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Sample records for lateral malleolar fracture

  1. Incidence of Peroneal Tendinopathy After Application of a Posterior Antiglide Plate for Repair of Supination External Rotation Lateral Malleolar Fractures.

    Science.gov (United States)

    Ahn, Jungtae; Kim, Sehun; Lee, Jung-Soo; Woo, Kyungjei; Sung, Ki-Sun

    2016-01-01

    Posterior antiglide plating is widely used to treat lateral malleolar fractures caused by supination-external rotation injuries. Despite its widespread use, this technique can be associated with postoperative peroneal tendinopathy. The purpose of the present observational review was to report the incidence of peroneal tendinopathy after the use of posterior antiglide plating to treat lateral malleolar fractures caused by a supination-external rotation injury. A total of 70 patients were followed up for a minimum of 12 (mean 55, range 12 to 109) months. Bony union was obtained in all cases after a mean of 57 (range 37 to 81) days. The median number of screw holes in the plate was 4.9 (range 4 to 7), and the median number of screws used to fixate the fibula was 6.58 (range 5 to 10). The mean American Orthopaedic Foot and Ankle Society hindfoot-ankle score at the final follow-up examination was 90.8 (range 55 to 100). Clinically, 3 (4.29%) of the 70 patients had lateral or posterolateral ankle pain indicative of peroneal tendinopathy after the index surgery, without any objective evidence. Of the 70 patients, 41 (58.57%) underwent surgical removal of the fibular hardware, 2 (4.87%) because of lateral ankle discomfort. At removal, inspection of the peroneal tendon sheath and/or tendons showed no gross evidence of tendinopathy in any of the patients. We concluded that the incidence of clinically evident peroneal tendon symptoms associated with posterior antiglide plating is low (4.3%), and direct operative inspection revealed no gross evidence of tendinopathy. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  2. Influence of hooks and a lag screw on internal fixation plates for lateral malleolar fracture: a biomechanical and ergonomic study.

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    Sakai, Rina; Uchino, Masataka; Yoneo, Terumasa; Ohtaki, Yasuaki; Minehara, Hiroaki; Matsuura, Terumasa; Gomi, Tsutomu; Ujihira, Masanobu

    2017-02-23

    For internal fixation of AO classification Type B lateral malleolar fracture, insertion of lag screws into the fracture plane and fixation with a one-third tubular plate as a neutralization plate are the standard treatment procedures. The one-third tubular plate is processed to a hook shape and hung on the distal end of the fibula. In this study, to compare the function of the hook and lag screws of a one-third tubular plate and LCP for osteosynthesis of lateral malleolar fracture, mechanical indices of internal fixation were compared among the one-third tubular plates with lag screws with and without the hook and a locking compression plate. As mechanical tests, a compression test was performed in which compression in the bone axis direction produced by supporting the body weight was simulated, and a torsion test was performed in which external rotation of the bone axis caused by plantar flexion of the ankle joint was simulated. Muscle strength during walking and the force and torque acting on the ankle and knee joints were determined using inverse dynamic analysis. Finite element analysis was performed to analyze the function of hooks and lag screws. The joint reaction force determined by inverse dynamic analysis was adopted as the loading condition of finite element analysis. A stiffness equivalent to that of healthy bone could be achieved by all three internal fixations. It was clarified that the presence of the hook does not make a difference in stiffness. Displacement of the one-third tubular plate was small regardless of the presence or absence of the hook compared with those of locking compression plates. The presence of the hook did not make any difference in stiffness, suggesting that active preparation of the hook is unnecessary. We also clarified that lag screws inhibit displacement.

  3. Interobserver variation in classification of malleolar fractures

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    Verhage, S.M.; Hoogendoorn, J.M. [MC Haaglanden, Department of Surgery, The Hague (Netherlands); Secretariaat Heelkunde, MC Haaglanden, locatie Westeinde, Postbus 432, CK, The Hague (Netherlands); Rhemrev, S.J. [MC Haaglanden, Department of Surgery, The Hague (Netherlands); Keizer, S.B. [MC Haaglanden, Department of Orthopaedic Surgery, The Hague (Netherlands); Quarles van Ufford, H.M.E. [MC Haaglanden, Department of Radiology, The Hague (Netherlands)

    2015-10-15

    Classification of malleolar fractures is a matter of debate. In the ideal situation, a classification system is easy to use, shows good inter- and intraobserver agreement, and has implications for treatment or research. Interobserver study. Four observers distributed 100 X-rays to the Weber, AO and Lauge-Hansen classification. In case of a trimalleolar fracture, the size of the posterior fragment was measured. Interobserver agreement was calculated with Cohen's kappa. Agreement on the size of the posterior fragment was calculated with the intraclass correlation coefficient. Moderate agreement was found with all classification systems: the Weber (K = 0.49), AO (K = 0.45) and Lauge-Hansen (K = 0.47). Interobserver agreement on the presence of a posterior fracture was substantial (K = 0.63). Estimation of the size of the fragment showed moderate agreement (ICC = 0.57). Classification according to the classical systems showed moderate interobserver agreement, probably due to an unclear trauma mechanism or the difficult relation between the level of the fibular fracture and syndesmosis. Substantial agreement on posterior malleolar fractures is mostly due to small (<5 %) posterior fragments. A classification system that describes the presence and location of fibular fractures, presence of medial malleolar fractures or deep deltoid ligament injury, and presence of relevant and dislocated posterior malleolar fractures is more useful in the daily setting than the traditional systems. In case of a trimalleolar fracture, a CT scan is in our opinion very useful in the detection of small posterior fragments and preoperative planning. (orig.)

  4. Endoscopic versus open bursectomy of lateral malleolar bursitis.

    Science.gov (United States)

    Choi, Jae Hyuck; Lee, Kyung Tai; Lee, Young Koo; Kim, Dong Hyun; Kim, Jeong Ryoul; Chung, Woo Chull; Cha, Seung Do

    2012-06-01

    Compare the result of endoscopic versus open bursectomy in lateral malleolar bursitis. Prospective evaluation of 21 patients (22 ankles) undergoing either open or endoscopic excision of lateral malleolar bursitis. The median age was 64 (38-79) years old. The median postoperative follow-up was 15 (12-18) months. Those patients undergoing endoscopic excision showed a higher satisfaction rate (excellent 9, good 2) than open excision (excellent 4, good 3, fair 1). The wounds also healed earlier in the endoscopic group although the operation time was slightly longer. One patient in the endoscopic group had recurrence of symptoms but complications in the open group included one patient with skin necrosis, one patient with wound dehiscence, and two patients of with superficial peroneal nerve injury. Endoscopic resection of the lateral malleolar bursitis is a promising technique and shows favorable results compared to the open resection. Therapeutic studies-Investigating the result of treatment, Level II.

  5. STUDY OF FUNCTIONAL OUTCOME OF SURGICAL MANAGEMENT OF UNSTABLE MALLEOLAR FRACTURES IN ADULTS : A CASE REPORT

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    Sankara Rao

    2015-09-01

    Full Text Available Malleolar fractures are one of the most common lower extremity fractures in orthopaedic traumatology. Ankle injuries gain importance because body weight is transmitted through it and locomotion depends upon the stability of this joint. Malleolar fractures have varied presentations which have given rise to a wide variety of classification systems, of which two ar e in vogue Lauge - Hansens and Danis - Weber classification. As with all intra articular fractures, malleolar fractures necessitate accurate reduction and stable internal fixation. When malleolar fractures are not reduced accurately they may lead to post tra umatic painful restriction of motion or osteoarthritis or both .

  6. Missed Medial Malleolar Fracture Associated With Achilles Tendon Rupture: A Case Report and Literature Review.

    Science.gov (United States)

    Nakajima, Koji; Taketomi, Shuji; Inui, Hiroshi; Nakamura, Kensuke; Sanada, Takaki; Tanaka, Sakae

    2016-01-01

    A 45-year-old man sustained an Achilles tendon rupture while playing futsal. A concomitant medial malleolar fracture was not diagnosed until the patient underwent an operation for Achilles tendon repair. A routine postoperative radiograph showed a minimally displaced medial malleolar fracture. Conservative treatment was chosen for the fracture. The function of the Achilles tendon recovered well, and the fracture was united. A medial malleolar fracture can be missed when an Achilles tendon rupture occurs simultaneously. Thus, surgeons should consider the possibility of medial malleolar fracture associated with an Achilles tendon rupture. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  7. Ankle fractures and alcoholism. The influence of alcoholism on morbidity after malleolar fractures

    DEFF Research Database (Denmark)

    Tønnesen, H; Pedersen, A; Jensen, M R

    1991-01-01

    The postoperative morbidity after osteosynthesis of malleolar fractures was investigated retrospectively by comparing 90 alcohol abusers with 90 controls. The two groups were selected from 626 male patients and were matched regarding trauma, treatment for cardiovascular, pulmonary and endocrine...

  8. Posterior malleolar fracture: technique and clinical ex-perience of the posterolateral approach

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    HUANG Ruo-kun

    2012-04-01

    Full Text Available 【Abstract】Objective: To introduce the postero-lateral surgical approach to the posterior malleolar fracture and report its clinical outcomes in 32 cases. Methods: This study consisted of 32 cases, 22 males and 10 females with the mean age of 48 years (range, 21-63 years, suffering from posterior malleolar fracture. All cases were treated with the posterolateral surgical approach to the ankle. The average follow-up period was 28 months (range, 24-35 months. The clinical outcomes of these cases were evaluated on the basis of the Olerud-Molander Ankle (OMA score and plain radiographs. Results: All cases showed radiological evidence of bony union at follow-up. The average OMA score was 82 points; 21 cases had excellent scores (90-100 points, 9 good (61-90 points, and 2 fair (31-60 points. The excellent-to-good rate was 93.8%. Although most cases did not show any wound dehiscence or necrosis, one patient had a su-perficial infection which healed after using antibiotic dress-ing and one had sural cutaneous nerve injury that under-went spontaneous remission without any treatment after three months. In addition, one presented with mild symp-toms of peroneal tendonitis that disappeared after plate removal. Conclusion: The posterolateral approach offers an effective technique for fracture reduction and fixation of large posterior malleolar fragments. Key words: Ankle injuries; Dislocations; Fracture fixation, internal

  9. TREATMENT OF DISPLACED MALLEOLAR FRACTURES AT CHILDREN

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    Franci Vindišar

    2004-04-01

    Full Text Available Background. The exact knowledge of the anatomic relations of the juvenile skeleton is of great importance for the determination of the injury and proper treatment. The treatment should be uniform and carried out in one act. Considering this facts the functional results are usually very good and no late sequel are recorded.Methods. In 5-years period 25 children with age 7 to 17 were treated with displaced fracture of ankle. The Salter-Harris classification (SHC was used. Children were classified in two groups. In first group (G-I 11 children were treated with closed reduction. Whole group was classified as type II fractures of SHC. In second group (G-II 14 children were treated operatively. 10 cases were type III, 2 cases were type IV of SHC and 2 were juvenil Tillaux fracture. In follow-up we registered the duration of immobilisation, non-weight bearing period, mobility and residual pain at the end of the treatment.Results. In G-I average non-weight bearing period was 10.4 weeks, in G-II only 7.8 weeks. At the end of the treatment in both groups very good functional results were achieved. There were no complications in operative group (G-II.Conclusions. Children relatively often suffer ankle injuries. With proper diagnosis and early adequate treatment the prognosis is good and no functional sequel were recorded.

  10. A PROSPECTIVE STUDY OF SURGICAL MANAGEMENT OF UNSTABLE MALLEOLAR FRACTURES IN ADULTS

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    Chandra Sekharam Naidu

    2015-10-01

    Full Text Available M alleolar fractures are one of the most common lower extremity fractures in orthopaedic traumatology. Ankle injuries gain importance because body weight is transmitted through it and locomotion depends upon the stability of this joint. Malleolar fractures have varied presentations which have given rise to a wide variety of classification systems, of which two are in vogue Lauge - Hansens and Danis - Weber classification. As with all intra articular fractures, malleolar fractu res necessitate accurate reduction and stable internal fixation. When malleolar fractures are not reduced accurately they may lead to post traumatic painful restriction of motion or osteoarthritis or both . 1 Many of the fractures which are stable are treate d by conservative treatment and have given good result. The other unstable, displaced and open fractures require open reduction internal fixation. The superiority of ORIF over closed treatment have been thoroughly demonstrated in literature . 2 The purpose o f this study is to assess the functional outcome and results of surgical treatment of malleolar fractures. The treatment options with ORIF technique available for malleolar fractures, to attain a proper anatomical alignment and stability of the ankle joint , can lead to rewarding outcome for the patient and surgeon

  11. Diagnostic accuracy of the gravity stress test and clinical signs in cases of isolated supination-external rotation-type lateral malleolar fractures.

    Science.gov (United States)

    Nortunen, S; Flinkkilä, T; Lantto, I; Kortekangas, T; Niinimäki, J; Ohtonen, P; Pakarinen, H

    2015-08-01

    We prospectively assessed the diagnostic accuracy of the gravity stress test and clinical findings to evaluate the stability of the ankle mortise in patients with supination-external rotation-type fractures of the lateral malleolus without widening of the medial clear space. The cohort included 79 patients with a mean age of 44 years (16 to 82). Two surgeons assessed medial tenderness, swelling and ecchymosis and performed the external rotation (ER) stress test (a reference standard). A diagnostic radiographer performed the gravity stress test. For the gravity stress test, the positive likelihood ratio (LR) was 5.80 with a 95% confidence interval (CI) of 2.75 to 12.27, and the negative LR was 0.15 (95% CI 0.07 to 0.35), suggesting a moderate change from the pre-test probability. Medial tenderness, both alone and in combination with swelling and/or ecchymosis, indicated a small change (positive LR, 2.74 to 3.25; negative LR, 0.38 to 0.47), whereas swelling and ecchymosis indicated only minimal changes (positive LR, 1.41 to 1.65; negative LR, 0.38 to 0.47). In conclusion, when gravity stress test results are in agreement with clinical findings, the result is likely to predict stability of the ankle mortise with an accuracy equivalent to ER stress test results. When clinical examination suggests a medial-side injury, however, the gravity stress test may give a false negative result.

  12. Removal of internal fixation--the effect on patients' complaints: a study of 66 cases of removal of internal fixation after malleolar fractures

    DEFF Research Database (Denmark)

    Jacobsen, S; Honnens de Lichtenberg, M; Jensen, C M

    1994-01-01

    To estimate the effect of removal of internal fixation after treatment of malleolar fractures on postoperatively presented complaints, we retrospectively evaluated 66 patients by their records and by personal questionnaires. Of all the patients, 89.4% had one or more complaints. These were typica...... period. We conclude that removal of internal fixation after malleolar fractures is indicated when common types of complaints are presented.......To estimate the effect of removal of internal fixation after treatment of malleolar fractures on postoperatively presented complaints, we retrospectively evaluated 66 patients by their records and by personal questionnaires. Of all the patients, 89.4% had one or more complaints. These were...

  13. A Rare Fracture That Ottawa Ankle Rules are Insufficient: Isolated Posterior Malleolar Fracture

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    Bulent Karslioglu

    2013-04-01

    Full Text Available Isolated fracture of the posterior malleolus is rare. A 23 year- old male patient admitted to our emergency department suffering from ankle pain after fall. Computed tomography revealed fracture line at posterior malleolus. As well as it encompasses less than 25% of the joint surface, conservative treatment planned and below-knee cast was applied. Physical therapy was started at six week later. Due to different mechanism of occurrence it is hard to diagnose isolated posterior malleolus fracture by means of Ottawa ankle rules. Thus when clinical manifestation is incompatible with radiologic appearance, diagnose of isolated posterior malleolus fracture should be kept in mind.

  14. A Rare Fracture That Ottawa Ankle Rules are Insufficient: Isolated Posterior Malleolar Fracture

    OpenAIRE

    Bulent Karslioglu

    2013-01-01

    Isolated fracture of the posterior malleolus is rare. A 23 year- old male patient admitted to our emergency department suffering from ankle pain after fall. Computed tomography revealed fracture line at posterior malleolus. As well as it encompasses less than 25% of the joint surface, conservative treatment planned and below-knee cast was applied. Physical therapy was started at six week later. Due to different mechanism of occurrence it is hard to diagnose isolated posterior malleolus fractu...

  15. 胫骨下段螺旋型骨折合并后踝骨折的诊断与治疗%Diagnosis and treatment of the distal spiral tibial shaft fracture associated with posterior mal-leolar fracture

    Institute of Scientific and Technical Information of China (English)

    张正廉; 王士波; 高迪; 郑杰; 赵廷虎; 高彦军; 张勇

    2015-01-01

    Objective To explore the cause of leak diagnosis, injury mechanism and treatment strategy of the distal 1/3 spiral tibial shaft fracture associated with occult posterior malleolar fracture. Methods 81 patients with distal third spiral tibia shaft fracture associated posterior malleolar fractures were treated by surgery. The radiology detected 38 posterior malleolar fracture. The rest fractures were determined by CT scan. All cases were fixed with tibial intr-amedulary nailing at the supination foot and the internal-rotation tibia. The posterior malleolar fractures were fixed with ø 4. 5 mm cannulated screws. All cases of distal 1/2 fibular fractures were fixed with plates or Kirschner wires. All of proximal fibular fractures were not fixed. Results 81 cases were all followed up from 4 months to 11 months. 68 cases of posterior malleolar fractures were fixed with cannulated screws, which can prevent displacement during in-tramedullary nailing of tibia shaft fractures, and all showed radiographic evidence of healing. 13 cases were not fixed for small and no displacement fractures. 79 cases of spiral tibial shaft fracture were healed according to plain radio-graphs standard. 2 cases were ununion for excessive gap between fractures and later healed with bone grafting. 1 case occurred ankle traumatic arthritis. The wounds were not contaminated and no osteomyelitis occurred. According to Johner-Wruhs evaluation standard, the results were excellent in 67 cases, good in 10, fair in 3 and poor in 1;the ex-cellent and good rate was 95%. Conclusions Distal spiral tibia shaft fractures are associated with ipsilateral posteri-or malleolar fractures, which plain radiographs are often insufficient for detecting. Using a preoperative CT protocol for spiral tibial shaft fractures can significantly improve the ability to diagnose associated posterior malleolar fractures that may not be evident on plain radiographs. Injury mechanism is the supination foot and the internal

  16. Risk Factors for Open Malleolar Fractures: An Analysis of the National Trauma Data Bank (2007 to 2011).

    Science.gov (United States)

    Shibuya, Naohiro; Liu, George T; Davis, Matthew L; Grossman, Jordan P; Jupiter, Daniel C

    2016-01-01

    A limited number of studies have described the epidemiology of open fractures, and the epidemiology of open ankle fractures is not an exception. Therefore, the risk factors associated with open ankle fractures have not been extensively evaluated. The frequencies and proportions of open ankle fractures among all the recorded malleolar fractures in the US National Trauma Data Bank data set from January 2007 to December 2011 were analyzed. Clinically relevant variables captured in the data set were also used to evaluate the risk factors associated with open ankle fractures, adjusting for other covariates. The entire cohort was further subdivided into "lower" and "higher" energy trauma groups and the same analysis performed for each group separately. We found that a body mass index of >40 kg/m(2) and farm location were risk factors for open ankle fractures and impaired sensorium was protective against open ankle fractures. In the "lower energy" group, male gender, alcohol use, peripheral vascular disease, other injuries, and injury occurring at a farm location were risk factors for open fractures. In the "higher energy" group, female gender, work-related injury, and injury at a farm or industry location demonstrated statistically significantly associations with open fractures.

  17. Salter-Harris Type III and IV medial malleolar fractures: growth arrest: is it a fate? A retrospective study of 48 cases with open reduction.

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    Cottalorda, Jérôme; Béranger, Vincent; Louahem, Djamel; Camilleri, Jean Philippe; Launay, Franck; Diméglio, Alain; Bourelle, Sophie; Jouve, Jean-Luc; Bollini, Gérard

    2008-09-01

    Salter-Harris type III and IV medial malleolar fractures (MacFarland fracture) is a joint fracture of the ankle in children. The fracture line passes through the medial part of the lower epiphyseal disk of the tibia. Prognosis is dominated by later risk of misalignment and osteoarthritis. The aim of this study was to evaluate the functional and radiological outcome of these fractures. We retrospectively analyzed the cases of 48 children with MacFarland fractures (31 boys and 17 girls), mean age at the time of trauma 11 years 6 months (range, 8-15 years). The fractures were classed into two groups according to the Salter and Harris classification for epiphyseal detachment: Salter III (30 cases) and Salter IV (18 cases). Surgical treatment was given in all cases (46 screw fixations, 2 pin fixations). Three outcome categories were used: good (no pain, no stiffness, no limp, no misalignment, no surgical complication, no healing problem), fair (pain and/or stiffness and/or limp and/or healing problem without misalignment, no surgical complication), and poor (misalignment or surgical complication). Mean follow-up was 3 years and 3 months (24-94 months). Twenty-eight children were skeletally mature at the longest follow-up. The three-month postoperative assessment showed 35 patients with good results and 13 children with fair results. Ankle stiffness was noted in 6 cases, ankle pain in 4 cases, wound healing complications in 4 cases, limp in 1 case, and snapping in 1 case. The long-term outcome was considered good for 45 patients, fair for 2 patients (1 wound adherence and 1 hypertrophic scar tissue), and poor for 1 patient (6-degree varus deformity). We did not note leg-length discrepancy or malunion at the longest follow-up. Our results show that growth arrest after MacFarland fracture is no fate. We used surgery more than is generally reported by other teams, opting for surgery as soon as the displacement was >or=1 mm. Surgical treatment was arthrotomy in all cases to

  18. Lateral malleolus hook plate for comminuted Weber A and B fractures: A retrospective study

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    Fang Zhenhua

    2013-01-01

    Full Text Available Background: The goal of managing the comminuted fracture of lateral malleolus is to restore length, rotation and alignment which might be more challenging with extensive comminution around the area of the distal tip. The common osteosynthesis techniques such as the one-third tubular plate, tension band wiring, K-wires, screws, or intramedullary nail may be insufficient in cases with a comminuted lateral malleolus. The anatomical hook plate is an alternative implant in such cases. We present our results of the comminuted lateral malleolar fractures (Weber A, B, managed by open reduction and internal fixation (ORIF with an anatomical hook plate of lateral malleolus (Königsee Implant Company, Germany. Materials and Methods: We retrospectively reviewed 20 patients of comminuted fracture of distal lateral malleolus between 2008 and 2010. There were 12 males and 8 females, right side was involved in 18 patients and left in 2. The mean age was 51.9 years (range 18-75 years. The fractures were categorized by Denis-Weber classification type A (n=1, B1 (n=1, B2 (n=13 and B3 (n=5. Nineteen cases were of closed injury and one of open injury (Gustilo Anderson type II. These patients underwent ORIF with a lateral malleolus anatomical hook plate. Followup including radiographs and clinical examinations were performed. The American Orthopedic Foot and Ankle Society (AOFAS ankle hindfoot scores were documented at followups. Results: The mean followup was 21.4 months (range 16-27 months. The average AOFAS score was 94.3 (range 78-100 points. A stable anatomic reduction and bony union were obtained in all the cases. The average time was 3.1 months (range 2.5-4 months. Four cases had complications like posttraumatic osteoarthritis, hardware impingement and superficial wound infection. Conclusion: A reasonably good stability can be obtained in distal most comminuted fractures of lateral malleolus with a lateral malleolus anatomical hook plate. We believe this

  19. 踝关节骨折后外踝畸形愈合的外科矫形%Lengthening osteotomy of the fibula in treatment of treating lateral malleolar malunon

    Institute of Scientific and Technical Information of China (English)

    谢鸣; 黄若昆; 方真华; 赵晶晶; 勘武生

    2010-01-01

    Objective To investigate the therapeutic effect of lengthening and rotational osteotomy of the fibula for lateral malleolar malunion. Methods Twenty-three patients who had suffering from the traumatic arthritis of ankle were due to lateral malleolar malunion treated with lengthening and rotational osteotomy from October 2005 to July 2008. Special radiographs were use to fully detect the extent of shortening and rotation of the fibula. The Lengthening and rotational osteotomy could be conducted with a special compression/distraction device and bone graft. The function of the ankles was evaluated by the American Orthopedic Foot Ankle Society (AOFAS) scoring system. Serial radiographs of the ankle were made to assess the bone healing and changes of posttraumatic osteoarthritis. Results Seventeen of 23 patients were followed up, with a mean 29.1 months (12-45 months). All the fractures were healed. The mean bone healing time was 13.3 weeks (11-16 weeks) and the mean time of total weight-bearing was 12.1 weeks (11-15 weeks). The ankle function score had improved from 29 (21-47) preoperatively to 81 (56-91)12 months after the operation. There was 5 in excellent, 8 in good, 3 in mild, 1 in poor, and the rate of good outcomes was 76.5%. After the operation, 1 patient had a skin necrosis around the wound which healed by conservative treatment. A slightly aggravated degeneration of the ankle joint was seen in 2 patients who responded to conservative managements. No failure of the internal fixation was noted in this group. Conclusion The outcomes demonstrate that reconstructive lengthening osteotomy is well worthwhile when there is absent or minimal osteoarthritic change, regardless the time from the original injury. Lengthening of the fibula is an important step in the treatment of the painful ankle when the fibula become shorter after injury, even when degenerative changes of the joint are already present. The lengthening of the fibula could lead to a good outcome in ankle

  20. 关节镜技术监视下治疗内踝骨折的临床疗效分析%Analysis of clinical effects of arthroscopy formedial malleolar fracture

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    胡丹; 郝跃峰; 司卫兵; 秦卫; 焦健; 顾雪平

    2016-01-01

    Objective To analysis the clinical effects of arthroscopy for medial malleolar frac-ture. Methods A total of 72 patients with medial malleolar fracturewere selected and randomly divided into the observation group and control group,with 36 cases in each group. Patients in the observation group received internal fixation under arthroscopy,while in the control group received open reduction and inter-nal fixation. Results Operative time,blood loss and fracture healing time in the observation group were significantly better than the control group[(44. 2 ± 6. 3)min vs(64. 6 ± 5. 2)min,(18. 4 ± 2. 3)ml vs (34. 7 ± 3. 9)ml,and(78. 5 ± 9. 3)d vs(91. 4 ± 10. 4)d,P 0. 05). Conclu-sion For medial malleolar fracture,arthroscopycan shorten the operation time,reduce intraoperativeblood loss,fasten fracture healing,and promote the recovery of joint function.%目的:分析关节镜技术治疗内踝骨折的临床效果。方法内踝骨折患者72例。随机分为观察组及对照组,每组各36例。对照组患者接受切开复位内固定治疗,观察组患者在关节镜下行内固定治疗。比较两组患者的治疗效果。结果观察组患者手术时间、术中出血量及骨折愈合时间分别为(44.2±6.3)分钟、(18.4±2.3)ml 和(78.5±9.3)天,对照组患者分别为(64.6±5.2)分钟、(34.7±3.9)ml 和(91.4±10.4)天,两组比较差异有统计学意义(P 0.05)。结论关节镜下治疗内踝骨折可缩短手术时间,减少术中出血,加快骨折愈合,促进踝关节功能恢复。

  1. Prospective study of ankle and foot fractures in elderly women

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    Yadagiri Surender Rao

    2015-01-01

    Full Text Available The epidemiology of ankle fractures in old people is changing as time passes on. The incidence of ankle fractures increases with advancing age. The study conducted was among a rural popula-tion which comprised of 68 women (32 women with ankle fractures & 36 women with foot fractures. Patients studied were in the age group more than 50 years. The study highlights the etiological & risk factors for fractures of ankle & foot. The commonest ankle fracture was the lateral malleolar fracture & the commonest foot fracture was the 5th Metatarsal fracture. Diabetes is a risk factor which increases the occurrence of ankle and foot injuries.

  2. 后外侧锁定接骨板治疗大块后踝骨折的疗效分析%Efficacy of Posterolateral Locking Plate in the Treatment of Large Posterior Malleolar Fracture

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    胥正锋; 尹望平; 倪妙忠; 吴荣博

    2014-01-01

    目的:探讨经后外侧入路应用锁定接骨板治疗大块后踝骨折的临床疗效。方法:2010年1月-2012年6月经后外侧入路应用锁定接骨板内固定治疗后踝大块骨折患者23例,其中男性15例,女性8例;年龄32~78岁,平均年龄43.7岁;受伤至手术时间5~12d,平均7.3d。术前以石膏或跟骨牵引术固定患肢,待患肢肿胀消退后,采用后外侧入路锁定接骨板治疗后踝骨折。根据美国足踝外科协会(American Orthopedic Foot and Ankle Society ,AOFAS )的踝与后足评分标准评价踝关节功能。结果:所有患者均获得随访,随访时间14~22个月,平均17.4个月。23例患者均获得骨性愈合,无内固定松动或断裂;X线片示骨折愈合时间为术后11~21周,平均14.7周;完全负重时间为15~25周,平均17.1周;术后12个月AOFAS评分为73~94分,平均83.4分。1例患者术后第7天出现伤口浅表感染,经换药及敏感抗生素治疗后愈合,其他患者伤口愈合良好。结论:采用后外侧入路锁定接骨板治疗能在直视下对后踝进行有效复位和妥当固定,用于治疗后踝大块骨折时疗效良好。%Objective:To investigate the clinical efficacy of posterolateral locking plate in the treatment of large posterior malle-olar fracture .Methods :From January 2010 to June 2012 ,23 patients with large posterior malleolar fractures were treated by posterolateral locking plate ,including 15 males and 8 females ,all of whom aged from 32 to 78 years with an average age of 43 .7 years .The average time from injury to operation was 7 .3 days ,which ranged from 5 to 12 days .Calcaneal traction fixa-tion or plaster was performed on the injured limb before operation .Once that swelling reduced ,all patients were treated by posterolateral locking plate and were assessed with the ankle hindfoot clinical rating system of the American Orthopaedic Foot and Ankle Society (AOFAS

  3. The posterolateral approach combined with medial approach fixation for the treatment of tri- malleolar fracture%后外侧入路联合内侧入路内固定治疗三踝骨折

    Institute of Scientific and Technical Information of China (English)

    石国栋; 马辉; 李幼德; 叶斌; 陆阳洋; 张驰; 张海林; 洪方业

    2015-01-01

    Objective To discuss the efficacy of the surgical treatment for trimalleolar fracture by posterolateral ap-proach combined with medial approach fixation. Methods 23 patients of trimalleolar fracture were treated by pos-terolateral approach combined with medial approach. According to Lauge-Hansen classification of ankle fractures:su-pination-external rotation type 15 cases, pronation and abduction type 4 cases, pronation-external rotation type 4 ca-ses. Regular follow-up after operation. Results The operation time was 45~85 (60 ± 15) min. Introperative blood loss was 50~100(71 ± 7. 2)ml. 2 patients were lost to follow-up, 21 cases were followed up for 15~24 months. All the fractures were healed. Normal gait, without the aid of auxiliary tools were obtained. At the last follow-up, accord-ing to the American Orthopaedic Foot and Ankle Society ( AOFAS) ankle and hindfoot score standard functional as-sessment, the results were excellent in 15 cases, good in 4, fair in 2. Conclusions The surgical treatment for tri-malleolar fracture by posterolateral approach combined with medial approach has advantages of safe and convenient approach, revealing clear,accurate reduction of the articular surface can be used directly, and can be stable fixing.%目的:探讨经后外侧入路联合内侧入路行内固定手术治疗三踝骨折的疗效。方法采用后外侧入路联合内侧入路治疗23例三踝骨折患者。根据Lauge-Hansen踝关节骨折分型:旋后外旋型15例,旋前外展型4例,旋前外旋型4例。术后定期门诊随访。结果手术时间45~85(60±15)min,术中失血量50~100(71±7.2)ml。2例失访,21例获得随访,时间15~24个月。随访患者骨折均愈合,步态正常,无需借助辅助工具。末次随访时根据美国矫形足踝协会( AOFAS)踝与后足评分标准进行功能评估,优15例,良4例,中2例。结论采用后外侧入路联合内侧入路治疗三踝骨折入路安全简便,显露清楚,可直接精确复位关

  4. Comparative finite element analysis of fixations for posterior malleolar fracture%后踝骨折内固定方法的有限元模拟比较研究

    Institute of Scientific and Technical Information of China (English)

    金丹; 付苏; 梅刚; 邹振吕; 刘松; 王尚冲; 刘军

    2014-01-01

    Objective To compare the tube plate,T-plate and screws in fixation of posterior malleolar fracture in terms of biomechanical stability.Methods The CT data of the ankle obtained from a normal male volunteer was used to make a three-dimensional reconstruction by software mimics 14.0 and geomagic 2012.After we built a three-dimensional finite element model of the ankle along with its stimulated ligaments in software ANSYS,the validity of the model was verified.The model of posterior malleolar fracture was cut from the posteromedial point of the tibia to the one-fourth point of the distance from the posterior to the anterior margin in the software Solidworks 2012.Models of screws,1/4 tube plate and T-plate were also constructed in Solidworks 2012.According to the established method in the literature,2 screws,a 1/4 tube plate and a T-plate were applied respectively.Under the same neutral weight bearing,the flexion and external loadings,the fragmental displacement,the stresses of fracture and fixation were calculated by finite element analysis.Results Under neutral or external loading,T-plate fixation caused the smallest fragmental displacement compared with the other 2 fixations and the 2 plate fixations caused a smaller displacement in Z-axis under neutral loading than screws fixation.However,similar displacements were identified in all fixations under flexion loading.Under all loading conditions,excessive concentration of the stress was not observed.Conclusions T-plate shows a better biomechanical stability than 1/4 tube-plate and screws while plating reduces the upward displacement than screws.All the 3 fixations show no obvious excessive concentration of the stress.%目的 使用有限元法分析比较螺钉、管型钢板、3孔T型钢板固定治疗后踝骨折的生物力学稳定性.方法 取1名23岁男性健康志愿者的足踝CT数据进行三维重建,建立带有周围韧带的踝关节有限元模型并进行有效性验证,将模型导入Solidworks软

  5. [Clinical features in the diagnosis and treatment of ankle fracture with Wagsaffe fragment].

    Science.gov (United States)

    Liu, Zhongyu; Xin, Jingyi; Liang, Jun

    2014-02-25

    To explore the methods in the diagnosis and treatment of ankle fracture with Wagsaffe fragment. Among 1 201 patients, there were 18 cases of concurrent Wagstaffe fractures at our hospital between January 2009 to January 2012. There were 11 males and 7 females with an average of 37.4 (17-54) years. The causes of injuries were fall (n = 10), sports-related injury (n = 4), traffic injury (n = 3) and high-altitude fall (n = 1). All of them had lateral malleolar fracture. Other injuries included internal malleolar fracture (n = 16), posterior malleolar fracture (n = 8) and disruption of medial deltoid ligament (n = 3). According to the Lauge-Hansen system, all fractures were of supination-external rotation type. The fractures of fibula and Wagstaffe were explored through an anterolateral approach. The lateral malleolar fracture was fixed with plate While Wagstaffe fragment secured with lag screw or thread. Disrupted anterior tibiofibular ligament was restored. Other treatments included open reduction and internal fixation of medial and posterior malleolus, repair of medial deltoid ligament and screw fixation of disrupted tibiofibular syndesmosis. Ankle function was evaluated by the Baird-Jackson criteria. Wagstaffe fracture occurred at a rate of 1.5% in ankle fractures. Wagstaffe fracture was found in 4.4% of ankle fracture of supination-external rotation type. Seventeen patients were followed up over an average follow-up period of 16.8 (12-25) months. All radiographs showed union of all fractures and normal mortise. Baird-Jackson ankle functional score was from 81 to 99. In all 17 patients, 9 were rated as excellent, 5 as good and 3 as fair. The excellent and good rate was 87.4%. At the latest follow-up, 14 patients resumed their preinjury activities. As an easily misdiagnosed condition, Wagstaffe fracture is associated with ankle diastase and prone to occur in ankle fracture of supination-external rotation type. Accurate reduction and stable fixation facilitate the

  6. Integrity of the lateral femoral wall in intertrochanteric hip fractures: an important predictor of a reoperation

    DEFF Research Database (Denmark)

    Palm, Henrik; Jacobsen, Steffen; Sonne-Holm, Stig

    2007-01-01

    -six fractures of the lateral femoral wall occurred during the operative procedure itself. A fracture of the lateral femoral wall occurred in only 3% (three) of the 103 patients with an AO/OTA type-31-A1.1, A1.2, A1.3, or A2.1 intertrochanteric fracture compared with 31% (thirty-one) of the ninety......-nine with an AO/OTA type 31-A2.2 or A2.3 fracture (p fracture of the lateral femoral wall was found to be the main predictor for a reoperation after an intertrochanteric fracture. Consequently, we concluded that patients with preoperative or intraoperative fracture......BACKGROUND: Reoperations after intertrochanteric fractures are often necessitated by fracture displacement following mobilization of the patient. The biomechanical complexity of the fracture, the position of the implant, and the patient's characteristics are known to influence postoperative outcome...

  7. Delayed Operative Management of Fractures of the Lateral Condyle of the Humerus in Children

    Directory of Open Access Journals (Sweden)

    Shabir AD

    2015-03-01

    Full Text Available Purpose; Delayed presentation of lateral condylar fractures of the humerus is relatively common in the developing regions of the world. These fractures are difficult to manage because of the displacement and fibrosis around the condylar fragment secondary to the delay. There is a paucity of literature concerning the management of these fractures. An oft repeated finding is the requirement of extensive dissection around the fragment for proper reduction. The purpose of this study was to assess the efficacy of surgical management of lateral condylar fractures with delayed presentation. Methods; We assessed the results of lateral condylar fracture fixation in 20 cases with delayed presentation. Results; The lateral condylar fractures in patients with a delayed presentation can be managed surgically with good results. Conclusions; Open reduction and internal fixation should continue to be the method of choice for the management of lateral condylar fractures which report late for management.

  8. 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

  9. Diagnosis of vertebral fractures on lateral chest X-ray: Intraobserver agreement of semi-quantitative vertebral fracture assessment

    Energy Technology Data Exchange (ETDEWEB)

    Jagt-Willems, H.C. van der, E-mail: Hvanderjagt@spaarneziekenhuis.nl [Department of Geriatrics, Slotervaart Hospital, Amsterdam (Netherlands); Department of Internal Medicine, Spaarne Hospital, Hoofddorp (Netherlands); Munster, B.C. van [Department of Internal Medicine, Academic Medical Center, Amsterdam (Netherlands); Department of Geriatrics, Gelre Hospitals, Apeldoorn (Netherlands); Leeflang, M. [Department of Geriatrics, Gelre Hospitals, Apeldoorn (Netherlands); Beuerle, E. [Department of Radiology, Slotervaart Hospital, Amsterdam (Netherlands); Tulner, C.R. [Department of Geriatrics, Slotervaart Hospital, Amsterdam (Netherlands); Lems, W.F. [Department of Rheumatology, VU Medical Center, Amsterdam (Netherlands)

    2014-12-15

    Highlights: • (Lateral) chest X-ray's are often performed in older individuals for various reasons. • Vertebral fractures are visualized on lateral chest X-ray, but the diagnosis of vertebral fractures is until now only validated on (lateral) spine X-ray's. • This study shows that a (lateral) chest X-ray is sufficient for the diagnosis of vertebral fractures. • Older individuals with a vertebral fracture on a (lateral) chest X-ray do not need further radiography with thoracic spine X-ray or vertebral fracture assessment with DXA. - Abstract: Background: In clinical practice lateral images of the chest are performed for various reasons. As these lateral chest X rays show the vertebrae of the thoracic and thoraco-lumbar region, we wondered if these X-rays can be used for evaluation of vertebral fractures instead of separate thoracic spine X-rays. Methods: To evaluate the agreement and intraobserver reliability of the semi-quantitative method for vertebral fractures on the lateral chest X-ray (X-chest) in comparison to the lateral thoracic spine X-ray (X-Tspine), two observers scored vertebral fractures on X-Tspine and twice on X-chest, separately, blinded and in different time periods. Agreement and Cohens’ kappa were calculated for a diagnosis of any fracture on patient level and on vertebral body level. The study was done in patients visiting an outpatient geriatric day clinic, with a high prevalence of vertebral fractures. Results: 109 patients were included. The intraobserver agreement for X-chest versus X-Tspine was 95–98% for the two levels of fracturing, with a Cohen's kappa of 0.88–0.91. The intraobserver agreement and reliability of the re-test on the X-chest showed an agreement between 91 and 98% with a Cohen's kappa of 0.81–0.93. More vertebrae were visible on the X-chest, mean 10.2, SD 0.66 versus mean 9.8, SD 0.73 on the X-Tspine (p < 0.001). Conclusion: The results show good agreement and intraobserver reliability on

  10. OK-432 sclerotherapy for malleolar bursitis of the ankle.

    Science.gov (United States)

    Park, Kwang Hwan; Lee, Jongseok; Choi, Woo Jin; Lee, Jin Woo

    2013-10-01

    The purpose of this study was to evaluate the clinical outcomes and usefulness of OK-432 (Picibanil) sclerotherapy as a new option in the conservative treatment of patients with malleolar bursitis of the ankle. Retrospectively, we reviewed a total of 20 consecutive patients (20 feet) in whom OK-432 sclerotherapy had been performed between March 2009 and June 2010. After aspiration of fluid in the malleolar bursal sac, 0.05 mg of OK-432 was injected into the malleolar bursal sac. We evaluated the clinical outcomes and side effects at the following time points: 2 weeks, 1 month, 3 months, 6 months, and 1 year after OK-432 sclerotherapy. The responses to the treatment were assessed according to the degree of fluctuation, shrinkage of the bursal sac, and soft tissue swelling. Complete resolution was observed in 19 patients (95%) after the first or second application of OK-432 sclerotherapy, and a partial response was observed in 1 patient (5%) after a second application of OK-432 sclerotherapy. The physical component scores of SF-36 improved from 70.0 ± 6.8 to 76.5 ± 7.3 at the last follow-up (P = .0002). OK-432 sclerotherapy was a useful procedure for patients not responding to the usual conservative treatment of malleolar bursitis of the ankle. Level IV, retrospective case series.

  11. Twenty-degree-tilt radiography for evaluation of lateral humeral condylar fracture in children

    Energy Technology Data Exchange (ETDEWEB)

    Imada, Hideaki; Tanaka, Ryuji; Itoh, Yohei; Kishi, Kazuhiko [National Hospital Organization, Higashi-Hiroshima Medical Center, Department of Orthopedic Surgery, Higashi Hiroshima, Hiroshima (Japan)

    2010-03-15

    To investigate the efficacy of '20 -tilt anteroposterior (A-P) radiography' in the assessment of lateral condylar fractures of the distal humerus. Eighteen children with lateral humeral condylar fractures were studied. Every child underwent conventional A-P and lateral radiography, and six children underwent multi-detector computed tomography (MDCT). For the investigation of 20 -tilt radiography, ten children with lateral humeral condylar fractures had conventional and 20 -tilt A-P and lateral radiography both preoperatively and postoperatively. Fragment dislocation was measured at the lateral and medial margins of the fracture on both the conventional A-P and 20 -tilt A-P radiographs. The lateral condylar fragment was triangular and was most prominent posteriorly. The fracture line was typically tilted approximately 20 to a reference line perpendicular to the long axis of the humerus in the lateral view. The extent of dislocation at the lateral and medial margins of the fracture site by 20 -tilt A-P radiography (9.3 {+-} 3.6 mm and 5.6 {+-} 2.5 mm) was significantly wider than that measured by the conventional method (6.8 {+-} 4.1 mm and 2.0 {+-} 1.5 mm), which may influence treatment. Twenty-degree-tilt A-P radiography may more precisely demonstrate fragment dislocation than standard radiographs and may influence patient treatment. (orig.)

  12. A careful evaluation of scout CT lateral radiograph may prevent unreported vertebral fractures

    Energy Technology Data Exchange (ETDEWEB)

    Bazzocchi, Alberto; Spinnato, Paolo [Imaging Division, Clinical Department of Radiological and Histocytopathological Sciences, University of Bologna, Sant’Orsola – Malpighi Hospital, Via Massarenti 9, 40138 Bologna (Italy); Albisinni, Ugo [Department of Radiology, Rizzoli Orthopaedic Institute, Via Pupilli 1, 40136 Bologna (Italy); Battista, Giuseppe [Imaging Division, Clinical Department of Radiological and Histocytopathological Sciences, University of Bologna, Sant’Orsola – Malpighi Hospital, Via Massarenti 9, 40138 Bologna (Italy); Rossi, Cristina [Section of Radiological Sciences, Department of Clinic Sciences, University of Parma, Via Gramsci 14, 43100 Parma (Italy); Guglielmi, Giuseppe, E-mail: g.guglielmi@unifg.it [Department of Radiology, University of Foggia, Viale Luigi Pinto 1, 71100 Foggia (Italy); Department of Radiology, Scientific Institute “Casa Sollievo della Sofferenza” Hospital, Viale Cappuccini 1, 71013 San Giovanni Rotondo, Foggia (Italy)

    2012-09-15

    Objectives: Our purpose was to review scout CT lateral radiographs to reveal osteoporotic vertebral fractures unreported by radiologists and to explore scout CT as a potential diagnostic tool in the detection of vertebral fractures. Methods: We considered 500 patients (303 males, 197 females, age 64.6 ± 13.5 year-old). Our investigation was firstly focused on scout CT lateral images to detect vertebral fractures with a combined semiquantitative and quantitative diagnostic approach. Findings addressed to vertebral fracture were subsequently confirmed by multiplanar sagittal CT reconstructions. Whenever a vertebral fracture was discovered the radiologist report was read and a collection of patient anamnesis followed to understand whether fractures were already known. Results: In 44/500 patients (8.8%) the evaluation on scout CT was incomplete or limited for patient/technical-based conditions, and 15 were excluded from the analysis. In 67/485 patients (13.8%) 99 vertebral fractures were detected. Among 67 fractured patients only 18 (26.9%) were previously diagnosed by radiologists. However, in the clinical history of 32 patients vertebral fractures were already known. Conclusions: The perception and sensibility to vertebral fractures among radiologists are still poor when the assessment of the spine is not the aim of the examination. Short time spent for the evaluation of scout CT lateral radiographs could improve our accuracy.

  13. Prospective comparison of the anterior and lateral approach in hemiarthroplasty for hip fractures: a study protocol

    National Research Council Canada - National Science Library

    Max P L van der Sijp; Inger B Schipper; Stefan B Keizer; Pieta Krijnen; Arthur HP Niggebrugge

    2017-01-01

    .... The aim of this study is to compare postoperative complications, hip function and patient mobility after hemiarthroplasty via the anterior or lateral approach following a displaced femoral neck fracture...

  14. "Roller coaster maneuver via lateral orbital approach" for reduction of isolated zygomatic arch fractures.

    Science.gov (United States)

    Pilanci, Ozgur; Basaran, Karaca; Datli, Asli; Kuvat, Samet Vasfi

    2013-11-01

    Numerous techniques have been reported for the reduction of zygomatic arch fractures. In this article, we aimed to describe a technique we named as "roller coaster maneuver via lateral orbital approach" to closed reduction of the isolated-type zygomatic arch fractures. Surgical outcomes of 14 patients treated with this method were outlined.

  15. Medio-lateral entry pin versus lateral entry pin for displaced pediatric supracondylar fractures: A comparative, prospective study

    Directory of Open Access Journals (Sweden)

    Manoj Kandel

    2016-01-01

    Full Text Available Background & Objectives: Supracondylar fracture is one of the commonest fractures in children. Although the technique of pinning is controversial, percutaneous medio-lateral entry pinning is theoretically considered more stable biomechanical construct. The drawback of this method is injury to ulnar nerve which is not encountered in only lateral entry pinning.Materials & Methods: This was a prospective, comparative and observational study done in 60 patients which was alternately divided into two groups. The first group (A underwent medio-lateral entry pinning and the second group (B underwent lateral entry pinning. They were followed for 24 weeks and the outcome was assessed using Flynn’s criteria.Results: At twenty-four weeks, the mean loss of range of motion of elbow in medio-lateral pinning group was 3.70 degrees (SD±1.93 and that in lateral pinning group was 4.23 degrees (SD ±1.38. The mean loss in carrying angle at twenty-four weeks in medio-lateral group was 2.93 degrees (SD±2.19 and that in lateral group was 4.17 (SD±2.24. There were 2 (6.67% cases of iatrogenic ulnar nerve injury in medio-lateral pinning group. Out of thirty patients, in medio-lateral pinning group, 25 had excellent results, 5 had good results and none had fair or poor results. While out of 30 patients in lateral pinning group, 23 had excellent results, 7 had good results and none had fair or poor results.Conclusion: There is no significant difference in outcome in terms of loss of carrying angle and range of motion between the medio-lateral pinning group and the lateral pinning group at the end of 6 months.Journal of College of Medical Sciences-Nepal, Vol.11(4 2015: 28-31

  16. [Elbow dislocation and lateral epicondyle fracture in a five year-old girl. Case report].

    Science.gov (United States)

    Rincón, D; Guzmén, R; Camacho, J; Abril, C

    2014-01-01

    Traumatic elbow dislocation in the pediatric population is a particularly unusual injury. It was first described by Stimson in 1900 and almost 100 years later revisited by Tachdjian in 1990. Three percent of cases are associated with lateral epicondyle fracture, so this is an infrequent injury that has been described in only a few papers as case reports. The mechanism of injury is not clearly known, nor is the best type of treatment or its complications. We report herein the case of a five year-old girl with fracture dislocation of the lateral epicondyle who was managed with closed reduction and percutaneous fixation with Kirschner nails, with good functional results.

  17. Two cases of missed Salter-Harris III coronal plane fracture of the lateral femoral condyle.

    Science.gov (United States)

    Sabharwal, Sanjeev; Henry, Patrick; Behrens, Fred

    2008-02-01

    Coronal plane fractures of the lateral femoral condyle can be difficult to diagnose, especially in children with open physis. Two adolescents who sustained this uncommon Salter-Harris III fracture of the knee were misdiagnosed after initial clinical examination and standard x-rays. Oblique x-rays, computed tomography, and magnetic resonance imaging were valuable in arriving at the correct diagnosis and in decision making.

  18. Humeral Supracondylar Fractures in Children: A Novel Technique of Lateral External Fixation and Kirschner Wiring

    Directory of Open Access Journals (Sweden)

    Kow RY

    2016-07-01

    Full Text Available Introduction: Supracondylar fracture of the humerus is the most common fracture around the elbow in children. Pinning with Kirschner wires (K-wires after open or closed reduction is generally accepted as the primary treatment modality. However, it comes with the risk of persistent instability and if the K-wire is not inserted properly, it may cause displacement and varus deformity. We present our two-year experience with a new technique of lateral external fixation and K-wiring of the humeral supracondylar fracture. Materials and Methods: A total of seven children with irreducible Gartland Type III supracondylar humeral fracture were treated with closed reduction and lateral external fixation and lateral Kirschner wiring. Patients with ipsilateral radial or ulnar fracture, open fracture and presence of neurovascular impairment pre-operatively were excluded. All the patients were followed up at one, three and six weeks and three and six months. The final outcomes were assessed based on Flynn's criteria. Results: All the patients achieved satisfactory outcomes in terms of cosmetic and functional aspects. All patients except one (85.5% regained excellent and good cosmetic and functional status. One patient (14.3% sustained pin site infection which resolved with oral antibiotic (CheckettsOtterburn grade 2. There was no neurological deficit involving the ulnar nerve and radial nerve. Conclusion: The introduction of lateral external fixation and lateral percutaneous pinning provide a promising alternative method for the treatment of humeral supracondylar fracture. This study demonstrates that it has satisfactory cosmetic and functional outcomes with no increased risk of complications compared to percutaneous pinning.

  19. Management of neglected lateral condyle fractures of humerus in children: A retrospective study

    Directory of Open Access Journals (Sweden)

    Anil Agarwal

    2012-01-01

    Full Text Available Background: Late presentation of humeral lateral condylar fracture in children is a surgical dilemma. Osteosynthesis of the fracture fragment or correction of elbow deformity with osteotomies and ulnar nerve transposition or sometimes both procedures combined is a controversial topic. We retrospectively evaluated open reduction and fixation cases in late presentation of lateral humeral condyle fracture in pediatric cases with regards to union and functional results. Materials and Methods: Twenty two pediatric (≤12 years patients with fractures of lateral condyle presenting 4 weeks or more post injury between the study period of 2006 and 2010 were included. Multiple K-wires / with or without screws along with bone grafting were used. At final evaluation, union (radiologically and elbow function (Liverpool Elbow Score, LES was assessed. Results: There were 19 boys and 3 girls. Followup averaged 33 months. Pain (n=9, swelling (n=6, restriction of elbow motion (n=6, prominence of lateral condylar region (n=4, valgus deformity (n=4 were the main presenting symptoms. Ulnar nerve function was normal in all patients. There were nine Milch type I and 13 type II fractures. Union occurred in 20 cases. One case had malunion and in another case there was resorption of condyle following postoperative infection and avascular necrosis. Prominent lateral condyles (4/12, fish tail appearance (n=7, premature epiphyseal closure (n=2 were other observations. LES averaged 8.12 (range, 6.66-9.54 at final followup. Conclusions: There is high rate of union and satisfactory elbow function in late presenting lateral condyle fractures in children following osteosynthesis attempt. Our study showed poor correlation between patient′s age, duration of late presentation or Milch type I or II and final elbow function as determined by LES.

  20. Neglected lateral process of talus fracture presenting as a loose body in tarsal canal

    Institute of Scientific and Technical Information of China (English)

    Kamal Bali; Sharad Prabhakar; Nitesh Gahlot; Mandeep S Dhillon

    2011-01-01

    Lateral process fractures of talus are rare injuries with a potential to cause significant morbidity if rnisdiagnosed.The appropriate management of these fractures is still controversial and only a few reports are available on this subject.We presented a case of a 37-year-old male with neglected fracture on the lateral process of talus which was misdiagnosed at the time of injury.The patient presented to 7 months after misdiagnosis with a chronic ankle pain.Our case is unique in the sense that it is a rare case of neglected fracture on the lateral process of talus which presented as a loose body in sinus tarsi.However,a surgery with an excision of the loose body presented a satisfactory outcome along with 2 years' follow-up.To our knowledge,it ought to be the first case reported in the English literature.Through this case report,we highlight the importance of high index of suspicion for such rare bony injuries while evaluating trauma to the lateral side of ankle and discuss the principles of management of these fractures.

  1. Transforaminal Endoscopic Decompression for Displaced End Plate Fracture After Lateral Lumbar Interbody Fusion: Technical Note.

    Science.gov (United States)

    Wagner, Ralf; Telfeian, Albert E; Krzok, Guntram; Iprenburg, Menno

    2017-10-01

    Lateral lumbar interbody fusion is a minimally invasive approach to anterior spinal column fusion, deformity correction, and indirect decompression of the lumbar spine. A rarely reported possible complication of the procedure is end plate fracture, which has the potential for nerve root compression. Here we present a case of end plate fracture and nerve compression after stand-alone lateral lumbar interbody fusion, its diagnosis, and its subsequent successful treatment with transforaminal endoscopic spine surgery. The case highlights the possible role for minimally invasive endoscopic surgery as a rescue procedure after fusion complication. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Accuracy of radiographs in assessment of displacement in lateral humeral condyle fractures.

    Science.gov (United States)

    Knutsen, Ashleen; Avoian, Tigran; Borkowski, Sean L; Ebramzadeh, Edward; Zionts, Lewis E; Sangiorgio, Sophia N

    2014-02-01

    Determining the magnitude of displacement in pediatric lateral humeral condyle fractures can be difficult. The purpose of this study was to (1) assess the effect of forearm rotation on true fracture displacement using a cadaver model and to (2) determine the accuracy of radiographic measurements of the fracture gap. A non-displaced fracture was created in three human cadaveric arms. The specimens were mounted on a custom apparatus allowing forearm rotation with the humerus fixed. First, the effect of pure rotation on fracture displacement was simulated by rotating the forearm from supination to pronation about the central axis of the forearm, to isolate the effects of muscle pull. Then, the clinical condition of obtaining a lateral oblique radiograph was simulated by rotating the forearm about the medial aspect of the forearm. Fracture displacements were measured using a motion-capture system (true-displacement) and clinical radiographs (apparent-displacement). During pure rotation of the forearm, there were no significant differences in fracture displacement between supination and pronation, with changes in displacement of <1.0 mm. During rotation about the medial aspect of the forearm, there was a significant difference in true displacements between supination and pronation at the posterior edge (p < 0.05). Overall, true fracture displacement measurements were larger than apparent radiographic displacement measurements, with differences from 1.6 to 6.0 mm, suggesting that the current clinical methods may not be sensitive enough to detect a displacement of 2.0 mm, especially when positioning the upper extremity for an internal oblique lateral radiograph.

  3. Lateralized odontoid in plain film radiography. Sign of fractures? A comparison study with MDCT

    Energy Technology Data Exchange (ETDEWEB)

    Keller, S.; Bieck, K.; Karul, M.; Schoennagel, B.; Adam, G.; Habermann, C.; Yamamura, J. [University Hospital Hamburg Eppendorf (Germany). Dept. of Diagnostic and Interventional Radiology

    2015-09-15

    To evaluate X-ray standards for the detection of odontoid fractures. Summary of background data: Cervical spine fractures are a common finding in emergency medicine, accounting for 1 - 3 % of injuries. Involvement of the C1 / C2 complex is found in 25 % of cases, affecting the odontoid peg in 55 - 80 %. Regarding the consequences of missed fractures, radiographic techniques built the groundwork for further treatment procedures. As standardized X-ray measurements have not been established, the incidence of unrecognized cervical spine fracture is expected to be up to 20 %. The establishment of X-ray-based guidelines is also limited by the presumed low specificity and sensitivity of distance measurements caused by rotational distortion which leads to a rising popularity of CT. 79 (age 60 ± 26 yrs) patients with lateralization of the odontoid process on conventional plain film radiography (anteroposterior, lateral, and open mouth odontoid process view projection) were examined. The distance between the odontoid process and lateral mass of C1, angles of vertical odontoid line and basis of C2 were measured in the ap view. In the lateral view, dorsal alignment and atlantodental distance were assessed. MDCT examinations were used as a reference. Discriminatory power test was applied to assess significance. 8/79 (10.1 %) odontoid process fractures were found. Diagnosis was achieved on conventional radiographs in 6 patients. Neither distance and angle measurements between odontoid and C1 nor the dorsal alignment of the vertebral bodies differed significantly between healthy and affected patients. Decentralization of the odontoid process is not necessarily an indirect sign for its fracture. In patients with suspected injury of the odontoid process, an MDCT scan might be the method of choice to rule out a fracture.

  4. PHILOS humerus plate for a distal tibial fracture.

    Science.gov (United States)

    Twaij, Haider; Damany, Dev

    2013-01-04

    This report discusses the use of an alternative implant in the emergency fixation of a distal tibial fracture. We planned to fix the shear-type medial malleolar fracture in a closed, tri-malleolar fracture with a locking distal tibial plate. Intra-operatively, it was noted that the required plate was unavailable. A PHILOS humeral plate seemed to fit the contours of the distal tibia. The broad end of the PHILOS, when placed distally, gave options to place locking screws in the medial malleolar fragment. The fracture was stable after fixation. The patient made a full post-operative recovery and follow-up at 4 months was satisfactory. Despite adequate planning, there will be instances where one has to improvise. An understanding of the principles of fracture management can aid in finding solutions. PHILOS humeral plate may be used to stabilize a distal tibial fracture if an appropriate distal tibial locking plate is not available.

  5. Toxic shock syndrome post open reduction and Kirschner wire fixation of a humeral lateral condyle fracture.

    Science.gov (United States)

    Chan, Yuen; Selvaratnam, Veenesh; Garg, Neeraj

    2015-08-11

    Use of Kirschner wires (K-wires) is the most common method of fracture stabilisation in lateral condyle fracture fixation in children. We report a case of toxic shock syndrome (TSS) following an open reduction and internal fixation using K-wires for a humeral lateral condyle fracture in a 5-year-old girl. TSS is a toxin-mediated multisystem illness. It typically presents with shock and it is most often attributed to toxin-producing strains of Staphylococcus aureus and Streptococcus pyogenes. It can lead to multiorgan failure and, ultimately, death. It is important to be aware of TSS, as it can present within any setting. Patients often have non-specific symptoms and their condition can worsen rapidly. TSS postorthopaedic surgery is rare; however, due to the serious nature of this disease, it is important to promptly recognise and diagnose TSS, and to ensure appropriate treatment is started without delay.

  6. Subciliary incision and lateral cantholysis in rigid internal fixation of zygomatic complex fractures

    Institute of Scientific and Technical Information of China (English)

    钟来平; 陈关福

    2004-01-01

    Objective: To introduce the technique of subciliary incision and lateral cantholysis with tri-dimension reduction and rigid internal fixation to treat zygomatic complex fractures.Methods: The subciliary incision and lateral cantholysis combined with tri-dimension reduction and rigid internal fixation of zygomatic complex fractures with titanium microplates were applied in 56 patients with zygomatic complex fractures. Another lateral eyebrow incision or sublabial incision was used to simplify the operation.Results: The postoperative follow-up period ranged from 6 months to 5 years. During the follow-up period, all the patients had satisfying postoperative results. All clinical symptoms disappeared except the numbness in the infraorbital region in 2 patients. In 94.6% patients no complications such as obvious scar, ectropion, entropion or blepharoedema were found, only 5.4% of the patients had slight ectropion 6 months after operation.Conclusions: The subciliary incision and lateral cantholysis have many advantages such as invisible scar,sufficient exposure, minimal injury, and few complications and combined with rigid internal fixation with titanium microplates this technique could be used as one of the routine operation methods to treat zygomatic complex fractures.

  7. Dorgan's lateral cross-wiring of supracondylar fractures of the humerus in children: A retrospective review.

    LENUS (Irish Health Repository)

    Queally, Joseph M

    2010-06-01

    The currently accepted treatment for displaced supracondylar humeral fractures in children is closed reduction and fixation with percutaneous Kirschner wires. The purpose of this study was to retrospectively review a novel cross-wiring technique where the cross-wire configuration is achieved solely from the lateral side, thereby reducing the risk of ulnar nerve injury.

  8. Experimental Investigation and Fracture Mechanical Modelling of Debonded Sandwich Panels Loaded with Lateral Pressure

    DEFF Research Database (Denmark)

    Jolma, Perttu; Segercrantz, Sebastian; Berggreen, Carl Christian

    2005-01-01

    For the determination of debonded sandwich panel residual strength with lateral loading a parametric finite element model is developed. The parametric model allows an arbitrary positioning of the debond within the panel and consists of both solid and shell elements. A fracture mechanical approach...

  9. Coracoclavicular stabilization using a suture button device for Neer type IIB lateral clavicle fractures.

    Science.gov (United States)

    Cho, Chul-Hyun; Jung, Jae-Hoon; Kim, Beom-Soo

    2017-05-01

    The purpose of this study was to evaluate the radiologic and clinical outcomes of coracoclavicular (CC) stabilization using a suture button device for Neer type IIB lateral clavicle fractures. Eighteen consecutive patients with Neer type IIB fractures were treated with CC stabilization using a TightRope device (Arthrex, Naples, FL, USA). The mean follow-up period was 46.6 months (range, 24-75 months). Radiologic outcomes were assessed using serial plain radiographs. Clinical outcomes were evaluated using the visual analog scale pain score; University of California, Los Angeles score; American Shoulder and Elbow Surgeons score; and subjective shoulder value. Intraoperative and postoperative complications were also evaluated. Of the 18 cases, 17 (94.4%) showed complete bony union. The mean final visual analog scale pain score was 1.1; University of California, Los Angeles score, 31.3; American Shoulder and Elbow Surgeons score, 88.6; and subjective shoulder value, 88.5%. Four complications were observed: (1) intraoperative coracoid process fracture, (2) nonunion, (3) delayed union, and (4) shoulder stiffness. The case with a coracoid process fracture during coracoid tunnel generation was converted to the K-wire tension band technique. CC stabilization using a suture button device for Neer type IIB lateral clavicle fractures yielded satisfactory radiologic and clinical outcomes. The major advantage of this technique is that implant removal is not required. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  10. Ultrasonography for non-displaced and mini-displaced humeral lateral condyle fractures in children

    Institute of Scientific and Technical Information of China (English)

    ZHANG Jing-dong; CHEN Hua

    2008-01-01

    Objective: To evaluate the value of ultrasonography in non-displaced and mini-displaced humeral lateral condyle fractures in children.Methods: Nine children aged 2-9 years with non-displaced or mini-displaced humeral lateral condyle fractures were examined by high-resolution ultrasonography.The fracture line through the joint surface was visualized by ultrasonography in 6 case,in which closed reduction and percutaneous pinning was performed on 3 patients and other 3 patients did not receive the treatment because of patients' or their parents'refusal.In the remaining 3 children,ultrasonography did not reveal the cartilaginous trochle involvement at the joint surface and conservative treatment was adopted.Results: The average follow-up period was 8 months.The sonographic findings were confirmed by magnetic resonance imaging in one child who received conservative treatment and another child who received percutaneous pinning.The elbow function and fractttre healing were good in cases received closed reduction and percutaneous pinning.Among the three cases who refused to receive closed reduction and internal f'txation,re-displacement occurred in 1 case and delayed union in 1 case.All three cases receiving conservative treatment had good results both in elbow function and fracture healing.Conclusion: High-resolution ultrasonography enable to reveal non-displaced and mini-displaced humeral lateral condyle fractures as well as to ascertain whether the cartilaginous trochlea humeri was involved.For these cases,arthrography or magnetic resonance imaging is unnecessary.

  11. Lateral Condyle Fracture of the Humerus in Children Treated with Bioabsorbable Materials

    Directory of Open Access Journals (Sweden)

    Véronique Andrey

    2013-01-01

    Full Text Available The aim of this study was to compare clinical and radiological outcome of lateral condyle fracture of the elbow in children treated with bioabsorbable or metallic material. From January 2008 to December 2009, 16 children with similar fractures and ages were grouped according to the fixation material used. Children were seen at 3, 6, and 12 months and more than 4 years (mean 51.8 months postoperatively. The clinical results were compared using the Mayo Elbow Performance Score (MEPS. Radiographic studies of the fractured and opposite elbow were assessed at last follow-up control. Twelve children had a sufficient followup and could be included in the study. Seven could be included in the traditional group and 5 in the bioabsorbable group. At 12 months, the MEPS was 100 for every child in both groups. Asymptomatic bony radiolucent visible tracks and heterotopic ossifications were noted in both groups. There were no significant differences in terms of clinical and radiological outcome between the two groups. The use of bioabsorbable pins or screws is a reasonable alternative to the traditional use of metallic materials for the treatment of lateral condyle fracture of the elbow in children.

  12. Comparison of Heterogeneously-Propped Hydraulic Fractures for Vertical and Lateral Wells

    Science.gov (United States)

    Morris, J.; Chugunov, N.

    2014-12-01

    Heterogeneous proppant placement (HPP) technologies offer improved hydraulic fracturing performance through the creation of channels within propped fractures (see figure). Such schemes, however, can suffer from reduced performance due to uncertainty in reservoir properties (e.g.: embedment and moduli). This is particularly true of unconventional reservoirs where properties can be highly heterogeneous. We demonstrate that the mechanisms controlling uncertainty in HPP performance differ between vertical and lateral wells. For computational efficiency, we combine the boundary element method to simulate formation deformation with a detailed discretization of the proppant within the fracture to predict conductivity of the HPP channels. We performed an extensive parameter study with thousands of scenarios relevant to HPP, including placement geometries consistent with both vertical and lateral wells. Global sensitivity analysis (GSA) was then applied to quantify and rank contributions from uncertain input parameters to variance in fracture conductivity. We were able to rigorously quantify the impact of parametric uncertainty. We found that for lateral wells the uncertainty in the conductivity is dominated by the uncertainty in diffusion of the proppant. For vertical wells, the dominant factors causing uncertainty in the performance change with stress. At low stress, performance is controlled by factors that dictate pillar geometry. At high stress, parameters that help preserve channels against closure stress control conductivity. Our results highlight the robustness of the HPP concept and quantify the sources of uncertainty in HPP performance. Further, we can clearly identify the fundamental parameters that control HPP conductivity and reveal that they are different for wellbore geometries that are typical of unconventional wells in North America. This implies that optimal HPP strategies will differ between vertical and lateral wells.

  13. Open-wedge high tibial osteotomy: incidence of lateral cortex fractures and influence of fixation device on osteotomy healing.

    Science.gov (United States)

    Dexel, Julian; Fritzsche, Hagen; Beyer, Franziska; Harman, Melinda K; Lützner, Jörg

    2017-03-01

    Open-wedge high tibial osteotomy (HTO) is an established treatment for young and middle-aged patients with medial compartment knee osteoarthritis and varus malalignment. Although not intended, a lateral cortex fracture might occur during this procedure. Different fixation devices are available to repair such fractures. This study was performed to evaluate osteotomy healing after fixation with two different locking plates. Sixty-nine medial open-wedge HTO without bone grafting were followed until osteotomy healing. In patients with an intact lateral hinge, no problems were noted with either locking plate. A fracture of the lateral cortex occurred in 21 patients (30.4 %). In ten patients, the fracture was not recognized during surgery but was visible on the radiographs at the 6-week follow-up. Lateral cortex fracture resulted in non-union with the need for surgical treatment in three out of eight (37.5 %) patients using the newly introduced locking plate (Position HTO Maxi Plate), while this did not occur with a well-established locking plate (TomoFix) (0 out of 13, p = 0.023). With regard to other adverse events, no differences between both implants were observed. In cases of lateral cortex fracture, fixation with a smaller locking plate resulted in a relevant number of non-unions. Therefore, it is recommended that bone grafting, another fixation system, or an additional lateral fixation should be used in cases with lateral cortex fracture. III.

  14. Late presentation of fractures of the lateral condyle of the humerus in children

    Directory of Open Access Journals (Sweden)

    Khare Ghanshyam

    2011-01-01

    Full Text Available Background: The current controversy regarding the management of fractures of the lateral condyle of the humerus presenting between 3 to 12 weeks prompted us to evaluate our results of open reduction and internal fixation of such fractures. Patients and Methods: Twenty-one patients operated between March 1995 and February 2001 qualified for this study. Five patients presented between 3-4 weeks, nine between 5-8 weeks and seven between 9-12 weeks post injury. Ten fractures were classified as stage II and eleven as stage III (Jacob et al. criteria. The mean age was 8 years (range: 4-14 years. All patients underwent surgery (open reduction and internal fixation with K-wires/screw, with or without bone grafting. The results were assessed by the modified criteria of Agarwal et al. after an average follow-up of 2.3 years. Results: Excellent to good results were observed in all the five patients presenting at 3-4 weeks post injury. In the patients presenting at 5-8 weeks, the results were excellent in one, good in four, fair in three, and poor in one patient. The fracture united in all cases; however, malunion was observed in four patients. The fractures that were operated at 9-12 weeks showed good results in one case, fair result in three cases, and poor result in three cases. Avascular necrosis of the lateral condyle in one patient, premature fusion in two patients, pin tract infection in three patients, and gross restriction of elbow movements in three patients were the major complications in this group. Accurate reduction was difficult as a result of new bone formation and remodeling at the fracture surfaces. Multiple incisions over the common extensor aponeurosis and bone graft supplementation were helpful for achieving acceptable reduction. Conclusion: Open reduction and internal fixation is recommended in all cases of displaced fractures of the lateral condyle of the humerus presenting at up to 12 weeks post injury. However, the results become

  15. Damage to the superficial peroneal nerve in operative treatment of fibula fractures: straight to the bone? Case report and review of the literature.

    Science.gov (United States)

    Halm, Jens A; Schepers, Tim

    2012-01-01

    Ankle fractures are a significant part of the lower extremity trauma seen in the emergency department. Neurologic complications of ankle fracture surgery are infrequently described but account for significant morbidity. The risk of nerve injury is increased for the Blair and Botte type B pattern of the intermediate cutaneous dorsal nerve branch, crossing the distal fibula from posterior to anterior (at 5 to 7 cm from malleolar tip). This pattern is present in about 10% to 15% of patients. Injuries to the superficial peroneal nerve and its branches negatively influence the outcome. Early recognition and protection might reduce the incidence of superficial peroneal nerve injuries during open reduction and internal fixation of lateral malleolus fractures. We describe 2 surgically treated ankle fractures with superficial peroneal nerve branch (intermediate cutaneous dorsal nerve) involvement and review the current literature.

  16. Medial Malleoli Fractures: Clinical Comparison Between Newly Designed Sled Device and Conventional Screws.

    Science.gov (United States)

    Maniar, Hemil; Kempegowda, Harish; Tawari, Akhil A; Rutter, Michael R; Borade, Amrut; Cush, Gerard; Horwitz, Daniel S

    2017-08-01

    The Trimed Medial Malleolar Sled is a newer device designed to treat medial malleolus fracture. The purpose of this study was to compare the outcome of medial malleolar fractures treated with the sled and conventional malleolar screws. After obtaining an institutional review board approval, we conducted a retrospective study to identify all skeletally mature patients who sustained an ankle fracture with medial malleolar involvement treated with the sled and we identified a matched cohort treated with conventional malleolar screws. The patients were divided into 2 groups: group A included patients treated with malleolar screws and group B included patients treated with the sled device. The outcomes measured included rate of union, implant removal, and pain over the implant site. Eighty-five medial malleolar ankle fractures were divided into 2 groups: group A included patients (n = 64) treated with malleolar screws and group B included patients (n = 21) treated with the sled device. In group A (n = 64), 62 patients (96.8%) achieved radiological union with a mean union rate of 11 weeks and 10 (15%) patients underwent repeat surgery for implant removal of which 3 patients (4.6%) had pain specifically over the medial implant. In group B (n = 21), all of the patients (100%) achieved radiological union with a mean union rate of 10.8 weeks and 3 patients (14.2%) underwent repeat surgery of which 1 (4.7%) was related to the medial pain. There is no significant difference between the groups for the outcomes measured, including rate of union (  P = .93), visual analog scale score for pain (  P = .07), implant removal (  P = .41), and pain over the implant site (  P = .88). Based on the data from our study, we conclude that there are no major differences between the sled devices and conventional screws relating to union rate and complications. Level III: Observational study.

  17. Clavicle hook plate fixation for displaced lateral-third clavicle fractures (Neer type II): a functional outcome study.

    LENUS (Irish Health Repository)

    Good, Daniel W

    2012-08-01

    Controversy exists with the use of the acromioclavicular hook plate for the treatment of lateral-third clavicle fractures (Neer type II). This is thought to stem from problems associated with the hook plate causing impingement symptoms, which can cause long-term limitation of movement and pain. Our aim was to evaluate the functional outcomes of patients with lateral-third clavicle fractures treated with the hook plate.

  18. Ipsilateral simultaneous fracture of the trochlea involving the lateral end clavicle and distal end radius: a rare combination and a unique mechanism of injury

    Directory of Open Access Journals (Sweden)

    Gupta RK

    2014-07-01

    Full Text Available 【Abstract】Isolated trochlea fracture in adults is a rare surgical entity as compared to its capitellar counterpart. It has been only mentioned sporadically in the literature as case reports. Fracture of the trochlea is accompanied by other elbow injuries like elbow dislocation, capitellum fracture, ulnar fracture and extraarticular condylar fracture. Here we report a unique case of isolated displaced trochlea fracture associated with fractures of the lateral end clavicle and the distal end radius. We propose a unique mechanism for this rare combination of injuries: typical triad of injury, i.e. fracture of the distal end radius with trochlea and fracture of the lateral end of the clavicle. Nonoperative treatment is recommended for undisplaced humeral trochlea fractures; but for displaced ones, anatomical reduction and internal fixation are essential to maintain the congruous trochleacoronoid articulation and hence to maintain the intrinsic stability of the elbow. Key words: Isolated trochlea fracture; Clavicle; Radius fractures

  19. Traumatic Testicular Dislocation Associated with Lateral Compression Pelvic Ring Injury and T-Shaped Acetabulum Fracture

    OpenAIRE

    Daniel Howard Wiznia; Mike Wang; Chang Yeon-Kim; Paul Tomaszewski; Michael P. Leslie

    2016-01-01

    We report a case of a unilateral testicular dislocation to the superficial inguinal region associated with a lateral compression type pelvic ring injury (OTA classification 61-C3.3a2, b2, c3) and left T-shaped acetabulum fracture (OTA classification 62-B2) in a 44-year-old male who was in a motorcycle accident. The testicular dislocation was noted during the emergency department primary survey, and its location and viability were verified with ultrasound. The testicle was isolated during surg...

  20. Minimally Invasive Double-Button Fixation of Displaced Lateral Clavicular Fractures in Athletes.

    Science.gov (United States)

    Ranalletta, Maximiliano; Rossi, Luciano A; Barros, Hugo; Nally, Francisco; Tanoira, Ignacio; Bongiovanni, Santiago L; Maignon, Gastón D

    2017-02-01

    Early union and a rapid return to prior function are the priorities for young athletes with lateral clavicular fractures. Furthermore, it is essential to avoid nonunion in this subgroup of patients, as this is frequently associated with persistent pain, restriction of movement, and loss of strength and endurance of the shoulder. To analyze the time to return to sport, functional outcomes, and complications in a group of athletes with displaced lateral clavicular fractures treated using closed reduction and minimally invasive double-button fixation. Case series; Level of evidence, 4. A total of 21 athletes with displaced lateral clavicular fractures were treated with closed reduction and minimally invasive double-button fixation between March 2008 and October 2013. Patients completed a questionnaire focused on the time to return to sport and treatment course. Functional outcomes were assessed with the Constant score and the short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire. Pain was evaluated with the visual analog scale (VAS). Radiographs were reviewed to identify radiographic union, malunion, and nonunion. Of the 21 study patients, 20 returned to sport after treatment; 100% returned to the same level. The mean time to return to play was 78 days (range, 41-120 days). Four patients (20%) returned to sport less than 6 weeks after surgery, 14 (70%) returned between 6 and 12 weeks after surgery, and 2 (10%) returned after 12 weeks. The mean Constant score was 89.1 ± 4.2 (range, 79-100), the mean QuickDASH score was 0.4 ± 2.6 (range, 0-7.1), and the mean VAS pain score was 0.4 ± 1.0 (range, 0-3) at final follow-up (mean, 41 months). The only complication was asymptomatic nonunion. Hardware removal was not necessary in any patient. Closed reduction and minimally invasive double-button fixation of displaced lateral clavicular fractures in athletes was successful in terms of returning to the previous level of athletic activity

  1. C1-C3 lateral mass fusion for type IIa and type III Hangman′s fracture

    Directory of Open Access Journals (Sweden)

    Natarajan Muthukumar

    2012-01-01

    Full Text Available Hangman′s fractures, also known as traumatic spondylolisthesis of axis, can be managed either conservatively with immobilization or by surgery. Surgery is usually indicated in cases with instability or failure of conservative treatment. Different surgical approaches, both anterior and posterior, have been described for treating Hangman′s fracture. We report two patients, one with type IIa and another with type III Hangman′s fracture treated with C1-C3 lateral mass fusion and discuss the advantages and limitations of this technique when compared to other techniques for fusion in patients with Hangman′s fracture.

  2. Comminuted supracondylar femoral fractures: a biomechanical analysis comparing the stability of medial versus lateral plating in axial loading

    Directory of Open Access Journals (Sweden)

    Nikolai Briffa

    2016-10-01

    Full Text Available Abstract The aim of this study was to compare the biomechanical properties of medial and lateral plating of a medially comminuted supracondylar femoral fracture. A supracondylar femoral fracture model comparing two fixation methods was tested cyclically in axial loading. One-centimetre supracondylar gap osteotomies were created in six synthetic femurs approximately 6 cm proximal to the knee joint. There were two constructs investigated: group 1 and group 2 were stabilized with an 8-hole LC-DCP, medially and laterally, respectively. Both construct groups were axially loaded. Global displacement (total length, wedge displacement, bending moment and strain were measured. Medial plating showed a significantly decreased displacement, bending moment and strain at the fracture site in axial loading. Medial plating of a comminuted supracondylar femur fracture is more stable than lateral plating.

  3. Integrity of the lateral femoral wall in intertrochanteric hip fractures: an important predictor of a reoperation

    DEFF Research Database (Denmark)

    Palm, Henrik; Jacobsen, Steffen; Sonne-Holm, Stig;

    2007-01-01

    BACKGROUND: Reoperations after intertrochanteric fractures are often necessitated by fracture displacement following mobilization of the patient. The biomechanical complexity of the fracture, the position of the implant, and the patient's characteristics are known to influence postoperative outco...

  4. Biomechanics of the incudo-malleolar-joint - Experimental investigations for quasi-static loads.

    Science.gov (United States)

    Ihrle, S; Gerig, R; Dobrev, I; Röösli, C; Sim, J H; Huber, A M; Eiber, A

    2016-10-01

    Under large quasi-static loads, the incudo-malleolar joint (IMJ), connecting the malleus and the incus, is highly mobile. It can be classified as a mechanical filter decoupling large quasi-static motions while transferring small dynamic excitations. This is presumed to be due to the complex geometry of the joint inducing a spatial decoupling between the malleus and incus under large quasi-static loads. Spatial Laser Doppler Vibrometer (LDV) displacement measurements on isolated malleus-incus-complexes (MICs) were performed. With the malleus firmly attached to a probe holder, the incus was excited by applying quasi-static forces at different points. For each force application point the resulting displacement was measured subsequently at different points on the incus. The location of the force application point and the LDV measurement points were calculated in a post-processing step combining the position of the LDV points with geometric data of the MIC. The rigid body motion of the incus was then calculated from the multiple displacement measurements for each force application point. The contact regions of the articular surfaces for different load configurations were calculated by applying the reconstructed motion to the geometry model of the MIC and calculate the minimal distance of the articular surfaces. The reconstructed motion has a complex spatial characteristic and varies for different force application points. The motion changed with increasing load caused by the kinematic guidance of the articular surfaces of the joint. The IMJ permits a relative large rotation around the anterior-posterior axis through the joint when a force is applied at the lenticularis in lateral direction before impeding the motion. This is part of the decoupling of the malleus motion from the incus motion in case of large quasi-static loads. Copyright © 2015 Elsevier B.V. All rights reserved.

  5. Treatment of Displaced Sacroiliac Fracture Using the Lateral Window for Short Plate Buttress Reduction and Percutaneous Sacroiliac Screw Fixation.

    Directory of Open Access Journals (Sweden)

    Colin Murphy

    2016-04-01

    Full Text Available Fractures through the sacroiliac joint are very challenging to treat, technically difficult to reduce through closed methods on account of the multiaxial displacement of fractures fragments, frequently occur in very unwell patients, and have poor outcomes if malreduction is present. We describe a technique utilising the lateral window and a short buttress plate to reduce and stabilize the fragments prior to percutaneous fixation with sacroiliac screws.

  6. Lateral migration with telescoping of a trochanteric fixation nail in the treatment of an intertrochanteric hip fracture

    Institute of Scientific and Technical Information of China (English)

    Liu Wanjun; Wang Junqiang; Michael J.Weaver; Mark S.Vrahas; Zhou Dongsheng

    2014-01-01

    Background The trochanteric fixation nail (TFN) can be used to treat stable and unstable fractures of intertrochanteric hip fractures.We study the common lateral migration that occurs with telescoping of intertrochanteric hip fractures treated with TFN and identify the predictors and relationships to clinical outcomes.Methods Patient demographic information,fracture type (Arbeitsgemeinschaft für Osteosynthesefragen (AO)/Orthopaedic Trauma Association (OTA) classification),radiographic data,and clinical data were collected.Lateral migration with telescoping was measured.Statistical analyses were performed to determine which variables predicted lateral migration with telescoping.Patient outcome scores were recorded using the Modified Harris Hip Score (MHHS),Hip Outcome Score-Activity of Daily Living (HOS-ADL),and Visual Analog Scale for pain.Results Two hundred and twenty-three patients (67 males,156 females) fitted the radiographic and follow-up (average 24.6 months) criteria.The average age was 77.2 years.The average lateral migration with telescoping was 4.8 mm.Twenty-one patients (9.4%) had excessive lateral migration with telescoping (≥10 mm).The quality of calcar reduction (P=0.01) and unstable fracture patterns (P=0.006) were significant predictive factors of lateral migration with telescoping.The mean outcome scores (MHHS and HOS-ADL) were 80.1 points and 78.7 points,respectively.All subjects had no significant relationship to lateral migration with telescoping (P >0.05).Of all the patients who developed lateral migration with telescoping,only one required removal of the blade for hip pain and all patients went on to uneventful union at an average time of 4.5 months.Conclusions Lateral migration with telescoping is a common mechanical complication of intertrochanteric hip fracture treated with the TFN procedure.It was predicted by the quality of calcar reduction and fracture type.However,this did not affect stable fixation and fracture healing

  7. Motion-preserving reduction and fixation of C1 Jefferson fracture using a C1 lateral mass screw construct.

    Science.gov (United States)

    Jo, Kwang-Wook; Park, Ik-Seong; Hong, Jae Taek

    2011-05-01

    The treatment of C1 Jefferson fractures is controversial. Non-surgical treatment with halo fixation always bears the risk of insufficient healing with further instability and increasing neck pain. However, a C1-2 fusion can markedly decrease the rotatory motion of the neck. The aim of this report is to describe a new treatment for C1 Jefferson fractures. We used open reduction and C1 fixation using a bilateral C1 lateral mass screw construct. The screws were connected with a rod and nuts to reduce lateral spread of the lateral masses. This method is an alternative surgical option for C1 Jefferson fractures in select patients and can maintain important C1-2 joint motion.

  8. Traumatic Testicular Dislocation Associated with Lateral Compression Pelvic Ring Injury and T-Shaped Acetabulum Fracture

    Directory of Open Access Journals (Sweden)

    Daniel Howard Wiznia

    2016-01-01

    Full Text Available We report a case of a unilateral testicular dislocation to the superficial inguinal region associated with a lateral compression type pelvic ring injury (OTA classification 61-C3.3a2, b2, c3 and left T-shaped acetabulum fracture (OTA classification 62-B2 in a 44-year-old male who was in a motorcycle accident. The testicular dislocation was noted during the emergency department primary survey, and its location and viability were verified with ultrasound. The testicle was isolated during surgical stabilization of the left acetabulum through a Pfannenstiel incision and modified-Stoppa approach and returned through the inguinal canal to the scrotum. In follow-up, the patient did not suffer urologic or sexual dysfunction. All motorcycle collision patients presenting with pelvic ring injuries or acetabulum fractures should be worked up for possible testicular dislocation with a scrotal exam. Advanced imaging and a urologic consult may be necessary to detect and treat these injuries.

  9. Delayed presentation of popliteal artery transection following undisplaced lateral condyle fracture of tibia

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    Mohit Gupta

    2016-01-01

    Full Text Available Literature suggests that vascular damage occurring with orthopedic injury of the lower extremity is rare and uncommon. We present a case of a young adult male who presented to the emergency room with a history of road traffic accident with complaints of pain in the right ankle diagnosed as medial malleolus fracture and pain in the left knee diagnosed as undisplaced lateral tibial condyle fracture. At the time of presentation, the left leg appeared normal and was stabilized with a knee brace, which on the next day developed severe swelling with absence of distal pulses. Doppler revealed no blood flow distal to popliteal artery with severe soft tissue edema. The patient was posted for emergency basis vascular exploration where popliteal artery was surprisingly found transected and was repaired followed by timely fasciotomy. This case report has also been prepared to stress the importance of secondary survey in patients after high energy trauma as it can prevent the important injuries from being missed.

  10. Influence of Lateral Muscle Loading in the Proximal Femur after Fracture Stabilization with a Trochanteric Gamma Nail (TGN)

    Science.gov (United States)

    Sitthiseripratip, Kriskrai; Mahaisavariya, Banchong; Suwanprateeb, Jintamai; Bohez, Erik; Vander Sloten, Jos

    The purpose of this study was to investigate the influence of lateral muscle loading on the stress/strain distributions of the trochanteric Gamma nail (TGN) fixation within the healed, trochanteric and subtrochanteric femoral fractures by means of a finite element method. The effect of three muscle groups, the abductors (ABD), the vastus lateralis (VL) and the iliotibial band (ITB), were investigated. The analytical results showed that addition of lateral muscle forces, iliotibial band and vastus lateralis, produced compensation of forces and reduction of bending moments in the bone and in the trochanteric Gamma nail especially in the lateral aspect. The iliotibial band produced a higher impact as compared to the vastus lateralis. Therefore in the finite element analysis of the proximal femur with the trochanteric Gamma nail fracture fixation should include the lateral muscle forces to simulate load condition with maximal physiological relevance to the closed nailing technique.

  11. Great increase in bone 66 kDa protein and osteocalcin at later stages with healing rat fractures: effect of zinc treatment.

    Science.gov (United States)

    Igarashi, Aki; Yamaguchi, Masayoshi

    2003-02-01

    Fracture healing has been demonstrated to increase production of bone growth factors, and this elevation has been shown to be enhanced by zinc treatment. Moreover, the effect of zinc treatment on production of bone osteocalcin, which is a kind of Ca2+-binding protein localized in bone matrix, at the later stages with bone fracture was investigated. Rats were sacrificed 7 (earlier stage) or 21 (later stage) days after fracture of femoral diaphysis. Femoral-diaphyseal tissues with fracture healing were cultured in a serum-free medium for 24 h. Many proteins in the bone tissues were released into the medium. Bone protein production was markedly elevated 21 days after bone fracture as compared with that of 7 days. A approximately 66 kDa protein molecule, a major protein component which was produced by the diaphyseal tissues during fracture healing, was predominantly increased at the later stages with fracture healing. Bone osteocalcin production was significantly increased during fracture healing. This increase was enhanced at the later stages with fracture healing. The presence of zinc acexamate (10(-4) M) in culture medium caused a significant increase in bone protein and osteocalcin production at 7 or 21 days after bone fracture. The effect of zinc acexamate in increasing bone total protein and osteocalcin production was remarkable at the later stages with fracture healing. Moreover, zinc treatment caused a significant increase in alkaline phosphatase activity, deoxyribonucleic acid (DNA) and calcium content in the femoral-diaphyseal tissues of the later stages with fracture healing in vitro. The present study demonstrates that bone protein production is markedly increased at the later stages with fracture healing, and that zinc treatment can enhance production of bone protein components including osteocalcin in vitro. Zinc treatment may stimulate the healing of femoral fracture at earlier and later stages.

  12. Kirschner wire fixation of Salter-Harris type IV fracture of the lateral aspect of the humeral condyle in growing dogs. A retrospective study of 35 fractures.

    Science.gov (United States)

    Cinti, Filippo; Pisani, Guido; Vezzoni, Luca; Peirone, Bruno; Vezzoni, Aldo

    2017-01-16

    To evaluate the use of Kirschner wires for treatment of fractures of the lateral aspect of the humeral condyle in growing dogs. Retrospective analysis of 35 elbow fractures (33 dogs) of the lateral aspect of the humeral condyle treated by insertion of multiple transcondylar and one anti-rotational Kirschner wires. Radiographic and clinical re-evaluations were carried out immediately after surgery, at four weeks and, when required, at eight weeks postoperatively. Long-term follow-up was planned after a minimum of six months. The relationship between different implant configurations and clinical outcome was analysed statistically. Complete functional recovery was seen in 31 elbows (30 dogs), three elbows (2 dogs) had reduction in the range of motion, and one elbow (1 dog) had persistent grade 1 lameness two months postoperatively. Major complications occurred in eight elbows (8 dogs) and all were resolved by implant removal. Implant configuration did not affect outcome. Long-term evaluation in 12 cases with a mean follow-up of four years showed absence of lameness, normal function and no or mild radiographic evidence of osteoarthritis in 11 cases. Fracture of the lateral aspect of the humeral condyle in growing dogs can be successfully treated by multiple transcondylar convergent or parallel Kirschner wires, resulting in adequate fracture healing.

  13. Temporary Sternoclavicular Plating for an Unusual Double Clavicle Fracture (Medial Nonunion, Lateral Acute Complicated by an Intraoperative Pneumothorax

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    John G. Skedros

    2014-01-01

    Full Text Available Double (segmental clavicle fractures, involving both the medial and lateral aspects of the clavicle, are very uncommon. Even less common is an asynchronous double fracture with one of the fractures being a nonunion. We report the case of a 30-year-old healthy male patient who had an unusual double clavicle fracture (medial nonunion, lateral acute that occurred in separate traumatic events during motocross (motorcycle racing. His fractures were treated surgically in two stages. In the first stage a long reconstruction plate was used that spanned onto the sternum and two transcortical screws were placed into the manubrium to enhance purchase for the deficient bone of the medial clavicle. In accordance with the preoperative plan, the medial one-third of the plate and the medial four screws (of the total 13 used were removed. Although our patient had an excellent final result, he did have an intraoperative pneumothorax that was treated uneventfully with a chest tube. Medial clavicle fractures are difficult to treat, especially if they are nonunions and surgical complication rates can be high. Our case is one of the few that has been described where temporary sternoclavicular plating was successful in achieving an excellent long-term outcome.

  14. Temporary sternoclavicular plating for an unusual double clavicle fracture (medial nonunion, lateral acute) complicated by an intraoperative pneumothorax.

    Science.gov (United States)

    Skedros, John G; Knight, Alex N; Mears, Chad S; Langston, Tanner D

    2014-01-01

    Double (segmental) clavicle fractures, involving both the medial and lateral aspects of the clavicle, are very uncommon. Even less common is an asynchronous double fracture with one of the fractures being a nonunion. We report the case of a 30-year-old healthy male patient who had an unusual double clavicle fracture (medial nonunion, lateral acute) that occurred in separate traumatic events during motocross (motorcycle) racing. His fractures were treated surgically in two stages. In the first stage a long reconstruction plate was used that spanned onto the sternum and two transcortical screws were placed into the manubrium to enhance purchase for the deficient bone of the medial clavicle. In accordance with the preoperative plan, the medial one-third of the plate and the medial four screws (of the total 13 used) were removed. Although our patient had an excellent final result, he did have an intraoperative pneumothorax that was treated uneventfully with a chest tube. Medial clavicle fractures are difficult to treat, especially if they are nonunions and surgical complication rates can be high. Our case is one of the few that has been described where temporary sternoclavicular plating was successful in achieving an excellent long-term outcome.

  15. Osteochondral Fracture Lateral Femoral Condyle Treated with ORIF Using Z-Plasty: A Modification of Coonse and Adams Approach

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    Sanjay Agarwala

    2011-01-01

    Full Text Available Osteochondral fractures of lateral femoral condyle are common in adolescents and young adults. They are usually caused by direct trauma or twisting injuries of the knee. We present a case of large osteochondral fracture of lateral femoral condyle involving the articular surface in a fifteen-year-old male with a positive history of significant weight gain of 5 kilograms in last six months. Blood investigations reported low vitamin D and testosterone levels with elevated alkaline phosphatase. Adequate exposure was achieved by doing Z-plasty of quadriceps apparatus. The fracture was treated with open reduction and internal fixation using Herbert's screws. Medical management in the form of vitamin D and calcium along with testosterone was given. After the surgery, full weight-bearing was allowed at three months. At one year followup, patient has good quadriceps function without any weakness of the muscle.

  16. The direct lateral approach to the distal tibia and fibula: a single incision technique for distal tibial and pilon fractures.

    Science.gov (United States)

    Femino, John E; Vaseenon, Tanawat

    2009-01-01

    Distal tibia fractures remain difficult injuries to treat when fracture displacement precludes non-operative treatment. Different methods of treatment including limited internal fixation with external fixation, as well as open reduction and internal fixation have been recommended. Open reduction and internal fixation is often favored for the improved ability to anatomically reduce displaced fractures, particularly articular fractures. However, wound complications due to the associated trauma to the fragile soft tissue envelope in this region continue to be a significant concern.The authors present a surgical approach for open reduction and fixation of distal tibia and fibula fractures through a single lateral incision, which respects the angiosomes of the distal leg and ankle. This can, in some cases, resolve the need to delay ORIF of the tibia since the incision is essentially the same as that used for the immediate ORIF of fibula fractures, which is commonly used in the staged treatment of distal tibial and plafond fractures. This approach can be extended proximally and distally to allow treatment of other injuries about the ankle and hindfoot. Illustrative cases are provided.

  17. The V sign in lateral talar process fractures: an experimental study using a foot and ankle model.

    Science.gov (United States)

    Jentzsch, Thorsten; Hasler, Anita; Renner, Niklas; Peterhans, Manuel; Sutter, Reto; Espinosa, Norman; Wirth, Stephan H

    2017-07-03

    Lateral talar process fractures (LTPF) are often missed on conventional radiographs. A positive V sign is an interruption of the contour of the LTP. It has been suggested, but not proven to be pathognomonic for LTPF. The objective was to study whether the V sign is pathognomonic for LTPF and if it can be properly assessed in different ankle positions and varying fracture types. An experimental study was conducted. Two investigators assessed lateral radiographs (n = 108) of a foot and ankle model. The exposure variables were different ankle positions and fracture types. The primary outcome was the correct detection of a V sign. The secondary outcomes were the detection of the V sign depending on ankle position and fracture type as well as the uncertainty. The interobserver agreement on the V sign and type of fracture were fair (κ = 0.35, 95% CI 0.18-0.53, p V sign were 77% (95% CI 67-86%), 59% (95% CI 39-78%), 85% (95% CI 75-92%), 46% (95% CI 29-63%), and 2. The mean uncertainty in the V sign detection was 38%. The V sign identification stratified by ankle position and fracture type showed significant better results with increasing inversion (p = 0.035 and p = 0.011) and type B fractures (p = 0.001 and p = 0.013). The V sign may not be pathognomonic and is not recommended as the only modality for the detection of LTPF. It is better visualized with inversion, but does not depend on plantar flexion or internal rotation. It is also better seen in type B fractures. It is difficult to detect and investigator-dependent. It may be helpful in a clinical setting to point into a direction, but a CT scan may be used if in doubt about a LTPF.

  18. A COMPARATIVE STUDY OF OUTCOMES OF PERCUTANEOUS CROSSED VS LATERAL DIVERGENT PINNING IN THE TREATMENT OF DISPLACED (GRADE - 3) SUPRACONDYLAR FRACTURES OF HUMERUS IN CHILDREN

    OpenAIRE

    Nirav Patel; Paresh Patil; Kiran Gaonkar; Pravin Patil; Himanshu Kulkarni; Ketan Gupta; Mandar Shaha; Nagesh Desai

    2015-01-01

    INTRODUCTION: Displaced supracondylar fractures of humerus are one of the most common fractures in paediatric age group with preferred treatment being close reduction with percutaneous k - wire fixation. This study compares whether lateral pin construct alone can provide same stability like medial and lateral pin fixation, and prevent iatrogenic ...

  19. Defining the lateral and accessory views of the patella: an anatomic and radiographic study with implications for fracture treatment.

    Science.gov (United States)

    Berkes, Marschall B; Little, Milton T M; Pardee, Nadine C; Lazaro, Lionel E; Helfet, David L; Lorich, Dean G

    2013-12-01

    The majority of orthopaedic surgeons rely on a lateral fluoroscopic image to assess reduction during patella fracture osteosynthesis. However, a comprehensive radiographic description of the lateral view of the patella has not been performed previously, and no accessory views to better visualize specific anatomic features have been developed. The purpose of this study was to provide a detailed anatomic description of all radiographic features of the true lateral of the patella, describe reproducible accessory views for assessing specific features of the patella, and demonstrate their utility in a fracture model. Twelve cadaver knee specimens free of patellofemoral pathology were used, and imaging was performed using standard C-arm fluoroscopy. For each specimen, a true lateral radiographic projection of the patella was obtained and distinct features were noted. Next, an arthrotomy was made and steel wire was contoured and fixed to various anatomic regions of the patella so as to obliterate the radiographic densities on the true lateral projection, thus confirming their anatomic correlation. Ideal views of the lateral and medial facets themselves were determined using radiographic markers and varying amounts of internal or external rotation of the specimen. Last, a transverse osteotomy was created in each patella and the ability of the true lateral and accessory views to detect malreduction was assessed. The true lateral projection of the patella was obtained with the limb in neutral alignment. Constant radiographic features of the lateral view of the patella include the articular tangent, a secondary articular density of variable length, and a dorsal cortical density. The articular tangent was produced by the central ridge between the medial and lateral facets in all specimens. The secondary articular density was created by a confluence of the edge of the lateral and edge of the medial facets in 5 patellas, a confluence of the edge of the lateral facet and the

  20. LATE OPEN REDUCTION AND INTERNAL FIXATION FOR FRACTURES OF LATERAL CONDYLE OF HUMERUS IN CHILDREN: A CLINICAL STUDY

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    Ajay

    2013-10-01

    Full Text Available ABSTRACT: BACKGROUND : Neglected fracture of the lateral condyle of distal humerus in children is very common. Patients with non union of the lateral condylar fracture have pain, instability or a progressive cubitus valgus deformity, condylar prominence. A neglected displaced lateral humeral condyle fracture remains a difficult problem to treat. The bone ends become indistinct and soft tissue becomes contracted; making anatomic reduction difficult. Moreover a n attempt to mobilize the fragment by stripping the soft tissues may lead to avascular necrosis. Several authors have recommended operative treatment for such patients, while others do not recommend operative intervention because stiff elbow and AVN are th e usual outcomes. The present study was undertaken to assess the results of open reduction and internal fixation in neglected lateral humeral condyle fracture in children. MATERIAL AND METHODS : This is a prospective study carried out between November 2008 and July 2011 in the department of orthopedics at Teerthanker Mahaveer Medical College and research centre, Moradabad. Eighteen patients (14M:4F with an average age of 7.3years (range 5.5 to 14 years who had lateral humeral condyle fracture and reporte d 3 or more weeks after sustaining injury, were included in the study. The fractures were classified according to the Jacobs system. All patients were operated using the lateral approach and fixation was done using K wire or screw with or without bone graf ting. The results were graded as excellent, good, fair or poor according to the modified criteria of Agarwal et al. RESULTS : There were 14 males and 4 females with a mean age of 7 years and 3 months (range 4 - 14 years. Among the nine (50% patients who pr esented between 5 to 8 weeks after injury, the results were excellent in 3, good in 4, fair in 1 and poor in 1 patient. Excellent to good results were seen in all the five (27% patients presenting between 3 - 5 weeks of injury. Among

  1. LATERAL APPROACH UNDER FLUROSCOPIC GUIDANCE WITH NONLOCKING CALCANEAL PLATE IS AN EFFECTIVE TECHNIQUE FOR CLOSED CALCANEAL FRACTURE

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    Alok Sobhan

    2014-06-01

    Full Text Available Intra-articular calcaneal fractures which accounts for about 75% of calcaneal fractures is usually associated with poor functional outcome. The present was under taken to evaluate the efficacy of open reduction and internal fixation of displaced articular fractures of calcaneum in adults through lateral approach under fluroscopic guidance with non-locking calcaneal plate and ipsilateral iliac crest bone graft. 30 adult patients (25 males and 5 females with closed displaced intra articular fractures of calcaneum of less than 15 days constituted the study group. All cases were operated by lateral approach as described by Seligson, a modification of Gould’s technique under spinal anaesthesia. All machers Arthrosis Rating Scale were used for the evaluation of posttraumatic posterior facet degenerative changes. Primarily27 of all 35 wounds (77% healed without any form of wound complications. Excellent to good results noted in 3 (100% patients with preoperative Bohler´s angle larger or equal to 20° (n = 3 whereas patients with preoperative Bohler´s angle smaller than 20° (n=32 achieved excellent to good results in 16 cases (50% Clinically significant subtalararthrosis (Allmacher grade 2-4 noted in 7 cases (20% cases with Bohler´s angle smaller than 20° (n=32. In 5 cases, clinically significant complaints (Allmachers Arthrosis Rating Scale grades II to V noted. Therapeutic success of such fracture depends on timely open reduction and internal fixation with proper fracture reduction and early rehabilitation. Thus management of these injuries as well as complications should be performed in a specialized orthopaedics or traumatology center.

  2. Snowboard, wakeboard, dashboard? Isolated fracture of the lateral process of the talus in a high-speed road traffic accident.

    Science.gov (United States)

    Ng, Evangeline Shimei; O'Neill, Barry James; Cunningham, Laurence Patrick; Quinlan, John Francis

    2013-07-10

    We present a 23-year-old man who sustained an isolated fracture of the lateral process of the talus (LPT) in a head-on vehicle collision at a combined speed of 200 km/h. The driver of the other vehicle sustained fatal injuries at the scene. The LPT was openly reduced and fixed with successful outcome at 3 months. This case is unusual in the method of injury, in particular in relation to the isolated relatively minor injury sustained.

  3. Snowboard, wakeboard, dashboard? Isolated fracture of the lateral process of the talus in a high-speed road traffic accident.

    LENUS (Irish Health Repository)

    Ng, Evangeline Shimei

    2013-01-01

    We present a 23-year-old man who sustained an isolated fracture of the lateral process of the talus (LPT) in a head-on vehicle collision at a combined speed of 200 km\\/h. The driver of the other vehicle sustained fatal injuries at the scene. The LPT was openly reduced and fixed with successful outcome at 3 months. This case is unusual in the method of injury, in particular in relation to the isolated relatively minor injury sustained.

  4. [Salter-Harris type IV epipyseal fracture of the lateral malleolus. A rare injury in childhood].

    Science.gov (United States)

    Lugeder, A; Jäger, C; Fecht, E; Riemer, C; Sattler, M; Kalbe, P; Zeichen, J

    2014-02-01

    This is a case presentation of a 9-year-old boy who sustained a rare Salter-Harris type IV distal fibular fracture including an avulsion fracture of the anterior inferior tibiofibular ligament at the fibular attachment. Treatment consisted of open reduction and internal fixation by Kirschner wire and cerclage. Possible posttraumatic growth disturbances and the major implications are highlighted.

  5. Conservative treatment of an anterior-lateral ankle dislocation without an associated fracture in a diabetic patient: a case report

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    Panagiotis K. Karampinas

    2012-06-01

    Full Text Available Anterior or anterior-lateral dislocation of the ankle is a rare condition that can be treated conservatively as well as any other similar types of ankle dislocations without associated fractures. We present a case report of an anterior-lateral ankle dislocation with a concomitant avulsion injury of the ankle's anterior capsule in a diabetic patient that was treated conservatively. At the patient's visit 12 months after the initial injury, he was asymptomatic with full range of motion of the ankle joint. To our knowledge, we could not identify this type of an injury in a diabetic patient that was treated successfully with conservative treatment in the existing literature.

  6. The role of the lateral pterygoid muscle in the sagittal fracture of mandibular condyle (SFMC) healing process.

    Science.gov (United States)

    Liu, Chng-Kui; Liu, Ping; Meng, Fan-Wen; Deng, Bang-Lian; Xue, Yang; Mao, Tian-Qiu; Hu, Kai-Jin

    2012-06-01

    The aim of this study was to examine the role of the lateral peterygoid muscle in the reconstruction of the shape of the condyle during healing of a sagittal fracture of the mandibular condyle. Twenty adult sheep were divided into 2 groups: all had a unilateral operation on the right side when the anterior and posterior attachments of the discs were cut, and an oblique vertical osteotomy was made from the lateral pole of the condyle to the medial side of the condylar neck. Ten sheep had the lateral pterygoid muscle cut, and the other 10 sheep did not. Sheep were killed at 4 weeks (n=2 from each group), 12 weeks (n=4), and 24 weeks (n=4) postoperatively. Computed tomograms (CT) were taken before and after operations. We dissected the joints, and recorded with the naked eye the shape, degree of erosion, and amount of calcification of the temporomandibular joint (TMJ). In the group in which the lateral peterygoid muscle had not been cut the joints showed overgrowth of new bone and more advanced ankylosis. Our results show that the lateral pterygoid muscle plays an important part in reconstructing the shape of the condyle during the healing of a sagittal fracture of the mandibular condyle, and combined with the dislocated and damaged disc is an important factor in the aetiology of traumatic ankylosis of the TMJ.

  7. [Difference of anti-fracture mechanical characteristics between lateral-root branches and adjacent upper straight roots of four plant species in vigorous growth period].

    Science.gov (United States)

    Liu, Peng-fei; Liu, Jing; Zhu, Hong-hui; Zhang, Xin; Zhang, Ge; Li, You-fang; Su, Yu; Wang, Chen-jia

    2016-01-01

    Taking four plant species, Caragana korshinskii, Salix psammophila, Hippophae rhamnides and Artemisia sphaerocephala, which were 3-4 years old and in vigorous growth period, as test materials, the anti-fracture forces of lateral-root branches and adjacent upper straight roots were measured with the self-made fixture and the instrument of TY 8000. The lateral-root branches were vital and the diameters were 1-4 mm. The results showed that the anti-fracture force and anti-fracture strength of lateral-root branches were lesser than those of the adjacent upper straight roots even though the average diameter of lateral-root branches was greater. The ratios of anti-fracture strength of lateral-root branches to the adjacent upper straight roots were 71.5% for C. korshinskii, 62.9% for S. psammophila, 45.4% for H. rhamnides and 35.4% for A. sphaerocephala. For the four plants, the anti-fracture force positively correlated with the diameter in a power function, while the anti-fracture strength negatively correlated with diameter in a power function. The anti-fracture strengths of lateral-root branches and adjacent upper straight roots for the four species followed the sequence of C. korshinskii (33.66 and 47.06 MPa) > S. psammophila (17.31 and 27.54 MPa) > H. rhamnides (3.97 and 8.75 MPa) > A. sphaerphala (2.18 and 6.15 MPa).

  8. Treatment of a Chronic Galeazzi Fracture-dislocation. A Case Report

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    Yaniel Truffin Rodríguez

    2016-10-01

    Full Text Available Galeazzi fracture-dislocation is a rare injury that may go unnoticed. It should be suspected when dealing with a displaced fracture of the junction of the distal and middle third of the radial shaft. For these reasons, we present the case of a 50-year-old patient who suffered a trauma with a cutting tool in the junction of the distal and middle third of his left forearm, which resulted in a wound on the dorsal aspect of the forearm and a Galeazzi fracture-dislocation. We could not determine whether the fracture had been open or not since the patient did not provide clear information during the assessment conducted in the Orthopedics Service of the hospital of Cienfuegos 55 days after the trauma. The open reduction and internal fixation of the fracture was performed. Given the time elapsed since the injury and the presence of degenerative lesions in the wrist, a distal radioulnar arthrodesis (the Sauvé-Kapandji procedure was carried out. The stabilization of the distal ulna was achieved by using a 3.5 mm malleolar screw placed in an ulnar to radial direction. The patient underwent physical rehabilitation and was discharged five months later with satisfactory results.

  9. The prevention of a lateral hinge fracture as a complication of a medial opening wedge high tibial osteotomy: a case control study.

    Science.gov (United States)

    Ogawa, H; Matsumoto, K; Akiyama, H

    2017-07-01

    We aimed to investigate factors related to the technique of medial opening wedge high tibial osteotomy which might predispose to the development of a lateral hinge fracture. A total of 71 patients with 82 osteotomies were included in the study. Their mean age was 62.9 years (37 to 80). The classification of the type of osteotomy was based on whether it extended beyond the fibular head. The level of the osteotomy was classified according to the height of its endpoint. At a mean follow-up of 20 months (6 to 52), a total of 15 lateral hinge fractures (18.3%) were identified. A sufficient osteotomy, in which both anterior and posterior tibial cortices were involved with extension into the lateral aspect of the plateau in relation to an anteroposterior line tangential to the medial edge of the fibular head in the CT axial plane, was seen in 48 knees (71.6%) in those without a lateral hinge fracture and in seven (46.7%) in those with a lateral hinge fracture. An osteotomy which ended above the level of the fibular head was seen in nine (13.4%) of the knees without a lateral hinge fracture and seven (46.7%) of the those with a lateral hinge fracture. There was a significant relationship between the absence of a lateral hinge fracture and both a sufficient osteotomy and one whose endpoint was at the level of the fibular head (p = 0.0451 and p = 0.0214, respectively). A sufficient osteotomy involving both the anterior and posterior cortices, whose endpoint is at the level of the fibular head, should be performed when undertaking a medial opening wedge high tibial osteotomy if a lateral hinge fracture is to be avoided as a complication. Cite this article: Bone Joint J 2017;99-B:887-93. ©2017 The British Editorial Society of Bone & Joint Surgery.

  10. Surgical Treatment of a Trimalleolar Ankle Fracture Diagnosed Six Weeks after the Injury

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    Yaniel Truffin Rodriguez

    2015-12-01

    Full Text Available Early diagnosis of traumatic injuries significantly changes patient outcomes. This statement remains true for the ankle since delay in treatment of ankle injuries can hinder its proper function. For these reasons, the case of a 29-year-old patient of rural origin treated at the Dr. Gustavo Aldereguía Lima University General Hospital in Cienfuegos is presented. The patient stated that he had suffered a horse fall six weeks earlier and presented with functional disability in addition to pain in his right ankle. A supra-syndesmotic fibular fracture, a medial malleolar fracture and a posterior malleolar fracture were diagnosed. To repair this injury, the Gatellier-Chastang approach was used for reduction and adequate fixation of the posterior malleolus. Osteosynthesis of the supra-syndesmotic fracture with a plate and screws was subsequently performed. Finally, the medial malleolar fracture was fixed with a malleolar screw. Six months after the surgery, the ankle showed normal ranges of dorsiflexion and plantar flexion; the edema was not significant and there was no pain when walking or resting.

  11. The effect of hydroxyapatite coated screw in the lateral fragility fractures of the femur. A prospective randomized clinical study.

    Science.gov (United States)

    Pesce, V; Maccagnano, G; Vicenti, G; Notarnicola, A; Moretti, L; Tafuri, S; Vanni, D; Salini, V; Moretti, B

    2014-01-01

    Due to a growing numbers of lateral fragility fractures of the femur and their high social costs the need to work out an effective strategy in order to find a better solution for these patients is warranted. From January 2010 to July 2011, we carried out a prospective randomized clinical study comparing the results of patients with femoral lateral fractures treated by nail and cephalic hydroxyapatite coated screws (study group including 27 patients) compared to the patients with the same fractures treated with nail and head standard screws (control group including 27 patients). We defined the two parts of the femoral neck as ROI 1 (under the head screw) and ROI 2 (above the femoral screw) on the AP view. The bone density of the two areas was calculated using DEXA at T0 (1st day post-surgery), at T1 (40th day post-surgery), at T2 (3 months later), at T3 (1 year later). The clinical-radiography evaluations were based on the Harris Hip Score (HHS), ADL test and x-ray views of the hip. As far as the bone mineral density average of ROI 1 and ROI 2 is concerned, we found a significant statistical increase at T1 and T3 in the study group, while it was not significant in the control group. We could account for this data through the higher mechanical stability of hydroxyapatite coated screws than standard screws. In fact, this material was responsible for improved implant osteointegration. Thanks to a 1 year follow-up we were able to demonstrate the implant utility associated with augmentation and the importance of densitometry exams such as easily repeatable and low cost diagnostics to prevent the onset of complications linked to screw loosening.

  12. Hook plate fixation of acute displaced lateral clavicle fractures: mid-term results and a brief literature overview

    Directory of Open Access Journals (Sweden)

    Tiren Davut

    2012-01-01

    Full Text Available Abstract Background The clavicle hook plate achieves like most other operative techniques, a high percentage of union and a low percentage of complications however concerns about long term complications still exist, particularly the involvement of the acromioclavicular joint. Methods To evaluate the results and long term effects in use of this plate we performed a retrospective analysis with a mean follow up of 65 months (5.4 years of 28 consecutive patients with acute displaced lateral clavicle fractures, treated with the clavicle hook plate. Results Short term functional results in all patients were good to excellent. All but one patient had a united fracture (96%. Nine patients (32% developed impingement symptoms and in 7 patients (25% subacromial osteolysis was found. These findings resolved after plate removal. Twenty-four patients were re-evaluated at a mean follow-up period of 5.4 years. The Constant-Murley score was 97 and the DASH score was 3.5. Four patients (14% developed acromioclavicular joint arthrosis of which one was symptomatic. Three patients (11% had extra articular ossifications of which one was symptomatic. There was no relation between the impingement symptoms, subacromial osteolysis and development of acromioclavicular joint arthrosis or extra articular ossifications. Conclusions The clavicle hook plate is a good primary treatment option for the acute displaced lateral clavicle fracture with few complications. At mid term the results are excellent and no long term complications can be addressed to the use of the plate.

  13. Ultrasound-Guided 50% Ethyl Alcohol Injection for Patients With Malleolar and Olecranon Bursitis: A Prospective Pilot Study

    Science.gov (United States)

    Hong, Ji Seong; Lee, Jin Hyung

    2016-01-01

    Objective To evaluate the feasibility and effect of ultrasound-guided ethyl alcohol injection on malleolar and olecranon synovial proliferative bursitis. Methods Twenty-four patients received ultrasound-guided 50% diluted ethyl alcohol injection at the site of synovial proliferative bursitis after aspiration of the free fluid. Results Swelling and symptoms significantly decreased in 13 of the 24 patients without any complications. Eleven patients had partial improvement in swelling and symptoms. Conclusion Ultrasound-guided alcohol injection could be an alternative therapeutic option before surgery in patients with chronic intractable malleolar and olecranon synovial proliferative bursitis. PMID:27152282

  14. Prognostic value of an immediate lateral standing X-ray with a TLSO in patients with a thoracolumbar burst fracture.

    Science.gov (United States)

    Díez-Ulloa, M A; Gallego-Goyanes, A

    2015-01-01

    The final collapse of a "stable" thoracolumbar burst fracture is difficult to predict. This collapse was prospectively studied radiologically in patients with T12 or L1 burst fractures who, after evaluating the admission x-rays and the CT scan with the patients themselves, opted for a rigid thoracolumbar brace with support in the sternal manubrium (TLSO). On the other hand, patients with rigid braces sometimes have low back pain on follow-up (due to overload of the L5-S1 joints). the standing lateral x-ray with only a TLSO for support (intrinsic mechanical stability) provides information on the final collapse and could also provide information on the low back pain. The study included 50 patients (20 males and 30 females, age: 63+14 years) admitted during 2011 and 2012, with 2 losses to follow-up. Farcy index and local kyphosis (Cobb at 3 vertebrae). X-Rays: admission, with TLSO (immediate: Rx0), and at 3 and 6 months. They were compared with the final clinical and radiological results. It was decided to surgically intervene in 4 patients after Rx0. There were no painful sequelae at the fracture level, and 16/44 (31%) had low back pain. Using linear regression mathematical models, the increase in the Farcy index (Rx0-Rx admission) was associated with the appearance of low back pain and with local kyphosis (Rx0-Rx admission), and with the final kyphosis. It is advisable to perform a lateral standing X-ray after TLSO for information on the final collapse of the fracture and the appearance of accompanying low back pain. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

  15. Snowboard, wakeboard, dashboard? Isolated fracture of the lateral process of the talus in a high-speed road traffic accident

    OpenAIRE

    2013-01-01

    We present a 23-year-old man who sustained an isolated fracture of the lateral process of the talus (LPT) in a head-on vehicle collision at a combined speed of 200 km/h. The driver of the other vehicle sustained fatal injuries at the scene. The LPT was openly reduced and fixed with successful outcome at 3 months. This case is unusual in the method of injury, in particular in relation to the isolated relatively minor injury sustained.

  16. Palatogingival groove mimicking as a mutilated root fracture in a maxillary lateral incisor: a case report.

    Science.gov (United States)

    Vasanth, Kumar; Kottoor, Jojo; Nandini, Suresh; Velmurugan, Natanasabapathy; Abarajithan, Mohan

    2014-01-01

    This article presents a case of a palatogingival groove (PPG) in tooth No. 12 that was misdiagnosed as a mutilated root fracture. A PPG is a developmental anomaly that predisposes a tooth to a severe periodontal defect. The initial diagnosis of mutilated root fracture on tooth No. 12 was made solely from radiographs that showed a vertical and horizontal radiolucent line with a radiolucent halo-shaped bone resorption in relation to the root apex. Transillumination, bite test, surgical visualization of the site, and the use of high-end diagnostic modalitieswere not considered prior to the final diagnosis. PPG was confirmed only after the tooth was extracted and observed under a dental operating microscope.

  17. 外侧切口治疗跟骨骨折%Treatment of calcaneal fracture with the lateral incision

    Institute of Scientific and Technical Information of China (English)

    王树金; 孔丹辉; 张华俊; 陈建红; 蒋波逸

    2013-01-01

    Objective To explore the effects of lateral incision surgical in treatment of calcaneal fractures. Methods From September of 2009 to December of 2011 using the lateral incision surgical treatment of calcaneal fractures in 21 patients:15 males and 6 females;ages 31~65 years old, with an average of 48. 3 years old. Unilateral calcaneus in 19 cases, bilateral in 2 cases, fall injury in 17 feet, crush injury in 4 feet. According to Sanders type: type II 9 feet, type III 11 feet, type IV 3 feet. The surgery time was 5~12 days after injury. Results Follow-up of 10~24 months, with an average of 16 months. 3 feet with superficial necrosis of skin flap, scar healing after changing dressing;2 feet with lateral edge of the skin is numb. 17 feet postoperative X-ray films showed that the articular surface reset good, calcaneal height and width satisfactory recovery;6 feet postoperative Bohler angle and Gissane angle than before surgery significantly improved, but not completely back to normal. Conclusion The efficacy by Maryland scoring criteria:excellent in 13 feet, good in 6 feet, general in 4 feet, good rate of 82.6%. Lateral incision treat calcaneal fractures have such advantages:fracture lines revealed clear, subtalar articular surface and formation calcaneocuboid articular surface can recoverable to normal arch form and calcaneal width, and have enough space to place plates and screws, which will properly protected Soft tissue. Sanders II fractures and articular surface crushed Sanders III fractures is applicable.%目的:探讨外侧切口手术治疗跟骨骨折的效果。方法2009年9月~2011年12月采用外侧切口治疗跟骨骨折21例,男15例,女6例;年龄31~65岁,平均48.3岁。单侧足19例,双侧足2例。坠落伤17例,压砸伤4例。按Sanders分型:Ⅱ型9足、Ⅲ型11足、Ⅳ型3足。手术时间为伤后5~12 d。结果随访10~24个月,平均16个月。术后3足出现皮缘浅表坏死,经换药后瘢痕愈合;2足出

  18. A COMPARATIVE STUDY OF OUTCOMES OF PERCUTANEOUS CROSSED VS LATERAL DIVERGENT PINNING IN THE TREATMENT OF DISPLACED (GRADE - 3 SUPRACONDYLAR FRACTURES OF HUMERUS IN CHILDREN

    Directory of Open Access Journals (Sweden)

    Nirav Patel

    2015-02-01

    Full Text Available INTRODUCTION: Displaced supracondylar fractures of humerus are one of the most common fractures in paediatric age group with preferred treatment being close reduction with percutaneous k - wire fixation. This study compares whether lateral pin construct alone can provide same stability like medial and lateral pin fixation, and prevent iatrogenic ulnar nerve injury. MATERIAL & METHODS: This is a prospective comparative randomized controlled trial. A total of 60 patients of displaced supracondylar fracture aged between 3 - 12 years with fresh fracture, without any compound injury or communition were enrolled for the study and randomly divided into two groups, A and B. For each group of 30 patients, they were assigned treatment of crossed pinning and lateral pinning respectively and outcome was evaluated on basis of pain, motion, stability and function according to Mayo’s elbow score and follow - up was maintained for a period of 45 days and test for statistical significance were applied. RESULTS: After assessing 30 patients in each group we found out that mean mayo score was 98 in cross pinning group and 96.83 in lateral pinning group. This difference is statistically not significant. (p value - 0.502. CONCLUSION: In our study we conclude that, Lateral pinning is an equally good treatment choice in these fractures and especially for grossly swollen elbows in which medial epicondyle is barely palpable with increased risk of ulnar nerve injury during placement of medial pin. Both the methods offer consistently satisfactory functional and cosmetic results

  19. [Application of three-dimensional printing personalized acetabular wing-plate in treatment of complex acetabular fractures via lateral-rectus approach].

    Science.gov (United States)

    Mai, J G; Gu, C; Lin, X Z; Li, T; Huang, W Q; Wang, H; Tan, X Y; Lin, H; Wang, Y M; Yang, Y Q; Jin, D D; Fan, S C

    2017-03-01

    Objective: To investigate reduction and fixation of complex acetabular fractures using three-dimensional (3D) printing technique and personalized acetabular wing-plate via lateral-rectus approach. Methods: From March to July 2016, 8 patients with complex acetabular fractures were surgically managed through 3D printing personalized acetabular wing-plate via lateral-rectus approach at Department of Orthopedics, the Third Affiliated Hospital of Southern Medical University. There were 4 male patients and 4 female patients, with an average age of 57 years (ranging from 31 to 76 years). According to Letournel-Judet classification, there were 2 anterior+ posterior hemitransverse fractures and 6 both-column fractures, without posterior wall fracture or contralateral pelvic fracture. The CT data files of acetabular fracture were imported into the computer and 3D printing technique was used to print the fractures models after reduction by digital orthopedic technique. The acetabular wing-plate was designed and printed with titanium. All fractures were treated via the lateral-rectus approach in a horizontal position after general anesthesia. The anterior column and the quadrilateral surface fractures were fixed by 3D printing personalized acetabular wing-plate, and the posterior column fractures were reduction and fixed by antegrade lag screws under direct vision. Results: All the 8 cases underwent the operation successfully. Postoperative X-ray and CT examination showed excellent or good reduction of anterior and posterior column, without any operation complications. Only 1 case with 75 years old was found screw loosening in the pubic bone with osteoporosis after 1 month's follow-up, who didn't accept any treatment because the patient didn't feel discomfort. According to the Matta radiological evaluation, the reduction of the acetabular fracture was rated as excellent in 3 cases, good in 4 cases and fair in 1 case. All patients were followed up for 3 to 6 months and all

  20. Effect of partiat Resection of Fibula on Malleolar Joint in Children%儿童期部分腓骨切除后对踝关节的影响

    Institute of Scientific and Technical Information of China (English)

    吴晋普; 韩西成

    1985-01-01

    32 transplatations of fibulae with nutrient vessels have been performed since 1978. Six patients were children under 13,4 males and 2 females. 5 transplantations were on the left and one on the right. They were done for congenital pseudoarthrosis of tibia in 5 cases and for giant cell tumour of the humerus in 1. Further observations were made for 2-3 years. X-ray examination showed upward displacement of the lateral malleolus in various degrees and widened malleolar hollow. To sum up,the stability of the malleolar joint will be decreased if part of the fibula is cut off.Therefore,we suggest that indications of this operation should be strictly controlled,especially in pediatric cases.%@@ 近10余年来,由于显微外科技术的开展,带血管蒂的腓骨切除手术有所增加.但是腓骨部分切除后对踝关节的影响,是值得注意的问题.对此,我们进行了一些实验研究和临床观察,提出讨论.

  1. Lateral cortex blowout during PFNA blade insertion in a subtrochanteric fracture -Should bone quality determine the type of nail used?

    Institute of Scientific and Technical Information of China (English)

    Sunil Gurpur Kini; Lai Choon Hin; Jikku Haniball

    2015-01-01

    Subtrochanteric fractures pose a therapeutic challenge to the surgeons.With the advent of proximal femoral nails, most of the cases are treated with nailing.Newer nails like proximal femoral nail ant-rotation (PFNA) require the blade to be directly hammered into the bone compared to older nails where the screws are drilled and tapped before insertion.We report one such case in a middle aged female that had intraoperative lateral cortex blowout during PFNA blade insertion in a sclerotic bone.This occurrence to the best of our knowledge is unreported in literature.It is therefore imperative to consider the quality of bone before a decision is made on the implant chosen.

  2. Drilling-induced lateral shifts along pre-existing fractures: A common cause of drilling problems

    Energy Technology Data Exchange (ETDEWEB)

    Maury, V.; Zurdo, C.

    1996-03-01

    Two gas well collapses showed a peculiar failure mechanism. Excessive fluid levels and temperature variations during the ultimate drilling phase and later workovers induced microannuli and cementation damage. Abnormal fluid pressures from deeper gas- or water-bearing layers channeled through damaged cementation and increased the pore pressure in uphole faults or bedding joints. Thus the effective normal stress on faults was released, inducing shear displacements and casing deformation. Weakened casings were further collapsed by later fluid-level variations. It was then suspected that this mechanism also occurred in open holes during drilling. This was shown to be so with borehole televiewer tool (BHTV) images showing borehole lateral shifts. Although never mentioned in the past in the domain of borehole stability, this mechanism explains some poorly understood drilling incidents, such as tight-holes, problems to run in hole (RIH) or pull out of hole (POOH), and abnormal torques, in spite of no indications of instability, such as cavings. This mechanism can be mitigated by taking the necessary precautions during drilling and by the adequate selection of mud characteristics.

  3. Ultrasonography as a diagnostic tool in assessing deltoid ligament injury in supination external rotation fractures of the ankle.

    LENUS (Irish Health Repository)

    Henari, Shwan

    2011-10-01

    The medial deltoid ligament is the primary stabilizing structure in the ankle joint following lateral malleolar fracture. However, medial deltoid ligament ruptures are difficult to diagnose using current imaging modalities. We hypothesized that ultrasonography can be used to accurately allow early clinical assessment of ankle fracture stability, thereby negating the need to perform plain film stress views of the acutely injured ankle. This prospective study included 12 patients (age range, 18-72) with supination external rotation fractures requiring operative fixation. Following induction of anesthesia, ultrasonography examination was performed, followed by an arthrogram under fluoroscopic screening. Radiographs, ultrasonography, and arthrographic findings were compared. There was 100% correlation between ultrasonography and arthrogram findings. Ultrasonography accurately diagnosed medial deltoid rupture with a sensitivity of 100% and specificity of 100%. Plain film radiographs of the ankle had a sensitivity of 57.1% and a specificity of 60%. The difference between these was significant (χ(2)=.0091). This study demonstrates diagnostic ultrasonography to be an accurate diagnostic modality in assessing medial deltoid ligament integrity in patients with supination external rotation fractures. It offers the same sensitivity and specificity as arthrography without the need for additional invasive procedures. Its relative ease of use and lack of ionizing radiation make it a potentially useful tool, particularly in a busy trauma service.

  4. Rate of Malunion Following Bi-plane Chevron Medial Malleolar Osteotomy.

    Science.gov (United States)

    Bull, Patrick E; Berlet, Gregory C; Canini, Cameron; Hyer, Christopher F

    2016-06-01

    Access to the medial half of the talus can be challenging even with an osteotomy. Although several techniques are presented in the literature, critical evaluation of fixation, union, and alignment is lacking. The chevron medial malleolar osteotomy provides advantages of perpendicular instrumentation access and wide exposure to the medial talus. Postoperative displacement resulting in malunion, and possibly provoking ankle osteoarthritis, is a known complication. The present study describes our experience with the osteotomy. A consecutive series cohort of 50 bi-plane chevron osteotomies performed from 2004 to 2013 were evaluated. Forty-six were secured using 2 lag screws, and 4 were secured using 2 lag screws and a medial buttress plate. Radiographic studies performed at 2, 6, and 12 weeks and at final follow-up were analyzed for postoperative displacement, malunion, non-union, and hardware-related complications. At initial postoperative follow-up, 47 of 50 had adequate radiographs for review, and 18 of 47 (38.3%) showed some displacement when compared to the initial osteotomy fixation position. By final follow-up, 15 of 50 (30.0%) had measurable incongruence. Hardware removal was performed in 13 (26.0%) cases at an average of 2.4 years postoperation. Bi-plane medial malleolar chevron osteotomy fixed with 2 lag screws showed a 30.0% malunion rate with an average of 2 mm of incongruence on final follow-up radiographs, which is higher than what has been reported in the literature. In our practice, we now use a buttress plate and more recently have eliminated postoperative osteotomy displacement. Level IV, retrospective case series. © The Author(s) 2016.

  5. Ultrasound-Guided 50% Ethyl Alcohol Injection for Patients With Malleolar and Olecranon Bursitis: A Prospective Pilot Study

    OpenAIRE

    2016-01-01

    Objective To evaluate the feasibility and effect of ultrasound-guided ethyl alcohol injection on malleolar and olecranon synovial proliferative bursitis. Methods Twenty-four patients received ultrasound-guided 50% diluted ethyl alcohol injection at the site of synovial proliferative bursitis after aspiration of the free fluid. Results Swelling and symptoms significantly decreased in 13 of the 24 patients without any complications. Eleven patients had partial improvement in swelling and sympto...

  6. Travel Times of Later Phases for Transmitting Waves through a Fracturing Westerly Granite Sample under a Triaxial Compressive Condition

    Science.gov (United States)

    Imahori, A.; Kawakata, H.; Hirano, S.; Yoshimitsu, N.; Takahashi, N.

    2015-12-01

    In laboratory, it is well-known that the elastic wave speed varies prior to compression fracture of the rock (e.g., Lockner et al., 1977, JGR). Using an enough number of travel times of elastic wave paths in a sample, we can estimate internal structure of the sample. However, the number of the elastic wave transducers is limited, and only the travel times of the first arrival are available in most experiments. Employing broadband transducers (Yoshimitsu et al., 2014, GRL), later phases become available to be analyzed. In the present study, we conduct a triaxial compressive test at room temperature under a dry condition and a confining pressure of 50 MPa, using a cylindrical Westerly granite sample of 100 mm long by 50 mm in diameter. Eight transducers are attached on the sample surface. One of the transducers is used as a wave source and voltage steps are repeatedly applied to it. The elastic waves passing through the sample are sensed by the other broadband transducers, and recorded at a sampling rate of 20 Msps. P-wave speed is estimated from the travel time of the direct P, and Vp/Vs value is assumed to be the √3 to give S-wave speed. We assume that all wave paths never bend except at the top and bottom surface of the sample. We calculate the travel times of later phases reflected at the top and/or bottom surfaces within 3 times. We collate the calculated travel times with observed waveforms. We can identify the travel time of two phases: single reflection from both top and bottom of the sample. On the other hand, some other observed and calculated phase arrivals do not match with each other. Then, we try to identify some remarkable phases using the calculated travel times of PS and SP converted waves and interfacial waves, taking into consideration of wave speed anisotropy.

  7. Bicortical screw fixation of distal fibula fractures with a lateral plate: an anatomic and biomechanical study of a new technique.

    Science.gov (United States)

    Milner, Brenton F; Mercer, Deana; Firoozbakhsh, Keikhosrow; Larsen, Kenna; Decoster, Thomas A; Miller, Richard A

    2007-01-01

    One of the potential drawbacks of lateral plating of distal fibula fractures is less than satisfactory fixation of unicortical screws commonly placed in the distal fragment to avoid implant penetration of the ankle joint. This study examines the anatomy of the distal fibula, proposes new techniques for bicortical screw fixation and radiographic evaluation of screw placement, and compares pullout strength of unicortical versus bicortical screws in this area. Sixteen pairs of human cadaver feet were used in this study. It was found that a large percentage of the surface area of the distal fibula is nonarticular and that the distal fibula could be divided into 3 zones with distinct anatomic features. Zone I is defined as the distal most 1.5 cm of the fibula, zone II is the next 1 cm of fibula proximal to zone I, and zone III is defined as the fibula above the ankle joint, starting at just over 2.5 cm proximal to the tip of the fibula. We determined a safe corridor for bicortical screw placement by means of a lateral plate in each zone. An improved radiographic view is described for confirmation of extraarticular screw placement. Screw pullout testing was performed on 8 pairs of fresh-frozen human cadaver fibulas. In both zone I and zone II, the bicortical screw fixation was significantly stronger than the unicortical screw fixation. In zone I, the average pullout strength for the bicortical screw fixation was 2.3 times higher than the unicortical screw fixation. In zone II, the average pullout strength for the bicortical screw fixation was 3.3 times higher than the unicortical screw fixation. This study shows that not only is bicortical screw placement in the distal fibula technically feasible, but it is also biomechanically stronger than unicortical placement in this area.

  8. Posttraumatic Displacement Management: Lateral Luxation and Alveolar Bone Fracture in Young Permanent Teeth with 5 Years of Follow-Up

    Directory of Open Access Journals (Sweden)

    Heitor Marques Honório

    2015-01-01

    Full Text Available Dental trauma is an important public health problem due to high prevalence and associated limitations. The external impact accounting for trauma may result in different injury types to teeth and supporting structures. This paper describes a clinical case of tooth trauma in an 8-year-old patient exhibiting the displacement of three permanent teeth with open root apexes. Although the traumatic impact resulted in two injury types to teeth and supporting tissues (lateral luxation and alveolar bone fracture, the therapeutic approach was the same in both situations. The bone and teeth were repositioned by digital pressure, stabilized by semirigid splint, and followed up at every week. After six weeks, the splint was removed. At that moment, the clinical and radiographic findings indicated normal soft/hard tissues and absence of pulp/periodontal pathologies. At the fifth year of follow-up, the treatment success of the case was confirmed, although it has been observed that all lower incisors exhibited pulp obliteration as a consequence of the dental trauma.

  9. Dental trauma. Combination injuries 3. The risk of pulp necrosis in permanent teeth with extrusion or lateral luxation and concomitant crown fractures without pulp exposure

    DEFF Research Database (Denmark)

    Lauridsen, Eva Fejerskov; Hermann, Nuno Vibe; Gerds, Thomas Alexander;

    2012-01-01

    Aim: To analyze the influence of a crown fracture without pulp exposure on the risk of pulp necrosis (PN) in teeth with extrusion or lateral luxation. Material and methods: The study included 82 permanent incisors with extrusion from 78 patients (57 male, 21 female) and 179 permanent incisors......, and response to electric pulp test at the initial examination. Results: A concomitant crown fracture significantly increased the risk of PN in teeth with lateral luxation. For teeth with immature root development (hazard ratio: 10 [95% confidence interval (CI): 1.1–100] P = 0.04), the overall risk increased...... increased from 56.5% (95% CI: 37.7–75.4) to 76.5% (95% CI: 58.9–94) in case of a concomitant crown fracture, but the difference was not statistically significant (P > 0.05). Conclusion: A concomitant crown fracture without pulp exposure significantly increased the risk of PN in teeth with lateral luxation...

  10. Evaluation of the results from surgical treatment of fractures of the lateral extremity of the clavicle, using the double ligature technique

    Directory of Open Access Journals (Sweden)

    Alberto Naoki Miyazaki

    2015-04-01

    Full Text Available OBJECTIVE: To evaluate the incidence of consolidation in surgical treatment of fractures of the lateral extremity of the clavicle using the double subcoracoid ligature technique, with nonabsorbable No. 5 thread.METHODS: Between May 1993 and June 2013, the Shoulder and Elbow Group of our service surgically treated 116 patients (116 shoulders with fractures of the lateral extremity of the clavicle. Among these, we were able to reassess 65 cases. The surgical technique used consisted of double subcoracoid ligature with two nonabsorbable threads. In two patients classified as type III, we had to combine this technique with use of an interfragmentary screw for fixation of the intra-articular portion of the acromioclavicular joint.RESULTS: We achieved fracture consolidation in 90%. Fourteen cases (21% evolved with major complications: four cases of pseudarthrosis, five of adhesive capsulitis, two of delayed consolidation and three of loss of reduction. Two cases (3% evolved with minor complications of skin granuloma.CONCLUSION: The double ligature technique for fractures of the lateral extremity of the clavicle promotes the stabilization needed for consolidation to take place, without the need for synthesis using metal components. It avoids reoperation for the synthesis material to be removed. Moreover, it is a low-cost procedure with good reproducibility and preservation of the acromioclavicular joint.

  11. Delayed presentation of fracture of lateral condyle of humerus in pediatric age group treated by ORIF and ulnar peg grafting: A case series

    Directory of Open Access Journals (Sweden)

    Nishikant Kumar

    2015-01-01

    Full Text Available Background: Fractures of lateral condyle of humerus in pediatric age group, the most common being distal humerus epiphyseal injury, are commonly associated with delayed presentation to terminal health care providers. Reasons accounted might be at every level, right from the patient to the physician. In the backdrop of existing disputed treatment strategy operative v/s non-operative treatment of fractures having more than 3-week duration of injury, same were treated by open reduction and k wire fixation using ulnar peg graft. Final functional result was evaluated with longest follow up of over 1 year. Materials and Methods: Twenty children having fracture of lateral condyle of humerus with duration of trauma more than 3 week were included in the prospective study. Age ranged from 5 years to 15 years. Average age was 8 years. Among the 20 patients, 8 were male and 12 were female. Average time of presentation was after 5 weeks of injury. Seven patients had milch type 1 injury and 13 patients had milch type II injury. All patients were treated by open reduction and internal fixation using k wires and ulnar peg graft. The follow-up period was over 1 year. Result: Results were evaluated using radiograph, and functional results were evaluated using the Liverpool elbow scoring system. In the present series, all fractures united with 92% excellent, 5% good, and 3% poor results. Poor results were associated with greater displacement of fracture, prior repeated attempts of close reduction, and history of massage. Conclusion: Being an epiphyseal injury and a common occurrence, fracture of lateral condyle of humerus in pediatric age group are commonly maltreated, with error contributed right from parents to even physician. Common reasons of delayed presentation are ignorance on parents′ side, malpractice by some bone-setters, poorly done radiograph, inaccurate radiographic interpretation by the physician, and poor selection of treatment methods.

  12. Anatomical plate lateral proximal and distal tibia fractures%外侧解剖型钢板治疗胫骨远近端骨折

    Institute of Scientific and Technical Information of China (English)

    闫开文; 翟江华; 许业伦

    2011-01-01

    目的 探讨外侧解剖型钢板内固定治疗小腿胫骨远近端骨折疗效.方法 回顾性总结分析采用外侧解剖型钢板内固定治疗小腿胫骨远近端骨折33例.结果 所有患者均得到随访,时间18~24个月,骨折均获骨折愈合,关节功能恢复基本正常.结论 外侧解剖型钢板内固定治疗小腿胫骨远近端骨折对位对线良,固定可靠,可早期功能锻炼,是治疗小腿胫骨远近端骨折较好的方法.%Objective To investigate the anatomical lateral plate internal fixation of tibial proximal and distal lower leg fractures.Methods Retrospectively analysis from January 2006 to April 2009 with lateral plate internal fixation with anatomic leg proximal and distal tibial fractures of 33 cases. Results All patients were followed up for 18 to 24 months, fractures were fracture healing, joint function was normal. Conclusion The anatomical lateral plate fixation proximal and distal tibial fractures leg position on the line of good, reliable fixation, and early functional exercise is the treatment of proximal and distal tibial fractures leg better way.

  13. Salter-Harris type III fracture of the lateral femoral condyle with a ruptured posterior cruciate ligament: an uncommon injury pattern.

    Science.gov (United States)

    Rafee, Asan; Kumar, A; Shah, S V

    2007-01-01

    We report a case of an obscure injury to the distal femoral epiphysis with an uncommon pattern in a 12-year-old boy following a road traffic accident. Initial plain radiographs of the knee were inconclusive. Further investigation with magnetic resonance imaging revealed Salter-Harris type III fracture of the lateral femoral condyle with a gap at the fracture site associated with avulsion of the posterior cruciate ligament. This potentially serious injury can be underestimated on plain radiographs and therefore any suspected injury to the distal femoral epiphysis should be thoroughly assessed and investigated to institute appropriate treatment and minimise the risk of long-term complications.

  14. Tratamento das fraturas femorais subtrocantéricas com placas de bloqueio lateral da parte proximal do fêmur The treatment of femoral subtrochanteric fractures with the proximal lateral femur locking plates

    Directory of Open Access Journals (Sweden)

    Sun-Jun Hu

    2012-12-01

    Full Text Available OBJETIVO: Estudar o desfecho de fraturas subtrocantéricas de quadril tratadas com placa de bloqueio lateral da parte proximal do fêmur. MÉTODO: Revisamos retrospectivamente os resultados clínicos de 48 casos de fraturas subtrocantéricas tratadas com placas de bloqueio lateral da parte proximal do fêmur de janeiro de 2008 a maio de 2010. Registrou-se o progresso da consolidação da fratura, assim como a ocorrência de complicações. A função da articulação do quadril foi avaliada pelo índice social de Harris e o escore de mobilidade de Parker-Palmer, um ano após a cirurgia. RESULTADO: Quarenta e cinco pacientes foram acompanhados até a união da fratura ou a revisão da cirurgia. Entre os 45 pacientes, 43 atingiram a união da fratura sem outra intervenção. Trinta e oito fraturas consolidaram sem perda da posição no acompanhamento de um ano. Não houve casos de perfuração da cabeça do fêmur pelo parafuso. O escore médio do índice social de Harris foi 86,5 ± 9,8 (73 ~95. A média do escore de mobilidade de Parker e Palmer foi 7,4 ± 2,1 (3~ 9. CONCLUSÃO: A placa de bloqueio lateral da parte proximal do fêmur é o tipo de fixação interna estável e efetiva para tratar as fraturas subtrocantéricas de quadril e tem a vantagem de fixação estável, em especial em fratura da parede lateral do fêmur. Nível de evidência IV, Série de Casos.OBJECTIVE: To study the outcome of subtrochanteric hip fractures treated by using a proximal lateral femur locking plate. METHOD: We retrospectively reviewed the clinical results of 48 cases of femoral subtrochanteric fractures treated with proximal lateral femur locking plates from Jan 2008 to May 2010. The progress of fracture healing, as well as the occurrence of complications, was recorded. The function of the hip joint was evaluated by Harris social index and the Parker and Palmer mobility score at 1 year after the operation. RESULT: 45 patients were followed up until fracture

  15. Arthroscopic excision of bone fragments in a neglected fracture of the lateral process of the talus in a junior soccer player.

    Science.gov (United States)

    Funasaki, Hiroki; Kato, Soki; Hayashi, Hiroteru; Marumo, Keishi

    2014-06-01

    Fractures of the lateral process of the talus are uncommon and often overlooked. Typically, they are found in adult snowboarders. We report the case of an 11-year-old male soccer player who complained of lateral ankle pain after an inversion injury 6 months earlier. He did not respond to conservative treatment and thus underwent arthroscopic excision of fragments of the talar lateral process. The ankle was approached through standard medial and anterolateral portals. A 2.7-mm-diameter 30° arthroscope was used. Soft tissues around the talus were cleared with a motorized shaver, and the lateral aspect of the talar process was then visualized. The lateral process presented as an osseous overgrowth, and a loose body was impinged between the talus and the calcaneus. The osseous overgrowth was resected piece by piece with a punch, and the loose body was removed en block. The patient returned to soccer 5 weeks after the operation. This case exemplifies 2 important points: (1) This type of fracture can develop even in children and not only in snowboarders. (2) Arthroscopic excision of talar lateral process fragments can be accomplished easily, and return to sports can be achieved in a relatively short time.

  16. [Atlas fractures].

    Science.gov (United States)

    Schären, S; Jeanneret, B

    1999-05-01

    Fractures of the atlas account for 1-2% of all vertebral fractures. We divide atlas fractures into 5 groups: isolated fractures of the anterior arch of the atlas, isolated fractures of the posterior arch, combined fractures of the anterior and posterior arch (so-called Jefferson fractures), isolated fractures of the lateral mass and fractures of the transverse process. Isolated fractures of the anterior or posterior arch are benign and are treated conservatively with a soft collar until the neck pain has disappeared. Jefferson fractures are divided into stable and unstable fracture depending on the integrity of the transverse ligament. Stable Jefferson fractures are treated conservatively with good outcome while unstable Jefferson fractures are probably best treated operatively with a posterior atlanto-axial or occipito-axial stabilization and fusion. The authors preferred treatment modality is the immediate open reduction of the dislocated lateral masses combined with a stabilization in the reduced position using a transarticular screw fixation C1/C2 according to Magerl. This has the advantage of saving the atlanto-occipital joints and offering an immediate stability which makes immobilization in an halo or Minerva cast superfluous. In late instabilities C1/2 with incongruency of the lateral masses occurring after primary conservative treatment, an occipito-cervical fusion is indicated. Isolated fractures of the lateral masses are very rare and may, if the lateral mass is totally destroyed, be a reason for an occipito-cervical fusion. Fractures of the transverse processes may be the cause for a thrombosis of the vertebral artery. No treatment is necessary for the fracture itself.

  17. Talocrural dislocation with associated weber type C fibular fracture in a collegiate football player: a case report.

    Science.gov (United States)

    Ricci, R Daniel; Cerullo, James; Blanc, Robert O; McMahon, Patrick J; Buoncritiani, Anthony M; Stone, David A; Fu, Freddie H

    2008-01-01

    To present the case of a talocrural dislocation with a Weber type C fibular fracture in a National Collegiate Athletic Association Division I football athlete. The athlete, while attempting to make a tackle during a game, collided with an opponent, who in turn stepped on the lateral aspect of the athlete's ankle, resulting in forced ankle eversion and external rotation. On-field evaluation showed a laterally displaced talocrural dislocation. Immediate reduction was performed in the athletic training room to maintain skin integrity. Post-reduction radiographs revealed a Weber type C fibular fracture and increased medial joint clear space. A below-knee, fiberglass splint was applied to stabilize the ankle joint complex. Subtalar dislocation, Maisonneuve fracture, malleolar fracture, deltoid ligament rupture, syndesmosis disruption. The sports medicine staff immediately splinted and transported the athlete to the athletic training room to reduce the dislocation. The athlete then underwent an open reduction and internal fixation procedure to stabilize the injury: 2 syndesmosis screws and a fibular plate were placed to keep the ankle joint in an anatomically reduced position. With the guidance of the athletic training staff, the athlete underwent an accelerated physical rehabilitation protocol in an effort to return to sport as quickly and safely as possible. Most talocrural dislocations and associated Weber type C fibular fractures are due to motor vehicle accidents or falls. We are the first to describe this injury in a Division I football player and to present a general rehabilitation protocol for a high-level athlete. Sports medicine practitioners must recognize that this injury can occur in the athletic environment. Prompt reduction, early surgical intervention, sufficient resources, and an accelerated rehabilitation protocol all contributed to a successful outcome in the patient.

  18. Long PFN in unstable subtrochantric fracture with absent lateral wall support in proximal fragment with delayed augmentation with encircalage wire and bone grafting

    Directory of Open Access Journals (Sweden)

    Sudarshan A. Kamble

    2015-10-01

    Full Text Available In 1949 Boyd and Griffin Subtrochanteric fracture femur as a variant of peritrochanteric fracture with higher incidence of unsatisfactory result both in the elderly and young. Most of this fracture is with higher incidence of unsatisfactory result after operative treatment This single case study shows one of the unpredicted iotrogenic complications. Material and method: Patient is 78yr female patient with multiple co-morbid conditions with subtrochanetric fracture. Surgery was done with long PFN nail inserted with good purchase in head, reduction check under C-arm with in antero-posterior and lateral view shows little malreduction and nail is out of medulary cavity in proximal fragment. Revision in same sitting not possible due to some medical reasons. Revision surgery done after fitness and reduction held with encieclage wire and bone grafting done. Conclusion: Even without lateral wall support if there is good purchase of screws in head and shaft, there will be good union and good functional outcome. [Int J Res Med Sci 2015; 3(10.000: 2847-2850

  19. Early results and future challenges of the Danish Fracture Database

    DEFF Research Database (Denmark)

    Gromov, K.; Brix, Michael; Kallemose, T.

    2014-01-01

    (currently 15,000). 85% of all procedures were performed on adult fractures and 15% on paediatric fractures. Proximal femur (33%), distal radius (15%) and malleolar fractures (12%) were the three most common primary adult fractures. Pain and discomfort from orthopaedic hardware, infection and failure......INTRODUCTION: The Danish Fracture Database (DFDB) was established in 2011 to establish nationwide prospective quality assessment of all fracture-related surgery. In this paper, we describe the DFDB's setup, present preliminary data from the first annual report and discuss its future potential...... are registered. Indication for reoperation is also recorded. The reoperation rate and the one-year mortality are the primary indicators of quality. RESULTS: Approximately 10,000 fracture-related surgical procedures were registered in the database at the time of presentation of the first annual DFDB report...

  20. An analysis of suboptimal outcomes of medial malleolus fractures in skeletally immature children.

    Science.gov (United States)

    Luhmann, Scott J; Oda, Jon E; O'Donnell, June; Keeler, Kathryn A; Schoenecker, Perry L; Dobbs, Matthew B; Gordon, J Eric

    2012-03-01

    We retrospectively analyzed cases of intra-articular medial malleolar fractures in skeletally-immature patients (Salter-Harris III and IV) with suboptimal outcomes at St. Louis Children's Hospital and Shriner's Hospital for Children. Common causes of poor outcome were frac­ture malunion or malreduction and physeal damage. Malreductions of only 2 mm does not appear to be toler­ated and the concept of "remodeling" does not apply to these fracture patterns. Based on this study, we "recom­mend" fracture reduction and fixation if there is greater than 1 mm of fracture step-off..

  1. Chip fractures from the distal lateral trochlear ridge of the talus of a quarter horse gelding: a veterinary medicine clinical report.

    Science.gov (United States)

    Groves, L

    2005-09-05

    An eighteen-month old quarter horse gelding was diagnosed with chip fractures from the distal lateral trochlear ridge of the talus. The horse presented with the symptom of persistent synovitis. The diagnosis was based on radiographic evidence. The horse was treated initially with arthroscopic surgery. He was given a non-steroidal anti-inflammatory agent, and a chondroprotective agent to prevent further damage to, and aid in the healing of, the damaged joint.

  2. Assessment of humeral length in dogs after repair of Salter-Harris type IV fracture of the lateral part of the humeral condyle.

    Science.gov (United States)

    Lefebvre, Jean-Benoit G N G; Robertson, Thomas R A; Baines, Stephen J; Jeffery, Nicholas D; Langley-Hobbs, Sorrel J

    2008-08-01

    To evaluate the effect of fracture and subsequent repair on future bone growth of the humerus after Salter-Harris type IV fracture of the lateral part of the humeral condyle (LPHC). Prospective study. Dogs (n=11). Dogs that had LPHC fracture and an open distal humeral physis repaired (1992-2006) were re-examined and radiographed at >or=12 months of age and humeral length was measured. Measurements from 11 dogs showed a significant (P=.02) increase in length of the humeral diaphysis of the affected leg compared with that of the intact limb (median, 1.2%; range, 1.3-3.4%). Condylar deformity secondary to growth disturbance was not observed. Shortening or growth deformity was not observed after fracture and repair even if a transcondylar screw was placed through the distal humeral growth plate. A mild overgrowth of the humeral diaphysis was observed, although likely considered clinically unimportant. Fracture of the LPHC and subsequent repair in dogs >3 months of age do not impair growth of the humeral diaphysis. A transcondylar humeral screw placed through the humeral physis will not result in shortening of the humeral diaphysis. Implant removal to allow for further growth is therefore not indicated.

  3. Fratura de fíbula e lesões de ligamento colateral e menisco lateral em muar: relato de caso Fibula fracture and injuries to the collateral ligament and lateral meniscus in mules: case report

    Directory of Open Access Journals (Sweden)

    C.O. Silveira

    2013-02-01

    Full Text Available Relata-se a ocorrência de fratura de fíbula e lesões de ligamento colateral e menisco lateral em um muar, fêmea, de dois anos de idade, provavelmente produzida por um coice na região da articulação femorotibiopatelar do membro pélvico esquerdo. O animal apresentava claudicação de grau 5 desse membro e obteve melhora após bloqueio dos nervos fibular, tibial e safena e da articulação afetada. O exame radiográfico da região acometida revelou fratura do terço proximal da fíbula e, ao exame ultrassonográfico, observaram-se pontos anecoicos no ligamento colateral lateral e menisco.This is a report of the occurrence of fibula fracture and injuries of the collateral ligament and lateral meniscus in a two year old mule, probably due to a kick in the joint area of the femurtibiopatellar left pelvic limb. The animal presented degree 5 lameness which improved after a nerve block of the affected joint. Radiographic examination of the affected area revealed a fracture on the proximal third of the fibula, and the ultrasound examination showed anechoic points observed in the lateral collateral ligament and meniscus.

  4. Effects on inadvertent endplate fracture following lateral cage placement on range of motion and indirect spine decompression in lumbar spine fusion constructs: A cadaveric study

    Science.gov (United States)

    Santoni, Brandon G.; Alexander, Gerald E.; Nayak, Aniruddh; Cabezas, Andres; Marulanda, German A.; Murtagh, Ryan; Castellvi, Antonio E.

    2013-01-01

    Background The lateral transpsoas approach to interbody fusion is gaining popularity. Existing literature suggests that perioperative vertebra-related complications include endplate breach owing to aggressive enedplate preparation and poor bone quality. The acute effects of cage subsidence on stabilization and indirect decompression at the affected level are unknown. The purpose of this study was to compare the kinematics and radiographic metrics of indirect decompression in lumbar spines instrumented with laterally placed cages in the presence of inadvertent endplate fracture, which was determined radiographically, to specimens instrumented with lateral cages with intact endplates. Methods Five levels in 5 specimens sustained endplate fracture during lateral cage implantation followed by supplementary fixation (pedicle screw/rod [PSR]: n = 1; anterolateral plate [ALP]: n = 4), as part of a larger laboratory-based study. Range of motion (ROM) in these specimens was compared with 13 instrumented specimens with intact endplates. All specimens were scanned using computed tomography (CT) in the intact, noninstrumented condition and after 2-level cage placement with internal fixation under a 400-N follower load. Changes in disc height, foraminal area, and canal area were measured and compared between specimens with intact endplates and fractured endplates. Results Subsidence in the single PSR specimen and 4 ALP specimens was 6.5 mm and 4.3 ± 2.7 mm (range: 2.2–8.3 mm), respectively. ROM was increased in the PSR and ALP specimens with endplate fracture when compared with instrumented specimens with intact endplates. In 3 ALP specimens with endplate fracture, ROM in some motion planes increased relative to the intact, noninstrumented spine. These increases in ROM were paralleled by increase in cage translations during cyclic loading (up to 3.3 mm) and an unpredictable radiographic outcome with increases or decreases in posterior disc height, foraminal area, and canal

  5. Modeling of the incudo-malleolar joint within a biomechanical model of the human ear

    Energy Technology Data Exchange (ETDEWEB)

    Ihrle, Sebastian; Eiber, Albrecht; Eberhard, Peter, E-mail: peter.eberhard@itm.uni-stuttgart.de [University of Stuttgart, Institute of Engineering and Computational Mechanics (Germany)

    2017-04-15

    Under large quasi-static loads, the incudo-malleolar joint (IM joint), connecting the malleus and the incus, is highly mobile. It can be classified as a mechanical filter decoupling large quasi-static motions while transferring small dynamic excitations. To investigate the influence of the behavior of the IM joint, a detailed simulation model of the IM-complex is created. Mathematical modeling of the IM joint behavior under quasi-static excitation requires adequate modeling of the mechanics of the diarthrodial joint. Therefore, the geometry of the articular surfaces, the ligaments, as well as their viscoelastic properties have to be included in the model. The contact of the articular surfaces is implemented using a penalty based contact formulation utilizing the geometric information obtained from micro computer tomography (micro-CT) scans. The ligaments of the joint capsule are modeled by distributing force elements along the joint capsule, with the position and orientation derived from the micro-CT scans. It is shown that the effects which were observed in measurements on human temporal bones are described adequately by the model, if the contact of the articular surfaces and the preload of the viscoelastic fibers are taken into account in the simulation model. In the following, the detailed model is implemented in an elastic multibody system of the entire ear. The model allows the study of different quasi-static load cases of the ossicles, such as it occurs in the reconstruction of the middle ear and form the basis for future simulative studies of sound transmission in natural or reconstructed ears.

  6. Open reduction and internal fixation for displaced supracondylar fractures of the humerus in children with crossed K-wires via lateral approach

    Directory of Open Access Journals (Sweden)

    Hussain Shahid

    2014-06-01

    Full Text Available Objective:To assess the therapeutic results of open reduction and internal fixation with crossed K-wires via lateral approach for displaced supracondylar fractures of the humerus in children. Methods: We prospectively followed 52 children who presented with Gartland type 3 displaced supracondylar fractures of the humerus and were managed by open reduction and internal fixation with crossed K-wires via lateral approach.There were 37 male and 15 female patients; average age was 7.39 years. The most common mechanism of trauma was fall while playing (n=23, followed by fall from height (n=20, road traffic accidents (n=5 and fall from standing height (n=2. In 2 cases, mode of injury was not available. The mean follow-up was 12 months and patients were assessed according to Flynn’s criteria. Results:Lateral approach provided an excellent view of the lateral column between two nervous planes and enabled an anatomical reduction in all cases. Immobilizing the elbow at 90 degrees or more of flexion was not needed after cross K-wire fixation. Majority of patients regained full range of motion within 6 weeks of pin removal. Two patients had postoperative ulnar nerve injuries that resolved after pin removal. The common late complication of cubitus varus was not seen in any patient. Delayed presentation to the emergency department, repeated manipulations by bone setters and massage with edible oil were responsible for stiffness in 5 patients. Superficial pin tract infection was noted in 5 patients that resolved with dressings and antibiotics. No deep infection occurred. A detailed clinical examination and radiographic analysis was done at final follow-up. They included measurement of carrying angle and range of movements of both operated and normal sides, and radiographs of both upper limbs for comparison. According to Flynn’s criteria, 90.4% patients showed satisfactory results.Conclusion:Lateral approach for open reduction and internal fixation of the

  7. Application of spiral CT image 3D reconstruction in severe talar neck fracture

    Institute of Scientific and Technical Information of China (English)

    HE Fei; HUANG He; DENG Ya-min; Wang Bing; ZHANG Chun-qiang; ZHAO Zhi; TANG Xi-zhang; ZHOU Zhao-wen; ZHAO Xue-ling

    2007-01-01

    Objective:To explore the application of the spiral computerized tomography (CT) image three-dimensional(3D ) reconstruction technique associated with the conventional radiography in the diagnosis and treatment of severe talar neck fracture. Methods:Using the multi-slice spiral CT image 3D reconstruction technique,we analysed 11 cases of talar neck fracture.The fractures were reduced and fixed through a minimal incision and internal fixation with titanium cannulated lag screws. Results:In the 11 cases,the results of CT image 3D reconstruction were in concordance with plain radiograph in 6 case of Hawkins type H.And the remaining 5 cases of Hawkins types Ⅲ and Ⅳ could not be classified exactly only by radiographs,one of whom was misdiagnosed.After using the CT image 3D reconstruction,the 5 cases were classified exactly before osteosynthesis.The classifications of these 11 cases were confirmed finally by surgical findings.The duration of operation were 45-140 min,averaging 81min (including the duration of C-arm fluoroscopy).X-ray exposure time was 6-58 seconds,averaging 22 seconds.The blood loss was less than 100 ml.The fracture union was achieved in 3 months. No nonunion, talus avascular necrosis or joint surface collapse occurred.Postoperative follow-up was from 1 to 25 months.According to Hawkins score,excellent result was found in 6 type Ⅱ cases and 1type Ⅲ case;good result in 1 type Ⅲ case with both medial and lateral malleolar fracture,1 type Ⅲ with medial malleolus fractures and 1 open type Ⅲ;fair result in 1 open type Ⅳ with lateral malleolus fracture. Conclusions:By using the multi-slice spiral CT image 3D reconstruction associated with radiography to diagnose and treat severe talar neck fractures,the accuracy of diagnosis can be improved obviously. Based on this technique,more consummate operational plan can be designed and performed so as to achieve a better therapeutic effect.

  8. 老年三踝骨折患者的手术治疗%Operative treatment of trimalleolar fractures in the elderly

    Institute of Scientific and Technical Information of China (English)

    刘忠玉; 辛景义; 梁军

    2014-01-01

    Objective To estimate the effect of open reduction and internal fixation for treating the trimalleolar fracture in the elderly.Methods 57 aged patients suffered from the trimalleolar fracture and were treated with internal fixation from January 2009 to June 2012.25 males and 32 females with an average age of 71.5 years ranged from 65 to 81 years were involved in this study.The supination-external rotation type were in 41 cases and pronation-external rotation type in 16 cases according to Lauge-hansen's classification.The posterior and lateral approach was taken for surgical procedure of lateral malleolar frature.The routine or locking plates were used to fix the fratures.The posterior malleolar fractures were usually fixed through the posterolateral approach as well.The screws or tension band fixation was selected for fixing the medial malleolar fragments.The parallel screwing fixation could be helpful for fixing the tibiofibular syndesmosis.Results The ankle function was evaluated by the criteria system of the American Orthopaedic Foot and Ankle Society (AOFAS).The efficacy was excellent in 23 patients,good in 24 patients,fair in 7 patients.The skin problems such as super facial infection and delayed union of incision were in 7 cases.Conclusions If choosing reasonable operation method and suitable internal plant,the open reduction and internal fixation has better effect in treating the trimalleolar fracture in the elderly,with fewer complications.%目的 探讨65岁及以上老年三踝骨折患者的手术治疗. 方法 三踝骨折患者57例,男25例,女32例;年龄65~81岁,平均71.5岁.根据Lauge-hansen分型,旋后外旋型41例;旋前外旋型16例.外踝骨折采用外踝后方入路,骨折复位后采用普通或锁定钢板固定.后踝骨折采用后外侧入路或经腓骨入路,直视下复位及固定后踝骨折,内踝骨折采用前内侧切口,以内踝的踝穴侧和前侧作为复位标准,采用螺钉或张力带固定.如果下胫

  9. Open reduction and internal fixation for displaced supracondylar fractures of the humerus in children with crossed K-wires via lateral approach

    Institute of Scientific and Technical Information of China (English)

    Shahid Hussain; Manzoor Ahmad; Tufail Muzaffar

    2014-01-01

    Objective:To assess the therapeutic results of open reduction and internal fixation with crossed K-wires via lateral approach for displaced supracondylar fractures of the humerus in children.Methods:We prospectively followed 52 children who presented with Gartland type 3 displaced supracondylar fractures of the humerus and were managed by open reduction and internal fixation with crossed K-wires via lateral approach.There were 37 male and 15 female patients; average age was 7.39 years.The most common mechanism of trauma was fall while playing (n=23),followed by fall from height (n=20),road traffic accidents (n=5) and fall from standing height (n=2).In 2 cases,mode of injury was not available.The mean follow-up was 12 months and patients were assessed according to Flynn's criteria.Results:Lateral approach provided an excellent view of the lateral column between two nervous planes and enabled an anatomical reduction in all cases.Immobilizing the elbow at 90 degrees or more of flexion was not needed after cross K-wire fixation.Majority of patients regained full range of motion within 6 weeks of pin removal.Two patients had postoperative ulnar nerve injuries that resolved after pin removal.The common late complication of cubitus varus was not seen in any patient.Delayed presentation to the emergency department,repeated manipulations by bone setters and massage with edible oil were responsible for stiffness in 5 patients.Superficial pin tract infection was noted in 5 patients that resolved with dressings and antibiotics.No deep infection occurred.A detailed clinical examination and radiographic analysis was done at final follow-up.They included measurement of carrying angle and range of movements of both operated and normal sides,and radiographs of both upper limbs for comparison.According to Flynn's criteria,90.4% patients showed satisfactory results.Conclusion:Lateral approach for open reduction and internal fixation of the widely-displaced supracondylar fracture of

  10. Fracture strength, failure type and Weibull characteristics of lithium disilicate and multiphase resin composite endocrowns under axial and lateral forces

    NARCIS (Netherlands)

    Gresnigt, Marco M M; Özcan, Mutlu; van den Houten, Mieke L A; Schipper, Laura; Cune, Marco S

    2016-01-01

    OBJECTIVE: Multiphase resin composite materials have been advocated as an alternative to reinforced ceramics but limited information is available to date on their stability. This in vitro study evaluated the effect of axial and lateral forces on the strength of endocrowns made of Li2Si2O5 and multip

  11. Treatment of ankle fracture and biomechanics of talus%踝部骨折治疗效果与距骨生物力学的关系

    Institute of Scientific and Technical Information of China (English)

    梁庆威; 范广宇; 吕刚

    2004-01-01

    BACKGROUND: The anatomical structure of ankle joint is not complicated, but its biomechanics is very important. The talus has participated in consisting of three joints and played very important role in supporting the functions of ankle. Therefore, it is very important to stabilize the position of talus in order to restore the anatomical structure of ankle.OBJECTIVE: To explore the relationship between treatment of ankle fracture and the biomechanics of the talus.DESIGN: A non-randomized case controlled study was conducted.SETTING and PARTICIPANTS: There were 95 patients with fracture of ankle joints during January 1985 to October 2000 from the First Affiliated Hospital of China Medical University. Three specimens of amputating legs due to malignant tumor were collected.INTERVENTIONS: The biomechanics of talus in ankle fracture was observed by amputated leg specimens and the clinical manifestation and Xray examinations were analyzed in the 95 fracture patients after treatment.MAIN OUTCOME MEASURES: Forces acting on different fracture types,relationship between therapeutic effects and biomechanics of talus.RESULTS: Sixty-five cases were followed up. There were 41 cases with very good therapeutic effects, 12 cases with good effects, 7 cases with fair effects and 5 cases with poor effects. Biomechanics results: the neck was compressed 0.48 cm when both ankles were broken. The lateral malleolar facet got more pressure than medial malleolar facet when vertical pressure acted in external facet fracture. When fracture happened in the lower 1/3 of fibula, the pressure acted on lateral malleolar facet was less than that on medial malleolar facet when in inversion position.CONCLUSION: It should pay more attention to the anatomical relations of talus in ankle cavity and the gap of lower tibiofibular joint no matter external fixation or internal fixation of manual reposition to ankle fracture was used. It is a very important treatment standard to restore the biomechanical

  12. Late diagnosis of a McFarland fracture: imaging and treatment

    Energy Technology Data Exchange (ETDEWEB)

    Symeonidis, Panagiotis D. [Aristotelian University of Thessaloniki, Thessaloniki (Greece); Konstantinidis, George Ath; Givisis, Panagiotis G. [Aristotelian University of Thessaloniki, Thessaloniki (Greece); Dionellis, Panagiotis S. [Hippocration General Hospital of Thessaloniki, Thessaloniki (Greece); Ousatzopoulos, John [Private Practice Thessaloniki, Thessaloniki (Greece)

    2014-01-15

    McFarland fractures represent a type of oblique medial malleolar fracture in children that can be challenging to diagnose and treat. A 14-year-old junior league soccer player with a Salter Harris type IV McFarland fracture presented late, as the initial routine two views radiological assessment failed to reveal a clear fracture line. The addition of a mortise ankle view led to the correct diagnosis and subsequent MRI findings guided nonsurgical treatment with an excellent outcome. The debate between obtaining two or three views in closed pediatric ankle injuries according to the so-called Ottawa rules and the usefulness of magnetic resonance imaging (MRI) in the decision making for the choice of treatment of McFarland fractures are discussed in this case report. (orig.)

  13. Foot and ankle fractures during childhood: review of the literature and scientific evidence for appropriate treatment

    Directory of Open Access Journals (Sweden)

    Stefan Rammelt

    Full Text Available ABSTRACT Foot and ankle fractures represent 12% of all pediatric fractures. Malleolar fractures are the most frequent injuries of the lower limbs. Hindfoot and midfoot fractures are rare, but inadequate treatment for these fractures may results in compartment syndrome, three-dimensional deformities, avascular necrosis and early post-traumatic arthritis, which have a significant impact on overall foot and ankle function. Therefore, the challenges in treating these injuries in children are to achieve adequate diagnosis and precise treatment, while avoiding complications. The objective of the treatment is to restore normal anatomy and the correct articular relationship between the bones in this region. Moreover, the treatment needs to be planned according to articular involvement, lower-limb alignment, ligament stability and age. This article provides a review on this topic and presents the scientific evidence for appropriate treatment of these lesions.

  14. 踝关节骨折合并Tillaux-Chaput和Volkmann骨折的临床特点及治疗方法%Characteristic and treatment of ankle fracture combined with Tillaux-Chaput and Volkmann fractures

    Institute of Scientific and Technical Information of China (English)

    辛景义; 刘忠玉; 严成渊

    2013-01-01

    -Chaput fracture,among whom 7 were diagnosed by CT scan.Classified by Lauge-Hansen system,ankle fracture could be divided into pronation-exterual rotation type in 4 cases,and pronation-abduction type in 11 cases.The fracture of fibula and the Volkmann tubercle were treated through the posterolateral approach.The fibular fracture was fixed with plate.The medial malleolar fracture was explored from medial curve approach.Tillaux-Chaput fracture was treated by the mierotubule cut.All patients were assessed with the ankle hindfoot clinical rating system of the American Orthopaedic Foot and Ankle Society (AOFAS).Results All patients were followed up for 8-20 months (average,12.5 months).The fracture healed 12-36 weeks later in all the 15 patients,with an average of 23.5 weeks.Twelve patients walked normally and 3 with mild claudication in the last follow-up.The AOFAS score was average 85.4 points,9 were excellent,4 were good,2were fair,with the good-excellent rate being 86.7% (13/15).The movement of ankle joint limited in 3 patients,tenderness occurred when weight bearing in 3 patients.Conclusion The ankle fracture include the simultaneous fractures of Tillaux-Chaput and Volkmann were more seen in the type of pronation-abduction.It is often misdiagnosis by the photograph; CT scan should be helpful to find the fracture fragments.The exact reduction and stable fixation were needed in the treatment of the ankle fracture combined with Tillaux-Chaput and Volkmann fractures.Inferior tibia fibular screw was not routinely used in this fracture.

  15. Evaluation of percutaneous vertebroplasty in osteoporotic vertebral fractures using a combination of CT fluoroscopy and conventional lateral fluoroscopy; Perkutane Vertebroplastie osteoporosebedingter Wirbelkoerperfrakturen: Erfahrungen mit der CT-Fluoroskopie

    Energy Technology Data Exchange (ETDEWEB)

    Pitton, M.B.; Schneider, J.; Brecher, B.; Herber, S.; Mohr, W.; Thelen, M. [Klinik fuer Radiologie, Universitaetskliniken Mainz (Germany); Drees, P.; Eckardt, A.; Heine, J. [Klinik fuer Orthopaedie, Universitaetskliniken Mainz (Germany)

    2004-07-01

    Purpose: Evaluation of vertebroplasty using a combination of CT-fluoroscopy and conventional lateral fluoroscopy in patients with osteoporotic vertebral fractures. Materials and Methods: Fifty-eight patients (23male, 35 women, age 69.7 {+-} 10.2 years) with painful osteoporotic vertebral fractures were treated with vertebroplasty in conscious sedation and local anesthesia. Spiral-CT with sagittal reconstructions of the respective vertebral bodies was used for classification of the fracture. The cannula was placed under CT-guidance in the ventral third of the respective vertebral bodies and cement instilled under CT fluoroscopy and lateral fluoroscopy. When cement migrated towards the vertebral canal, the injection was immediately stopped for 30-60 seconds. After polymerization in this location, the injection was continued until sufficient filling of the vertebra. Results were documented by spiral CT with sagittal reconstructions. Results: A total of 123 vertebral bodies were treated, comprising 39 thoracic and 84 lumbar vertebral bodies, with a mean of 2.1 {+-} 1.3 (range 1 to 6) vertebral bodies in each patient and a maximum of 3 vertebral bodies per session. All interventions were successfully completed in conscious sedation and local anesthesia. A mean volume of 5.9 {+-} 0.6 ml (range 2 to 14 ml) cement was applied for each vertebra, with 79.7% of procedures performed using a unilateral access. To achieve a sufficient cement deposit, a bilateral access was used in 20.3%. The dorsal wall of the vertebra was included in 23.6% of the fractures. In one case, cement migration into the spinal canal was detected, reducing the diameter of the canal by 30%. In two other cases, cement leakage was seen at the puncture site of the vertebra (one intercostotransversally in the 10{sup th} thoracic vertebra and one dorsolaterally in the 1{sup st} lumbar vertebra) with retrograde cement migration through the neuroforamen into the epidural space. In one of these cases, the

  16. 股骨近端外侧锁定钢板治疗Russell-Taylor Ⅱ型股骨转子下骨折%Femoral subtrochanteric fractures treated with proximal lateral femur locking Plate

    Institute of Scientific and Technical Information of China (English)

    胡孙君; 陈舰; 陈杰; 俞光荣; 张世民

    2012-01-01

    目的 探讨股骨近端外侧锁定钢板治疗股骨转子下骨折的治疗效果.方法 对28例Russell-Taylor Ⅱ型股骨转子下骨折患者采用股骨近端外侧锁定钢板固定.结果 28例均获得随访,时间10~24个月.根据髋关节Harris评分:优13例,良10例,中5例.结论 股骨近端外侧锁定钢板治疗股骨转子下骨折可以达到可靠的固定效果,骨折愈合较快,短期临床疗效良好.%Objective To study the outcome of subtrochanteric hip fractures treated by proximal lateral femur locking plate. Methods 28 elder patients with subtrochanteric hip fractures were treated with proximal lateral femur locking plate. Results All patients were followed up for 10 ~24 months. According to Hams index, there were 13 excellent cases, f 0 good and 5 fair. Conclusions The proximal lateral femur locking plate is the kind of stable and effective internal fixation of treating subtrochanteric hip fractures, and the clinical outcome is satisfied.

  17. Results of surgically treated talar fractures

    Institute of Scientific and Technical Information of China (English)

    Ali Yeganeh; Atefe Alaee; Bahram Boddouhi; Ali Behkam-Rad; Gholamreza Shahoseini

    2013-01-01

    Objective:Talar fractures present a great challenge to surgeons due to poor treatment outcome and high incidence of sequelae.The purpose of this study was to report the surgical treatment outcome of displaced talar fractures treated by internal fixation.Methods:Atotal of 30 patients with a mean age of 38 years presenting with talar body or neck fractures were studied retrospectively to assess postoperative outcome based on American Orthopaedic Foot & Ankle Society AnkleHindfoot scale.Results:Postoperatively,malunion was found in 18 cases,infection in 5 cases and avascular necrosis in 12 cases.There were 12 cases with subtalar arthritis and 18 cases with both subtalar and malleolar arthritis.The average score of questionnaire was 64± 12.Functional score was 53± 15 and pain score was 65±13.Range of motion failure was detected as 15±4.Conclusion:Talar injuries can compromise motion of the foot and ankle and result in poor prognosis on longterm evaluation.Late complications subsequent to surgically treated talar body fractures are inevitable,and patients are supposed to be counseled about the adverse outcome.

  18. Evaluation of lateral straight incision approach in the treatment of scapula fractures and investigation of operational details%外侧直切口入路治疗肩胛骨骨折的疗效和操作细节

    Institute of Scientific and Technical Information of China (English)

    张川; 王蕾; 张作君; 赵明; 李星星; 蔡鸿敏

    2016-01-01

    Background The approach of choice for open reduction internal fixation of displaced scapular fractures involving the scapula neck or body is from posterior including modified Judet approach,the lateral straight incision approach and so on.The chosen surgical approach depends on fracture location,complexity,and chronicity.Less invasive approaches are preferred when feasible, but are technically more demanding.There is an unstudied belief that patients rehabilitate faster and have less pain with less invasive dissection.In this study,lateral straight incision approach was evaluated as the treatment of some subgroup of scapular fractures.Methods 278 cases of scapular fractures were treated operatively in our hospital from 2005 to 2015,most of the cases were operated through Judet or modified Judet approach.Eighty-seven cases underwent lateral straight incision approach,46 cases (47 scapulas)of them were followed up for more than 6 months from May 2010 to February 2015.The age of the 34 males and 12 females ranged from 22 to 65 years old with an average age of 44.9.The causes of injury included fell from height in 12 cases,automobile accident in 13 cases,crashed injury in 5 cases,fell from standing height in 14 cases,torsional injury of arm in 1 case,beated by other guy in 1 case.There were 8 solo scapular fractures,1 bilateral scapular fracture with associate injuries of pneumohemothorax and multiple rib fractures,all the other 35 patients had associate inj uries,including 8 cases of craniocerebral inj ury,1 6 cases of multiple rib fracture and 2 solo rib fracture,1 1 cases of contusion of lung and pleural effusion,1 2 cases of pneumohemothorax,3 cases of spine fractures with no spinal cord inj ury,8 cases of craniocerebral inj ury,8 cases of ipsilateral clavicular fracture,1 case respectively with the inj ury of posterior fracture-dislocation of proximal humerus,cervical cord injury,ipsilateral ulnar fracture,disassociation of acromioclavicular joint caused by

  19. Surgical treatment of lateral clavicle fractures associated with complete coracoclavicular ligament disruption: Clinico-radiological outcomes of acromioclavicular joint sparing and spanning implants

    Science.gov (United States)

    Bhatia, Deepak N.; Page, Richard S.

    2012-01-01

    Purpose: Distal clavicle fracture associated with complete coracoclavicular ligament disruption represents an unstable injury, and osteosynthesis is recommended. This study was performed (1) to retrospectively analyse the clinico-radiological outcomes of two internal fixation techniques, and (2) to identify and analyse radiographic fracture patterns of fracture that are associated with this injury. Materials and Methods: A total of 15 patients underwent osteosynthesis with either (1) acromioclavicular joint-spanning implants (Group 1, Hook plate device, n = 10) or (2) joint-sparing implants (Group 2, distal radius plate, n = 5); these were reviewed at a mean period of 26.1 months (12 to 40 months). Clinical outcomes were measured using Constant Score (CS), Simple Shoulder Test (SST), and Walch ACJ score (WS). Radiographs and ultrasonography were used to assess the glenohumeral and acromioclavicular joints, and the subacromial space. Preoperative radiographs were analyzed for assessment of fracture lines to identify radiographic patterns. Statistical analysis of the data was performed to determine any significant differences between the two groups. Results: The overall clinical outcome was satisfactory (CS 80.8, SST 11.3, WS 17.6) and a high union rate (93.3%) was observed. Radiographic complications (acromioclavicular degeneration and subluxation, hook migration, abnormal ossification) did not negatively influence the final clinical outcomes. Four distinct radiographic fracture patterns were observed. A statistically significant difference ( P < 0.05) was observed in the reoperation rates between the two groups. Conclusions: Internal fixation of this fracture pattern is associated with a high union rate and favorable clinical outcomes with both techniques. A combination of distal radius plate and ligament reconstruction device resulted in stable fixation and significantly lower reoperation rates, and should be used when fracture geometry permits (Types 1 and 2

  20. Front and Lateral Elbow Approach for the Treatment of Radial Head Fractures%肘前侧与肘外侧入路治疗桡骨头骨折分析

    Institute of Scientific and Technical Information of China (English)

    董传明

    2013-01-01

    目的分析肘前入路与肘外侧入路治疗桡骨头骨折的临床效果。方法将128例桡骨头骨折患者平均分成甲组和乙组各64例。甲组为肘前侧入路;乙组为肘外侧入路。对比两组的并发症及6个月后肘关节功能的恢复情况。结果甲组并发症低于乙组,6个月后甲组肘关节功能评分的优良率也高于乙组。结论肘前侧入路比肘外侧入路更适合对桡骨头骨折的治疗。%Objective To analyze the clinical ef ect of anterior elbow approach road and elbow lateral approach for the treatment of radial head fractures. Methods 128 cases of radial head fracture patients were divided into group A and group B 64 cases. Group A for the elbow anterior approach; B for the lateral approach to the elbow. The two groups were compared complications and elbow function after six months of recovery. Results Group A complication is less than B, six months after the Group A elbow score excel ent rate is also higher than B Conclusion anterior elbow elbow than lateral approach is more suitable for the treatment of radial head fractures.

  1. Proximal humerus fractures.

    Science.gov (United States)

    Price, Matthew C; Horn, Pamela L; Latshaw, James C

    2013-01-01

    Proximal humerus fractures are among the most common fractures associated with osteoporosis. With an aging population, incidence of these fractures will only increase. The proximal humerus not only forms the lateral portion of the shoulder articulation but also has significant associations with musculoskeletal and neurovascular structures. As a result, fractures of the proximal humerus can significantly impact not only the function of the shoulder joint, but the health and function of the entire upper extremity as well. Understanding of these fractures, the management options, and associated nursing care, can help reduce morbidity rate and improve functional outcomes.

  2. Comparison of the Therapeutic Effect of Modified Stoppa Approach and Rectus Lateral Approach for the Treatment of Acetabular Fracture Combined with Ipsilateral Pelvic Fracture%改良stoppa切口入路与腹直肌外侧入路治疗合并骨盆骨折的髋臼骨折的疗效比较

    Institute of Scientific and Technical Information of China (English)

    邵晏清; 熊然; 张潇; 杨晓东; 夏广; 樊仕才

    2016-01-01

    Objective To compare the curative effect of the modified stoppa incision and rectus lateral incision approach in treatment of acetabular fracture combined with ipsilateral pelvic fracture .Methods A retrospective analysis of the clinical data of 29 patients with acetabular fracture combined with ipsilateral pel-vic fracture treated in Southern Medical University Third Hospital from Mar .2011 to Apr.2014 was done, including 18 cases of lateral rectus incision approach(group A),11 cases of modified stoppa incision ap-proach(group B).The surgical exposure time,intraoperative blood loss,the fracture recovery and the postop-erative complications of the two groups were compared.Results Surgical exposure time in group A,B were (17.4 ±3.6) min,(16.9 ±4.4) min respectively; postoperative hip joint function score were (16.8 ± 2.7),(17.3 ±2.2) respectively,the differences had no statistical significance(P >0.05);intraoperative blood loss of group A was less than that in group B[(627 ±26) mL vs (742 ±40) mL],the difference was statistically significant(P0.05);A组术中出血量少于B组[(627 ±26) mL比(742 ±40) mL],差异有统计学意义(P0.05 ). 结论 经腹直肌外侧切口入路能充分显露髋臼前柱和四方体,能正视下复位并固定髋臼骨折,且手术显露简单、损伤小,手术并发症少,是治疗髋臼前方骨折尤其是累及四方体骨折的理想手术入路.

  3. False negative rate of syndesmotic injury in pronation-external rotation stage IV ankle fractures

    Directory of Open Access Journals (Sweden)

    Kwang-Soon Song

    2013-01-01

    Full Text Available Background: To investigate false negative rate in the diagnosis of diastasis on initial static anteroposterior radiograph and reliability of intraoperative external rotational stress test for detection of concealed disruption of syndesmosis in pronation external rotation (PER stage IV (Lauge-Hansen ankle fractures. Materials and Methods: We prospectively studied 34 PER stage IV ankle fractures between September 2001 and September 2008. Twenty (59% patients show syndesmotic injury on initial anteroposterior radiographs. We performed an intraoperative external rotation stress test in other 14 patients with suspicious PER stage IV ankle fractures, which showed no defined syndesmotic injury on anteroposterior radiographs inspite of a medial malleolar fracture, an oblique fibular fracture above the syndesmosis and fracture of the posterior tubercle of the tibia. Results: All 14 fractures showed different degrees of tibiofibular clear space (TFCS and tibiofibular overlapping (TFO on the external rotation stress test radiograph compared to the initial plain anteroposterior radiograph. It is important to understand the fracture pattern characterstic of PER stage IV ankle fractures even though it appears normal on anteroposterior radiographs, it is to be confirmed for the concealed syndesmotic injury through a routine intraoperative external rotational stress radiograph.

  4. 急诊经单一外侧入路治疗胫骨远端开放性骨折合并腓骨骨折%Emergency treatment of distal tibial open fracture combined with fibula fracture through single lateral approach

    Institute of Scientific and Technical Information of China (English)

    刘明; 勘武生; 李鹏; 程文俊; 何大为

    2011-01-01

    目的 探讨急诊经单一外侧入路治疗胫骨远端开放性骨折合并腓骨骨折的方法和疗效.方法 36例胫骨远端开放性骨折合并腓骨骨折患者行急诊手术治疗,清创后经单一外侧入路腓骨接骨板内固定,胫骨有限内固定(必要时加用跨踝外固定支架),直接缝合或原位植皮闭合开放伤口,患肢石膏外固定.结果 患者术后随访8~36个月(平均20个月).34例患者(94.4%)骨折愈合,愈合时间3~18个月(平均5.8个月),其中5例(13.9%)为延迟愈合;2例患者(5.6%)骨不连.术后14例患者(38.9%)原开放伤口出现皮肤坏死,其中2例(5.6%)发生伤口感染.根据美国足踝骨科学会评分系统,踝关节功能恢复总体优良率为80.6%.结论 急诊经单一外侧人路治疗胫骨远端开放性骨折合并腓骨骨折可有效复位并内固定骨折,促进骨折愈合.%Objective To evaluate the operative method and clinical outcomes of the emergency treatment of distal tibial open fracture combined with fibula fracture through single lateral approach. Methods Thirty-six patients with distal tibial open fracture combined with fibula fracture underwent emergency treatment. After emergency debridement, all patients were treated with plate fixation of fibular and limited internal fixation of tibia through single lateral approach, as well as span-ankle external fixation when necessary. The original open wounds were closed by direct suture or in situ skin graft after fracture fixation. The injured limbs were stabilized with plaster external fixation. Results Patients were followed up for 8 to 36 months (20 months in average). Thirty-four patients ( 94.4% ) experienced fracture healing, with healing time of 3 to 18 months (5.8 months in average), and delayed union occurred in 5 patients (13.9%). Nonunion occurred in 2 patients (5.6%). Postoperative skin necrosis occurred in 14 patients(38.9% ), among whom 2(5.6% ) experienced wound infection. According to

  5. Contrastive study on economic evaluation of fractured vertical well and multi-lateral well for coal bed methane reservoir%煤层气压裂直井与多分支井经济评价对比研究

    Institute of Scientific and Technical Information of China (English)

    安永生; 陈勇光; 吴晓东; 皇甫龙; 李鑫旺; 张艳荣

    2011-01-01

    Fractured vertical wells and multi-lateral wells are the main well types used in coal bed methane reservoir. Based on these two kinds of wells, the economic evaluation under different permeability and different layer thickness conditions were studied in this paper using the net present value method, and then the development technical economic potential of these two kinds of wells is compared under different conditions. The results show that: multi-lateral wells have great advantage on the productivity of individual wells. But when it comes to the economic benefit, multi-lateral wells with lower permeability and thin coal bed methane reservoir beat the fractured vertical wells. Therefore, fractured vertical wells will be the dominant well type for a long time in the development of coal bed methane, while multi-lateral wells will play an important role in the low permeability and thin coal bed methane reservoirs.%压裂直井和多分支井是目前煤层气增产所采用的主要井型.基于这两种井型,采用净现值法对不同渗透率和不同厚度储层进行了经济评价研究,比较了两种井型在不同条件下的开发技术经济潜力.计算结果表明:多分支井在单井产量方面具有巨大的优势,在经济效益方面,仅在渗透率较低、厚度较薄的储层中优于压裂直井.因此,压裂直井在今后一段时间内仍将是煤层气开发的主力井型,多分支井可以作为压裂直井在特低渗透薄层中的重要补充.

  6. Image diagnosis of nasal bone fracture

    Energy Technology Data Exchange (ETDEWEB)

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

    1988-04-01

    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.

  7. 腓骨近段骨折在后外侧柱复杂胫骨平台骨折中的参考意义%Reference significance of proximal fibula fractures for selecting surgical procedures for complex tibial plateau fractures involving posterior lateral spine

    Institute of Scientific and Technical Information of China (English)

    霍永峰; 殷照阳; 厉雷明; 于吉文; 顾光学; 孙晓

    2015-01-01

    目的:探讨腓骨近段骨折对累及后外侧柱复杂胫骨平台骨折手术的参考意义。方法69例累及后外侧柱的复杂胫骨平台骨折患者(Schatzker分型Ⅴ、Ⅵ型),按术后即刻骨折复位质量Rasmussen评分进行筛选,筛选出评分为优且一般情况相似的39例,按是否伴有腓骨近段骨折和是否接受后外侧支撑钢板固定分为A1、A2和B1、B2组。A1组为未合并腓骨近段骨折但接受了后外侧支撑钢板固定,共10例;A2组为未合并腓骨近段骨折也未接受后外侧支撑钢板固定,共11例;B1组为合并有腓骨钢板近段骨折并接受后外侧支撑钢板固定,共9例;B2组为合并有腓骨近段骨折未接受后外侧支撑钢板固定,共9例。于随访12~14个月(平均12.8个月)时评定膝关节功能恢复情况,比较4组评分的相关性。结果 B1、B2两组美国特种外科医院膝关节评分(HSS评分)比较差异有统计学意义(P<0.01),而A1、A2两组HSS评分比较差异无统计学意义(P>0.05)。结论伴有腓骨近段骨折并累及后外侧髁的复杂胫骨平台,手术中进行后外侧支撑钢板固定者康复后将获得更满意的效果。%Objective To compare the effects of two surgical procedures via comparison on tibial fractures with/without proximal fibula fractures ,and to explore the reference importance of proximal fibula fractures in surgery for complex tibial plateau fracturesinvolvingposterior and lateral spine .Methods Totally 69 cases of patients with complex tibial plateau fracturesinvolving‐posterior and lateral spine (Schatzker Ⅴ and Ⅵ) were selected ,who accepted treatment between January 2008 and October 2012 . The patients were screed according to the quality of fracture reduction immediately after operation .39 cases were screened whose scores were excellent and the general condition was similar .The patients were divided into group A1 ,A2 and B1 and B2

  8. New propant schedule in hydralic fracturing

    Energy Technology Data Exchange (ETDEWEB)

    Wang, H.; Fan, C.

    1981-01-01

    A new proppant schedule is suggested to obtain maximum propping surface area and maximum fracture conductivity near the borehole. The small and middle size sands are suspended in the fracturing fluids under fracturing condition to prop the total fracture surface area created by fracturing. The coarse sands pumped into fracture later deposit in the fracture at the dynamic width near the borehole during fracturing and reach the equilibrium height in the time interval of pumping coarse sands. Thus, fracture conductivity near the borehole is increased. Computer calculation of the sand program, the corresponding fluid program and pumping rates are presented also.

  9. Comparison Of Lateral Mass Screw Fixation Technique And Hartshill Rectangle Technique In The Treatment Of Sub-Axial Cervical Spine Fractures

    Directory of Open Access Journals (Sweden)

    Mohit KM

    2012-11-01

    Full Text Available INTRODUCTION: Cervical injury in a polytrauma patient is one of the most critical injuries. The aim of this study was to compare the lateral mass screw technique with the Hartshill rectangle technique for treatment of such cases. MATERIALS AND METHODS: This prospective study consisted of 40 patients. Both groups were followed for three years clinically and radiologically. RESULTS: In the lateral mass technique, there were no cases of vertebral artery injury, radiculopathy, screw pullout, dural tears, residual kyphosis or persistent pain. In the Hartshill technique 3 patients experienced intra- operative dural tears, 1 case of wire breakage at the six months follow up, 6 patients with persistent neck pain and 1 with worsening neurological status. One hundred per cent fusion was achieved in both groups. There was significant radiation exposure in the lateral mass group. Post-operative immobilisation was required only in the Hartshill. CONCLUSION: Lateral mass screw technique is definitely a relatively better procedure. But Hartshill rectangle still stands out in certain practical situations.

  10. 外侧克氏针固定儿童肱骨髁上骨折的有限元分析%The finite element analysis of using lateral pinning to treat supracondylar fractures of the humerus in children

    Institute of Scientific and Technical Information of China (English)

    刘飞; 楼跃; 唐凯; 张志群; 林刚; 孙祥水; 倪磊; 董展; 郑朋飞

    2012-01-01

    [目的]运用三维有限元分析方法,对儿童肱骨髁上骨折外侧克氏针固定常见方式的稳定性进行对比评价,为临床固定方法的优化提供理论依据.[方法]选取1名健康发育儿童,使用螺旋CT对志愿儿童肱骨进行水平扫描,以Dicom格式文件储存所得的扫描图像.使用Mimics 13.1及3-matic 5.1数字化三维医学影像软件、ANSYS10.0有限元处理软件,建立儿童肱骨远端有限元模型.在此基础上进一步生成肱骨髁上骨折模型,将ProE 2.0软件中生成的克氏针模型导入骨折模型并装配,设定边界及载荷条件,进行三维有限元分析.予模拟侧方弯曲和扭转实验,分析不同外侧克氏针固定方式下骨折模型的最大位移值和转角值.[结果]成功建立了不同外侧克氏针固定的儿童肱骨髁上骨折模型,并予模拟力学实验.从侧方弯曲实验结果看,外侧3枚克氏针固定模型最大位移值为4.92 mm,明显小于其他模型,抗内翻稳定性最强;从扭转实验结果看,外侧3枚克氏针固定模型的最大转角值为1.29.,亦小于其他模型,抗扭转稳定性最强.[结论]肱骨髁上骨折外侧3枚克氏针分散固定的生物力学稳定性最强.临床上对肱骨髁上骨折闭合复位后肘关节肿胀明显、肱骨内上髁触摸不清的患儿,可行外侧3枚克氏针分散固定,达到稳定骨折断端的结果,且避免损伤尺神经,更降低了术后肘内翻畸形的发生.%[Objective]To analyze the mechanical characteristics of lateral pinning techniques for pediatric supracondylar humerus fracture using finite element analysis(FEA)method,so as to provide theoretical mechanics for clinical optimal configuration of pinning fixation in children with supracondylar fractures of the humerus. [ Method] A healthy development of child was selected,and the right humerus of a healthy voluntary child was scanned by Brilliancel6-detector row spiral CT and serial sections were obtained. And the

  11. Tratamiento quirúrgico de las fracturas laterales de clavícula. Un nuevo concepto / Surgical treatment for lateral clavicle fractures. A new concept / Tratamento cirúgico das fraturas laterais da clavícula. Um novo conceito

    Directory of Open Access Journals (Sweden)

    Roberto Joaquín Del Gordo-D´Amato

    2014-11-01

    Full Text Available Introducción: El tercio lateral de la clavícula resulta el segundo de mayor afectación, después del tercio medio en patología fracturaria y el tratamiento de estas lesiones día a día migra hacia el tratamiento quirúrgico en razón a que la mayoría resultan con grandes desplazamientos. Objetivo: Determinar si la reducción abierta y fijación interna de las fracturas de clavícula con placas de extensión lateral representan una alterativa en el tratamiento para este tipo de lesiones. Metodología: Se presenta un estudio de cohorte prospectivo, en el cual 36 pacientes fueron intervenidos quirúrgicamente por fracturas laterales de clavícula en el periodo comprendido entre abril de 2011 y septiembre de 2012, mediante reducción abierta y fijación interna con placa anatómica bloqueada con extensión lateral (LCP para clavícula. De los treinta y seis pacientes intervenidos, fueron realizados seguimientos completos aplicando la escala análoga visual de dolor (VAS y la escala funcional de Constant, a las seis semanas, tres meses, seis meses y al año posoperatorio. Resultados: Se pudo mostrar que hubo cambios progresivos en la mejora del dolor y funcionalidad en cada uno de los periodos de seguimiento a partir de la sexta semana posoperatoria con evidencia significativa (p<0.001 y sin cambios en la calificación del dolor entre el sexto mes y el año de seguimiento (p= 0.083. Conclusiones: Se puede concluir que la reducción abierta y fijación interna de las fracturas de clavícula con placas de extensión lateral representan una excelente alternativa de tratamiento para este tipo de lesiones, con pronta y completa recuperación funcional y baja probabilidad de complicaciones. [Del Gordo RJ, Acuña J, Torres E. Tratamiento quirúrgico de las fracturas laterales de clavícula. Un nuevo concepto. MedUNAB 2015; 17(2:X:X] Introduction. The lateral third of the clavicle is the second most affected, after the third fracture means in pathology

  12. Stress fractures of the ankle malleoli diagnosed by ultrasound: a report of 6 cases

    Energy Technology Data Exchange (ETDEWEB)

    Bianchi, Stefano [CIM SA, Cabinet Imagerie Medicale, Geneve (Switzerland); Luong, Dien Hung [CIM SA, Cabinet Imagerie Medicale, Geneve (Switzerland); University of Montreal, Department of Physical Medicine and Rehabilitation, Montreal (Canada)

    2014-06-15

    To present the ultrasound appearance of stress fractures (SF) of the ankle malleoli. We present a retrospective review of 6 patients (4 women and 2 men, with an age range of 24-52 years, mean age of 39 years) in which ultrasound diagnosed, together with the clinical findings, an SF of the ankle malleoli. For all of these patients ultrasound was the first imaging technique applied because of a clinical suspicion of soft tissue injuries following excessive exertion. Patients were subsequently examined using standard radiographs and/or MRI. At ultrasound patients showed thickening of the periosteum in all patients, calcified bone callus was evident in 3 out of 6 patients. Cortical irregularities and subcutaneous oedema were found in all but one patient. Colour Doppler showed local hypervascular changes in all patients. Local compression with the transducers during real-time scanning increased pain in all cases. Ultrasound, together with the clinical findings, can diagnose an SF of the ankle malleoli. We suggest that sonologists should include malleolar SF in their differential diagnosis, particularly in the case of perimalleolar pain from over-solicitation. They must also include, as part of every ultrasound examination of the ankle, the evaluation of both malleoli and should be aware of the ultrasound appearance of malleolar SF. If the diagnosis remains uncertain, an MRI should be prescribed. (orig.)

  13. Transverse Stress Fracture of the Proximal Patella: A Case Report

    National Research Council Canada - National Science Library

    Atsumi, Satoru; Arai, Yuji; Kato, Ko; Nishimura, Akinobu; Nakazora, Shigeto; Nakagawa, Shuji; Ikoma, Kazuya; Fujiwara, Hiroyoshi; Sudo, Akihiro; Kubo, Toshikazu

    2016-01-01

    .... Regarding patella stress fractures, so far only distal transverse or lateral longitudinal fractures have been reported, but there are no reports of transverse fractures occurring in the proximal patella...

  14. Iliotibial band avulsion fracture: a case report with differential diagnosis.

    Science.gov (United States)

    Fay, Kristin; Mannem, Rajeev; Baynes, Keith; Sarin, Dhruv; DuBois, Melissa

    2016-02-01

    Avulsion injuries of the knee are common sequelae of significant trauma given the number of ligamentous and tendinous insertions around the joint. Commonly discussed avulsion fractures of the lateral knee include the Segond fracture of the lateral tibial plateau and the arcuate complex avulsion fracture of the fibular styloid process. A less common avulsion fracture is the iliotibial (IT) band avulsion fracture involving the anterolateral corner of the tibia (Gerdy's tubercle). It is crucial to identify IT band avulsion fractures because of the frequent associated internal derangements of the knee. This case report describes the imaging of an acute IT band avulsion fracture and compares these findings with other lateral knee avulsion fractures.

  15. 改良外侧“L”形切口治疗跟骨关节内移位骨折%The effect of surgical treatment of displaced intra-articular calcaneal fracture via modified lateral Lshaped incision

    Institute of Scientific and Technical Information of China (English)

    梁军; 辛景义; 曹红彬

    2012-01-01

    目的 探讨改良外侧“L”形切口治疗跟骨关节内移位骨折的临床疗效.方法 自2005年1月至2011年10月收治跟骨关节内移位骨折患者133例143足,男125例,女8例;年龄19~65岁,平均43.2岁.左侧56例,右侧67例,双侧10例,均为闭合骨折.其中3例合并脊柱损伤.根据Sanders分型:Ⅱ型15足、Ⅲ型107足、Ⅳ型21足.均采用外侧改良“L”型切口,切开复位异型钢板内固定.术后均未给予石膏外固定,早期行踝关节功能练习,术后6周部分负重,12周完全负重.采用美国足与踝关节外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足功能评分系统评价术后足踝功能.结果 125例135足获得随访(8例8足术后12周后失访),随访时间12~28个月,平均18.5个月.骨折均愈合,愈合时间8~16周,平均13周.无神经损伤,骨髓炎.4足切口裂开,骨折愈合内固定钢板取出后皮肤愈合.17足发生距下关节创伤性关节炎,行走时疼痛.5足负重后关节面出现塌陷.根据AOFAS踝与后足功能评分系统,优94例、良29例、可14例、差6例,优良率为92.9%.结论 应用改良外侧切口切开复位异型钢板内固定治疗跟骨关节内移位骨折可以获得满意疗效,但在临床应用中需要掌握熟练手术技术.%Objective To explore clinical effect of surgical treatment of displaced intra-articular calcaneal fractures via modified lateral L-shaped incision.Methods From January 2005 to October 2011,133patients (143 feet) with displaced intra-articular calcaneal fractures,including 125 males and 8 females,aged from 19 years to 65 years (average,43.2 years),underwent open reduction and internal fixation via modified lateral L-shaped incision.There were 56 cases of left calcaneal fractures,67 cases of right calcaneal fractures,and 10 cases of bilateral calcaneal fractures,and all of them were closed fracture.According to Sanders classification,15 feet were classified as type Ⅱ,107 type

  16. Transphyseal Distal Humerus Fracture.

    Science.gov (United States)

    Abzug, Joshua; Ho, Christine Ann; Ritzman, Todd F; Brighton, Brian

    2016-01-01

    Transphyseal distal humerus fractures typically occur in children younger than 3 years secondary to birth trauma, nonaccidental trauma, or a fall from a small height. Prompt and accurate diagnosis of a transphyseal distal humerus fracture is crucial for a successful outcome. Recognizing that the forearm is not aligned with the humerus on plain radiographs may aid in the diagnosis of a transphyseal distal humerus fracture. Surgical management is most commonly performed with the aid of an arthrogram. Closed reduction and percutaneous pinning techniques similar to those used for supracondylar humerus fractures are employed. Cubitus varus caused by a malunion, osteonecrosis of the medial condyle, or growth arrest is the most common complication encountered in the treatment of transphyseal distal humerus fractures. A corrective lateral closing wedge osteotomy can be performed to restore a nearly normal carrying angle.

  17. Tibial Plateau Fractures

    DEFF Research Database (Denmark)

    Elsøe, Rasmus

    This PhD thesis reported an incidence of tibial plateau fractures of 10.3/100,000/year in a complete Danish regional population. The results reported that patients treated for a lateral tibial plateau fracture with bone tamp reduction and percutaneous screw fixation achieved a satisfactory level...... with only the subgroup Sport significantly below the age matched reference population. The thesis reports a level of health related quality of life (Eq5d) and disability (KOOS) significantly below established reference populations for patients with bicondylar tibial plateau fracture treated with a ring...... fixator, both during treatment and at 19 months following injury. In general, the thesis demonstrates that the treatment of tibial plateau fractures are challenging and that some disabilities following these fractures must be expected. Moreover, the need for further research in the area, both with regard...

  18. Hip Fracture

    Science.gov (United States)

    Diseases and Conditions Hip fracture By Mayo Clinic Staff A hip fracture is a serious injury, with complications that can be life-threatening. The risk of hip fracture rises with age. Older people are at a ...

  19. Chopart fractures.

    Science.gov (United States)

    Klaue, Kaj

    2004-09-01

    The Chopart articular space was described by François Chopart (1743-1795) as a practical space for amputations in cases of distal foot necrosis. It corresponds to the limit between the anatomical hind-foot and the mid-foot. The bones involved are the talus and the calcaneus proximally, and the navicular and the cuboid distally. This space thus holds two functionally distinct entities, the anterior part of the coxa pedis (an essential functional joint) and the calcaneo-cuboidal joint,which can be considered to be an "adaptive joint" within a normal foot. Trauma to this region may cause fractures and/or dislocations and, in high energy trauma,compartment syndromes. Principles of treatment are immediate reduction of dislocations and realignment of the medial and lateral column of the foot in length and orientation. Open reduction and internal fixation of talus and navicular fractures are often indicated to restore the "coxa pedis". Open reconstruction or fusion in correct length of the calcaneo-cuboidal joint is occasionally indicated. Salvage procedures in malunions include navicular osteotomies and calcaneo-cuboidal bone block fusions. Treatment of joint destructions, especially involving the talo-navicular joint, include triple arthrodesis.

  20. Application of CT Three Dimensional Reconstruction Technique for Closed Tibia Shaft Fracture%CT三维重建技术在闭合性胫骨骨折中的应用

    Institute of Scientific and Technical Information of China (English)

    曹渊武; 沈笛; 陈子贤; 姜晓幸; 施德源; 姜南春

    2015-01-01

    目的:探讨C T三维重建技术诊断闭合性胫骨骨折合并踝关节损伤的准确性。方法:对117例在复旦大学附属中山医院就诊的闭合性胫骨骨折患者术前常规行X线及三维CT检查。比较两种检查手段对胫骨骨折合并踝关节损伤的诊断价值。结果:术前X线检查发现19例胫骨骨折患者合并后踝骨折;而三维C T重建图像发现34例患者伴后踝骨折,比X线摄片多检查出15例。结论:对于胫骨骨折合并后踝关节损伤,三维C T重建技术较X线检查的诊断率更高,能降低漏诊率。%Objective:To explore the accuracy of CT three dimensional reconstruction technique for the diagnosis of tibia shaft fracture accompanied by ankle injury .Methods:Both X‐ray examination and three dimensional CT scanning were conducted for the 117 patients with closed tibia shaft fracture ,who went to Zhongshan Hospital of Fudan University ,before surgery .The numbers of patients ,who were diagnosed with tibia shaft fracture accompanied by ankle injury ,were compared between the two examination methods .Results:Nineteen patients with tibia shaft fracture were diagnosed with accompanied posterior malleolar fracture by X‐ray examination before surgery . However ,34 patients were diagnosed with accompanied posterior malleolar fracture by CT three dimensional reconstruction images . Thus , 15 more patients were diagnosed by CT three dimensional reconstruction technique than that by X‐ray imaging .Conclusions:Comparing with X‐ray examination , three dimensional CT reconstruction technique could increase the diagnosis accuracy for posterior malleolar fracture associated with tibia shaft fracture and reduce the rate of missed diagnosis .

  1. Temporal Variation in Ankle Fractures and Orthopedic Resident Program Planning in an Urban Level 1 Trauma Center.

    Science.gov (United States)

    Wynkoop, Aaron; Ndubaku, Osy; Walter, Norman; Atkinson, Theresa

    Previous studies have described the mechanism of ankle fractures, their seasonal variation, and fracture patterns but never in conjunction. In addition, the cohorts previously studied were either not from trauma centers or were often dominated by low-energy mechanisms. The present study aimed to describe the epidemiology of ankle fractures presenting to an urban level 1 trauma center. The records from an urban level 1 trauma center located in the Midwestern United States were retrospectively reviewed, and the injury mechanism and energy, time of injury, day of week, month, and patient characteristics (age, gender, comorbidities, smoking status) were collected. The fractures were classified using the AO (Arbeitsgemeinschaft für Osteosynthesefragen), Lauge-Hansen, and Danis-Weber systems. Of these systems, the Lauge-Hansen classification system resulted in the greatest number of "unclassifiable" cases. Most ankle fractures were due to high-energy mechanisms, with motor vehicle collisions the most common high-energy mechanism. The review found that most ankle fractures were malleolar fractures, regardless of the mechanism of injury. The ankle fracture patients had greater rates of obesity, diabetes, and smoking than present in the region where the hospital is located. The fractures were most likely to occur in the afternoon, with more fractures presenting on the weekend than earlier in the week and more fractures in the fall and winter than in the spring and summer. The temporal variation of these fractures should be considered for health services planning, in particular, in regard to resident physician staffing at urban level 1 trauma centers. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  2. Study of technical parameters of C1 lateral screws placement in Jefferson-fracture reduction plate%寰椎骨折前路复位内固定钢板置钉参数研究

    Institute of Scientific and Technical Information of China (English)

    夏虹; 林宏衡; 许国庆; 何小华; 尹庆水; 王智运; 许俊杰

    2012-01-01

    Objective To clarify the technical parameters of Cl lateral mass screw in anterior Jefferson-fracture reduction plate. Methods Anatomic structure of Cl lateral mass using 1-mm CT scans were measured with MIMICS software in 80 Cl lateral mass of 40 cases. 2 entry points were selected for superior and inferior screw placement and screws (2.5mm in diameter) , and simulation procedure was performed at these entry, points. Length, angle of screw and relation with adjacent anatomical structures were recorded. Results Distance from medial wall of vertebral artery hole to midline of atlas was 23.2 mm. Distance between medial wall of posterior arch junction with lateral mass and midline was 13.2 mm, and from entry point of superior screw to anterior edge of superior articular and midline were 6.2mm, 20.0mm respectively. The length of superior screw was 21.5 mm and the range of sagittal angulation was upward 1.5° to downward 11.6°. Distance from entry point of inferior screw to anterior edge of inferior articular was 8.9mm. Length of inferior screw was 15.2mm. The largest downward angulation for inferior screw was 20.7°. Distance from medial wall of vertebral hole to inferior screw was 1.9mm. The area of lateral mass (17.6~23.2) mm away from midline of atlas is relative safe for screw placement. Conclusions It is feasible to place C1 lateral mass screws (superior and inferior screw) in anterior Jefferson-fracture reduction plate. Making final decision of entry points and screw direction must depend on preoperative 3-dimensional CT evaluation. According to our research, the angulation of superior screw below turn to downward, and the angulation of inferior screw turn to inside were recommended.%目的 明确寰椎骨折前路复位内固定钢板寰椎侧块置钉可行性及置钉技术参数. 方法 用Mimics软件,对40例被检查者的CT数据进行三维重建,解剖测量,并模拟置入寰椎侧块螺钉,测量并获得置钉的技术参数.结果 椎

  3. 可吸收线张力带合并克氏针交叉固定治疗儿童陈旧性肱骨外髁骨折%Absorbable thread tension with the needle was merged cross ifxed treat children chronic humerus lateral condyle fracture

    Institute of Scientific and Technical Information of China (English)

    江政晃; 余舒鹏

    2016-01-01

    目的:探讨可吸收线张力带合并克氏针治疗儿童陈旧性肱骨外髁骨折的治疗效果及儿童肱骨外髁骨折治疗的注意事项和经验。方法回顾性研究2014年1月至2016年1月江西中医药大学附属医院收治的18例陈旧性肱骨外髁骨折患儿临床资料,均采用可吸收线张力带合并克氏针交叉固定治疗,术后定期随访患儿骨折愈合情况。结果18例患儿均获得随访。骨折愈合时间4~12周,平均6周。无术后感染、神经损伤、肱骨小头缺血坏死、骨不连等并发症。肘关节活动根据 hardacre的疗效标评估,优16例(88.9%),良2例(11.1%)。结论可吸收线张力带合并克氏针交叉固定治疗儿童陈旧性肱骨外髁骨折获得较为满意的治疗效果;肱骨外髁骨折骨折的处理第一要务就是在于早期的诊断,及时正确的治疗,防止陈旧性肱骨外髁骨折的产生,而对于陈旧性肱骨外髁骨折的早期手术治疗却能够使得肘关节的外观和功能得到有效的纠正。%Objective to explore the absorbable thread tension with the needle was merged the curative effect of treating children chronic humerus lateral condyle fracture and children humerus condyle fracture treatment considerations and experience.Methods retrospective study between January 2014 and January 2014 in jiangxi university of traditional Chinese medicine affiliated hospital of 18 cases of pulmonary humerus lateral condyle fracture with clinical data, adopts absorbable thread tension with the needle was merged cross fixed treatment, postoperative follow-up on a regular basis with fracture healing.Results 18 cases were follow-up. Fracture healing time 4 ~ 12 weeks, 6 weeks on average. No postoperative infection, nerve injury, capitellum complications such as ischemic necrosis, bone nonunion. Elbow movement according to the curative effect of hardacre standard evaluation, optimal 16 cases (88.9%), good in 2 cases (11

  4. Clinical value of weight-bearing lateral radiographs in evaluation of ankle fracture restoration%负重X线侧位片评估踝关节骨折复位情况的价值分析

    Institute of Scientific and Technical Information of China (English)

    杨勇; 陈维毅; 易兴彪

    2016-01-01

    Objective To discuss the clinical value of L-value measured in weight -bearing lateral radio-graphs in evaluation of ankle fracture restoration .Methods Totally 45 cases of ankle joint fracture treated in our hospital from Jan.2011 to Jan.2014 had been used as samples of a retrospective analysis .According to whether they had a joint pain,movement limitation and other complications after treatment ,the patients were divided into group A (n=27) and group B(n=18).The two groups were compared to find out whether there was a significant difference in L-value.Patients in group B needed to restore fracture by operation and the L-value in the process was decreased and the curative effect before and after operation was compared .Results L-value of group A was (1.26 ±1.4)mm, and was(2.43 ±2.0)mm in group B.The difference was statistically significant (t=2.312,P<0.05).Group B con-tained 18 cases of malunited ankle fracture .After the surgery,they were followed up for an average of (17.1 ±7.3) months.All fractures healed well.AOFAS score was (43.1 ±15.9) before surgery,and (83.3 ±11.8) after surgery. The change of AOFAS score was statistically significant (t=8.614,P<0.05).Conclusion Since L-value can be used as a standard to accurately evaluate ankle joint replacement ,it has both clinical and practical value .%目的:探讨负重X线侧位片“距骨中心胫骨中轴距”L值对于评估踝关节骨折复位的临床价值。方法笔者以2011年1月~2014年1月收治的45例踝关节骨折患者为样本进行回顾性分析,根据有无复位后关节疼痛、活动受限等并发症将患者分为A组(27例)和B组(18例),对比A、B组负重X线侧位片L值有无统计学差异;对于需要进行重建手术的B组,通过手术干预,减小L值,对比手术前后的疗效。结果 A、B组患者L值分别为(1.26±1.4)mm、(2.43±2.0)mm,两者对比有统计学意义(t=2.312,P<0.05);B组18例踝关节

  5. Diplopia and orbital wall fractures.

    Science.gov (United States)

    Boffano, Paolo; Roccia, Fabio; Gallesio, Cesare; Karagozoglu, K Hakki; Forouzanfar, Tymour

    2014-01-01

    Diplopia is a symptom that is frequently associated with orbital wall fractures. The aim of this article was to present the incidence and patterns of diplopia after orbital wall blow-out fractures in 2 European centers, Turin and Amsterdam, and to identify any correlation between this symptom and such fractures. This study is based on 2 databases that have continuously recorded data of patients hospitalized with maxillofacial fractures between 2001 and 2010. On the whole, 447 patients (334 males, 113 females) with pure blow-out orbital wall fractures were included. The most frequently involved orbital site was the floor (359 fractures), followed by medial wall (41 fractures) and lateral wall (5 fractures). At presentation, 227 patients (50.7%) had evidence of diplopia. In particular, in most patients, a diplopia in all directions was referred (78 patients). Statistically significant associations were found between diplopia on eye elevation and orbital floor fractures (P diplopia and medial wall fractures (P diplopia on eye elevation and horizontal diplopia at presentation could be useful clinical indicators orbital floor and medial wall fractures, respectively.

  6. Root fractures

    DEFF Research Database (Denmark)

    Andreasen, Jens Ove; Christensen, Søren Steno Ahrensburg; Tsilingaridis, Georgios

    2012-01-01

    The purpose of this study was to analyze tooth loss after root fractures and to assess the influence of the type of healing and the location of the root fracture. Furthermore, the actual cause of tooth loss was analyzed.......The purpose of this study was to analyze tooth loss after root fractures and to assess the influence of the type of healing and the location of the root fracture. Furthermore, the actual cause of tooth loss was analyzed....

  7. Stress Fractures

    Science.gov (United States)

    Stress fractures Overview Stress fractures are tiny cracks in a bone. They're caused by repetitive force, often from overuse — such as repeatedly jumping up and down or running long distances. Stress fractures can also arise from normal use of ...

  8. Lateral Concepts

    Directory of Open Access Journals (Sweden)

    Christopher Gad

    2016-06-01

    Full Text Available This essay discusses the complex relation between the knowledges and practices of the researcher and his/her informants in terms of lateral concepts. The starting point is that it is not the prerogative of the (STS scholar to conceptualize the world; all our “informants” do it too. This creates the possibility of enriching our own conceptual repertoires by letting them be inflected by the concepts of those we study. In a broad sense, the lateral means that there is a many-to-many relation between domains of knowledge and practice. However, each specific case of the lateral is necessarily immanent to a particular empirical setting and form of inquiry. In this sense lateral concepts are radically empirical since it locates concepts within the field. To clarify the meaning and stakes of lateral concepts, we first make a contrast between lateral anthropology and Latour’s notion of infra-reflexivity. We end with a brief illustration and discussion of how lateral conceptualization can re-orient STS modes of inquiry, and why this matters.

  9. Fracture Networks in Sea Ice

    Directory of Open Access Journals (Sweden)

    Jonas Nesland Vevatne

    2014-04-01

    Full Text Available Fracturing and refreezing of sea ice in the Kara sea are investigated using complex networkanalysis. By going to the dual network, where the fractures are nodes and their intersectionslinks, we gain access to topological features which are easy to measure and hence comparewith modeled networks. Resulting network reveal statistical properties of the fracturing process.The dual networks have a broad degree distribution, with a scale-free tail, high clusteringand efficiency. The degree-degree correlation profile shows disassortative behavior, indicatingpreferential growth. This implies that long, dominating fractures appear earlier than shorterfractures, and that the short fractures which are created later tend to connect to the longfractures.The knowledge of the fracturing process is used to construct growing fracture network (GFNmodel which provides insight into the generation of fracture networks. The GFN model isprimarily based on the observation that fractures in sea ice are likely to end when hitting existingfractures. Based on an investigation of which fractures survive over time, a simple model forrefreezing is also added to the GFN model, and the model is analyzed and compared to the realnetworks.

  10. [Subtrochanteric femoral fractures].

    Science.gov (United States)

    Ulmar, B; Simon, S; Eschler, A; Mittlmeier, T

    2013-12-01

    Subtrochanteric femoral fractures are proximal femoral fractures which are located between the trochanter minor and an area of 3 cm below the minor trochanter on the femoral shaft. About 10-15% of all proximal femoral fractures correspond to this fracture site. Elderly or geriatric patients are generally affected and the injury is often the result of a fall in the home, while high-energy trauma is the cause in a small group of generally younger patients. Clinical evaluation of the affected extremity shows disability of axial weight-bearing and pain during compression and rotation of the hip joint. Basic diagnostics include conventional x-rays of the injured femur in the anterior-posterior and lateral planes. These subtrochanteric femoral fractures are almost always treated surgically due to the inherent high degree of instability. The main goals of surgical intervention are to achieve anatomic fracture reduction and primary full weight-bearing stability of the corresponding leg. Intramedullary interlocking nails are used for primary treatment, while extramedullary implants are often used in revision surgery. Early mobilization and intensive respiratory exercises are necessary to prevent early postoperative complications.

  11. Clavicle fractures - incidence of supraclavicular nerve injury

    Directory of Open Access Journals (Sweden)

    Pedro Jose Labronici

    2013-08-01

    Full Text Available OBJECTIVE: To analyze retrospectively 309 fractures in the clavicle and the relation with injury of the supraclavicular nerve after trauma. METHODS: It was analyzed 309 patients with 312 clavicle fractures. The Edinburgh classification was used. Four patients had fractures in the medial aspect of the clavicle, 33 in the lateral aspect and 272 in the diaphyseal aspect and three bilateral fractures. RESULTS: 255 patients were analyzed and five had paresthesia in the anterior aspect of the thorax. Four patients had type 2 B2 fracture and one type 2 B1 fracture. All patients showed spontaneous improvement, in the mean average of 3 months after the trauma. CONCLUSION: Clavicle fractures and/ or shoulder surgeries can injure the lateral, intermediary or medial branches of the supraclavicular nerve and cause alteration of sensibility in the anterior aspect of the thorax. Knowledge of the anatomy of the nerve branches helps avoid problems in this region.

  12. CURBSIDE CONSULTATION IN FRACTURE MANAGEMENT: 49 CLINICAL QUESTIONS

    Directory of Open Access Journals (Sweden)

    Walter W. Virkus

    2008-12-01

    Full Text Available DESCRIPTION: A user-friendly, unique resource for the treatment of fractures designed in a casual questions and answers format which provides basic knowledge, current information and evidence based expert advices enhanced by images and diagrams and supported by ref-erences.PURPOSE: Designing this book the editor has aimed to prepare not only a source of current knowledge and opin-ions by experienced authors in fracture management for decision making in daily practice but also a brief refer-ence and useful educational resource in orthopedic trauma surgery.FEATURES: Three Sections are composed of 49 sub-jects in a form of the answers of frequently asked ques-tions richly illustrated by images and diagrams and in-cluding references at the end of each subject.The Section I is “UPPER EXTREMITIES” including: Neck fracture; Humerus shaft fracture; Management of radial nerve palsy associated with humeral fracture; Clavicle fractures; Elbow fractures in children; Fasciot-omy technic of the forearm; Distal radius fracture; Indica-tions of radial head replacement, Femur and humeral shaft fractures; Treatment of posterolateral elbow dislocation; The Section II is “LOWER EXTREMITIES” including : Femur fractures; Pelvic fractures; Life threatening pelvic fractures; Decision for surgical treatment in pelvic frac-tures; Treatment of anterior fracture of femoral head and hip joint incongruity; Management of a displaced femoral neck fracture in young patient in ER; Elder patients with displaced femoral head fracture; Patella and tibial plateau fractures; Criteria for compartment syndromes in the tibia; Tricks in nailing proximal and distal tibial fractures; Surgical management of distal tibia spiral fracture in middle aged women; Pilon fracture; Management of syn-desmotic screws in adult patient; The management of minimally displaced posterior malleol in three malleolar fractures; Postoperative management of bimalleolar frac-tures; Management of minimally

  13. Modeling 3D Fracture Network in Carbonate NFR: Contribution from an Analogue Dataset, the Cante Perdrix Quarry, Calvisson, SE France

    NARCIS (Netherlands)

    Gauthier, B.D.M.; Bisdom, K.; Bertotti, G.

    2012-01-01

    The full 3D characterization of fracture networks is a key issue in naturally fractured reservoir modeling. Fracture geometry (e.g., orientation, size, spacing), fracture scale (e.g., bed-confined fractures, fracture corridors), lateral and vertical variations, need to be defined from limited, gener

  14. Efficacy analysis of the modified posterolateral approach for trimalleolar fractures%改良后外侧入路治疗三踝骨折临床疗效分析

    Institute of Scientific and Technical Information of China (English)

    吴祖耀; 曾伟锋; 王长涛; 吴吉悦

    2014-01-01

    Objective To evaluate the clinical outcomes and efficiency the modified posterolateral approach for trimalleolar fractures. Methods From October 2010 to October 2012,32 patients with trimalleolar fractures were treated,including 18 males and 14 females,aged from 20 to 65 years.Fractures were classified with Lange-Hansen classification system:supination-external rotation in 18 cases,and pronation-external rotation in 14 cases. The patients were followed in outpatient clinic way.The fracture healing and ankle function were observed by the X-ray examinations postoperatively.Results All patients got follow-up visit for at least 12 months (from 12 to 18 months,mean 14 months).1 case of all incision was infected Superficially. Postoperative radiograph showed bone union in all the patients.At the final follow-up,according to Phillips ankle scoring system,the score ranged from 110 to 150,with an average of(140.7±5.5). There was excellent in 20 cases,good in 7 cases,fair in 4 cases and poor in 1 case,with an excellent and good rate of 84.3%. Conclusion The modified posterolateral approach can treat the fractures of lateral and posterior malleolar fractures simultaneously,less invasive and has characteristics of good surgical exposure,accurate fracture reduction,and worthwhile for spreading in clinical practice.%目的:探讨改良后外侧入路在三踝骨折治疗中的临床疗效。方法2010年10月~2012年10月对32例三踝骨折的病例采用改良的后外侧入路行切开复位内固定治疗。根据Lauge-Hansen踝关节骨折分型,旋后外旋型18例,旋前外旋型14例。观察术后伤口愈合、骨折恢复及内固定情况,同时按Phillips踝关节评分标准踝关节功能进行评估。结果本组随访12~18个月,骨折全部愈合,愈合时间为10~13周。术后切口表浅感染1例。根据术后踝关节功能根据Phillips踝关节评分标准,本组评分为110~150分,平均(140.7±5.5)分;获优20

  15. Buttress plating for a rare case of comminuted medial condylar Hoffa fracture associated with patellar fracture

    Institute of Scientific and Technical Information of China (English)

    Ashwani Soni; Ramesh K Sen; Uttam Chand Saini; Dajjit Singh; Sushil Chaudhary

    2012-01-01

    Hoffa fracture is an uncommon injury.In the literature,lateral condylar Hoffa fracture is mentioned as a more common injury pattern than medial condylar Hoffa fracture.The mechanism of injury and method of treatment is not very well described in the literature.We are presenting a rare case of comminuted medial condylar Hoffa fracture with ipsitateral patellar fracture.The mechanism of injury has not been described in the literature.Lag screw fixation,which is the most acceptable method of treatment,is not possible due to comminution.We explain the possible mechanism of injury and fix the fracture with L-buttress plate.

  16. A case of acute hangman's fracture

    Directory of Open Access Journals (Sweden)

    Alexander John Scumpia

    2016-07-01

    Full Text Available Hangman's fracture classically results from hyperextension/distraction of the upper cervical spine, causing the axis to break symmetrically across its pedicles or lateral masses and may involve the body of the vertebrae. Interestingly, Starr and Eismont described an atypical hangman's fracture where fracture lines are not parallel and may pass through the foramen transversarium unilaterally from a hyperextension and lateral side-bending injury, as the mechanism described herein. We present a case of an atypical hangman's fracture in a 73-year-old Caucasian female after being involved in a low-speed motor vehicle collision.

  17. Posterior bicondylar tibial plateau fractures.

    Science.gov (United States)

    Carlson, DuWayne A

    2005-02-01

    To present a case series of patients with posterior bicondylar tibial plateau fractures treated by direct fracture exposure and fixation through dual incisions. Retrospective clinical study. Level 1 trauma centers. Eight patients were identified that had posterior bicondylar tibial plateau fractures. Two patients had depressed posterolateral tibial plateau fractures with contained defects and did not have direct fracture exposure. One patient died of medical problems leaving 5 patients who underwent direct fracture exposure, reduction, and fixation. Posteromedial followed by posterolateral open reduction and internal fixation of posterior bicondylar tibial plateau fractures. At 6 to 24 months follow-up (mean 13 months), all patients returned to near full activities, each with aching after prolonged standing (8-hour shift). Range of motion averaged 2 degrees to 121 degrees of flexion. Three of 5 returned to manual labor jobs; the others were not employed at the time of injury. Posterior bicondylar tibial plateau fractures have a high association with lateral meniscal pathology and can be associated with anterior cruciate ligament injury. Reduction of the posterior plateau condyles is easiest with the knee in full extension. Flexion contractures can be a problem, and patients should be encouraged to regain/maintain knee extension. The dual-incision approach to these challenging fractures can result in good to excellent knee function for these patients.

  18. Atypical Pelvic Crescent Fracture Caused by Vertical Shear Force

    OpenAIRE

    2014-01-01

    The crescent fracture consists of a posterior iliac wing fracture with extension into the sacroiliac joint and a dislocation of the sacroiliac joint. This fracture represents a subset of lateral compression injury. The strong posterior ligaments of sacroiliac joint remain intact and a fracture fragment (crescent shape) involving the posterior superior iliac spines remains firmly attached to the sacrum. We report a patient with atypical pelvic crescent fracture that is mainly influenced by ver...

  19. [Acetabular fractures].

    Science.gov (United States)

    Gänsslen, A; Oestern, H J

    2011-12-01

    Treatment of acetabular fractures requires extensive knowledge of the bony anatomy, the amount of possible exposure of the bone with the selected approaches and fracture type-dependent indications of operative treatment. Classification of the fracture with detailed analysis of the fracture morphology is the basis for decision making and planning. The primary treatment aim is the anatomic reconstruction of the acetabulum which results in optimal long-term results.The basis of this overview is the presentation of standard treatment concepts in acetabular fracture surgery. Beside characteristics of the acetabular bony anatomy, biomechanical and pathomechanical principles and the relevant radiological anatomy, the treatment options, both conservative and operative and basic principles of the indications for standard surgical approaches will be discussed.The special fracture type is discussed in detail regarding incidence, injury mechanism, concomitant injuries, options for conservative and operative treatment, quality of operative reduction and long-term results.Furthermore, epidemiological data on typical postoperative complications are evaluated.

  20. Pulsative hematoma: A penile fracture complication

    Directory of Open Access Journals (Sweden)

    Nale Đorđe

    2007-01-01

    Full Text Available Background. Fracture of the penis is a direct blunt trauma of the erect or semi-erect penis. It can be treated by conservative or surgical means. Retrospective analyses of conservative penile fracture treatment reveal frequent immediate and later complications. Case report. We presented a 41- year-old patient with pulsative hematoma caused by an unusual fracture of the penis. Fracture had appeared 40 days before the admittance during a sexual intercourse. The patient was treated surgically. Conclusion. Pulsative hematoma (pulsative diverticulum is a very rare, early complication of a conservatively treated penile fracture. Surgical treatment has an advantage over surgical one, which was confirmed by our case report.

  1. Sports fractures.

    OpenAIRE

    DeCoster, T. A.; Stevens, M. A.; Albright, J. P.

    1994-01-01

    Fractures occur in athletes and dramatically influence performance during competitive and recreational activities. Fractures occur in athletes as the result of repetitive stress, acute sports-related trauma and trauma outside of athletics. The literature provides general guidelines for treatment as well as a variety of statistics on the epidemiology of fractures by sport and level of participation. Athletes are healthy and motivated patients, and have high expectations regarding their level o...

  2. Hamate fractures.

    Science.gov (United States)

    Sarabia Condés, J M; Ibañez Martínez, L; Sánchez Carrasco, M A; Carrillo Julia, F J; Salmerón Martínez, E L

    2015-01-01

    The purpose of this paper is to present our experience in the treatment of the fractures of the hamate and to make a review of the literature on this topic. We retrospectively reviewed 10 patients treated in our clinic between 2005-2012 suffering from fractures of the hamate. Six cases were fractures of the body and four were fractures of the hamate. Five cases were of associated injuries. Diagnostic delay ranged from 30 days to 2 years. Patient follow-up ranged from 1 to 10 years. Patient satisfaction was evaluated using the DASH questionnaire. Five patients with a fracture of the body underwent surgery, and one was treated conservatively. Two patients with fracture of the hook of the hamate were treated with immobilization, and two more patients had the fragment removed. The grip strength and the digital clip were reduced in 2 cases. Flexion and extension of the wrist was limited in 3 cases. The mobility of the fingers was normal in all the cases, except in one. The results obtained from the DASH questionnaire were normal in all the cases, except in one case of fracture of the hamate, and in two cases of fracture of the body. The surgical treatment should reduce the dislocation and stabilize the injuries with osteosynthesis. The fractures of the hamate are usually diagnosed late, and the most recommended treatment is removal of the fragment, although it cannot be deduced from this study. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

  3. Colles Fracture

    OpenAIRE

    Sánchez León, Belisario; Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Perú

    2014-01-01

    Our expertise is the study of more than 2,000 cases of Colles' fractures. Colles name should in this case to synthesize the type of fractures of the lower end of the radius. There have been various proposed classifications according to the different fracture lines can be demonstrated radiologically in the region of the wrist. We believe that these ratings should only be retained if the concept of the articular fracture or not in the classical sense, since it has great value in the functional ...

  4. 儿童后内侧和后外侧移位肱骨髁上骨折和肘内翻畸形之间的关系%Children medial and lateral displacement of fracture and cubitus varus deformity relationship between supracondylar humerus

    Institute of Scientific and Technical Information of China (English)

    胡欣

    2014-01-01

    Objective To investigate the child after the medial and lateral shift after supracondylar fractures and de-formity occurs turn the relationship between the inner elbow. Methods 33 cases of supracondylar fractures were treated with closed reduction and Kirschner wire fixation ( Gartland typeⅢA 18 cases, typeⅢB 15 cases) . Surgery combined with external fixation plaster for 3~4 weeks. After being in the elbow, the lateral X-ray measurement of the carrying angle and elbow range of motion, carrying angle changes observed, analyzed and cubitus varus displacement direction of the relationship. Results The children were followed up for 1~2 years. 18 cases of typeⅢA fracture of the elbow carrying angle lost 15. 2° ± 5. 1°, 15 cases of type ⅢB person carrying angle lost 8. 8° ± 3. 5°. Cubitus varus typeⅢA andⅢB fractures caused a statistically significant difference compared (P<0. 05). No patient expe-rienced elbow limited mobility. According to Flynn criteria:18 cases of type ⅢA fracture patients, 10 cases of be-nign and 8 were poor;15 cases of patients with typeⅢB fracture patients, 9 cases of benign and 6 were poor. Con-clusions Type ⅢA fractures compared to ⅢB fractures are more likely to occur cubitus varus. Even after surgery has been anatomically, typeⅢA fractures may still lead to cubitus varus deformity, which may be typeⅢA compres-sion fracture of the medial cortical bone, or accompanied by epiphyseal injuries.%目的:探讨儿童后内侧和后外侧移位肱骨髁上骨折和发生肘内翻畸形之间的关系。方法采用闭合复位克氏针内固定治疗33例Gartland Ⅲ型肱骨髁上骨折患儿(ⅢA型18例,ⅢB型15例),术后辅以石膏托外固定3~4周。术后在肘关节正、侧位X线片上测量提携角和肘关节的运动范围,观察提携角变化,分析移位方向和肘内翻的关系。结果患儿均获随访,时间1~2年。18例ⅢA型骨折者提携角丢失15.2°±5.1°,15例

  5. Hoffa fracture associated with ipsilateral femoral shaft fracture: clinical feature and treatment.

    Science.gov (United States)

    Gong, Yu-Bao; Li, Qing-Song; Yang, Chen; Li, Shu-Qiang; Liu, Jian-Guo; Qi, Xin

    2011-01-01

    Hoffa fracture associated with ipsilateral femoral shaft fracture is very rare. Three cases of this rare type of injury were retrospectively reviewed. The sites of femoral shaft fractures and Hoffa fractures were documented. All femoral shaft fractures were managed with internal fixation. The rate of misdiagnosis for the Hoffa fractures was documented. Functions of the affected knees were evaluated according to the modified Hospital for Special Surgery (HSS) scores at two years follow-up. Femoral fractures were either transverse or composite in all three cases. Ipsilateral Hoffa fractures occurred at medial condyle in two cases, and lateral condyle in one case. Only one Hoffa fracture was identified preoperatively. All the femoral shaft fractures healed uneventfully. In the patient whose Hoffa fracture was correctly diagnosed, the modified HSS score was 94. In another patient, whose Hoffa fracture was treated by a second operation, the modified HSS score was 93. And in the third case, who refused additional operation for the Hoffa fracture, the modified HSS score was only 70. Conclusively femoral shaft fracture can be associated with ipsilateral Hoffa fracture, especially in motorcycle accident. This type of injury is very rare and misdiagnosis is common.

  6. Hoffa fracture associated with ipsilateral femoral shaft fracture: clinical feature and treatment

    Institute of Scientific and Technical Information of China (English)

    GONG Yu-bao; LI Qing-song; YANG Chen; LI Shu-qiang; LIU Jian-guo; QI Xin

    2011-01-01

    Hoffa fracture associated with ipsilateral femoral shaft fracture is very rare.Three cases of this rare type of injury were retrospectively reviewed.The sites of femoral shaft fractures and Hoffa fractures were documented.All femoral shaft fractures were managed with internal fixation.The rate of misdiagnosis for the Hoffa fractures was documented.Functions of the affected knees were evaluated according to the modified Hospital for Special Surgery (HSS) scores at two years follow-up.Femoral fractures were either transverse or composite in all three cases.Ipsilateral Hoffa fractures occurred at medial condyle in two cases,and lateral condyle in one case.Only one Hoffa fracture was identified preoperatively.All the femoral shaft fractures healed uneventfully.In the patient whose Hoffa fracture was correctly diagnosed,the modified HSS score was 94.In another patient,whose Hoffa fracture was treated by a second operation,the modified HSS score was 93.And in the third case,who refused additional operation for the Hoffa fracture,the modified HSS score was only 70.Conclusively femoral shaft fracture can be associated with ipsilateral Hoffa fracture,especially in motorcycle accident.This type of injury is very rare and misdiagnosis is common.

  7. Application of C2 Transpedicular Screw Fixation Combined with C3 Lateral Mass Screw Plate Fixation in Posterior Treatment of Old Hangman's Fracture%经后路C2椎弓根C3侧块短节段固定治疗陈旧性枢椎椎弓骨折

    Institute of Scientific and Technical Information of China (English)

    曹成刚; 梁益建; 何睿; 石化洋; 曾勇; 陈伶

    2012-01-01

    Objective To approach the therapeutic effect of C2 transpedicular screw fixation combined with C3 lateral mass screw plate fixation on old Hangman' s fracture. Methods Nine patients with old Hangman' s fracture were treated with C2 transpedicular screw fixation combined with C3 lateral mass screw plate fixation as well as bone gr'aft fusion in our hospital from 2002. Results A mean follow-up time was 8 months(6 to 15 months). All cases got bony union. No infection, neurological deficits, or other complications were found. Conclusion It can be an effective and simple way to treat old Hangman' s fracture with C2 transpedicular screw fixation combined with C3 lateral mass screw plate fixation, which can ultimately preserve the cervical function.%目的 探讨经后路C2椎弓根C3侧块短节段内固定治疗陈旧性枢椎椎弓骨折(Hangman骨折)的疗效.方法 2002年以来9例陈旧性Hangman骨折采用经后路C2椎弓根C3侧块短节段固定,植骨融合治疗.结果 所有患者随访6~15个月,平均8个月.所有患者均骨性愈合,未出现感染、神经损伤等并发症.结论 经后路C2椎弓根C3侧块短节段内固定治疗陈旧性Hangman骨折是一种安全有效并能最大程度保留患者颈部功能的方法.

  8. C2椎弓根 C3侧块螺钉固定治疗不稳定性 Hangman 骨折%C2 Pedicle Screw C3 Lateral Mass Screw Fixation for Treatment of Unstable Hangman Fracture

    Institute of Scientific and Technical Information of China (English)

    吴磊磊; 邱玉金; 李攀

    2012-01-01

      Objective To evaluate the clinical effect of unstable Hangman fracture treated with C 2 pedicle screw C3 lateral mass screw fixation.Methods From July 2003 to July 2011,32 cases of patients with unstable Hangman fracture were treated in our hospital . Based on Levine-Edwards classification,typeⅡ-14 cases,typeⅡA -15 cases,type Ⅲ -3 cases.All the cases were treated with C 2 pedicle screw C3 lateral mass screw fixation.Results There was no spinal cord and vertebral artery injury or other complications during the opera -tion.All the patients were followed up from 3th to 24th months,average of 13.7months and got bony fusion.The preoperative displacement of C2 ~3 vertebral bodies was (5.7 ±1.3)mm,the postoperative displacement of C 2 ~3 vertebral bodies followed up for 6 months was(2.3 ±1.7) mm,P <0.05;The preoperative angulation of C 2 ~3 vertebral bodies was 12.6°±1.4°,the postoperative angulation of C 2 ~3 vertebral bodies followed up for 6 months was 7.3°±1.7°,P <0.05;based on JOA 17 scores for assessment of spinal cord function ,the preoperative score was 6.3 ±0.3,the postoperative score followed up for 6 months was 13.5 ±1.1,the recovery rate of nervous function was 67%.Conclusion For treatment of unstable Hangman fracture ,C2 pedicle screw C3 lateral mass screw fixation is an effective method .

  9. A Rare Case of Segmental Clavicle Fracture in an Adolescent

    Science.gov (United States)

    Daolagupu, Arup Kumar; Gogoi, Parag Jyoti; Mudiganty, Srikanth

    2013-01-01

    Clavicular fractures commonly occur in adults and children. The usual mechanism of injury is a fall on the outstretched hand or direct trauma. The usual site of these fractures is the mid clavicle with lateral end and medial end clavicular fractures being less common, respectively. Segmental clavicular fractures have been reported in the literature; they usually occur at the medial and lateral ends and tend to occur in adults. Bipolar clavicular injuries involving medial and lateral ends have also been reported rarely but all in adults. We report a very rare case of segmental clavicular fracture involving the mid clavicle and lateral end in an adolescent caused by direct trauma. The management of segmental clavicle fractures has not been clearly outlined although operative intervention is indicated. We report the successful management of segmental fracture clavicle in an adolescent and discuss the relevant literature. PMID:23476850

  10. A Rare Case of Segmental Clavicle Fracture in an Adolescent

    Directory of Open Access Journals (Sweden)

    Arup Kumar Daolagupu

    2013-01-01

    Full Text Available Clavicular fractures commonly occur in adults and children. The usual mechanism of injury is a fall on the outstretched hand or direct trauma. The usual site of these fractures is the mid clavicle with lateral end and medial end clavicular fractures being less common, respectively. Segmental clavicular fractures have been reported in the literature; they usually occur at the medial and lateral ends and tend to occur in adults. Bipolar clavicular injuries involving medial and lateral ends have also been reported rarely but all in adults. We report a very rare case of segmental clavicular fracture involving the mid clavicle and lateral end in an adolescent caused by direct trauma. The management of segmental clavicle fractures has not been clearly outlined although operative intervention is indicated. We report the successful management of segmental fracture clavicle in an adolescent and discuss the relevant literature.

  11. Lateral Mixing

    Science.gov (United States)

    2012-11-08

    being made on their analysis. A process we became very curious about was the separation of tendrils of warm salty water from the north wall figure 7...structure, and to remove the effect of internal waves by mapping this structure onto isopycnals. This has been very successful in elucidating lateral...we passed through the same water on multiple passes, and that changes in the horizontal structure of the water mas should be readily apparent from

  12. Fracture Mechanics

    CERN Document Server

    Zehnder, Alan T

    2012-01-01

    Fracture mechanics is a vast and growing field. This book develops the basic elements needed for both fracture research and engineering practice. The emphasis is on continuum mechanics models for energy flows and crack-tip stress- and deformation fields in elastic and elastic-plastic materials. In addition to a brief discussion of computational fracture methods, the text includes practical sections on fracture criteria, fracture toughness testing, and methods for measuring stress intensity factors and energy release rates. Class-tested at Cornell, this book is designed for students, researchers and practitioners interested in understanding and contributing to a diverse and vital field of knowledge. Alan Zehnder joined the faculty at Cornell University in 1988. Since then he has served in a number of leadership roles including Chair of the Department of Theoretical and Applied Mechanics, and Director of the Sibley School of Mechanical and Aerospace Engineering.  He teaches applied mechanics and his research t...

  13. OCCURRENCE AND INCIDENCE OF THE 2ND HIP FRACTURE

    DEFF Research Database (Denmark)

    SCHRODER, HM; Petersen, KK; ERLANDSEN, M

    1993-01-01

    During a 16-year period, 256 second hip fractures were found in 3898 persons 40 years of age and older who had a previous hip fracture. Ninety-two percent of the second fractures were contra-lateral, and 68% of these were the same type as the first. Thus, 62% of the femoral neck and 72......% of the trochanteric fractures were preceded by a contra-lateral fracture of the same type. The mean interval between fractures was 3.3 years, and there was no significant difference between genders or among fracture types. The risk of the first fracture was 1.6 per 1000 men per year and 3.6 per 1000 women......, and for the second fracture 15 per 1000 men per year and 22 per 1000 women. This increase was highly significant for both genders, especially for men....

  14. Fractures of the Capitellum and Trochlea

    NARCIS (Netherlands)

    Guitton, Thierry G.; Doornberg, Job N.; Raaymakers, Ernst L. F. B.; Ring, David; Kloen, Peter

    2009-01-01

    Background: Recent work has established that apparently isolated fractures of the capitellum are often more complex and involve the lateral epicondyle, trochlea, and posterior aspect of the distal part of the humerus. We assessed the experience with operative stabilization of fractures of the capite

  15. Effects of fracture reactivation and diagenesis on fracture network evolution: Cambrian Eriboll Formation, NW Scotland

    Science.gov (United States)

    Hooker, J. N.; Eichhubl, P.; Xu, G.; Ahn, H.; Fall, A.; Hargrove, P.; Laubach, S.; Ukar, E.

    2011-12-01

    The Cambrian Eriboll Formation quartzarenites contain abundant fractures with varying degrees of quartz cement infill. Fractures exist that are entirely sealed; are locally sealed by bridging cements but preserve pore space among bridges; are mostly open but lined with veneers of cement; or are devoid of cement. Fracture propagation in the Eriboll Formation is highly sensitive to the presence of pre-existing fractures. Fracture reactivation occurs in opening mode as individual fractures repeatedly open and are filled or bridged by syn-kinematic cements. As well, reactivation occurs in shear as opening of one fracture orientation coincides with shear displacement along pre-existing fractures of different orientations. The tendency for pre-existing fractures to slip varies in part by the extent of cement infill, yet we observe shear and opening-mode reactivation even among sealed fractures. Paleotemperature analysis of fluid inclusions within fracture cements suggests some fractures now in outcrop formed deep in the subsurface. Fractures within the Eriboll Formation may therefore affect later fracture propagation throughout geologic time. With progressive strain, fault zones develop within fracture networks by a sequence of opening-mode fracture formation, fracture reactivation and linkage, fragmentation, cataclasis, and the formation of slip surfaces. Cataclasite within fault zones is commonly more thoroughly cemented than fractures in the damage zone or outside the fault zone. This variance of cement abundance is likely the result of (1) continued exposure of freshly broken quartz surfaces within cataclasite, promoting quartz precipitation, and (2) possibly more interconnected pathways for mass transfer within the fault zone. Enhanced cementation of cataclasite results in strengthening or diagenetic strain hardening of the evolving fault zone. Further slip is accommodated by shear localization along discrete slip surfaces. With further linkage of fault segments

  16. Fractures in infants and toddlers with rickets

    Energy Technology Data Exchange (ETDEWEB)

    Chapman, Teresa; Done, Stephen [Seattle Children' s Hospital, Department of Radiology, Seattle, WA (United States); Sugar, Naomi; Feldman, Kenneth [Seattle Children' s Hospital, Children' s Protection Program, Seattle, WA (United States); Marasigan, Joanne; Wambold, Nicolle [University of Washington, College of Arts and Sciences, Seattle, WA (United States)

    2010-07-15

    Rickets affects young infants and toddlers. However, there is a paucity of literature regarding the types of fractures that occur in rachitic patients. To evaluate the age of patients at which radiographically evident rickets occurs, and to characterize the age incidence and fractures that are observed in infants and toddlers with radiographically evident rickets. A retrospective study of children younger than 24 months was performed. Clinical data and radiographs were reviewed. Radiographs obtained within 1 month of the diagnosis were evaluated for the presence or absence of osteopenia, presence or absence of fraying-cupping, and presence and characterization of fractures. After exclusion criteria were applied, 45 children were included in the study. Children with rickets evident by radiograph were in the age range of 2-24 months. Fractures were present in 17.5% of the study group, exclusively in mobile infants and toddlers. Fracture types included transverse long bone fractures, anterior and anterior-lateral rib fractures, and metaphyseal fractures. All fractures occurred exclusively in patients with severe, overtly evident rickets. Fractures occur in older infants and toddlers with overt rickets and can be seen by radiograph. Fractures do not resemble high-risk non-accidental trauma fractures. (orig.)

  17. Anterior fracture dislocation of sacroiliac joint: A rare type of crescent fracture

    Directory of Open Access Journals (Sweden)

    Vivek Trikha

    2015-01-01

    Full Text Available Crescent fractures of the pelvis are usually described as posterior sacro iliac fracture dislocations. Rarely anterior displacement of the fractured iliac fragment along with dislocation has been reported in crescent fractures. Four cases of anterior fracture dislocation of the sacro iliac joint managed in the last two years by a single surgeon are presented. The injury mechanism, radiological diagnosis, management protocol along with functional outcomes of all the four patients have been discussed. CT scan is essential in the diagnosis and preoperative planning of this injury pattern. Early fixation along with proper reduction leads to excellent functional outcome in this subset of lateral compression injuries of the pelvis.

  18. Fracture mechanics

    CERN Document Server

    Perez, Nestor

    2017-01-01

    The second edition of this textbook includes a refined presentation of concepts in each chapter, additional examples; new problems and sections, such as conformal mapping and mechanical behavior of wood; while retaining all the features of the original book. The material included in this book is based upon the development of analytical and numerical procedures pertinent to particular fields of linear elastic fracture mechanics (LEFM) and plastic fracture mechanics (PFM), including mixed-mode-loading interaction. The mathematical approach undertaken herein is coupled with a brief review of several fracture theories available in cited references, along with many color images and figures. Dynamic fracture mechanics is included through the field of fatigue and Charpy impact testing. Explains computational and engineering approaches for solving crack-related problems using straightforward mathematics that facilitate comprehension of the physical meaning of crack growth processes; Expands computational understandin...

  19. Fracture mechanics

    Science.gov (United States)

    Shannon, John L., Jr.

    1986-01-01

    The application of fracture mechanics to the design of ceramic structures will require the precise measurement of crack growth and fracture resistance of these materials over their entire range of anticipated service temperatures and standardized test methods for making such measurements. The development of a standard test for measuring the plane strain fracture toughness is sought. Stress intensity factor coefficients were determined for three varieties of chevron-notch specimens, and fracture toughness measurements were made on silicon nitrides, silicon carbides, and aluminum oxides to assess the performance of each specimen variety. It was determined that silicon nitride and silicon carbides have flat crack growth resistance curves, but aluminum oxide does not. Additionally, batch-to-batch differences were noticed for the aluminum oxide. Experiments are continuing to explain the rising crack growth resistance and batch-to-batch variations for the aluminum oxide.

  20. Spontaneous bilateral fracture of patella.

    Science.gov (United States)

    Moretti, Biagio; Speciale, Domenico; Garofalo, Raffaele; Moretti, Lorenzo; Patella, Silvio; Patella, Vittorio

    2008-03-01

    Bilateral patellae fractures represent a rare entity, accounting for approximately 2.9% of all lesions interesting in this anatomical district. In most cases found in the published work, they are described as stress fractures or as complications of chronic diseases such as osteoporosis, renal failure and secondary hyperparathyroidism. Although many pathogenetic mechanisms have been supposed, none have been proved for certain. Insufficiency fractures of the patellae are rare events and no data has been published on their incidence. We present a case of bilateral fracture of the patellae due to an indirect trauma occurring in an 85-year-old patient affected by Parkinson's disease, osteoporosis and diffuse degenerative osteoarthritis. X-ray of the knees (anteroposterior and lateral) and magnetic resonance imaging evaluation confirmed the fractures. The patient was treated conservatively. She had a good result, returning to her previous autonomous ambulation. This case is unusual because there was no direct trauma to the knees because of bilaterality, but confirmed previous observations about insufficiency fractures of patellae in the presence of comorbidity. Insufficiency fractures of patellae can be an insidious condition in elderly people. Prepatellar pain, a common symptom in the relapse phase of degenerative arthritis of the knee, should not be underestimated, particularly in patients with diseases influencing metabolism of bone and with an elevated risk of fall. A periodical clinical and instrumental follow up should be done in these patient. Moreover, we underline the necessity of a multidisciplinary approach.

  1. The observation of curative effect of conventional incision versus minimally invasive techniques in the treatment of lateral tibial plateau fractures%传统切口与微创技术治疗胫骨外侧平台骨折的疗效观察

    Institute of Scientific and Technical Information of China (English)

    钱本俄; 张世华; 李祥; 章志祥; 张金林; 张世旭

    2015-01-01

    目的:分析比较传统切口加普通高尔夫钢板与解剖锁定板联合微创固定技术在治疗胫骨外侧平台骨折的临床疗效. 方法:回顾分析2010年1月至2013年12月收治胫骨外侧平台骨折患者100例 ,其中对照组49 例采用传统切口加普通高尔夫钢板治疗 ,观察组51例采用解剖锁定板联合微创技术治疗.术后随访9~15个月 ,比较分析两组患者的手术时间、骨折愈合时间、术后并发症及术后功能恢复情况.结果:观察组手术时间、骨折愈合时间短于对照组(P 0 .05 ).结论:解剖锁定板联合微创技术治疗胫骨外侧平台骨折具有优势 ,该方法局部组织创伤小 ,软组织破坏少 ,能有效保留骨折周围血液循环 ,手术切口愈合快 ,有利于早起功能锻炼 ,恢复关节功能.%Objective:To compare and analysis the clinical effects of the conventional incision using ordinary golf steel plate and mini-mally invasive techniques combined with dissection locKing plate in the treatment of lateral tibial plateau fractures .Methods :The clinical data of 100 patients with lateral tibial plateau fractures enrolled from January 2010 to December 2013 were retrospectively analyzed .In the control group ,49 cases were treated with conventional incision plus ordinary golf steel plate .The observation group of 51 cases re-ceived anatomical locKing plate combined with minimally invasive treatment .Patients were followed up for 9~15 months after the surger-y .The operation time ,fracture healing time ,postoperative complications and functional recovery of the two groups were compared and analyzed between the two groups .Results :The operation time and fracture healing time of the observation group were shorter than that of the control group( P 0 .05) .Conclusion:Minimally invasive technique combined with dissection locKing plate is an advantageous way to treat lateral tibial plateau fractures ,for it provides effective protection of blood cir

  2. Treatment of midfacial fractures; Therapie von Mittelgesichtsfrakturen

    Energy Technology Data Exchange (ETDEWEB)

    Schubert, J. [Universitaetsklinik und Poliklinik fuer Mund-, Kiefer- und Plastische Gesichtschirurgie, Martin-Luther-Univ. Halle-Wittenberg, Halle (Germany). Universitaetsklinikum Kroellwitz

    2007-07-15

    Fractures of the midface constitute half of all traumas involving facial bones. Computed tomography is very useful in primary diagnosis. Isolated fractures of the nasal bone and lateral midfacial structures may be diagnosed sufficiently by conventional X-rays. An exact description of the fracture lines along the midfacial buttresses is essential for treatment planning. For good aesthetics and function these have to be reconstructed accurately, which can be checked with X-rays. The treatment of midfacial fractures has been revolutionized over the last two decades. A stable three-dimensional reconstruction of the facial shape is now possible and the duration of treatment has shortened remarkably. The frequently occurring isolated fractures in the lateral part of the midface may be treated easily and effectively by semisurgical methods such as the Gillies procedure or hook-repositioning. (orig.)

  3. Genu Recurvatum Deformity in a Child due to Salter Harris Type V Fracture of the Proximal Tibial Physis Treated with High Tibial Dome Osteotomy

    Directory of Open Access Journals (Sweden)

    Theodoros Beslikas

    2012-01-01

    Full Text Available Salter-Harris type V fracture is a very rare injury in the immature skeleton. In most cases, it remains undiagnosed and untreated. We report a case of genu recurvatum deformity in a 15-year-old boy caused by a Salter-Harris type V fracture of the proximal tibial physis. The initial X-ray did not reveal fracture. One year after injury, genu recurvatum deformity was detected associated with significant restriction of knee flexion and limp length discrepancy (2 cm as well as medial and posterior instability of the joint. Further imaging studies revealed anterior bone bridge of the proximal tibial physis. The deformity was treated with a high tibial dome osteotomy combined with a tibial tubercle osteotomy stabilized with malleolar screws and a cast. Two years after surgery, the patient gained functional knee mobility without clinical instability. Firstly, this case highlights the importance of early identification of this rare lesion (Salter-Harris type V fracture and, secondly, provides an alternative method of treatment for genu recurvatum deformity.

  4. Genu Recurvatum Deformity in a Child due to Salter Harris Type V Fracture of the Proximal Tibial Physis Treated with High Tibial Dome Osteotomy.

    Science.gov (United States)

    Beslikas, Theodoros; Christodoulou, Andreas; Chytas, Anastasios; Gigis, Ioannis; Christoforidis, John

    2012-01-01

    Salter-Harris type V fracture is a very rare injury in the immature skeleton. In most cases, it remains undiagnosed and untreated. We report a case of genu recurvatum deformity in a 15-year-old boy caused by a Salter-Harris type V fracture of the proximal tibial physis. The initial X-ray did not reveal fracture. One year after injury, genu recurvatum deformity was detected associated with significant restriction of knee flexion and limp length discrepancy (2 cm) as well as medial and posterior instability of the joint. Further imaging studies revealed anterior bone bridge of the proximal tibial physis. The deformity was treated with a high tibial dome osteotomy combined with a tibial tubercle osteotomy stabilized with malleolar screws and a cast. Two years after surgery, the patient gained functional knee mobility without clinical instability. Firstly, this case highlights the importance of early identification of this rare lesion (Salter-Harris type V fracture) and, secondly, provides an alternative method of treatment for genu recurvatum deformity.

  5. Galeazzi fracture.

    Science.gov (United States)

    Atesok, Kivanc I; Jupiter, Jesse B; Weiss, Arnold-Peter C

    2011-10-01

    Galeazzi fracture is a fracture of the radial diaphysis with disruption at the distal radioulnar joint (DRUJ). Typically, the mechanism of injury is forceful axial loading and torsion of the forearm. Diagnosis is established on radiographic evaluation. Underdiagnosis is common because disruption of the ligamentous restraints of the DRUJ may be overlooked. Nonsurgical management with anatomic reduction and immobilization in a long-arm cast has been successful in children. In adults, nonsurgical treatment typically fails because of deforming forces acting on the distal radius and DRUJ. Open reduction and internal fixation is the preferred surgical option. Anatomic reduction and rigid fixation should be followed by intraoperative assessment of the DRUJ. Further intraoperative interventions are based on the reducibility and postreduction stability of the DRUJ. Misdiagnosis or inadequate management of Galeazzi fracture may result in disabling complications, such as DRUJ instability, malunion, limited forearm range of motion, chronic wrist pain, and osteoarthritis.

  6. 改良前外侧入路胫骨近端锁定加压钢板固定治疗胫骨平台后外侧骨折%CLINICAL EFFECT OF IMPROVED ANTEROLATERAL PROXIMAL TIBIA AFTER LOCKING COM- PRESSION PLATE FIXATION IN THE TREATMENT OF LATERAL TIBIA PLATEAU FRACTURE

    Institute of Scientific and Technical Information of China (English)

    何建华

    2015-01-01

    Objective To analyze the clinical effect of modified anterolateral proximal tibia locking compres‐sion plate fixation in patients with lateral tibia plateau fracture .Methods Totally 80 cases of tibia plateau lateral fracture patients were treated in author's hospital from March 2011 to March 2013 were randomly di‐vided into observation group and control group .The control group received conventional treatment methods anterolateral approach ,while the observation group received an improved anterolateral approach proximal tibia compression plate fixation ,and then the clinical effect were compared between the two groups .Results There were significant difference (P The modified anterolateral proximal tibia locking compression plate fixation is worthy of clinical use for patients of the poster lateral tibia plateau fractures with a significant effect ,simple and safe operation .%目的:分析改良前外侧入路胫骨近端锁定加压钢板固定治疗胫骨平台后外侧骨折的临床效果。方法将收治的80例胫骨平台后外侧骨折患者随机分为观察组和对照组,对照组给予传统前外侧入路的治疗方法,观察组给予改良前外侧入路胫骨近端加压钢板固定治疗,分析和比较二组患者的治疗效果。结果二组患者平均手术时间、手术出血量、并发症发生率等各手术参数、随访结果及膝关节功能评分的比较差异有统计学意义(P<0.05)。结论改良前外侧入路胫骨近端锁定加压钢板固定治疗胫骨平台后外侧骨折疗效显著、操作简便、安全性高,值得临床推广使用。

  7. Fracture Blisters

    Directory of Open Access Journals (Sweden)

    Uebbing, Claire M

    2011-02-01

    Full Text Available Fracture blisters are a relatively uncommon complication of fractures in locations of the body, such as the ankle, wrist elbow and foot, where skin adheres tightly to bone with little subcutaneous fat cushioning. The blister that results resembles that of a second degree burn.These blisters significantly alter treatment, making it difficult to splint or cast and often overlying ideal surgical incision sites. Review of the literature reveals no consensus on management; however, most authors agree on early treatment prior to blister formation or delay until blister resolution before attempting surgical correction or stabilization. [West J Emerg Med. 2011;12(1;131-133.

  8. Finite element analysis of tibial fractures

    DEFF Research Database (Denmark)

    Wong, Christian Nai En; Mikkelsen, Mikkel Peter W; Hansen, Leif Berner

    2010-01-01

    INTRODUCTION: Fractures of the tibial shaft are relatively common injuries. There are indications that tibial shaft fractures share characteristics in terms of site, type and local fracture mechanisms. In this study, we aimed to set up a mathematical, computer-based model using finite element...... analysis of the bones of the lower leg to examine if such a model is adequate for prediction of fracture locations and patterns. In future studies, we aim to use these biomechanical results to examine fracture prevention, among others, and to simulate different types of osteosynthesis and the process...... Project. The data consisted of 21,219 3D elements with a cortical shell and a trabecular core. Three types of load of torsion, a direct lateral load and axial compression were applied. RESULTS: The finite element linear static analysis resulted in relevant fracture localizations and indicated relevant...

  9. C2 Pedicle Screw Combined with C3 Lateral Mass Screw Fixation for Treatment of Instable Hangman's Fracture%C2椎弓根螺钉联合C3侧块螺钉固定治疗不稳定性Hangman骨折

    Institute of Scientific and Technical Information of China (English)

    杨国进; 章筛林; 石志才

    2012-01-01

    Objective To evaluate the surgical management and result of C2 pedicle screw combined with C3 lateral mass screw fixation for treatment of instable Hangman's fracture. Methods From August 2005 to December 2010,16 patients with instable Hangman's fracture were all treated with C2 pedicle screw combined with C3 lateral mass screw fixation,which involved 11 males and 5 females with an average age of 35. 4 years old (range 19- 59). According to Levine-Edwards classification ,11 cases were type Ⅰ ,5 cases were type Ⅱ a,2 cases were type Ⅲ . All the patients complained neck pain and limitation of cervical movement. There were D spinal injury in 3 cases and E in 13 cases according to Frankel scale. Results All patients were followed up for a mean time of 13. 5 months (range 9~36 months). The operative time was 95~170 min (average 114 min) and the blood loss was 290~450 mL(average 353 mL). All fractures healed at 6 months postoperatively. There was no internal fixation fracture or loosing occurred. The cervical movement was excellent. Three cases of grade D spinal injury recovered to grade E. Conclusion C2 pedicle screw combined with C3 lateral mass screw fixation is an effective method for treatment of instable Hangman's fracture.%目的 探讨C2椎弓根螺钉联合C3侧块螺钉内固定治疗不稳定性Hangman骨折的临床效果及应用价值.方法 2005年8月至2010年12月采用后路C2椎弓根螺钉联合C3侧块螺钉内固定治疗16例不稳定性Hangman骨折患者,男11例,女5例;年龄19~59岁,平均35.4岁.骨折按Levine-Edwards分类,Ⅱ型9例,Ⅱa型5例,Ⅲ型2例.脊髓损伤按Frankel分级,D级3例,E级13例.结果 所有患者均获随访,随访时间9~36个月(平均18个月).手术时间95~170 min(平均114 min),术中出血290~450 mL(平均353mL),术后6个月复查时,骨折均愈合,无断钉、断棒及螺钉松动发生,颈部活动功能恢复良好.脊髓功能D级3例均恢复至E级.结论 经后路C2

  10. 外侧锁定板与内侧支持接骨板联合治疗C2及C3型股骨髁间骨折%Internal Fixation of Femoral Intercondylar Fracture with Lateral Locking Plate and Medial Buttress Plate

    Institute of Scientific and Technical Information of China (English)

    周建刚; 孟维春; 曹骏敏; 蒋臻欢

    2011-01-01

    Objective:To investigate the clinical effects of the treatment of type C2 and C3 femoral intercondylar fractures using locking plate and buttress plate. MethodS:From 2007 to 2010,18 cases of femoral intercondylar fractures were treated with lateral locking plates and medial buttress plates. According to Osteosynthe stfragen (AO) fracture classification, the fractures were classified as type C2 in 12 cases and type C3 in 6 cases. Medial and lateral approaches were used in the operation. After reduction,buttress plates were placed medially and locking plates were inserted laterally. There was no additional external fixation device postoperatively. Results: All the cases were followed up for an average of 8. 3 months and they all got bony union in 12-22 weeks. According to the criteria of Lysholm Knee Score, the result was as follows: 8 excellent, 8 good and 2 fair. The excellent and good rate was 89%. Conclusions: Open reduction and internal fixation with locking and buttress plates in the treatment of type C2 and C3 femoral intercondylar fracture has the advantage of a low rate complication, stable fixation and rapid bone union,and presents good clinical outcome.%目的:探讨外侧锁定板结合内侧支持接骨板治疗股骨髁间C2及C3型骨折的可行性.方法:采用外侧锁定板结合内侧支持接骨板治疗股骨髁间骨折患者18例.按AO分型:C2型12例,C3型6例,手术均采用内、外侧联合入路,骨折解剖复位后分别在外侧放置髁支持钢板,内侧放置普通钢板固定,术后不予外固定.结果:所有患者获得随访,平均随访时间为8.3个月,骨折均愈合,愈合时间12~22周.膝关节功能Lysholm评分:优8例,良8例,可2例,优良率为89%.结论:切开复位外侧锁定板结合内侧支持接骨板内固定治疗C2及C3股骨髁间型骨折并发症少、固定牢固、骨折愈合快,能获得良好的临床效果.

  11. Vertebral Geometry Parameters Can Predict Fractures

    Directory of Open Access Journals (Sweden)

    P Tofighi

    2007-08-01

    Full Text Available Background: The aim of this study was to investigate vertebral geometry changes and determine cutoff value of vertebral height to predict fractures. Methods: In a cross-sectional study, 280 postmenopausal women recruited .In all subjects bone mineral density and radiog¬raphy of the lumbar spine performed. Lateral radiographs were evaluated for identification of vertebral fractures, using a validated semiquantitative method. T-score of vertebral height was calculated based on data extracted from Iranian Multi¬center Osteoporosis Study. ROC curve used to determine cut off value of vertebral height T-score to predict fractures. Results: The mean of age and BMI were 55.34±8.7 years and 27.73±5 kg/m2, respectively. Among osteoporotic women, 59.8% had one or more vertebral fractures and 23.8% had at least 2 fractures. In fracture group the T-score of spine and femur BMD was lower than the others. The mean of vertebral height in women without fractures was 12.94±0.6 cm, and in the patient with 4 or more fractures was12.3, thus every fracture accompany with 1.2% decreases in the height of vertebrae. The prevalence of vertebral fracture in osteoporotic patients was 71.4% and in healthy cases 39.5%. Better estimation of vertebral height T score in ROC curve was less than -0.7.The sensitivity and specificity of the cut off value were 81.3% and 52.9%, respectively. Conclusion: Vertebral fractures are common fractures in postmenopausal women. There was a correlation between verte¬bral height and fractures. Vertebral geometric parameters especially height T score can be used for fracture screening.

  12. 经腹直肌外侧切口治疗骨盆、骶骨骨折合并腰骶丛损伤的临床疗效%Lateral-rectus approach for treatment of pelvic and sacral fracture complicated with lumbosacral plexus injury

    Institute of Scientific and Technical Information of China (English)

    谷诚; 杨晓东; 夏广; 麦奇光; 王华; 谭新宇; 黄海; 廖坚文; 樊仕才

    2016-01-01

    目的 探讨经腹直肌外侧切口治疗骨盆、骶骨骨折合并腰骶丛损伤的手术方法及临床疗效.方法 回顾性分析2013年1月至2015年1月,采用经腹直肌外侧切口治疗9例骨盆、骶骨骨折合并腰骶丛损伤患者资料,男4例,女5例;年龄21~61岁,平均38岁;伤后至手术时间:6例为7~20 d,3例为21~59 d.骨盆骨折Tile分型:B2型2例,B3型1例,C1型2例,C2型1例,C3型3例;骶骨骨折Denis分型:Ⅰ型3例,Ⅱ型6例;神经损伤分级:完全损伤1例,部分损伤8例;其中3例合并髋臼骨折,3例合并同侧股骨中段骨折,2例合并胫骨骨折,其他脏器损伤5例.术前通过3D打印制作1:1骨折模型,并在电脑上进行骨折模拟复位;5例患者术前1h在血管造影下行患侧髂内动脉栓塞术.手术经腹直肌外侧切口进入,于腰骶干外侧显露骶髂关节,在骶正中血管与腰骶干、髂内血管间分离显露S1椎体前方,复位骶骨骨折并松解腰骶丛,紧贴骨面放置钢板跨骶髂关节固定,而后再处理合并的耻骨支及髋臼骨折.结果 9例患者均顺利完成手术,手术时间125~224 min,平均183 min;术中出血440~2 760 ml,平均1 150 ml.术后影像学检查示骨折复位固定良好,无一例发生手术相关并发症,骶骨骨折均愈合,愈合时间8~12周,陈旧骨折与新鲜骨折愈合时间无明显差异;术后3个月,6例新鲜骨折中5例腰骶丛损伤症状完全恢复,1例恢复良好;3例陈旧骨折患者,其中2例于术后6个月神经症状大部分恢复,1例无恢复.结论 采用经腹直肌外侧切口入路能较好显露骶髂关节周围,松解骨折压迫的腰骶丛神经根,通过腰骶干下方跨骶髂关节钢板固定能达到较好的固定效果,是治疗骶骨骨折合并腰骶丛损伤的一种可行性手术方法.%Objective To explore the lateral-rectus approach for surgical treatment of pelvic and sacral fracture with lumbosacral plexus injury and its effect.Methods From January 2013

  13. Hand Fractures

    Science.gov (United States)

    ... Z Videos Infographics Symptom Picker Anatomy Bones Joints Muscles Nerves Vessels Tendons About Hand Surgery What is a Hand Surgeon? What is ... serve as a framework. This framework supports the muscles that make the wrist ... When one of these hand bones is broken (fractured), it can prevent you ...

  14. Fracture source

    Directory of Open Access Journals (Sweden)

    2003-07-01

    Full Text Available The fracture properties of many different types of fibers are covered in a timely new book that will prove to be a tremendous source of information and references for researchers in the wide and diverse field of fibers and composites, says Bill Clegg.

  15. Rib Fractures

    Science.gov (United States)

    ... Commentary Recent News Scientists Working on Solar-Powered Prosthetic Limbs Exercise a Great Prescription to Help Older Hearts Bavencio Approved for Rare Skin Cancer Older Mothers May Raise Better-Behaved Kids, Study ... or a collapsed lung (pneumothorax—see Traumatic Pneumothorax ). An injury that fractures the lower ribs sometimes also damages the liver (see Liver ...

  16. [Thoracolumbar fractures].

    Science.gov (United States)

    Freslon, M; Bouaka, D; Coipeau, P; Defossez, G; Leclercq, N; Nebout, J; Marteau, E; Poilbout, N; Prebet, R

    2008-06-01

    Thoracolumbar fractures are frequent and the functional outcomes are sometimes severe. This multicentric study, including five medical centers, was performed to evaluate the long-term outcomes of the patients. One hundred and thirty six patients with thoracolumbar fracture (T11 to L2) was evaluated with a minimal follow-up of two years. Every one had a clinical exam with a score of Oswestry and an X-Ray study (before and after treatment and at revision). Most of them presented compression fractures, the most often at L1 level. On X-rays, a gain was noted on the vertebral kyphosis immediately after surgery, but there is a loss of correction over time whatever the treatment. The clinical outcomes for the patients were great, with an Oswestry average score of 6,4. A correlation was noted between this functional score and vertebral kyphosis. So, an anterior column strengthening (isolated or performed during the surgery) could improve these functional outcomes. Moreover, the Thoraco Lumbar Injury Severity Score (TLISS) seems to be a simple organigram to determine the most appropriate treatment of these fractures, with particular attention to the distraction mechanism or posterior ligamentous complex lesions. However, RMI before surgery is necessary to evaluate these lesions.

  17. Current concepts in pediatric femur fracture treatment.

    Science.gov (United States)

    Kanlic, Enes; Cruz, Miguel

    2007-12-01

    Femoral neck fractures require urgent evacuation of intracapsular hematoma, anatomic reduction, and secure fixation with screws and cast immobilization. Extracapsular trochanteric and subtrochanteric fractures are best treated by fixed angle devices (locked plates or dynamic screw and side plate). "Length stable" low energy shaft fractures with minimal displacement or fractures are treated operatively. Transverse or short oblique shaft fractures in patients fractures. Children > 12 years have less risk of vascular disturbance to the proximal physis, and should have lateral transtrochanateric entry locked rigid nails. Fractures with severe soft tissue injuries could be temporized with external fixation. Distal physis and epiphyseal injuries require anatomical reduction and smooth wires and/or screw fixation (placed in such a way as to minimize further damage to the physis) and need to be augmented with a brace. Leg-length discrepancy is not a significant clinical problem in operatively treated patients. We recommend hardware removal after complete fracture healing, usually in 6 to 12 months. Implants left in the growing child could become buried deep inside of the bone, or cause "periprosthetic" fractures and/or eventually impede adult reconstruction. Minimal risks are reported for hardware removal in healthy patients with healed fractures (4 cortices bridged).

  18. Correlation analysis between compression sites and Lange-Hansen types of malleolar fractures%踝关节骨折局限性压缩部位与Lange-Hansen分型的相关性

    Institute of Scientific and Technical Information of China (English)

    徐强; 肖鹏; 赵仁欢; 巫宗德; 张宇; 刘亮; 魏国华

    2015-01-01

    目的 探讨踝关节骨折出现局限性压缩的部位与Lange-Hansen分型的相关性,并总结该类型损伤的诊疗特点.方法 对本院自2013-01-2014-01诊治的149例踝关节骨折的影像学资料及相关病历资料进行分析,数据通过SPSS19.0统计学软件分析,对压缩部位进行二项式检验,与Lange-Hansen分型交叉分析并进行x2检验.结果 149例踝关节骨折中出现15例(10.1%)胫骨远端局限性压缩,胫骨内侧穹窿压缩3例,胫骨外侧穹窿压缩2例,后踝压缩10例.10例旋后-内收型骨折中出现胫骨内侧穹窿压缩3例,2例旋前-外展型骨折中出现胫骨外侧穹窿压缩1例,50例旋前-外旋型骨折中出现胫骨外侧穹窿压缩1例、后踝压缩4例,87例旋后-外旋型骨折中出现后踝压缩6例.经统计学分析,结果提示在现有数据的基础上,压缩部位与其踝关节骨折Lange-Hansen分型间存在显著的关联性(Sig<0.05).结论 踝关节骨折出现局限性压缩的部位与其Lange-Hansen分型间存在一定的联系,且其治疗有一定特殊性.

  19. Fracturas laterales de cadera. Cien primeros casos tratados con el sistema de estabilización con placa de compresión percutánea. [First 100 cases with the PCCP system in lateral fractures of the hip].

    Directory of Open Access Journals (Sweden)

    Horacio Gomez

    2016-08-01

    Conclusiones:  La utilización de placa PCCP para el tratamiento de las fracturas laterales inestables mostró en nuestra serie excelentes resultados, con una disminución ostensible del tiempo quirúrgico y una menor necesidad de transfusiones sanguíneas. La posibilidad de realizar una adecuada estabilización en fracturas con compromiso de la pared lateral en forma percutánea con un mínimo daño muscular y tisular, hace que este método sea probablemente el nuevo estándar de oro para este tipo de fracturas.

  20. Animal experimental study on the role of the lateral pterygoid muscles in healing process of the sagittal fracture of mandibular condyles%翼外肌在髁突矢状骨折愈合过程中对髁突形态改建影响的动物实验研究

    Institute of Scientific and Technical Information of China (English)

    刘昌奎; 胡开进; 刘平; 邓天阁; 江欣; 程鹏

    2012-01-01

    目的 观察翼外肌在髁突矢状骨折愈合过程中对髁突形态的改建是否有影响以及是否会进一步导致关节强直的发生.方法 将12只健康成年绵羊随机分为2组,均以右侧颞下颌关节作为手术实验侧,人为手术造成髁突矢状骨折.一组保留翼外肌在髁突内极的附丽,行使其功能,另一组切断翼外肌在髁突内极的附丽,阻断其功能,术后即刻行MRI检查,确定翼外肌是否离断.术后1周对动物模型行CT三维检查,测量髁突骨折块的移位距离及髁突内外径的改变,术后4周、12周及24周时处死动物,再次行CT检查,多平面重建后对髁突形态相关参数测量,以观察髁突的形态变化.结果 通过CT三维测量,两组髁突内外径的改变有明显的差异(P<0.05),证实翼外肌对髁突游离骨折端有牵拉作用,保留翼外肌功能组,对髁突矢状骨折后髁突形态的影响更明显.结论 此动物模型的建立,证实翼外肌对髁突矢状骨折后髁突形态改建的确有影响,为进一步研究“翼外肌牵张成骨在创伤性颞下颌关节强直发生中的作用研究”提供研究平台.%Objective To examine whether they may further cause joint ankylosis lateral pterygoid muscles influence the condyle morphology in the healing process of sagittal fracture of mandibular condyles ( SFMC ) . Methods Twelve healthy adult sheep were included in our study, and all the animals were treated with surgery to make the condyles fracture on the right side of the temporomandibu-lar joint. The animals were randomly divided into two groups: the pterygoids of sheep in one group were cut and not able to function. The others in the other group were not cut. They were still on the internal poles of the fractured condyles and their functions remained. We immediately examined whether the pterygoid muscles were cut ( or not) by MRI after the operation. 3D computed tomograms ( CT) were taken 1,4,12 and 24 weeks after the operation

  1. 翼外肌对下颌骨髁突矢状骨折后骨折区新骨形成影响的显微CT研究%The role of the lateral pterygoid muscle in the new bone formation in the sagittal fractured mandibular condyle examined by Micro-CT

    Institute of Scientific and Technical Information of China (English)

    江欣; 胡开进; 邓天阁; 刘昌奎; 薛洋; 刘平; 程鹏

    2013-01-01

    Objective: To investigate the role of the lateral pterygoid muscle in the new bone formation during healing of sagittal fracture of the mandibular condyle. Methods: Oblique sagittal fracture on the right condyle of 24 adult sheep was made by osteotomy. In the control group(n = 12) the lateral pterygoid muscle was cut, and in the experimental(n= 12) was not. 4 sheep were killed at 4, 12 and 24 weeks after operation respectively. Three-dimensional reconstruction was performed by micro-CT, the tra-becula number (Tb. N) , trabecula thickness ( Tb. Th) , trabecula space (Tb. Sp) and bone volume fraction ( BV/TV ) of the fractured condyles were measured, the data were analyzed by SPSS 13. 0. Results: The shape of condyle was changed more in the experimental group than in the control. In the experimental group Tb. N, Tb. Th and BV/TV increased (P 0. 05 ) . Conclusion: The lateral pterygoid muscle can promote the new bone formation in the reconstruction of the mandibular condyle during healing of sagittal fracture.%目的:观察翼外肌在颞下颌骨髁突矢状骨折愈合时新骨形成中的作用.方法:24只绵羊随机分为2组,每组各12只,实验组:髁突截骨术造成绵羊右侧髁突矢状骨折,保留翼外肌;对照组:髁突截骨术造成绵羊右侧髁突矢状骨折,离断翼外肌.分别于术后4、12、24周3个时间点实验组及对照组各处死4只动物,进行显微CT(Micro-CT)扫描,观察分析骨折区新生骨的骨小梁数量(trabecula number,Tb.N),骨小梁厚度(trabecula thickness,Tb.Th),骨体积分数(bone volumefraction,BV/TV)及骨小梁间隙宽度(trabecula space,Tb.SP)的变化,并用方差分析法对数据进行统计学分析.结果:实验组髁突形态改变较对照组明显,显微CT图像新生骨小梁结构显示清晰,Tb.N、Tb.Th、BV/TV增加(P<0.05),Tb.Sp减小(P<0.05),组间比较差异均具有统计学意义(P<0.05),对照组各参数变化无统计学意义(P>0.05).结论:翼外肌在颞下颌关

  2. Magnetic Resonance Imaging in Pediatric Elbow Fractures

    Energy Technology Data Exchange (ETDEWEB)

    Pudas, T.; Hurme, T.; Mattila, K.; Svedstroem, E. [Univ. of Turku, (Finland). Depts. of Radiology and Pediatric Surgery

    2005-10-01

    Purpose: Magnetic resonance imaging (MRI) evaluation of pediatric elbow trauma with or without a visible fracture on radiography. Material and Methods: MRI was performed in the acute phase in 25 children with an elbow injury. Nine patients with an elbow effusion only on radiographs and 16 with a fracture or luxation seen on radiographs underwent subsequent MRI. No sedation was used. Results: MRI revealed eight occult fractures (89%) in seven out of nine patients who had only an effusion on radiographs. Based on MRI findings, septic arthritis was suspected in one patient. Two patients out of five with a supracondylar fracture on the radiograph had a cartilage lesion in the humerus. MRI depicted a 3-mm gap on the articular surface in two patients with a lateral condyle fracture, a more accurate fracture location in two patients than the radiographs, and an additional occult fracture in two patients. MRI showed a fracture not seen on radiographs in two of three patients with prior luxation. Conclusion: MRI is a sensitive and accurate method in the diagnosis of pediatric elbow injuries, especially when only an effusion is present on radiographs. Occult fractures are more common in pediatric patients with elbow injury than reported earlier.

  3. Hip fracture: diagnosis, treatment, and secondary prevention.

    Science.gov (United States)

    LeBlanc, Kim Edward; Muncie, Herbert L; LeBlanc, Leanne L

    2014-06-15

    Hip fractures cause significant morbidity and are associated with increased mortality. Women experience 80% of hip fractures, and the average age of persons who have a hip fracture is 80 years. Most hip fractures are associated with a fall, although other risk factors include decreased bone mineral density, reduced level of activity, and chronic medication use. Patients with hip fractures have pain in the groin and are unable to bear weight on the affected extremity. During the physical examination, displaced fractures present with external rotation and abduction, and the leg will appear shortened. Plain radiography with cross-table lateral view of the hip and anteroposterior view of the pelvis usually confirms the diagnosis. If an occult hip fracture is suspected and plain radiography is normal, magnetic resonance imaging should be ordered. Most fractures are treated surgically unless the patient has significant comorbidities or reduced life expectancy. The consulting orthopedic surgeon will choose the surgical procedure. Patients should receive prophylactic antibiotics, particularly against Staphylococcus aureus, before surgery. In addition, patients should receive thromboembolic prophylaxis, preferably with low-molecular-weight heparin. Rehabilitation is critical to long-term recovery. Unless contraindicated, bisphosphonate therapy should be used to reduce the risk of another hip fracture. Some patients may benefit from a fall-prevention assessment.

  4. Prophylactic Nailing of Incomplete Atypical Femoral Fractures

    Directory of Open Access Journals (Sweden)

    Chang-Wug Oh

    2013-01-01

    Full Text Available Introduction. Recent reports have described the occurrence of low-energy subtrochanteric and femoral shaft fractures associated with long-term bisphosphonate use. Although information regarding the surgical treatment of these atypical femoral fractures is increasing, it is unclear if the preventive operation is useful in incomplete fractures. This study examined the results of preventive intramedullary nailing for incomplete atypical femoral fractures. Material and Methods. A retrospective search was conducted for patients older than 50 years receiving bisphosphonate therapy, with incomplete, nondisplaced fractures in either the subtrochanteric or diaphyseal area of the femur. Seventeen patients with a total of 20 incomplete, non-displaced lesions were included. The mean duration of bisphosphonate use was 50.5 months. Eleven of the 17 (64.7% patients had complete or incomplete fractures on the contralateral femur. All were treated with prophylactic fixation of an intramedullary (IM nail. The minimum followup was 12 months. Results. All cases healed with a mean period of 14.3 weeks. Nineteen of the 20 cases healed with the dissolution of incomplete fractures of the lateral aspect. A complete fracture developed at the time of nailing in one patient, but it healed with callus bridging. Conclusion. IM nailing appears to be a reliable way of preventing the progress of incomplete atypical femoral fractures.

  5. Analysis of Clinical Effect of Lateral Position and Supine Position Under the Proximal Femoral Intramedullary Nail in Treatment of Femoral Intertrochanteric Fracture%侧卧位与平卧位下股骨近端防旋髓内钉治疗股骨转子间骨折的临床效果分析

    Institute of Scientific and Technical Information of China (English)

    孙秀钦

    2015-01-01

    目的:探讨侧卧位与平卧位下股骨近端防旋髓内钉(PFNA)治疗肥胖患者股骨转子间骨折的疗效。方法回顾性分析59例应用PFNA内固定治疗股骨转子间骨折患者的临床资料,随机分为侧卧位组和平卧位组,比较两组患者的手术时间、术中出血量、转子顶端切口长度、骨折愈合时间及髋关节Harris评分等。结果侧卧位组患者手术时间、转子顶端切口长度短于平卧位组,差异有统计学意义(P<0.05),侧卧位组患者术中出血量少于平卧位组,差异有统计学意义(P<0.05),两组患者骨折愈合时间、髋关节Harris评分等比较差异均无统计学意义(P>0.05)。结论侧卧位行PFNA治疗肥胖患者股骨转子间骨折,降低了手术难度,缩短了手术时间和手术切口长度,减少了术中出血量,较平卧位行PFNA治疗肥胖患者股骨转子间骨折有明显优势。%Objective The paper explores the curative effects of proximal femur nail anti-rotation (PFNA) on obese patients’ intertrochanteric fracture in lateral position and horizontal position.MethodsThe paper makes a retrospective analysis on the clinical data of 59 cases applying PFNA internal ifxation for the treatment of intertrochanteric facture, and divides the cases into the lateral position group and the horizontal position group randomly to compare the two groups in terms of duration of operation,blood loss during operation, incision length on trochanter top, facture healing time and Harris hip score.Results Lateral position group’s duration of operation and incision length on trochanter top are signiifcantly shorter than those of horizontal position group, of which the difference shows the statistical significance (P0.05). Conclusion The horizontal-position PFNA for obese patients’ intertrochanteric fracture decreases operation dififculty, shortens operation time and length of surgical incision and reduces blood loss

  6. Weber B Distal Fibular Fracture Diagnosed by Point of Care Ultrasound in the Emergency Department

    OpenAIRE

    Makinen, James

    2016-01-01

    We report the case of a 45 year-old woman who presented to the Emergency Department (ED) after an acute ankle inversion injury. After history and physical exam suggested a potential fracture, point of care (POC) ultrasound demonstrated a cortical defect of the distal fibula, consistent with fracture. Plain radiography failed to demonstrate a fracture. Later, the fracture was identified as a Weber B distal fibular fracture by stress-view radiography. This case reviews the evaluation of acute a...

  7. Role of the Lateral Pterygoid Muscle in the Sagittal Fracture of Mandibular Condyle (SFMC) Healing Process%翼外肌在髁突矢状骨折愈合过程中对髁突形态改建的影响

    Institute of Scientific and Technical Information of China (English)

    刘平; 刘昌奎; 邓天阁; 江欣; 程鹏; 胡开进

    2012-01-01

    Objective: To examine the effect of the lateral peterygoid muscle in the reconstruct the condylar shape during the sagittal fracture of mandibular condyle (SFMC) healing process. Methods: Twenty梖our adult sheep were divided into 2 groups . All sheep had a unilateral operation on the right side of cuting anterior and posterior attachments of the the discs, and an oblique vertical osteotomy was made from the lateral pole of the condyle to the medial side of the condylar neck. One group (groupl) of twelve sheep's lateral pterygoid muscle were cut. The other group (group2) weren't cut the lateral pterygoid muscle. Each group sheep was sacrificed at 4 weeks (2 sheep) , 12 weeks (4 sheep), and 24 weeks (4 sheep) after surgery. Computed tomograms (CT) were taken after sacrificed, and the three imensional compute tomographic reconstruction was used to observe condylar shape. Results: In the group without cut the lateral peterygoid muscle, the joints showed greater overgrows of new bone and more advanced ankylosis. Conclusion: This study shows that the lateral pterygoid muscle plays an important part in reconstructing the condylar shape during the sagittal fracture of mandibular condyle (SFMC) healing process.%目的:本实验的目的是检查翼外肌在髁突矢状骨折愈合过程中,对髁突形态改建的影响.方法:20只1岁龄成年绵羊,随机分为两组,每组10只动物,所有绵羊都用超声骨刀造成髁突矢状骨折,剪断关节盘前后附着并将其推向内侧,其中组1动物切断翼外肌,组2动物保留翼外肌功能.每组动物分别在术后4周(各2只)、12周(各4只)、24周(各4只)处死.处死后行CT检查,CT三维重建观察髁突形态,并解剖颞颌关节(TMJ)以观察髁突形态.结果:组2即保留翼外肌功能组,较组1髁突有更多新骨形成,髁突形态改变更严重.结论:翼外肌在髁突矢状骨折愈合过程中对髁突形态改建的影响起非常重要的作用.

  8. Thoracic kyphosis and rate of incident vertebral fractures: the Fracture Intervention Trial

    Science.gov (United States)

    Vittinghoff, E.; Kado, D. M.; Lane, N. E.; Ensrud, K. E.; Shipp, K.

    2016-01-01

    Summary Biomechanical analyses support the theory that thoracic spine hyperkyphosis may increase risk of new vertebral fractures. While greater kyphosis was associated with an increased rate of incident vertebral fractures, our analysis does not show an independent association of kyphosis on incident fracture, after adjustment for prevalent vertebral fracture. Excessive kyphosis may still be a clinical marker for prevalent vertebral fracture. Introduction Biomechanical analyses suggest hyperkyphosis may increase risk of incident vertebral fracture by increasing the load on vertebral bodies during daily activities. We propose to assess the association of kyphosis with incident radiographic vertebral fracture. Methods We used data from the Fracture Intervention Trial among 3038 women 55–81 years of age with low bone mineral density (BMD). Baseline kyphosis angle was measured using a Debrunner kyphometer. Vertebral fractures were assessed at baseline and follow-up from lateral radiographs of the thoracic and lumbar spine. We used Poisson models to estimate the independent association of kyphosis with incident fracture, controlling for age and femoral neck BMD. Results Mean baseline kyphosis was 48° (SD = 12) (range 7–83). At baseline, 962 (32 %) participants had a prevalent fracture. There were 221 incident fractures over a median of 4 years. At baseline, prevalent fracture was associated with 3.7° greater average kyphosis (95 % CI 2.8–4.6, p < 0.0005), adjusting for age and femoral neck BMD. Before adjusting for prevalent fracture, each 10° greater kyphosis was associated with 22 % increase (95 % CI 8–38 %, p = 0.001) in annualized rate of new radiographic vertebral fracture, adjusting for age and femoral neck BMD. After additional adjustment for prevalent fracture, estimated increased annualized rate was attenuated and no longer significant, 8 % per 10° kyphosis (95 % CI −4 to 22 %, p = 0.18). Conclusions While greater kyphosis increased the rate of

  9. CT for diagnosing fractures of the undersurface of the talus and mechanism of injury

    Energy Technology Data Exchange (ETDEWEB)

    Okamoto, Hideaki; Shibata, Yoshimori; Nishi, Genzaburo; Tago, Kyoji; Tsuchiya, Daiji; Chiba, Takehiro; Okumura, Hisashi [Aichiken Koseiren Kainan Hospital, Yatomi (Japan); Ikeda, Takeshi; Wada, Ikuo

    2000-02-01

    Talus fractures whose fracture lines extend to the subtalar joint, except fractures of the neck and the body of the talus, are defined as fractures of the lower portion of the talus. It is difficult to make a correctly diagnosis of inferior fractures of the talus by plain radiography or tomography alone. The author encountered 12 cases of inferior fractures of the talus between 1989 and 1997, and CT imaging in 2 directions, in the horizontal and frontal plane, was useful in making the diagnosis. The correct diagnosis rate was 100%, and differentiation of the site and extent of the fractures was possible. Based on the CT findings, the fractures were classified into 8 types (fractures of the lateral process of the talus, fractures of the medial tubercle, fractures of the posterior process, and combinations of the above, and comminuted fractures). The mechanism of the injuries was also investigated, and the fractures of the lateral process of the talus seemed to have been caused by excessive eversion force on the ankle joint, with the lateral process becoming trapped between the fibula and the calcaneus. Medial tubercle fractures also seemed to be caused by forcible inversion of the ankle, with the tip of the medial malleous impacting and the medial tubercle being trapped between it and the sustentaculum tali. The comminuted fractures seem to have been caused by axial compression added to various of external forces. (K.H.)

  10. Modification of expanded lateral L-shaped approach for treatment of intraarticular fractures of calcaneus%改良扩大跟外侧L形入路治疗跟骨关节内骨折

    Institute of Scientific and Technical Information of China (English)

    李嗣生; 孙军; 潘承波; 刘法银; 张子峰; 李玲; 王维军

    2009-01-01

    目的 对跟骨经典扩大跟外侧L形入路进行改良,并探讨其临床应用效果. 方法 自2004年7月至2009年1月应用改良扩大跟外侧L形入路对81例89足(8例双侧)跟骨关节内骨折施行切开复位内固定术,观察临床效果.并与同期采用经典跟外侧扩大L形入路的32例患者的疗效进行比较. 结果 所有患者随访6~48个月,平均30.6个月,骨折全部愈合.按Maryland足部评分系统评价术后功能,其中改良组平均(84.37±12.22)分,优良率为83.2%;经典跟外侧扩大L形入路组平均(81.72±13.91)分,优良率为81.3%.两组术后Maryland足部评分值及优良率比较差异均无统计学意义(t=1.014,P>0.05;X~2=0.009,P>0.05).两组术后皮瓣坏死发生率及腓肠皮神经损伤发生率比较,差异有统计学意义(P 0.05; X~2=0.009, P>0.05). Only flap necrosis and lesion to sural cutaneous nerve occurred in the 2 groups and there were significant differences between the two (P < 0.05). Conclusion The modified expanded lateral L-shaped approach can protect maximally the lateral pedal artery and its con-comitant sural cutaneous nerve, thus effectively preventing such complications as flap necrosis, incision dis-union and skin functional impairment at the operation area.

  11. Clinical comparative study of antiglide reconstruction plates by posterior-lateral approach and an-atomical plates by lateral approach in treatment of Danis-Weber type B trimalleolar fractures%后外侧抗滑重建钢板与外侧解剖钢板在治疗Danis-Weber B 型三踝骨折的对比研究

    Institute of Scientific and Technical Information of China (English)

    王冰一; 潘芋钢; 吴学建; 郑飞; 孟祥雷

    2016-01-01

    Objective To investigate the clinical effects of antiglide plates and anatomical plates on Danis-Weber type B trimalleolar fractures. Methods All the 46 Danis-Weber type B trimalleolar fractures meeting the inclusion criteria were treated from June 2011 to August 2013. The 21 patients were treated by antiglide plate via posterolateral approach,the other 25 patients were treated by anatomical plate by posterior approach. The patients undertook a follow-up of 12-36 months,14. 6 months on aver-age. Complications such as infection,nonunion,peroneal tendonitis were observed. Ankle functions were assessed according to the Olerud and Monlander scoring system one year after surgery. All the data inclu-ding injury to operation time,operating room time,hospital stay and ankle joint functional scores,were analyzed with complete randomized design t-test. Results There was no difference in injury to operation time,operating room time,hospital stay or ankle joint functional scores between the two methods. Conclusions For Danis-Weber type B trimalleolar fractures,clinical results between antiglide plates and anatomical plates do not show statistical differences.%目的:对比研究后外侧抗滑重建钢板与外侧解剖钢板治疗 Danis-Weber B 型三踝骨折的临床疗效。方法回顾性分析2011年6月至2013年8月符合纳入标准的46例 Danis-Weber B 型三踝骨折患者的临床资料,21例患者采用后外侧抗滑重建钢板治疗,25例患者采用外侧解剖钢板治疗,术后随访12~36个月,平均14.6个月。观察术后切口感染、骨折不愈合、腓骨肌腱炎等并发症,术后1年应用 Olerud and Monlander 系统对患者进行踝关节功能评分,采用成组设计的 t 检验,对两组受伤至手术时间、手术时间、住院时间以及踝关节功能评分进行评价。结果两组受伤至手术时间、手术时间、住院时间以及踝关节功能评分比较差异均未见统计学意义( P 均>0.05

  12. Residual impairment after lower extremity fracture

    DEFF Research Database (Denmark)

    Faergemann, C; Frandsen, P A; Röck, N D

    1998-01-01

    to the hospital for an interview and a clinical assessment 6 months later. The disability was measured by administering the Sickness Impact Profile (SIP) to all patients by an interview process. SIP scores were calculated for pretraumatic and posttraumatic states. The pretraumatic SIP scores described...... the functional status before the injury. Additionally, three major aspects of impairments were measured 6 months after the fractures: range of motion, muscle strength, and pain. Most patients had a significantly higher SIP score 6 months after the fracture(s) than pretraumatically. The mean overall SIP score...

  13. Open Calcaneus Fractures and Associated Injuries.

    Science.gov (United States)

    Worsham, Jacob R; Elliott, Mark R; Harris, Anthony M

    2016-01-01

    Open calcaneus fractures are usually the result of high-energy mechanisms and are associated with other orthopedic and whole body system injures. Understanding the difference between open versus closed fractures is essential for the provider, and they must be vigilant for the associated injuries that present with this condition. We performed a retrospective medical record review of 62 patients (64 calcaneus fractures) with open calcaneus fractures from January 2003 to January 2013 presenting at a level 1 trauma center. Sex, age, laterality, mechanism of injury, wound appearance, initial management, and associated injures were recorded. The most common mechanisms were motor vehicle accidents (35 [56.4%]) and falls from >6 ft (15 [24.1%]). Four (6.4%) patients had a posterior tibial artery transection. Eight (12.9%) patients had a femoral shaft fracture, 14 (22.5%) an ipsilateral ankle fracture, 16 (25.8%) a metatarsal fracture, and 11 (17.7%) had associated midfoot fractures. Of the midfoot fractures, 12 (19.3%) patients had a talus fracture and 5 (8.0%) a cuboid fracture. Spinal fractures were present in 9 (14.5%) of the patients, with lumbar fractures occurring in 6 (9.6%) patients. Fifteen (24.1%) patients had associated upper extremity fractures. Thirteen (20.9%) patients had an associated pulmonary injury, including 8 pneumothoraces. Ten (16.1%) patients had a closed head injury and 6 (9.6%) had an abdominal injury. Fifteen (23.4%) patients were treated with percutaneous wire fixation and 7 (10.9%) with open reduction internal fixation. A total of 44 (68.7%) fractures were treated without internal fixation. Overall, 5 (8.0%) patients with an open calcaneus fracture eventually underwent a below-the-knee amputation. Open calcaneus fractures are severe, high-energy injuries with the potential for considerable morbidity to the patient, given the high rate of concomitant orthopedic and whole body system injuries. Type III open injuries have an increased risk of

  14. Acidization of shales with calcite cemented fractures

    Science.gov (United States)

    Kwiatkowski, Kamil; Szymczak, Piotr; Jarosiński, Marek

    2017-04-01

    wormholes is the strongest when coating thickness is a few times larger than the initial aperture of the fracture. This leads to formation of favorable complex networks of wormholes which provide adequate transport of reactive fluids to fracture surfaces and - at the same time - are capable of supporting fracture surfaces. As a conclusion, acidization of the reactivated fractures with hydrochloric acid seems to be an attractive treatment to apply at fracking stage or later on as EGR. The results contribute to the discussion on the use of acidization to enhance the gas production in the shale reservoirs. This communication stresses the importance of the dissolution of calcite cement in natural fractures in shale formations, which are initially sealed and become reactivated during fracking. While this research is based on the analysis of fractures in the Pomeranian shale basin its results are general enough to be applicable to different formations worldwide.

  15. Fibula fracture stabilization with a guide wire as supplementary fixation in tibia fractures.

    Science.gov (United States)

    Dombroski, Derek; Scolaro, John A; Pulos, Nicholas; Beingessner, Daphne M; Dunbar, Robert; Mehta, Samir

    2012-05-01

    The tibia is the most commonly fractured long bone. Although the goals of fracture management are straightforward, methods for achieving anatomical alignment and stable fixation are limited. Type of management depends on fracture pattern, local soft-tissue involvement, and systemic patient factors. Tibial shaft fractures with concomitant fibula fractures, particularly those at the same level, may be difficult to manage because of their inherent instability. Typically, management of lower extremity fractures is focused on the tibia fixation, and the associated fibula fracture is managed without fixation. In this article, we describe a novel technique for intramedullary fixation of the fibula, using a humeral guide wire as an adjunct to tibia fixation in the setting of tibial shaft fracture. This technique aids in determining length, alignment, and rotation of the tibia fracture and may help support the lower extremity as whole by stabilizing the lateral column. In addition, this technique can be used to help maintain reduction of the fibula when there is concern about the soft tissues of the lower extremity secondary to swelling or injury. Our clinical case series demonstrates the safety, effectiveness, and cost-sensitivity of this technique in managing select concurrent fractures of the tibia and fibula.

  16. Growth Plate Fractures

    Science.gov (United States)

    ... the most widely used by doctors is the Salter-Harris system, described below. Type I Fractures These ... incidence of growth plate fractures peaks in adolescence. Salter-Harris classification of growth plate fractures. AAOS does ...

  17. Less invasive corrective surgery using oblique lateral interbody fusion (OLIF) including L5-S1 fusion for severe lumbar kyphoscoliosis due to L4 compression fracture in a patient with Parkinson's disease: a case report.

    Science.gov (United States)

    Wakita, Hiromasa; Shiga, Yasuhiro; Ohtori, Seiji; Kubota, Go; Inage, Kazuhide; Sainoh, Takeshi; Sato, Jun; Fujimoto, Kazuki; Yamauchi, Kazuyo; Nakamura, Junichi; Takahashi, Kazuhisa; Toyone, Tomoaki; Aoki, Yasuchika; Inoue, Gen; Miyagi, Masayuki; Orita, Sumihisa

    2015-04-07

    Corrective surgery for kyphoscoliosis patients tend to be highly invasive due to osteotomy. The present case introduce less invasive corrective surgery using anterior oblique lateral interbody fusion (OLIF) technique. An 80-year-old Japanese man with a history of Parkinson's disease presented to our hospital because of severe kyphoscoliosis and gait disturbance. Considering the postsurgical complications due to osteotomy, we performed an anterior-posterior combined corrective fusion surgery: OLIF of Lumbar (L) 2-3, L3-4, and L4-5 (Medtronic Sofamor Danek, Memphis, TN, USA) followed by L5-Sacral (S) 1 anterior lumbar fusion via the OLIF approach using an anterior intervertebral cage, and posterior L3-4 and L4-5 facetectomy and posterior fusion using percutaneous pedicle screws from Thoracic (T) 10 to S1 with a T-9 hook system. The surgery was performed in a less invasive manner with no osteotomy, and it improved the sagittal alignments with moderate restoration, which improved the patient's posture and gait disturbance. The patient showed transient muscle weakness of proximal lower extremity contralateral side to the surgical site, which fully recovered by physical rehabilitation 3 months after the surgery. The surgical corrective procedure using the minimally invasive OLIF method including L5-S1 fusion showed a great advantage in treating degenerative kyphoscoliosis in a Parkinson's disease patient in its less-invasive approac.

  18. 内镜下侧方入路单椎体内固定治疗胸腰椎压缩性骨折的解剖学研究%Anatomical study of only injured vertebrae internal fixation through lateral approach by endoscope to treat thoracolumbar vertebral compression fracture

    Institute of Scientific and Technical Information of China (English)

    李际才; 刘平均; 刘君华; 贺用礼; 毛炳焱; 王文聪; 晏平华; 丁原; 胡志喜

    2012-01-01

      目的探讨内镜下侧方入路单椎体内固定术治疗胸腰椎压缩性骨折在应用解剖上的可行性。方法随机选取12具脊柱胸腰段保存完整的成人尸体标本,垂直于矢状面将克氏针钻入T11-L4椎体侧方中央,观察脊神经的走行方向、冠状面上各克氏针与其后方经过的上位脊神经的距离、胸腰段椎体节段血管在椎体侧方的走行位置、椎体高度、椎体后缘与腔静脉、主动脉的距离,测量椎体侧方手术安全区。结果冠状面上T10-L3脊神经均走行于下位椎体侧方中线(克氏针)的后方,胸腰段椎体节段性血管紧贴椎体侧方自内上斜向外下走向,本手术路径无法避开,胸腰椎侧方存在手术安全区,左侧手术区较右侧更安全。结论内镜下侧方入路单椎体内固定治疗胸腰椎压缩性骨折在解剖学上是可行性的。%  Objective To investigate the feasibility of treatment thoracolumbar vertebral compression fracture by endoscopic lateral approach which only injured vertebrae internal fixated. Methods Select 12 thoracolumbar vertebrae with adult corpses specimens randomly, perpendicular to the vertical plane a gram needle drilling into the T11-L4 vertebral body side in central, observe the nerve way of T10-L3, coronary face every gram its rear after superior needle of the distance and chest pairs of vertebral segment lumbar blood vessels in the vertebral body side walk line position, thoracolumbar vertebral height, after vertebral bodies flanges and vena cava, aortic distance, calculation vertebral lateral surgical area safety. Results Coronary face T10-L3 nerve walking on lateral vertebral bodies under a line(gram needle) rear, segment artery of thoracolumbar vertebrae cling to the body, this surgery path can't avoid it, vertebral lateral side being security operation window, the left is right safety. Conclusion Minimal invasion through lateral approach by endoscopic treatment

  19. The risk of second hip fracture is decreased with compliant and persistent use of bisphosphonates

    DEFF Research Database (Denmark)

    Hansen, Louise; Vestergaard, Peter; Petersen, Karin Dam

    on the medical assumption that 50% of additional hip fractures may be prevented with compliant and persistent use of alendronate in five years following the initial fracture. RESULTS: In the no treatment arm, the average cost was EUR 16,233 and 0.32 hip fractures per woman, and in the alendronate treatment arm...... the average cost was EUR 13,395 and 0.17 hip fractures per woman. The incremental cost-effectiveness ratio (ICER) resulted in a cost saving of EUR 18,623 per prevented hip fracture. In the alendronate treatment arm, the average cost and effect was EUR 5,631 and 0.16 hip fractures per man. The no treatment arm...... the first month after fracture and does not normalise until 15 years later. Fracture prevention programs have focused on identifying patients at risk of secondary low energy trauma fractures. The secondary prevention programs for fractures begin immediately after the first fracture, through identification...

  20. Pediatric elbow fractures: a new angle on an old topic

    Energy Technology Data Exchange (ETDEWEB)

    Emery, Kathleen H.; Anton, Christopher G. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States); Zingula, Shannon N. [Mayo Clinic, Department of Radiology, Rochester, MN (United States); Salisbury, Shelia R. [Cincinnati Children' s Hospital Medical Center, Biostatistics and Epidemiology, Cincinnati, OH (United States); Tamai, Junichi [Cincinnati Children' s Hospital Medical Center, Department of Pediatric Orthopedics, Cincinnati, OH (United States)

    2016-01-15

    The three most common elbow fractures classically reported in pediatric orthopedic literature are supracondylar (50-70%), lateral condylar (17-34%), and medial epicondylar fractures (10%), with fractures of the proximal radius (including but not limited to fractures of the radial neck) being relatively uncommon (5-10%). Our experience at a large children's hospital suggests a different distribution. Our goals were (1) to ascertain the frequency of different elbow fracture types in a large pediatric population, and (2) to determine which fracture types were occult on initial radiographs but detected on follow-up. Review of medical records identified 462 children, median age 6 years and interquartile range for age of 4-8 years (range 0.8-18 years), who were diagnosed with elbow fractures at our institution over a 10-month period. Initial and follow-up radiographs were reviewed in blinded fashion independently by two experienced pediatric musculoskeletal radiologists to identify fracture types on initial and follow-up radiographs. The most common fractures included supracondylar (n = 258, 56%), radial neck (n = 80, 17%), and lateral condylar (n = 69, 15%). Additional fractures were seen on follow-up exams in 32 children. Of these, 25 had a different fracture type than was identified on initial radiographs. The most common follow-up fractures were olecranon (n = 23, 72%), coronoid process (n = 4, 13%) and supracondylar (n = 3, 9%). Olecranon fractures were significantly more common on follow-up radiographs than they were on initial radiographs (n = 33, 7%; P <.0001). Twenty-six children had more than one fracture type on the initial radiograph. The most common fracture combinations were radial neck with olecranon (n = 9) and supracondylar with lateral condylar (n = 9). Supracondylar fractures are the most frequent elbow fracture seen initially, followed by radial neck, lateral condylar, and olecranon fractures in a distribution different from what has been

  1. Discussion on clinical efficacy and discussion of prone position after ankle lateral,posterolateral approach combined with medial joint approach for the treatment of trimalleolar fracture%探讨内踝、外踝与后踝俯卧位联合入路治疗三踝骨折的临床研究

    Institute of Scientific and Technical Information of China (English)

    周瑜斌

    2016-01-01

    Objective To investigate the clinical efficacy of prone position after ankle lateral,posterolateral approach combined with medial joint approach for the treatment of trimalleolar fracture.Methods 52 cases of patients who were treated for trimalleolar fracture in hour hospital from June 2013 to June 2014 in our hospital were selected as the research object,.They were randomly divided into observation group and the control group.The observation group was used the prone position after ankle lateral,posterolateral approach combined with medial joint approach for treatment, the control group was used conventional fracture for treatment.The clinical curative effect was observed.Results For the obervation group,the mean operative time was (93.5±4.6) minutes,the average amount of bleeding was (85.5±10.3) ml, the average hospitalization time of postoperative was (11.2±1.1) days,the average healing time was (5.2±0.5) months.As for the control group,the average operation time was (103.5±8.7) minutes,the average amount of bleeding was (105.5 ± 8.6) ml,the averaged postoperative hospitalization time was (13.4 ±1.5) days,the average healing time was (5.9 ±0.8) months.In the observation group,the average operation time,average bleeding volume,postoperative hospitalization time, the average healing time were significantly lower than those in the control group,and there were significant differences (P﹤0.05).There were no fracture displacement,no implant loosening,no wound infection;while the patients of the control group patients were stage Ⅰ healing,2 cases of fracture displacement,2 cases in the locker,3 cases of wound infection and bone.According to Baird Jackson scoring system was used to evaluate the effect,the result showed that, observation group was excellent in 10 cases,good in 10 cases,6 cases,the excellent and good rate was 76.9%;the control group were excellent in 4 cases,good in 5 cases,17 cases,the overall excellent and good rate was 34.6%,the excellent

  2. 经腹直肌外侧切口入路重建钢板辅助后柱顺行拉力螺钉治疗复杂髋臼骨折%Surgical treatment of complex acetabular fractures through the lateral-rectus approach with the pelvic reconstructive plate and antegrade posterior-column lag screw

    Institute of Scientific and Technical Information of China (English)

    张潇; 杨晓东; 夏广; 李涛; 王华; 熊然; 樊仕才

    2015-01-01

    Objective To evaluate the clinical value of the lateral-rectus approach with the pelvic recon-structive plate and antegrade posterior -column lag screw in the treatment of complex acetabular fractures .Meth-ods Between May 2012 and Jan.2014,9 patients with complex acetabular fractures were treated with pelvic recon-structive plate and antegrade posterior-column lag screw through the lateral-rectus approach . There were 6 males and 3 females,aged 27-74 years(mean,39 years).Fractures were caused by traffic accident in 5 cases,by falling in 2 cases,and by heavy crash in 2 cases.According to Letournel classification ,there were 2 cases of transverse frac-ture,4 cases of anterior column with posterior hemi-transverse lesion fracture,and 3 cases of both-column fracture with 1 case of central dislocation of hip joint .The operation time and blood loss were statistically analyzed .The pa-tients were evaluated clinically according to Merle d'Aubigne-Postel scoring system and X ray performance based on the criteria described by Matta .Results The average time of operation was 200 minutes ( 150-255 minutes );the average blood loss was 730ml(300-1250ml);the average follow up was 15.9 months(9-30 months);the clinical results were excellent in 5 patients,good in 2 and fair in 2.The radiological results were anatomical reduction in 5 patients,satisfactory in 3 and fair in 1.All the patients were healed within 3 months and there were no complications such as infection ,avascular necrosis of the femoral head ( ANFH) ,or heterotopic ossification .Conclusion The lat-eral-rectus approach is suitable for some complex acetabular fractures ,with advantages of the adequate exposure of quadrilateral surface and insertion of the posterior column antegrade lag screw .%目的:评价经腹直肌外侧切口入路以前柱重建钢板配合后柱顺行拉力螺钉内固定治疗复杂髋臼骨折的临床疗效。方法回顾性分析自2012年5月~2014年1月本科

  3. Autoimmune Myasthenia Gravis after Sternal Fracture

    Directory of Open Access Journals (Sweden)

    Jens A. Petersen

    2012-01-01

    Full Text Available We report a 54-year-old woman who suffered a commotio cerebri, whiplash injury and a chest trauma with sternal fracture due to a high-velocity car accident. Two months later, she developed unilateral ptosis and blurred vision, which worsened during the day. Multiple diagnoses were suggested, ranging from thoracic outlet syndrome towards depression. Symptoms persisted and five years later, the patient consulted a neurologist. Laboratory analysis revealed significantly elevated levels of antibodies to acetylcholine receptors, and the diagnosis of myasthenia gravis was made. Speculatively, the damage of retrosternal thymic remnants due to a sternal fracture might have precipitated the condition or exacerbated subclinical disease.

  4. Fractures of the distal radius (Colles' fracture)

    National Research Council Canada - National Science Library

    João Carlos Belloti; João Baptista Gomes dos Santos; Álvaro Nagib Atallah; Walter Manna Albertoni; Flavio Faloppa

    2007-01-01

    CONTEXT AND OBJECTIVE: Although Colles' fracture is a common clinical situation for the orthopedist, we did not find any information in the literature that would allow safe decision-making on the best treatment for each fracture type...

  5. Recognizing and reporting vertebral fractures: reducing the risk of future osteoporotic fractures

    Energy Technology Data Exchange (ETDEWEB)

    Lentle, B.C. [Univ. of British Columbia, Dept. of Radiology, Vancouver, British Columbia (Canada); Brown, J.P. [Laval Univ., Dept. of Medicine, Sainte-Foy, Quebec (Canada); Khan, A. [McMaster Univ., Dept. of Medicine, Hamilton, Ontario (Canada)]. E-mail: blentle@shaw.ca (and others)

    2007-02-15

    fractures should be assessed from lateral spinal or chest radiographs according to the semiquantitative method of Genant and colleagues. Grade II and Grade III fractures as classified by this method should be given the greatest emphasis. Semiquantitative fracture recognition should include the recognition of changes such as loss of vertebral end-plate parallelism, cortical interruptions, and quantitative changes in the anterior, midbody, and posterior heights of vertebral bodies. (author)

  6. Preferential Flow in Fractured Welded Tuffs

    Energy Technology Data Exchange (ETDEWEB)

    Salve, Rohit

    2004-08-15

    To better understand preferential flow in fractured rock, we carried out an in situ field experiment in the Exploratory Studies Facility at Yucca Mountain, Nevada. This experiment involved the release of {approx} 22 m3 of ponded water (at a pressure head of {approx} 0.04 m) over a period of 7 months, directly onto a 12 m2 infiltration plot located on a fractured welded tuff surface. As water was released, changes in moisture content were monitored along horizontal boreholes located in the formation {approx} 19-22 m below. Distinct flow zones, varying in flow velocity, wetted cross-sectional area, and extent of lateral movement, intercepted the monitoring boreholes. There was also evidence of water being diverted above the ceiling of a cavity in the immediate vicinity of the monitoring boreholes. Observations from this field experiment suggest that isolated conduits, each encompassing a large number of fractures, develop within the fractured rock formation to form preferential flow paths that persist if there is a continuous supply of water. In addition, in fractured welded tuffs the propensity for fracture-matrix interactions is significantly greater than that suggested by existing conceptual models,in which flow occurs along a section of fracture surfaces. An overriding conclusion is that field investigations at spatial scales of tens of meters provide data critical to the fundamental understanding of flow in fractured rock.

  7. Halfmoon-sign in distal fractures of the humerus

    Energy Technology Data Exchange (ETDEWEB)

    Schild, H.; Mueller, H.A.; Schreiber, G.

    1981-11-01

    The halfmoon-sign is described. It consists of typically shaped fragments seen on the lateral view of the elbow in the area around the fossa radialis. With rare exceptions the halfmoon-sign is indicative of a fracture of the distal humerus in the coronal plane, mostly fractures of the capitulum humeri.

  8. An Irreducible Ankle Fracture Dislocation: The Bosworth Injury

    NARCIS (Netherlands)

    T. Schepers (Tim); T. Hagenaars (Tjebbe); D. den Hartog (Dennis)

    2012-01-01

    textabstractIrreducible fracture dislocations of the ankle are rare and represent true orthopedic emergencies. We present a case of a fracture dislocation that was irreducible owing to a fixed dislocation of the proximal fibular fragment posterior to the lateral ridge of the tibia. This particular t

  9. Mandibular Fractures at Veer Chandra Singh Garhwali Government ...

    African Journals Online (AJOL)

    Mandibular fractures constitute a substantial proportion of cases of maxillofacial ... facial injury that the average practicing dental surgeon may expect to encounter. .... anterior, left and right lateral oblique, panoramic and computed tomography. Simple ... Table 4 shows the relation of fracture site to cause of the mandibular ...

  10. 空心钉结合带筋膜跗外侧血管蒂骰骨骨膜瓣移位治疗距骨颈骨折%Cannulated screws combined with transposition of cuboid periosteal flap pedicled with fascia and lateral tarsal artery in the treatment of talus neck fractures

    Institute of Scientific and Technical Information of China (English)

    周炎; 刘世清; 瞿新丛; 廖琦; 余铃; 黄涛

    2014-01-01

    目的 探讨空心钉结合带筋膜跗外侧血管蒂骰骨骨膜瓣移位治疗距骨颈骨折的手术方法及临床疗效. 方法 2008年3月至2011年6月,对收治的12例距骨颈骨折采用空心钉结合带筋膜跗外侧血管蒂骰骨骨膜瓣移位治疗.术后非负重功能位外固定12~14周,并根据X线片显示骨折愈合情况确定负重时间.末次随访时根据美国足与踝关节外科协会踝与后足功能评分系统评价术后功能. 结果 12例术后随访12 ~ 48个月,平均24个月.1例出现切口皮缘坏死,经换药处理后愈合.距骨颈骨折均获愈合,愈合时间为16~ 24周,平均20周.末次随访时AOFAS踝与后足功能评分为55~ 96分,平均82.5分,其中优4例,良5例,可3例.2例发生距下关节轻度创伤性关节炎,口服消炎镇痛药后疼痛缓解;1例发生距骨体缺血性坏死,X线片显示距骨体骨质硬化,但未塌陷,嘱患者减少负重并定期随访观察. 结论 应用空心钉结合带筋膜跗外侧血管蒂骰骨骨膜瓣移位治疗距骨颈骨折,能改善距骨体血供,降低距骨缺血性坏死的发生,是有效的治疗手段.%Objective To investigate the surgical techniques and clinical efficacy of cannulated screws combined with transposition of cuboid periosteal flap pedicled with fascia and lateral tarsal artery in the treatment of talus neck fractures.Methods From March 2008 to June 2011,12 cases with talus neck fractures were treated with cannulated screws combined with transposition of cuboid periosteal flap pedicled with fascia and lateral tarsal artery.External fixation in functional position for 12-14 weeks,and the load time was determined by X-ray fracture healing.Functional results were assessed according to AOFAS (American Orthopaedic Foot and Ankle Society) score at last follow-up.Results Twelve cases were followed up for an average of 24 months (12 to 48 months).One case of skin flap necrosis healed by dressing.All the fractures healed

  11. [Atlas burst fracture (Jefferson fracture) requiring surgical treatment after conservative treatment--report of two cases].

    Science.gov (United States)

    Yamamoto, Hiromichi; Kurimoto, Masanori; Hayashi, Nakamasa; Ohmori, Tomoaki; Hirashima, Yutaka; Endo, Shunro

    2002-09-01

    Most cases of atlas burst fracture do not require surgical stabilization, because they can be successfully treated with external immobilization. The authors present two cases of atlas burst fracture in which surgical stabilization was required after external immobilization. The first patient was a 50-year-old male and the second patient was a 34-year-old male. Both presented with neck pain without neurological symptoms after a traffic accident. Neuroradiological examinations revealed atlas burst fracture in both patients. They were initially treated with conservative treatment; one with a rigid collar and the other with a halo vest. However, lateral offset of the atlas on the axis increased and atlanto-axial instability became evident three months later in both patients. They underwent upper cervical arthrodesis with satisfactory results. The authors review surgical indication and its timing in patients with atlas burst fracture.

  12. Effect of Natural Fractures on Hydraulic Fracturing

    Science.gov (United States)

    Ben, Y.; Wang, Y.; Shi, G.

    2012-12-01

    Hydraulic Fracturing has been used successfully in the oil and gas industry to enhance oil and gas production in the past few decades. Recent years have seen the great development of tight gas, coal bed methane and shale gas. Natural fractures are believed to play an important role in the hydraulic fracturing of such formations. Whether natural fractures can benefit the fracture propagation and enhance final production needs to be studied. Various methods have been used to study the effect of natural fractures on hydraulic fracturing. Discontinuous Deformation Analysis (DDA) is a numerical method which belongs to the family of discrete element methods. In this paper, DDA is coupled with a fluid pipe network model to simulate the pressure response in the formation during hydraulic fracturing. The focus is to study the effect of natural fractures on hydraulic fracturing. In particular, the effect of rock joint properties, joint orientations and rock properties on fracture initiation and propagation will be analyzed. The result shows that DDA is a promising tool to study such complex behavior of rocks. Finally, the advantages of disadvantages of our current model and future research directions will be discussed.

  13. Fracture channel waves

    Science.gov (United States)

    Nihei, Kurt T.; Yi, Weidong; Myer, Larry R.; Cook, Neville G. W.; Schoenberg, Michael

    1999-03-01

    The properties of guided waves which propagate between two parallel fractures are examined. Plane wave analysis is used to obtain a dispersion equation for the velocities of fracture channel waves. Analysis of this equation demonstrates that parallel fractures form an elastic waveguide that supports two symmetric and two antisymmetric dispersive Rayleigh channel waves, each with particle motions and velocities that are sensitive to the normal and tangential stiffnesses of the fractures. These fracture channel waves degenerate to shear waves when the fracture stiffnesses are large, to Rayleigh waves and Rayleigh-Lamb plate waves when the fracture stiffnesses are low, and to fracture interface waves when the fractures are either very closely spaced or widely separated. For intermediate fracture stiffnesses typical of fractured rock masses, fracture channel waves are dispersive and exhibit moderate to strong localization of guided wave energy between the fractures. The existence of these waves is examined using laboratory acoustic measurements on a fractured marble plate. This experiment confirms the distinct particle motion of the fundamental antisymmetric fracture channel wave (A0 mode) and demonstrates the ease with which a fracture channel wave can be generated and detected.

  14. Traumatic thoracolumbar spine fractures

    NARCIS (Netherlands)

    J. Siebenga (Jan)

    2013-01-01

    textabstractTraumatic spinal fractures have the lowest functional outcomes and the lowest rates of return to work after injury of all major organ systems.1 This thesis will cover traumatic thoracolumbar spine fractures and not osteoporotic spine fractures because of the difference in fracture

  15. Assessment of fracture risk

    Energy Technology Data Exchange (ETDEWEB)

    Kanis, John A. [WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield S10 2RX (United Kingdom)], E-mail: w.j.pontefract@sheffield.ac.uk; Johansson, Helena; Oden, Anders [WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield S10 2RX (United Kingdom); McCloskey, Eugene V. [WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield S10 2RX (United Kingdom); Osteoporosis Centre, Northern General Hospital, Sheffield (United Kingdom)

    2009-09-15

    Fractures are a common complication of osteoporosis. Although osteoporosis is defined by bone mineral density at the femoral neck, other sites and validated techniques can be used for fracture prediction. Several clinical risk factors contribute to fracture risk independently of BMD. These include age, prior fragility fracture, smoking, excess alcohol, family history of hip fracture, rheumatoid arthritis and the use of oral glucocorticoids. These risk factors in conjunction with BMD can be integrated to provide estimates of fracture probability using the FRAX tool. Fracture probability rather than BMD alone can be used to fashion strategies for the assessment and treatment of osteoporosis.

  16. Analysis of Internal Fixation for Tri-ankle Fracture in 36 Cases%内固定治疗三踝骨折36例分析

    Institute of Scientific and Technical Information of China (English)

    张小东; 钟桂午; 王晓红; 杜小龙; 王贻幸

    2011-01-01

    Objective: To evaluate the efficacy and prognosis of internal fixation treatment for the tri-malleolar fracture with posterolateral approach combined with medial approach. Methods:36 cases of trimalleo-lar fracture were treated with internal fixation by posterolateral approach combined with medial approach. Results:All the patients were followed up for 6 -21 months, the average time is 12. 5 months; the fracture healed in 12 - 16 weeks postoperative. According to Baird - Jackson criteria,there were excellent in 20 cases, good in 12 cases and fair in 4 case. Excellent and good rate clinical result was 88. 9%. Conclusions:The internal fixation treatment of trimalleolar fracture with posterolateral approach combined with medial approach is easy to perform and the fixation is reliable, which is suitable for the surgical treatment of the trimalleolar fracture.%目的:探讨后外侧入路联合内侧入路内固定治疗三踝骨折的疗效及预后.方法:对36例三踝骨折采用后外侧入路联合内侧入路切开复位内固定.结果:术后均得到10~32个月,平均12.5个月的随访.骨折愈合时间12~16周.疗效评定依据Baird-jackson踝关节评分标准:本组优20例,良12例,可4例,优良率88.9%.结论:采用后外侧入路联合内侧入路进行内固定治疗三踝骨折,其操作简便,固定可靠,适用于三踝骨折的手术治疗.

  17. Ankle post-traumatic osteoarthritis: a CT arthrography study in patients with bi- and trimalleolar fractures

    Energy Technology Data Exchange (ETDEWEB)

    Kraniotis, Pantelis; Petsas, Theodore [University Hospital of Patras, Department of Radiology, Rion, Patras (Greece); Maragkos, Spyridon; Tyllianakis, Minos [University Hospital of Patras, Department of Orthopedics, Rion, Patras (Greece); Karantanas, Apostolos H. [University Hospital, Heraklion, Department of Medical Imaging, Stavrakia, Crete (Greece)

    2012-07-15

    To detect radiographically occult cartilage lesions using CT arthrography (CTa) in patients with malleolar fractures treated with open reduction internal fixation and to correlate the lesions with the functional outcome score. Twenty-one patients (13 men and 8 women, mean age 35 years, range 16-55) underwent ankle CTa after a mean postoperative period of 565 days (range 271-756). CTa images were analyzed by two radiologists. Articular surface post-traumatic collapse and subsequent cartilage defects or erosions were recorded in millimeters and in a binary mode (i.e., present if >50% of cartilage thickness) respectively. The functional outcome was assessed using the American Orthopedic Foot and Ankle Society (AOFAS) score by two orthopaedic surgeons. The statistical analysis correlated the AOFAS score with both imaging parameters and was performed with ANOVA using the MedCalc statistical package, version 11.3. Of the total of 12 articular surface steps recorded, 2/12 (16.67%) were anterolateral, 4/12 (33.33%) posterolateral, 5/12 (41.67%) anteromedial, and 1/12(8.33%) posteromedial. Of the total of 42 cartilage lesions, 7/42 (16.67%) were anterolateral, 14/42 (33.33%) posterolateral, 12/42 (28.57%) anteromedial, and 9/42 (21.43%) posteromedial. The mean AOFAS score was 8.67 (range 5.95-9.70). There was no statistically significant correlation between the AOFAS score and the post-traumatic internal derangement of the ankle joint (p = 0.524). CTa detects radiographically silent cartilage lesions in patients with fractures of the ankle joint. There is no correlation of the extent of lesions and the patient's AOFAS score. (orig.)

  18. [Periprosthetic Acetabulum Fractures].

    Science.gov (United States)

    Schreiner, A J; Stuby, F; de Zwart, P M; Ochs, B G

    2016-12-01

    In contrast to periprosthetic fractures of the femur, periprosthetic fractures of the acetabulum are rare complications - both primary fractures and fractures in revision surgery. This topic is largely under-reported in the literature; there are a few case reports and no long term results. Due to an increase in life expectancy, the level of patients' activity and the number of primary joint replacements, one has to expect a rise in periprosthetic complications in general and periprosthetic acetabular fractures in particular. This kind of fracture can be intra-, peri- or postoperative. Intraoperative fractures are especially associated with insertion of cementless press-fit acetabular components or revision surgery. Postoperative periprosthetic fractures of the acetabulum are usually related to osteolysis, for example, due to polyethylene wear. There are also traumatic fractures and fractures missed intraoperatively that lead to some kind of insufficiency fracture. Periprosthetic fractures of the acetabulum are treated conservatively if the implant is stable and the fracture is not dislocated. If surgery is needed, there are many possible different surgical techniques and challenging approaches. That is why periprosthetic fractures of the acetabulum should be treated by experts in pelvic surgery as well as revision arthroplasty and the features specific to the patient, fracture and prosthetic must always be considered. Georg Thieme Verlag KG Stuttgart · New York.

  19. Transverse Stress Fracture of the Proximal Patella

    Science.gov (United States)

    Atsumi, Satoru; Arai, Yuji; Kato, Ko; Nishimura, Akinobu; Nakazora, Shigeto; Nakagawa, Shuji; Ikoma, Kazuya; Fujiwara, Hiroyoshi; Sudo, Akihiro; Kubo, Toshikazu

    2016-01-01

    Abstract Among stress fractures associated with sports activities, patellar stress fracture is rare. Regarding patella stress fractures, so far only distal transverse or lateral longitudinal fractures have been reported, but there are no reports of transverse fractures occurring in the proximal patella. We describe an extremely rare case of transverse stress fracture of proximal patella in a 9-year-old athlete. A 9-year old boy, who participated in sports (sprints and Kendo) presented with left knee pain without any external injury. In plain radiographs, a fracture line was observed in the proximal 1/3 of the left patella, and a patella stress fracture was diagnosed. For treatment, because 7 months of conservative therapy showed no improvement, internal fixation was carried out using Acutrak screws, and bone union was thus achieved. Three months after the operation, he was able to return to his previous level of athletic sports activity. Regarding the mechanism of onset, it is believed that the causes are longitudinal traction force and patellofemoral contact pressure. On the other hand, the contact region of the patella with the femur changes with the flexion angle of the knee. In the current case, the fracture occurred at a site where the patella was in contact with the femur at a flexion angle of >90°, so it is believed that it occurred as a clinical condition from being subjected to repeated longitudinal traction force and patellofemoral contact pressure at a flexion angle of >90°, during the sports activities of sprints and Kendo. The nonunion of the transverse stress fracture of his proximal patella was successfully treated with internal fixation using Acutrak screws. PMID:26871789

  20. Experimental intra-articular calcaneal fractures: anatomic basis for a new classification.

    Science.gov (United States)

    Carr, J B; Hamilton, J J; Bear, L S

    1989-10-01

    Experimental calcaneus fractures were produce by axially loading 18 specimens. Anatomic dissections were performed and documented. Two constant primary fracture lines were identified, dividing the calcaneus in the coronal and sagittal planes. A constant anterolateral fragment was identified, as were three patterns of calcaneocuboid joint fracture involvement. Based on the pathoanatomy and surgical anatomy of the calcaneus, a medial and lateral column classification is proposed. The medial column includes the superomedial fragment. The lateral column includes the calcaneocuboid joint, lateral wall and posterior facet. This concept can help identify fracture displacements and correlate them with a treatment plan.

  1. Case report: nonoperative treatment of an unstable Jefferson fracture using a cervical collar.

    Science.gov (United States)

    Haus, Brian M; Harris, Mitchel B

    2008-05-01

    The treatment of unstable burst fractures of the atlas (Jefferson fractures) is controversial. Unstable Jefferson fractures have been managed successfully with either immobilization, typically halo traction or halo vest, or surgery. We report a patient with an unstable Jefferson fracture treated nonoperatively with a cervical collar, frequent clinical examinations, and flexion-extension radiographs. Twelve months after treatment, the patient achieved painless union of his fracture. The successful treatment confirms prior studies reporting unstable Jefferson fractures have been treated nonoperatively. The outcome challenges the clinical relevance of treatment algorithms that rely on the "rules of Spence" to guide treatment of unstable Jefferson fractures and illustrates instability may not necessarily be present in patients with considerable lateral mass widening. Additionally, it emphasizes a more reliable way of assessing C1-C2 stability in unstable Jefferson fractures is by measuring the presence and extent of anterior subluxation on lateral flexion and extension views.

  2. Imaging of vertebral fractures

    Directory of Open Access Journals (Sweden)

    Ananya Panda

    2014-01-01

    Full Text Available Vertebral fracture is a common clinical problem. Osteoporosis is the leading cause of non-traumatic vertebral fracture. Often, vertebral fractures are not clinically suspected due to nonspecific presentation and are overlooked during routine interpretation of radiologic investigations. Moreover, once detected, many a times the radiologist fails to convey to the clinician in a meaningful way. Hence, vertebral fractures are a constant cause of morbidity and mortality. Presence of vertebral fracture increases the chance of fracture in another vertebra and also increases the risk of subsequent hip fracture. Early detection can lead to immediate therapeutic intervention improving further the quality of life. So, in this review, we wish to present a comprehensive overview of vertebral fracture imaging along with an algorithm of evaluation of vertebral fractures.

  3. 经皮克氏针固定儿童肱骨髁上骨折术中外侧进针点的定位方法研究%Determination of lateral needle insertion point in percutaneous Kirschner wire fixation for pediatric supracondylar fractures of humerus

    Institute of Scientific and Technical Information of China (English)

    罗冬冬; 颉强; 马益善; 卢健

    2016-01-01

    Objective To report our method to determine lateral needle insertion point (intersection point skin marker) in closed reduction and percutaneous Kirschner wire fixation for pediatric supracondylar fracture of humerus.Methods From May 2012 to June 2014,125 children with supracondylar fracture of humerus were treated with closed reduction and percutaneous Kirschner wire fixation.Of them,60 did not use the intersection point method to determine the lateral needle insertion point (group A),including 46 boys and 14 girls,with an average age of 6.3 ±0.6 years.According to Gartland classification,28 cases were type Ⅱ and 32 cases type Ⅲ.In the other 65 children,the intersection point method was used to determine the lateral needle insertion point (group B),including 50 boys and 15 girls,with an average age of 6.4 ± O.9 years.According to Gartland classification,29 cases were type Ⅱ and 36 cases type Ⅲ.The 2 groups were compared in terms of operation time,fluoroscopy times,hospital stay and hospitalization cost.The efficacy was evaluated at the final follow-ups using Flynn criteria.The 2 groups were compatible without significant differences in preoperative general data (P > 0.05).Results All the 125 children obtained successful closed reduction and percutaneous pin fixation,and an average follow-up of 13 months (from 12 to 15 months)as well.There were significant differences between groups A and B in average operation time (23.1 ± 15.3 min versus 17.5 ± 10.3 min) and fluoroscopy times (9.2 ± 1.0 times versus 5.3 ± 1.3 times) (P < 0.05).There was no statistically significant difference between the 2 groups either in Flynn excellent to good rate [(98.3% (59/60) versus 98.5% (64/65)] (P > O.05).Needle irritation occurred in 2 cases and Kirschner wire shift in one in group A while tensile blistering occurred in one in group B.Conclusion In closed reduction and percutaneous Kirschner wire fixation for pediatric supracondylar fracture of humerus

  4. Rib fractures in infants due to cardiopulmonary resuscitation efforts.

    Science.gov (United States)

    Dolinak, David

    2007-06-01

    Although it is widely known that adults may sustain fractures of the anterior and/or lateral aspects of the ribs due to cardiopulmonary resuscitation (CPR) efforts, relatively little is written about the generation of CPR-related rib fractures in the infant age range. In a series of 70 consecutive autopsies in infants ranging in age from 2 weeks to 8 months, with no history or indications of injury, the parietal pleura of the thoracic cage was stripped and the ribs carefully examined for fracture. Subtle fractures of the anterolateral aspects of the ribs were discovered in 8 (11%) of the 70 cases. In 7 of the 8 cases, multiple ribs were fractured (ranging up to 10 rib fractures), and in 5 of these cases, the rib fractures were bilateral. All of the rib fractures were subtle, had little if any associated blood extravasation, and would have been easily missed had the parietal pleura not been stripped. These anterolateral rib fractures in infants are the likely correlate of anterolateral rib fractures that are not uncommonly seen in the adult population, resulting from resuscitation efforts. The rib fractures are subtle and may not be identified unless the parietal pleura is stripped.

  5. Fracture Criterion for Fracture Mechanics of Magnets

    Institute of Scientific and Technical Information of China (English)

    潘灏; 杨文涛

    2003-01-01

    The applicability and limitation of some fracture criteria in the fracture mechanics of magnets are studied.It is shown that the magnetic field intensity factor can be used as a fracture criterion when the crack in a magnet is only affected by a magnetic field. For some magnetostrictive materials in which the components of magnetostriction strain do not satisfy the compatibility equation of deformation, the stress intensity factor can no longer be effectively applicable as a fracture criterion when the crack in a magnet is affected by a magnetic field and mechanical loads simultaneously.

  6. Tennis Elbow (Lateral Epicondylitis)

    Science.gov (United States)

    .org Tennis Elbow (Lateral Epicondylitis) Page ( 1 ) Tennis elbow, or lateral epicondyliti s, is a painful condition of the elbow caused by overuse. Not surprisingly, playing tennis or other racquet sports can cause ...

  7. Atypical metatarsal fracture in a patient on long term bisphosphonate therapy

    Directory of Open Access Journals (Sweden)

    Pavan Pradhan

    2012-01-01

    Full Text Available A 24 years old female of cushing disease had undergone adrenelectomy. She was put on alendronate and steroid. After six and a half years she developed pathological fracture subtrochanteric femur. The patient was treated with proximal femoral nailing and the fracture united. 2 years later she developed pain right foot. She was diagnosed as transverse fracture of fifth metatarsal. We report this rare case of atypical metatarsal fracture in a patient on long term bisphosphonate therapy.

  8. Atypical Subtrochanteric Femur Fracture in Patient with Metastatic Breast Cancer Treated with Zoledronic Acid

    OpenAIRE

    2012-01-01

    Several case series have suggested an association exists between atypical femoral subtrochanteric fractures and long-term use of bisphosphonates. It is thought that prolonged use of bisphosphonates may lead to adynamic, fragile bone. The radiologic features of atypical fractures include diffuse cortical thickening, transverse fracture, and beaking at the lateral subtrochanteric area. Atypical subtrochanteric femur fractures have been reported after use of alendronate, but there have been rare...

  9. 三种不同手术方式治疗跟骨骨折的疗效分析%Efficacy of three approaches for fractures of calcaneus:percutaneous reduction surgery, L-shaped lateral approach and small sinus tarsi approach

    Institute of Scientific and Technical Information of China (English)

    葛晨; 徐向阳; 王亚梓; 刘津浩; 朱渊

    2014-01-01

    比较有显著统计学差异。末次随访时撬拨组的AOFAS评分显著低于另两组(Q<0.05),但“L”形切口组与小切口组之间无明显统计学差异(Q>0.05)。三组的SF36评分无明显统计学差异。再次手术发生率分别为撬拨组12.00%,“L”形切口组15.71%,小切口组2.67%,三组间有统计学差异。结论:对于骨折块较完整、单纯跟距关节面塌陷骨折,撬拨复位手术时间短、损伤小、无伤口愈合问题,存在部分复位丢失,发生距下关节炎后常需行距下关节融合。“L”形切口与小切口疗效相当,但小切口直接暴露距下关节面,便于复位;内固定物少;医源性软组织损伤小。小切口是一种有效的治疗跟骨关节内骨折的方法;术后并发症及再次手术发生率明显低于其他两种方法。%Background:Fractures of calcaneus are complex injuries with a high incidence in feet and usually the result of a fall from a great height. Surgical techniques are the preferred methods for displaced and comminuted fractures. Due to the rising rate of complications after operation, such as wound infection and pain, controversies remain regarding treatment options and sur-gical approaches. In this article, we attempted to investigate clinical effects by three different surgical treatments. Objective:To compare the complications and outcomes of three operations to determine the better approach for the treat-ment of calcaneal intraarticular fracture. Methods:Between 1990 and 2010, 175 patients were admitted for 195 calcaneal fracture, including 50 feet with percutane-ous reduction by leverage, 70 feet with L-shaped lateral approach and 75 feet with small sinus tarsi approach. All fractures were fresh closed fractures of calcaneus. There were 95 cases of SandersⅡand 78 cases of SandersⅢ. The mean age of the patients was 43 years (range, 22-62 years). The measured parameters during treatment were compared between

  10. Long term surgical treatment outcome of talar body fracture

    Institute of Scientific and Technical Information of China (English)

    Ramesh Kumar Sen; Sujit Kumar Tripathy; Shakthivel RR Manoharan; Vibhu Krishnan; Tajir Tamuk; Vanyambadi Jagadeesh

    2011-01-01

    Objective: Talar body fractures are rare and have poor treatment outcome. The purpose of this study is to report the long term surgical treatment outcome of closed talar dome fractures.Methods: Eight closed talar body fractures, treated by open reduction and internal fixation with small fragment cancellous screws and/or Herbert screws in our level Ⅰ trauma centre were retrospectively analyzed. Preoperative and postoperative radiographs of the foot (antero-posterior, lateral and oblique views) and ankle (antero-posterior, lateral and mortise views) were obtained. The patients were followed up both radiologically and functionally (foot function index, FFI) after 3 weeks, 6 weeks, 3 months, 6 months and then annually.Results: There were five crush fractures and three shear fractures (two sagittal shear and one coronal shear),with average follow-up of 5 years. No early complications were noticed in these patients. Late complications included osteoarthrosis of subtalar/ankle joints in six patients and osteonecrosis oftalar body in four patients. On functional assessment, mean FFI after 5 years was 104.63 points and worse outcome was noticed in crush injury and coronal shear fractures. Sagittal shear fractures had a good functional and radiological outcome.Conclusions: Late complications subsequent to surgically treated talar body fractures are inevitable, even though exact reduction and rigid fixation are achieved, thus patients are supposed to be counseled about the adverse outcome. Although crush and coronal shear fractures have poor outcome, sagittal injuries have good prognosis on long term evaluation.

  11. 空心钉克氏针内固定治疗儿童陈旧性肱骨外髁骨折近期疗效观察%Short-term effect of cannulated screw with K-wires used as internal fixation in management of pediatric neglected humeral lateral condylar fractures

    Institute of Scientific and Technical Information of China (English)

    易新成; 鲍琨; 陈博昌

    2014-01-01

    目的:探讨空心钉克氏针内固定手术治疗儿童陈旧性肱骨外髁骨折的临床疗效。方法回顾性分析2009年10月至2012年12月我们收治并获完整随访的的11例肱骨外髁陈旧性骨折患儿临床资料,其中男9例,女2例,年龄2岁1个月至6岁4个月,平均4岁5个月。患儿受伤至手术时间为30~90 d,平均52 d。受伤初期按Milch分型,MilchⅠ型4例,MilchⅡ型7例,肘关节功能有不同程度受限。患儿均切开复位后用1枚空心钉外加2枚交叉克氏针内固定治疗。术后随访观察骨折愈合时间及并发症情况,术后1年采用Dhillon评分值和Baumann角评定疗效。结果所有患儿术后均获12~34个月(平均22.7个月)随访。均在术后6~8周获骨性愈合。术后1年按照Dhillon评分标准,10例为优,1例为良,优良率100%,术前患侧肘关节活动弧度平均为90.5°±27.3°,术后1年时平均为129.1°±11.8°,二者差异有统计学意义(t=6.527,P=0.000)。术后1年所有患儿Baumann角均在正常范围(68°~80°),平均74.3°±4.2°。无一例发生术后感染、骨折延迟愈合、畸形愈合、骨不连、肘内外翻、肱骨小头缺血坏死、医源性血管神经损伤等并发症。结论切开复位后采用1枚空心钉外加2枚交叉克氏针内固定治疗儿童陈旧性肱骨外髁骨折可达到复位满意、内固定稳定和良好的近期疗效,并发症少。%Objetive To discuss the short-term effect of cannulated screw with K-wires used as internal fixation in management of pediatric neglected humeral lateral condylar fractures. Methods The clinical data of 1 1 cases with neglected humeral lateral condylar fracture were analyzed retrospectively.from October 2009 to December 2012.There were 9 boys and 2 girls,aged from 2 years and 1month to 6 year and 4 months old (aver-age,4 years and 5 months).The duration of initially trauma to surgery ranged

  12. The Bristol Hip View: Its Role in the Diagnosis and Surgical Planning and Occult Fracture Diagnosis for Proximal Femoral Fractures

    Directory of Open Access Journals (Sweden)

    J. Harding

    2013-01-01

    Full Text Available Aim. To evaluate whether a modified radiographic view of the femoral neck improves the diagnosis of occult proximal femoral. Materials and Methods. Prospective study of patients presenting with clinically suspected proximal femoral fractures or who underwent traditional plain radiographic views and the Bristol hip view (a 30-degree angled projection. Six blinded independent observers assessed the images for presence of a fracture, anatomical level, and displacement. Results. 166 consecutive patients presenting with the clinical diagnosis of a proximal femoral fracture, of which 61 sustained a fracture. Six of these were deemed occult due to negative plain and had proven fractures on subsequent cross-sectional imaging. The Bristol hip view demonstrated five of these six fractures. It performed better than the traditional lateral hip view to identify the injury. The Bristol hip view predicted correctly the fracture type and displacement in all cases and missed only one of the occult fractures. Conclusion. The Bristol hip view is more sensitive and clearer than a lateral projection for patients. It adds useful diagnostic information and performs better than the traditional views in occult fractures. Its use may prevent the need for further cross sectional imaging and subsequent surgical delay.

  13. 固定角度侧块与椎弓根钉棒系统治疗无神经损伤胸腰椎骨折%The fixed-angle lateral masses and pedicle screw and rod system for thoracolumbar fractures without nerve injuries

    Institute of Scientific and Technical Information of China (English)

    滕勇; 季明华; 李强; 向阳; 张文举; 戎帅; 郭树章; 谷长增

    2013-01-01

    Objective To investigate the curative results of fixed-angle lateral masses in the posterior approach and the pedicle screw and rod system in the treatment of thoracolumbar fractures without nerve injuries. Methods From October 2008 to February 2012, 38 patients who had thoracolumbar burst fractures without neurological symptoms or decompression and with mechanical instability were included in the study. They were treated by the ifxed-angle lateral masses in the posterior approach (-100,-50, 00, 50 and 100 ) and reduction and ifxation of the pedicle screw and rod system. Single short-segment ifxation was performed on the patients without posterior ligamentous complex injuries. Pedicle screw ifxation at the injured level was performed on the patients with posterior ligamentous complex injuries and complete pedicle at the injured level. The patients with combined pedicle injuries at the injured level underwent ifxation of 2 vertebral bodies up and down. Posterolateral fusion was achieved in all patients with posterior ligamentous complex injuries. Wearing a brace, all patients were able to walk at 1-3 days after the operation. The preoperative and postoperative X-ray, CT and MRI data of all patients were reviewed. Results All patients were followed up thoroughly for a mean period of 28.2 months ( range;4-40 months ). No breakage of screws or rods or the failure of internal ifxation occurred. The mean operation time was 92 ( 82.6±19.2 ) minutes. The mean height of injured vertebral bodies was 41.6% preoperatively, which was increased to 91.2% postoperatively. The mean Cobb’s angle was 35.3° preoperatively, which was decreased to 7.8° postoperatively. The mean sagittal plane displacement was ( 32.7±7.6 )%preoperatively, which was decreased to ( 8.7±4.9 )%postoperatively ( P<0.05 ). Conclusions It is an ideal treatment method of the fixed-angle lateral masses and pedicle screw and rod system for thoracolumbar burst fractures without nerve injuries and with

  14. Tibia (Shinbone) Shaft Fractures

    Science.gov (United States)

    ... energy collisions, such as an automobile or motorcycle crash, are common causes of tibial sha fractures. In cases like these, the bone can be broken into several pieces (comminuted fracture). Sports injuries, such as a fall while skiing or running ...

  15. Fractures in anisotropic media

    Science.gov (United States)

    Shao, Siyi

    Rocks may be composed of layers and contain fracture sets that cause the hydraulic, mechanical and seismic properties of a rock to be anisotropic. Coexisting fractures and layers in rock give rise to competing mechanisms of anisotropy. For example: (1) at low fracture stiffness, apparent shear-wave anisotropy induced by matrix layering can be masked or enhanced by the presence of a fracture, depending on the fracture orientation with respect to layering, and (2) compressional-wave guided modes generated by parallel fractures can also mask the presence of matrix layerings for particular fracture orientations and fracture specific stiffness. This report focuses on two anisotropic sources that are widely encountered in rock engineering: fractures (mechanical discontinuity) and matrix layering (impedance discontinuity), by investigating: (1) matrix property characterization, i.e., to determine elastic constants in anisotropic solids, (2) interface wave behavior in single-fractured anisotropic media, (3) compressional wave guided modes in parallel-fractured anisotropic media (single fracture orientation) and (4) the elastic response of orthogonal fracture networks. Elastic constants of a medium are required to understand and quantify wave propagation in anisotropic media but are affected by fractures and matrix properties. Experimental observations and analytical analysis demonstrate that behaviors of both fracture interface waves and compressional-wave guided modes for fractures in anisotropic media, are affected by fracture specific stiffness (controlled by external stresses), signal frequency and relative orientation between layerings in the matrix and fractures. A fractured layered medium exhibits: (1) fracture-dominated anisotropy when the fractures are weakly coupled; (2) isotropic behavior when fractures delay waves that are usually fast in a layered medium; and (3) matrix-dominated anisotropy when the fractures are closed and no longer delay the signal. The

  16. Sprains, Strains and Fractures

    Science.gov (United States)

    ... Young Physicians Annual Scientific Meeting Webinars Careers in Podiatry APMA 2040 Student Profiles CPME REdRC Manage Your ... and fractures. Many fractures and sprains occur during sports. Football players are particularly vulnerable to foot and ...

  17. Hip fracture - discharge

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000168.htm Hip fracture - discharge To use the sharing features on this page, please enable JavaScript. Hip fracture surgery is done to repair a break in ...

  18. Hip fracture surgery

    Science.gov (United States)

    ... neck fracture repair; Trochanteric fracture repair; Hip pinning surgery; Osteoarthritis - hip ... You may receive general anesthesia for this surgery. This means you ... spinal anesthesia . With this kind of anesthesia, medicine is ...

  19. Metatarsal stress fractures - aftercare

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/patientinstructions/000553.htm Metatarsal stress fractures - aftercare To use the sharing features on ... that connect your ankle to your toes. A stress fracture is a break in the bone that ...

  20. Periprosthetic acetabular fractures.

    Science.gov (United States)

    Benazzo, Francesco; Formagnana, Mario; Bargagliotti, Marco; Perticarini, Loris

    2015-10-01

    The aim of this article is to propose a diagnostic and therapeutic algorithm for the acetabular periprosthetic fractures. This article explores the current literature on the epidemiology, causes and classification of periprosthetic acetabular fractures. Integrating data with the experience of the authors, it offers a guide to diagnosis and possible therapeutic strategies. Intra-operative fractures can occur during rasping, reaming or implant impaction, and they must be treated immediately if the component(s) is (are) unstable. Post-operative fractures can be due to major trauma (acute fractures) or minor forces in bone osteolysis; it is possible to plan reconstruction and fixation according to fracture characteristics. Treatment choice depends upon fracture site and implant stability. Periprosthetic acetabular fractures are uncommon complications that can occur intra-operatively or post-operatively, and a reconstructive surgeon must be able to manage the procedure. Accurate planning and reconstruction implant are necessary to achieve good cup stability.

  1. Identifying osteoporotic vertebral fracture

    OpenAIRE

    Griffith, James F.

    2015-01-01

    Osteoporosis per se is not a harmful disease. It is the sequela of osteoporosis and most particularly the occurrence of osteoporotic fracture that makes osteoporosis a serious medical condition. All of the preventative measures, investigations, treatment and research into osteoporosis have one primary goal and that is to prevent the occurrence of osteoporotic fracture. Vertebral fracture is by far and away the most prevalent osteoporotic fracture. The significance and diagnosis of vertebral f...

  2. Difficulties encountered in preauricular approach over retromandibular approach in condylar fracture.

    Science.gov (United States)

    Jayavelu, Perumal; Riaz, R; Tariq Salam, A R; Saravanan, B; Karthick, R

    2016-10-01

    Fracture of mandible can be classified according to its anatomical location, in which condylar fracture is the most common one overall and is missed on clinical examination. Due to the unique geometry of the mandible and temporomandibular joint, without treatment the fractures can result in marked pain, dysfunction, and deformity. The condylar fracture may be further classified depending on the sides involved: unilateral/bilateral, depending on the height of fracture: intracapsular (within the head of condyle), extracapsular - head and neck (high condyle fracture), and subcondylar (low condyle fracture), and depending on displacement: nondisplaced, displaced (anteromedially, medially, and lateral), and dislocated. The clinical features include swelling and tenderness over the temporomandibular joint region, restricted mouth opening, and anterior open bite. A 34-year-old male patient reported to the Department of Oral and Maxillofacial Surgery at Madha Dental College and Hospital; suffered fall trauma resulting in bilateral condyle fracture, dentoalveolar fracture in mandible with restricted mouth opening, and anterior open bite.

  3. Fracture prevention in men

    NARCIS (Netherlands)

    Geusens, PP; Sambrook, P.N.; Lems, W.F.

    2009-01-01

    The lifetime risk of experiencing a fracture in 50-year-old men is lower (20%) than the risk in women (50%). Consequently, much less research has been carried out on osteoporosis and fracture risk in men. Differences in the risk and incidence of fractures between men and women are related to differe

  4. Imaging of insufficiency fractures

    Energy Technology Data Exchange (ETDEWEB)

    Krestan, Christian [Department of Radiology, Medical University of Vienna, Vienna General Hospital, Waehringerstr. 18-20, 1090 Vienna (Austria)], E-mail: christian.krestan@meduniwien.ac.at; Hojreh, Azadeh [Department of Radiology, Medical University of Vienna, Vienna General Hospital, Waehringerstr. 18-20, 1090 Vienna (Austria)

    2009-09-15

    This review focuses on the occurrence, imaging and differential diagnosis of insufficiency fractures. Prevalence, the most common sites of insufficiency fractures and their clinical implications are discussed. Insufficiency fractures occur with normal stress exerted on weakened bone. Postmenopausal osteoporosis is the most common cause of insufficiency fractures. Other conditions which affect bone turnover include osteomalacia, hyperparathyroidism, chronic renal failure and high-dose glucocorticoid therapy. It is a challenge for the radiologist to detect and diagnose insufficiency fractures, and to differentiate them from other bone lesions. Radiographs are still the most widely used imaging method for identification of insufficiency fractures, but sensitivity is limited, depending on the location of the fractures. Magnetic resonance imaging (MRI) is a very sensitive tool to visualize bone marrow abnormalities associated with insufficiency fractures. Thin section, multi-detector computed tomography (MDCT) depicts subtle fracture lines allowing direct visualization of cortical and trabecular bone. Bone scintigraphy still plays a role in detecting fractures, with good sensitivity but limited specificity. The most important differential diagnosis is underlying malignant disease leading to pathologic fractures. Bone densitometry and clinical history may also be helpful in confirming the diagnosis of insufficiency fractures.

  5. Arthroscopic-assisted treatment of coronoid fractures.

    Science.gov (United States)

    Adams, Julie E; Merten, Sheri M; Steinmann, Scott P

    2007-10-01

    Little information exists regarding arthroscopic treatment of coronoid fractures; this study reports outcomes in a series of patients. Forty-one coronoid fractures were identified by retrospective chart review; 7 were treated arthroscopically; 6 with >12 months of available follow-up. Regan-Morrey fracture types were II (n = 4) and III (n = 3). The age of the patients averaged 37 years; the mechanism of injury was a fall in 6 patients and a motocross accident in 1 patient. Fracture fixation included: plate-and-screws following arthroscopic reduction (1); screws (2) and threaded Steinmann pins (2); 2 fractures were debrided. Three patients had immediate (2) or delayed (1) lateral ulnar collateral ligament repair. Follow-up averaged 31.8 months. The range of motion averaged 9 degrees to 133 degrees in flexion-extension and 87 degrees/79 degrees in prono-supination. Mayo Elbow Performance scores were 100 in 5 of 6 patients and unavailable in 1 patient. Complications included asymptomatic heterotopic ossification (1) and delayed ulnar neuropathy (1). In our series of coronoid fractures treated with arthroscopic means, all patients had a functional, pain-free result. All patients returned to preoperative avocations and occupations. Level IV, therapeutic case series.

  6. ARTHROSCOPIC TREATEMENT OF PATELLA FRACTURES IN CHILDREN

    Directory of Open Access Journals (Sweden)

    Igor V. Timofeev

    2017-03-01

    Full Text Available Introduction. The frequency of patellar fractures is approximately 0.5% to 1.5% of all skeletal injuries. The following types of fractures can be distinguished: avulsive, transverse, longitudinal, and comminuted. In cases of displacement of more than 2–3 mm and quadriceps tendon injuries open reduction and internal fixation with the restoration of the articular surface is more preferable. In cases of longitudinal fractures, arthroscopy is regarded as a highly effective method of surgical treatment. Materials and methods. Using arthroscopy, we have operated on 4 patients with longitudinal fracture of the patella. The average age of the injured persons was 15.4 years (14–17. These were 3 males and 1 female. All patients had sport-related injuries. Because of the longitudinal fracture of the patella, the lateral knee extensor mechanism remained intact, and arthrosopy-assisted surgical intervention with closed reposition of fragments and transcutaneous wire fixation was performed without wire suturing. Results and discussion. Minimal invasiveness, the possibility of visual control over the recovery quality of patellar surface, the reliability of fragment fixation, and a significant reduction in the subsequent rehabilitation make arthroscopy a highly effective method of surgical treatment for patellar fractures.

  7. Stress fractures in runners.

    Science.gov (United States)

    McCormick, Frank; Nwachukwu, Benedict U; Provencher, Matthew T

    2012-04-01

    Stress fractures are a relatively common entity in athletes, in particular, runners. Physicians and health care providers should maintain a high index of suspicion for stress fractures in runners presenting with insidious onset of focal bone tenderness associated with recent changes in training intensity or regimen. It is particularly important to recognize “high-risk” fractures, as these are associated with an increased risk of complication. A patient with confirmed radiographic evidence of a high-risk stress fracture should be evaluated by an orthopedic surgeon. Runners may benefit from orthotics, cushioned sneakers, interval training, and vitamin/calcium supplementation as a means of stress fracture prevention.

  8. Role of MRI in hip fractures, including stress fractures, occult fractures, avulsion fractures

    Energy Technology Data Exchange (ETDEWEB)

    Nachtrab, O. [Department of Radiology, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Gobowen, Oswestry Shropshire SY10 7AG (United Kingdom); Cassar-Pullicino, V.N., E-mail: Victor.Pullicino@rjah.nhs.uk [Department of Radiology, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Gobowen, Oswestry Shropshire SY10 7AG (United Kingdom); Lalam, R.; Tins, B.; Tyrrell, P.N.M.; Singh, J. [Department of Radiology, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Gobowen, Oswestry Shropshire SY10 7AG (United Kingdom)

    2012-12-15

    MR imaging plays a vital role in the diagnosis and management of hip fractures in all age groups, in a large spectrum of patient groups spanning the elderly and sporting population. It allows a confident exclusion of fracture, differentiation of bony from soft tissue injury and an early confident detection of fractures. There is a spectrum of MR findings which in part is dictated by the type and cause of the fracture which the radiologist needs to be familiar with. Judicious but prompt utilisation of MR in patients with suspected hip fractures has a positive therapeutic impact with healthcare cost benefits as well as social care benefits.

  9. Fractures in multiple sclerosis

    DEFF Research Database (Denmark)

    Stenager, E; Jensen, K

    1991-01-01

    In a cross-sectional study of 299 MS patients 22 have had fractures and of these 17 after onset of MS. The fractures most frequently involved the femoral neck and trochanter (41%). Three patients had had more than one fracture. Only 1 patient had osteoporosis. The percentage of fractures increased...... with increasing age and disease duration. Among 34 deceased MS patients 4 had had fractures. These findings are discussed in relation to physical and cognitive impairment in MS. A case-control study is recommended....

  10. [Fractures of carpal bones].

    Science.gov (United States)

    Lögters, T; Windolf, J

    2016-10-01

    Fractures of the carpal bones are uncommon. On standard radiographs fractures are often not recognized and a computed tomography (CT) scan is the diagnostic method of choice. The aim of treatment is to restore pain-free and full functioning of the hand. A distinction is made between stable and unstable carpal fractures. Stable non-displaced fractures can be treated conservatively. Unstable and displaced fractures have an increased risk of arthritis and non-union and should be stabilized by screws or k‑wires. If treated adequately, fractures of the carpal bones have a good prognosis. Unstable and dislocated fractures have an increased risk for non-union. The subsequent development of carpal collapse with arthrosis is a severe consequence of non-union, which has a heterogeneous prognosis.

  11. Orbital fractures: a review

    Directory of Open Access Journals (Sweden)

    Jeffrey M Joseph

    2011-01-01

    Full Text Available Jeffrey M Joseph, Ioannis P GlavasDivision of Ophthalmic Plastic and Reconstructive Surgery, Department of Ophthalmology, School of Medicine, New York University, New York, NY, USA; Manhattan Eye, Ear, and Throat Hospital, New York, NY, USAAbstract: This review of orbital fractures has three goals: 1 to understand the clinically relevant orbital anatomy with regard to periorbital trauma and orbital fractures, 2 to explain how to assess and examine a patient after periorbital trauma, and 3 to understand the medical and surgical management of orbital fractures. The article aims to summarize the evaluation and management of commonly encountered orbital fractures from the ophthalmologic perspective and to provide an overview for all practicing ophthalmologists and ophthalmologists in training.Keywords: orbit, trauma, fracture, orbital floor, medial wall, zygomatic, zygomatic complex, zmc fracture, zygomaticomaxillary complex fractures 

  12. Oblique Axis Body Fracture

    DEFF Research Database (Denmark)

    Takai, Hirokazu; Konstantinidis, Lukas; Schmal, Hagen

    2016-01-01

    Purpose. Anderson type III odontoid fractures have traditionally been considered stable and treated conservatively. However, unstable cases with unfavorable results following conservative treatment have been reported. Methods. We present the cases of two patients who sustained minimally displaced...... Anderson type III fractures with a characteristic fracture pattern that we refer to as "oblique type axis body fracture." Results. The female patients aged 90 and 72 years, respectively, were both diagnosed with minimally displaced Anderson type III fractures. Both fractures had a characteristic "oblique...... type" fracture pattern. The first patient was treated conservatively with cervical spine immobilization in a semirigid collar. However, gross displacement was noted at the 6-week follow-up visit. The second patient was therefore treated operatively by C1-C3/4 posterior fusion and the course...

  13. Type 4 capitellum fractures: Diagnosis and treatment strategies

    Directory of Open Access Journals (Sweden)

    Suresh S

    2009-01-01

    Full Text Available Background: Fractures of the capitellum are rare injuries of the elbow usually seen in the adolescents. This fracture is often missed in the emergency room if a proper radiograph is not available. Recent reports have described many modalities of treatment favoring headless screw for fixation. The facility for headless screw fixation, however, is not available in most centers. This paper presents the diagnosis and management of type 4 capituller fractures (Mckee with gadgets available in a district hospital. Materials and Methods: Between 2004 and 2007 three patients with right sided type IV capetullar fracture were treated in a district hospital. There were two boys aged 15 and 17 and one 33 years old lady. In one case, the fracture was missed in the emergency room. A double arc sign in the lateral views of the X-rays of the elbow was seen in all the cases. In each case a preoperative CT scan was done and a diagnosis of Mckee type IV fracture of the capitellum was made. Under tourniquet, using extended lateral approach, open reduction and internal fixation was done using 4mm partially threaded AO cancellous screws (n=2 and 2.7 mm AO screws (n=1, under vision from posterior to anterior direction from the posterior aspect of lateral condyle of humerus avoiding articular penetration. Results: All the fractures united uneventfully. At the end of one year follow-up, two cases had excellent elbow function; implants were removed and there were no signs of AVN or arthritis. The third case had good elbow ROM at 11 months without AVN. Conclusion: Double arc sign on lateral X-rays of the elbow along with pre-operative CT scan evaluation is important to avoid a missed diagnosis and analysis of type IV capitellur fracture. Fixation with non-cannulated ordinary AO screws using extended Kocher′s lateral approach has given good results.

  14. Fractured-basement reservoir modeling using continuous fracture modeling (CFM) method

    Science.gov (United States)

    Isniarny, Nadya; Haris, Abdul; Nurdin, Safrizal

    2016-02-01

    The challenge in oil and gas exploration has now shifted due to increasingly difficult to get back up economic value in a conventional reservoir. Explorationist are developing various drilling technology, optimizing conventional reserves and unconventional reserve in reservoirs. One of the unconventional reservoir that has been developed is the basement reservoir. This rock type has no primary porosity and the permeability of the rocks of this type are generally influenced by the naturally fracture networks. The purpose of this study is to map the fracture intensity distribution in the basement reservoir using Continuous Fracture Modeling (CFM) method. CFM method applies the basic concepts of neural network in finding a relationship between well data with seismic data in order to build a model of fracture intensity. The Formation Micro Imager (FMI) interpretation data is used to identify the presence of fracture along the well as dip angle and dip azimuth. This indicator will be laterally populated in 3D grid model. Several seismic attribute which are generated from seismic data is used as a guidance to populate fracture intensity in the model. The results from the model were validated with Drill Stem Test (DST) data. Zones of high fracture intensity on the model correlates positively with the presence of fluid in accordance with DST data.

  15. Under-reporting of osteoporotic vertebral fractures on computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Williams, Alexandra L. [Department of Radiology, Manchester Royal Infirmary, Oxford Road, Manchester (United Kingdom)], E-mail: alexandra.firth@virgin.net; Al-Busaidi, Aisha [Department of Radiology, Manchester Royal Infirmary, Oxford Road, Manchester (United Kingdom)], E-mail: albusaidi@doctors.org.uk; Sparrow, Patrick J. [Department of Radiology, Manchester Royal Infirmary, Oxford Road, Manchester (United Kingdom)], E-mail: patsparrow@doctors.org.uk; Adams, Judith E. [Department of Radiology, Manchester Royal Infirmary, Oxford Road, Manchester (United Kingdom); Department of Clinical Radiology, Imaging Science and Biomedical Engineering, Stopford Building, , University of Manchester, Oxford Road, Manchester M13 9PT (United Kingdom)], E-mail: judith.adams@manchester.ac.uk; Whitehouse, Richard W. [Department of Radiology, Manchester Royal Infirmary, Oxford Road, Manchester (United Kingdom)], E-mail: Richard.Whitehouse@cmmc.nhs.uk

    2009-01-15

    Purpose: Osteoporotic vertebral fractures are frequently asymptomatic. They are often not diagnosed clinically or radiologically. Despite this, prevalent osteoporotic vertebral fractures predict future osteoporotic fractures and are associated with increased mortality and morbidity. Appropriate management of osteoporosis can reduce future fracture risk. Fractures on lateral chest radiographs taken for other conditions are frequently overlooked by radiologists. Our aim was to assess the value of computed tomography (CT) in the diagnosis of vertebral fracture and identify the frequency with which significant fractures are missed. Materials and methods: The thoracic CT scans of 100 consecutive male and 100 consecutive female patients over 55 years were reviewed. CT images were acquired on General Electric Lightspeed multi-detector (MD) CT scanners (16 or 32 row) using 1.25 mm slice thickness. Midline sagittal images were reconstructed from the 3D volume images. The presence of moderate (25-40% height loss) or severe (>40% height loss) vertebral fractures between T1 and L1 was determined using an established semi-quantitative method and confirmed by morphological measurement. Results were compared with the formal CT report. Results: Scans of 192 patients were analysed (95 female; 97 male); mean age 70.1 years. Thirty-eight (19.8%) patients had one or more moderate to severe vertebral fractures. Only 5 (13%) were correctly reported as having osteoporotic fractures in the official report. The sensitivity of axial CT images to vertebral fracture was 0.35. Conclusion: Incidental osteoporotic vertebral fractures are under-reported on CT. The sensitivity of axial images in detecting these fractures is poor. Sagittal reformations are strongly recommended to improve the detection rate.

  16. 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.).

  17. Long term surgical treatment outcome of talar body fracture

    Directory of Open Access Journals (Sweden)

    Sen Ramesh Kumar

    2012-02-01

    Full Text Available 【Abstract】Objective: Talar body fractures are rare and have poor treatment outcome. The purpose of this study is to report the long term surgical treatment outcome of closed talar dome fractures. Methods: Eight closed talar body fractures, treated by open reduction and internal fixation with small fragment cancellous screws and/or Herbert screws in our level I trauma centre were retrospectively analyzed. Preoperative and postoperative radiographs of the foot (antero-posterior, lateral and oblique views and ankle (antero-posterior, lateral and mortise views were obtained. The patients were followed up both radiologically and functionally (foot function index, FFI after 3 weeks, 6 weeks, 3 months, 6 months and then annually. Results: There were five crush fractures and three shear fractures (two sagittal shear and one coronal shear, with average follow-up of 5 years. No early complications were noticed in these patients. Late complications included osteoarthrosis of subtalar/ankle joints in six patients and osteonecrosis of talar body in four patients. On functional assessment, mean FFI after 5 years was 104.63 points and worse outcome was noticed in crush injury and coronal shear fractures. Sagittal shear fractures had a good functional and radiological outcome. Conclusions: Late complications subsequent to surgically treated talar body fractures are inevitable, even though exact reduction and rigid fixation are achieved, thus patients are supposed to be counseled about the adverse outcome. Although crush and coronal shear fractures have poor outcome, sagittal injuries have good prognosis on long term evaluation. Key words: Fractures, bone; Talus; Fracture fixation, internal

  18. Carbonate fracture stratigraphy: An integrated outcrop and 2D discrete element modelling study

    Science.gov (United States)

    Spence, Guy; Finch, Emma

    2013-04-01

    Constraining fracture stratigraphy is important as natural fractures control primary fluid flow in low matrix permeability naturally fractured carbonate hydrocarbon reservoirs. Away from the influence of folds and faults, stratigraphic controls are known to be the major control on fracture networks. The fracture stratigraphy of carbonate nodular-chert rhythmite successions are investigated using a Discrete Element Modelling (DEM) technique and validated against observations from outcrops. Comparisons are made to the naturally fractured carbonates of the Eocene Thebes Formation exposed in the west central Sinai of Egypt, which form reservoir rocks in the nearby East Ras Budran Field. DEM allows mechanical stratigraphy to be defined as the starting conditions from which forward numerical modelling can generate fracture stratigraphy. DEM can incorporate both stratigraphic and lateral heterogeneity, and enable mechanical and fracture stratigraphy to be characterised separately. Stratally bound stratified chert nodules below bedding surfaces generate closely spaced lateral heterogeneity in physical properties at stratigraphic mechanical interfaces. This generates extra complexity in natural fracture networks in addition to that caused by bed thickness and lithological physical properties. A series of representative geologically appropriate synthetic mechanical stratigraphic models were tested. Fracture networks generated in 15 DEM experiments designed to isolate and constrain the effects of nodular chert rhythmites on carbonate fracture stratigraphy are presented. The discrete element media used to model the elastic strengths of rocks contain 72,866 individual elements. Mechanical stratigraphies and the fracture networks generated are placed in a sequence stratigraphic framework. Nodular chert rhythmite successions are shown to be a distinct type of naturally fractured carbonate reservoir. Qualitative stratigraphic rules for predicting the distribution, lengths, spacing

  19. [Fracture endoprosthesis of distal humerus fractures].

    Science.gov (United States)

    Müller, L P; Wegmann, K; Burkhart, K J

    2013-08-01

    The treatment of choice for fractures of the distal humerus is double plate osteosynthesis. Due to anatomical preshaped angle stable plates the primary stability and management of soft tissues has been improved. However, osteoporotic comminuted fractures in the elderly are often not amenable to stable osteosynthesis and total elbow arthroplasty has been established as an alternative therapy. Although complication rates have been reduced, complications of total elbow arthroplasty are still much more frequent than in total hip replacement. Furthermore, patients are advised not to exceed a weight bearing of 5 kg. Therefore, the indications for elbow arthroplasty must be evaluated very strictly and should be reserved for comminuted distal humeral fractures in the elderly with poor bone quality that are not amenable to stable osteosynthesis or for simple fractures in cases of preexisting symptomatic osteoarthritis. This article introduces and discusses modern concepts of elbow arthroplasty, such as modular convertible prosthesis systems, hemiarthroplasty and radial head replacement in total elbow arthroplasty.

  20. Displaced fracture through the anterior atlantal synchondrosis

    Energy Technology Data Exchange (ETDEWEB)

    Thakar, Chrishan; Allibone, James [Royal National Orthopaedic Hospital NHS Trust, Department of Spinal Deformity, Stanmore, Middlesex (United Kingdom); Harish, Srinivasan [Royal National Orthopaedic Hospital NHS Trust, Department of Radiology, Stanmore, Middlesex (United Kingdom); Saifuddin, Asif [Royal National Orthopaedic Hospital NHS Trust, Department of Radiology, Stanmore, Middlesex (United Kingdom); University College, The Institute of Orthopaedics and Musculoskeletal Sciences, London (United Kingdom)

    2005-09-01

    In the acute setting, accurate radiological interpretation of paediatric cervical spine trauma can be difficult due to a combination of normal variants and presence of multiple synchondroses. We present a rare case of a fracture through the anterior atlantal synchondrosis in a paediatric spine. A five-year-old boy, who fell backwards onto the top of his head while swinging across on a monkey bar frame, presented with neck pain, cervical muscle spasm and decreased right lateral rotation and extension of his neck. Computed tomography showed a displaced diastatic fracture through right anterior atlantal synchondrosis. There are only 12 cases of paediatric C1 fractures reported in the world literature. The importance of considering this diagnosis in the appropriate clinical setting, and the normal variants in the paediatric atlas that can cause diagnostic dilemma to the interpreting radiologist, are discussed in this case report. (orig.)

  1. Experience in the management of patients with nasal fractures.

    Directory of Open Access Journals (Sweden)

    Sahily Espino Otero

    2009-03-01

    Full Text Available Background: Nasal fracture is the most frequent facial trauma; its immediate treatment help avoiding further complications. Objective: to characterize the patients with nasal fracture who meet the criteria for treatment. Method: An observational, descriptive study was developed, including all patients (114 of 15 years or more with nasal fracture received at the Emergency Maxilo-Facial Surgical Department in the provincial hospital of Cienfuegos from June 2006 to April 2007. The studies variables were age, sex, aetiology, clinical signs, classification depending on the fractures focus and direction of the trauma, treatment following the guidelines for good clinical practices and post-treatment assessment. Results: There was higher incidence of males and the age group between 15 and 44. The main cause of fracture were fights, the most frequent clinical sign was epistaxis. The most common fractures were closed fractures and lateral deviation fractures. Most of the patients received immediate treatment. Among the clinical postsurgical sing was nasal congestion. Conclusions: We proved that immediate care should be provided to patients with this kind of fractures with local anaesthesia to avoid further risks.

  2. Fracturing tests on reservoir rocks: Analysis of AE events and radial strain evolution

    CERN Document Server

    Pradhan, S; Fjær, E; Stenebråten, J; Lund, H K; Sønstebø, E F; Roy, S

    2015-01-01

    Fracturing in reservoir rocks is an important issue for the petroleum industry - as productivity can be enhanced by a controlled fracturing operation. Fracturing also has a big impact on CO2 storage, geothermal installation and gas production at and from the reservoir rocks. Therefore, understanding the fracturing behavior of different types of reservoir rocks is a basic need for planning field operations towards these activities. In our study, the fracturing of rock sample is monitored by Acoustic Emission (AE) and post-experiment Computer Tomography (CT) scans. The fracturing experiments have been performed on hollow cylinder cores of different rocks - sandstones and chalks. Our analysis show that the amplitudes and energies of acoustic events clearly indicate initiation and propagation of the main fractures. The amplitudes of AE events follow an exponential distribution while the energies follow a power law distribution. Time-evolution of the radial strain measured in the fracturing-test will later be comp...

  3. Jaw fractures in children.

    Science.gov (United States)

    Kotilainen, R; Kärjä, J; Kullaa-Mikkonen, A

    1990-03-01

    From a total of 350 jaw fractures treated in 1980-1984 at Kuopio University Central Hospital, 20% were in children. These injuries were evaluated retrospectively regarding age, sex, incidence and etiology. Forty-five of the patients were boys and 25 girls. The frequency of maxillary and mandibular fractures in 70 young patients was 28.6%. The most common type of bone fractures was fracture of the alveolar process, which was prevalent in persons with mixed dentition. Before the age of 7 years, falls from height were the common causes of jaw fractures. The major cause of the jaw fractures in children from 7 to 15 years old was road accidents (47.1%), especially in boys. Most of these were cycling accidents, only a few patients were victims of automobile accidents. In addition, about one third (25.7%) of the patients were treated in the hospital because of multiple injuries to other organs.

  4. Growing skull fracture

    Directory of Open Access Journals (Sweden)

    Mihajlović Miljan H.

    2006-01-01

    Full Text Available Background. Growing skull fracture or craniocerebral erosion is a rare complication of linear skull fracture in childhood. It is characterized by progressive diastatic enlargement of the fracture line, which leads to a cranial defect, dural cleft, and cerebral herniation. It is presented as a soft pulsabile scalp swelling above the fracture, with a clear cranial defect. Case report. In this paper we presented a patient, an 8-month-old boy with the growing skull fracture revealed four weeks after the injury. After the surgical treatment, the boy was in a good general condition without the presence of neurologic impairment. Conclusion. Early recognition of craniocerebral erosion is very important. Timely detection prevents further progression of the disease and the evolution of neurological impairment. Surgery is the method of choice for treating a growing skull fracture .

  5. Pelvic fractures and mortality.

    OpenAIRE

    K.H. Chong; DeCoster, T.; Osler, T.; Robinson, B.

    1997-01-01

    A retrospective study of all patients (N = 343) with pelvic fractures admitted to our trauma service was conducted to evaluate the impact of pelvic fractures on mortality. All patients sustained additional injuries with an average Injury Severity Score (ISS) of twenty. Thirty-six patients died. This group had more severe pelvic fractures as graded by the Tile classification as well as a greater number and severity of associated injuries. Six patients died as a direct result of pelvic hemorrha...

  6. Oblique Axis Body Fracture

    DEFF Research Database (Denmark)

    Takai, Hirokazu; Konstantinidis, Lukas; Schmal, Hagen;

    2016-01-01

    was uneventful. Conclusions. Oblique type axis body fractures resemble a highly unstable subtype of Anderson type III fractures with the potential of severe secondary deformity following conservative treatment, irrespective of initial grade of displacement. The authors therefore warrant a high index of suspicion......Purpose. Anderson type III odontoid fractures have traditionally been considered stable and treated conservatively. However, unstable cases with unfavorable results following conservative treatment have been reported. Methods. We present the cases of two patients who sustained minimally displaced...

  7. Stress fracture of the proximal fibula after total knee arthroplasty.

    Science.gov (United States)

    Vaish, Abhishek; Vaishya, Raju; Agarwal, Amit Kumar; Vijay, Vipul

    2016-04-22

    We report a rare case of proximal fibular fatigue fracture developing 14 years after total knee arthroplasty in a known case of rheumatoid arthritis. A valgus deformity of the knee can put abnormal stress on the upper fibula leading to its failure. We believe that, as the fibula acts as an important lateral strut, its disruption due to a fracture led to rapid progress of the valgus deformity of the knee in this patient.

  8. Subtrochanteric Femoral Insufficiency Fracture Following Bisphosphonate Therapy for Osseous Metastases

    OpenAIRE

    Bush, Lisabeth A.; Chew, Felix S.

    2015-01-01

    We present the case of an insufficiency fracture of the femoral shaft in a 61-year-old man who had received bisphosphonate therapy to reduce the fracture risk from lytic renal cell carcinoma metastases to the spine. Approximately 1.5 years after beginning monthly intravenous infusions of zoledronic acid (Zometa), the patient complained of persistent thigh pain. Radionuclide bone scan showed mildly increased activity in the lateral subtrochanteric cortex of the right femur, where there was foc...

  9. Acute finger injuries: part II. Fractures, dislocations, and thumb injuries.

    Science.gov (United States)

    Leggit, Jeffrey C; Meko, Christian J

    2006-03-01

    Family physicians can treat most finger fractures and dislocations, but when necessary, prompt referral to an orthopedic or hand surgeon is important to maximize future function. Examination includes radiography (oblique, anteroposterior, and true lateral views) and physical examination to detect fractures. Dislocation reduction is accomplished with careful traction. If successful, further treatment focuses on the concomitant soft tissue injury. Referral is needed for irreducible dislocations. Distal phalanx fractures are treated conservatively, and middle phalanx fractures can be treated if reduction is stable. Physicians usually can reduce metacarpal bone fractures, even if there is a large degree of angulation. An orthopedic or hand surgeon should treat finger injuries that are unstable or that have rotation. Collateral ligament injuries of the thumb should be examine with radiography before physical examination. Stable joint injuries can be treated with splinting or casting, although an orthopedic or hand surgeon should treat unstable joints.

  10. [(Impending) pathological fracture].

    Science.gov (United States)

    Sutter, P M; Regazzoni, P

    2002-01-01

    Pathological fractures will be encountered in increasing frequency due to more patients with cancer, surviving a longer period. The skeleton is the third most frequent localization for metastases. Breast cancer is still the most common primary tumor, but bone metastases from lung cancer seem to be diagnosed more and more. Despite of finding metastases most often in the spinal column, fractures are seen mostly at the femoral site. A pathological fracture and, in almost all cases, an impending fracture are absolute indication for operation. An exact definition of an "impending fracture" is still lacking; it is widely accepted, that 50 per cent of bone mass must be destroyed before visualization in X-ray is possible, thus defining an impending fracture. The score system by Mirels estimates the fracture risk by means of four parameters (localization, per cent of destructed bone mass, type of metastasis, pain). Improving quality of life, relieving pain, preferably with a single operation and a short length of stay are the goals of (operative) treatment. For fractures of the proximal femur, prosthetic replacement, for fractures of the subtrochanteric region or the shaft, intramedullary nails are recommended. Postoperative radiation therapy possibly avoids tumor progression. In patient with a good long term prognosis, tumor should be removed locally aggressive.

  11. Fracture mechanics safety approaches

    Energy Technology Data Exchange (ETDEWEB)

    Roos, E.; Schuler, X.; Eisele, U. [Materials Testing Inst. (MPA), Univ. of Stuttgart (Germany)

    2004-07-01

    Component integrity assessments require the knowledge of reliable fracture toughness parameters characterising the initiation of the failure process in the whole relevant temperature range. From a large number of fracture mechanics tests a statistically based procedure was derived allowing to quantify the initiation of fracture toughness as a function of temperature as a closed function as well as the temperature dependence of the cleavage instability parameters. Alternatively to the direct experimental determination one also can use a correlation between fracture toughness and notch impact energy. (orig.)

  12. Scaphoid fractures in children

    Directory of Open Access Journals (Sweden)

    Gajdobranski Đorđe

    2014-01-01

    Full Text Available Introduction. Scaphoid fractures are rare in childhood. Diagnosis is very difficult to establish because carpal bones are not fully ossified. In suspected cases comparative or delayed radiography is used, as well as computerized tomography, magnetic resonance imaging, ultrasound and bone scintigraphy. Majority of scaphoid fractures are treated conservatively with good results. In case of delayed fracture healing various types of treatment are available. Objective. To determine the mechanism of injury, clinical healing process, types and outcome of treatment of scaphoid fractures in children. Methods. We retrospectively analyzed patients with traumatic closed fracture of the scaphoid bone over a ten-year period (2002-2011. The outcome of the treatment of “acute” scaphoid fracture was evaluated using the Mayo Wrist Score. Results. There were in total 34 patients, of mean age 13.8 years, with traumatic closed fracture of the scaphoid bone, whose bone growth was not finished yet. Most common injury mechanism was fall on outstretched arm - 76% of patients. During the examined period 31 children with “acute” fracture underwent conservative treatment, with average immobilization period of 51 days. Six patients were lost to follow-up. In the remaining 25 patients, after completed rehabilitation, functional results determined by the Mayo Wrist Score were excellent. Conclusion. Conservative therapy of “acute” scaphoid fractures is an acceptable treatment option for pediatric patients with excellent functional results.

  13. Atraumatic First Rib Fracture

    Directory of Open Access Journals (Sweden)

    Koray Aydogdu

    2014-12-01

    Full Text Available Rib fractures are usually seen after a trauma, while atraumatic spontaneous rib fractures are quite rare. A first rib fracture identified in our 17 years old female patient who had not a history of trauma except lifting a heavy weight was examined in details in terms of the potential complications and followed-up for a long time. We presented our experience on this case with atraumatic first rib fracture that has different views for the etiology in light of the literature.

  14. Nonunion of subtrochanteric fractures: Comminution or Malreduction

    Science.gov (United States)

    Park, Sang Hyun; Kong, Gyu Min; HA, Byeong Ho; Park, Jun Ho; Kim, Kun Hyung

    2016-01-01

    Objective: This study aimed to investigate the impact on nonunion of the extent of comminution and postoperative displacement in patients surgically treated for subtrochanteric fractures. Methods: From 2008 to 2013, 44 patients with subtrochanteric fractures underwent surgery and follow-up. Retrospective data collection showed that it had 32 male and 12 female. Their mean age was 45 years. The case distribution according to Seinsheimer classification was as follows: IIA,8; IIB, 5; IIC, 7; IIIA, 8; IIIB, 3; IV, 9; and V, 4. Cephalomedullary nails were used in 28 cases; ordinary nails, in 9; and plates, in 7. After surgery, the fractures were evaluated for displacement on anteroposterior (AP) and lateral radiography. Results: Of the 44 patients, 37 achieved union from primary surgery at a mean time of 8.4 months. Five cases did not show union within the follow-up period. Two cases of nail breakage were diagnosed as non-union. Among the non-union cases, two were Seinsheimer classification IIIA; 3, IV; and 2, V. Displacement was observed on the lateral and A Pradiographs of 4 cases, on only the lateral radiographs of two cases, and in neither radiograph of one case. The risk of non-union was approximately 15.4 and 24.2 times higher when displacement was observed on the AP (95% confidence interval [CI]: 1.33–176.82) and lateral images (95% CI: 1.76–335.67), respectively. Conclusion: When displacement occurred after surgical treatment for subtrochanteric fractures, the risk of nonunion increased owing to the difficulty achieving stable fixation. PMID:27375695

  15. Amyotrophic Lateral Sclerosis (ALS)

    Science.gov (United States)

    ... ALS Neurons' broken machinery piles up in ALS Esclerosis Lateral Amiotrófica Dormant viral genes may awaken to ... Dementia Information Page Multifocal Motor Neuropathy Information Page Multiple Sclerosis Information Page Muscular Dystrophy Information Page Myasthenia ...

  16. Amyotrophic lateral sclerosis (ALS)

    Science.gov (United States)

    Lou Gehrig disease; ALS; Upper and lower motor neuron disease; Motor neuron disease ... 98. Shaw PJ. Amyotrophic lateral sclerosis and other motor neuron diseases. In: Goldman L, Schafer AI, eds. Goldman's Cecil ...

  17. TIBIAL PLATEAU FRACTURES – SURGICAL MANAGEMENT BY MIPPO

    Directory of Open Access Journals (Sweden)

    Bharath Raju

    2014-06-01

    Full Text Available BACKGROUND AND OBJECTIVES: Tibial plateau fractures are one of the most common intra-articular fractures. They are the outcome of indirect coronal or direct compressive forces. The incidence of tibial plateau fractures is 1.3% of all fractures. These fractures have varied degree of fracture configuration involving medial, lateral or both tibial plateaus with varied degree of intra-articular depressions and displacements. Due to speedy vehicles and mechanization there has been increase in the number of tibial plateau fractures. Knee joints being one of the major weight bearing joints of human body, these fractures are of big importance. METHODS: We studied 30 cases of tibial plateau fractures treated by MIPPO at kempegowda institute of medical sciences from June 2012 to April 2014 with minimum follow up of up to 6months. RESULTS: All the selected patients were evaluated both clinically as well as radiologically. The lab investigations were done and then they were taken up for the surgery. The fractures were classified as per schatzker’s classification and treated accordingly. In the post-op period early range of movements were started and the patients were non weight bearing till 6 weeks. Till 12 weeks partial weight bearing was allowed and full weight bearing was allowed after radiological union of the fracture. CONCLUSION: Tibial plateau fractures when treated with MIPPO give articular anatomical reduction, rigid fixation and early mobolisation of the knee joint. This prevents development of osteoarthritis and includes all the advantages of minimally invasive procedure and so better patient compliance.

  18. Fracture of the styloid process associated with the mandible fracture

    Directory of Open Access Journals (Sweden)

    K N Dubey

    2013-01-01

    Full Text Available Fracture of the styloid process (SP of temporal bone is an uncommon injuries. Fracture of the SP can be associated with the facial injuries including mandible fracture. However, injury to the SP may be concealed and missed diagnosis may lead to the improper or various unnecessary treatments. A rare case of SP fracture associated with the ipsilateral mandibular fracture and also the diagnostic and management considerations of the SP fracture are discussed.

  19. Fracture Penis: An Analysis of 26 Cases

    Directory of Open Access Journals (Sweden)

    G.V.Soundra Pandyan

    2006-01-01

    Full Text Available The aim of this study was to review the pattern of penile fracture occurrence, its clinical presentation, diagnosis, management, and outcome at our center. A retrospective analysis of 26 patients with penile fractures treated at our hospital from January 1997 to January 2005 was carried out. We noted an incidence of 3.5 cases per year, occurring more commonly in unmarried men. Of our study group, 28 episodes of penile fractures occurred in 26 patients. Hospital presentation after trauma varied from 2 h to 21 days. Masturbation was the main initiating causative factor and penile hematoma was the most common clinical finding. Nearly 81% noticed the characteristic click prior to the fracture. Clinical diagnosis was adequate in a majority of the cases. Midshaft fractures with right-sided laterality were more frequent in this series. The tear size ranged from 0.5—2.5 cm with a mean of 1.1 cm. All cases, but one, were treated by surgical repair using absorbable sutures. Out of three cases treated conservatively, two failed to respond and had to be treated surgically. False fracture with dorsal vein tear was present in two cases. Involvement of bilateral corpora was seen in one patient. Infection was the most common early complication, while pain with deviation was the late complication. In our experience, clinical findings are adequate enough to diagnose fracture penis in a majority of cases. Surgical exploration with repair of the tear is recommended both in early and delayed presentations. There was no noticeable relationship to the time of initial presentation or with the size and site of tear to the final outcome.

  20. A Salter Harris type II fracture of the distal ulna in a fourteen month female neutered Great Dane.

    Science.gov (United States)

    Langley-Hobbs, S J

    2005-01-01

    A displaced Salter Harris type II fracture of the distal ulna and a minimally displaced Salter Harris type II fracture of the distal radius were diagnosed in a fourteen month female neutered Great Dane dog. Fracture reduction was challenging but treatment was successful. Aetiology of the unusual fracture is discussed. Long bone physes may close later in giant breeds, early neutering can cause a further delay.

  1. Neck of femur fracture fixation in a bilateral amputee: an uncommon condition requiring an improvised fracture table positioning technique.

    Science.gov (United States)

    Berg, Andrew James; Bhatia, Chandra

    2014-02-21

    While neck of femur fractures are common it is rare to see this injury in a bilateral leg amputee. Special consideration needs to be given to the management of these patients. We report the case of a 58-year-old man with bilateral leg amputation who presented to the emergency department with left hip pain following a fall. A fracture of the left neck of femur with extension into the femoral shaft was diagnosed. Internal fixation was planned with a dynamic hip screw. Standard fracture table setup, which allows for traction of the fractured limb and positioning of the contralateral limb such that anteroposterior and lateral X-rays can be obtained, was not possible in this case due to the amputations. We highlight considerations that need to be made in positioning a bilateral amputee for neck of femur fracture fixation and also highlight an improvised technique that can be utilised by other surgeons.

  2. Dynamic biomechanics of the human head in lateral impacts.

    Science.gov (United States)

    Zhang, Jiangyue; Yoganandan, Narayan; Pintar, Frank A

    2009-10-01

    The biomechanical responses of human head (translational head CG accelerations, rotational head accelerations, and HIC) under lateral impact to the parietal-temporal region were investigated in the current study. Free drop tests were conducted at impact velocities ranging from 2.44 to 7.70 m/s with a 40 durometer, a 90 durometer flat padding, and a 90 durometer cylinder. Specimens were isolated from PMHS subjects at the level of occipital condyles, and the intracranial substance was replaced with brain simulant (Sylgard 527). Three tri-axial accelerometers were instrumented at the anterior, posterior, and vertex of the specimen, and a pyramid nine accelerometer package (pNAP) was used at the contra-lateral site. Biomechanical responses were computed by transforming accelerations measured at each location to the head CG. The results indicated significant "hoop effect" from skull deformation. Translational head CG accelerations were accurately measured by transforming the pNAP, the vertex accelerations, or the average of anterior/posterior acceleration to the CG. The material stiffness and structural rigidity of the padding changed the biomechanical responses of the head with stiffer padding resulting in higher head accelerations. At the skull fracture, HIC values were more than 2-3x higher than the frontal skull fracture threshold (HIC=1000), emphasizing the differences between frontal and lateral impact. Rotational head accelerations up to 42.1 krad/s(2) were observed before skull fracture, indicating possible severe brain injury without skull fracture in lateral head impact. These data will help to establish injury criteria and threshold in lateral impacts for improved automotive protection and help clinicians understand the biomechanics of lateral head impact from improved diagnosis.

  3. Uncommon Variant of Type II Monteggia Fracture with Concomitant Distal Humeral Fracture

    Science.gov (United States)

    Matta, Jihad F.; El Rassi, George S.; Abd El Nour, Hicham G.; El Asmar, Rachel

    2015-01-01

    Monteggia fracture-dislocation, a common injury sustained by pediatric population, is a rare entity in adults. It was first observed by Giovanni Battista Monteggia and later classified by Bado into 4 groups. The term “Monteggia equivalent or variant” was introduced to describe certain injuries with similar radiographic pattern and biomechanism of injury. Since then various types and their variants have been described in the literature. We present a complex fracture pattern in a 55-year-old male not previously described in the literature along with its treatment modality and favorable outcome. PMID:26550509

  4. Hip Fractures among Older Adults

    Science.gov (United States)

    ... online training for health care providers. Learn More Hip Fractures Among Older Adults Recommend on Facebook Tweet Share ... get older. What You Can Do to Prevent Hip Fractures You can prevent hip fractures by taking steps ...

  5. Fracture resistance of composite resin restorations and porcelain veneers in relation to residual tooth structure in fractured incisors.

    Science.gov (United States)

    Batalocco, Guido; Lee, Heeje; Ercoli, Carlo; Feng, Changyong; Malmstrom, Hans

    2012-02-01

    The aim of the present study was to investigate whether there is a direct correlation between the amount of residual tooth structure in a fractured maxillary incisor and the fracture resistance of composite resin restorations or porcelain veneers after cyclic loading. Sixty human-extracted maxillary central and lateral incisors were mounted in an acrylic block with the coronal aspect of the tooth protruding from the block surface. The teeth were assigned to two groups: 2-mm incisal fracture and 4-mm incisal fracture. Then, the teeth were further divided into two different restoration subgroups, porcelain laminate veneer and composite resin restoration, therefore obtaining four groups for the study (n=15). The specimens were subjected to 1000 cycles of thermocycling and were mechanically tested with a custom-designed cyclic loading apparatus for 2×106 cycles or until they failed. The specimens that survived the cyclic loading were loaded on the incisal edge along the long axis of the tooth with a flat stainless steel applicator until they fractured using a universal testing machine to measure the failure load. Two-way anova was used to assess the significance of restoration, amount of fracture, and interaction effect (α=0.05). During the cyclic loading, for the composite resin group, two specimens with 2-mm fracture and three specimens with 4-mm fracture failed. For the porcelain veneer group, two specimens with 2-mm fracture and one specimen with 4-mm fracture failed. The 2-way anova did not show statistical significance for restoration (P=0.584), amount of fracture (P=0.357), or interaction effect (P=0.212). A composite resin restoration and a porcelain veneer could perform similarly for replacing a fractured incisor edge up to 4mm. Other factors such as esthetic and/or cost would be considerations to indicate one treatment over the other.

  6. Lateral epicondylitis and beyond: imaging of lateral elbow pain with clinical-radiologic correlation.

    Science.gov (United States)

    Kotnis, Nikhil A; Chiavaras, Mary M; Harish, Srinivasan

    2012-04-01

    The diagnosis of lateral epicondylitis is often straightforward and can be made on the basis of clinical findings. However, radiological assessment is valuable where the clinical picture is less clear or where symptoms are refractory to treatment. Demographics, aspects of clinical history, or certain physical signs may suggest an alternate diagnosis. Knowledge of the typical clinical presentation and imaging findings of lateral epicondylitis, in addition to other potential causes of lateral elbow pain, is necessary. These include entrapment of the posterior interosseous and lateral antebrachial cutaneous nerves, posterolateral rotatory instability, posterolateral plica syndrome, Panner's disease, osteochondritis dissecans of the capitellum, radiocapitellar overload syndrome, occult fractures and chondral-osseous impaction injuries, and radiocapitellar arthritis. Knowledge of these potential masquerades of lateral epicondylitis and their characteristic clinical and imaging features is essential for accurate diagnosis. The goal of this review is to provide an approach to the imaging of lateral elbow pain, discussing the relevant anatomy, various causes, and discriminating factors, which will allow for an accurate diagnosis.

  7. Lateral epicondylitis and beyond: imaging of lateral elbow pain with clinical-radiologic correlation

    Energy Technology Data Exchange (ETDEWEB)

    Kotnis, Nikhil A. [McMaster University, Departments of Radiology, Hamilton, ON (Canada); Sheffield Teaching Hospitals, Department of Medical Physics and Medical Imaging, Sheffield (United Kingdom); Chiavaras, Mary M. [McMaster University, Departments of Radiology, Hamilton, ON (Canada); Harish, Srinivasan [McMaster University, Departments of Radiology, Hamilton, ON (Canada); St. Joseph' s Healthcare, Department of Diagnostic Imaging, Hamilton, ON (Canada)

    2012-04-15

    The diagnosis of lateral epicondylitis is often straightforward and can be made on the basis of clinical findings. However, radiological assessment is valuable where the clinical picture is less clear or where symptoms are refractory to treatment. Demographics, aspects of clinical history, or certain physical signs may suggest an alternate diagnosis. Knowledge of the typical clinical presentation and imaging findings of lateral epicondylitis, in addition to other potential causes of lateral elbow pain, is necessary. These include entrapment of the posterior interosseous and lateral antebrachial cutaneous nerves, posterolateral rotatory instability, posterolateral plica syndrome, Panner's disease, osteochondritis dissecans of the capitellum, radiocapitellar overload syndrome, occult fractures and chondral-osseous impaction injuries, and radiocapitellar arthritis. Knowledge of these potential masquerades of lateral epicondylitis and their characteristic clinical and imaging features is essential for accurate diagnosis. The goal of this review is to provide an approach to the imaging of lateral elbow pain, discussing the relevant anatomy, various causes, and discriminating factors, which will allow for an accurate diagnosis. (orig.)

  8. Pneumothorax complicating isolated clavicle fracture.

    Science.gov (United States)

    Hani, Redouane; Ennaciri, Badr; Jeddi, Idriss; El Bardouni, Ahmed; Mahfoud, Mustapha; Berrada, Mohamed Saleh

    2015-01-01

    Isolated clavicle fractures are among the commonest of traumatic fractures in the emergency department. Complications of isolated clavicle fractures are rare. Pneumothorax has been described as a complication of a fractured clavicle only rarely in English literature. In all the reported cases, the pneumothorax was treated by a thoracostomy and the clavicle fracture was treated conservatively. In our case, the pneumothorax required a chest drain insertion and the clavicle fracture was treated surgically with good result.

  9. Clinical usefulness of CT in the diagnosis of severe pelvic fractures

    Energy Technology Data Exchange (ETDEWEB)

    Gotoh, Shinsuke; Tajima, Hiroyuki [Nippon Medical School, Tokyo (Japan)

    1998-11-01

    The purpose of this paper is to clarify the clinical significance of CT in the diagnosis of severe pelvic fractures. Fifty-six consecutive patients with severe pelvic ring fractures were the subjects of this study. The assessments were as follows: comparison of the diagnostic value of plain X-P and CT for the detection of pelvic fractures, comparison hemodynamic findings before TAE therapy, comparison between abnormal angiographic findings and fracture sites on CT, and comparison between abnormal angiographic findings and volume of retroperitoneal hematomas on CT. CT was more useful for the detection of severe pelvic ring fractures, especially for sacral fracture and iliosacral joint dislocations, than plain X-P. Sacral fracture group was more severe than iliac fracture group on CT. There was a discrepancy between the angiographic findings and fracture sites in 20 of the 56 patients. Angiographic abnormalities without fracture were seen especially in the lateral sacral artery and iliolumbar artery. There was a discrepancy between the angiographic findings and retroperitoneal hematomas in 38 of the 56 patients. Retroperitoneal hematomas, especially around the ilium, were seen on CT in 40 areas in the absence of any abnormal angiographic findings. Conversely, angiographic extravasation without hematoma on CT was seen in 20 areas, especially in lateral sacral artery. CT is useful for detection and intervention in severe pelvic ring fractures. (author)

  10. Vertebral Fracture Prediction

    DEFF Research Database (Denmark)

    2008-01-01

    Vertebral Fracture Prediction A method of processing data derived from an image of at least part of a spine is provided for estimating the risk of a future fracture in vertebraeof the spine. Position data relating to at least four neighbouring vertebrae of the spine is processed. The curvature...

  11. Radial head fracture - aftercare

    Science.gov (United States)

    ... Philadelphia, PA: Elsevier Saunders; 2015:chap 6. Prawer A. Radius and ulna fractures. In: Eiff M, Hatch R, eds. Fracture Management for Primary Care . 3rd ed. Philadelphia, PA: Elsevier Saunders; 2012:chap ... PhD, and the A.D.A.M. Editorial team. Related MedlinePlus Health ...

  12. Displaced patella fractures.

    Science.gov (United States)

    Della Rocca, Gregory J

    2013-10-01

    Displaced patella fractures often result in disruption of the extensor mechanism of the knee. An intact extensor mechanism is a requirement for unassisted gait. Therefore, operative treatment of the displaced patella fracture is generally recommended. The evaluation of the patella fracture patient includes examination of extensor mechanism integrity. Operative management of patella fractures normally includes open reduction with internal fixation, although partial patellectomy is occasionally performed, with advancement of quadriceps tendon or patellar ligament to the fracture bed. Open reduction with internal fixation has historically been performed utilizing anterior tension band wiring, although comminution of the fracture occasionally makes this fixation construct inadequate. Supplementation or replacement of the tension band wire construct with interfragmentary screws, cerclage wire or suture, and/or plate-and-screw constructs may add to the stability of the fixation construct. Arthrosis of the patellofemoral joint is very common after healing of patella fractures, and substantial functional deficits may persist long after fracture healing has occurred. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  13. THORACIC SPINE FRACTURES

    Institute of Scientific and Technical Information of China (English)

    戴力扬

    2001-01-01

    Objective. To investigate the unique characteristics and treatment of thoracic spine fractures.Methods. Severty-seven patients with thoracic spine fractures were retrospectively reviewed. Of these, therewere 37 compressior fractures, 34 fracture-dislocations, 3 burst fractures and 3 burst-dislocations. Twenty-six pa-tients had a complete lesion of the spinal cord, 14 sustained a neurologically incomplete injury, and 37 wereneurologically intact. Fifty-three patients were treated nonoperatively and 24 treated operatively.Results. All patients were followed up for 2 ~ 15 years. None of the 26 patients with a complete lesion recov-ered any significant function. Of 37 neurologically intact patients, 13 had local pain although all of them re-mained normal function. Two of 14 patients with incomplete paraplegia returned to normal, 7 recovered some func-tion and 5 did not recovered.Conclusions. E ecause of the unique anatomy and biomechanics of the thoracic spine, the classification common-ly applied to thoracolumbar fractures is not suitable for thoracic fractures. Fusion and instrumentation are indicat-ed when the fractures are unstable, while patients with incomplete lesion of the spinal cord may be the candidatesfor supplemented decompression.

  14. An alternative method of osteosynthesis for distal humeral shaft fractures.

    Science.gov (United States)

    Levy, Jonathan C; Kalandiak, Steven P; Hutson, James J; Zych, Gregory

    2005-01-01

    Treatment of extra-articular distal humerus shaft fractures with plating techniques is often difficult, as traditional centrally located posterior plates often encroach on the olecranon fossa, limiting distal osseous fixation. The use of a modified Synthes Lateral Tibial Head Buttress Plate (Synthes, Paoli, PA) allows for a centrally placed posterior plating of the humeral shaft that angles anatomically along the lateral column to treat far distal humeral shaft fractures. Fifteen patients treated in this manner were followed to radiographic and clinical union. There were no cases of instrumentation failure or loss of reduction.

  15. Pediatric supracondylar humerus fractures: effect of bone-implant interface conditions on fracture stability.

    Science.gov (United States)

    Lamdan, Ron; Liebergall, Meir; Gefen, Amit; Symanovsky, Naum; Peleg, Eran

    2013-12-01

    Closed reduction and percutaneous fixation with Kirschner wires (KWs) is the standard of care of pediatric supra-condylar humerus fractures (SCHFs). Failure modes leading to loss of reduction are not clear and have not been quantified. Multiple factors may weaken the KW-bone interface bonding conditions. To the best of our knowledge, the possible effect of this decrease on different KW configurations and fracture stability has never been studied. To investigate the effect of bone-KW friction conditions on SCHF post-operative mechanical stability and to formulate clinical guidelines for KW configuration under different conditions. Finite element-based model of a fixated SCHF was used to simulate structure stability for two lateral divergent versus crossed lateral and medial KW configurations under varying KW-bone friction conditions. Finite element simulations demonstrated that crossed KWs provide superior stability compared with the divergent configuration when KW-bone bonding is compromised. When KW-bone bonding conditions are adequate, crossed and divergent KW configurations provide similar, sufficient fracture stability. Under normal bone-implant interface conditions, the two diverging lateral KW configuration offers satisfactory mechanical stability and may be the preferred choice of SCHF fixation. When KW-bone bonding is suboptimal, as when one or more of the lateral KWs are re-drilled, addition of a medial KW should be considered in order to improve stability despite risk to ulnar nerve.

  16. Galeazzi fracture-dislocations.

    Science.gov (United States)

    Mikić, Z D

    1975-12-01

    Among 125 patients with the Galeazzi-type fracture-dislocation of the forearm, there were fourteen children and eighty-six adults with the classic Galeazzi lesion, and twenty-five patients with a special type -- fracture of both bones and dislocation of the distal radio-ulnar joint. Conservative management was successful only in children. In adults this method resulted in failure in 80 per cent of cases. The results of operative treatment were much better. The fracture fragments of the radius and the dislocation of the radio-ulnar joint in this complex injury are very unstable, especially in the lesion with fractures of the radius and ulna, and it appears that rigid internal fixation is necessary for the dislocation as well as the fracture. With combined fixation over half of the results were excellent.

  17. Dynamic fracture mechanics

    Science.gov (United States)

    Kobayashi, A. S.; Ramulu, M.

    1985-01-01

    Dynamic fracture and crack propagation concepts for ductile materials are reviewed. The equations for calculating dynamic stress integrity and the dynamic energy release rate in order to study dynamic crack propagation are provided. The stress intensity factor versus crack velocity relation is investigated. The uses of optical experimental techniques and finite element methods for fracture analyses are described. The fracture criteria for a rapidly propagating crack under mixed mode conditions are discussed; crack extension and fracture criteria under combined tension and shear loading are based on maximum circumferential stress or energy criteria such as strain energy density. The development and use of a Dugdale model and finite element models to represent crack and fracture dynamics are examined.

  18. Dating fractures in infants

    Energy Technology Data Exchange (ETDEWEB)

    Halliday, K.E., E-mail: kath.halliday@nuh.nhs.uk [Department of Radiology, Nottingham University Hospitals, Queen' s Medical Centre, Nottingham (United Kingdom); Broderick, N.J.; Somers, J.M. [Department of Radiology, Nottingham University Hospitals, Queen' s Medical Centre, Nottingham (United Kingdom); Hawkes, R. [Department of Radiology, Paul O' Gorman Building, Bristol (United Kingdom)

    2011-11-15

    Aim: To document the timing of the appearance of the radiological features of fracture healing in a group of infants in which the date of injury was known and to assess the degree of interobserver agreement. Materials and methods: Three paediatric radiologists independently assessed 161 images of 37 long bone fractures in 31 patients aged 0-44 months. The following features were assessed: soft-tissue swelling, subperiosteal new bone formation (SPNBF), definition of fracture line, presence or absence of callus, whether callus was well or ill defined, and the presence of endosteal callus. Results: Agreement between observers was only moderate for all discriminators except SPNBF. SPNBF was invariably seen after 11 days but was uncommon before this time even in the very young. In one case SPNBF was seen at 4 days. Conclusion: With the exception of SPNBF, the criteria relied on to date fractures are either not reproducible or are poor discriminators of fracture age.

  19. Correlation between Operation Result and Patient Satisfaction of Nasal Bone Fracture.

    Science.gov (United States)

    Kang, Chang Min; Han, Dong Gil

    2017-03-01

    Many authors have evaluated the post-reduction result of nasal bone fracture through patient satisfaction or postoperative complications. However, these results are limited because they are subjective. The aim of this study was to correlate an objective operation result with patient satisfaction and postoperative complications according to the type of nasal bone fractures. Our study included 313 patients who had isolated nasal bone fractures and had undergone a closed reduction. Postoperative outcomes were evaluated objectively using computed tomographic (CT) images, while patient satisfaction was evaluated one month after the operation. The correlation of the operation result with patient satisfaction was then evaluated. The correlation between the operation result and patient satisfaction was highest for the lateral impact group type I (LI) type of fracture and lowest for the comminuted fracture group (C) type of fracture. However, there were no statistically significant differences in correlation between the overall result and patient satisfaction by fracture type. The complication rate of lateral impact group type II (LII), C, and frontal impact group type I (FI) fractures were statistically significantly higher than that of frontal impact group type II (FII) and LI fractures. There were no statistically significant relationships between the prevalence of complications and septal fracture or deviation according to the fracture type. In the total group, however, there was a statistically significant difference in complication rate by septal fracture. We found that the CT outcomes correlated with patient satisfaction. The complication rate of LII, C, and FI fractures were statistically significantly higher than that of FII and LI fractures. Septal fracture/deviation increased the postoperative complication in the total group.

  20. Unstable Jefferson fractures: Results of transoral osteosynthesis

    Directory of Open Access Journals (Sweden)

    Yong Hu

    2014-01-01

    Full Text Available Background: Majority of C 1 fractures can be effectively treated conservatively by immobilization or traction unless there is an injury to the transverse ligament. Conservative treatment usually involves a long period of immobilization in a halo-vest. Surgical intervention generally involves fusion, eliminating the motion of the upper cervical spine. We describe the treatment of unstable Jefferson fractures designed to avoid these problems of both conservative and invasive methods. Materials and Methods: A retrospective review of 12 patients with unstable Jefferson fractures treated with transoral osteosynthesis of C 1 between July 2008 and December 2011 was performed. A steel plate and C 1 lateral mass screw fixation were used to repair the unstable Jefferson fractures. Our study group included eight males and four females with an average age of 33 years (range 23-62 years. Results: Patients were followed up for an average of 16 months after surgery. Range of motion of the cervical spine was by and large physiologic: Average flexion 35° (range 28-40°, average extension 42° (range 30-48°. Lateral bending to the right and left averaged 30° and 28° respectively (range 12-36° and 14-32° respectively. The average postoperative rotation of the atlantoaxial joint, evaluated by functional computed tomography scan was 60° (range 35-72°. Total average lateral displacement of the lateral masses was 7.0 mm before surgery (range 5-12 mm, which improved to 3.5 mm after surgery (range 1-6.5 mm. The total average difference of the atlanto-dens interval in flexion and extension after surgery was 1.0 mm (range 1-3 mm. Conclusions: Transoral osteosynthesis of the anterior ring using C 1 lateral mass screws is a viable option for treating unstable Jefferson fractures, which allows maintenance of rotation at the C 1-C 2 joint and restoration of congruency of the atlanto-occipital and atlantoaxial joints.

  1. [Fracture of macroporous hydroxyapatite prosthesis].

    Science.gov (United States)

    Adetchessi, A T; Pech-Gourg, G; Metellus, P; Fuentes, S

    2012-12-01

    Different prosthesis implants are offered to perform a cranioplasty after a decompressive craniectomy when autologous bone graft cannot be used. The authors report the case of a 25-year-old man who benefited a unilateral decompressive craniectomy after a severe head trauma. Seven months later, a cranioplasty using custom macroporous hydroxyapatite prosthesis was performed. The postoperative course was marked by a generalized seizure leading to a traumatic head injury. The CT-scan showed a comminutive fracture of the prosthesis and an extradural hematoma. The patient underwent a removal of the fractured prosthesis and an evacuation of the extradural clot. The postoperative course was uneventful with a Glasgow outcome scale score at 5. A second cranioplasty using a polyether ether ketone (PEEK) implant was performed. Among cranioplasty prosthesis solutions, hydroxyapatite implants seem to have similar property to the bone. However, its weak mechanic resistance is an actual problem in patients susceptible to present generalized seizures with consecutive head impact. Hence, in patients with decompressive craniectomy who are exposed to potential brain injury, we favor the use of more resistant implant as PEEK prosthesis.

  2. Laterally loaded masonry

    DEFF Research Database (Denmark)

    Raun Gottfredsen, F.

    In this thesis results from experiments on mortar joints and masonry as well as methods of calculation of strength and deformation of laterally loaded masonry are presented. The strength and deformation capacity of mortar joints have been determined from experiments involving a constant compressive...... stress and increasing shear. The results show a transition to pure friction as the cohesion is gradually destroyed. An interface model of a mortar joint that can take into account this aspect has been developed. Laterally loaded masonry panels have also been tested and it is found to be characteristic...

  3. Flow of fluids from matrix to fractures in rock

    Energy Technology Data Exchange (ETDEWEB)

    Lupo, M.J.

    1987-01-01

    The flow of a single-phase compressible fluid from the rock matrix to fractures was modeled using the pressure diffusion equation. Pressure histories are presented for homogeneous isotropic blocks bounded by planar fractures. The case of an infinite slab bounded by planes of constant pore pressure was studied. The slab was divided by a planar fracture perpendicular to the planes. Lateral flow was found to cease once equilibrium is reached between the fracture and the matrix. Disequilibrium is found to be short-lived for laboratory-sized specimens of typical reservoir rock. The most-important parameter in cross-flow is the distance l between the two planes of constan pore pressure. When a second fracture was added, parallel to the first, the cross-flow behavior was nearly identical to the one fracture case if the spacing of the fractures is greater than l. The pressure history of the blocks of the continuum model of naturally fractured reservoirs was examined with a discrete mathematical model. An analytical solution to the pressure diffusion equation with time dependent boundary conditions is presented for blocks in both a finite and infinite reservoir.

  4. Multidisciplinary Management of Complicated Crown-Root Fracture of an Anterior Tooth Undergoing Apexification

    OpenAIRE

    Merve Mese; Merve Akcay; Bilal Yasa; Huseyin Akcay

    2015-01-01

    The purpose of this case report was to present the multidisciplinary management of a subgingival crown-root fracture of a patient undergoing apexification treatment. A 12-year-old male patient was referred to the pediatric dentistry clinic with an extensive tooth fracture of the right permanent maxillary lateral incisor. Clinical and radiographic examinations revealed the presence of a complicated crown-root fracture, which had elongated to the buccal subgingival area. The dental history disc...

  5. Lateral Thinking of Prospective Teachers

    Science.gov (United States)

    Lawrence, A. S. Arul; Xavier, S. Amaladoss

    2013-01-01

    Edward de Bono who invented the term "lateral thinking" in 1967 is the pioneer of lateral thinking. Lateral thinking is concerned with the generation of new ideas. Liberation from old ideas and the stimulation of new ones are twin aspects of lateral thinking. Lateral thinking is a creative skills from which all people can benefit…

  6. Computed tomograms of blowout fracture

    Energy Technology Data Exchange (ETDEWEB)

    Ito, Haruhide; Hayashi, Minoru; Shoin, Katsuo; Hwang, Wen-Zern; Yamamoto, Shinjiro; Yonemura, Taizo

    1985-02-01

    We studied 18 cases of orbital fractures, excluding optic canal fracture. There were 11 cases of pure blowout fracture and 3 of the impure type. The other 4 cases were orbital fractures without blowout fracture. The cardinal syndromes were diplopia, enophthalmos, and sensory disturbances of the trigeminal nerve in the pure type of blowout fracture. Many cases of the impure type of blowout fracture or of orbital fracture showed black eyes or a swelling of the eyelids which masked enophthalmos. Axial and coronal CT scans demonstrated: 1) the orbital fracture, 2) the degree of enophthalmos, 3) intraorbital soft tissue, such as incarcerated or prolapsed ocular muscles, 4) intraorbital hemorrhage, 5) the anatomical relation of the orbital fracture to the lacrimal canal, the trochlea, and the trigeminal nerve, and 6) the lesions of the paranasal sinus and the intracranial cavity. CT scans play an important role in determining what surgical procedures might best be employed. Pure blowout fractures were classified by CT scans into these four types: 1) incarcerating linear fracture, 2) trapdoor fracture, 3) punched-out fracture, and 4) broad fracture. Cases with severe head injury should be examined to see whether or not blowout fracture is present. If the patients are to hope to return to society, a blowout fracture should be treated as soon as possible. (author).

  7. Fibular fracture stabilization with a guidewire as supplementary fixation in tibia fractures.

    Science.gov (United States)

    Dombroski, Derek; Scolaro, John A; Pulos, Nicholas; Beingessner, Daphne M; Dunbar, Robert; Mehta, Samir

    2012-11-01

    We present a novel technique of intramedullary fixation of the fibula using a humeral guide wire as an adjunct to tibial fixation, in the setting of tibial shaft fracture. Not only does this technique aid in determining length, alignment, and rotation of the tibial fracture, but it may also help the support of the lower extremity as whole by stabilizing the lateral column. In addition, this technique can be used to help maintain reduction of the fibula when there is concern for the soft tissues of the lower extremity secondary to swelling or injury. Our clinical case series demonstrates this safe, effective, and cost-sensitive technique to be used in the treatment of select concurrent fractures of the tibia and fibula.

  8. Analysis of fracture patterns and local stress field variations in fractured reservoirs

    Science.gov (United States)

    Deckert, Hagen; Drews, Michael; Fremgen, Dominik; Wellmann, J. Florian

    2010-05-01

    A meaningful qualitative evaluation of permeabilities in fractured reservoirs in geothermal or hydrocarbon industry requires the spatial description of the existing discontinuity pattern within the area of interest and an analysis how these fractures might behave under given stress fields. This combined information can then be used for better estimating preferred fluid pathway directions within the reservoir, which is of particular interest for defining potential drilling sites. A description of the spatial fracture pattern mainly includes the orientation of rock discontinuities, spacing relationships between single fractures and their lateral extent. We have examined and quantified fracture patterns in several outcrops of granite at the Costa Brava, Spain, and in the Black Forest, Germany, for describing reservoir characteristics. For our analysis of fracture patterns we have used photogrammetric methods to create high-resolution georeferenced digital 3D images of outcrop walls. The advantage of this approach, compared to conventional methods for fracture analysis, is that it provides a better 3D description of the fracture geometry as the entity of position, extent and orientation of single fractures with respect to their surrounding neighbors is conserved. Hence for instance, the method allows generating fracture density maps, which can be used for a better description of the spatial distribution of discontinuities in a given outcrop. Using photogrammetric techniques also has the advantage to acquire very large data sets providing statistically sound results. To assess whether the recorded discontinuities might act as fluid pathways information on the stress field is needed. A 3D model of the regional tectonic structure was created and the geometry of the faults was put into a mechanical 3D Boundary Element (BE) Model. The model takes into account the elastic material properties of the geological units and the orientation of single fault segments. The

  9. Onset dominance in lateralization.

    Science.gov (United States)

    Freyman, R L; Zurek, P M; Balakrishnan, U; Chiang, Y C

    1997-03-01

    Saberi and Perrott [Acustica 81, 272-275 (1995)] found that the in-head lateralization of a relatively long-duration pulse train could be controlled by the interaural delay of the single pulse pair that occurs at onset. The present study examined this further, using an acoustic pointer measure of lateralization, with stimulus manipulations designed to determine conditions under which lateralization was consistent with the interaural onset delay. The present stimuli were wideband pulse trains, noise-burst trains, and inharmonic complexes, 250 ms in duration, chosen for the ease with which interaural delays and correlations of select temporal segments of the stimulus could be manipulated. The stimulus factors studied were the periodicity of the ongoing part of the signal as well as the multiplicity and ambiguity of interaural delays. The results, in general, showed that the interaural onset delay controlled lateralization when the steady state binaural cues were relatively weak, either because the spectral components were only sparsely distributed across frequency or because the interaural time delays were ambiguous. Onset dominance can be disrupted by sudden stimulus changes within the train, and several examples of such changes are described. Individual subjects showed strong left-right asymmetries in onset effectiveness. The results have implications for understanding how onset and ongoing interaural delay cues contribute to the location estimates formed by the binaural auditory system.

  10. Laterality and reproductive indices.

    Science.gov (United States)

    Kalichman, Leonid; Kobyliansky, Eugene

    2008-01-01

    Several previous studies support the association between manual dominance and age at menarche or age at menopause. The aim of the present study was to estimate the association between indices of laterality and reproductive indices. The studied sample comprised 650 Chuvashian women aged 18 to 80 years (mean, 46.9; SD = 16.2). The independent-sample t test was used to compare the age at menarche or age at menopause between individuals with right or left dominance of handedness, dominant eye, hand clasping, and arm folding. No significant differences in age at menarche or age at menopause between women with right and left dominance in any of the studied laterality indices were found. This is the first study that simultaneously evaluates the association between dominance in four laterality indices (handedness, dominant eye, hand clasping, and arm folding) and two reproductive indices (age at menarche and age at menopause). Result of our study do not support the hypothesis of a possible association between handedness (and other indices of laterality) and an early age at menarche or age at natural menopause.

  11. Spontaneous rib fractures.

    Science.gov (United States)

    Katrancioglu, Ozgur; Akkas, Yucel; Arslan, Sulhattin; Sahin, Ekber

    2015-07-01

    Other than trauma, rib fracture can occur spontaneously due to a severe cough or sneeze. In this study, patients with spontaneous rib fractures were analyzed according to age, sex, underlying pathology, treatment, and complications. Twelve patients who presented between February 2009 and February 2011 with spontaneous rib fracture were reviewed retrospectively. The patients' data were evaluated according to anamnesis, physical examination, and chest radiographs. The ages of the patients ranged from 34 to 77 years (mean 55.91 ± 12.20 years), and 7 (58.4%) were male. All patients had severe cough and chest pain. The fractures were most frequently between 4th and 9th ribs; multiple rib fractures were detected in 5 (41.7%) patients. Eight (66.7%) patients had chronic obstructive pulmonary disease, 2 (16.7%) had bronchial asthma, and 2 (16.7%) had osteoporosis. Bone densitometry revealed a high risk of bone fracture in all patients. Patients with chronic obstructive pulmonary disease or bronchial asthma had been treated with high-dose steroids for over a year. Spontaneous rib fracture due to severe cough may occur in patients with osteoporosis, chronic obstructive pulmonary disease, or bronchial asthma, receiving long-term steroid therapy. If these patients have severe chest pain, chest radiography should be performed to check for bone lesions. © The Author(s) 2015.

  12. Osteosynthesis of fractures of the femur with flexible metallic intramedullary nails.

    Science.gov (United States)

    Firica, A; Troianescu, O; Petre, M

    1978-04-01

    The authors discuss their use of Ender's method in the treatment of fractures of the femur. The diameter and length of the nails depends on the type of fracture. 1) Three nails of 4 mm diameter are introduced in parallel from the medial condyle in fractures of the femoral neck; 2) 5 mm nails are used, in similar fashion, for the fixation of intertrochanteric and subtrochanteric fractures; 3) 5 mm nails are used for diaphyseal, supracondylar and intercondylar fractures, introduced in crossed fashion ("Eiffel Tower" technique) from both medial and lateral condyles. This method of fixation has proved to be extremely stable. The operation itself is quick, with no blood loss or shock. The patient can resume partial weight bearing after a week in stabilised intertrochanteric and shaft fractures, after a month in less stable types, and after three to four months in fractures of the neck of the femur. This report is based on the first 250 cases treated by this method.

  13. A Complex Facial Trauma Case with Multiple Mandibular Fractures and Dentoalveolar Injuries

    Directory of Open Access Journals (Sweden)

    Yeliz Guven

    2015-01-01

    Full Text Available The principles of management of mandibular fractures differ in children when compared to adults and depend on the specific age-related status of the growing mandible and the developing dentition. This paper presents a case report with a complex facial trauma affecting the mandibular body and condyle region and dentoalveolar complex. Clinical examination revealed soft tissue injuries, limited mouth opening, lateral deviation of the mandible, an avulsed incisor, a subluxated incisor, and a fractured crown. CBCT examination revealed a nondisplaced fracture and an oblique greenstick fracture of the mandibular body and unilateral fracture of the condyle. Closed reduction technique was chosen to manage fractures of the mandible. Favorable healing outcomes on multiple fractures of the mandible throughout the 6-year follow-up period proved the success of the conservative treatment. This case report is important since it presents a variety of pathological sequelae to trauma within one case.

  14. A Complex Facial Trauma Case with Multiple Mandibular Fractures and Dentoalveolar Injuries.

    Science.gov (United States)

    Guven, Yeliz; Zorlu, Sevgi; Cankaya, Abdulkadir Burak; Aktoren, Oya; Gencay, Koray

    2015-01-01

    The principles of management of mandibular fractures differ in children when compared to adults and depend on the specific age-related status of the growing mandible and the developing dentition. This paper presents a case report with a complex facial trauma affecting the mandibular body and condyle region and dentoalveolar complex. Clinical examination revealed soft tissue injuries, limited mouth opening, lateral deviation of the mandible, an avulsed incisor, a subluxated incisor, and a fractured crown. CBCT examination revealed a nondisplaced fracture and an oblique greenstick fracture of the mandibular body and unilateral fracture of the condyle. Closed reduction technique was chosen to manage fractures of the mandible. Favorable healing outcomes on multiple fractures of the mandible throughout the 6-year follow-up period proved the success of the conservative treatment. This case report is important since it presents a variety of pathological sequelae to trauma within one case.

  15. 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.

  16. Failure Mode of the Water-filled Fractures under Hydraulic Pressure in Karst Tunnels

    Science.gov (United States)

    Dong, Xin; Lu, Hao; Huang, Houxu; Hao, Yiqing; Xia, Yuanpu

    2017-06-01

    Water-filled fractures continue to grow after the excavation of karst tunnels, and the hydraulic pressure in these fractures changes along with such growth. This paper simplifies the fractures in the surrounding rock as flat ellipses and then identifies the critical hydraulic pressure values required for the occurrence of tensile-shear and compression-shear failures in water-filled fractures in the case of plane stress. The occurrence of tensile-shear fracture requires a larger critical hydraulic pressure than compression-shear failure in the same fracture. This paper examines the effects of fracture strike and lateral pressure coefficient on critical hydraulic pressure, and identifies compression-shear failure as the main failure mode of water-filled fractures. This paper also analyses the hydraulic pressure distribution in fractures with different extensions, and reveals that hydraulic pressure decreases along with the continuous growth of fractures and cannot completely fill a newly formed fracture with water. Fracture growth may be interrupted under the effect of hydraulic tensile shear.

  17. Failure Mode of the Water-filled Fractures under Hydraulic Pressure in Karst Tunnels

    Directory of Open Access Journals (Sweden)

    Dong Xin

    2017-06-01

    Full Text Available Water-filled fractures continue to grow after the excavation of karst tunnels, and the hydraulic pressure in these fractures changes along with such growth. This paper simplifies the fractures in the surrounding rock as flat ellipses and then identifies the critical hydraulic pressure values required for the occurrence of tensile-shear and compression-shear failures in water-filled fractures in the case of plane stress. The occurrence of tensile-shear fracture requires a larger critical hydraulic pressure than compression-shear failure in the same fracture. This paper examines the effects of fracture strike and lateral pressure coefficient on critical hydraulic pressure, and identifies compression-shear failure as the main failure mode of water-filled fractures. This paper also analyses the hydraulic pressure distribution in fractures with different extensions, and reveals that hydraulic pressure decreases along with the continuous growth of fractures and cannot completely fill a newly formed fracture with water. Fracture growth may be interrupted under the effect of hydraulic tensile shear.

  18. Hydraulic Fracture Containment in Sand

    NARCIS (Netherlands)

    Dong, Y.

    2010-01-01

    The mechanism of hydraulic fracturing in soft, high permeability material is considered fundamentally different from that in hard, low permeability rock, where a tensile fracture is created and conventional linear elastic fracture mechanics (LEFM) applies. The fracturing and associated modeling work

  19. A new method of CT scanning for the diagnosis of mandibular fractures; A preliminary report: diagnosis of condyle fractures

    Energy Technology Data Exchange (ETDEWEB)

    Tsukagoshi, Taku; Satoh, Kaneshige; Onizuka, Takuya (Showa Univ., Tokyo (Japan). School of Medicine)

    1990-08-01

    The condylar neck of the mandible is one of the most common fracture sites in the facial skeleton. Such a fracture is routinely diagnosed by A-P, lateral oblique, and Towne projection roentgenography or orthopantomography. Despite the combination of these films, fracture of the neck of the mandible is still difficult to diagnose definitely. Therefore, a new CT scanning method was developed for diagnosing fractures of the neck of the condylar mandible. The CT axis is projected along the length of the mandible, extending from the condyle to the symphysis. This projection visualizes both the condyle and the mandibular symphysis in the same plane. The patient is placed in a supine position with the head fully extended. The base line, a line extending from the midpoint of the glenoid fossa to the menton, is determined with a lateral facial cephalogram. CT scanning with a 5 mm window is performed in parallel with and 2 cm anterior to and 2 cm posterior to the base line. When CT scanning was performed in a healthy volunteer, the condition of the condyle and the condylar neck of the mandible was clearly shown, and the view extended from the condyle to the symphysis. For automobile accident patients in whom fracture of the neck of the mandible was associated with fracture of the symphysis, two fractures were found in the same plane. A newly developed CT scanning technique is useful in the diagnosis of fractures of the condylar neck of the mandible and in the identification of fractures at other mandibular sites. It also allows scanning of patients in a supine position, which may aid in managing patients with multiple traumas. (N.K.).

  20. Subtrochanteric Fracture following Removal of a Porous Tantalum Implant

    OpenAIRE

    2013-01-01

    Osteonecrosis of the hip accounts for about 10% of all total hip arthroplasty cases and presents a significant challenge for those patients with and without femoral head collapse. Subtrochanteric femur fractures have been reported with numerous types of proximal femoral implants. Care must be taken to avoid penetrating the lateral cortex of the proximal femur inferior to the distal border of the lesser trochanter. Core decompression requires a 3 mm to 20 mm defect in the lateral femoral corte...

  1. Subtrochanteric stress fractures in patients on oral bisphosphonate therapy: an emerging problem.

    LENUS (Irish Health Repository)

    Murphy, Colin G

    2012-01-31

    The emergence of a new variant of subtrochanteric stress fractures of the femur, affecting patients on oral bisphosphonate therapy, has only recently been described. This fracture is often preceded by pain and distinctive radiographic changes (lateral cortical thickening), and associated with a characteristic fracture pattern (transverse fracture line and medial cortical spike). A retrospective review (2007-2009) was carried out for patients who were taking oral bisphosphonates and who sustained a subtrochanteric fracture after a low velocity injury. Eleven fractures were found in 10 patients matching the inclusion criteria outlined. All were females, and taking bisphosphonates for a mean of 43 years. Five of the 10 patients mentioned prodromal symptoms, for an average of 9.4 months before the fracture. Although all fractures were deemed low velocity, 5 of 11 were even atraumatic. Two patients had previously sustained contralateral subtrochanteric fractures. Plain radiographs of two patients showed lateral cortical thickening on the contralateral unfractured femur; the bisphosphonate therapy was stopped and close surveillance was started. Patients taking oral bisphosphonates may be at risk of a new variant of stress fracture of the proximal femur. Awareness of the symptoms is the key to ensure that appropriate investigations are undertaken.

  2. Subtrochanteric stress fractures in patients on oral bisphosphonate therapy: an emerging problem.

    Science.gov (United States)

    Murphy, Colin G; O'Flanagan, Shay; Keogh, Peter; Kenny, Patrick

    2011-10-01

    The emergence of a new variant of subtrochanteric stress fractures of the femur, affecting patients on oral bisphosphonate therapy, has only recently been described. This fracture is often preceded by pain and distinctive radiographic changes (lateral cortical thickening), and associated with a characteristic fracture pattern (transverse fracture line and medial cortical spike). A retrospective review (2007-2009) was carried out for patients who were taking oral bisphosphonates and who sustained a subtrochanteric fracture after a low velocity injury. Eleven fractures were found in 10 patients matching the inclusion criteria outlined. All were females, and taking bisphosphonates for a mean of 43 years. Five of the 10 patients mentioned prodromal symptoms, for an average of 9.4 months before the fracture. Although all fractures were deemed low velocity, 5 of 11 were even atraumatic. Two patients had previously sustained contralateral subtrochanteric fractures. Plain radiographs of two patients showed lateral cortical thickening on the contralateral unfractured femur; the bisphosphonate therapy was stopped and close surveillance was started. Patients taking oral bisphosphonates may be at risk of a new variant of stress fracture of the proximal femur. Awareness of the symptoms is the key to ensure that appropriate investigations are undertaken.

  3. Similar Fracture Patterns in Human Nose and Gothic Cathedral.

    Science.gov (United States)

    Lee, Shu Jin; Tse, Kwong Ming; Lee, Heow Pueh

    2015-10-01

    This study proposes that the bony anatomy of the human nose and masonry structure of the Gothic cathedral are geometrically similar, and have common fracture patterns. We also aim to correlate the fracture patterns observed in patients' midface structures with those seen in the Gothic cathedral using computational approach. CT scans of 33 patients with facial fractures were examined and compared with computer simulations of both the Gothic cathedral and human nose. Three similar patterns were found: (1) Cracks of the nasal arch with crumpling of the vertical buttresses akin to the damage seen during minor earthquakes; (2) lateral deviation of the central nasal arch and collapse of the vertical buttresses akin to those due to lateral forces from wind and in major earthquakes; and (3) Central arch collapse seen as a result of collapse under excessive dead weight. Interestingly, the finding of occult nasal and septal fractures in the mandible fractures with absence of direct nasal trauma highlights the possibility of transmission of forces from the foundation to the arch leading to structural failure. It was also found that the structural buttresses of the Gothic cathedral delineate the vertical buttresses in the human midface structure. These morphologic similarities between the human nose and Gothic cathedral will serve as a basis to study the biomechanics of nasal fractures. Identification of structural buttresses in a skeletal structure has important implications for reconstruction as reestablishment of structural continuity restores normal anatomy and architectural stability of the human midface structure.

  4. Isolated osteochondral fracture of the patella without patellar dislocation.

    Science.gov (United States)

    Bhatt, Jay; Montalban, Antonio Santa Cruz; Wang, Kook Hyun; Lee, Hee Du; Nha, Kyung Wook

    2011-01-03

    Chondral fractures of the patella are associated with acute dislocation of the patella. Osteochondral fracture in patellar dislocation is located in the medial facet of the patella. This article presents a case of a 15-year-old female ballerina with isolated displaced osteochondral fracture of the patella without patellar dislocation. She had no history of trauma. A Merchant's view of both knees showed mild subluxation of the patella, a small fragment on the lateral aspect of the knee, and a small defect of the centromedial patella. Axial magnetic resonance imaging (MRI) revealed an osteochondral fragment measuring 13 mm medial to the patella. However, the medial patellofemoral ligament and medial retinaculum were intact. An effusion on the medial side of the patella consistent with hemarthrosis was observed. An absence of a contusion or bone bruise on the lateral femoral condyle was shown. The loose body was removed arthroscopically. Intraoperative findings included a 1.5×2 cm osteochondral fragment. It is unusual that the osteochondral patellar defect site in this patient was in the inferior and central areas of the patella. Patellar chondral fractures without dislocation or patella fracture are rare. Therefore, the possibility of a trivial trauma leading to an osteochondral fracture should be kept in mind in adolescent and young adults who present with knee pain and hemarthrosis. Copyright 2011, SLACK Incorporated.

  5. Concomitant physeal fractures of the distal femur and proximal tibia

    Energy Technology Data Exchange (ETDEWEB)

    Sferopoulos, N.K. [Aristotle University of Thessaloniki, Department of Pediatric Orthopaedics, Thessaloniki (Greece)

    2005-07-01

    Concomitant physeal fractures of the distal femur and proximal tibia are very rare in children and adolescents. They are included in the classification of the ''floating knee'' injuries. Two cases with this combined injury are reported. They were closed injuries and in both patients the fracture of the proximal tibial epiphyseal plate was nondisplaced. In the first, a six-year-old girl, an early diagnosis was made radiographically. The intra-articular femoral fracture was operatively reduced and fixed. No growth abnormality was encountered 12 years later. The second patient, a 16-year-old boy, was conservatively treated for a displaced fracture-separation of the distal femoral epiphysis. Four weeks later there was physeal widening on both sides of the knee which indicated an associated fracture of the proximal tibial epiphyseal plate. One year after injury there was a varus deformity of the knee that was treated with a corrective osteotomy. Ten years later there is normal alignment of the leg. (orig.)

  6. Quantitative geometric description of fracture systems in an andesite lava flow using terrestrial laser scanner data

    Science.gov (United States)

    Massiot, Cécile; Nicol, Andrew; Townend, John; McNamara, David D.; Garcia-Sellés, David; Conway, Chris E.; Archibald, Garth

    2017-07-01

    Permeability hosted in andesitic lava flows is dominantly controlled by fracture systems, with geometries that are often poorly constrained. This paper explores the fracture system geometry of an andesitic lava flow formed during its emplacement and cooling over gentle paleo-topography, on the active Ruapehu volcano, New Zealand. The fracture system comprises column-forming and platy fractures within the blocky interior of the lava flow, bounded by autobreccias partially observed at the base and top of the outcrop. We use a terrestrial laser scanner (TLS) dataset to extract column-forming fractures directly from the point-cloud shape over an outcrop area of ∼3090 m2. Fracture processing is validated using manual scanlines and high-resolution panoramic photographs. Column-forming fractures are either steeply or gently dipping with no preferred strike orientation. Geometric analysis of fractures derived from the TLS, in combination with virtual scanlines and trace maps, reveals that: (1) steeply dipping column-forming fracture lengths follow a scale-dependent exponential or log-normal distribution rather than a scale-independent power-law; (2) fracture intensities (combining density and size) vary throughout the blocky zone but have similar mean values up and along the lava flow; and (3) the areal fracture intensity is higher in the autobreccia than in the blocky zone. The inter-connected fracture network has a connected porosity of ∼0.5 % that promote fluid flow vertically and laterally within the blocky zone, and is partially connected to the autobreccias. Autobreccias may act either as lateral permeability connections or barriers in reservoirs, depending on burial and alteration history. A discrete fracture network model generated from these geometrical parameters yields a highly connected fracture network, consistent with outcrop observations.

  7. Comparison of therapeutic effects between open reduction and internal fixation with conventional plate via L-shaped lateral approach and internal fixation with percutaneous plate using a sinus tarsi approach in treatment of calcaneal fractures%经跗骨窦切口插入钢板与经外侧L形切口钢板内固定治疗跟骨骨折临床疗效的比较

    Institute of Scientific and Technical Information of China (English)

    夏胜利; 王秀会; 陆耀刚; 王惠中; 王子平

    2012-01-01

    Objective To compare therapeutic effects between open reduction and internal fixation with conventional plate via L-shaped lateral approach and internal fixation with percutaneous plate using a sinus tarsi approach in the treatment of calcaneal fractures. Methods All of 108 patients (117 feet) of displaced intra—articular calcaneal fractures were randomly divided into two groups: minimally invasive treatment group with 59 cases (64 feet) and conventional treatment group with 49 cases (53 feet).Results All patients were followed up for 8 to 28 months (mean 19 months).Lateral roentgenograms showed satisfactory restoration of the calcaneal height,width,length,Bohlers angle and Gissanes angle after operation in all patients.Early wound complications occurred postoperatively in 8 feet in conventional treatment group, while no feet developed wound complication in invasive treatment group. Maryland foot score demonstrated excellent results achieved in 49 feet, good in 11, fair in 4 in minimally invasive treatment group with the excellent and good rates of 93.8%, and excellent results in 31 feet, good in 15 feet, fair in 7 feet in conventional treatment group with the excellent and good rates of 86.8%, with significant difference found between two groups (P <0.01). Conclusion Compared with conventional surgical methods of treatment of displaced intra—articular calcaneal fractures, sinus tarsi approach for the reduction and internal fixation with percutaneous plate not only significantly reduces operative time and achieves satisfactory clinical therapeutic effects, but also effectively avoids postoperative complications.%目的 比较经跗骨窦切口插入钢板内固定与经外侧L形切口复位钢板内固定治疗跟骨骨折的临床疗效.方法 108例(117足)跟骨关节内骨折被随机分为微创及常规治疗组,微创治疗组59例(64足)采用经跗骨窦切口插入钢板内固定,常规治疗组49例(53足)采用外侧L

  8. Lateral Attitude Change.

    Science.gov (United States)

    Glaser, Tina; Dickel, Nina; Liersch, Benjamin; Rees, Jonas; Süssenbach, Philipp; Bohner, Gerd

    2015-08-01

    The authors propose a framework distinguishing two types of lateral attitude change (LAC): (a) generalization effects, where attitude change toward a focal object transfers to related objects, and (b) displacement effects, where only related attitudes change but the focal attitude does not change. They bring together examples of LAC from various domains of research, outline the conditions and underlying processes of each type of LAC, and develop a theoretical framework that enables researchers to study LAC more systematically in the future. Compared with established theories of attitude change, the LAC framework focuses on lateral instead of focal attitude change and encompasses both generalization and displacement. Novel predictions and designs for studying LAC are presented.

  9. Treatment of lateral epicondylitis.

    Science.gov (United States)

    Johnson, Greg W; Cadwallader, Kara; Scheffel, Scot B; Epperly, Ted D

    2007-09-15

    Lateral epicondylitis is a common overuse syndrome of the extensor tendons of the forearm. It is sometimes called tennis elbow, although it can occur with many activities. The condition affects men and women equally and is more common in persons 40 years or older. Despite the prevalence of lateral epicondylitis and the numerous treatment strategies available, relatively few high-quality clinical trials support many of these treatment options; watchful waiting is a reasonable option. Topical nonsteroidal anti-inflammatory drugs, corticosteroid injections, ultrasonography, and iontophoresis with nonsteroidal anti-inflammatory drugs appear to provide short-term benefits. Use of an inelastic, nonarticular, proximal forearm strap (tennis elbow brace) may improve function during daily activities. Progressive resistance exercises may confer modest intermediate-term results. Evidence is mixed on oral nonsteroidal antiinflammatory drugs, mobilization, and acupuncture. Patients with refractory symptoms may benefit from surgical intervention. Extracorporeal shock wave therapy, laser treatment, and electromagnetic field therapy do not appear to be effective.

  10. [Lateral lumbar disk herniation].

    Science.gov (United States)

    Deburge, A; Barre, E; Guigui, P

    A retrospective study of 41 lateral discal hernias observed between 1984 and 1991 were studied among the 1080 discal hernias treated during this period. CT scan, performed in all cases, distinguished several different types of hernia: foramen hernias (26), extraforamen hernias (12), mixed forms (5) associated with canal component (11). Thirteen disco scans were required. Nucleolysis was performed in 24 patients (58%) and surgical treatment was the first intention choice in 17 (41%). Outcome, evaluated with a function score developed in the unit were good in the 17 surgery cases (100%). In the nucleolysis patients results were good or excellent in 13, average in 4, and poor in 7. Five of the nucleolysis failures were later operated leading to good results in 3, average in 1 and no change in 1. Indications for surgery are more frequent in this type of discal hernia and results in our surgical series were better than those for chemonucleolysis.

  11. Paediatric talus fracture.

    LENUS (Irish Health Repository)

    Byrne, Ann-Maria

    2012-01-01

    Paediatric talus fractures are rare injuries resulting from axial loading of the talus against the anterior tibia with the foot in dorsiflexion. Skeletally immature bone is less brittle, with higher elastic resistance than adult bone, thus the paediatric talus can sustain higher forces before fractures occur. However, displaced paediatric talus fractures and those associated with high-energy trauma have been associated with complications including avascular necrosis, arthrosis, delayed union, neurapraxia and the need for revision surgery. The authors present the rare case of a talar neck fracture in a skeletally immature young girl, initially missed on radiological review. However, clinical suspicion on the part of the emergency physician, repeat examination and further radiographic imaging revealed this rare paediatric injury.

  12. Geothermal Ultrasonic Fracture Imager

    Energy Technology Data Exchange (ETDEWEB)

    Patterson, Doug [Baker-Hughes Oilfield Operation Inc., Houston, TX (United States); Leggett, Jim [Baker-Hughes Oilfield Operation Inc., Houston, TX (United States)

    2013-07-29

    The Geothermal Ultrasonic Fracture Imager project has a goal to develop a wireline ultrasonic imager that is capable of operating in temperatures up to 300°C (572°F) and depths up to 10 km (32,808 ft). This will address one of the critical needs in any EGS development of understanding the hydraulic flow paths in the reservoir. The ultrasonic imaging is well known in the oil and gas industry as one of the best methods for fracture evaluation; providing both high resolution and complete azimuthal coverage of the borehole. This enables fracture detection and characterization, both natural and induced, providing information as to their location, dip direction and dip magnitude. All of these factors are critical to fully understand the fracture system to enable the optimization of the thermal drainage through injectors and producers in a geothermal resource.

  13. Clavicle Fracture (Broken Collarbone)

    Science.gov (United States)

    ... Bahk MS, Kuhn JE, Galatz LM, Connor PM, Williams GR: Acromioclavicular and sternoclavicular injuries and cla- vicular, ... Orthopaedic Surgeons. .org Clavicle Fracture cont. Rehabilitation Specific exercises will help restore movement and strengthen your shoulder. ...

  14. Proximal femoral fractures

    DEFF Research Database (Denmark)

    Palm, Henrik; Teixidor, Jordi

    2015-01-01

    BACKGROUND: In hip fracture surgery, the exact choice of implant often remains somewhat unclear for the individual surgeon, but the growing literature consensus has enabled publication of evidence-based surgical treatment pathways. The aim of this article was to review author pathways and national...... guidelines for hip fracture surgery and discuss a method for future pathway/guideline implementation and evaluation. METHODS: By a PubMed search in March 2015 six studies of surgical treatment pathways covering all types of proximal femoral fractures with publication after 1995 were identified. Also we...... searched the homepages of the national heath authorities and national orthopedic societies in West Europe and found 11 national or regional (in case of no national) guidelines including any type of proximal femoral fracture surgery. RESULTS: Pathway consensus is outspread (internal fixation for un...

  15. Shape regression for vertebra fracture quantification

    Science.gov (United States)

    Lund, Michael Tillge; de Bruijne, Marleen; Tanko, Laszlo B.; Nielsen, Mads

    2005-04-01

    Accurate and reliable identification and quantification of vertebral fractures constitute a challenge both in clinical trials and in diagnosis of osteoporosis. Various efforts have been made to develop reliable, objective, and reproducible methods for assessing vertebral fractures, but at present there is no consensus concerning a universally accepted diagnostic definition of vertebral fractures. In this project we want to investigate whether or not it is possible to accurately reconstruct the shape of a normal vertebra, using a neighbouring vertebra as prior information. The reconstructed shape can then be used to develop a novel vertebra fracture measure, by comparing the segmented vertebra shape with its reconstructed normal shape. The vertebrae in lateral x-rays of the lumbar spine were manually annotated by a medical expert. With this dataset we built a shape model, with equidistant point distribution between the four corner points. Based on the shape model, a multiple linear regression model of a normal vertebra shape was developed for each dataset using leave-one-out cross-validation. The reconstructed shape was calculated for each dataset using these regression models. The average prediction error for the annotated shape was on average 3%.

  16. The lateral angle revisited

    DEFF Research Database (Denmark)

    Morgan, Jeannie; Lynnerup, Niels; Hoppa, R.D.

    2013-01-01

    measurements taken from computed tomography (CT) scans. Previous reports have observed that the lateral angle size in females is significantly larger than in males. The method was applied to an independent series of 77 postmortem CT scans (42 males, 35 females) to validate its accuracy and reliability...... method appears to be of minimal practical use in forensic anthropology and archeology. © 2013 American Academy of Forensic Sciences....

  17. Lateral Elbow Tendinopathy

    Science.gov (United States)

    Bhabra, Gev; Wang, Allan; Ebert, Jay R.; Edwards, Peter; Zheng, Monica; Zheng, Ming H.

    2016-01-01

    Lateral elbow tendinopathy, commonly known as tennis elbow, is a condition that can cause significant functional impairment in working-age patients. The term tendinopathy is used to describe chronic overuse tendon disorders encompassing a group of pathologies, a spectrum of disease. This review details the pathophysiology of tendinopathy and tendon healing as an introduction for a system grading the severity of tendinopathy, with each of the 4 grades displaying distinct histopathological features. Currently, there are a large number of nonoperative treatments available for lateral elbow tendinopathy, with little guidance as to when and how to use them. In fact, an appraisal of the clinical trials, systematic reviews, and meta-analyses studying these treatment modalities reveals that no single treatment reliably achieves outstanding results. This may be due in part to the majority of clinical studies to date including all patients with chronic tendinopathy rather than attempting to categorize patients according to the severity of disease. We relate the pathophysiology of the different grades of tendinopathy to the basic science principles that underpin the mechanisms of action of the nonoperative treatments available to propose a treatment algorithm guiding the management of lateral elbow tendinopathy depending on severity. We believe that this system will be useful both in clinical practice and for the future investigation of the efficacy of treatments. PMID:27833925

  18. Fracture Behavior under Impact.

    Science.gov (United States)

    1982-07-01

    discussed for the different loading rates ob- tai ned . 1. Introduction In static fracture mechanics crack tip stress intensity factors can easi- - ly...deviation to the left or to the right hand side of the original crack path was observed. Herrmann [151 speculated that this behavior results from stress...Materials’ Draft 2c, American Society for Testing and Materials, Philadelphia, .. ,-- 1980. 15. Herrmann , G., "Dynamic Fracture of Beams in Bending

  19. Relative permeability through fractures

    Energy Technology Data Exchange (ETDEWEB)

    Diomampo, Gracel, P.

    2001-08-01

    The mechanism of two-phase flow through fractures is of importance in understanding many geologic processes. Currently, two-phase flow through fractures is still poorly understood. In this study, nitrogen-water experiments were done on both smooth and rough parallel plates to determine the governing flow mechanism for fractures and the appropriate methodology for data analysis. The experiments were done using a glass plate to allow visualization of flow. Digital video recording allowed instantaneous measurement of pressure, flow rate and saturation. Saturation was computed using image analysis techniques. The experiments showed that gas and liquid phases flow through fractures in nonuniform separate channels. The localized channels change with time as each phase path undergoes continues breaking and reforming due to invasion of the other phase. The stability of the phase paths is dependent on liquid and gas flow rate ratio. This mechanism holds true for over a range of saturation for both smooth and rough fractures. In imbibition for rough-walled fractures, another mechanism similar to wave-like flow in pipes was also observed. The data from the experiments were analyzed using Darcy's law and using the concept of friction factor and equivalent Reynold's number for two-phase flow. For both smooth- and rough-walled fractures a clear relationship between relative permeability and saturation was seen. The calculated relative permeability curves follow Corey-type behavior and can be modeled using Honarpour expressions. The sum of the relative permeabilities is not equal one, indicating phase interference. The equivalent homogeneous single-phase approach did not give satisfactory representation of flow through fractures. The graphs of experimentally derived friction factor with the modified Reynolds number do not reveal a distinctive linear relationship.

  20. Atomistic simulations of fracture

    Energy Technology Data Exchange (ETDEWEB)

    Farkas, D. [Virginia Polytechnic Inst. and State Univ., Blacksburg, VA (United States). Dept. of Materials Science and Engineering

    1997-12-31

    Embedded atom interaction potentials are used to simulate the atomistic aspects of the fracture process. Simulations are presented for the behavior of cracks in pure metals and intermetallics, near the Griffith condition. The materials considered include Fe, Cu, Ni as well as Fe, Ni, Co, and Ti aluminides. The work focuses on the comparative study of fracture behavior in the different materials. The role of the atomic relaxation at the crack tip and of lattice trapping phenomena is analyzed.

  1. Science of Fracture.

    Science.gov (United States)

    1980-10-22

    Fracture Set-Up .............. 163 Dr. Jan T. Lindt 4.i0 Fracture in Fully Plastic Bodies ............................... 171 Dr. Howard Kuhn iii I...Benthem’s results and results obtained by 15 Bazant and Estenssoro (12) who used a finite element method of determining critical eigenvalues. Each of...14) is made by Benthem in (10) and (11) and only che sentence quoted above made by Bazant and Estenssoro (12). This is unfortunate since constructive

  2. Acute traumatic posterior fracture dislocation of the elbow in pediatric patients: impact of surgery time and associated fractures on outcome.

    Science.gov (United States)

    Bilgili, Fuat; Dikmen, Goksel; Baş, Ali; Asma, Ali; Batibay, Sefa G; Şirikçi, Murat; Atalar, Ata Can

    2016-09-01

    This study assessed the effect of the time interval from initial injury to surgery and the presence of associated fracture on functional outcomes after acute posterior elbow fracture dislocation. Twenty-six pediatric patients were evaluated with respect to operation time point (within 24 h vs. later) and associated fracture retrospectively. The Mayo Elbow Performance Index (MEPI) score was used to assess functional results. The MEPI score was 91 (80-100) in patients with one associated fracture and 83 (75-95) (P=0.02) in patients with more than one associated fracture. The MEPI score in patients treated within 24 h was 90.3 (75-95) and in those treated later than 24 h, it was 88.6 (75-100) (P=0.6). Treatment time (within 24 h vs. later) does not affect outcomes, but increasing numbers of associated injuries affect outcomes negatively. Level of study: Level IV case series.

  3. Subduction of fracture zones

    Science.gov (United States)

    Constantin Manea, Vlad; Gerya, Taras; Manea, Marina; Zhu, Guizhi; Leeman, William

    2013-04-01

    Since Wilson proposed in 1965 the existence of a new class of faults on the ocean floor, namely transform faults, the geodynamic effects and importance of fracture zone subduction is still little studied. It is known that oceanic plates are characterized by numerous fracture zones, and some of them have the potential to transport into subduction zones large volumes of water-rich serpentinite, providing a fertile water source for magma generated in subduction-related arc volcanoes. In most previous geodynamic studies, subducting plates are considered to be homogeneous, and there is no clear indication how the subduction of a fracture zone influences the melting pattern in the mantle wedge and the slab-derived fluids distribution in the subarc mantle. Here we show that subduction of serpentinized fracture zones plays a significant role in distribution of melt and fluids in the mantle wedge above the slab. Using high-resolution tree-dimensional coupled petrological-termomechanical simulations of subduction, we show that fluids, including melts and water, vary dramatically in the region where a serpentinized fracture zone enters into subduction. Our models show that substantial hydration and partial melting tend to concentrate where fracture zones are being subducted, creating favorable conditions for partially molten hydrous plumes to develop. These results are consistent with the along-arc variability in magma source compositions and processes in several regions, as the Aleutian Arc, the Cascades, the Southern Mexican Volcanic Arc, and the Andean Southern Volcanic Zone.

  4. Prevention of hip fractures.

    Science.gov (United States)

    Meunier, P J

    1993-11-30

    For a 50-year old Caucasian woman today, the risk of a hip fracture over her remaining life-time is about 17%. Tomorrow the situation will clearly be worse because the continuous increase in life expectancy will cause a three-fold increase in worldwide fracture incidence over the next 60 years. Through diagnostic bone mass measurements at the hip and assessment of biochemical parameters, a great deal has been learned in recent years about reduction of hip fracture risk. Preventive strategies are based on prevention of falls, use of hip protectors, and prevention of bone fragility. The latter includes the optimization of peak bone mass during childhood, postmenopausal estrogen replacement therapy, and also late prevention consisting in reversing senile secondary hyperparathyroidism, which plays an important role in the decrease of skeletal strength. This secondary hyperparathyroidism, which results from both vitamin D insufficiency and low calcium intake, is preventable with vitamin D3 and calcium supplements. They have recently been shown capable of providing effective prevention of hip fractures in elderly women living in nursing homes, with a reduction of about 25% in the number of hip fractures noted in a 3-year controlled study in 3,270 women (intention-to-treat analysis). In conclusion, it is never too early to reduce the risk of osteoporosis and never too late to prevent hip fractures.

  5. FRACTURING FLUID CHARACTERIZATION FACILITY

    Energy Technology Data Exchange (ETDEWEB)

    Subhash Shah

    2000-08-01

    Hydraulic fracturing technology has been successfully applied for well stimulation of low and high permeability reservoirs for numerous years. Treatment optimization and improved economics have always been the key to the success and it is more so when the reservoirs under consideration are marginal. Fluids are widely used for the stimulation of wells. The Fracturing Fluid Characterization Facility (FFCF) has been established to provide the accurate prediction of the behavior of complex fracturing fluids under downhole conditions. The primary focus of the facility is to provide valuable insight into the various mechanisms that govern the flow of fracturing fluids and slurries through hydraulically created fractures. During the time between September 30, 1992, and March 31, 2000, the research efforts were devoted to the areas of fluid rheology, proppant transport, proppant flowback, dynamic fluid loss, perforation pressure losses, and frictional pressure losses. In this regard, a unique above-the-ground fracture simulator was designed and constructed at the FFCF, labeled ''The High Pressure Simulator'' (HPS). The FFCF is now available to industry for characterizing and understanding the behavior of complex fluid systems. To better reflect and encompass the broad spectrum of the petroleum industry, the FFCF now operates under a new name of ''The Well Construction Technology Center'' (WCTC). This report documents the summary of the activities performed during 1992-2000 at the FFCF.

  6. Fracture toughness of graphene.

    Science.gov (United States)

    Zhang, Peng; Ma, Lulu; Fan, Feifei; Zeng, Zhi; Peng, Cheng; Loya, Phillip E; Liu, Zheng; Gong, Yongji; Zhang, Jiangnan; Zhang, Xingxiang; Ajayan, Pulickel M; Zhu, Ting; Lou, Jun

    2014-04-29

    Perfect graphene is believed to be the strongest material. However, the useful strength of large-area graphene with engineering relevance is usually determined by its fracture toughness, rather than the intrinsic strength that governs a uniform breaking of atomic bonds in perfect graphene. To date, the fracture toughness of graphene has not been measured. Here we report an in situ tensile testing of suspended graphene using a nanomechanical device in a scanning electron microscope. During tensile loading, the pre-cracked graphene sample fractures in a brittle manner with sharp edges, at a breaking stress substantially lower than the intrinsic strength of graphene. Our combined experiment and modelling verify the applicability of the classic Griffith theory of brittle fracture to graphene. The fracture toughness of graphene is measured as the critical stress intensity factor of and the equivalent critical strain energy release rate of 15.9 J m(-2). Our work quantifies the essential fracture properties of graphene and provides mechanistic insights into the mechanical failure of graphene.

  7. Transverse Stress Fracture of the Proximal Patella: A Case Report.

    Science.gov (United States)

    Atsumi, Satoru; Arai, Yuji; Kato, Ko; Nishimura, Akinobu; Nakazora, Shigeto; Nakagawa, Shuji; Ikoma, Kazuya; Fujiwara, Hiroyoshi; Sudo, Akihiro; Kubo, Toshikazu

    2016-02-01

    Among stress fractures associated with sports activities, patellar stress fracture is rare. Regarding patella stress fractures, so far only distal transverse or lateral longitudinal fractures have been reported, but there are no reports of transverse fractures occurring in the proximal patella. We describe an extremely rare case of transverse stress fracture of proximal patella in a 9-year-old athlete.A 9-year old boy, who participated in sports (sprints and Kendo) presented with left knee pain without any external injury. In plain radiographs, a fracture line was observed in the proximal 1/3 of the left patella, and a patella stress fracture was diagnosed. For treatment, because 7 months of conservative therapy showed no improvement, internal fixation was carried out using Acutrak screws, and bone union was thus achieved. Three months after the operation, he was able to return to his previous level of athletic sports activity.Regarding the mechanism of onset, it is believed that the causes are longitudinal traction force and patellofemoral contact pressure. On the other hand, the contact region of the patella with the femur changes with the flexion angle of the knee. In the current case, the fracture occurred at a site where the patella was in contact with the femur at a flexion angle of >90°, so it is believed that it occurred as a clinical condition from being subjected to repeated longitudinal traction force and patellofemoral contact pressure at a flexion angle of >90°, during the sports activities of sprints and Kendo. The nonunion of the transverse stress fracture of his proximal patella was successfully treated with internal fixation using Acutrak screws.

  8. Synkinematic quartz cementation in partially open fractures in sandstones

    Science.gov (United States)

    Ukar, Estibalitz; Laubach, Stephen E.; Fall, Andras; Eichhubl, Peter

    2014-05-01

    Faults and networks of naturally open fractures can provide open conduits for fluid flow, and may play a significant role in hydrocarbon recovery, hydrogeology, and CO2 sequestration. However, sandstone fracture systems are commonly infilled, at least to some degree, by quartz cement, which can stiffen and occlude fractures. Such cement deposits can systematically reduce the overall permeability enhancement due to open fractures (by reducing open fracture length) and result in permeability anisotropies. Thus, it is important to identify the factors that control the precipitation of quartz in fractures in order to identify potential fluid conduits under the present-day stress field. In many sandstones, quartz nucleates syntaxially on quartz grain or cement substrate of the fracture wall, and extends between fracture walls only locally, forming pillars or bridges. Scanning electron microscope cathodoluminescence (SEM-CL) images reveal that the core of these bridges are made up of bands of broken and resealed cement containing wall-parallel fluid inclusion planes. The fluid inclusion-rich core is usually surrounded by a layer of inclusion-poor clear quartz that comprises the lateral cement. Such crack-seal textures indicate that this phase was precipitating while the fractures were actively opening (synkinematic growth). Rapid quartz accumulation is generally believed to require temperatures of 80°C or more. Fluid inclusion thermometry and Raman spectroscopy of two-phase aqueous fluid-inclusions trapped in crack-seal bands may be used to track the P-T-X evolution of pore fluids during fracture opening and crack-seal cementation of quartz. Quartz cement bridges across opening mode fractures in the Cretaceous Travis Peak Formation of the tectonically quiescent East Texas Basin indicate individual fractures opened over a 48 m.y. time span at rates of 16-23 µm/m.y. Similarly, the Upper Cretaceous Mesaverde Group in the Piceance Basin, Colorado contains fractures that

  9. Subtrochanteric Fracture following Removal of a Porous Tantalum Implant

    Directory of Open Access Journals (Sweden)

    Derek F. Amanatullah

    2013-01-01

    Full Text Available Osteonecrosis of the hip accounts for about 10% of all total hip arthroplasty cases and presents a significant challenge for those patients with and without femoral head collapse. Subtrochanteric femur fractures have been reported with numerous types of proximal femoral implants. Care must be taken to avoid penetrating the lateral cortex of the proximal femur inferior to the distal border of the lesser trochanter. Core decompression requires a 3 mm to 20 mm defect in the lateral femoral cortex. Subtrochanteric femur fractures are a well-known complication of core decompression as well. We present a case of a subtrochanteric fracture following the removal of a porous tantalum implant.

  10. Importance of greenstick lamina fractures in low lumbar burst fractures

    Science.gov (United States)

    Ersozlu, S.; Aydinli, U.

    2006-01-01

    Lumbar burst fractures (L3–L5) represent a small percentage of all spinal fractures. The treatment of fractures involving the lumbar spine has been controversial. Lamina fractures may be complete or of the greenstick type. Dural tears and nerve root entrapment may accompany these lamina fractures. The aim of this retrospective study was to determine the incidence of dural tear in patients who had lumbar burst fractures with greenstick lamina fractures and the importance of these lamina fractures when choosing the optimum treatment. Twenty-six patients with 28 lumbar burst fractures were treated from 1995 through 2002. The average follow-up was 60 months (range 32–110 months). The male to female ratio was 21:5 and the mean age was 37 years (17–64). Dural tear was detected in seven (25%) out of 28 burst fractures. The functional outcome of the entire study group was assessed using the Smiley-Webster Scale. Good to excellent results were obtained in 24 (92%) of 26 patients. Lumbar burst fractures with greenstick lamina fractures occur mostly in the L2–L4 area. In the surgical treatment, any reduction manoeuvre will close the fracture and crush the entrapped neural elements. Therefore, it may be better to explore the greenstick lamina fracture whether there is any neural entrapment or not, before any reduction manoeuvre is attempted. PMID:16501977

  11. A case report of missed femoral neck stress fracture

    Directory of Open Access Journals (Sweden)

    Onibere Oruaro Adebayo

    2015-01-01

    Full Text Available Femoral neck stress fracture (FNSF is an uncommon but potentially serious orthopaedic problem. This is a case report on missed femoral neck stress fracture in a 62-year-old female who was initially treated as early-onset coxarthrosis. She later presented to us with a displaced intra-capsular neck of left femur fracture and underwent total hip replacement. This case illustrates that causes other than osteoarthritis should be taken into consideration in patients presenting with anterior hip pain where symptoms are disproportionate to clinical and radiological findings. More advanced investigations such as MRI scan or regular follow up with plain radiographs should be performed. A delay in diagnosis can lead to secondary displacement of the femoral neck stress fracture.

  12. Tensile Fracture Behavior of Progressively-Drawn Pearlitic Steels

    Directory of Open Access Journals (Sweden)

    Jesús Toribio

    2016-05-01

    Full Text Available In this paper a study is presented of the tensile fracture behavior of progressively-drawn pearlitic steels obtained from five different cold-drawing chains, including each drawing step from the initial hot-rolled bar (not cold-drawn at all to the final commercial product (pre-stressing steel wire. To this end, samples of the different wires were tested up to fracture by means of standard tension tests, and later, all of the fracture surfaces were analyzed by scanning electron microscopy (SEM. Micro-fracture maps (MFMs were assembled to characterize the different fractographic modes and to study their evolution with the level of cumulative plastic strain during cold drawing.

  13. Open Reduction of Subcondylar Fractures Using a New Retractor

    Directory of Open Access Journals (Sweden)

    Akira Sugamata

    2011-01-01

    Full Text Available Many operative approaches have been described for the open reduction of subcondylar fractures and rigid fixation. However, fracture portions are deep and embedded among facial nerves so that visual surgery in this region is extremely limited. Once the operative field is exposed, the displacement of the condylar head is often dislocated by the anteromedial pull of the lateral pterygoid muscle and the fracture end of the condylar process is pulled up to the mandibular fossa by contraction of the masseter muscle. We made a new retractor to achieve a better field of view. It is possible to pull down the condylar process by opening the tips of the retractor using the specially made wrench system without special effort and keep the condylar process in the same position during reduction. In using this retractor, the fracture stumps were clearly exposed and more easily reposited.

  14. A Posteriorly Displaced Distal Metaphyseal Clavicular Fracture (Type IV AC Joint Dislocation-Like in Children: A Case Report and Literature Review Study

    Directory of Open Access Journals (Sweden)

    Ahmed Kotb

    2016-01-01

    Full Text Available Fractures of the lateral end of the clavicle are common in pediatric patients; most of these fractures occur at the physeal level representing Salter Harris injuries. The vast majority of fractures of the lateral end of the clavicle are managed nonoperatively. In this report, we describe a unique type of fracture of the distal end of the clavicle in the pediatric patients in which the fracture occurs in the metaphyseal lateral clavicle with the proximal edge of the fracture displaced posteriorly through the trapezius muscle causing obvious deformity. It is similar in pathology to type IV AC joint dislocation. In this study we report this injury in eleven-year-old boy. Literature review showed that similar injuries were described before three times (two of them in pediatric patients. Due to the significant clinical deformity of this category with entrapment of the bone through the trapezius muscle, reduction (open or closed of the fracture is the recommended treatment.

  15. A Novel Approach for Treatment of Acetabular Fractures

    Science.gov (United States)

    Xue, Zichao; Qin, Hui; Ding, Haoliang; An, Zhiquan

    2016-01-01

    Background There is no single approach that provides adequate exposure for treatment of all types of acetabular fractures. We describe our experience with an easier, relatively less invasive pubic symphysis approach (PSA) for the treatment of acetabular fractures. Material/Methods Between March 2011 and March 2012, fifteen patients with acetabular fracture underwent surgery using the PSA technique. Fracture reduction and treatment outcomes were assessed by clinical and radiological examination. Operation time, intraoperative blood loss and postoperative complications were documented. Results Mean operative time was 222±78 minutes. Average blood loss was 993±361 mL. Anatomical reduction was achieved in all patients. Minimum follow-up period was 31 months. Postoperative hypoesthesia in the area of innervation of the lateral femoral cutaneous nerve was reported in one patient, with spontaneous recovery at one month after surgery. No complications were reported during the follow-up period. At the most recent follow up, clinical outcomes were graded as “excellent” in six patients, “good” in eight patients and “fair” in one patient based on the modified Merle d’Aubigné-Postel score. Conclusions PSA appears to be a timesaving and safe approach for treatment of acetabular fractures that affords good visual access and allows for excellent fracture reduction. Our preliminary results revealed a much lower incidence of complications than traditional approaches, suggesting PSA is an alternative for treatment of acetabular fractures. PMID:27734825

  16. CT of pelvic fractures

    Energy Technology Data Exchange (ETDEWEB)

    Falchi, Marco E-mail: marcofalchi@yahoo.it; Rollandi, Gian Andrea

    2004-04-01

    Although magnetic resonance imaging has become the dominant modality for cross-sectional musculo-skeletal imaging, the widespread availability, speed, and versatility of computed tomography (CT) continue to make it a mainstay of emergency room (ER) diagnostic imaging. Pelvic ring and acetabular fractures occur as the result of significant trauma secondary to either a motor vehicle accident or a high-velocity fall. These injuries are correlated with significant morbidity and mortality, both from the complications of pelvic ring fractures and from commonly associated injuries. The most commonly used classification of pelvic and acetabular fractures has been based on conventional radiographs that are, in the majority of cases, sufficient to determine the type of injury. However, because of the complexity of pelvic and acetabular fractures, precise pathological anatomy is not easily demonstrated by routine radiographs and in many cases details of fractures are not visible. Moreover, the insufficient co-operation of the patient or the difficulty of maintaining special positions can be overcome by using computed tomography. Spiral computed tomography provides information regarding the extent of the fractures and is complementary to radiography for ascertaining the spatial arrangement of fracture fragments. Spiral computed tomography is an effective tool for understanding complex fracture patterns, particularly when combined with multi-planar reconstruction two-dimensional (MPR 2D) reformatted images or three-dimensional images (3D) images. Including these techniques of reconstruction in routine pelvic imaging protocols can change management in a significant number of cases. Subtle fractures, particularly those oriented in the axial plane, are better seen on MPR images or 3D volume-rendered images. Complex injuries can be better demonstrated with 3D volume-rendered images, and complicated spatial information about the relative positions of fracture fragments can be easily

  17. Dynamics of fracture in dissipative systems

    Energy Technology Data Exchange (ETDEWEB)

    Rautiainen, T.T.; Kaski, K. [Helsinki Univ. of Technology, Otaniemi (Finland). Lab. of Computational Engineering; Alava, M.J. [Helsinki Univ. of Technology, Otaniemi (Finland). Lab. of Physics

    1997-12-31

    Dynamics of fracture in two-dimensional systems is studied with a dissipative network model by including the local relaxation of the force field via Maxwellian viscoelasticity. In addition to disorder the fundamentals of crack formation and propagation depend on the strength of dissipation compared to the loading rate. We investigate the dynamics of a single crack and the role of stress reduction at the crack tip when dissipation is increased. As a consequence, the crack starts to propagate slowly and it reaches terminal velocity later. If the relaxation of local forces is strong enough compared with crack velocity, crack arrest takes place. For a disordered system, the presence of strong dissipation in local dynamics is reflected as ductility and as an increase in the damage, accumulated during the fracture process. (orig.) 25 refs.

  18. Metatarsal fracture leading to massive pulmonary embolism

    Directory of Open Access Journals (Sweden)

    Vikas Rajpurohit

    2017-01-01

    Full Text Available Immobilization and bed rest after fracture and orthopedic surgery are routinely advised protocol. Period of bed rest usually depends on the type of injury and orthopedic procedure, ranging from few days to weeks. The trauma, surgery, and immobilization with other contributing factors can lead to deep vein thrombosis and pulmonary embolism (PE in these patients. Although there is high incidence of PE in such patients, it is difficult to diagnose, primarily because of the variety of nonspecific signs and symptoms. Here, we discuss a case of a 30-year-old female, who had suffered a trivial roadside accident leading to metatarsal bone fracture and later on presented in emergency with seizures, pulmonary edema, and cardiac arrest, after immobilization of just 5 days which was diagnosed to be result of massive PE. Here, we will discuss the pathophysiology, risk factors, and management of massive PE.

  19. Numerical evaluation of strength and deformability of fractured rocks

    Institute of Scientific and Technical Information of China (English)

    Majid Noorian Bidgoli; Zhihong Zhao; Lanru Jing

    2013-01-01

    that both criteria can provide fair estimates of the compressive strengths for all tested numerical models. Parameters of the elastic deformability of fractured models during elastic deformation stages were also evaluated, and represented as equivalent Young’s modulus and Poisson’s ratio as functions of lateral confining pressure. It is the first time that such systematic numerical predicting for strength of fractured rocks was performed considering different loading conditions, with important findings for different behaviors of fractured rock masses, compared with testing intact rock samples under similar loading conditions.

  20. High bone turnover is associated with low bone mass and spinal fracture in postmenopausal women

    DEFF Research Database (Denmark)

    Ravn, Pernille; Rix, M; Andreassen, H;

    1997-01-01

    -eight women had a lumbar spine bone mineral density (BMD) above 0.860 g/cm2, and 278 women had a BMD below 0.860 g/cm2. Spinal fracture was diagnosed from lateral spine X-ray studies and defined as at least 20% height reduction (wedge, compression, or endplate fracture) in at least one vertebra (T4-L4). Bone......, and prevalence of spinal fracture, which supports the theory that high bone turnover is a risk factor for spinal fracture and osteoporosis....

  1. Atypical bisphosphonate-associated subtrochanteric and femoral shaft stress fractures: diagnostic features on bone scan.

    Science.gov (United States)

    Probst, Stephan; Rakheja, Rajan; Stern, Jerry

    2013-05-01

    A 69-year-old woman presented with a spontaneous right subtrochanteric hip fracture. Pan-imaging following orthopedic repair failed to identify a primary malignancy to explain the presumed pathologic basis for this fracture. The patient then underwent bone scintigraphy and SPECT/CT which showed mild uptake in multifocal endosteal thickening of the lateral left femoral diaphysis, diagnostic of bisphosphonate-associated femoral shaft stress fractures, but no evidence of metastatic bone disease. Atypical bisphosphonate-associated subtrochanteric and femoral shaft stress fractures have a fairly specific appearance on bone scintigraphy, and nuclear medicine physicians should be aware of this relatively infrequent emerging pathology.

  2. Undiagnosed Hoffa fracture of medial femoral condyle presenting as chronic pain in a post-polio limb

    Institute of Scientific and Technical Information of China (English)

    Aditya Krishna Mootha; Priyanka Majety; Vishal Kumar

    2014-01-01

    Isolated coronal fracture of medial femoral condyle with intact lateral femoral condyle is extremely rare.A high index of suspicion is necessary for early diagnosis especially in cases of undisplaced fractures.Here we report a case of medial Hoffa fracture in a post-polio limb presenting as chronic pain.Management of such fractures in limbs affected by late sequelae of poliomyelitis is particularly problematic in view ofosteoporosis and osseous hypoplasia.The fracture was approached through medial parapatellar arthrotomy and fixation was done with cannulated cancellous screws in anteroposterior direction.Union was achieved at 16 weeks.

  3. The lateral line microcosmos.

    Science.gov (United States)

    Ghysen, Alain; Dambly-Chaudière, Christine

    2007-09-01

    The lateral-line system is a simple sensory system comprising a number of discrete sense organs, the neuromasts, distributed over the body of fish and amphibians in species-specific patterns. Its development involves fundamental biological processes such as long-range cell migration, planar cell polarity, regeneration, and post-embryonic remodeling. These aspects have been extensively studied in amphibians by experimental embryologists, but it is only recently that the genetic bases of this development have been explored in zebrafish. This review discusses progress made over the past few years in this field.

  4. Bilateral distal fibula fractures in a woman on long-term bisphosphonate therapy.

    Science.gov (United States)

    Murray, J C; Audet, M C; Bédard, M; Michou, L

    2016-02-01

    We report the case of a 53-year-old female, treated by bisphosphonate for 12 years, who presented atraumatic fractures of both fibulas. Her X-rays showed bilateral distal fibula fractures with radiological features similar to atypical femur fractures. The distal fibula should be considered as a potential site for stress fractures in bisphosphonate users. Bisphosphonates are the most widely used drugs in the treatment of osteoporosis. During the last decade, the occurrence of atypical fractures, mostly subtrochanteric and diaphyseal femoral fractures, has been acknowledged in patients with long-term use of bisphosphonates. We report the case of a 53-year-old female on alendronate therapy for the past 12 years who presented with a few months history of atraumatic right, and subsequently left, lateral ankle pain. Her X-rays showed bilateral distal fibula fractures with radiological features similar to atypical femur fractures. She had been treated conservatively with walking boots and her treatment with bisphosphonate had been stopped 5 months prior to the fractures. Callus was progressively seen on serial follow-up X-rays, and both fractures healed completely within a reasonable period of 1 year. Investigations did not reveal any secondary causes of osteoporosis or metabolic bone disorders. To our knowledge, this is the first reported case of bilateral distal fibula fractures in a patient on long-term bisphosphonate therapy.

  5. Atypical subtrochanteric femoral shaft fractures: role for mechanics and bone quality.

    Science.gov (United States)

    van der Meulen, Marjolein C H; Boskey, Adele L

    2012-08-29

    Bisphosphonates are highly effective agents for reducing osteoporotic fractures in women and men, decreasing fracture incidence at the hip and spine up to 50%. In a small subset of patients, however, these agents have recently been associated with 'atypical femoral fractures' (AFFs) in the subtrochanteric region or the diaphysis. These fractures have several atypical characteristics, including occurrence with minimal trauma; younger age than typical osteoporotic fractures; occurrence at cortical, rather than cancellous sites; early radiographic appearance similar to that of a stress fracture; transverse fracture pattern rather than the familiar spiral or transverse-oblique morphologies; initiation on the lateral cortex; and high risk of fracture on the contralateral side, at the same location as the initial fracture. Fracture is a mechanical phenomenon that occurs when the loads applied to a structure such as a long bone exceed its load-bearing capacity, either due to a single catastrophic overload (traumatic failure) or as a result of accumulated damage and crack propagation at sub-failure loads (fatigue failure). The association of AFFs with no or minimal trauma suggests a fatigue-based mechanism that depends on cortical cross-sectional geometry and tissue material properties. In the case of AFFs, bisphosphonate treatment may alter cortical tissue properties, as these agents are known to alter bone remodeling. This review discusses the use of bisphosphonates, their effects on bone remodeling, mechanics and tissue composition, their significance as an effective therapy for osteoporosis, and why these agents may increase fracture risk in a small population of patients.

  6. Condylar restoration after early TMJ fractures and functional appliance therapy. Part II: Muscle evaluation.

    Science.gov (United States)

    Kahl-Nieke, B; Fischbach, R

    1999-01-01

    The aim of this study was to analyze and to describe the condition of the lateral pterygoid muscle during and after functional appliance therapy in children who had sustained condylar fractures. The treatment group consisted of 19 patients with an average age of 13.4 years, who had sustained a unilateral fracture at an average age of 8.4 years and had been treated functionally for 6 to 8 months. Muscle condition was assessed through axial soft tissue description. The volume and density of the lateral pterygoid muscle were measured in both groups and were compared on the basis of sex, age and fracture type. 74% of the patients in the follow-up group showed muscle differences of more than 10% between the 2 sides. In 2/3 of these patients the lateral pterygoid of the fracture side was 13 to 69% smaller. The volumes of the contralateral pterygoid muscles in the 2 patient groups differed by 10% on the basis of sex. Both in the treatment group and in the follow-up group the volume difference between the healthy and fractured side was as high as 70% depending on localization and type of fracture. Deep fractures and fractures with complete dislocation of the condyle evoked the most serious reduction in muscle volume.

  7. Identification of Differentially Expressed Gene after Femoral Fracture via Microarray Profiling

    Directory of Open Access Journals (Sweden)

    Donggen Zhong

    2014-01-01

    Full Text Available We aimed to investigate differentially expressed genes (DEGs in different stages after femoral fracture based on rat models, providing the basis for the treatment of sport-related fractures. Gene expression data GSE3298 was downloaded from Gene Expression Omnibus (GEO, including 16 chips. All femoral fracture samples were classified into earlier fracture stage and later fracture stage. Total 87 DEGs simultaneously occurred in two stages, of which 4 genes showed opposite expression tendency. Out of the 4 genes, Rest and Cst8 were hub nodes in protein-protein interaction (PPI network. The GO (Gene Ontology function enrichment analysis verified that nutrition supply related genes were enriched in the earlier stage and neuron growth related genes were enriched in the later stage. Calcium signaling pathway was the most significant pathway in earlier stage; in later stage, DEGs were enriched into 2 neurodevelopment-related pathways. Analysis of Pearson's correlation coefficient showed that a total of 3,300 genes were significantly associated with fracture time, none of which was overlapped with identified DEGs. This study suggested that Rest and Cst8 might act as potential indicators for fracture healing. Calcium signaling pathway and neurodevelopment-related pathways might be deeply involved in bone healing after femoral fracture.

  8. Asisstance Arthroscopy in Juvenile Tillaux Fractures

    Science.gov (United States)

    Mañero, Luciano Martin; Arroquy, Damian; Barrios, Juan Manuel; Botta, Juan Martin; Caceres, Carlos Alberto

    2017-01-01

    Introduction: Juvenile Tillaux Fracture is an isolated fracture of the lateral portion of the distal tibial epiphysis, considered SALTER-HARRIS fracture type 3, wherein the fragment is moved by the anterolateral ligament anterior inferior tibiofibular. They occur at the beginning of the 2nd decade of life and are caused by a force external rotation. The pattern of injury is considered a result of the closing sequence of the distal tibial physis, which usually closes around 15 years of age in girls and 17 in boys, this process usually takes about 18 months, occurring first in the central area of the physis, extending medially and finally to side, being this epiphyseal portion which is open at the time of the vulnerable to fracture injury in this age group. The curriculum includes RX, and TAC, being more sensitive to detect fragments of 2 or more mm of travel, but may overestimate the true displacement. The non-displaced fracture can be treated with cast immobilization and displaced with closed reduction (plantar flexion external rotation in the pronated foot and direct pressure on the anterolateral epiphysis). An equal displacement or > 2 mm of the articular surface is indication of open reduction and percutaneous fixation, because it may increase the risk of osteoarthritis in the future. Objective: Presentation of a case Juvenile Tillaux Fractures with surgical resolution under arthroscopic assistance. Methods: Male patient 14 years old who suffered indirect trauma left ankle during practice sports (rugby) in September 2015, 48 hours of evolution. After performing X-rays and scans one left Salter Harris type III at the level of distal tibial epiphysis (Tillaux fracture) ankle fracture was diagnosed. It had a greater than 2 mm displacement. As a reduction treatment and percutaneous osteosynthesis with more osteodesis screw with arthroscopic assistance and fluoroscopy was performed. After surgery a long leg cast was placed for three weeks, continuing with three other

  9. Seepage properties of a single rock fracture subjected to triaxial stresses

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Coupled properties of seepage and stress fields of rock fractures greatly influence the safety of geotechnical engineering work.Based on the closing defomation principle of a single rock fracture,equations describing relationships of aperture and triaxial stresses are developed,and coupled models of seepage and triaxial stresses are proposed.Seepage tests are conducted under triaxial stress conditions by adopting hard granite specimens with an artificial fracture.The results show that the normal stress,lateral stress and seepage pressure significantly affect the flow behavior of rock fractures,and that hydraulic conductivity decreases with increasing normal.stress,but increases with rising lateral stress or seepage pressure.In addition,an exponential function provides a good representation of the seepage characteristics of a single rock fracture subjected to triaxial stresses.

  10. Management of Horizontal Root Fracture in the Middle Third via Intraradicular Splinting Using a Fiber Post

    Directory of Open Access Journals (Sweden)

    Ishani Karhade

    2016-01-01

    Full Text Available Radicular fractures in permanent teeth are uncommon injuries and account for only 0.5–7% of dental traumas. These fractures commonly result from a horizontal impact and are transverse to oblique in direction. Their incidence is more in the middle third of the root than at the apical and cervical thirds. This paper describes a case of complicated crown fracture of maxillary incisors along with horizontal root fracture at the middle third of maxillary right central and lateral incisor. The fractured root fragments of the upper right central and lateral incisor were united with the help of a glass fiber post after receiving an endodontic treatment. The other two incisors were treated endodontically followed by post endodontic restorations. Eventually the four incisors were restored with porcelain fused to metal crowns. A one-year follow-up revealed a well stabilized assembly of the root fragments and the post.

  11. Fractures in the deep critical zone characterized by drilling and geophysics in the Laramie Range, Wyoming

    Science.gov (United States)

    Hayes, J. L.; Holbrook, W. S.; Carr, B.; Flinchum, B. A.; Rempe, D.; Novitsky, C. G.; Dewey, J.

    2016-12-01

    Fractures are linked to many processes that influence the architecture of the deep critical zone; for example, fractures may regulate the influx of meteoric water and thus direct the propagation of chemical weathering. It is therefore important to understand the subsurface distribution of fractures and their control on deep critical zone architecture. Several proposed theoretical frameworks imply that the distribution of fractures in the deep critical zone may vary along hillslopes. Frost cracking models predict variations in cracking intensity depending on aspect and temperature variation. Surface curvature and inherited tectonic fractures may also provide controls on fracture distribution. A recently proposed model combines topographic and tectonic stresses to calculate the lateral distribution of subsurface stress and failure potential, thus implying local and regional controls on the distribution and density of fractures. In light of these models, we use geophysical surveys and observations from boreholes to characterize fractures in the deep critical zone in the Laramie Mountains, Wyoming. Our geophysical results from seismic refraction surveys suggest that local topographic and regional tectonic stresses control the distribution of fractures. This interpretation is supported by borehole measurements, which show that fracture density decreases with depth and is lower beneath valleys than ridges. We estimate fracture density from pixel analysis of amplitude and traveltime acoustic televiewer data, which accounts for fracture aperture. Comparisons of p-wave velocities and fracture density show that increasing seismic velocity (i.e., from 1-4 km/s) corresponds to decreasing fracture density. From optical televiewer images of the borehole we also interpret thick (> 10 cm) weathering zones along fractures in the upper portions of boreholes located on the ridge. This observation emphasizes the complex interplay of chemical and physical processes in shaping the deep

  12. Creativity in later life.

    Science.gov (United States)

    Price, K A; Tinker, A M

    2014-08-01

    The ageing population presents significant challenges for the provision of social and health services. Strategies are needed to enable older people to cope within a society ill prepared for the impacts of these demographic changes. The ability to be creative may be one such strategy. This review outlines the relevant literature and examines current public health policy related to creativity in old age with the aim of highlighting some important issues. As well as looking at the benefits and negative aspects of creative activity in later life they are considered in the context of the theory of "successful ageing". Creative activity plays an important role in the lives of older people promoting social interaction, providing cognitive stimulation and giving a sense of self-worth. Furthermore, it is shown to be useful as a tool in the multi-disciplinary treatment of health problems common in later life such as depression and dementia. There are a number of initiatives to encourage older people to participate in creative activities such as arts-based projects which may range from visual arts to dance to music to intergenerational initiatives. However, participation shows geographical variation and often the responsibility of provision falls to voluntary organisations. Overall, the literature presented suggests that creative activity could be a useful tool for individuals and society. However, further research is needed to establish the key factors which contribute to patterns of improved health and well-being, as well as to explore ways to improve access to services.

  13. Brainmining emotive lateral solutions

    Directory of Open Access Journals (Sweden)

    Theodore Scaltsas

    2016-07-01

    Full Text Available BrainMining is a theory of creative thinking that shows how we should exploit the mind’s spontaneous natural disposition to use old solutions to address new problems – our Anchoring Cognitive Bias. BrainMining develops a simple and straightforward method to transform recalcitrant problems into types of problems which we have solved before, and then apply an old type of solution to them. The transformation makes the thinking lateral by matching up disparate types of problem and solution. It emphasises the role of emotive judgements that the agent makes, when she discerns whether a change of the values or the emotions and feelings in a situation, which would expand the space of solutions available for the problem at hand, would be acceptable or appropriate in the situation. A lateral solution for an intractable problem is thus spontaneously brainmined from the agent’s old solutions, to solve a transformed version of the intractable problem, possibly involving changes in the value system or the emotional profile of the situation, which the agent judges, emotively, will be acceptable, and even appropriate in the circumstances.

  14. Lateral Lumbar Interbody Fusion

    Science.gov (United States)

    Hughes, Alexander; Girardi, Federico; Sama, Andrew; Lebl, Darren; Cammisa, Frank

    2015-01-01

    The lateral lumbar interbody fusion (LLIF) is a relatively new technique that allows the surgeon to access the intervertebral space from a direct lateral approach either anterior to or through the psoas muscle. This approach provides an alternative to anterior lumbar interbody fusion with instrumentation, posterior lumbar interbody fusion, and transforaminal lumbar interbody fusion for anterior column support. LLIF is minimally invasive, safe, better structural support from the apophyseal ring, potential for coronal plane deformity correction, and indirect decompression, which have has made this technique popular. LLIF is currently being utilized for a variety of pathologies including but not limited to adult de novo lumbar scoliosis, central and foraminal stenosis, spondylolisthesis, and adjacent segment degeneration. Although early clinical outcomes have been good, the potential for significant neurological and vascular vertebral endplate complications exists. Nevertheless, LLIF is a promising technique with the potential to more effectively treat complex adult de novo scoliosis and achieve predictable fusion while avoiding the complications of traditional anterior surgery and posterior interbody techniques. PMID:26713134

  15. CT classification of acetabular fractures

    Energy Technology Data Exchange (ETDEWEB)

    Marincek, B.; Porcellini, B.; Robotti, G.

    1984-05-01

    The contribution of computed tomography (CT) in classifying acetabular fractures was analysed retrospectively in 33 cases. CT and plain radiography classification agreed in 27 cases (82%). CT revealed more extensive fractures in 6 patients (thereof 5 patients with associated fractures). In 10 patients (thereof 9 patients with associated fractures) CT showed intraarticular fragments; radiographically intraarticular fragments were seen only in 2 patients and suspected in 4. CT is of considerable aid in defining the fracture pattern. It should be used mainly in patients with radiographically difficult interpretable associated fractures in order to assess preoperatively the weight-bearing part of the acetabulum, the degree of displacement and the presence of intraarticular fragments.

  16. Atomistic Simulations of Nanotube Fracture

    CERN Document Server

    Belytschko, T; Schatz, G; Ruoff, R S

    2002-01-01

    The fracture of carbon nanotubes is studied by atomistic simulations. The fracture behavior is found to be almost independent of the separation energy and to depend primarily on the inflection point in the interatomic potential. The rangle of fracture strians compares well with experimental results, but predicted range of fracture stresses is marketly higher than observed. Various plausible small-scale defects do not suffice to bring the failure stresses into agreement with available experimental results. As in the experiments, the fracture of carbon nanotubes is predicted to be brittle. The results show moderate dependence of fracture strength on chirality.

  17. [Humeral shaft fractures].

    Science.gov (United States)

    Schittko, A

    2004-08-01

    Since Lorenz Böhler postulated in his 1964 summary with the title "Against the operative treatment of fresh humeral shaft fractures" that the operative treatment is the exception in the therapy of humeral fractures times have changed. In the last years a conservative treatment of a humeral fracture is the exception and only used after straight indications. The operative therapy nowadays is the gold standard because of the development of new intramedullar and rotation stable implants in addition to the classical osteosynthesis with the plate. But even the external fixator for primary stabilisation in polytrauma patients or as rescue procedure after complications should be in repertory of every orthopedic surgeon. Attention should be put on the avoidance of primary and the correct treatment of secondary nerval lesions, esp. of the radial nerve. Here we are tending to the operative revision of the nerve in indistinct cases. In the treatment of the seldom humeral shaft fracture of the child conservative treatment is to prefer; in complications a resolute shift to a final operative stabilisation of the fracture is necessary.

  18. Pin fixation in treatment of dislocated lateral condyle of the humerus in pediatric population

    Directory of Open Access Journals (Sweden)

    Gajdobranski Đorđe R.

    2004-01-01

    Full Text Available Introduction Fractures of lateral condyle represent 17% of all pediatric fractures of the distal humerus, and in current pediatric orthopedics there is still no agreement regarding optimal treatment modalities. We presented a treatment protocol for pediatric dislocated fractures of the lateral condyle of the humerus used at the Pediatric Surgery Clinic in Novi Sad. Material and methods Over the study period (1991-2000 a total of 48 patients with dislocated fractures of the lateral condyle of the humerus were hospitalized at the Pediatric Surgery Clinic. Orthopedic reduction and percutaneous pin fixation under radiological supervision was done in 15 patients, while 33 patients needed surgical reduction and pin fixation. Results Satisfactory results were obtained in 42 patients (91.3%, out of which 29 patients (63.1% presented with excellent resuls. Good results were obtained in 8 patients (17.4%, and fair results in 5 patients (10.8%. Unsatisfactory results were present in 4 patients (8.7%. Two patients were lost to follow-up. Discussion Dislocation fractures of the lateral condyle represent high risk for development of complications. Adequate diagnosis and treatment represent basic conditions for successful post-interventional result. Orthopedic reduction with percutaneous pin fixation is recommended for fractures that may be anatomically reduced. In cases of unsatisfactory results of reduction, as well as in cases with completely dislocated and rotated fragments, surgical reduction and pin fixation is necessary. Conclusions Satisfactory results in 91.3% of cases, and long-term experience suggest that the recommended therapeutic option is adequate in treatment of dislocated fractures of the lateral condyle of the humerus in pediatric population.

  19. Fracture-Flow-Enhanced Solute Diffusion into Fractured Rock

    Energy Technology Data Exchange (ETDEWEB)

    Wu, Yu-Shu; Ye, Ming; Sudicky, E.A.

    2007-12-15

    We propose a new conceptual model of fracture-flow-enhanced matrix diffusion, which correlates with fracture-flow velocity, i.e., matrix diffusion enhancement induced by rapid fluid flow within fractures. According to the boundary-layer or film theory, fracture flow enhanced matrix diffusion may dominate mass-transfer processes at fracture-matrix interfaces, because rapid flow along fractures results in large velocity and concentration gradients at and near fracture-matrix interfaces, enhancing matrix diffusion at matrix surfaces. In this paper, we present a new formulation of the conceptual model for enhanced fracture-matrix diffusion, and its implementation is discussed using existing analytical solutions and numerical models. In addition, we use the enhanced matrix diffusion concept to analyze laboratory experimental results from nonreactive and reactive tracer breakthrough tests, in an effort to validate the new conceptual model.

  20. How Much are Emergency Medicine Specialists’ Decisions Reliable in the Diagnosis and Treatment of Pediatric Fractures?

    Directory of Open Access Journals (Sweden)

    Mohsen Mardani-Kivi

    2016-01-01

    Full Text Available Background: Considering the importance of an early diagnosis and proper decision-making in regards to the treatment of pediatric distal radius and elbow fractures, this study examines emergency medicine specialists’ accuracy in the diagnosis and treatment of these patients. Methods: From 2012 and 2013, children less than 14 years old who were referred to an academic hospital emergency department with elbow or distal radius fractures were enrolled. Initially, patients were examined by an emergency medicine specialist and then they were referred to an orthopedic surgeon. Type of fracture and the proposed treatment of two specialists were compared. Results: In total, there were 108 patients (54 patients in each group with a mean age of 8.1+3.3 years. Identical diagnosis in 48 cases (88.9% of distal radius and 36 cases (66.7% of elbow trauma were observed. We found a difference between diagnosis of the two specialists in diagnosing lateral condyle of the humerus fracture in the elbow group and growth plate fracture in the distal radius fracture group, but the differences were not significant. Among 108 patients, 70 patients (64.8% received identical treatment. Conclusion: Although the emergency medicine specialists responded similarly to the orthopedic specialists in the diagnosis of pediatric distal radius and elbow fractures, diagnosis of more complicated fractures such as lateral condylar humoral fractures, distal radius growth plate and for choosing the proper treatment option, merits further education.

  1. Arthroscopic double-row suture anchor fixation of minimally displaced greater tuberosity fractures.

    Science.gov (United States)

    Ji, Jong-Hun; Kim, Weon-Yoo; Ra, Ki-Hang

    2007-10-01

    In cases of displaced greater tuberosity fractures, treatments by arthroscopic-assisted reduction and percutaneous screw fixation have been reported. However, in cases in which there is a comminuted fracture or a minimally displaced fracture combined with concomitant lesions such as rotator cuff tear or labral pathology, it is difficult to reduce the fracture and to treat other pathologies by use of a percutaneous screw. Recently, many surgeons have used the double-row repair method in rotator cuff repair, which provides a tendon-bone interface better suited for biologic healing and restoring normal anatomy. In accordance with this method, we used the arthroscopic technique of double-row suture anchor fixation for a minimally displaced greater tuberosity fracture without additional incision. Initially, debridement was performed on the fracture surface by use of a shaver, and the medial-row anchor was inserted through the anterior portal or the intact cuff. Two lateral-row anchors were inserted just anterior and posterior to the lower margin of the fractured fragment under C-arm guidance. The medial-row sutures and lateral-row sutures were then placed. Arthroscopic double-row suture anchor fixation of a displaced greater tuberosity fracture restores the original footprint of the rotator cuff and normal tendon-bone interface of the displaced greater tuberosity fracture.

  2. Treatment of maxilla and palate sagittal fracture by lateral ligation and fixation between bilateral maxillary molars%双侧上颌磨牙间横向结扎固定治疗上颌骨及腭骨矢状骨折

    Institute of Scientific and Technical Information of China (English)

    白晓峰; 张霞; 杨鸣良; 卢利

    2012-01-01

    目的 探讨上颌骨及腭骨矢状骨折的治疗方法,评价上颌磨牙间横向环状结扎联合犁状孔缘坚强内固定对上颌骨和腭骨矢状骨折的疗效,以进一步提高面中部骨折的治疗水平.方法 回顾性研究2005年1月至2011年1月就诊于中国医科大学附属口腔医院的79例上颌骨及腭骨矢状骨折病例.根据骨折移位程度、咬牙 合情况及伤后至就诊时间等因素选择手术治疗或非手术治疗.手术治疗采用双侧上颌磨牙间横向环状结扎恢复上颌牙弓宽度,并联合应用微型钛板于上颌骨犁状孔缘完成上颌骨和腭骨矢状骨折的固定.结果 本组患者中,75例随访3~6个月,治疗效果稳定.73例(占97.33%)患者术后咬牙合关系恢复较好,1例术后出现咬牙合无力,1例术后出现单侧咬牙 合不良.结论 采用双侧上颌磨牙间横向结扎固定,可以使上颌骨及腭骨矢状骨折恢复至正常咬牙合关系,达到理想的治疗效果.%Objective To explore the treating method of sagittal fracture of maxilla and palate, evaluating the effect of intermolar wiring fixation with combined with the maxilla rigid internal fixation on their sagittal fracture. Methods Totally 79 patients in Hospital of Stomatology, China Medical University, from January 2005 to January 2011, with the diagnosis of sagittal fracture of maxilla and palate confirmed by 3D-CT were retrospectively reviewed. Surgical or non-surgical management had been performed on those cases according to the displacement, occlusion condition and the duration from injury to treatment. Intermolar wiring had been used to reduce the palate bone and restore the width of upper dental arch. The intermolar wiring fixation with combination of rigid internal fixation at pyriform rim by titanium microplate had been performed to treat the sagittal fracture of maxilla and palate. The intermolar wiring fixationg had been maintained for 4 weeks after operation to stabilize the

  3. Transstyloid, transscaphoid, transcapitate fracture: a variant of scaphocapitate fractures.

    LENUS (Irish Health Repository)

    Burke, Neil G

    2014-01-01

    Transstyloid, transscaphoid, transcapitate fractures are uncommon. We report the case of a 28-year-old man who sustained this fracture following direct trauma. The patient was successfully treated by open reduction internal fixation of the scaphoid and proximal capitate fragment, with a good clinical outcome at 1-year follow-up. This pattern is a new variant of scaphocapitate fracture as involves a fracture of the radial styloid as well.

  4. Sacral Insufficiency Fractures: Recognition and Treatment in Patients with Concurrent Lumbar Vertebral Compression Fractures

    Science.gov (United States)

    Granville, Michelle; Jacobson, Robert E; Berti, Aldo

    2017-01-01

    Introduction In reviewing a larger group of osteoporotic vertebral compression fractures (VCFs), we found that the overall incidence of sacral insufficiency fractures (SIFs) is higher than commonly reported values. This is especially seen in patients with previous or concurrent lumbar VCFs and also in a subgroup that had lumbar stenosis or hip arthroplasty. The altered biomechanics due to associated lumbar stenosis or hip arthroplasty lead to increased mechanical stress on already weakened and deficient sacral alae, which are more vulnerable to osteoporotic weakening than other parts of the sacrum. Materials & methods We studied an overall population of patients with VCF seen clinically and separated the patients into the following groups: patients not previously treated, patients treated with vertebroplasty or kyphoplasty at one or more levels, and patients diagnosed with sacral fractures and treated with vertebroplasty or kyphoplasty. We wanted to see if a pattern existed among the patients who had sacral symptoms, were diagnosed with sacral insufficiency fractures, and subsequently underwent sacroplasty. Results In a review of 79 consecutive patients, over a 24-month period, with VCF who underwent surgical treatment, there were 10 patients who also had sacral insufficiency fractures. Four of the patients had sacral insufficiency fractures without VCF. None of the patients with sacral insufficiency fractures were on treatment for osteoporosis at the time of diagnosis. The following symptoms indicated SIF: lower sacral pain (n = 10), buttock pain (n = 7), lateral hip pain (n = 5), and groin pain radiating to the thigh (n = 4). The average time to diagnose SIF was two months after the onset of pain. Conclusions Sacral insufficiency fractures are a frequent cause of both acute and chronic pain; however, they are often missed by the majority of physicians. The frequency of undetected sacral fractures is high. This is due to a number of potential pitfalls

  5. Hydromechanical and Thermomechanical Behaviour of Elastic Fractures during Thermal Stimulation of Naturally Fractured Reservoirs

    Science.gov (United States)

    Jalali, Mohammadreza; Valley, Benoît

    2015-04-01

    behaviors become dominant at different time scales, i.e. HM effects is dominant at early time after injection initiation, whereas the TM effect becomes more dominant at later time as the temperature propagation is slower than pressure propagation in the rock due to different value of hydraulic and thermal diffusivities. Due to the relative similarity of thermoelasticity and poroelasticity on the mechanical behavior of fractures, an analogy between these two mechanisms is introduced which can be used to estimate the effect of one of the mechanisms based on the other one on the mechanical behavior of the considered medium in the cases where only one of the solution exists. There may be merit in developing this work to generate more accurate and higher order functions to represent fractures within a general analogy of THM coupled problems as the computational time of this approach is at least one order less than the conventional THM iterative approaches.

  6. 中药熏洗结合功能锻炼治疗四肢骨折后期关节功能障碍的疗效观察%Analysis of Curative Effect of Chinese Herbal Fumigation and Washing Combined with Functional Exercise in the Treatment of Limbs Fracture Later Joint Dysfunction

    Institute of Scientific and Technical Information of China (English)

    汤颖; 杜海清

    2014-01-01

    目的:评价中药熏洗结合功能锻炼治疗四肢骨折后期关节功能障碍的临床观察。方法通过回顾分析64例四肢骨折后期关节功能障碍经过中药熏洗结合功能锻炼治疗的临床资料。结果64例患者获得随访,优49例,占76.6%;良11例,占17.2%;可3例,占4.7%;差1例,占1.5%,优良率93.8%。结论中药熏洗结合功能锻炼治疗四肢骨折后期关节功能障碍是一种安全、有效的治疗方法。%Objective To evaluate the clinical observation on Chinese medicine fumigation combined with functional exercise for treatment of limb fractures after joint dysfunction. Methods retrospective analysis of 64 cases of limb fractures late joint dysfunction after fumigation with traditional Chinese medicine combined with clinical data and functional exercise therapy. Results 64 patients were excellent in 49 cases, accounting for 76.6%;good in 11 cases, accounting for 17.2%;3 cases, accounting for 4.7%;1 cases, accounting for 1.5%, the excellent and good rate was 93.8%. Conclusion Chinese herb fumigation combined with functional exercise for treatment of limb fractures after joint dysfunction is a safe and ef ective method in the treatment of.

  7. Vertebral Geometry Parameters Can Predict Fractures

    Directory of Open Access Journals (Sweden)

    P Tofighi

    2007-01-01

    Conclusion: Vertebral fractures are common fractures in postmenopausal women. There was a correlation between verte¬bral height and fractures. Vertebral geometric parameters especially height T score can be used for fracture screening.

  8. Distal fibula fracture diagnosed with ultrasound imaging.

    Science.gov (United States)

    Kardouni, Joseph R

    2012-10-01

    The patient was a 31-year-old man serving in a military special forces unit at a remote location. He presented to a physical therapist with a chief complaint of worsening right lateral ankle pain that limited his ability to bear weight. Because the patient met the Ottawa ankle rules and there was concern for a fracture, radiographs were indicated. However, the nearest facility with radiographic capabilities was only available through air medical evacuation. Therefore, the physical therapist assessed the patient's ankle with an onsite portable ultrasound imaging unit, which demonstrated cortical irregularity along the distal fibula.

  9. Galeazzi fractures and dislocations.

    Science.gov (United States)

    Giannoulis, Filippos S; Sotereanos, Dean G

    2007-05-01

    In 1934, fractures of the middle and distal third of the radius associated with instability of the distal radial ulnar joint (DRUJ) were described by Galeazzi. This type of lesion is characterized by its unstable nature and the need for open reduction and internal fixation to achieve a satisfactory functional outcome. A high index of suspicion should be maintained by the surgeon, and a thorough examination for instability of the DRUJ must be conducted. The marked instability of this fracture-dislocation complex is further enhanced by the disruption of the triangular fibrocartilage complex, either with or without ulna styloid fracture. Treatment in adults is surgical, and both bone and soft tissue injuries should be addressed.

  10. DEM Particle Fracture Model

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Boning [Univ. of Colorado, Boulder, CO (United States); Herbold, Eric B. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Homel, Michael A. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Regueiro, Richard A. [Univ. of Colorado, Boulder, CO (United States)

    2015-12-01

    An adaptive particle fracture model in poly-ellipsoidal Discrete Element Method is developed. The poly-ellipsoidal particle will break into several sub-poly-ellipsoids by Hoek-Brown fracture criterion based on continuum stress and the maximum tensile stress in contacts. Also Weibull theory is introduced to consider the statistics and size effects on particle strength. Finally, high strain-rate split Hopkinson pressure bar experiment of silica sand is simulated using this newly developed model. Comparisons with experiments show that our particle fracture model can capture the mechanical behavior of this experiment very well, both in stress-strain response and particle size redistribution. The effects of density and packings o the samples are also studied in numerical examples.

  11. Closed Reduction and Percutaneous Fixation of Calcaneal Fractures in Children.

    Science.gov (United States)

    Feng, Yongzeng; Yu, Yang; Shui, Xiaolong; Ying, Xiaozhou; Cai, Leyi; Hong, Jianjun

    2016-07-01

    Open reduction and internal fixation has been widely used to treat displaced intra-articular calcaneus fractures in children. However, the complications of surgical trauma and the wound created through the extended lateral approach cannot be ignored. This study analyzed the outcomes of displaced intra-articular calcaneal fractures in children treated with closed reduction and percutaneous fixation. Medical records of pediatric patients who had displaced intra-articular calcaneus fractures and underwent closed reduction and percutaneous fixation at the study institution between January 2008 and January 2013 were reviewed. Preoperative radiographs and computed tomography scans were used to evaluate and classify the fractures. Clinical outcomes and radiographic findings were assessed at postoperative follow-up. The study included 14 displaced intra-articular calcaneal fractures in 11 patients (7 boys and 4 girls). Mean patient age was 11.18 years (range, 6-16 years), and average follow-up time was 42.8 months postoperatively (range, 12-72 months). There were 6 tongue-type fractures and 8 joint depression-type fractures, based on the Essex-Lopresti classification, and there were 11 type II and 3 type III fractures, based on the Sanders classification. Average Böhler angle was 8.00° (range, -5° to 18°) preoperatively and 30.79° (range, 26° to 40°) postoperatively (P<.001). Average subjective American Orthopaedic Foot and Ankle Society hindfoot score was 65.7 (range, 52-68). No patients had wound breakdown or infection. In the treatment of displaced intra-articular calcaneal fractures in pediatric patients, closed reduction and percutaneous fixation achieved good outcomes, with few complications. [Orthopedics. 2016; 39(4):e744-e748.]. Copyright 2016, SLACK Incorporated.

  12. Stress Fractures of the Foot and Ankle in Athletes

    Science.gov (United States)

    Mayer, Stephanie W.; Joyner, Patrick W.; Almekinders, Louis C.; Parekh, Selene G.

    2014-01-01

    Context: Stress fractures of the foot and ankle are a common problem encountered by athletes of all levels and ages. These injuries can be difficult to diagnose and may be initially evaluated by all levels of medical personnel. Clinical suspicion should be raised with certain history and physical examination findings. Evidence Acquisition: Scientific and review articles were searched through PubMed (1930-2012) with search terms including stress fractures and 1 of the following: foot ankle, medial malleolus, lateral malleolus, calcaneus, talus, metatarsal, cuboid, cuneiform, sesamoid, or athlete. Study Design: Clinical review. Level of Evidence: Level 5. Results: Stress fractures of the foot and ankle can be divided into low and high risk based upon their propensity to heal without complication. A wide variety of nonoperative strategies are employed based on the duration of symptoms, type of fracture, and patient factors, such as activity type, desire to return to sport, and compliance. Operative management has proven superior in several high-risk types of stress fractures. Evidence on pharmacotherapy and physiologic therapy such as bone stimulators is evolving. Conclusion: A high index of suspicion for stress fractures is appropriate in many high-risk groups of athletes with lower extremity pain. Proper and timely work-up and treatment is successful in returning these athletes to sport in many cases. Low-risk stress fracture generally requires only activity modification while high-risk stress fracture necessitates more aggressive intervention. The specific treatment of these injuries varies with the location of the stress fracture and the goals of the patient. PMID:25364480

  13. [Osteoporotic fractures of the proximal femur. What's new?].

    Science.gov (United States)

    Bonnaire, F; Straßberger, C; Kieb, M; Bula, P

    2012-10-01

    Proximal femoral fractures in the elderly are still increasing and are almost always associated with osteoporosis. Especially the over 80-year-olds are increasing and at risk in this respect. In the treatment of these patients new knowledge has been achieved over the last years. An interdisciplinary, multimodal approach with early involvement of internists, geriatricians, anesthetists, osteologists, social workers, care facilities and outpatient trauma and orthopedic surgeons seems to generate a better outcome with fewer complications. In cases of suspected proximal femoral fracture diagnostic imaging should include a computed tomography scan of the posterior pelvic ring to detect commonly occurring fragility fractures of the lateral mass of the sacrum. Early surgery within the first 48 h has a significant positive effect with respect to general and local complications and early mortality. Medical and organizational barriers to an early operation, such as anticoagulant medication, limited capability of communication due to mental dysfunction and lack of operation capacity are continuously declining and subsequently complication rates are decreasing annually in Germany. Endoprosthetics are still associated with higher perioperative mortality than osteosynthesis (4.4 % versus 5.8 %). The innovations in the field of implants and surgical technique also contribute to these lower complication rates. While endoprosthetic treatment is still the gold standard for severely dislocated femoral neck fractures, non-dislocated or slightly dislocated fractures should be fixed with a stable extramedullary implant. For pertrochanteric fractures extramedullary stabilization can only be recommended for stable types of fractures. Every instable trochanteric fracture should be fixed with an intramedullary implant. The use of third generation nails has implicated a significant reduction of complication rates regarding cut-out and reoperations. Rotational fixing of the head

  14. Epicondilite lateral do cotovelo

    OpenAIRE

    Cohen,Marcio; Motta Filho,Geraldo da Rocha

    2012-01-01

    A epicondilite lateral, também conhecida como cotovelo do tenista, é uma condição comum que acomete de 1 a 3% da população. O termo epicondilite sugere inflamação, embora a análise histológica tecidual não demonstre um processo inflamatório. A estrutura acometida com mais frequência é a origem do tendão extensor radial curto do carpo e o mecanismo de lesão está associado à sua sobrecarga. O tratamento incruento é o de escolha e inclui: repouso, fisioterapia, infiltração com cortisona ou plasm...

  15. Vitiligo Lateral Lower Lip

    Directory of Open Access Journals (Sweden)

    Sahoo Antaryami

    2002-01-01

    Full Text Available Vitiligo characteristically affecting the lateral lower lip (LLL is a common presentation in South Orissa. This type of lesion has rarely been described in literature. One hundred eighteen such cases were studied during the period from October 1999 to September, 2000. LLL vitiligo constituted 16.39% of all vitiligo patients. Both sexes were affected equally. The peak age of onset was in the 2nd decade, mean duration of illness 21.46 months. Fifty six patients had unilateral lesion (38 on the left and 18 on the right. Among the 62 patients having bilateral lesions, the onset was more frequent on the left (38 than either the right (8 or both sides together (16. All the patients were right handed. Association with local factors like infection, trauma, cheilitis, FDE etc were associated in 38.98% of cases, but systemic or autoimmune diseases were not associated. Positive family history was found in 22% of cases.

  16. Lateral conduction infrared photodetector

    Science.gov (United States)

    Kim, Jin K.; Carroll, Malcolm S.

    2011-09-20

    A photodetector for detecting infrared light in a wavelength range of 3-25 .mu.m is disclosed. The photodetector has a mesa structure formed from semiconductor layers which include a type-II superlattice formed of alternating layers of InAs and In.sub.xGa.sub.1-xSb with 0.ltoreq.x.ltoreq.0.5. Impurity doped regions are formed on sidewalls of the mesa structure to provide for a lateral conduction of photo-generated carriers which can provide an increased carrier mobility and a reduced surface recombination. An optional bias electrode can be used in the photodetector to control and vary a cut-off wavelength or a depletion width therein. The photodetector can be formed as a single-color or multi-color device, and can also be used to form a focal plane array which is compatible with conventional read-out integrated circuits.

  17. Unilateral lag-screw technique for an isolated anterior 1/4 atlas fracture

    Directory of Open Access Journals (Sweden)

    Semih Keskil

    2016-01-01

    Full Text Available Study Design: Fractures of the atlas are classified based on the fracture location and associated ligamentous injury. Among patients with atlas fractures treated using external immobilization, nonunion of the fracture could be seen. Objective: Ideally, treatment strategy for an unstable atlas fracture would involve limited fixation to maintain the fracture fragments in a reduced position without restricting the range of motion (ROM of the atlantoaxial and atlantooccipital joints. Summary of Background Data: Such a result can be established using either transoral limited internal fixation or limited posterior lateral mass fixation. However, due to high infection risk and technical difficulty, posterior approaches are preferred but none of these techniques can fully address anterior 1/4 atlas fractures such as in this case. Materials and Methods: A novel open and direct technique in which a unilateral lag screw was placed to reduce and stabilize a progressively widening isolated right-sided anterior 1/4 single fracture of C 1 that was initially treated with a rigid cervical collar is described. Results: Radiological studies made after the surgery showed no implant failure, good cervical alignment, and good reduction with fusion of C 1 . Conclusions: It is suggested that isolated C 1 fractures can be surgically reduced and immobilized using a lateral compression screw to allow union and maintain both C 1-0 and C 1-2 motions, and in our knowledge this is the first description of the use of a lag screw to achieve reduction of distracted anterior 1/4 fracture fragments of the C1 from a posterior approach. This technique has the potential to become a valuable adjunct to the surgeon′s armamentarium, in our opinion, only for fractures with distracted or comminuted fragments whose alignment would not be expected to significantly change with classical lateral mass screw reduction.

  18. Transparotid approach for mandibular condylar neck and subcondylar fractures.

    Science.gov (United States)

    Croce, A; Moretti, A; Vitullo, F; Castriotta, A; Rosa, De M; Citraro, L

    2010-12-01

    Mandibular condylar neck fractures and subcondylar fractures represent, respectively, 19-29% and 62-70% of all mandibular fractures; treatment involves some problems, common to both, concerning the choice of an adequate approach. Herewith, personal experience is reported related to the surgical treatment of some cases of mandibular condylar neck and subcondylar fractures by transparotid approaches with partial parotidectomy, removing the salivary tissue overlying the condylar neck and/or the subcondylar region. Over the last 5 years, we observed 22 fractures of the condylar neck and 10 fractures of the subcondylar region. In 13 patients (11 male, 2 female, age range 10-68 years, mean 33 years), 10 of whom had other mandibular and/or other maxillo-facial and skeleton fractures - 50% of these with dislocated condylar heads - and the other 3 for their free choice, regarding the different treatments, 18 transparotid approaches with partial parotidectomy (bilateral in 5 cases), were performed reducing and fixing 12 condylar neck fractures and 5 subcondylar region fractures with appropriate plates (2.0 mm) and screws. After surgery, no intermaxillary fixation was performed. Complications included 4 salivary fistulae (bilateral in 1 patient), which closed spontaneously after 4 or 5 weeks with a dressing, 1 case of Frey's syndrome, which healed after 2 treatments with botulin and 6 cases of transient facial palsy lasting 4-8 weeks (1 case bilateral) affecting zygomatic, buccal and marginal mandibular nerves. During follow-up, functional parameters considered were: restoration of original pre-injury occlusion; vertical, lateral and protrusion mandibular movements. All patients re-acquired the original pre-injury occlusion; the maximal post-operative intrinsical distance was at least 40 mm after a variable period of rehabilitation and lateral and protrusion movements also led to satisfactory final results. All patients were free of pain and had no deflection or clicking upon

  19. Surgical management of combined fracture of atlas associated with fracture of axis vertebrae (CAAF: Case Series

    Directory of Open Access Journals (Sweden)

    Satyarthee Guru Dutta

    2015-09-01

    Full Text Available Combined fracture involving atlas together associated with axis (CAAF accounts for approximately 3 % of traumatic cervical spine injury, CAAF are rarely reported, so modalities of management and outcome are not well understood, due to paucity of literature and only few reports reported in the form of isolated case report. CAFF management possess challenge as it is associated with high incidence non-union with previously conservative method. However, missed diagnosis and subsequent delay may be associated with catastrophic worsening in neurological deficit. So early diagnosis and management remains the key for successful neurological outcome. Such fractures are rare. Authors report five such cases of CAFF, all required surgical management with good outcome with no mortality. Current study, all cases were males (n=5, commonest mode of injury was fall (n=3, time interval since injury was within 24 hours in (n=4, however rest one presented after a gap of eight months. Commonest clinical feature was neck pain (n=3, neurological deficit (n=2, neck tenderness and swelling tenderness (n=3 Neuroimaging including X-ray, CT scan and MRI were carried out for all cases revealed fracture of arches of atlas (n=5, one case had multiple site fracture of both arches, odontoid fracture (n=2, lateral mass of atlas fracture in 1 cases. Astonishingly two cases had disruption of transverse ligament. Surgical procedures performed considering economic consideration included occipito-cervcial fusion (n=3, transarticular C1-C2 fusion and anterior odontoid screw fixation in one cases each. Management options in CAFF and review of literature discussed in present study.

  20. Complications of mandibular fractures.

    Science.gov (United States)

    Zweig, Barry E

    2009-03-01

    Before any definitive treatment of mandibular fractures, the patient needs to be evaluated for more potentially life-threatening injuries. Complications can and do occur with treatment of mandibular fractures and can occur during any of the phases of treatment. The development of an accurate diagnosis and appropriate treatment plan is vital in achieving optimal success and decreasing complications. Knowledge of the anatomy and the principles of bone healing is also an important factor in preventing complications. To limit long-term untoward effects, complications should be recognized early and the appropriate treatment should be started before a minor complication becomes a complex one that is more difficult to manage.

  1. Fractured Petroleum Reservoirs

    Energy Technology Data Exchange (ETDEWEB)

    Firoozabadi, Dr. Abbas

    2000-01-18

    In this report the results of experiments of water injection in fractured porous media comprising a number of water-wet matrix blocks are reported for the first time. The blocks experience an advancing fracture-water level (FWL). Immersion-type experiments are performed for comparison; the dominant recovery mechanism changed from co-current to counter-current imbibition when the boundary conditions changed from advancing FWL to immersion-type. Single block experiments of co-current and counter-current imbibition was performed and co-current imbibition leads to more efficient recovery was found.

  2. [Supracondylar fractures in children].

    Science.gov (United States)

    Petrov, N; Gucev, S; Kirkov, Lj; Dajljevik, S; Ruso, B

    1982-01-01

    In the Department of Pediatric surgery, during the last ten years, 190 patients with supracondylar fractures (second and third degree, according to Bauman's classification) have been treated. The operation was performed in only 5% of all hospitalized cases. There were only one patient with neurological and vascular complications in the early stage, but without any complications in the late stage. The presented cases showed a high percentage of flexion type of fractures. The conservative treatment by a reposition has given the most satisfactory results.

  3. Preliminary functional results of endoscope-assisted transoral treatment of displaced bilateral condylar mandible fractures.

    Science.gov (United States)

    Schoen, R; Fakler, O; Metzger, M C; Weyer, N; Schmelzeisen, R

    2008-02-01

    Temporomandibular joint (TMJ) function was evaluated following endoscope-assisted transoral open reduction and miniplate fixation of displaced bilateral condylar mandibular fractures. The transoral treatment of bilateral condylar fractures was performed in 13 patients from May 2000 to December 2004. Eleven of the 13 patients had additional mandibular fractures. Out of 26 fractures of the condylar process, 11 were located at the condylar neck and 15 were subcondylar. One, 6 and 12 months after surgery TMJ function was evaluated. Anatomic reduction was achieved using an endoscope-assisted transoral approach even when the condylar fragment was displaced medially and in fractures with comminution. Good TMJ function was noted 6 and 12 months after surgery. Mouth opening was measured to be more than 40 mm without deviation. Postoperative range of motion with a satisfying lateral excursion was found. Early rehabilitation and pre-injury TMJ function was achieved following minimally invasive anatomic fracture reduction.

  4. Acute rib fracture diagnosis in an infant by US: a matter of child protection

    Energy Technology Data Exchange (ETDEWEB)

    Kelloff, Jennifer; Spivey, Maria [Washington University School of Medicine, Department of Pediatrics, Section on Child Abuse and Neglect, St. Louis Children' s Hospital, One Children' s Place, Box 8116, St. Louis, MO (United States); Hulett, Rebecca [Washington University School of Medicine, Department of Radiology, St. Louis Children' s Hospital, St. Louis, MO (United States)

    2009-01-15

    Rib fractures in infants and children are highly specific for inflicted injury in the absence of a major accidental injury or underlying bone disorder. We present a 9-week-old infant diagnosed with an acute rib fracture by US at the site where physicians palpated chest wall crepitus when no rib fractures had been visualized on the skeletal survey, including oblique views of the ribs. Based on the US diagnosis of the acute rib fracture the infant was taken into protective custody. Follow-up skeletal survey 2 weeks later revealed healing fractures of the left 6th and 7th posterolateral ribs and right 7th, 8th and 9th anterolateral ribs. We were unable to locate previous reports describing the diagnosis of rib fractures in infants by US. (orig.)

  5. Distal Radius Fracture (Broken Wrist)

    Science.gov (United States)

    .org Distal Radius Fracture (Broken Wrist) Page ( 1 ) The radius is the larger of the two bones of the forearm. The ... the distal end. A fracture of the distal radius occurs when the area of the radius near ...

  6. Colles wrist fracture – aftercare

    Science.gov (United States)

    ... www.ncbi.nlm.nih.gov/pubmed/21228899 . Prawer A. Radius and ulna fractures. In: Eiff MP, Hatch RL, eds. Fracture Management for Primary Care . 3rd ed. Philadelphia, PA: Elsevier Saunders; 2011:chap ...

  7. Fracture After Total Hip Replacement

    Science.gov (United States)

    ... osteolysis. Symptoms The most common symptoms of periprosthetic hip fracture include: • Pain around the hip or thigh • Swelling ... o en very painful, someone with a periprosthetic hip fracture will most likely go directly to the emergency ...

  8. Fracture of the proximal humerus with disruption of the tendon of the pectoralis major

    Directory of Open Access Journals (Sweden)

    Bart M Berghs

    2016-01-01

    Full Text Available Combined pectoralis major disruption and proximal humeral fractures are uncommon. A simple radiologic diagnostic tool which consists of the measurement of the displacement from the humeral shaft to the lateral side of the humeral head (lateral to the outer proximal cortex can help to diagnose this combined lesion.

  9. AXIS侧板钢板螺钉内固定系统对下颈椎骨折脱位后颈髓功能恢复作用%Effect of AXIS lateral mass screw- plate internal fixation system on functional recovery of spinal cord in fracture of lower cervical vertebrae

    Institute of Scientific and Technical Information of China (English)

    昌耘冰; 尹庆水; 夏虹; 吴增晖; 徐国洲; 张余; 权日; 章凯

    2003-01-01

    AIM:To evaluate the methods and results of the AXIS lateral mass screw- plate system in the treating of lower cervical spine injury.METHODS:29 cases of lower cervical vertebrae injury were fixed with AXIS system.All of them were followed- up for more than 1 year.RESULTS:All cases had a good bone union without malformation.We found no complication of the injury to the vertebral arteries or nerves.There was no loosening of the plate and screw. CONCLUSION:AXIS lateral mass screw- plate system has the characteristic of stable,simple and safe and is suitable for the treatment of lower cervical spine injury.

  10. Clinical study of treatment of intercondylar fractures of the distal humerus by double plate fixation viacombined medial and lateral triceps approach%经肱三头肌内外侧联合入路双钢板内固定治疗肱骨髁间骨折的临床研究

    Institute of Scientific and Technical Information of China (English)

    朱俊锟; 应锦河; 柳育健

    2009-01-01

    Objective To evaluate the treatmene results of double plating of type C1,C2(AO/ASIF) intercondylar fractures of the distal humerus through combinod mediolateral tricepe-sparing approach (TSA).Methods A retrospective analysis of 7 cases of intercondylar comminuted fractures of the distal humerus was conducted. There were 3 cases of type C1 and 4 cases of type C2. All the patients were treated with open reduction and double plate and cannulated screw fixation through combined mediolateral triceps-sparing approach. Results Postoperative follow up period was 15 montks (range, 8 to 18 months). Results were evaluated using the Mayo Elbow Performance Score (MEPS). Five cases were graded as excellent, while 2 cases good. Average elbow flexion was (118.6±11.4)°. Average extension lag was (22.9±12.1)°. Carrying angle was (20±5)°. No implant loosening or breakage was noted. Conclusion Combined mediolateral TSA is an ideal approach for fixation of type C1, C2 intercondylar fractures of the distal humerus in that it provides adequate exposure to the fracture site, facilitates fracture reduction and allows early rehabilitation.%目的 探讨经肱三头肌内外侧联合人路(triceps-sparing approach,TSA)双钢板内固定治疗C1、C2型(AO/ASIF)肱骨髁间骨折的疗效.方法 对7例肱骨髁间粉碎性骨折(C1型3例,C2型4例)的患者,采用经肱三头肌内外侧联合入路,双钢板及髁间空心钉固定.结果 术后随访时间为8~18个月,平均15个月.根据Mayo评分系统(MEPS)评定:优5例,良2例.肘关节平均屈曲角度为(118.6±11.4)°,平均伸直角度丢失(22.9±12.1)°,肘关节携带角(20±5)°.无一例出现内固定松动、断裂.结论 经肱三头肌内外侧联合入路治疗C4、C2型肱骨髁间骨折是较理想的手术入路,具有暴露充分、骨折达到良好复位固定及术后早期康复等优点.

  11. Concordance in the radiological diagnosis of thoracolumbar spine fractures.

    Science.gov (United States)

    Hirschfeld, M; Rodriguez, M; Cerván, A M; Ortega, J A; Rivas-Ruiz, F; Guerado, E

    2015-01-01

    Thoracolumbar spine fractures are frequent and severe. Early diagnosis and appropriate treatment to obtain good clinical results is essential, with many classifications being proposed for this purpose. To determine the external validity of radiographic and computed tomography (CT) measurements for the most used classifications, and decide on the type of treatment required. The working hypothesis is the existence of external validity of radiographic measurements. A sample of patients with thoracolumbar fracture was selected. Three spine specialists and a resident performed measurements on anteroposterior and lateral radiographic images as well as coronal, sagittal and axial CT slices. Fractures were classified as stable or unstable, evaluating the degree of intra-and interobserver agreement based on a standard observer. Sagittal index of Farcy, lateral wedging, Beck Index, traumatic regional angulation and channel occupancy were studied. All indicators studied, except the lateral wedging, showed a high degree of concordance. Instability determinants studied with radiographs and CT, which had obtained statistical significance, are reliable and accurate for the classification of thoracolumbar fractures and, therefore, to indicate an appropriate treatment. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

  12. How can horizontal wells help in naturally fractured reservoir characterization?

    Energy Technology Data Exchange (ETDEWEB)

    Mazouzi, A.; Deghmoum, A.; Azzouguen, A. [Sonatrach Inc., Hydra (Algeria); Oudjida, A. [Anadarko Inc., (Algeria)

    2000-11-01

    Two successfully drilled horizontal gas wells in the Tin Fouye Tabankort (TFT) fractured reservoir in Algeria were described. The productivity index of horizontal wells compared to vertical wells depends on the pay zone height, vertical anisotropy, lateral anisotropy, the length of the horizontal drain and the amplitude of the damaged zone. Transient tests in horizontal wells can solve the problem of quantifying the vertical and lateral anisotropies. Horizontal wells also minimize the turbulence effects in the vicinity of the wellbore, particularly in gas wells. The two horizontal wells in the TFT reservoir provide an important gas flow rate. The productivity index for each well is triple that of a vertical well. The permeability tensor on the TFT reservoir is established on the basis of transient test reconstitution using numerical simulation. The vertical permeability yields the best match for pressure response. It can be shown as a translation effect in time at the beginning of the linear flow regime. The horizontal anisotropy reacts to the translation of pressure and its derivative in the vertical direction. The configuration of the reservoir shows a high lateral anisotropy with regards to permeability. The vertical permeability can be considered as the composite permeability of both the matrix and fractures. Numerical and laboratory studies show that low permeability is due to fracture opening. Therefore, fracture doesn't necessarily enhance permeability. 8 refs., 3 tabs., 13 figs.

  13. Lateral Thinking and Technology Education.

    Science.gov (United States)

    Waks, Shlomo

    1997-01-01

    Presents an analysis of technology education and its relevance to lateral thinking. Discusses prospects for utilizing technology education as a platform and a contextual domain for nurturing lateral thinking. Argues that technology education is an appropriate environment for developing complementary incorporation of vertical and lateral thinking.…

  14. Microcracks and Overpressure- Induced Fractures

    Institute of Scientific and Technical Information of China (English)

    Ahmed M. Al - QAHTANI

    2001-01-01

    The microfractures and natural fractures studies have a great significance in the hydrocarbon accumulation exploration and can be a good supporter for wide geophysical study on the major structures. This paper is a brief review on microcracks and overpressure- induced fracture. It is to discuss different views on the mechanism of fractures in the subsurface of the earth.

  15. Radiological findings and healing patterns of incomplete stress fractures of the pars interarticularis

    Energy Technology Data Exchange (ETDEWEB)

    Dunn, Andrew J.; Campbell, Robert S.D. [Royal Liverpool and Broadgreen University Teaching Hospitals, Department of Medical Imaging, Liverpool (United Kingdom); Mayor, Peter E. [Leighton Hospital, Department of Medical Imaging, Crewe, Cheshire (United Kingdom); Rees, Dai [Robert Jones and Agnes-Hunt Orthopaedic Hospital, Department of Orthopaedic Surgery, Oswestry, Shropshire (United Kingdom)

    2008-05-15

    The objective was to retrospectively record the CT and MRI features and healing patterns of acute, incomplete stress fractures of the pars interarticularis. The CT scans of 156 adolescents referred with suspected pars interarticularis stress fractures were reviewed. Patients with incomplete (grade 2) pars fractures were included in the study. Fractures were assessed on CT according to vertebral level, location of cortical involvement and direction of fracture propagation. MRI was also performed in 72 of the 156 cases. MRI images of incomplete fractures were assessed for the presence of marrow oedema and cortical integrity. Fracture healing patterns were characterised on follow-up CT imaging. Twenty-five incomplete fractures were identified in 23 patients on CT. All fractures involved the inferior or infero-medial cortex of the pars and propagated superiorly or superolaterally. Ninety-two percent of incomplete fractures demonstrated either complete or partial healing on follow-up imaging. Two (8%) cases progressed to complete fractures. Thirteen incomplete fractures in 11 patients confirmed on CT also had MRI, and 92% demonstrated oedema in the pars. Ten out of thirteen fractures (77%) showed a break in the infero-medial cortex with intact supero-lateral cortex, which correlated with the CT findings. MRI incorrectly graded one case as a complete (grade 3) fracture, and 2 cases as (grade 1) stress reaction. Six fractures had follow-up MRI, 67% showed partial or complete cortical healing, and the same number showed persistent marrow oedema. Incomplete fracture of the pars interarticularis represents a stage of the evolution of a complete stress fracture. The direction of fracture propagation is consistent, and complete healing can be achieved in most cases with appropriate clinical management. CT best demonstrates fracture size and extent, and is the most appropriate modality for follow-up. MRI is limited in its ability to fully depict the cortical integrity of

  16. Fracture of the occipital condyle caused by minor trauma in child.

    Science.gov (United States)

    Kapapa, Thomas; Tschan, Christoph A; König, Kathrin; Schlesinger, Arkadius; Haubitz, Bernd; Becker, Hartmut; Zumkeller, Matthias; Eckhard, Rickels

    2006-10-01

    We report a case of fractured occipital condyle caused by minor trauma accompanied by light pain on palpation at the lateral cervical trigonum. A 15-year-old boy complained of nuchal pain, particularly pain on palpation at the left lateral cervical trigonum in the absence of neurologic deficits after head deceleration trauma. Computed tomography demonstrated a unilateral nonluxated fracture of the occipital condyle. Owing to consequent immobilization by means of cervical orthosis, pain disappeared after the first 48 hours. Follow-up examination 4 weeks later showed no neurologic deficits. The boy had no severe impairment of movements at the cervical spine.

  17. Fracture design modelling

    Energy Technology Data Exchange (ETDEWEB)

    Crichlow, H.B.; Crichlow, H.B. (ed.)

    1980-02-07

    A design tool is discussed whereby the various components that enter the design process of a hydraulic fracturing job are combined to provide a realistic appraisal of a stimulation job in the field. An interactive computer model is used to solve the problem numerically to obtain the effects of various parameters on the overall behavior of the system.

  18. Forearm Fractures in Children

    Science.gov (United States)

    ... secure them in place. Your doctor may recommend surgery if: Casts support and protect broken bones while they heal. Reproduced from Pring M, Chambers H: Pediatric forearm fractures. Orthopaedic Knowledge Online Journal 2007; 5(5). Accessed October 2014. • The bone ...

  19. Fracture Toughness Characterization

    Directory of Open Access Journals (Sweden)

    Manuel Beltrán Z

    2014-11-01

    Full Text Available This paper addresses the fracture toughness ( , or also known as critical stress intensity Factor, according to conditions of Lineal Elastic Fracture Mechanics (LEFM. The characterization of the mechanical properties in tensile and fracture toughness of structural steel pipes API-5L used in hydrocarbons transportation was performed. For fracture toughness, the material was tested through fatigue crack propagation on standardized compact specimen (CT according to ASTM E-399 norm. A thickness (B equal to and a crack size (a equal to 0.5w were used. With the porpoise of establishing the adequate conditions at the crack tip, the specimens were subjected to fatigue pre-cracking by application of repeated cycles of load in tensile-tensile and constant load amplitude with a load ratio of R = 0.1. The experimental Compliance method was used based on data obtained from load vs. Crack Mouth Opening Displacement (CMOD. The results show a Stress Intensity factor of 35.88 MPa√m for a 25 mm crack size specimen. The device used for testing is a MTS-810 machine with capacity of 100KN and 6 kHz sampling rate, which meets the conditions of the ASTM E-399 standard. The cracking susceptibility of steel is influenced by the size, morphology and distribution of non-metallic inclusions, thermochemical interaction with the environment and microstructure.

  20. Neglected hangman fracture

    Directory of Open Access Journals (Sweden)

    Sudhir Kumar Srivastava

    2015-01-01

    Full Text Available Acute management of hangman fracture is well described; however the surgical management of neglected hangman fracture has not been described in literature. We report the surgical management of an untreated hangman′s fracture. A 30-year-old male had fallen from a tree 12 weeks back. Patient presented with cervical myelopathy and restricted neck movements. Radiographs and computed tomography (CT scan revealed fracture of pars interarticularis of axis with Grade III C2-C3 spondylolisthesis with localized kyphosis of 33°. Gentle reduction under general anesthesia (GA failed to improve the alignment. Patient was operated in three stages in a single setting. In Stage I, release of contracted anterior structures and C2-C3 discectomy was done in supine position followed by C2-C3 posterior fixation and fusion in Stage II. C2-C3 interbody bone grafting and anterior plating completed the third stage. C2-C3 interbody fusion was seen at 5 months and a CT scan at 18 months postoperative confirmed fusion and maintenance of alignment. The satisfactory outcome in our patient leads us to believe that anterior-posterior-anterior is the appropriate surgical approach for treatment of such patients.

  1. Injection through fractures

    Energy Technology Data Exchange (ETDEWEB)

    Johns, R.A.

    1987-05-01

    Tracer tests are conducted in geothermal reservoirs as an aid in forecasting thermal breakthrough of reinjection water. To interpret tracer tests, mathematical models have been developed based on the various transport mechanisms in these highly fractured reservoirs. These tracer flow models have been applied to interpret field tests. The resulting matches between the model and field data were excellent and the model parameters were used to estimate reservoir properties. However, model fitting is an indirect process and the model's ability to estimate reservoir properties cannot be judged solely on the quality of the match between field data and model predictions. The model's accuracy in determining reservoir characteristics must be independently verified in a closely controlled environment. In this study, the closely controlled laboratory environment was chosen to test the validity and accuracy of tracer flow models developed specifically for flow in fractured rocks. The laboratory tracer tests were performed by flowing potassium iodide (KI) through artificially fractured core samples. The tracer test results were then analyzed with several models to determine which best fit the measured data. A Matrix Diffusion model was found to provide the best match of the tracer experiments. The core properties, as estimated by the Matrix Diffusion model parameters generated from the indirect matching process, were then determined. These calculated core parameters were compared to the measured core properties and were found to be in agreement. This verifies the use of the Matrix Diffusion flow model in estimating fracture widths from tracer tests.

  2. Fracture Mechanics of Concrete

    DEFF Research Database (Denmark)

    Ulfkjær, Jens Peder

    Chapter 1 Chapter l contains the introduction to this thesis. The scope of the thesis is partly to investigate different numerical and analytical models based on fracture mechanical ideas, which are able to predict size effects, and partly to perform an experimental investigation on high-strength......Chapter 1 Chapter l contains the introduction to this thesis. The scope of the thesis is partly to investigate different numerical and analytical models based on fracture mechanical ideas, which are able to predict size effects, and partly to perform an experimental investigation on high......-strength concrete. Chapter 2 A description of the factors which influence the strength and cracking of concrete and high strength concrete is made. Then basic linear fracture mechanics is outlined followed by a description and evaluation of the models used to describe concrete fracture in tension. The chapter ends...... with a description of the different types of size effects. Three examples which discuss the two terms 'size effect' and 'brittleness' and the importance of a stiff test rig. Finally some brittleness numbers are defined. Chapter 3 In chapter 3 the most well-known numerical methods which use the fictitious crack...

  3. [Lateral lumbar disk hernia].

    Science.gov (United States)

    Monod, A; Desmoineaux, P; Deburge, A

    1990-01-01

    Lateral lumbar disc herniations (L.D.H.) develop in the foramen, and compress the nerve root against the overlying vertebral pedicle. In our study of L.D.H. from the clinical, radiographical, and therapeutical aspects, we reviewed 23 cases selected from the 590 patients treated for discal herniation from 1984 to 1987. The frequency of L.D.H. in this series was 3.8 per cent. The clinical pattern brings out some suggestive signs of L.D.H. (frequency of cruralgia, a seldom very positive Lasegue's test, the paucity of spinal signs, non impulsive pain). Saccoradiculography and discography rarely evidenced the L.D.H.. The T.D.M. was the investigation of choice on condition that it was correctly used. When the image was doubtful, disco-CT confirmation should be proceeded too. This latter method of investigation enabled the possibility of sequestration to be explored. 14 patients were treated by chemonucleolysis, with 9 successful outcomes. The 5 failures were cases where chemonucleolysis should not have been indicated, mainly due to associated osseous stenosis. 9 patients underwent immediate surgery with good results in each case.

  4. Amyotrophic lateral sclerosis: update

    Directory of Open Access Journals (Sweden)

    Zapata-Zapata, Carlos Hugo

    2016-04-01

    Full Text Available Amyotrophic lateral sclerosis is a neurodegenerative disease with devastating consequences for the patient and his/her family. Its etiology is still not clear. In about 10 % of the patients there is a hereditary pattern of the disease. Worldwide, prevalence ranges from 2 to 11 cases per 100,000 people. Age of presentation varies from 58 to 63 years for sporadic cases, and from 47 to 52 years for the familial ones. Concerning gender, there is a slight preference for males. Clinical manifestations include signs of upper and lower motor neurons, damage in limbs and bulbar muscles, and, in some patients, frontotemporal cognitive dysfunction. Diagnosis is essentially clinical supported by neurophysiological studies, such as needle electromyography, which is the most important test for early diagnosis. There is no cure, but riluzol has proven to delay the use of mechanical ventilation and to slightly prolong survival. Consequently, management is based on support measures, such as those related to nutrition and ventilatory function, in addition to control of the motor and non-motor symptoms of the disease.

  5. Unique Mechanism of Chance Fracture in a Young Adult Male

    Directory of Open Access Journals (Sweden)

    Aaron Birch

    2013-03-01

    Full Text Available Since the first description of the Chance fracture in 1948, there have been few case reports ofunique mechanisms causing this classical flexion-extension injury to the spine in motor vehicleaccidents, sports injury, and falls. To our knowledge, this injury has not been reported from a fall withthe mechanistic forces acting laterally on the spine and with spinal support in place. We present a21-year-old male who slid down a flight of stairs onto his side wearing a heavy mountaineering stylebackpack, subsequently sustaining a Chance fracture of his first lumbar vertebrae.

  6. Unique mechanism of chance fracture in a young adult male.

    Science.gov (United States)

    Birch, Aaron; Walsh, Ryan; Devita, Diane

    2013-03-01

    Since the first description of the Chance fracture in 1948, there have been few case reports of unique mechanisms causing this classical flexion-extension injury to the spine in motor vehicle accidents, sports injury, and falls. To our knowledge, this injury has not been reported from a fall with the mechanistic forces acting laterally on the spine and with spinal support in place. We present a 21-year-old male who slid down a flight of stairs onto his side wearing a heavy mountaineering style backpack, subsequently sustaining a Chance fracture of his first lumbar vertebrae.

  7. Pressure Transient Analysis of Multi-Fractured Horizontal Well in Tight Gas Reservoirs

    Directory of Open Access Journals (Sweden)

    Zhao Ermeng

    2016-01-01

    Full Text Available Multi-fractured horizontal well is applied in tight gas reservoirs due to the low permeability. A new pressure transient model of multi-fractured horizontal well based on discrete-fracture model in which the hydraulic fractures are discretized as 2D entities is built in this paper, The model is divided into hydraulic fracture region and formation region. The model can be solved using the Galerkin finite element method, then the pressure transient type curves are plotted by computer programming. The results show that there are five different flow regimes observed in type curves including early linear flow, early radial flow, elliptical flow, later pseudo-radial flow and boundary response regime. A sensitivity analysis is conducted to study impacts of hydraulic fracture number, hydraulic fracture half-length, hydraulic fracture spacing, and hydraulic fracture conductivity on pressure transient type curves. The new model and obtained results in this paper not only enrich the well testing models, but also play a guiding role in analyzing pressure transient response of multi-fractured horizontal well in tight gas reservoirs.

  8. A Fundamental Approach to the Simulation of Flow and Dispersion in Fractured Media

    Energy Technology Data Exchange (ETDEWEB)

    Miller, J.D.

    1983-12-15

    Fracture systems may be generalized in terms of number and orientation of sets of parallel fractures and the distribution of length, width, thickness and separation. Borehole measurements may be used to particularize these parameters for a specific site. Global flow and dispersion in an aquifer occur in the interconnected fractures and may be related to specific fracture elements. A fluid dynamics code named SALE has been used to solve the Navier-Stokes equations for laminar flow in these elemental geometries. A marker particle calculation has been added to characterize longitudinal dispersion due to the velocity profile across the fracture and lateral dispersion due to flow disturbances at junctions. Local flow and dispersion in the matrix occur in the finer fracture structure and are evaluated using porous media approaches. These results or models are integrated in a 2D isothermal reservoir simulator named FRACSL. Discrete fractures are superimposed on the edges or diagnoals of rectangular grid elements. Water may flow from node to node through the matrix or through the fracture. The heads are found by iterating for the distribution which conserves the appropriate local mass. Marker particles are used to monitor the tracer dispersion due to motion in the fractures, in the matrix and between the two. Results are given showing flow and dispersion in an orthogonal junction and in a sample fractured reservoir.

  9. Correlation of hip fracture with other fracture types: Toward a rational composite hip fracture endpoint.

    Science.gov (United States)

    Colón-Emeric, Cathleen; Pieper, Carl F; Grubber, Janet; Van Scoyoc, Lynn; Schnell, Merritt L; Van Houtven, Courtney Harold; Pearson, Megan; Lafleur, Joanne; Lyles, Kenneth W; Adler, Robert A

    2015-12-01

    With ethical requirements to the enrollment of lower risk subjects, osteoporosis trials are underpowered to detect reduction in hip fractures. Different skeletal sites have different levels of fracture risk and response to treatment. We sought to identify fracture sites which cluster with hip fracture at higher than expected frequency; if these sites respond to treatment similarly, then a composite fracture endpoint could provide a better estimate of hip fracture reduction. Cohort study using Veterans Affairs and Medicare administrative data. Male Veterans (n=5,036,536) aged 50-99 years receiving VA primary care between 1999 and 2009 were included. Fractures were ascertained using ICD9 and CPT codes and classified by skeletal site. Pearson correlation coefficients, logistic regression and kappa statistics were used to describe the correlation between each fracture type and hip fracture within individuals, without regard to the timing of the events. 595,579 (11.8%) men suffered 1 or more fractures and 179,597 (3.6%) suffered 2 or more fractures during the time under study. Of those with one or more fractures, the rib was the most common site (29%), followed by spine (22%), hip (21%) and femur (20%). The fracture types most highly correlated with hip fracture were pelvic/acetabular (Pearson correlation coefficient 0.25, pfractures cluster with hip fractures within individuals at greater than expected frequency. If we observe similar treatment risk reductions within that cluster, subsequent trials could consider the use of a composite endpoint to better estimate hip fracture risk. Published by Elsevier Inc.

  10. Subtrochanteric Femoral Insufficiency Fracture Following Bisphosphonate Therapy for Osseous Metastases.

    Science.gov (United States)

    Bush, Lisabeth A; Chew, Felix S

    2008-01-01

    We present the case of an insufficiency fracture of the femoral shaft in a 61-year-old man who had received bisphosphonate therapy to reduce the fracture risk from lytic renal cell carcinoma metastases to the spine. Approximately 1.5 years after beginning monthly intravenous infusions of zoledronic acid (Zometa), the patient complained of persistent thigh pain. Radionuclide bone scan showed mildly increased activity in the lateral subtrochanteric cortex of the right femur, where there was focally increased T2 signal on MRI and a small, triangular ridge or cortical beak on radiographs. The lesion was initially thought to represent a metastasis, but after the patient returned with a transverse femoral shaft fracture through the ridge following minimal trauma, MRI and biopsy of the lesion failed to show any evidence of tumor. We suggest that this fracture is similar to the low-energy proximal femoral shaft fractures recently reported in postmenopausal women who have received oral bisphosphonates for osteoporosis. Suppression of bone turnover may play a role in the development of these fractures.

  11. Modelling karst aquifer evolution in fractured, porous rocks

    Science.gov (United States)

    Kaufmann, Georg

    2016-12-01

    The removal of material in soluble rocks by physical and chemical dissolution is an important process enhancing the secondary porosity of soluble rocks. Depending on the history of the soluble rock, dissolution can occur either along fractures and bedding partings of the rock in the case of a telogenetic origin, or within the interconnected pore space in the case of eogenetic origin. In soluble rocks characterised by both fractures and pore space, dissolution in both flow compartments is possible. We investigate the dissolution of calcite both along fractures and within the pore space of a limestone rock by numerical modelling. The limestone rock is treated as fractured, porous aquifer, in which the hydraulic conductivity increases with time both for the fractures and the pore spaces. We show that enlargement of pore space by dissolution will accelerate the development of a classical fracture-dominated telogenetic karst aquifer, breakthrough occurs faster. In the case of a pore-controlled aquifer as in eogenetic rocks, enlargement of pores results in a front of enlarged pore spaces migrating into the karst aquifer, with more homogeneous enlargement around this dissolution front, and later breakthrough.

  12. Effects of Hip Geometry on Fracture Patterns of Proximal Femur

    Directory of Open Access Journals (Sweden)

    Seyyed Morteza Kazemi

    2016-07-01

    Full Text Available Background: Some studies have previously shown that geometry of proximal femur can affect the probability of fracture and type of fracture. It happens since the geometry of the proximal femur determines how a force is applied to its different parts. In this study, we have compared proximal femur’s geometric characteristics in femoral neck (FNF, intertrochanteric (ITF and Subtrochanteric (STF fractures. Methods: In this study, 60 patients who had hip fractures were studied as case studies. They were divided into FNF, ITF and STF groups based on their fracture types (20 patients in each group. Patients were studied with x-ray radiography and CT scans. Radiological parameters including femoral neck length from lateral cortex to center of femoral head (FNL, diameter of femoral head (FHD, diameter of femoral neck (FND, femoral head neck offset (FHNO, neck-shaft angle (alpha, femoral neck anteversion (beta were measured and compared in all three groups. Results: Amount of FNL was significantly higher in STF group compared to FNF (0.011 while ITF and STF as well as FNT and ITF did not show a significant different. Also, FND in FNF group was significantly lower than the other two groups, i.e. ITF and STF. In other cases there were no instances of significant statistical difference. Conclusion: Hip geometry can be used to identify individuals who are at the risk of fracture with special pattern. Also, it is important to have more studies in different populations and more in men.

  13. Effects of Hip Geometry on Fracture Patterns of Proximal Femur

    Science.gov (United States)

    Kazemi, Seyyed Morteza; Qoreishy, Mohamad; Keipourfard, Ali; Sajjadi, Mohammadreza Minator; Shokraneh, Shahram

    2016-01-01

    Background: Some studies have previously shown that geometry of proximal femur can affect the probability of fracture and type of fracture. It happens since the geometry of the proximal femur determines how a force is applied to its different parts. In this study, we have compared proximal femur’s geometric characteristics in femoral neck (FNF), intertrochanteric (ITF) and Subtrochanteric (STF) fractures. Methods: In this study, 60 patients who had hip fractures were studied as case studies. They were divided into FNF, ITF and STF groups based on their fracture types (20 patients in each group). Patients were studied with x-ray radiography and CT scans. Radiological parameters including femoral neck length from lateral cortex to center of femoral head (FNL), diameter of femoral head (FHD), diameter of femoral neck (FND), femoral head neck offset (FHNO), neck-shaft angle (alpha), femoral neck anteversion (beta) were measured and compared in all three groups. Results: Amount of FNL was significantly higher in STF group compared to FNF (0.011) while ITF and STF as well as FNT and ITF did not show a significant different. Also, FND in FNF group was significantly lower than the other two groups, i.e. ITF and STF. In other cases there were no instances of significant statistical difference. Conclusion: Hip geometry can be used to identify individuals who are at the risk of fracture with special pattern. Also, it is important to have more studies in different populations and more in men. PMID:27517071

  14. STRESS FRACTURES IN SPORT

    Directory of Open Access Journals (Sweden)

    Đivo Ban

    2009-11-01

    Full Text Available Children and adolescents today, all before starting with regular sports activities and involvement in semi-professional and top professional sport, so it increases the num- ber of discovered stress fractures in this age. This type of injury can occur as a consequence of action one strong force, or the many repeated small force strength, to be exact, when the load (stress transcend ability reparations bones. Stress fractures are recorded and described up to the lower limbs. Research has been confirmed that the bones of lower leg are mostly made in injury, and with the el- derly and with the population of children and young adolescents. Occur in many sports, something to them is greater when the frequency of running and often are present in the female population. According to the results of numerous investigations, mistakes in the training are the most common cause of the emergence of stress fracture. In a direct comparison with complemented these injuries is the condition of muscles, so it is important that at the sa- me time carry out exercises strengthen muscles and stretching. Typical clinical signs of stress fractures are localized painful sensitivity to palpa- tion and runoff in a small number of cases. The basic diagnostic procedure is a medical check, it is the small, radiology and scintigraphyc diagnostics (most accurate and mag- netic resonance imaging. Treatment is usually without surgery and conservative, with rest and reducing stress, and its activity athlete breaks mainly between four and eight weeks. Only the very need surgical treatment The most important thing is that attention is focused on the proper prevention and to take all that it ever occurred to stress fractures that athletes ramble of the courts and the competition (better education of sports workers, separation of groups with increa- sed risk of the formation of an injury, adaptation activities age and abilities of athletes, adequate sports equipment, high-quality sports

  15. Evaluation and treatment of an adult quarter horse with an unusual fracture of the humerus and septic arthritis

    OpenAIRE

    Mitchell,Colin; Riley, Christopher B.

    2002-01-01

    Humeral fractures are rare and usually carry a guarded prognosis in adult horses. This paper describes the evaluation and the successful surgical management of a fracture of the lateral supracondyloid crest and part of the epicondyle of the humerus in an adult quarter horse.

  16. Evaluation and treatment of an adult quarter horse with an unusual fracture of the humerus and septic arthritis.

    Science.gov (United States)

    Mitchell, Colin; Riley, Christopher B

    2002-02-01

    Humeral fractures are rare and usually carry a guarded prognosis in adult horses. This paper describes the evaluation and the successful surgical management of a fracture of the lateral supracondyloid crest and part of the epicondyle of the humerus in an adult quarter horse.

  17. A retrospective analysis of loss of reduction in operated supracondylar humerus fractures

    Directory of Open Access Journals (Sweden)

    Balasubramanian Balakumar

    2012-01-01

    Full Text Available Background: Loss of reduction following closed or open reduction of displaced supracondylar fractures of the humerus in children varies widely and is considered dependent on stability of the fracture pattern, Gartland type, number and configuration of pins for fixation, technical errors, adequacy of initial reduction, and timing of the surgery. This study was aimed to evaluate the factors responsible for failure of reduction in operated pediatric supracondylar fracture humerus. Materials and Methods: We retrospectively assessed loss of reduction by evaluating changes in Baumann′s angle, change in lateral rotation percentage, and anterior humeral line in 77 consecutive children who were treated with multiple Kirschner wire fixation and were available for followup. The intraoperative radiographs were compared with those taken immediately after surgery and 3 weeks postoperatively. Multivariate logistic regression analysis was performed by STATA 10. Results: Reduction was lost in 18.2% of the patients. Technical errors were significantly higher in those who lost reduction (P = 0.001; Odds Ratio: 57.63. Lateral pins had a significantly higher risk of losing reduction than cross pins (P = 0.029; Odds Ratio: 7.73. Other factors including stability of fracture configuration were not significantly different in the two groups. Conclusions: The stability of fracture fixation in supracondylar fractures in children is dependent on a technically good pinning. Cross pinning provides a more stable fixation than lateral entry pins. Fracture pattern and accuracy of reduction were not important factors in determining the stability of fixation.

  18. Diamond heteroepitaxial lateral overgrowth

    Science.gov (United States)

    Tang, Yung-Hsiu

    This dissertation describes improvements in the growth of single crystal diamond by microwave plasma-assisted chemical vapor deposition (CVD). Heteroepitaxial (001) diamond was grown on 1 cm. 2 a-plane sapphiresubstrates using an epitaxial (001) Ir thin-film as a buffer layer. Low-energy ion bombardment of the Ir layer, a process known as bias-enhanced nucleation, is a key step in achieving a high density of diamond nuclei. Bias conditions were optimized to form uniformly-high nucleation densities across the substrates, which led to well-coalesced diamond thin films after short growth times. Epitaxial lateral overgrowth (ELO) was used as a means of decreasing diamond internal stress by impeding the propagation of threading dislocations into the growing material. Its use in diamond growth requires adaptation to the aggressive chemical and thermal environment of the hydrogen plasma in a CVD reactor. Three ELO variants were developed. The most successful utilized a gold (Au) mask prepared by vacuum evaporation onto the surface of a thin heteroepitaxial diamond layer. The Au mask pattern, a series of parallel stripes on the micrometer scale, was produced by standard lift-off photolithography. When diamond overgrows the mask, dislocations are largely confined to the substrate. Differing degrees of confinement were studied by varying the stripe geometry and orientation. Significant improvement in diamond quality was found in the overgrown regions, as evidenced by reduction of the Raman scattering linewidth. The Au layer was found to remain intact during diamond overgrowth and did not chemically bond with the diamond surface. Besides impeding the propagation of threading dislocations, it was discovered that the thermally-induced stress in the CVD diamond was significantly reduced as a result of the ductile Au layer. Cracking and delamination of the diamond from the substrate was mostly eliminated. When diamond was grown to thicknesses above 0.1 mm it was found that

  19. Scaphoid fractures in the athlete.

    Science.gov (United States)

    Winston, Mark J; Weiland, Andrew J

    2017-03-01

    Scaphoid fractures are a common wrist injury, especially in athletes. Clinicians should have a high index of suspicion for a scaphoid fracture in any patient complaining of radial-sided wrist pain after a fall on an outstretched hand. Advanced imaging, including CT and MRI scans, may be useful in diagnosis and classification of fracture patterns. Treatment varies based on the fracture location, stability of the fracture, and predictability of the fracture to heal. Treatment involves either non-operative management with a thumb spica cast or brace, or operative fixation with a headless compression screw, k-wires, or scaphoid-specific plates. Return to play is dependent on many variables, including sport, fracture union, and ability to play with cast.

  20. Collagen turnover after tibial fractures

    DEFF Research Database (Denmark)

    Joerring, S; Krogsgaard, M; Wilbek, H

    1994-01-01

    Collagen turnover after tibial fractures was examined in 16 patients with fracture of the tibial diaphysis and in 8 patients with fracture in the tibial condyle area by measuring sequential changes in serological markers of turnover of types I and III collagen for up to 26 weeks after fracture...... collagen. A group comparison showed characteristic sequential changes in the turnover of types I and III collagen in fractures of the tibial diaphysis and tibial condyles. The turnover of type III collagen reached a maximum after 2 weeks in both groups. The synthesis of type I collagen reached a maximum...... after 2 weeks in the diaphyseal fractures and after 6 weeks in the condylar fractures. The degradation of type I collagen increased after 4 days and reached a maximum at 2 weeks in both groups. The interindividual variation was wide. On a group basis, the turnover of types I and III collagen had...

  1. Periprosthetic fractures evaluation and treatment.

    Science.gov (United States)

    Masri, Bassam A; Meek, R M Dominic; Duncan, Clive P

    2004-03-01

    Periprosthetic fracture is a serious complication of total hip arthroplasty (THA) that can be difficult to treat, and can be potentially fraught with complications. The incidence of such fractures is increasing, especially after the use of cementless revision arthroplasty. The prevention of these fractures is achieved by understanding the risk factors involved. If the risks are not understood, the best outcome is achieved when the surgeon has a thorough understanding of the principles of treatment of these fractures and has access to various fixation and prosthetic devices, and allograft bone when necessary. Acetabular fractures are rare and relatively little has been reported on their treatment. Periprosthetic femoral fracture treatment is based on the site of fracture, implant stability, and bone stock. The Vancouver classification offers a reproducible description of these factors with the subsequently easy formation of a treatment plan.

  2. Short- and long-term results following standing fracture repair in 34 horses.

    Science.gov (United States)

    Payne, R J; Compston, P C

    2012-11-01

    Standing fracture repair in the horse is a recently described surgical procedure and currently there are few follow-up data. This case series contains 2 novel aspects in the standing horse: repair of incomplete sagittal fractures of the proximal phalanx and medial condylar repair from a lateral aspect. To describe outcome in a case series of horses that had lower limb fractures repaired under standing sedation at Rossdales Equine Hospital. Case records for all horses that had a fracture surgically repaired, by one surgeon at Rossdales Equine Hospital, under standing sedation and local anaesthesia up until June 2011, were retrieved. Hospital records, owner/trainer telephone questionnaire and the Racing Post website were used to evaluate follow-up. Thirty-four horses satisfied the inclusion criteria. Fracture sites included the proximal phalanx (incomplete sagittal fracture, n = 14); the third metacarpal bone (lateral condyle, n = 12, and medial condyle, n = 7); and the third metatarsal bone (lateral condyle, n = 1). One horse required euthanasia due to caecal rupture 10 days post operatively. Twenty horses (66.7% of those with available follow-up) have returned to racing. Where available, mean time from operation to return to racing was 226 days (range 143-433 days). Standing fracture repair produced similar results to fracture repair under general anaesthesia in terms of both the number of horses that returned to racing and the time between surgery and race. Repair of lower limb fracture in the horse under standing sedation is a procedure that has the potential for tangible benefits, including avoidance of the inherent risks of general anaesthesia. The preliminary findings in this series of horses are encouraging and informative when discussing options available prior to fracture repair. © 2012 EVJ Ltd.

  3. Hydraulic fracture propagation modeling and data-based fracture identification

    Science.gov (United States)

    Zhou, Jing

    Successful shale gas and tight oil production is enabled by the engineering innovation of horizontal drilling and hydraulic fracturing. Hydraulically induced fractures will most likely deviate from the bi-wing planar pattern and generate complex fracture networks due to mechanical interactions and reservoir heterogeneity, both of which render the conventional fracture simulators insufficient to characterize the fractured reservoir. Moreover, in reservoirs with ultra-low permeability, the natural fractures are widely distributed, which will result in hydraulic fractures branching and merging at the interface and consequently lead to the creation of more complex fracture networks. Thus, developing a reliable hydraulic fracturing simulator, including both mechanical interaction and fluid flow, is critical in maximizing hydrocarbon recovery and optimizing fracture/well design and completion strategy in multistage horizontal wells. A novel fully coupled reservoir flow and geomechanics model based on the dual-lattice system is developed to simulate multiple nonplanar fractures' propagation in both homogeneous and heterogeneous reservoirs with or without pre-existing natural fractures. Initiation, growth, and coalescence of the microcracks will lead to the generation of macroscopic fractures, which is explicitly mimicked by failure and removal of bonds between particles from the discrete element network. This physics-based modeling approach leads to realistic fracture patterns without using the empirical rock failure and fracture propagation criteria required in conventional continuum methods. Based on this model, a sensitivity study is performed to investigate the effects of perforation spacing, in-situ stress anisotropy, rock properties (Young's modulus, Poisson's ratio, and compressive strength), fluid properties, and natural fracture properties on hydraulic fracture propagation. In addition, since reservoirs are buried thousands of feet below the surface, the

  4. LATERAL SURVIVAL: AN OT ACCOUNT

    Directory of Open Access Journals (Sweden)

    Moira Yip

    2004-12-01

    Full Text Available When laterals are the targets of phonological processes, laterality may or may not survive. In a fixed feature geometry, [lateral] should be lost if its superordinate node is eliminated by either the spreading of a neighbouring node, or b