperative period monitors a dynamic healing process. Furthermore, the ultrasound velocity of radiographically healed bones returns to 80% of the intact bone value, whereas the correlation coefficient of the velocity with the material and mechanical properties of the healing bone ranges from 0.699 to 0.814. The USBone system constitutes the first telemedicine system for the out-hospital management of patients sustained open fractures and treated with external fixation devices.

  10. Application of calcium phosphates and fibronectin as complementary treatment for osteoporotic bone fractures.

    Science.gov (United States)

    Plaza, Javier Quintana; Garzón, Lorena Benito; Gimenez, Beatriz Bravo; Moraleda, Belén Fernández-Montes; Collía, Francisco; Rodríguez-Lorenzo, Luis M

    2016-09-01

    The gradual aging of the population results in increased incidence of osteoporotic bone fractures. In a good quality bone, the fixation with the usual methods is adequate, but not in osteoporotic bone, in which consolidation delays and other complications are common, with failure rates for screws up to 25%. To test fibronectin loaded hydroxyapatite as a complementary treatment for osteoporotic fractures. This study was performed in a vivo model; 42 female osteoporotic adult rabbits 4-5kg (White New Zealand) were used. Two groups (hydroxyapatite and fibronectin loaded hydroxyapatite) and a control group were tested. 3 time points 24h, 48h and 5days were studied. Defects were created in both femurs, in one of them, a cannulated screw (4mm) and a biocompatible material were placed; in the other femur a screw was inserted without supplemented material forming the control group. Osteoporosis was induced from models already known throughout administration of steroids. Samples were analyzed histologically and through imaging (micro Ct). Basal levels of BMD are observed below to normal when compared to other studies (0.25/0.3 instead of 0.4). Global and dependent of time analysis of samples, show no significant differences for samples analyzed. However, an important trend was noted for variables that define the trabecular bone microarchitecture. Indices that define trabecular microarchitecture in the comparative analysis found to have statistical differences (p<0.01). Osteosynthesis in an osteoporotic bone is a challenge for the surgeon, due to a reduced bone mineral density and different bone architecture. The main finding was the verification of the hypothesis that the trabecular bone parameters increases with our augmentation material in weak rabbit bone quality. Also, the histological analyses of samples show an increase of non inflammatory cells in protein samples (OHAp-Fn) from the first 24hours. An early response of rabbit osteroporotic bone to a complementary

  11. [Treatment of open femur fracture with critical bone loss of femoral shaft in politrauma patient--case report].

    Science.gov (United States)

    Skowronek, Paweł; Dutka, Julian; Skowronek, Michał; Dutka, Łukasz

    2011-01-01

    The authors describe the case of a 21 year old patient who suffered an politrauma injury in a traffic accident (motorcyclist). Presentation of possiblities of treatment femur bone fracture with critical bone loss using intramedullary nail. Patients's Injury included: fractures of the femur, temporal bone, and ulna. The patient's Severity Score (ISS) was 24. The dominant trauma fracture was open, comminuted fracture of femur shaft (AO 32-C2, Anderson-Gustilo IIIa) with bone loss stated as critical (loss of femoral shaft over 10 cm, including the loss of more than 50% of the circumference was about 8 cm length, and the loss of the full circumference of more than two branches of the missing bone). Osteosynthesisnad bone length reconstruction of the femur was with use of intramedullary locking nail. Full reconstruction was regenerated after 12 months. Although there was extensive injury no local and general complications appeared. Early definitive fracture stabilization and secondary dynamisation possible to obtain the bone regeneration at the defect site.

  12. [Atypical fracture of metatarsal bone in a patient with multiple myeloma who was treated long-term with bisphosphonates].

    Science.gov (United States)

    Adam, Z; Sprláková-Puková, A; Chaloupka, R; Krejčí, M; Pour, L; Král, Z; Mayer, J

    2013-11-01

    The first reports found in professional literature on the use of bisphosphonates as a treatment date back to 1972. We found the first report on the use of a bisphosphonate comprising nitrogen in its molecule in a publication from 1990. Some of the adverse effects of the particular types of bisphosphonates were described in the registration studies. At least two serious adverse effects of this group of medicines had not been described until 2000. We found the first description of jaw osteonecrosis in relation to the longterm application of bisphosphonates in a publication from 2002 and we found the first description of an atypical bone fracture originating without a corresponding traumatic event in a location with no presence of an osteolytic focus in an article from 2006. These so  called atypical fractures, which are also called fractures without a corresponding traumatic event (low energy fractures), have been described to have occurred in femurs, in the pelvis and less frequently in the metatarsal area. "Atypical fractures" are linked to longterm administration of bisphosphonates, which significantly increases the bone density and impedes osteolysis but it simultaneously increases the fragility of bones and decreases their flexibility. The definition of an atypical fracture of the skeleton emphasises the fact that such fractures occur with an inadequately minimal force (energy) in the aforementioned predilection locations. In the following text we are describing a patient who has been treated for a multiple myeloma with an atypical fracture of the Metatarsal bone 2. This fracture occurred during a regular walk without any excessive load and the patient could not recall any corresponding injury or longer walking. The patient had been administered bisphosphonates for 34 months before the atypical metatarsal fracture occurred. The metatarsal bone fracture was treated through a nonweight  bearing regime for the sole and the pain diminished within a single month

  13. Behavioral differences of laying hens with fractured keel bones within furnished cages

    Directory of Open Access Journals (Sweden)

    Teresa Marie Casey-Trott

    2016-05-01

    Full Text Available High prevalence of keel bone fractures in laying hens is reported in all housing systems. Keel fractures have been associated with pain and restricted mobility in hens in loose housing. The objective was to determine whether keel fractures were associated with activity of hens in furnished cages. Thirty-six pairs of LSL Lite hens (72 wk were enrolled in the study. One hen with a fractured keel and one hen without were identified by palpation in each of 36 groups of hens housed in either 30 or 60-bird cages stocked at 750cm2/hen. Behavioral activity of each hen was recorded by four observers blind to keel status using focal animal sampling for 10 min within a 2 hr period in the morning (08:00-10:00, afternoon (12:00-14:00, and evening (17:00-19:00. All hens were observed during each of the three sample periods for three days totaling 90 min, and individual hen data was summed for analysis. Hens were euthanized 48hr after final observations, dissected, and classified by keel status: F0 (no fracture, N=24; F1 (single fracture, N=17; F2 (multiple fractures, N=31. The percentages of time hens performed each behavior were analyzed using a mixed procedure in SAS with fracture severity, body weight, cage size, rearing environment, and tier in the model. Fracture severity affected the duration of perching (P=0.04 and standing (P=0.001, bout length of standing (P<0.0001, and location (floor vs perch of resting behaviors (P=0.01. F2 hens perched longer than F0 hens, 20.0% ± 2.9 and 11.6% ± 3.2. F2 hens spent less time standing, 15.2% ± 1.5, than F0 and F1 hens, 20.7% ± 1.6 and 21.6% ± 1.8. F2 hens had shorter standing bouts (22.0 sec ± 4.2 than both F0 and F1 hens, 33.1 sec ± 4.3 and 27.4 sec ± 4.4. Non-fractured hens spent 80.0% ± 6.9 of total resting time on the floor whereas F1 and F2 hens spent 56.9% ± 12.4 and 51.5% ± 7.7, resting on the floor. Behavioral differences reported here provide insight into possible causes of keel damage, or

  14. Assessing vertebral fracture risk on volumetric quantitative computed tomography by geometric characterization of trabecular bone structure

    Science.gov (United States)

    Checefsky, Walter A.; Abidin, Anas Z.; Nagarajan, Mahesh B.; Bauer, Jan S.; Baum, Thomas; Wismüller, Axel

    2016-03-01

    The current clinical standard for measuring Bone Mineral Density (BMD) is dual X-ray absorptiometry, however more recently BMD derived from volumetric quantitative computed tomography has been shown to demonstrate a high association with spinal fracture susceptibility. In this study, we propose a method of fracture risk assessment using structural properties of trabecular bone in spinal vertebrae. Experimental data was acquired via axial multi-detector CT (MDCT) from 12 spinal vertebrae specimens using a whole-body 256-row CT scanner with a dedicated calibration phantom. Common image processing methods were used to annotate the trabecular compartment in the vertebral slices creating a circular region of interest (ROI) that excluded cortical bone for each slice. The pixels inside the ROI were converted to values indicative of BMD. High dimensional geometrical features were derived using the scaling index method (SIM) at different radii and scaling factors (SF). The mean BMD values within the ROI were then extracted and used in conjunction with a support vector machine to predict the failure load of the specimens. Prediction performance was measured using the root-mean-square error (RMSE) metric and determined that SIM combined with mean BMD features (RMSE = 0.82 +/- 0.37) outperformed MDCT-measured mean BMD (RMSE = 1.11 +/- 0.33) (p < 10-4). These results demonstrate that biomechanical strength prediction in vertebrae can be significantly improved through the use of SIM-derived texture features from trabecular bone.

  15. Internal fixation and muscle pedicle bone grafting in femoral neck fractures

    Directory of Open Access Journals (Sweden)

    Gupta A

    2008-01-01

    Full Text Available Background: The treatment of displaced intracapsular femoral neck fracture is still an unsolved problem. Non-union and avascular necrosis are the two main complications of this fracture, especially if patient presents late. Muscle pedicle bone grafting has been advocated to provide additional blood supply. We present analysis of our 32 cases of displaced femoral neck fracture treated by internal fixation and quadratus femoris based muscle pedicle bone grafting. Materials and Methods: Open reduction and internal fixation with muscle pedicle grafting was done in 32 patients. The age of patients varied from 14-62 years (average age 45 years with male to female ratio of 13:3. Twenty-nine fractures were more than three weeks old. All the cases were treated by Meyers′ procedure. The fracture was internally fixed after open reduction and then a muscle pedicle graft was applied. It was supplemented by cancellous bone graft in seven cases. Fixation was done by parallel cancellous lag screws ( n = 19, crossed Garden′s screws ( n = 7, parallel Asnis screws ( n = 5 and Moore′s pin ( n = 1.Quadratus femoris muscle pedicle graft was used in 32 cases. In the initial 12 cases the graft was fixed with circumferential proline sutures, but later, to provide a secure fixation, the graft was fixed with a cancellous screw ( n = 20. Postoperative full weight bearing was deferred to an average of 10 weeks. Results: Union was achieved in 26/29 (89.65% cases which could be followed for an average period of 3.4 years, (2-8.5 years with good functional results and had the ability to squat and sit cross-legged. Results were based on hip rating system given by Salvatti and Wilson. The results were excellent in 15 cases, good in four cases, fair in four cases and poor in six cases. Complications were avascular necrosis ( n = 2, transient foot drop ( n = 2, coxa-vara ( n = 1 and temporary loss of scrotal sensation ( n = 1. Conclusion: Muscle pedicle bone grafting with

  16. Differences of bone healing in metaphyseal defect fractures between osteoporotic and physiological bone in rats.

    Science.gov (United States)

    Thormann, Ulrich; El Khawassna, Thaqif; Ray, Seemun; Duerselen, Lutz; Kampschulte, Marian; Lips, Katrin; von Dewitz, Helena; Heinemann, Sascha; Heiss, Christian; Szalay, Gabor; Langheinrich, Alexander C; Ignatius, Anita; Schnettler, Reinhard; Alt, Volker

    2014-03-01

    Discrepancies in bone healing between osteoporotic and non-osteoporotic bone remain uncertain. The focus of the current work is to evaluate potential healing discrepancies in a metaphyseal defect model in rat femora. Female Sprague-Dawley rats were either ovariectomized (OVX, n=14) and combined with a calcium-, phosphorus- and vitamin D3-, soy- and phytoestrogen-free diet or received SHAM operation with standard diet rat (SHAM, n=14). Three months post-ovariectomy, DEXA measurement showed a reduction of bone mineral density reflecting an osteoporotic bone status in OVX rats. Rats then underwent a 3 mm wedge-shaped osteotomy at the distal metaphyseal area of the left femur stabilized with a T-shaped mini-plate and allowed to heal for 6 weeks. Biomechanical competence by means of a non-destructive three-point bending test showed significant lower flexural rigidity in the OVX rats at 3 mm lever span compared to SHAM animals (p=0.048) but no differences at 10 mm lever span. Microcomputer tomography (μCT) showed bridging cortices and consolidation of the defect in both groups, however, no measurable differences were found in either total ossified tissue or vascular volume fraction. Furthermore, histology showed healing discrepancies that were characterized by cartilaginous remnant and more unmineralized tissue presence in the OVX rats compared to more mature consolidation appearance in the SHAM group. In summary, bone defect healing in metaphyseal bone slightly differs between osteoporotic and non-osteoporotic bone in the current 3 mm defect model in both 3mm lever span biomechanical testing and histology. Copyright © 2013 Elsevier Ltd. All rights reserved.

  17. Identification of Nasal Bone Fractures on Conventional Radiography and Facial CT: Comparison of the Diagnostic Accuracy in Different Imaging Modalities and Analysis of Interobserver Reliability.

    Science.gov (United States)

    Baek, Hye Jin; Kim, Dong Wook; Ryu, Ji Hwa; Lee, Yoo Jin

    2013-09-01

    There has been no study to compare the diagnostic accuracy of an experienced radiologist with a trainee in nasal bone fracture. To compare the diagnostic accuracy between conventional radiography and computed tomography (CT) for the identification of nasal bone fractures and to evaluate the interobserver reliability between a staff radiologist and a trainee. A total of 108 patients who underwent conventional radiography and CT after acute nasal trauma were included in this retrospective study. Two readers, a staff radiologist and a second-year resident, independently assessed the results of the imaging studies. Of the 108 patients, the presence of a nasal bone fracture was confirmed in 88 (81.5%) patients. The number of non-depressed fractures was higher than the number of depressed fractures. In nine (10.2%) patients, nasal bone fractures were only identified on conventional radiography, including three depressed and six non-depressed fractures. CT was more accurate as compared to conventional radiography for the identification of nasal bone fractures as determined by both readers (P fractures. For the identification of nasal bone fractures, CT was significantly superior to conventional radiography. Although a staff radiologist showed better values in the identification of nasal bone fracture and differentiation between depressed and non-depressed fractures than a trainee, there was no statistically significant difference in the interpretation of conventional radiography and CT between a radiologist and a trainee.

  18. Successful reimplantation of extruded long bone segments in open fractures of lower limb--a report of 3 cases.

    Science.gov (United States)

    Shanmuganathan, Rajasekaran; Chandra Mohan, Arun Kamal; Agraharam, Devendra; Perumal, Ramesh; Jayaramaraju, Dheenadhayalan; Kulkarni, Sunil

    2015-07-01

    Extruded bone segments are rare complication of high energy open fractures. Routinely these fractures are treated by debridement followed by bone loss management in the form of either bone transport or free fibula transfer. There are very few reports in the literature about reimplantation of extruded segments of bone and there are no clear guidelines regarding timing of reimplantation, bone stabilisation and sterilisation techniques. Reimplantation of extruded bone is a risky procedure due to high chances of infection which determines the final outcome and can result in secondary amputations. We present two cases of successful reimplantation of extruded diaphyseal segment of femur and one case of reimplantation of extruded segment of tibia. Copyright © 2015 Elsevier Ltd. All rights reserved.

  19. Fracture patterns of the growth plate and surrounding bone in the ovine knee joint at different ages.

    Science.gov (United States)

    Celarek, A; Fischerauer, S F; Weinberg, A M; Tschegg, E K

    2014-01-01

    Fractures of the growth plate region were performed with cadaver specimens obtained from the ovine distal femur and proximal tibia. Specimens of 6 different ages, ranging from 1 week to 4 years, were investigated in order to determine changes in the fracture characteristics. Mechanical properties (crack resistance and notch tensile strength), supported by microscopy of the distal tibia (thickness of growth plate and its zones, trabecular bone volume ratio) were determined. The crack propagated through different regions depending on age, which was observed both in microscopy and mechanical tests. In specimens of younger animals the fracture typically went through trabecular bone, often parallel to the growth plate, and only sometimes through the growth plate cartilage. Specimens of older animals fractured directly through the growth plate cartilage, while trabecular bone was not affected at all. Adult specimens had significantly higher mechanical values than the young ones. The results reveal the underlying mechanical properties that induce different fracture patterns of the epiphyseal growth plate at different stages of growth. The possibility of fractures through trabecular bone parallel to the growth plate in newborns and infants should be considered when clinical radiographs of paediatric fractures are analysed and classified. © 2013 Elsevier Ltd. All rights reserved.

  20. Maternal smoking during pregnancy is associated with childhood bone fractures in offspring - A birth-cohort study of 6718 children.

    Science.gov (United States)

    Parviainen, Roope; Auvinen, Juha; Pokka, Tytti; Serlo, Willy; Sinikumpu, Juha-Jaakko

    2017-08-01

    In children there is limited understanding about the biological and environmental risk factors of fractures. Therefore, we aimed to study the effect of maternal smoking on preschool children's fractures hypothesizing that the fracture risk might be programmed during intrauterine growth in means of disturbed bone formation. A prospective birth cohort included women living in Northern Finland with an expected date of delivery between July 1st, 1985 and June 30th, 1986 (N=9362), and their offspring (N=9432). Smoking was inquired during pregnancy and when the offspring reached seven years of age. Information on in-hospital-treated fractures among the children was collected from the National Hospital Discharge Register (NHDR). The cases who declined to participate or suffered from any bone dysplasia such as osteogenesis imperfecta or any malignancy were excluded, thus 6718 subjects (71.2%) were finally included. Poisson regression analysis with adjustment for gender, asthma, rheumatoid arthritis, socioeconomic status of the family, maternal age and body mass index (BMI) of the children was used to determine the association between maternal smoking during pregnancy and bone fractures. Maternal smoking during pregnancy was associated with a 1.83-fold (95% CI 1.06-3.02, p=0.022) increased risk of in-hospital-treated fractures at pre-school age. The fracture risk in childhood is perhaps increased as a result of modified bone development of the fetus due to maternal smoking. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Characterizing trabecular bone structure for assessing vertebral fracture risk on volumetric quantitative computed tomography

    Science.gov (United States)

    Nagarajan, Mahesh B.; Checefsky, Walter A.; Abidin, Anas Z.; Tsai, Halley; Wang, Xixi; Hobbs, Susan K.; Bauer, Jan S.; Baum, Thomas; Wismüller, Axel

    2015-03-01

    While the proximal femur is preferred for measuring bone mineral density (BMD) in fracture risk estimation, the introduction of volumetric quantitative computed tomography has revealed stronger associations between BMD and spinal fracture status. In this study, we propose to capture properties of trabecular bone structure in spinal vertebrae with advanced second-order statistical features for purposes of fracture risk assessment. For this purpose, axial multi-detector CT (MDCT) images were acquired from 28 spinal vertebrae specimens using a whole-body 256-row CT scanner with a dedicated calibration phantom. A semi-automated method was used to annotate the trabecular compartment in the central vertebral slice with a circular region of interest (ROI) to exclude cortical bone; pixels within were converted to values indicative of BMD. Six second-order statistical features derived from gray-level co-occurrence matrices (GLCM) and the mean BMD within the ROI were then extracted and used in conjunction with a generalized radial basis functions (GRBF) neural network to predict the failure load of the specimens; true failure load was measured through biomechanical testing. Prediction performance was evaluated with a root-mean-square error (RMSE) metric. The best prediction performance was observed with GLCM feature `correlation' (RMSE = 1.02 ± 0.18), which significantly outperformed all other GLCM features (p < 0.01). GLCM feature correlation also significantly outperformed MDCTmeasured mean BMD (RMSE = 1.11 ± 0.17) (p< 10-4). These results suggest that biomechanical strength prediction in spinal vertebrae can be significantly improved through characterization of trabecular bone structure with GLCM-derived texture features.

  2. Frontal plane fractures of the accessory carpal bone and implications for the carpal sheath of the digital flexor tendons.

    Science.gov (United States)

    Minshall, G J; Wright, I M

    2014-09-01

    Accurate radiological and ultrasonographic descriptions of frontal plane fractures of the accessory carpal bone (ACB) are lacking, and implications of these fractures for the carpal sheath and its contents have not previously been reported. Aims were as follows: 1) to describe the location and radiological features of frontal plane fractures of the ACB; 2) to document communication of displaced fractures with the carpal sheath and consequent injury to the deep digital flexor tendon (DDFT); 3) to describe ultrasonographic identification of lesions; and 4) to report tenoscopic evaluation and treatment. Retrospective case series. Analysis of frontal plane fractures of the ACB referred to a single hospital between 2006 and 2012, including review of radiographic, ultrasonographic and tenoscopic images. Nine fractures were identified, of which 8 displaced fractures all communicated with the carpal sheath. Comminuted fragments and/or protruding fracture margins lacerated the lateral margin of the enclosed DDFT. This was identifiable ultrasonographically and confirmed at tenoscopy in 7 cases. Treatment in these horses consisted of removal of torn tendon tissue together with fragmentation and protuberant fracture edges, and 7 of 7 cases returned to work. One horse with a nondisplaced fracture was managed with immobilisation; the fracture healed, and the horse returned to work. One horse with a displaced fracture was retired to stud. Frontal plane fractures of the ACB occur palmar to the groove in its lateral margin for the tendon of insertion of ulnaris lateralis. Comminuted fragments can displace distally within the carpal sheath to a mid-metacarpal level or abaxially to lie extrathecally, lateral to the parent bone. Displaced fractures communicate with the carpal sheath and traumatise the DDFT. © 2013 EVJ Ltd.

  3. How reliable and accurate is the AO/OTA comprehensive classification for adult long-bone fractures?

    Science.gov (United States)

    Meling, Terje; Harboe, Knut; Enoksen, Cathrine H; Aarflot, Morten; Arthursson, Astvaldur J; Søreide, Kjetil

    2012-07-01

    Reliable classification of fractures is important for treatment allocation and study comparisons. The overall accuracy of scoring applied to a general population of fractures is little known. This study aimed to investigate the accuracy and reliability of the comprehensive Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association classification for adult long-bone fractures and identify factors associated with poor coding agreement. Adults (>16 years) with long-bone fractures coded in a Fracture and Dislocation Registry at the Stavanger University Hospital during the fiscal year 2008 were included. An unblinded reference code dataset was generated for the overall accuracy assessment by two experienced orthopedic trauma surgeons. Blinded analysis of intrarater reliability was performed by rescoring and of interrater reliability by recoding of a randomly selected fracture sample. Proportion of agreement (PA) and kappa (κ) statistics are presented. Uni- and multivariate logistic regression analyses of factors predicting accuracy were performed. During the study period, 949 fractures were included and coded by 26 surgeons. For the intrarater analysis, overall agreements were κ = 0.67 (95% confidence interval [CI]: 0.64-0.70) and PA 69%. For interrater assessment, κ = 0.67 (95% CI: 0.62-0.72) and PA 69%. The accuracy of surgeons' blinded recoding was κ = 0.68 (95% CI: 0.65- 0.71) and PA 68%. Fracture type, frequency of the fracture, and segment fractured significantly influenced accuracy whereas the coder's experience did not. Both the reliability and accuracy of the comprehensive Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association classification for long-bone fractures ranged from substantial to excellent. Variations in coding accuracy seem to be related more to the fracture itself than the surgeon. Diagnostic study, level I.

  4. Outcomes of long bone fractures treated by open intramedullary nailing at the St. Ann's Bay Hospital, Jamaica.

    Science.gov (United States)

    Barnes, D; McDowell, D

    2010-10-01

    Between May 2001 to August 2004, 35 patients had open nailing of long bones. There were 40 fractures fixed. Of these 40 fractures, there were 25 femoral fractures, 11 were tibial fractures and 4 were humeral fractures. There were 33 (82.5%) closed fractures and 7 (17.5%) open fractures. In the group of patients with open fractures, there were two Grade I, two Grade II and three Grade IIIB. Seven (20%) patients were lost to follow-up; all of whom had closed fractures. The final analysis as it relates to complications was done using 28 patients with 32 fractures. The majority of fractures healed without significant complication. All the patients with closed fractures went on to bony union. There was one non-union and three delayed unions. There were two infections (osteomyelitis) and this was from the open fracture cohort. This represents an infection rate of 28.6% in this cohort. Two (7.0%) patients had persistent pain and one (3.6%) patient had early removal of the nail because of failure of fixation. The mean time from injury to surgery for the fractured femur was 15.5 (range 0-49) days; fractured tibia 24.4 (range 0-40), days and fractured humerus 41.5 (20-81) days. The mean hospital stay was 18.9 (range 9-37) days for patients with fractured femur; for fractured tibia, it was 20.5 (range 3-82) days and for fractured humerus, it was 22.7 (range 3-82) days. The mean postoperative stay was 4.1 (range 1-14) days for fractured femur, 4.5 (range 1-14) days for fractured tibia and 4.0 (range 1-10) days for fractured humerus. The mean time to healing (consolidation) as defined by X-rays was 5.0 (range 3-11) months for fractured femur 5.2 (range 3-11) months for tibia and 7.0 (range 6-8) months for fractured humerus.

  5. Looking beyond low bone mineral density: multiple insufficiency fractures in a woman with post-menopausal osteoporosis on alendronate therapy.

    Science.gov (United States)

    Lee, P; van der Wall, H; Seibel, M J

    2007-01-01

    Insufficiency fractures occur most commonly in the pelvic girdle and in the sacrum, followed by the tibia and the femoral neck. Insufficiency fractures of the femoral diaphyses are rare, with only few reported cases in the literature. The strongest associations exist with untreated osteoporosis. We describe an unusual case of multiple insufficiency fractures in a 73-yr-old Chinese woman who presented with a 10-month history of bilateral groin pain and difficulty with walking in the absence of trauma, diagnosed 18 months following the commencement of anti-resorptive therapy with alendronate. The pathogenesis of such insufficiency fractures is poorly understood, but next to low bone mineral density and micro-architectural damage likely involves other components such as changes in bone turnover and patient-related factors (e.g. non-compliance). This case report and review of the literature draws attention to some of the challenges in the diagnosis and management of such rare insufficiency fractures.

  6. Bisphosphonate-associated atypical sub-trochanteric femur fractures: paired bone biopsy quantitative histomorphometry before and after teriparatide administration.

    Science.gov (United States)

    Miller, Paul D; McCarthy, Edward F

    2015-04-01

    Bisphosphonate-associated atypical sub-trochanteric femur fractures (ASFF) may be seen with long-term bisphosphonate use, though these fractures are also seen in patients never exposed to bisphosphonates. One theory for the mechanism of action whereby bisphosphonates may induce these ASFF is over-suppression of bone turnover. Bisphosphonates suppress bone turnover, but in bisphosphonate clinical trials, over-suppression defined whether by maintaining the biochemical markers of bone turnover below the defined reference range or by quantitative bone histomorphometry, has not been observed. We studied 15 clinic patients referred to The Colorado Center for Bone Research (CCBR) after they had a bisphosphonate-associated ASFF and performed quantitative bone histomorphometry both before and after 12 months of teriparatide (20µg SQ/day). All patients had been on long-term alendronate (mean = 7 years, range: 6-11 years) and had already had intramedullary rods placed when first seen (6 weeks to 7 months after rod placement). Alendronate had been discontinued in all patients at the time of their first clinic visit to CCBR. All of the fractures fulfilled The American Society for Bone and Mineral Research major radiological criteria for ASFF. Three key dynamic histomorphometric features show that 7 of the 15 patients had unmeasurable bone formation, mineralizing surface, and mineral apposition, while the other 8 patients had measurable dynamic parameters; although for all 15 patients, the mean values for all 3 dynamic parameters was far below the average for the published normal population. Administration of teriparatide was associated with an increase in all 3 dynamic histomorphometric parameters. Baseline bone turnover markers did not correlate with the baseline histomorphometry. While there is heterogeneity in the bone turnover in patients with bisphosphonate ASFF, there is a large portion in this uncontrolled series that had absent bone turnover at the standard biopsy site

  7. High fluoride and low calcium levels in drinking water is associated with low bone mass, reduced bone quality and fragility fractures in sheep.

    Science.gov (United States)

    Simon, M J K; Beil, F T; Rüther, W; Busse, B; Koehne, T; Steiner, M; Pogoda, P; Ignatius, A; Amling, M; Oheim, R

    2014-07-01

    Chronic environmental fluoride exposure under calcium stress causes fragility fractures due to osteoporosis and bone quality deterioration, at least in sheep. Proof of skeletal fluorosis, presenting without increased bone density, calls for a review of fracture incidence in areas with fluoridated groundwater, including an analysis of patients with low bone mass. Understanding the skeletal effects of environmental fluoride exposure especially under calcium stress remains an unmet need of critical importance. Therefore, we studied the skeletal phenotype of sheep chronically exposed to highly fluoridated water in the Kalahari Desert, where livestock is known to present with fragility fractures. Dorper ewes from two flocks in Namibia were studied. Chemical analyses of water, blood and urine were executed for both cohorts. Skeletal phenotyping comprised micro-computer tomography (μCT), histological, histomorphometric, biomechanical, quantitative backscattered electron imaging (qBEI) and energy-dispersive X-ray (EDX) analysis. Analysis was performed in direct comparison with undecalcified human iliac crest bone biopsies of patients with fluoride-induced osteopathy. The fluoride content of water, blood and urine was significantly elevated in the Kalahari group compared to the control. Surprisingly, a significant decrease in both cortical and trabecular bones was found in sheep chronically exposed to fluoride. Furthermore, osteoid parameters and the degree and heterogeneity of mineralization were increased. The latter findings are reminiscent of those found in osteoporotic patients with treatment-induced fluorosis. Mechanical testing revealed a significant decrease in the bending strength, concurrent with the clinical observation of fragility fractures in sheep within an area of environmental fluoride exposure. Our data suggest that fluoride exposure with concomitant calcium deficit (i) may aggravate bone loss via reductions in mineralized trabecular and cortical bone

  8. Delayed Union of a Sacral Fracture: Percutaneous Navigated Autologous Cancellous Bone Grafting and Screw Fixation

    International Nuclear Information System (INIS)

    Huegli, R. W.; Messmer, P.; Jacob, A. L.; Regazzoni, P.; Styger, S.; Gross, T.

    2003-01-01

    Delayed or non-union of a sacral fracture is a serious clinical condition that may include chronic pain, sitting discomfort, gait disturbances, neurological problems, and inability to work. It is also a difficult reconstruction problem. Late correction of the deformity is technically more demanding than the primary treatment of acute pelvic injuries. Open reduction, internal fixation (ORIF), excision of scar tissue, and bone grafting often in a multi-step approach are considered to be the treatment of choice in delayed unions of the pelvic ring. This procedure implies the risk of neurological and vascular injuries, infection, repeated failure of union, incomplete correction of the deformity, and incomplete pain relief as the most important complications. We report a new approach for minimally invasive treatment of a delayed union of the sacrum without vertical displacement. A patient who suffered a Malgaigne fracture (Tile C1.3) was initially treated with closed reduction and percutaneous screw fixation (CRPF) of the posterior pelvic ring under CT navigation and plating of the anterior pelvic ring. Three months after surgery he presented with increasing hip pain caused by a delayed union of the sacral fracture. The lesion was successfully treated percutaneously in a single step procedure using CT navigation for drilling of the delayed union, autologous bone grafting, and screw fixation

  9. Stress fractures of the base of the metatarsal bones in young trainee ballet dancers

    Science.gov (United States)

    Albisetti, Walter; De Bartolomeo, Omar; Tagliabue, Lorenzo; Camerucci, Emanuela; Calori, Giorgio Maria

    2009-01-01

    Classical ballet is an art form requiring extraordinary physical activity, characterised by rigorous training. These can lead to many overuse injuries arising from repetitive minor trauma. The purpose of this paper is to report our experience in the diagnosis and treatment of stress fractures at the base of the second and third metatarsal bones in young ballet dancers. We considered 150 trainee ballet dancers from the Ballet Schools of "Teatro Alla Scala" of Milan from 2005 to 2007. Nineteen of them presented with stress fractures of the base of the metatarsal bones. We treated 18 dancers with external shockwave therapy (ESWT) and one with pulsed electromagnetic fields (EMF) and low-intensity ultrasound (US); all patients were recommended rest. In all cases good results were obtained. The best approach to metatarsal stress fractures is to diagnose them early through clinical examination and then through X-ray and MRI. ESWT gave good results, with a relatively short time of rest from the patients’ activities and a return to dancing without pain. PMID:19415273

  10. Stress fractures of the base of the metatarsal bones in young trainee ballet dancers.

    Science.gov (United States)

    Albisetti, Walter; Perugia, Dario; De Bartolomeo, Omar; Tagliabue, Lorenzo; Camerucci, Emanuela; Calori, Giorgio Maria

    2010-02-01

    Classical ballet is an art form requiring extraordinary physical activity, characterised by rigorous training. These can lead to many overuse injuries arising from repetitive minor trauma. The purpose of this paper is to report our experience in the diagnosis and treatment of stress fractures at the base of the second and third metatarsal bones in young ballet dancers. We considered 150 trainee ballet dancers from the Ballet Schools of "Teatro Alla Scala" of Milan from 2005 to 2007. Nineteen of them presented with stress fractures of the base of the metatarsal bones. We treated 18 dancers with external shockwave therapy (ESWT) and one with pulsed electromagnetic fields (EMF) and low-intensity ultrasound (US); all patients were recommended rest. In all cases good results were obtained. The best approach to metatarsal stress fractures is to diagnose them early through clinical examination and then through X-ray and MRI. ESWT gave good results, with a relatively short time of rest from the patients' activities and a return to dancing without pain.

  11. Determining when a fracture occurred: Does the method matter? Analysis of the similarity of three different methods for estimating time since fracture of juvenile long bones.

    Science.gov (United States)

    Drury, Anne; Cunningham, Craig

    2018-01-01

    Radiographic fracture date estimation is a critical component of skeletal trauma analysis in the living. Several timetables have been proposed for how the appearance of radiographic features can be interpreted to provide a likely time frame for fracture occurrence. This study compares three such timetables for pediatric fractures, by Islam et al. (2000), Malone et al. (2011), and Prosser et al. (2012), in order to determine whether the fracture date ranges produced by using these methods are in agreement with one another. Fracture date ranges were estimated for 112 long bone fractures in 96 children aged 1-17 years, using the three different timetables. The extent of similarity of the intervals was tested by statistically comparing the overlap between the ranges. Results showed that none of the methods were in perfect agreement with one another. Differences seen included the size of the estimated date range for when a fracture occurred, and the specific dates given for both the upper and lower ends of the fracture date range. There was greater similarity between the ranges produced by Malone et al. (2011) and both the other two studies than there was between Islam et al. (2000) and Prosser et al. (2012). The greatest similarity existed between Malone et al. (2011) and Islam et al. (2000). The extent of differences between methods can vary widely, depending on the fracture analysed. Using one timetable gives an average earliest possible fracture date of less than 2 days before another, but the range was extreme, with one method estimating minimum time since fracture as 25 days before another method for a given fracture. In most cases, one method gave maximum time since fracture as a week less than the other two methods, but range was extreme and some estimates were nearly two months different. The variability in fracture date estimates given by these timetables indicates that caution should be exercised when estimating the timing of a juvenile fracture if relying

  12. Bone fracture toughness and strength correlate with collagen cross-link maturity in a dose-controlled lathyrism mouse model.

    Science.gov (United States)

    McNerny, Erin M B; Gong, Bo; Morris, Michael D; Kohn, David H

    2015-03-01

    Collagen cross-linking is altered in many diseases of bone, and enzymatic collagen cross-links are important to bone quality, as evidenced by losses of strength after lysyl oxidase inhibition (lathyrism). We hypothesized that cross-links also contribute directly to bone fracture toughness. A mouse model of lathyrism using subcutaneous injection of up to 500 mg/kg β-aminopropionitrile (BAPN) was developed and characterized (60 animals across 4 dosage groups). Three weeks of 150 or 350 mg/kg BAPN treatment in young, growing mice significantly reduced cortical bone fracture toughness, strength, and pyridinoline cross-link content. Ratios reflecting relative cross-link maturity were positive regressors of fracture toughness (HP/[DHLNL + HLNL] r(2)  = 0.208, p toughness and strength. Thus, cross-link profile perturbations associated with bone disease may provide insight into bone mechanical quality and fracture risk. © 2014 American Society for Bone and Mineral Research.

  13. Polymorphisms of muscle genes are associated with bone mass and incident osteoporotic fractures in Caucasians

    DEFF Research Database (Denmark)

    Harsløf, Torben; Nielsen, Morten Frost Munk; Nielsen, T L

    2013-01-01

    .02 (95 % CI 1.20-3.41, p = 0.01). The same allele was associated with increased bone loss (BMC) at the total hip of 4.1 versus 0.5 % in individuals either heterozygous or homozygous for the common allele (p = 0.006), a reduced 10-year growth in bone area at the total hip of 0.4 versus 2.2 and 2......The interaction between muscle and bone is complex. The aim of this study was to investigate if variations in the muscle genes myostatin (MSTN), its receptor (ACVR2B), myogenin (MYOG), and myoD1 (MYOD1) were associated with fracture risk, bone mineral density (BMD), bone mineral content (BMC......), and lean body mass. We analyzed two independent cohorts: the Danish Osteoporosis Prevention Study (DOPS), comprising 2,016 perimenopausal women treated with hormone therapy or not and followed for 10 years, and the Odense Androgen Study (OAS), a cross-sectional, population-based study on 783 men aged 20...

  14. Case of femoral diaphyseal stress fracture after long-term risedronate administration diagnosed by iliac bone biopsy

    Directory of Open Access Journals (Sweden)

    Nagai T

    2013-04-01

    Full Text Available Takashi Nagai, Keizo Sakamoto, Koji Ishikawa, Emi Saito, Takuma Kuroda, Katsunori Inagaki Department of Orthopaedic Surgery, Showa University School of Medicine, Shinagwa-ku, Tokyo, Japan Abstract: Bisphosphonate excessively inhibits bone resorption and results in pathological fracture of the femur or ilium. The subject of this study was administered risedronate for 7 years; we suspected an easy fracture of the femoral diaphysis. In this study, we report the results of this patient's bone biopsy and bone morphometric analysis. A 76-year-old female patient presented with right femoral pain. Bone mineral density of the anteroposterior surface of the 2nd to 4th lumbar vertebrae (L2-L4 was decreased and levels of bone turnover markers were high. Therefore, we initiated treatment with risedronate. As she continued the medication, urinary levels of cross-linked N-terminal telopeptides of type I collagen and alkaline phosphatase (bone-type isozyme were found to be within the normal ranges. After 7 years of administration, the patient experienced pain when she put weight on the right femur and right femoral pain while walking. Plain radiographic examination revealed polypoid stress fracture-like lesions on the right femoral diaphysis and on the slightly distal-lateral cortical bone. Similar lesions were observed on magnetic resonance imaging and bone scintigraphy. We suspected severely suppressed bone turnover. Bone biopsy was obtained after labeling with tetracycline, and bone morphometric analysis was performed. On microscopic examination, slight double tetracycline labeling was observed. The trabeculae were narrow, and the numbers of osteoblasts and osteoclasts were decreased. Further, rates of bone calcification and bone formation were slow. Hence, we diagnosed fracture as a result of low turnover osteopathy. Risedronate was withdrawn, and Vitamin D3 was administered to improve the bone turnover. At 6 months, abnormal signals on magnetic resonance

  15. The interplay of transcriptional and post-transcriptional regulation of migration of mesenchymal stem cells during early stages of bone fracture healing.

    Science.gov (United States)

    Dong, C-H; Deng, Y-S; Yang, X-J; Liu, J; Liu, R; Hou, F-Y; Li, S-S; Zhen, P

    2017-12-01

    Bone fractures are a medical condition where the continuity of the bone is broken due to a fall or accident. The fracture may also be the result of medical conditions such as osteoporosis, cancers of bone or osteogenesis imperfect. During the bone fracture healing process, the mesenchymal stem cells (undifferentiated connective tissue cells) are recruited from local and systemic sources. The modulation of mesenchymal cell migration to the fractured site is the desired goal. Still, there are many processes that are still required to be studied and analyzed. We aimed to consolidate and review the available information on this topic.

  16. Cancer therapy associated bone loss: Implications for hip fractures in mid-life women with breast cancer

    Science.gov (United States)

    Edwards, Beatrice J.; Raisch, Dennis W.; Shankaran, Veena; McKoy, June M.; Gradishar, William; Bunta, Andrew D.; Samaras, Athena T.; Boyle, Simone N.; West, Dennis P.; Guise, Theresa A.

    2010-01-01

    Purpose Aromatase inhibitors (AIs) have been recently associated with hip fractures. We present a case series of breast cancer survivors and a systematic review of bone health care in breast cancer. Experimental Design We completed clinical assessments and bone density testing (BMD) of hip fractures from January 2005–December 2008. Pre-fracture and 12-month functional status was obtained. Systematic review included case reports and review of MEDLINE, PubMed, EMBASE, and Food and Drug Administration Adverse Event Reporting System (FDA AERS) from January 1998–December 2008 (search terms: breast cancer, bone loss, osteopenia, osteoporosis, malignancy, cancer treatment, menopause, adriamycin, cytoxan, tamoxifen, and AIs). Results Median age was 53.5 years; five women had osteopenia, one osteoporosis. Five cases were ER (+), and received surgery, XRT chemotherapy, and anastrozole. Functional decline was noted at 12 months, with difficulty in performing heavy housekeeping, climbing stairs and shopping. The FDA AERS database included 228 cases of fractures associated with breast cancer therapy; 77/228 (29.4%) were hip or femur fractures. Among mid-life women under the age of 64 years there were 78 fractures; 15/228 (19%) were hip and femur fractures. AIs were the most common drug class associated with fractures (n=149, 65%). Conclusions CTIBL results in hip fractures among mid-life women with breast cancer. Hip fractures occur at younger ages and higher BMD than expected for patients in this age group without breast cancer. Hip fractures result in considerable functional decline. Greater awareness of this adverse drug effect is needed. PMID:21288927

  17. Surface Reconstruction from Parallel Curves with Application to Parietal Bone Fracture Reconstruction.

    Directory of Open Access Journals (Sweden)

    Abdul Majeed

    Full Text Available Maxillofacial trauma are common, secondary to road traffic accident, sports injury, falls and require sophisticated radiological imaging to precisely diagnose. A direct surgical reconstruction is complex and require clinical expertise. Bio-modelling helps in reconstructing surface model from 2D contours. In this manuscript we have constructed the 3D surface using 2D Computerized Tomography (CT scan contours. The fracture part of the cranial vault are reconstructed using GC1 rational cubic Ball curve with three free parameters, later the 2D contours are flipped into 3D with equidistant z component. The constructed surface is represented by contours blending interpolant. At the end of this manuscript a case report of parietal bone fracture is also illustrated by employing this method with a Graphical User Interface (GUI illustration.

  18. Combined Microwave Ablation and Cementoplasty in Patients with Painful Bone Metastases at High Risk of Fracture

    Energy Technology Data Exchange (ETDEWEB)

    Pusceddu, Claudio, E-mail: clapusceddu@gmail.com [Regional Referral Center for Oncologic Diseases, Division of Interventional Radiology, Department of Oncological Radiology, Ocological Hospital “A. Businco” (Italy); Sotgia, Barbara, E-mail: barbara.sotgia@gmail.com; Fele, Rosa Maria, E-mail: rosellafele@tiscali.it [Regional Referral Center for Oncological Diseases, Department of Oncological Radiology, Oncological Hospital “A. Businco” (Italy); Ballicu, Nicola, E-mail: nicolaballicu77@gmail.com [Regional Referral Center for Oncologic Diseases, Division of Interventional Radiology, Department of Oncological Radiology, Ocological Hospital “A. Businco” (Italy); Melis, Luca, E-mail: doclucamelis@tiscali.it [Regional Referral Center for Oncological Diseases, Department of Oncological Radiology, Oncological Hospital “A. Businco” (Italy)

    2016-01-15

    PurposeTo retrospectively evaluate the effectiveness of computed tomography-guided percutaneous microwave ablation (MWA) and cementoplasty in patients with painful bone metastases at high risk of fracture.Materials and MethodsThirty-five patients with 37 metastatic bone lesions underwent computed tomography-guided MWA combined with cementoplasty (polymethylmethacrylate injection). Vertebrae, femur, and acetabulum were the intervention sites and the primary end point was pain relief. Pain severity was estimated by visual analog scale (VAS) before treatment; 1 week post-treatment; and 1, 6, and 12 months post-treatment. Functional outcome was assessed by improved patient walking ability. Radiological evaluation was performed at baseline and 3 and 12 months post-procedure.ResultsIn all patients, pain reduction occurred from the first week after treatment. The mean reduction in the VAS score was 84, 90, 90 % at week 1, month 1, and month 6, respectively. Improved walking ability occurred in 100 and 98 % of cases at the 1- and 6-month functional outcome evaluations, respectively. At the 1-year evaluation, 25 patients were alive, and 10 patients (28 %) had died because of widespread disease. The mean reduction in the VAS score and improvement in surviving patients’ walking ability were 90 and 100 %, respectively. No patients showed evidence of local tumor recurrence or progression and pathological fracture in the treated sites.ConclusionOur results suggest that MWA combined with osteoplasty is safe and effective when treating painful bone metastases at high risk of fracture. The number of surviving patients at the 1-year evaluation confirms the need for an effective and long-lasting treatment.

  19. Nasal Carriage of 200 Patients with Nasal Bone Fracture in Korea

    Directory of Open Access Journals (Sweden)

    Jun Wook Lee

    2013-09-01

    Full Text Available BackgroundPathogens in the nasal cavity during nasal surgery could lead to a systemic infectious condition, such as bacteremia, nosocomial infection, or toxic shock syndrome. However, there is no research about the prevalence of nasal carriage in patients with nasal bone fracture.MethodsThis was a prospective, double-blind, randomized study about the rate of nasal carriage in 200 patients with nasal bone fracture in Korea. Nasal secretions were taken from both the middle nasal meatus and colonized. All analyses were carried out using SPSS software.ResultsPathogens were identified in 178 of the 200 cases. Coagulase-negative staphylococci (CNS were the most cultured bacteria in 127 (66.84% of the 190 total patients after excluding 10 cases of contaminated samples, and methicillin-resistant coagulase-negative staphylococci (MRCNS were found in 48 (25.26%. Staphylococcus aureus was the second most identified pathogen, found in 36 (18.95%, followed by 7 cases (3.68% of methicillin-resistant Staphylococcus aureus (MRSA. The prevalence rate of MRSA in the females was higher than that in the males (RR=4.70; 95% CI, 1.09-20.18, but other demographic factors had no effect on the prevalence rate of MRSA and MRCNS.ConclusionsThe prevalence rate of these pathogens in patients with nasal bone fracture in Korea was similar to other reports. However, few studies have addressed the prevalence rate of CNS and MRCNS in accordance with risk factors or the change in prevalence according to specific prophylaxis against infectious complications. Additional research is needed on the potential connections between clinical factors and microbiological data.

  20. Scaphoid fracture: Bone marrow edema detected with dual-energy CT virtual non-calcium images and confirmed with MRI

    Energy Technology Data Exchange (ETDEWEB)

    Dareez, Nazeer M.; Engesland, Eirin; Lindland, Elisabeth S. [Department of Radiology, SSHF Arendal, Arendal (Norway); Dahlslett, Kristine H. [Haukelands Universitetssjukehus, Department of Radiology, Bergen (Norway)

    2017-12-15

    We aimed to determine whether bone marrow edema (BME) in acute traumatic scaphoid fracture could be demonstrated with dual-energy CT (DECT) using MRI as the gold standard. In recent years, virtual non-calcium (VNCa) images have been used to demonstrate BME in trauma cases, for example, in vertebral compression fractures, hip trauma to detect occult fractures and knee fractures. We present three cases of acute scaphoid trauma. Two patients had subtle or invisible fractures on x-ray and conventional CT images, while DECT VNCa images clearly visualized the BME, which was confirmed by MRI. One patient had negative findings on both VNCa and MRI images. The DECT VNCa algorithm is a promising technique to demonstrate BME in scaphoid fractures, with potential for increasing the diagnostic value of CT in this type of injury. (orig.)

  1. Quantitative assessment of bone marrow attenuation values at MDCT: An objective tool for the detection of bone bruise related to occult sacral insufficiency fractures

    Energy Technology Data Exchange (ETDEWEB)

    Henes, F.O.; Groth, M.; Bley, T.A.; Regier, M.; Ittrich, H.; Adam, G.; Bannas, P. [University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Radiology, Hamburg (Germany); Nuechtern, J.V. [University Medical Center Hamburg-Eppendorf, Department of Trauma, Hand and Reconstructive Surgery, Hamburg (Germany); Treszl, A. [University Medical Center Hamburg-Eppendorf, Center for Experimental Medicine, Department of Medical Biometry and Epidemiology, Hamburg (Germany)

    2012-10-15

    To prove the feasibility of using Hounsfield attenuation values at MDCT to detect bone bruises related to sacral insufficiency fractures. Twenty-two patients with acute sacrum trauma and no fracture findings at MDCT were included in our prospective study. Two observers independently reviewed CTs regarding visual signs of bone bruises in 132 defined regions of the sacral alae. Interobserver agreement was tested by {kappa} statistics. Subsequently, HU values were obtained in the same regions, and attenuation differences between the two sides were calculated. Validity and reliability were assessed by intraclass correlation coefficient and Bland-Altman analysis. HU differences were subjected to ROC curve analysis to determine sensitivity, specificity, PPV and NPV. MRI served as standard reference. MRI revealed 19 regions with bone bruises and associated sacral insufficiency fractures. HU measurements demonstrated good validity and reliability (r = 0.989). ROC curve analysis exhibited an ideal cutoff value of 35.7 HU density difference between affected and non-affected regions. Visual evaluation revealed moderate agreement ({kappa} = 0.48); diagnostic accuracy was inferior to objective evaluation. Assessment of differences in bone marrow density by HU measurements is an objective and reliable tool for detection of bone bruises associated with occult sacral insufficiency fractures. (orig.)

  2. Quantitative measures of damage to subchondral bone are associated with functional outcome following treatment of displaced acetabular fractures.

    Science.gov (United States)

    Lubovsky, Omri; Kreder, Michael; Wright, David A; Kiss, Alex; Gallant, Aimee; Kreder, Hans J; Whyne, Cari M

    2013-12-01

    Current analysis of displaced acetabular fractures is limited in its ability to predict functional outcome. This study aimed to (1) quantify initial acetabular damage following acetabular fracture through measurement of subchondral bone density and fracture lines, and (2) evaluate associations between acetabular damage and functional outcomes following fracture. Subchondral bone intensity maps were created for 24 patients with unilateral acetabular fractures. Measures of crack length and density differences between corresponding regions in the fractured acetabuli, normalized by the unfractured side, were generated from preoperative CT images. Damage measures were compared to quality of life survey data collected for each patient at least 2 years post-injury (Musculoskeletal Functional Assessment [MFA] and Short Form-36 [SF-36], with specific focus on parameters that best describe patients' physical health). CT image quantification of initial damage to acetabular subchondral bone was associated with functional outcome post-injury. In general, damage as quantified through differences in density in the superior dome region (zones 8 and 12) and the central anterior region of the acetabulum (zone 3) were found to be the strongest significant predictors of functional outcome (adjusted R(2) = 0.3-0.45, p fractures toward improving clinical prognoses. © 2013 Orthopaedic Research Society.

  3. Vertebral Body Compression Fractures and Bone Density: Automated Detection and Classification on CT Images.

    Science.gov (United States)

    Burns, Joseph E; Yao, Jianhua; Summers, Ronald M

    2017-09-01

    Purpose To create and validate a computer system with which to detect, localize, and classify compression fractures and measure bone density of thoracic and lumbar vertebral bodies on computed tomographic (CT) images. Materials and Methods Institutional review board approval was obtained, and informed consent was waived in this HIPAA-compliant retrospective study. A CT study set of 150 patients (mean age, 73 years; age range, 55-96 years; 92 women, 58 men) with (n = 75) and without (n = 75) compression fractures was assembled. All case patients were age and sex matched with control subjects. A total of 210 thoracic and lumbar vertebrae showed compression fractures and were electronically marked and classified by a radiologist. Prototype fully automated spinal segmentation and fracture detection software were then used to analyze the study set. System performance was evaluated with free-response receiver operating characteristic analysis. Results Sensitivity for detection or localization of compression fractures was 95.7% (201 of 210; 95% confidence interval [CI]: 87.0%, 98.9%), with a false-positive rate of 0.29 per patient. Additionally, sensitivity was 98.7% and specificity was 77.3% at case-based receiver operating characteristic curve analysis. Accuracy for classification by Genant type (anterior, middle, or posterior height loss) was 0.95 (107 of 113; 95% CI: 0.89, 0.98), with weighted κ of 0.90 (95% CI: 0.81, 0.99). Accuracy for categorization by Genant height loss grade was 0.68 (77 of 113; 95% CI: 0.59, 0.76), with a weighted κ of 0.59 (95% CI: 0.47, 0.71). The average bone attenuation for T12-L4 vertebrae was 146 HU ± 29 (standard deviation) in case patients and 173 HU ± 42 in control patients; this difference was statistically significant (P high sensitivity and with a low false-positive rate, as well as to calculate vertebral bone density, on CT images. © RSNA, 2017 Online supplemental material is available for this article.

  4. Prevalent role of porosity and osteonal area over mineralization heterogeneity in the fracture toughness of human cortical bone.

    Science.gov (United States)

    Granke, Mathilde; Makowski, Alexander J; Uppuganti, Sasidhar; Nyman, Jeffry S

    2016-09-06

    Changes in the distribution of bone mineralization occurring with aging, disease, or treatment have prompted concerns that alterations in mineralization heterogeneity may affect the fracture resistance of bone. Yet, so far, studies assessing bone from hip fracture cases and fracture-free women have not reached a consensus on how heterogeneity in tissue mineralization relates to skeletal fragility. Owing to the multifactorial nature of toughening mechanisms occurring in bone, we assessed the relative contribution of heterogeneity in mineralization to fracture resistance with respect to age, porosity, and area fraction of osteonal tissue. The latter parameters were extracted from quantitative backscattered electron imaging of human cortical bone sections following R-curve tests of single-edge notched beam specimens to determine fracture toughness properties. Microstructural heterogeneity was determined as the width of the mineral distribution (bulk) and as the sill of the variogram (local). In univariate analyses of measures from 62 human donors (21 to 101 years), local but not bulk heterogeneity as well as pore clustering negatively correlated with fracture toughness properties. With age as covariate, heterogeneity was a significant predictor of crack initiation, though local had a stronger negative contribution than bulk. When considering all potential covariates, age, cortical porosity and area fraction of osteons explained up to 50% of the variance in bone׳s crack initiation toughness. However, including heterogeneity in mineralization did not improve upon this prediction. The findings of the present work stress the necessity to account for porosity and microstructure when evaluating the potential of matrix-related features to affect skeletal fragility. Published by Elsevier Ltd.

  5. Bisphosphonates inhibit pain, bone loss, and inflammation in a rat tibia fracture model of complex regional pain syndrome

    Science.gov (United States)

    Wang, Liping; Guo, Tian-Zhi; Wei, Tzuping; Li, Wen-wu; Shi, Xiaoyou; Clark, J David; Kingery, Wade S

    2016-01-01

    BACKGROUND Bisphosphonates are used to prevent the bone loss and fractures associated with osteoporosis, bone metastases, multiple myeloma, and osteogenis deformans. Distal limb fractures cause regional bone loss with cutaneous inflammation and pain in the injured limb that can develop into complex regional pain syndrome (CRPS). Clinical trials have reported that anti-resorptive bisphosphonates can prevent fracture-induced bone loss, inhibit serum inflammatory cytokine levels, and alleviate CRPS pain. Previously we observed that the inhibition of inflammatory cytokines or adaptive immune responses attenuated the development of pain behavior in a rat fracture model of CRPS and we hypothesized that bisphosphonates could prevent pain behavior, trabecular bone loss, post-fracture cutaneous cytokine up-regulation, and adaptive immune responses in this CRPS model. METHODS Rats underwent tibia fracture and cast immobilization for 4 weeks and were chronically administered either subcutaneously perfused alendronate or oral zoledronate. Behavioral measurements included hindpaw von Frey allodynia, unweighting, warmth, and edema. Bone microarchitecture was measured by uCT and bone cellular activity was evaluated by static and dynamic histomorphometry. Spinal cord Fos immunostaining was performed and skin cytokine (TNF, IL-1, IL-6) and nerve growth factor (NGF) levels were determined by EIA. Skin and sciatic nerve immunoglobulin levels were determined by EIA. RESULTS Tibia fracture rats developed hindpaw allodynia, unweighting, warmth, and edema, increased spinal Fos expression, trabecular bone loss in the lumbar vertebra and bilateral distal femurs as measured by uCT, increased trabecular bone resorption and osteoclast surface with decreased bone formation rates, increased cutaneous inflammatory cytokine and NGF expression and elevated immunocomplex deposition in skin and nerve. Alendronate (60 μg/kg/day s.c.) or zoledronate (3 mg/kg/day p.o.) treatment for 28 days, started

  6. 7 Tesla MRI of bone microarchitecture discriminates between women without and with fragility fractures who do not differ by bone mineral density.

    Science.gov (United States)

    Chang, Gregory; Honig, Stephen; Liu, Yinxiao; Chen, Cheng; Chu, Kevin K; Rajapakse, Chamith S; Egol, Kenneth; Xia, Ding; Saha, Punam K; Regatte, Ravinder R

    2015-05-01

    Osteoporosis is a disease of poor bone quality. Bone mineral density (BMD) has limited ability to discriminate between subjects without and with poor bone quality, and assessment of bone microarchitecture may have added value in this regard. Our goals were to use 7 T MRI to: (1) quantify and compare distal femur bone microarchitecture in women without and with poor bone quality (defined clinically by presence of fragility fractures); and (2) determine whether microarchitectural parameters could be used to discriminate between these two groups. This study had institutional review board approval, and we obtained written informed consent from all subjects. We used a 28-channel knee coil to image the distal femur of 31 subjects with fragility fractures and 25 controls without fracture on a 7 T MRI scanner using a 3-D fast low angle shot sequence (0.234 mm × 0.234 mm × 1 mm, parallel imaging factor = 2, acquisition time = 7 min 9 s). We applied digital topological analysis to quantify parameters of bone microarchitecture. All subjects also underwent standard clinical BMD assessment in the hip and spine. Compared to controls, fracture cases demonstrated lower bone volume fraction and markers of trabecular number, plate-like structure, and plate-to-rod ratio, and higher markers of trabecular isolation, rod disruption, and network resorption (p  0.05). In receiver-operating-characteristics analyses, microarchitectural parameters could discriminate cases and controls (AUC = 0.66-0.73, p energy X-ray absorptiometry (DXA).

  7. Role of bone mineral density in predicting morphometric vertebral fractures in patients with HIV infection.

    Science.gov (United States)

    Porcelli, T; Gotti, D; Cristiano, A; Maffezzoni, F; Mazziotti, G; Focà, E; Castelli, F; Giustina, A; Quiros-Roldan, E

    2014-09-01

    This study investigated the bone of HIV patients both in terms of quantity and quality. It was found that HIV-infected patients did fracture independently of the degree of bone demineralization as in other forms of secondary osteoporosis. We aimed to determine the prevalence of vertebral fractures (VFs) in HIV patients who were screened by bone mineral density (BMD) and to explore possible factors associated with VFs. This is a cross-sectional study that included HIV-infected patients recruited in the Clinic of Infectious and Tropical Diseases and that underwent BMD measurement by dual-energy X-ray absorptiometry (DXA) at the lumbar spine and hip (Lunar Prodigy, GE Healthcare). For the assessment of VFs, anteroposterior and lateral X-ray examinations of the thoracic and lumbar spines were performed and were centrally digitized. Logistic regression models were used in the statistical analysis of factors associated with VFs. One hundred thirty-one consecutive patients with HIV infection (93 M, 38 F, median age 51 years; range, 36-75) underwent BMD measurement: 25.2 % of patients showed normal BMD, while 45 % were osteopenic and 29.7 % osteoporotic. Prevalence of low BMD (osteopenia and osteoporosis) was higher in females as compared to males (90 vs 69 %) with no significant correlation with age and body mass index. VFs occurred more frequently in patients with low BMD as compared to patients with normal BMD (88.5 vs. 11.4 %; p osteoporosis (43 vs. 46 %; p = 0.073). VFs were significantly associated with older age and previous AIDS events. These results suggest a BMD patients at risk of skeletal fragility and, therefore, good candidates for morphometric evaluation of spine X-ray in line with other forms of secondary osteoporosis with impaired bone quality.

  8. LRP4 association to bone properties and fracture and interaction with genes in the Wnt- and BMP signaling pathways.

    Science.gov (United States)

    Kumar, Jitender; Swanberg, Maria; McGuigan, Fiona; Callreus, Mattias; Gerdhem, Paul; Akesson, Kristina

    2011-09-01

    Osteoporosis is a common complex disorder in postmenopausal women leading to changes in the micro-architecture of bone and increased risk of fracture. Members of the low-density lipoprotein receptor-related protein (LRP) gene family regulates the development and physiology of bone through the Wnt/β-catenin (Wnt) pathway that in turn cross-talks with the bone morphogenetic protein (BMP) pathway. In two cohorts of Swedish women: OPRA (n=1002; age 75 years) and PEAK-25 (n=1005; age 25 years), eleven single nucleotide polymorphisms (SNPs) from Wnt pathway genes (LRP4; LRP5; G protein-coupled receptor 177, GPR177) were analyzed for association with Bone Mineral Density (BMD), rate of bone loss, hip geometry, quantitative ultrasound and fracture. Additionally, interaction of LRP4 with LRP5, GPR177 and BMP2 were analyzed. LRP4 (rs6485702) was associated with higher total body (TB) and lumbar spine (LS) BMD in the PEAK-25 cohort (p=0.006 and 0.005 respectively), and interaction was observed with LRP5 (p=0.007) and BMP2 (p=0.004) for TB BMD. LRP4 also showed significant interaction with LRP5 for femoral neck (FN) and LS BMD in this cohort. In the OPRA cohort, LRP4 polymorphisms were associated with significantly lower fracture incidence overall (p=0.008-0.001) and fewer hip fractures (rs3816614, p=0.006). Significant interaction in the OPRA cohort was observed for LRP4 with BMP2 and GPR177 for FN BMD as well as for rate of bone loss at TB and FN (p=0.007-0.0001). In conclusion, LRP4 and interaction between LRP4 and genes in the Wnt and BMP signaling pathways modulate bone phenotypes including peak bone mass and fracture, the clinical endpoint of osteoporosis. Copyright © 2011 Elsevier Inc. All rights reserved.

  9. [Effect of different bone cement dispersion types in the treatment of osteoporotic vertebral compression fracture].

    Science.gov (United States)

    Zhao, Yong-Sheng; Li, Qiang; Li, Qiang; Zheng, Yan-Ping

    2017-05-25

    To observe different bone cement dispersion types of PVP, PKP and manipulative reduction PVP and their effects in the treatment of senile osteoporotic vertebral compression fractures and the bone cement leakage rate. The clinical data of patients with osteoporotic vertebral compression fractures who underwent unilateral vertebroplasty from January 2012 to January 2015 was retrospectively analyzed. Of them, 56 cases including 22 males and 34 females aged from 60 to 78 years old were treated by PVP operation; Fouty-eight cases including 17 males and 31 females aged from 61 to 79 years old were treated by PKP operation; Forty-three cases including 15 males and 28 females aged from 60 to 76 years old were treated by manipulative reduction PVP operation. AP and lateral DR films were taken after the operation; the vertebral bone cement diffusion district area and mass district area were calculated with AutoCAD graphics processing software by AP and lateral DR picture, then ratio(K) of average diffusion area and mass area were calculated, defining K100% as diffusion type. Different bone cement dispersion types of PVP, PKP and manipulative reduction PVP operation were analyzed. According to bone cement dispersion types, patients were divided into diffusion type, mixed type and mass type groups.Visual analogue scale (VAS), vertebral body compression rate, JOA score and bone cement leakage rate were observed. All patients were followed up for 12-24 months with an average of 17.2 months. There was significant difference in bone cement dispersion type among three groups ( P <0.05). The constituent ratio of diffusion type, mixed type and mass type in PVP operation was 46.43%, 35.71%, 17.86%, in PKP was 16.67%, 37.50% , 45.83%, and in manipulative reduction PVP was 37.21%, 44.19% and 18.60%, respectively. PVP operation and manipulative reduction PVP were mainly composed of diffusion type and mixed type, while PKP was mainly composed of mass type and mixed type. There was no

  10. Insertion Torques of Self-Drilling Mini-Implants in Simulated Mandibular Bone: Assessment of Potential for Implant Fracture.

    Science.gov (United States)

    Hosein, Yara K; Smith, Angie; Dunning, Cynthia E; Tassi, Ali

    2016-01-01

    Fracture of orthodontic mini-implants during insertion is a limiting factor for their clinical success. The purpose of this study was to determine the fracture potential of commonly used self-drilling orthodontic mini-implants when placed into simulated thick, dense mandibular bone. Six mini-implant systems were assessed for the potential for fracture (Aarhus, Medicon; Dual-Top, Jeil Medical; OrthoEasy, Forestadent; tomas-pin, Dentaurum; Unitek, 3M; and VectorTAS, Ormco). First, mini-implants were inserted manually, without predrilling, into bone substitutes (Sawbones) with a 3-mm-thick, dense (1.64 g/cm(3)) cortical layer. A custom-made insertion device was used for placement of mini-implants. A sixaxis force/torque transducer was secured at the base of the bone blocks to measure the maximum torque experienced during insertion. Measured insertion torques were compared with previously reported fracture torques, yielding a torque ratio (insertion torque as a percentage of fracture torque), which was used as an indicator of the potential for mini-implant fracture. Mini-implants that experienced torque ratios ≥ 75% upon insertion underwent further testing, following the manufacturer's recommendations for predrilling in thick, dense bone conditions. Significant differences in torque ratios were found among all mini-implants, except between OrthoEasy and Dual-Top, and OrthoEasy and VectorTAS. Overall, Aarhus had the highest torque ratio (91% ± 3%), with Unitek showing the lowest ratio (37% ± 3%). Aarhus and tomas-pin mini-implants displayed torque ratios ≥ 75% and experienced fracture upon insertion. When the manufacturer's specific predrilling recommendations were followed, no changes in torque ratio were found for Aarhus and tomas-pin. However, while Aarhus continued to fracture upon insertion, all tomas-pin mini-implants were inserted fully without fracture following predrilling. These findings support the safe use of Unitek, VectorTAS, Dual-Top, and Ortho

  11. Outcome of Distal Both Bone Leg Fractures Fixed by Intramedulary Nail for Fibula & MIPPO in Tibia

    Directory of Open Access Journals (Sweden)

    Anil Gupta

    2015-04-01

    Full Text Available Background:  Fractures of the distal third of the tibia are mostly associated with a fibular fracture that often requires fixation. The preferred treatment of distal tibial fracture is the minimally invasive percutaneous plate osteosynthesis  (MIPPO procedure. However, there are no clear cut guidelines on fixation of the fibular fracture and currently most orthopedic surgeons use a plate osteosynthesis for the fibula as well. A common complication associated with dual plating is an increased chance of soft tissue necrosis, infection, and in some cases resulting in an exposed implant. We conducted a prospective study to analyze the results of fractures of the distal in both leg bones managed by the MIPPO procedure for tibial fractures and a rush nail for fibular fractures.  Methods:  The study was conducted in a tertiary care hospital from November 2012 to May 2014, a total of 30 fractures in 30 patients (18 males, 12 females with a mean age of 42.4 years (26-60 years were treated in our institution in the aforesaid time period with MIPPO for tibia and rush nail for fibular fractures. All the cases were operated on by a single surgeon in emergency within 24 hours. The patients with skin blistering and compound fractures were excluded from this study. Rehabilitative measures were proceeded as per patient’s pain profile, isometric and isotonic exercises were started on the first post-operative day, with full weight bearing at 10-12 weeks after assessing clinical and radiological union. Regular follow up of patients was done, radiographs were taken at the immediate post-operative period and at 3, 6, 12 and 24 weeks.  Results:  All the patients were available for regular follow up. Radiological and clinical union proceeded normally in all the patients, no patients had signs of any deep infection, delayed union or nonunion, three patients had a superficial infection of the tibial incision that healed with a change in

  12. An epidemiological evaluation of pediatric long bone fractures - a retrospective cohort study of 2716 patients from two Swiss tertiary pediatric hospitals.

    Science.gov (United States)

    Joeris, Alexander; Lutz, Nicolas; Wicki, Bárbara; Slongo, Theddy; Audigé, Laurent

    2014-12-20

    Children and adolescents are at high risk of sustaining fractures during growth. Therefore, epidemiological assessment is crucial for fracture prevention. The AO Comprehensive Injury Automatic Classifier (AO COIAC) was used to evaluate epidemiological data of pediatric long bone fractures in a large cohort. Data from children and adolescents with long bone fractures sustained between 2009 and 2011, treated at either of two tertiary pediatric surgery hospitals in Switzerland, were retrospectively collected. Fractures were classified according to the AO Pediatric Comprehensive Classification of Long Bone Fractures (PCCF). For a total of 2716 patients (60% boys), 2807 accidents with 2840 long bone fractures (59% radius/ulna; 21% humerus; 15% tibia/fibula; 5% femur) were documented. Children's mean age (SD) was 8.2 (4.0) years (6% infants; 26% preschool children; 40% school children; 28% adolescents). Adolescent boys sustained more fractures than girls (p fractures was falls (27%), followed by accidents occurring during leisure activities (25%), at home (14%), on playgrounds (11%), and traffic (11%) and school accidents (8%). There was boy predominance for all accident types except for playground and at home accidents. The distribution of accident types differed according to age classes (p fracture distribution were sex and age related. Overweight and obese patients seemed to be at increased risk of sustaining fractures. Our data give valuable input into future development of prevention strategies. The AO PCCF proved to be useful in epidemiological reporting and analysis of pediatric long bone fractures.

  13. Ovariectomized Rats with Established Osteopenia have Diminished Mesenchymal Stem Cells in the Bone Marrow and Impaired Homing, Osteoinduction and Bone Regeneration at the Fracture Site.

    Science.gov (United States)

    Tewari, Deepshikha; Khan, Mohd Parvez; Sagar, Nitin; China, Shyamsundar P; Singh, Atul K; Kheruka, Subhash C; Barai, Sukanta; Tewari, Mahesh C; Nagar, Geet K; Vishwakarma, Achchhe L; Ogechukwu, Omeje E; Bellare, Jayesh R; Gambhir, Sanjay; Chattopadhyay, Naibedya

    2015-04-01

    We investigated deleterious changes that take place in mesenchymal stem cells (MSC) and its fracture healing competence in ovariectomy (Ovx)-induced osteopenia. MSC from bone marrow (BM) of ovary intact (control) and Ovx rats was isolated. (99m)Tc-HMPAO (Technitium hexamethylpropylene amine oxime) labeled MSC was systemically transplanted to rats and fracture tropism assessed by SPECT/CT. PKH26 labeled MSC (PKH26-MSC) was bound in scaffold and applied to fracture site (drill-hole in femur metaphysis). Osteoinduction was quantified by calcein binding and microcomputed tomography. Estrogen receptor (ER) antagonist, fulvestrant was used to determine ER dependence of osteo-induction by MSC. BM-MSC number was strikingly reduced and doubling time increased in Ovx rats compared to control. SPECT/CT showed reduced localization of (99m)Tc-HMPAO labeled MSC to the fracture site, 3 h post-transplantation in Ovx rats as compared with controls. Post-transplantation, Ovx MSC labeled with PKH26 (Ovx PKH26-MSC) localized less to fracture site than control PKH26-MSC. Transplantation of either control or Ovx MSC enhanced calcein binding and bone volume at the callus of control rats over placebo group however Ovx MSC had lower efficacy than control MSC. Fulvestrant blocked osteoinduction by control MSC. When scaffold bound MSC was applied to fracture, osteoinduction by Ovx PKH26-MSC was less than control PKH26-MSC. In Ovx rats, control MSC/E2 treatment but not Ovx MSC showed osteoinduction. Regenerated bone was irregularly deposited in Ovx MSC group. In conclusion, Ovx is associated with diminished BM-MSC number and its growth, and Ovx MSC displays impaired engraftment to fracture and osteoinduction besides disordered bone regeneration.

  14. Bone fractures and lumbar mineral density after renal transplantation. A long-term cross-sectional study.

    Science.gov (United States)

    Jiménez, Sara; Marcén, Roberto; Vaamonde, Carlos; Caballero, Carmen; Fernández-Rodríguez, Ana; Villafruela, Juan José; Galeano, Cristina; Teruel, José Luis; Quereda, Carlos

    2016-02-01

    The purpose of this work was to investigate the association of vertebral and peripheral fractures 10 yr after grafting with bone metabolic markers and body mass density (BMD). One hundred thirty-eight recipients with stable graft function were included in a cross-sectional study. Graft function, biochemical mineral metabolism markers and body mass density (DEXA) were measured. Vertebral fractures were assessed by a semiquantitative analysis of lateral spine X-ray exam. At the time of the study, intact parathyroid hormone levels were 127.5 ± 78.4 pg/mL and serum calcidiol 20.4 ± 9.3 ng/mL. DEXA showed osteopenia in 47% and osteoporosis in 23% at lumbar spine, 51% and 14% at femoral neck, and 53% and 8% at trochanter. Eighty-five recipients presented vertebral fractures, 69 mild and 16 moderate/severe fractures. In the multivariate analysis, vertebral fractures were associated with older age (p = 0.010), length of follow-up (p = 0.022) and trochanter T-score (p = 0.038). Twenty-three patients presented peripheral fractures and 19 of them also had vertebral fractures. Patients with peripheral fractures were younger, mostly women and had lower BMD. Vertebral fractures were associated with lower BMD at trochanter. Most fractures were mild and were several times more frequent than in general population. Their clinical significance needs to be determined. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  15. Predictors of Fracture Risk and Bone Mineral Density in Men with Prostate Cancer on Androgen Deprivation Therapy

    Directory of Open Access Journals (Sweden)

    Katherine Neubecker

    2011-01-01

    Full Text Available Decrease of bone mineral density (BMD and fracture risk is increased in men with prostate cancer receiving androgen deprivation therapy (ADT. We looked at possible predictors of decreased BMD and increased fracture risk in men with prostate cancer; most of whom were on ADT. In a retrospective study, we analyzed serum, BMD, and clinical risk factors used in the Fracture Risk Assessment (FRAX tool and others in 78 men with prostate cancer with reported height loss. The subjects were divided in two groups: 22 men with and 56 without vertebral fractures. 17 of the 22 men with vertebral fractures on spine X-rays did not know they had a vertebral fracture. Of those 17 men, 9 had not previously qualified for treatment based on preradiograph FRAX score calculated with BMD, and 6 based on FRAX calculated without BMD. Performing spine films increased the predictive ability of FRAX for vertebral fracture. Vertebral fracture was better predicted by FRAX for other osteoporotic fractures than FRAX for hip fractures. The inclusion of BMD in FRAX calculations did not affect the predictive ability of FRAX. The PSA level showed a positive correlation with lumbar spine BMD and accounted for about 9% of spine BMD.

  16. Change of Bone Mineral Density Measurement among Patients with Osteoporotic Fractures in Korean Population Using National Claim Database.

    Science.gov (United States)

    Park, Chan Ho; Lee, Young-Kyun; Ha, Yong-Chan

    2017-08-01

    Prior osteoporotic fractures are strongly associated with subsequent fractures. To prevent this, the diagnosis of osteoporosis following an osteoporotic fracture is important. The measurement of bone mineral density (BMD) is the first step in the diagnosis and management of osteoporosis. Therefore, this study aimed 1) to evaluate the rate of BMD measurement after osteoporotic fracture in the Korean population, and 2) to determine whether the rate of BMD measurement after osteoporotic fracture changed between 2005 and 2010. Using the database of the Health Insurance Review Assessment Service (HIRA), we identified patients with osteoporotic fractures (hip, spine, humerus, and wrist fractures) in 2005 and 2010. BMD examinations were evaluated by using procedure codes and medicines, exclusively approved for osteoporosis treatment. During the study period, about half of all patients with osteoporotic fractures had BMD measurement. Between 2005 and 2010, the rate of BMD measurement significantly increased from 42.0% (65,556/156,190) to 53.9% (103,785/192,556) ( P osteoporotic fractures had BMD measurement, and that screening for osteoporosis in patients with osteoporotic fractures increased between 2005 and 2010.

  17. Delayed cementless total hip arthroplasty for neglected dislocation of hip combined with complex acetabular fracture and deficient bone stock

    Directory of Open Access Journals (Sweden)

    Gavaskar Ashok S

    2012-12-01

    Full Text Available 【Abstract】Total hip arthroplasty (THA for an un-treated acetabular fracture is technically challenging and the long-term result is not so favorable. A 45-year-old fe-male patient with untreated column and comminuted poste-rior wall fracture of the acetabulum was treated in our insti-tution by reconstruction of the posterior wall using iliac strut autograft and plate stabilization of the posterior col-umn with cancellous grafting and cementless THA in a single stage. At 3 years’ follow-up, the patient was independently mobile without limb length discrepancy. Radiological evalu-ation showed well integrated components and bone grafts. No evidence of aseptic loosening or osteolysis was found. This report aims to emphasize that bony acetabular recon-struction allows the use of primary hip components, which improves prosthesis longevity and preserves bone stock for a future revision. Key words: Acetabulum; Fractures, bone; Hip dislocation; Arthroplasty, replacement, hip

  18. Two-Dimensional Image Fusion of Planar Bone Scintigraphy and Radiographs in Patients with Clinical Scaphoid Fracture: An Imaging Study

    DEFF Research Database (Denmark)

    Henriksen, O.M.; Lonsdale, M.N.; Jensen, T.D.

    2008-01-01

    experienced nuclear medicine physicians. In addition to the diagnosis, the degree of diagnostic confidence was scored in each case. Results: The addition of fusion images changed the interpretation of each of the three observers in seven, four, and two cases, respectively, reducing the number of positive....... Bone scintigraphy is highly sensitive for the detection of fractures, but exact localization of scintigraphic lesions may be difficult and can negatively affect diagnostic accuracy. Purpose: To investigate the influence of image fusion of planar bone scintigraphy and radiographs on image interpretation...... in patients with suspected scaphoid fracture. Material and Methods: In 24 consecutive patients with suspected scaphoid fracture, a standard planar bone scintigraphy of both hands was supplemented with fusion imaging of the injured wrist. Standard and fusion images were evaluated independently by three...

  19. Two-dimensional fusion imaging of planar bone scintigraphy and radiographs in patients with clinical scaphoid fracture: an imaging study

    DEFF Research Database (Denmark)

    Henriksen, Otto Mølby; Lonsdale, Markus Georg; Jensen, T D

    2009-01-01

    experienced nuclear medicine physicians. In addition to the diagnosis, the degree of diagnostic confidence was scored in each case. RESULTS: The addition of fusion images changed the interpretation of each of the three observers in seven, four, and two cases, respectively, reducing the number of positive....... Bone scintigraphy is highly sensitive for the detection of fractures, but exact localization of scintigraphic lesions may be difficult and can negatively affect diagnostic accuracy. PURPOSE: To investigate the influence of image fusion of planar bone scintigraphy and radiographs on image interpretation...... in patients with suspected scaphoid fracture. MATERIAL AND METHODS: In 24 consecutive patients with suspected scaphoid fracture, a standard planar bone scintigraphy of both hands was supplemented with fusion imaging of the injured wrist. Standard and fusion images were evaluated independently by three...

  20. On the effect of x-ray irradiation on the deformation and fracture behavior of human cortical bone

    Energy Technology Data Exchange (ETDEWEB)

    Barth, Holly D.; Launey, Maximilien E.; McDowell, Alastair A.; Ager III, Joel W.; Ritchie, Robert O.

    2010-01-10

    In situ mechanical testing coupled with imaging using high-energy synchrotron x-ray diffraction or tomography imaging is gaining in popularity as a technique to investigate micrometer and even sub-micrometer deformation and fracture mechanisms in mineralized tissues, such as bone and teeth. However, the role of the irradiation in affecting the nature and properties of the tissue is not always taken into account. Accordingly, we examine here the effect of x-ray synchrotron-source irradiation on the mechanistic aspects of deformation and fracture in human cortical bone. Specifically, the strength, ductility and fracture resistance (both work-of-fracture and resistance-curve fracture toughness) of human femoral bone in the transverse (breaking) orientation were evaluated following exposures to 0.05, 70, 210 and 630 kGy irradiation. Our results show that the radiation typically used in tomography imaging can have a major and deleterious impact on the strength, post-yield behavior and fracture toughness of cortical bone, with the severity of the effect progressively increasing with higher doses of radiation. Plasticity was essentially suppressed after as little as 70 kGy of radiation; the fracture toughness was decreased by a factor of five after 210 kGy of radiation. Mechanistically, the irradiation was found to alter the salient toughening mechanisms, manifest by the progressive elimination of the bone's capacity for plastic deformation which restricts the intrinsic toughening from the formation 'plastic zones' around crack-like defects. Deep-ultraviolet Raman spectroscopy indicated that this behavior could be related to degradation in the collagen integrity.

  1. Taylor spatial frame fixation in patients with multiple traumatic injuries: study of 57 long-bone fractures.

    Science.gov (United States)

    Sala, Francesco; Elbatrawy, Yasser; Thabet, Ahmed M; Zayed, Mahmoud; Capitani, Dario

    2013-08-01

    To evaluate the Taylor spatial frame (TSF) for primary and definitive fixation of lower limb long-bone fractures in patients with multiple traumatic injuries. Retrospective. Level I trauma center. Consecutive series of 52 patients, 57 fractures (25 femoral and 32 tibial), treated between 2005 and 2009. Forty-nine fractures (86%) were open. Injury Severity Score ≥16 for all patients. Fifty-four fractures (95%) underwent definitive fixation with the TSF and 3 were treated primarily within 48 hours of injury. In 22 cases (39%), fractures were acutely reduced with the TSF, fixed to bone and the struts in sliding mode without further adjustment, and in 35 cases (61%), the total residual deformity correction program was undertaken. Clinical and radiological. Complete union was obtained in 52 fractures (91%) without additional surgery at an average of 29 weeks. Four nonunions and 1 delayed union occurred. Results based on Association for the Study and Application of the Method of Ilizarov criteria: 74% excellent, 16% good, 4% fair, and 7% poor for bone outcomes and 35% excellent, 47% good, and 18% fair for functional outcomes. Eighty-eight percent of patients returned to preinjury work activities. Primary and definitive fixation with the TSF is effective. Advantages include continuity of device until union, reduced risk of infection, early mobilization, restoration of primary defect caused by bone loss, easy and accurate application, convertibility and versatility compared with a monolateral fixator, and improved union rate and range of motion for lower extremity long-bone fractures in patients with multiple traumatic injuries.

  2. Association of Protein Intake with Bone Mineral Density and Bone Mineral Content among Elderly Women: The OSTPRE Fracture Prevention Study.

    Science.gov (United States)

    Isanejad, M; Sirola, J; Mursu, J; Kröger, H; Tuppurainen, M; Erkkilä, A T

    2017-01-01

    It has been hypothesized that high protein intakes are associated with lower bone mineral content (BMC). Previous studies yield conflicting results and thus far no studies have undertaken the interaction of body mass index (BMI) and physical activity with protein intakes in relation to BMC and bone mineral density (BMD). To evaluate the associations of dietary total protein (TP), animal protein (AP) and plant protein (PP) intakes with BMC and BMD and their changes. We tested also the interactions of protein intake with, obesity (BMI ≤30 vs. >30 kg/m2) and physical activity level (passive vs. active). Design/ Setting: Prospective cohort study (Osteoporosis Risk-Factor and Fracture-Prevention Study). Participants/measures: At the baseline, 554 women aged 65-72 years filled out a 3-day food record and a questionnaire covering data on lifestyle, physical activity, diseases, and medications. Intervention group received calcium 1000 mg/d and cholecalciferol 800 IU for 3 years. Control group received neither supplementation nor placebo. Bone density was measured at baseline and year 3, using dual energy x-ray absorptiometry. Multivariable regression analyses were conducted to examine the associations between protein intake and BMD and BMC. In cross-sectional analyses energy-adjusted TP (P≤0·029) and AP (P≤0·045) but not PP (g/d) were negatively associated with femoral neck (FN) BMD and BMC. Women with TP≥1·2 g/kg/body weight (BW) (Ptrend≤0·009) had lower FN, lumbar spine (LS) and total BMD and BMC. In follow-up analysis, TP (g/kg/BW) was inversely associated with LS BMD and LS BMC. The detrimental associations were stronger in women with BMI30 kg/m2 and physical activity.

  3. Roles of Vitamins D and K, Nutrition, and Lifestyle in Low-Energy Bone Fractures in Children and Young Adults.

    Science.gov (United States)

    Karpiński, Michał; Popko, Janusz; Maresz, Katarzyna; Badmaev, Vladimir; Stohs, Sidney J

    2017-07-01

    The research on skeletal system health in children and young adults, while recognizing the important role of calcium and vitamin D, goes beyond these nutritional standards. This review focuses on the role of vitamin K in combination with vitamin D and other factors in bone health. The current understanding is that maintaining bone health and prevention of low-energy fractures in any pediatric population includes nutritional factors combined with an active lifestyle. Calcium, vitamin D, and vitamin K supplementation contribute independently and collectively to bone health. The beneficial role of vitamin K, particularly vitamin K2 as menaquinone-7 (MK-7), in bone and cardiovascular health is reasonably well supported scientifically, with several preclinical, epidemiological, and clinical studies published over the last decade. Osteocalcin and matrix-Gla (glutamate-containing) protein (MGP) exemplify vitamin K-dependent proteins involved in building bone matrix and keeping calcium from accumulating in the arterial walls, respectively. An important part of the mechanism of vitamin K involves carboxylation and posttranslational activation of the family of vitamin K-dependent proteins, which prevent expression of pro-inflammatory factors and support improvement in bone mineral concentration, bone mineral density, and the quality of bone matrix. Understanding the combined approach to a healthy skeletal system in children and young adults, including the roles of vitamins D and K, calcium, healthy diet, and exercise, is particularly important in view of reports of subclinical insufficiency of vitamins D and K in otherwise healthy pediatric populations with low-energy bone fractures.

  4. Review of techniques for monitoring the healing fracture of bones for implementation in an internally fixated pelvis.

    Science.gov (United States)

    Wong, Lydia Chwang Yuh; Chiu, Wing Kong; Russ, Matthias; Liew, Susan

    2012-03-01

    Sacral fractures from high-impact trauma often cause instability in the pelvic ring structure. Treatment is by internal fixation which clamps the fractured edges together to promote healing. Healing could take up to 12 weeks whereby patients are bedridden to avoid hindrances to the fracture from movement or weight bearing activities. Immobility can lead to muscle degradation and longer periods of rehabilitation. The ability to determine the time at which the fracture is stable enough to allow partial weight-bearing is important to reduce hospitalisation time. This review looks into different techniques used for monitoring the fracture healing of bones which could lead to possible methods for in situ and non-invasive assessment of healing fracture in a fixated pelvis. Traditional techniques being used include radiology and CT scans but were found to be unreliable at times and very subjective in addition to being non in situ. Strain gauges have proven to be very effective for accurate assessment of fracture healing as well as stability for long bones with external fixators but may not be suitable for an internally fixated pelvis. Ultrasound provides in situ monitoring of stiffness recovery but only assesses local fracture sites close to the skin surface and has only been tested on long bones. Vibration analysis can detect non-uniform healing due to its assessment of the overall structure but may suffer from low signal-to-noise ratio due to damping. Impedance techniques have been used to assess properties of non-long bones but recent studies have only been conducted on non-biological materials and more research needs to be done before it can be applicable for monitoring healing in the fixated pelvis. Copyright © 2011 IPEM. Published by Elsevier Ltd. All rights reserved.

  5. Whole-genome sequencing identifies EN1 as a determinant of bone density and fracture

    Science.gov (United States)

    Zheng, Hou-Feng; Forgetta, Vincenzo; Hsu, Yi-Hsiang; Estrada, Karol; Rosello-Diez, Alberto; Leo, Paul J; Dahia, Chitra L; Park-Min, Kyung Hyun; Tobias, Jonathan H; Kooperberg, Charles; Kleinman, Aaron; Styrkarsdottir, Unnur; Liu, Ching-Ti; Uggla, Charlotta; Evans, Daniel S; Nielson, Carrie M; Walter, Klaudia; Pettersson-Kymmer, Ulrika; McCarthy, Shane; Eriksson, Joel; Kwan, Tony; Jhamai, Mila; Trajanoska, Katerina; Memari, Yasin; Min, Josine; Huang, Jie; Danecek, Petr; Wilmot, Beth; Li, Rui; Chou, Wen-Chi; Mokry, Lauren E; Moayyeri, Alireza; Claussnitzer, Melina; Cheng, Chia-Ho; Cheung, Warren; Medina-Gómez, Carolina; Ge, Bing; Chen, Shu-Huang; Choi, Kwangbom; Oei, Ling; Fraser, James; Kraaij, Robert; Hibbs, Matthew A; Gregson, Celia L; Paquette, Denis; Hofman, Albert; Wibom, Carl; Tranah, Gregory J; Marshall, Mhairi; Gardiner, Brooke B; Cremin, Katie; Auer, Paul; Hsu, Li; Ring, Sue; Tung, Joyce Y; Thorleifsson, Gudmar; Enneman, Anke W; van Schoor, Natasja M; de Groot, Lisette C.P.G.M.; van der Velde, Nathalie; Melin, Beatrice; Kemp, John P; Christiansen, Claus; Sayers, Adrian; Zhou, Yanhua; Calderari, Sophie; van Rooij, Jeroen; Carlson, Chris; Peters, Ulrike; Berlivet, Soizik; Dostie, Josée; Uitterlinden, Andre G; Williams, Stephen R.; Farber, Charles; Grinberg, Daniel; LaCroix, Andrea Z; Haessler, Jeff; Chasman, Daniel I; Giulianini, Franco; Rose, Lynda M; Ridker, Paul M; Eisman, John A; Nguyen, Tuan V; Center, Jacqueline R; Nogues, Xavier; Garcia-Giralt, Natalia; Launer, Lenore L; Gudnason, Vilmunder; Mellström, Dan; Vandenput, Liesbeth; Karlsson, Magnus K; Ljunggren, Östen; Svensson, Olle; Hallmans, Göran; Rousseau, François; Giroux, Sylvie; Bussière, Johanne; Arp, Pascal P; Koromani, Fjorda; Prince, Richard L; Lewis, Joshua R; Langdahl, Bente L; Hermann, A Pernille; Jensen, Jens-Erik B; Kaptoge, Stephen; Khaw, Kay-Tee; Reeve, Jonathan; Formosa, Melissa M; Xuereb-Anastasi, Angela; Åkesson, Kristina; McGuigan, Fiona E; Garg, Gaurav; Olmos, Jose M; Zarrabeitia, Maria T; Riancho, Jose A; Ralston, Stuart H; Alonso, Nerea; Jiang, Xi; Goltzman, David; Pastinen, Tomi; Grundberg, Elin; Gauguier, Dominique; Orwoll, Eric S; Karasik, David; Davey-Smith, George; Smith, Albert V; Siggeirsdottir, Kristin; Harris, Tamara B; Zillikens, M Carola; van Meurs, Joyce BJ; Thorsteinsdottir, Unnur; Maurano, Matthew T; Timpson, Nicholas J; Soranzo, Nicole; Durbin, Richard; Wilson, Scott G; Ntzani, Evangelia E; Brown, Matthew A; Stefansson, Kari; Hinds, David A; Spector, Tim; Cupples, L Adrienne; Ohlsson, Claes; Greenwood, Celia MT; Jackson, Rebecca D; Rowe, David W; Loomis, Cynthia A; Evans, David M; Ackert-Bicknell, Cheryl L; Joyner, Alexandra L; Duncan, Emma L; Kiel, Douglas P; Rivadeneira, Fernando; Richards, J Brent

    2016-01-01

    SUMMARY The extent to which low-frequency (minor allele frequency [MAF] between 1–5%) and rare (MAF ≤ 1%) variants contribute to complex traits and disease in the general population is largely unknown. Bone mineral density (BM