Treatment of unstable intraarticular fracture of distal radius: POP casting with external fixation.

Science.gov (United States)

ur Rahman, Obaid; Khan, Mohammad Qadeem; Rasheed, Haroon; Ahmad, Saleem

2012-04-01

To compare radiological and functional outcome of external fixation and distraction with conservative Plaster of Paris (POP) cast for unstable intra-articular fractures of the distal radius. The study was conducted on 60 patients with unstable intra-articular fracture of distal radius who reported to emergency or outpatient Orthopaedic Surgery department of Benazir Bhutto Hospital, Rawalpindi, between March and August 2007. They were divided into two equal groups: Group A and Group B, treated by Plaster of Paris cast, and external fixation with distraction respectively. The functional outcome in terms of freedom from pain, range of movement, grip power and deformity, and the radiological outcome of radial length, incongruity and radio-ulnar joint position were analysed at three months follow-up using a 3-point scoring scale. In Group A, 1 (3%) patient showed excellent result, 8 (27%) patients good results, 19 (63%) patients fair results and 2 (7%) patients poor result. In Group B, 14 (47%) patients showed excellent results, 11 (37%) patients good results, 4 (13%) patients fair results and 1 (3%) patient poor result. The outcome score of the Group B patients was significantly better compared to the Group A patients (p value advantages over conventional Plaster of Paris cast in the treatment of unstable intra-articular fractures of distal radius.

CT virtual reality in the preoperative workup of malunited distal radius fractures: preliminary results

International Nuclear Information System (INIS)

Rieger, Michael; Gruber, Hannes; Jaschke, Werner R.; Gabl, Markus; Mallouhi, Ammar

2005-01-01

Our objective was to evaluate the usefulness of CT virtual preoperative planning in the surgical repositioning of malunited distal radius fracture. Eleven patients with malunited distal radius fracture underwent multislice CT of both wrists. A preoperative workup was performed in a virtual reality environment created from the CT data sets. Virtual planning comprised three main procedures, carrying out the virtual osteotomy of the radius, prediction of the final position of the distal radius after osteotomy and computer-assisted manufacturing of a repositioning device, which was later placed at the surgical osteotomy site to reposition objectively the distal radius fragment before fixation with the osteosynthesis. All patients tolerated the surgical procedure well. During surgery, the orthopedic surgeons were not required in any of the cases to alter the position of the distal radius that was determined by the repositioning device. At postoperative follow-up, the anatomic relationship of the distal radius was restored (radial inclination, 21.4 ; volar tilt, 10.3 ; ulnar variance, 0.5 mm). Clinically, a significant improvement of pronation (P=0.012), supination (P=0.01), flexion (P=0.001) and extension (P=0.006) was achieved. Pain decreased from 54 to 7 points. CT virtual reality is a valuable adjunct for the preoperative workup and surgical reposition of malunited distal radius fractures. (orig.)

A PROSPECTIVE STUDY OF CLINICAL OUTCOME AFTER USING LIGAMENTOTAXIS IN MANAGEMENT OF DISTAL RADIUS FRACTURES

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Chandrashekhar V. Mudgal

2017-04-01

Full Text Available BACKGROUND A study was done to evaluate the effect of the ligamentotaxis in the management of intraarticular fractures of the distal radius. MATERIALS AND METHODS 34 patients were studied prospectively between March 2014 and February 2016. All patients had intraarticular fracture of distal end of radius and all were treated with ligamentotaxis after closed reduction with fluoroscopic guidance. The follow-up period was 12 months. At the time of surgery, the mean age was 45.29 years. RESULTS In all fracture cases, the mean of fracture union was 5.8 weeks. During the final follow-up, the mean range of motion was 55.30 in flexion, 56.60 in extension, 21.0 in ulnar deviation, 9.00 in radial deviation, 70.30 in pronation and 67.10 in supination. According to the scoring system of Gartland and Werley, the clinical and functional outcomes showed that 15 patients (44.1% had excellent results, 14 (41.1% had good results, 3 (8.8% had fair results and 2 (5.8% had poor results. CONCLUSION Closed reduction under fluoroscopic image guidance and the ligamentotaxis is useful and effective in the treatment of intraarticular fractures of the distal radius.

Clinical and functional outcome of open primary repair of triangular fibrocartilage complex tears associated with distal radius fractures.

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Johandi, Faisal; Sechachalam, Sreedharan

2017-01-01

We evaluate the clinical and functional outcome of open primary repair of acute TFCC tears in distal radius fracture, when there is gross intraoperative distal radioulnar joint (DRUJ) instability after fixation of the distal radius, in the absence of an ulnar styloid fracture or when the ulnar fracture fragment is too small to be fixed. A retrospective review of our institution's distal radius fracture database over a 4-year period (January 2010 to December 2013). A total of 12 (1.38%) out of 3379 patients had an open TFCC repair in the same setting as fixation of distal radius. Assessment of outcome involved the analysis of objective and subjective clinical and functional outcomes. All patient regained Activities of Daily Living (ADL) independence; eleven out of 12 patients (91.7%) returned to pre-injury function and 8 out of 11 patients (72.7%) returned to their jobs. DRUJ stability was preserved in 10 patients (83.3%) with 10 patients (83.3%) having grip strength of at least 50%, compared to the uninjured hand, and 7 (58.3%) with grip strength of more than or equal to 75%. Complications of surgery identified can be classified into 4 broad categories: infection, neurological complications, persistent DRUJ instability and prolonged pain. The authors believe a primary open repair of the TFCC should be considered when patients present with instability during intra-operative DRUJ ballottement test after distal radius fixation, in the absence of an ulnar styloid fracture or when the ulnar fracture fragment is too small to be fixed.

Radiographic Outcomes of Dorsal Distraction Distal Radius Plating for Fractures With Dorsal Marginal Impaction.

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Huish, Eric G; Coury, John G; Ibrahim, Mohamed A; Trzeciak, Marc A

2017-04-01

The purpose of this study is to compare radiographic outcomes of patients treated with dorsal spanning plates with previously reported normal values of radiographic distal radius anatomy and compare the results with prior publications for both external fixation and internal fixation with volar locked plates. Patients with complex distal radius fractures including dorsal marginal impaction pattern necessitating dorsal distraction plating at the discretion of the senior authors (M.A.T. and M.A.I.) from May 30, 2013, to December 29, 2015, were identified and included in the study. Retrospective chart and radiograph review was performed on 19 patients, 11 male and 8 female, with mean age of 47.83 years (22-82). No patients were excluded from the study. All fractures united prior to plate removal. The average time the plate was in place was 80.5 days (49-129). Follow-up radiographs showed average radial inclination of 20.5° (13.2°-25.5°), radial height of 10.7 mm (7.5-14 mm), ulnar variance of -0.3 mm (-2.1 to 3.1 mm), and volar tilt of 7.9° (-3° to 15°). One patient had intra-articular step-off greater than 2 mm. Dorsal distraction plating of complex distal radius fractures yields good radiographic results with minimal complications. In cases of complex distal radius fractures including dorsal marginal impaction where volar plating is not considered adequate, a dorsal distraction plate should be considered as an alternative to external fixation due to reduced risk for infection and better control of volar tilt.

[Clinical observation on the effect of joint mobilization in treating elderly patients after distal radius fractures operation].

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Jia, Xue-Feng; Cai, Hong-Xin; Lin, Ge-Sheng; Fang, Ji-Shi; Wang, Yong; Wu, Zhi-Yong; Tu, Xu-Hui

2017-07-25

To investigate the effect of joint mobilization on postoperative wrist joint function, pain and grip strength for elderly patients with distal radius fracture. From January 2015 to June 2016, a total of 67 elderly patients with distal radius fracture were randomly divided into routine exercise group and joint mobilization group. Among them, 37 patients in the routine exercise group underwent conventional distal radius fracture postoperative joint function exercise regimen, including 16 males and 21 females with a mean age of (67.8±3.2) years old ranging from 60 to 72 years old;the injured side was dominant in 23 cases and non-dominant in 14 cases;injury mechanism was fall in 26 cases, traffic accident in 11 cases; for AO type, 6 cases were type B3, 18 cases were type C1, 7 cases were type C2, 6 cases was type C3. Other 30 patients in the joint mobilization group underwent joint mobilization on the basis of the routine exercise group including 14 males and 16 females with a mean age of (67.1±4.0) years old ranging from 61 to 74 years old; the injured side was dominant in 21 cases and non-dominant in 9 cases;injury mechanism was fall in 25 cases, traffic accident in 5 cases;for AO type, 8 cases were type B3, 13 cases were type C1, 6 cases were type C2, 9 cases were type C3. The wrist joint activity, Gartland-Werley wrist joint function score, VAS pain score and grip strength were observed at 3 months afrer treatment. After 3 months' treatment, the VAS in the routine exercise group was higher than that of the joint mobilization group ( P joint mobilization group was higher than that in routine exercise group( P joint mobilization group( P joint mobilization group had no significant difference ( P >0.05). In the comparison of each item of Gartland-Werley, there was no significant difference between two groups in residual deformity and complication( P >0.05); the average score of subjective score, objective score and total score in routine exercise group were

Complaints in the follow-up of conservatively treated distal radius fractures - predictors in the initial radiograph

International Nuclear Information System (INIS)

Freund, W.; Aschoff, A.J.; Einsiedel, T.; Kramer, M.; Trnavac, S.; Bezirkskrankenhaus Guenzburg

2007-01-01

Purpose: Radius fractures are frequent in adults, and the long-term results of conservative treatment remain disappointing. This study examines predictors for the clinical outcome in the initial radiograph. This will help to identify patients who will benefit from surgical treatment. Materials and Methods: A cohort study including a standardized telephone interview (Cooney score) was used to identify all conservatively treated patients with a distal radius fracture over a five-year period. The additional selection criteria were: over 15 years old, initial X-ray available, patient reachable by phone for the follow-up interview. The following measurements were taken from the initial radiograph: Radius-base angle, radial shortening, radiopalmar angle and intraarticular displacement. Correlations and a simple test to predict negative outcome were computed. Results: Of the initially identified 2211 patients with distal radius fracture, 179 also fulfilled the other criteria. The patients were 56.2 years old on average (standard deviation SD = ± 22.45 years) and 72 % were female. 60 % of the fractures were on the right side. The average follow-up was 4.3 years (SD ± 1.66). The Cooney score results averaged 85 points (with 100 being the optimal and maximum score), indicating good or very good functional results in the long term follow-up for 61 % of patients. However, 31 % received a rating of fair or poor and therefore had an unfavorable outcome. With respect to the correlations, age and shortening of the radius (but not gender) had a significant influence on the functional result. Using an age of 75 years or above and a radial shortening of at least 4 mm to predict an unfavorable outcome, the sensitivity is only 16 %, but the positive predictive value is 73 % and the specificity is 96 %. (orig.)

Patterns of triangular fibrocartilage complex (TFCC) injury associated with severely dorsally displaced extra-articular distal radius fractures.

Science.gov (United States)

Scheer, Johan H; Adolfsson, Lars E

2012-06-01

The aim of the study was to examine triangular fibrocartilage (TFCC) injury patterns associated with unstable, extra-articular dorsally displaced distal radius fractures. Twenty adult patients with an Arbeitsgemeinschaft für Osteosynthesefragen (AO), type A2 or A3, distal radius fracture with an initial dorsal angulation greater than 20° were included. Nine had a tip fracture (distal to the base) of the ulnar styloid and 11 had no such fracture. They were all openly explored from an ulnopalmar approach and TFCC injuries were documented. Eleven patients also underwent arthroscopy and intra-articular pathology was recorded. All patients had TFCC lesions of varying severity, having an extensor carpi ulnaris subsheath avulsion in common. Eighteen out of 20 also displayed deep foveal radioulnar ligament lesions, with decreasingly dorsal fibres remaining. The extent of this foveal injury could not be appreciated by radiocarpal arthroscopy. Severe displacement of an extra-articular radius fracture suggests an ulnar-sided ligament injury to the TFCC. The observed lesions concur with findings in a previous cadaver study. The lesions follow a distinct pattern affecting both radioulnar as well as ulnocarpal stabilisers. Copyright © 2012 Elsevier Ltd. All rights reserved.

A STUDY ON FRACTURE FIXATION OF DISTAL END OF RADIUS BY PERCUTANEOUS PINNING

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Kiran Kumar L

2016-07-01

Full Text Available BACKGROUND Various treatment modalities have been described for the treatment of distal radius fractures each with its own merits and demerits. Most of the work done with percutaneous pinning has shown a significant residual stiffness of the hand and wrist. Our technique involves percutaneous pinning of the fracture and immobilisation in neutral position of the wrist for. This study's aim was to examine the functional outcome of percutaneous K-wiring of these distal radius fractures with immobilisation in neutral position of the wrist. METHODS A prospective study conducted on thirty adult patients with distal radial fractures treated at Department of Orthopaedics, Rangaraya Medical college, Kakinada between October 2013 to September 2015. RADIOGRAPHIC EXAMINATION Standard radiographs in PA and lateral views were taken for confirmation of the diagnosis and also to know the type of fracture. Oblique views were also taken in a few patients who had complex comminuted fractures. The fracture fragments were analysed and involvement of radiocarpal and distal radioulnar joints were assessed and classified according to the Frykman classification. Of the cases, 6(20% of the fractures were type I, 2(6.6% of type II, 3(10% of type III, 6(20% of type IV, 8(26.6% of type V, 5(16.6% of type VI, no cases of type VII and VIII.SURGICAL PROCEDURE The procedures were performed under regional anaesthesia in all cases. After sterile preparation and draping, fracture is reduced by traction and the reduction was evaluated fluoroscopically. A 1.5 cm incision given longitudinally (if needed beginning at the radial styloid and proceeds proximally across to the medial metaphysis and diaphysis. At least two pins (1.6 mm Kirschner wire were inserted and adequate reduction was confirmed on AP/LAT views under image intensifier. Another 1.6 mm K-wire percutaneously 90 degrees orthogonally to these wires starting at the dorsal rim of distal radius just distal to the Lister�

A COMPARATIVE STUDY OF CONSERVATIVE MANAGEMENT VS. EXTERNAL FIXATION OF COMMINUTED DISTAL RADIUS FRACTURES

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Sanjeev Kumar Kare

2016-12-01

Full Text Available BACKGROUND Fracture of the distal radius (‘broken wrist’ is a common clinical problem. It can be treated conservatively usually involving wrist immobilisation in a plaster cast or surgically. A key method of surgical fixation is external fixation. MATERIALS AND METHODS A prospective study was carried out on 66 patients admitted between June 2014 to May 2016 for evaluation of conservative and surgical management of distal radius fractures. RESULTS Excellent, fair or good result was noticed in around 85% of cases managed conservatively and in above 90% of cases managed by external fixator. CONCLUSION There is some evidence to support the use of external fixation for dorsally displaced fractures of the distal radius in adults. Though, there is insufficient evidence to confirm a better functional outcome, external fixation reduces redisplacement gives improved anatomical results and most of the excess surgically-related complications are minor.

Fractures of the shafts of the radius and ulna

International Nuclear Information System (INIS)

Bender, C.E.; Campbell, D.C.

1985-01-01

Although the clinical presentation of fracture of the forearm bones is usually quite obvious, thorough radiologic examination of the radius and ulna and adjacent wrist and elbow joints is mandatory. Standard views of the forearm of the patient include the AP and lateral projections. The degree of shortening, angulation, rotation, and comminution should be noted. The selected films must be long enough to include the adjacent elbow and wrist joints

Treatment of unstable distal radius fractures with Ilizarov circular, nonbridging external fixator.

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Tyllianakis, Minos; Mylonas, Spyros; Saridis, Alkis; Kallivokas, Alkiviadis; Kouzelis, Antonis; Megas, Panagiotis

2010-03-01

Unstable distal radius fractures remain a challenge for the treating orthopaedic surgeon. We present a retrospective follow-up study (mean follow-up 12.5 months) of 20 patients with 21 unstable distal radius fractures that were reduced in a closed manner and stabilized with a nonbridging Ilizarov external fixator. Subsequent insertion of olive wires for interfragmentary compression was performed in cases with intra-articular fractures. According to the overall evaluation proposed by Gartland and Werley scoring system 12 wrists were classified as excellent, 6 as good, 2 as fair and 1 as poor. Grade II pin-tract infection in distal fracture fragment was detected in 3 wires from a total of 78 (3.8%) and in 4 half pins out of a total of 9 (44.4%). Pronation was the most frequently impaired movement. This was restricted in 4 patients (19%) in whom a radioulnar transfixing wire was applied. Symptoms of irritation of superficial sensory branch of the radial nerve occurred in 3 patients with an olive wire applied in a closed manner in the distal fragment. Ilizarov method yields functional results comparable to that of other methods whilst it avoids wrist immobilization, open reduction and reoperation for implant removal. The method is associated with a low rate of major complication and satisfactory functional outcome. Copyright 2009 Elsevier Ltd. All rights reserved.

[Injury to the Scapholunate Ligament in Distal Radius Fractures: Peri-Operative Diagnosis and Treatment Results].

Science.gov (United States)

Gajdoš, R; Pilný, J; Pokorná, A

2016-01-01

PURPOSE OF THE STUDY Injury to the scapholunate ligament is frequently associated with a fracture of the distal radius. At present neither a unified concept of treatment nor a standard method of diagnosis in these concomitant injuries is available. The aim of the study was to evaluate a group of surgically treated patients with distal radius fractures in order to assess a contribution of combined conventional X-ray and intra-operative fluoroscopic examinations to the diagnosis of associated lesions and to compare short-term functional outcomes of sugically treated patients with those of patients treated conservatively. MATERIAL AND METHODS A group of patients undergoiong surgery for distal radius fractures using plate osteosynthesis was evaluated retrospectively. The peri-operative diagnosis of associated injury to the scapholunate ligament was based on pre-operative standard X-ray views and intra-operative fluoroscopy. The latter consisted of images of maximum radial and ulnar deviation as well as an image of the forearm in traction exerted manually along the long axis. All views were in postero-anterior projection. Results were read directly on the monitor of a fluoroscopic device after its calibration or were obtained by comparing the thickness of an attached Kirschner wire with the distance to be measured. Subsequently, pixels were converted to millimetres. When a scapholunate ligament injury was found and confirmed by examination of the contralateral wrist, the finding was verified by open reduction or arthroscopy. Both static and dynamic instabilities were treated together with the distal radius fracture at one-stage surgery. After surgery, the patients without ligament injury had the wrist immobilised for 4 weeks, then rehabilitation followed. In the patients with a damaged ligament, immobilisation in a short brace lasted until transarticular wires were removed. All patients were followed up for a year at least. At follow-up, the injured wrist was examined

Effectiveness of external fixator combined with T-plate internal fixation for the treatment of comminuted distal radius fractures.

Science.gov (United States)

Han, L R; Jin, C X; Yan, J; Han, S Z; He, X B; Yang, X F

2015-03-31

This study compared the efficacy between external fixator combined with palmar T-plate internal fixation and simple plate internal fixation for the treatment of comminuted distal radius fractures. A total of 61 patients classified as type C according to the AO/ASIF classification underwent surgery for comminuted distal radius fractures. There were 54 and 7 cases of closed and open fractures, respectively. Moreover, 19 patients received an external fixator combined with T-plate internal fixation, and 42 received simple plate internal fixation. All patients were treated successfully during 12-month postoperative follow-up. The follow-up results show that the palmar flexion and dorsiflexion of the wrist, radial height, and palmar angle were significantly better in those treated with the external fixator combined with T-plate compared to those treated with the simple plate only (P 0.05). Hence, the effectiveness of external fixator combined with T-plate internal fixation for the treatment of comminuted distal radius fractures was satisfactory. Patients sufficiently recovered wrist, forearm, and hand function. In conclusion, compared to the simple T-plate, the external fixator combined with T-plate internal fixation can reduce the possibility of the postoperative re-shifting of broken bones and keep the distraction of fractures to maintain radial height and prevent radial shortening.

The effect of search term on the quality and accuracy of online information regarding distal radius fractures.

Science.gov (United States)

Dy, Christopher J; Taylor, Samuel A; Patel, Ronak M; Kitay, Alison; Roberts, Timothy R; Daluiski, Aaron

2012-09-01

Recent emphasis on shared decision making and patient-centered research has increased the importance of patient education and health literacy. The internet is rapidly growing as a source of self-education for patients. However, concern exists over the quality, accuracy, and readability of the information. Our objective was to determine whether the quality, accuracy, and readability of information online about distal radius fractures vary with the search term. This was a prospective evaluation of 3 search engines using 3 different search terms of varying sophistication ("distal radius fracture," "wrist fracture," and "broken wrist"). We evaluated 70 unique Web sites for quality, accuracy, and readability. We used comparative statistics to determine whether the search term affected the quality, accuracy, and readability of the Web sites found. Three orthopedic surgeons independently gauged quality and accuracy of information using a set of predetermined scoring criteria. We evaluated the readability of the Web site using the Fleisch-Kincaid score for reading grade level. There were significant differences in the quality, accuracy, and readability of information found, depending on the search term. We found higher quality and accuracy resulted from the search term "distal radius fracture," particularly compared with Web sites resulting from the term "broken wrist." The reading level was higher than recommended in 65 of the 70 Web sites and was significantly higher when searching with "distal radius fracture" than "wrist fracture" or "broken wrist." There was no correlation between Web site reading level and quality or accuracy. The readability of information about distal radius fractures in most Web sites was higher than the recommended reading level for the general public. The quality and accuracy of the information found significantly varied with the sophistication of the search term used. Physicians, professional societies, and search engines should consider

A new building block: costo-osteochondral graft for intra-articular incongruity after distal radius fracture.

Science.gov (United States)

Tang, Chris Yuk Kwan; Fung, Boris; Poon, T L; Fok, Margaret

2014-01-01

Even with the invention of locking plates, intra-articular fractures of distal radius with extreme comminution remain a challenge for orthopaedic surgeons. Osteochondral graft is a potential choice to reconstruct the articular defect. We report a patient who had a fracture of distal radius with costo-osteochondral graft for articular reconstruction which has not yet been described in the English literature. At nine-year follow-up, he was pain free and had full range of movement of the wrist. The authors suggest that costo-osteochondral graft could be an option with satisfactory result.

Osteosynthesis with long volar locking plates for meta- physeal-diaphyseal fractures of the distal radius

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Gogna Paritosh

2013-12-01

Full Text Available 【Abstract】Objective: Metaphyseal-diaphyseal fractures of the distal radius are a major treatment dilemma and orthopaedic surgeons have to pay due consideration to restoration of anatomy of distal radius together with ro- tation of the radial shaft and maintenance of radial bow and interosseous space. We performed this study to evaluate the clinic-radiological outcome of metaphyseal-diaphyseal fractures of the distal radius treated with long volar locking plates. Methods: This prospective study involved 27 pa- tients (22 males and 5 females with metaphyseal-diaphy- seal fracture of the distal radius. Their mean age was (30.12± 11.48 years (range 19-52 years and the follow-up was 26.8 months (range 22-34 months. All patients underwent open reduction and internal fixation with a long volar locking plate. According to AO/OTA classification, there were 7 type A3, 13 type C2 and 7 type C3 fractures. Subjective assessment was done based on the disabilities of the arm, shoulder and hand (DASH questionnaire. Functional evaluation was done by measuring grip strength and range of motion around the wrist and the radiological determinants included radial angle, radial length, volar angle and ulnar variance. The final as- sessment was done according to Gartland and Werley scor- ing system. Results: Postoperative radiological parameters were well maintained throughout the trial, and there was signifi- cant improvement in the functional parameters from 6 weeks to final follow-up. The average DASH scores improved from 37.5 at 6 weeks to 4.2 at final follow-up. Final assessment using Gartland and Werley scoring system revealed 66.67% (n=18 excellent and 33.33% (n=9 good results. There was one case of superficial infection which responded to antibi- otics and another carpel tunnel syndrome which was ma- naged conservatively. Conclusion: Volar locking plate fixation for metaphy- seal-diaphyseal fractures of distal radius is associated with excellent to good

Peak incidence of distal radius fractures due to ice skating on natural ice in The Netherlands

NARCIS (Netherlands)

van Lieshout, Arno P. W.; van Manen, Christiaan J.; du Pré, Karel J.; Kleinlugtenbelt, Ydo V.; Poolman, Rudolf W.; Goslings, J. Carel; Kloen, Peter

2010-01-01

An increase of distal radius fractures was seen in 2009 when an extended cold spell allowed natural ice skating in Amsterdam. This resulted in overload of our Emergency Departments and operating rooms. This study reports patient and fracture characteristics of these injuries. We also determined

Factors Associated with Infection Following Open Distal Radius Fractures

OpenAIRE

Glueck, Dane A.; Charoglu, Constantine P.; Lawton, Jeffrey N.

2009-01-01

Open fractures are often classified according to a system described by Gustilo and Anderson. However, this system was applied to open long bone factures, which may not predict the incidence of infection in open metaphyseal fractures of the upper extremity. Other studies have found that wound contamination and systemic illness were the best predictors of infections in open hand fractures. Our study assessed infection in open distal radius fractures and identifies factors that are associated wi...

Is Bone Grafting Necessary in the Treatment of Malunited Distal Radius Fractures?

Science.gov (United States)

Disseldorp, Dominique J. G.; Poeze, Martijn; Hannemann, Pascal F. W.; Brink, Peter R. G.

2015-01-01

Background Open wedge osteotomy with bone grafting and plate fixation is the standard procedure for the correction of malunited distal radius fractures. Bone grafts are used to increase structural stability and to enhance new bone formation. However, bone grafts are also associated with donor site morbidity, delayed union at bone–graft interfaces, size mismatch between graft and osteotomy defect, and additional operation time. Purpose The goal of this study was to assess bone healing and secondary fracture displacement in the treatment of malunited distal radius fractures without the use of bone grafting. Methods Between January 1993 and December 2013, 132 corrective osteotomies and plate fixations without bone grafting were performed for malunited distal radius fractures. The minimum follow-up time was 12 months. Primary study outcomes were time to complete bone healing and secondary fracture displacement. Preoperative and postoperative radiographs during follow-up were compared with each other, as well as with radiographs of the uninjured side. Results All 132 osteotomies healed. In two cases (1.5%), healing took more than 4 months, but reinterventions were not necessary. No cases of secondary fracture displacement or hardware failure were observed. Significant improvements in all radiographic parameters were shown after corrective osteotomy and plate fixation. Conclusion This study shows that bone grafts are not required for bone healing and prevention of secondary fracture displacement after corrective osteotomy and plate fixation of malunited distal radius fractures. Level of evidence Therapeutic, level IV, case series with no comparison group PMID:26261748

[Treatment type C fracture of the distal radius with locking compression plate and external fixators].

Science.gov (United States)

Yang, Xiang; Zhao, You-ming; Chen, Lin; Ye, Cong-cong; Guo, Wei-jun; Wang, Bo

2013-12-01

To compare efficacy of unilateral external fixators and locking compression plates in treating type C fractures of the distal radius. From January 2009 to June 2010, 76 patients with distal radius fracture were treated with LCP and external fixators, 54 patients were followed up. Among them, 29 cases were male and 25 cases were female with an average age of 45.31 (ranged, 24 to 68) years old. There were 29 patients in LCP group. According to AO classification, 8 cases were type C1, 7 cases were type C2 and 14 cases were type C3. There were 25 cases in external fixators group. According to AO classification, 6 cases were type C1, 8 cases were type C2 and 11 cases were type C3. Radial height, volar tilt and radial inclination were compared, advanced Gartland-Werley scoring were used to assessed wrist joint function after 6 and 12 months' following up. Two cases were suffered from nail infection in external fixators group. Fifty-four patients were followed up from 12 to 24 months with an average of 21.3 months. Radial height was (9.60 +/- 0.72) mm, volar tilt was (9.55 +/- 0.80) degrees and radial inclination was (21.40 +/- 0.78) degrees in LCP group,while those were (9.40 +/- 0.70) mm, (9.47 +/- 0.71) degrees and (21.20 +/- 0.73) degrees in external fixtors group, and with no statistical significance (P>0.05). Advanced Gartland-Werley score after 6 months' following up was 3.31 +/- 1.17 in LCP group, 5.56 +/- 1.58 in external fixtors group, and with significant difference (t=-5.99,Pmeaning (t=-1.55, P>0.05). LCP and external fixtors can receive good curative effects in treating type C distal radius fracture, and LCP can obtain obviously short-term efficacy, while there is no significant difference between two groups in long-term results. For serious distal radius comminuted fracture which unable to plate internal fixation, external fixators is a better choice.

Association of Insulin-like Growth Factor-1, Bone Mass and Inflammation to Low-energy Distal Radius Fractures and Fracture Healing in Elderly Women Attending Emergency Care.

Science.gov (United States)

Chisalita, Simona I; Chong, Lee Ti; Wajda, Maciej; Adolfsson, Lars; Woisetschläger, Mischa; Spångeus, Anna

2017-11-01

Elderly patients suffer fractures through low-energy mechanisms. The distal radius is the most frequent fracture localization. Insulin-like growth factor-1 (IGF1) plays an important role in the maintenance of bone mass and its levels decline with advancing age and in states of malnutrition. Our aim was to investigate the association of IGF1 levels, bone mass, nutritional status, and inflammation to low-energy distal radius fractures and also study if fracture healing is influenced by IGF1, nutritional status, and inflammation. Postmenopausal women, 55 years or older, with low-energy distal radius fractures occurring due to falling on slippery ground, indoors or outdoors, were recruited in the emergency department (ED) and followed 1 and 5 weeks after the initial trauma with biomarkers for nutritional status and inflammation. Fractures were diagnosed according to standard procedure by physical examination and X-ray. All patients were conservatively treated with plaster casts in the ED. Patients who needed interventions were excluded from our study. Fracture healing was evaluated from radiographs. Fracture healing assessment was made with a five-point scale where the radiological assessment included callus formation, fracture line, and stage of union. Blood samples were taken within 24 h after fracture and analyzed in the routine laboratory. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry (DXA). Thirty-eight Caucasian women, aged 70.5 ± 8.9 years (mean ± SD) old, were recruited. Nutritional status, as evaluated by albumin (40.3 ± 3.1 g/L), IGF1 (125.3 ± 39.9 μg/L), body mass index (26.9 ± 3.6 kg/m 2 ), arm diameter (28.9 ± 8.9 cm), and arm skinfold (2.5 ± 0.7 cm), was normal. A positive correlation was found between IGF1 at visit 1 and the lowest BMD for hip, spine, or radius (r = 0.39, P = 0.04). High sensitive C-reactive protein (hsCRP) and leukocytes were higher at the fracture event compared to 5 weeks later (P = 0.07 and P

[Long-term efficacy of open reduction and internal fixation versus external fixation for unstable distal radius fractures: a meta-analysis].

Science.gov (United States)

Yang, Z; Yuan, Z Z; Ma, J X; Ma, X L

2017-11-07

Objective: To make a systematic assessment of the Long-term efficacy of open reduction and internal fixation versus external fixation for unstable distal radius fractures. Methods: A computer-based online search of PubMed, ScienceDirect, EMBASE, BIOSIS, Springer and Cochrane Library were performed. The randomized and controlled trials of open reduction and internal fixation versus external fixation for unstable distal radius fractures were collected. The included trials were screened out strictly based on the criterion of inclusion and exclusion. The quality of included trials was evaluated. RevMan 5.0 was used for data analysis. Results: Sixteen studies involving 1 268 patients were included. There were 618 patients with open reduction and internal fixation and 650 with external fixation. The results of meta-analysis indicated that there were statistically significant differences with regard to the complications postoperatively (infection( I (2)=0%, RR =0.27, 95% CI 0.16-0.45, Z =4.92, P internal fixation and external fixation are effective treatment for unstable distal radius fractures. Compared with external fixation, open reduction and internal fixation provides reduced complications postoperatively, lower DASH scores and better restoration of volar tilt for treatment of distal radius fractures.

Immobilisation of extra-articular distal radius fractures (Colles type) in dorsiflexion. The functional and anatomical outcome.

Science.gov (United States)

Baruah, Ranjit Kr; Islam, Mohibul; Haque, Russel

2015-09-01

Cast immobilisation after successful closed reduction is a standard treatment for displaced extra-articular fractures of lower end radius. The position of the wrist during immobilisation is controversial. Immobilisation in dorsiflexion prevents redisplacement after closed reduction. Our aim is to determine the effectiveness of immobilization of wrist in dorsiflexion in such cases and evaluate anatomical and functional outcome. Study included 54 patients, above 19 years of age with closed extra-articular fractures of lower end radius treated conservatively with below elbow cast application. The wrist was maintained in 15° of dorsiflexion during plaster immobilisation. At 24 weeks, functional results were evaluated with subjective symptoms and objective signs, as per modified Demerit Point Score System. Anatomical result was evaluated based on the scheme devised by Lidstrom (1959) and modified by Sarmiento et al. (1980). 76% patients had Excellent to Good subjective symptoms. Out of 42 patients that had residual dorsal angulation of less than 10°, 37 had excellent to good functional outcome. 39 of the 43 patients who had loss of radial length less than 6 mm had excellent to good functional outcome. 40 out of 49 patients having loss of radial angulation less than 9° showed excellent to good functional outcome. Functional result was directly proportional to anatomical outcome. Cast immobilization of extra articular fractures of lower end radius with wrist in dorsiflexion prevents re-displacement of the fragments resulting in satisfactory anatomical & functional outcome.

Does formal education and training of staff reduce the operation rate for fractures of the distal radius?

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McDonald, Kyle; Murphy, Lynn; Gallagher, Brendan; Eames, Niall

2013-12-01

Fractures of the distal radius are one of the most common extremity fractures, and operation rates are increasing. Staff within our unit felt that formal teaching, particularly of new medical staff, with regards to fracture reduction and appropriate cast application could result in a reduction in operation rates. Retrospective data was extracted from FORD (Fracture Outcome and Research Database), including: number of fractures, number of fractures undergoing ORIF, fracture configuration, patient demographics, and mechanism of injury. All patients undergoing ORIF had their radiographs assessed by two separate reviewers. Information regarding adequate fracture reduction, adequate cast application (using Gap Index), and appropriate plaster cast moulding was recorded. Formal teaching was then given to the next group of medical staff rotating through the unit, and the same data was collected prospectively for that six-month period. Exclusion criteria included bilateral injuries, and polytrauma patients. A total of 1623 distal radial fractures were treated in our unit over the 12-month period, with 71 undergoing ORIF in the first 6 months and 39 in the second 6 months, this was statistically significant (p = 0.0009). Our study found that formal teaching and education significantly reduced the operation rate for distal radial fractures. This effect was most significant for extra-articular, dorsally angulated fractures of the distal radius. Our study proves that just 1 h of basic training at the beginning of an attachment can have significant benefits to both the unit and, more importantly, the patients. Copyright © 2013 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

[Roof folding and rotary pushing for the treatment of back to back fractures of distal radius and ulna in children].

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Xu, Ping; Dong, Xiao-jun; Lu, Zhou-tong; Wang, Gongjun; Zhang, Han-qing; Chen, Xuan-ning; Li, Dong

2015-09-01

To evaluate the technique and the clinical effect of folding roof and rotary pushing in treatment of children with distal radius and ulna fracture of "back to back". From January 2012 to February 2014,38 children with distal radius and ulna fracture of "back to back" were treated by using the technique of folding roof and rotary pushing to reset and splint fixation including 23 males and 15 females with an average age of 9.5 years old ranging from 6 to 14 years old. Injury time was from 45 min to 3 days (averaged 1.3 days). All cases was unilateral closed fracture without symptoms of nerve injury occurred. The wrist joint anteroposterior and lateral radiographs showed double fracture of radius and ulna, and the broken end of radius was typical "back to back" displacement. The quality of reduction was assessed according to Dienst recommendation on the combination of Aro measurement, and the therapeutic effect was evaluated using standard of Anderson function. All patients were followed up from 3 to 13 months with an average of 6 months. There were no iatrogenic nerve injury. Thirty cases were treated successfully for the first time, 8 cases were again reset successfully; 28 cases were anatomical reduction, 7 cases were near anatomic reduction, 3 cases were functional reduction. At the second day 7 cases with hand and finger swelling appeared in multiple reset patients. Quality results of reduction were excellent in 33 cases, good in 5 cases. According to the standard of Anderson function evaluation, 35 cases were excellent, 3 cases were good. All fractures were healed with of deformity of wrist. Using the technique of folding roof and rotary pushing in treatment of children with distal radius and ulna fracture of "back to back" is very successful, the patient's limb function recovered well, the whole operation process is simple.

Arthroscopic knotless anchor repair of triangular fibrocartilage in distal radius fracture.

Science.gov (United States)

García-Ruano, Á A; Najarro-Cid, F; Jiménez-Martín, A; Gómez de los Infantes-Troncoso, J G; Sicre-González, M

2015-01-01

Lesions of triangular fibrocartilage (TFC) are associated with distal radioulnar joint instability. Arthroscopic treatment of these lesions improves functional outcome of affected patients. The aim of the present work is to evaluate functional and occupational outcome of TCF repair using an arthroscopic knotless anchor device in patients with associated distal radius fracture. An observational, descriptive study was carried out between November 2011 and January 2014 including 21 patients with distal radius fracture and Palmer 1B lesions of TCF (Atzei class 2 and 3) that were treated by arthroscopic knotless anchor (PopLok® 2,8mm, ConMed, USA). Mean follow-up was 18 months. Functional (Mayo Wrist Score) and occupational outcome results were analyzed. Mean age of the group was 43.0±8.8 years, with 19% of the patients being female. There was an associated scapholunate lesion in 5 cases. Functional results reached a mean of 83.4±16.1 points onMayo Wrist Score. Mean sick-leave time was 153.16±48.5 days. Complete occupational reintegration was reached in 89.5% of cases. There were no postoperative complications. Arthroscopic knotless anchor repair of 1B TFC tears is a minimally invasive method of treatment that improves tension of fixation, avoiding subsequent loosen, in our experience, with few complications and good functional and occupational results. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

Factors in secondary prevention subsequent to distal radius fracture : Focus on physical function, co-morbidity, bone mineral density and health-related quality of life

OpenAIRE

Nordvall, Helena

2009-01-01

In Sweden approximately 25000 distal radius fractures occur annually, which is 37 % of all fractures related to osteoporosis. In this thesis, risk factors for osteoporosis, bone mineral density (BMD) and health-related quality of life (the SF-36) were compared in patients who suffered a distal radius fracture after low energy trauma with a control group matched on the basis of age, gender, and municipality of residence. The aim was also to analyse, among these patients, whether a risk factor ...

The outcome of conservative treatment of adult distal radius fractures compared with the other wrist: radiological and functional evaluation

Directory of Open Access Journals (Sweden)

Mustafa Uslu

2014-09-01

Full Text Available Objective: This study was designed to evaluate anatomical and functional results of closed reduction-long arm cast treatment for distal radius fractures and compared other healthy wrist in the adults. Methods: 77 patients with distal radius fracture were treated conservatively between January 2010 and December 2010. The fractures were classified according to AO and Frykman classification system and investigated prospectively. The radiological and anatomical results were assessed by the Stewart score criteria. The functional results were assessed by Quick-Disability of Arm, Shoulder and Hand questionnaire (Q-DASH and the Stewart II score criteria. The mean follow-up of patients was 12 months. Results: The forty patients had right wrist fractured, 37 patients had left wrist fractured. According to Frykman classification 46 patients were type I-II fractured, according to AO classification 59 patients were type 23,A2,1 and 23,A2,2 fractured. According to Stewart the radiological and anatomical, the result were excellent in 57, good in 17, fair in 3. According to Stewart II functional criteria, the results were assessed excellent in 57, good in 8, fair in 12 The mean Q-DASH score was 6,37. The overall complication rate was 12.98%. Mild Carpal tunnel syndrome was observed in the two patients, ulna styloid nonunion in the four patients, pain of distal radioulnar joint in the one patient, mild carpal tunnel syndrome and tenderness of distal radioulnar joint in the three patients. Conclusion: Closed reduction and cast immobilization is still an effective and inexpensive treatment method in distal radial fractures. J Clin Exp Invest 2014; 5 (3: 403-409

Two peg spade plate for distal radius fractures A novel technique

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Sharad M Hardikar

2015-01-01

Conclusions: The two peg volar spade plate provides a stable subchondral support in comminuted intraarticular fractures and maintains reduction in osteoporotic fractures of the distal radius. Early mobilization with this implant helps in restoring wrist motion and to prevent development of wrist stiffness.

The prevalence of pain and disability one year post fracture of the distal radius in a UK population: A cross sectional survey

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Leonardi-Bee Jo

2008-09-01

Full Text Available Abstract Background A fracture of the distal radius is a commonly occurring fracture and accounts for a third of all fractures in the elderly. Thus far, one year estimates of pain and disability following a fracture of the distal radius have been reported on Canadian populations. The primary aim of this study is to investigate the prevalence of pain and disability in a UK population one year post fracture of the distal radius. Methods A cross-sectional survey was undertaken, of all subjects suffering a fracture of the distal radius between October 2005 and February 2006 in Nottingham, UK. Primary outcomes used were the VAS for pain and the DASH for disability. Prevalence of pain and disability were calculated and odds ratios presented for associations between demographics, pain and disability. Results 93/264 (35% subjects responded to the questionnaire. 6 subjects did not fulfill the inclusion criteria and were excluded from further analysis. 11% of subjects reported moderate to very severe pain. 16% of subjects reported moderate to very severe disability. Statistically significant associations were found between pain medication usage for the wrist fracture and moderate to very severe pain (OR 11.20, 95% CI 2.05 – 61.23. Moderate to very severe disability was associated with older age (OR 6.53, 95%CI 1.65 – 25.90 and pain medication usage for the wrist fracture (OR 4.75, 95% CI 1.38 – 16.37. Working was associated with a reduction in risk of moderate to very severe disability (OR 0.14, 95% CI 0.03 – 0.67. Conclusion This study demonstrates that there are a small proportion of patients who are still suffering moderate to very severe pain and disability one year post fracture of the distal radius. The study also demonstrates that there are significant associations between characteristics of the patients and the level of pain and disability. This highlights the need for further research into the most appropriate management of these patients

Nerve Stimulator Guided Axillary Block in Painless Reduction of Distal Radius Fractures; a Randomized Clinical Trial

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Hossein Alimohammadi

2013-12-01

Full Text Available Introduction: Given the high prevalence of upper extremity fractures and increasing need to perform painless reduction in the emergency departments, the use of analgesic methods with fewer complications and more satisfaction appears to be essential. The aim of this study is comparison the nerve stimulator guided axillary block (NSAB with intravenous sedation in induction of analgesia for painless reduction of distal radius fractures. Methods: In the present randomized clinical trial, 60 patients (18-70 years of age suffered from distal radius fractures, were divided into two equal groups. One group received axillary nerve block by nerve stimulator guidance and the other procedural sedation and analgesia (PSA using midazolam/fentanyl. Onset of analgesia, duration of analgesic effect, total procedure time and pain scores were recorded using visual analogue scale (VAS and the outcomes were compared. Chi-squared and student t test were performed to evaluate differences between two groups. Results: Sixty patients were randomly divided into two groups (83.3% male. The mean age of patients was 31 ±0.7 years. While the onset of analgesia was significantly longer in the NSAB group, the mean total time of procedure was shorter than PSA (p<0.001. The NSAB group needed a shorter post-operative observation time (P<0.001. Both groups experienced equal pain relief before, during and after procedure (p>0.05. Conclusion: It seems that shorter post-operative monitoring time and consequently lesser total time of procedure, make nerve stimulator guided axillary block as an appropriate alternative for procedural sedation and analgesia in painless reduction of distal radius fractures in emergency department. 

Evaluation of sarcopenia in patients with distal radius fractures.

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Roh, Young Hak; Koh, Young Do; Noh, Jung Ho; Gong, Hyun Sik; Baek, Goo Hyun

2017-12-01

Sarcopenia is more prevalent in patients with distal radius fracture (DRF) than in age- and sex-matched controls. Lower appendicular mass index in men and weaker grip strength in both men and women increase the likelihood of DRF. Sarcopenia is a core component of physical frailty that predisposes older people to falls and negatively impacts the activities of daily living. The objectives of this study were to compare the prevalence of sarcopenia in patients with DRF with that in age- and sex-matched controls without DRF; and evaluate the association between sarcopenia and the occurrence of DRF. We prospectively recruited 132 patients over 50 years of age who sustained DRF due to fall and 132 age- and sex-matched controls without DRF. A definition of sarcopenia was based on the consensus of the Asian Working Group for Sarcopenia. Sarcopenic components including appendicular lean body mass, grip strength, and gait speed were compared between the two groups. Other factors assessed for the occurrence of DRF were age, gender, body mass index (BMI), lumbar, and hip bone mineral density (BMD) values. A conditional logistic regression analysis was conducted to evaluate the associations between sarcopenia and the occurrence of DRF. A total of 39 (30%) of 132 DRF patients were sarcopenic, whereas 23 (17%) of the 132 controls were within the sarcopenic criteria (p = 0.048). The patient group had significantly lower lean body mass and weaker grip strength than those of the control group. However, there was no significant difference in gait speed between the two groups. According to regression analysis, lower appendicular mass index in men was associated with an increased incidence of DRF (odds ratio [OR] = 0.84, 95% confidence interval [CI] = 0.72, 0.95) while weaker grip strength and lower total hip BMD values were associated with the occurrence of DRF in both men (OR = 0.77, 95% CI = 0.63, 0.92; and OR = 0.79, 95% CI = 0.64, 0.94, respectively) and women (OR�

Radiographic diagnosis of scapholunate dissociation among intra-articular fractures of the distal radius: interobserver reliability

NARCIS (Netherlands)

Gradl, Gertraud; Neuhaus, Valentin; Fuchsberger, Thomas; Guitton, Thierry G.; Prommersberger, Karl-Josef; Ring, David; Wahegaonkar, Abhijeet L.; Shafritz, Adam B.; Garcia, Aida E.; Caputo, Andrew E.; Terrono, Andrew L.; Spoor, Andy B.; Eschler, Anica; Vochteloo, Anne J. H.; Beumer, Annechien; Barquet, Antonio; Kristan, Anze; van der Zwan, Arnard L.; Berner, Arne; Ilyas, Asif; Jubel, Axel; Sutker, Ben; Nolan, Betsy M.; Petrisor, Brad; Cross, Brian J.; Wills, Brian P. D.; Barreto, Camilo J. R.; Fernandes, Carlos H.; Swigart, Carrie; Zalavras, Charalampos; Goldfarb, Charles A.; Cassidy, Charles; Eaton, Charles; Wilson, Chris; Cheng, Christine J.; Wall, Christopher J.; Walsh, Christopher J.; Jones, Christopher M.; Garnavos, Christos; Klostermann, Cyrus; Kirkpatrick, D. Kay; Eygendaal, Denise; Verbeek, Diederik O. F.; Beeres, Frank J. P.; Thomas, George; Ponsen, Kornelis J.; van den Bekerom, Michel P. J.; Schep, Niels; Kloen, Peter; Haverlag, Robert

2013-01-01

To evaluate the reliability and accuracy of diagnosis of scapholunate dissociation (SLD) among AO type C (compression articular) fractures of the distal radius. A total of 217 surgeons evaluated 21 sets of radiographs with type C fractures of the distal radius for which the status of the

[APPLICATION OF BUTTERFLY SHAPED LOCKING COMPRESSION PLATE IN COMPLEX DISTAL RADIUS FRACTURES].

Science.gov (United States)

Jiang, Zongyuan; Ma, Tao; Xia, Jiang; Hu, Caizhi; Xu, Lei

2014-06-01

To investigate the effectiveness of butterfly shaped locking compression plate for the treatment of complex distal radius fractures. Between June 2011 and January 2013, 20 cases of complex distal radius fractures were treated with butterfly shaped locking compression plate fixation. There were 11 males and 9 females with an average age of 54 years (range, 25-75 years). Injury was caused by falling in 10 cases, by traffic accident in 7 cases, and by falling from height in 3 cases. All of fractures were closed. According to AO classification system, there were 8 cases of type C1, 8 cases of type C2, and 4 cases of type C3. Of them, 9 cases had radial styloid process fracture, 4 cases had sigmoid notch fracture, and 7 cases had both radial styloid process fracture and sigmoid notch fracture. The mean interval between injury and operation was 5.2 days (range, 3-15 days). All incisions healed by first intention; no complications of infection and necrosis occurred. All cases were followed up 14 months on average (range, 10-22 months). All factures healed after 9.3 weeks on average (range, 6-11 weeks). No complications such as displacement of fracture, joint surface subsidence, shortening of the radius, and carpal tunnel syndrome were found during follow-up. At last follow-up, the mean palmar tilt angle was 10.2° (range, 7-15°), and the mean ulnar deviation angle was 21.8° (range, 17-24°). The mean range of motion of the wrist was 45.3° (range, 35-68°) in dorsal extension, 53.5° (range, 40-78°) in palmar flexion, 19.8° (range, 12-27°) in radial inclination, 26.6° (range, 18-31°) in ulnar inclination, 70.2° (range, 45-90°) in pronation, and 68.4° (range, 25-88°) in supination. According to the Dienst scoring system, the results were excellent in 8 cases, good in 10 cases, and fair in 2 cases, and the excellent and good rate was 90%. Treatment of complex distal radius fractures with butterfly shaped locking compression plate can reconstruct normal anatomic

UK DRAFFT - A randomised controlled trial of percutaneous fixation with kirschner wires versus volar locking-plate fixation in the treatment of adult patients with a dorsally displaced fracture of the distal radius

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Brown Jaclyn

2011-09-01

Full Text Available Abstract Background Fractures of the distal radius are extremely common injuries in adults. However, the optimal management remains controversial. In general, fractures of the distal radius are treated non-operatively if the bone fragments can be held in anatomical alignment by a plaster cast or orthotic. However, if this is not possible, then operative fixation is required. There are several operative options but the two most common in the UK, are Kirschner-wire fixation (K-wires and volar plate fixation using fixed-angle screws (locking-plates. The primary aim of this trial is to determine if there is a difference in the Patient-Reported Wrist Evaluation one year following K-wire fixation versus locking-plate fixation for adult patients with a dorsally-displaced fracture of the distal radius. Methods/design All adult patients with an acute, dorsally-displaced fracture of the distal radius, requiring operative fixation are potentially eligible to take part in this study. A total of 390 consenting patients will be randomly allocated to either K-wire fixation or locking-plate fixation. The surgery will be performed in trauma units across the UK using the preferred technique of the treating surgeon. Data regarding wrist function, quality of life, complications and costs will be collected at six weeks and three, six and twelve months following the injury. The primary outcome measure will be wrist function with a parallel economic analysis. Discussion This pragmatic, multi-centre trial is due to deliver results in December 2013. Trial registration Current Controlled Trials ISRCTN31379280 UKCRN portfolio ID 8956

Effect of facility on the operative costs of distal radius fractures.

Science.gov (United States)

Mather, Richard C; Wysocki, Robert W; Mack Aldridge, J; Pietrobon, Ricardo; Nunley, James A

2011-07-01

The purpose of this study was to investigate whether ambulatory surgery centers can deliver lower-cost care and to identify sources of those cost savings. We performed a cost identification analysis of outpatient volar plating for closed distal radius fractures at a single academic medical center. Multiple costs and time measures were taken from an internal database of 130 consecutive patients and were compared by venue of treatment, either an inpatient facility or an ambulatory, stand-alone surgery facility. The relationships between total cost and operative time and multiple variables, including fracture severity, patient age, gender, comorbidities, use of bone graft, concurrent carpal tunnel release, and surgeon experience, were examined, using multivariate analysis and regression modeling to identify other cost drivers or explanatory variables. The mean operative cost was considerably greater at the inpatient facility ($7,640) than at the outpatient facility ($5,220). Cost drivers of this difference were anesthesia services, post-anesthesia care unit, and operating room costs. Total surgical time, nursing time, set-up, and operative times were 33%, 109%, 105%, and 35% longer, respectively, at the inpatient facility. There was no significant difference between facilities for the additional variables, and none of those variables independently affected cost or operative time. The only predictor of cost and time was facility type. This study supports the use of ambulatory stand-alone surgical facilities to achieve efficient resource utilization in the operative treatment of distal radius fractures. We also identified several specific costs and time measurements that differed between facilities, which can serve as potential targets for tertiary facilities to improve utilization. Economic and Decisional Analysis III. Copyright © 2011 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Fixation via dorsal for complex fractures of radius distal with plate P

International Nuclear Information System (INIS)

Rojas, Sandra; Bocanegra, Sergio; Suarez, Fabio

2002-01-01

The existence of multiple alternatives in the handling of the complex fractures of the radius distal it constitutes a reflection of the challenge that these they represent as for the possibility of recovering an appropriate consistency to articulate and orientation and radial height. This prospective study included 13 patients assisted in the hospital military of Bogota, by means of internal fixation with plate π. This treatment alternative, it solves many present inconveniences with other methods and it allows the precocious postoperative rehabilitation

Distal radius fractures result in alterations in scapular kinematics: a three-dimensional motion analysis.

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Ayhan, Cigdem; Turgut, Elif; Baltaci, Gul

2015-03-01

Scapular motion is closely integrated with arm motion. Injury to a distal segment requires compensatory changes in the proximal segments leading to alterations in scapular motion. Since the effects of distal injuries on scapular kinematics remain unknown, in the present study we investigated the influences on scapular motion in patients with distal injuries. Sixteen subjects with a history of distal radius fracture and 20 asymptomatic healthy subjects (controls) participated in the study. Three-dimensional scapular and humeral kinematic data were collected on all 3 planes of shoulder elevation: frontal, sagittal, and scapular. All testing was performed in a single session; therefore, the sensors remained attached to the participants for all testing. The position and orientation data of the scapula at 30°, 60°, 90°, and 120° humerothoracic elevation and 120°, 90°, 60°, and 30° lowering were used for statistical comparisons. Independent samples t-test was used to compare the scapular internal/external rotation, upward/downward rotation, and anterior/posterior tilt between the affected side of subjects with a distal radius fracture and the dominant side of asymptomatic subjects at the same stage of humerothoracic elevation. Scapular internal rotation was significantly increased at 30° elevation (P=0.01), 90° elevation (P=0.03), and 30° lowering (P=0.03), and upward rotation was increased at 30° and 60° elevation (Pplane elevation. Scapular upward rotation and anterior tilt were significantly increased during 30° lowering on both the scapular (P=0.002 and 0.02, respectively) and sagittal planes (P=0.01 and 0.02. respectively). Patients with distal radius fractures exhibit altered scapular kinematics, which may further contribute to the development of secondary musculoskeletal pathologies. Copyright © 2014 Elsevier Ltd. All rights reserved.

Do radiographic indices of distal radius fracture reduction predict outcomes in older adults receiving conservative treatment?

International Nuclear Information System (INIS)

Jaremko, J.L.; Lambert, R.G.W.; Rowe, B.H.; Johnson, J.A.; Majumdar, S.R.

2007-01-01

Aim: To investigate whether radiographic deformities suggesting inadequate reduction would be associated with adverse clinical outcomes. Materials and methods: Consecutive patients over 50 years of age (n = 74) with non-operatively managed distal radius fractures were enrolled in a prospective cohort study. They had radiographs at cast removal (∼6 weeks) and completed DASH (Disabilities of the Arm, Shoulder and Hand), SF-12 (health-related quality of life), and satisfaction surveys 6-months post-fracture. A reference-standard musculoskeletal radiologist, blinded to outcomes status, measured palmar (dorsal) tilt, radial angle, radial height, ulnar height, and intra-articular step and gap. Radiographic indices were correlated to each other and to the various patient-reported outcomes in univariate and multivariate regression analyses. DASH score was the primary study outcome. Results: Of the cohort studied (n = 74, mean age 68.5 years, primarily white women), 71% had at least one 'unacceptable' radiographic deformity by traditional criteria. Acceptable reduction varied from 60-99% depending on which single index was reported, and 44% of patients had more than two indices reported as unacceptable. Despite these radiographic findings, 6-months post-reduction, self-reported disability was low (DASH = 24 ± 17), health-related quality of life was near normal, and 72% were satisfied with their care. No radiographic index of wrist deformity (alone or in combination) was significantly correlated to any of the patient-reported outcomes. Conclusion: Self-reported outcomes in older adults with conservatively managed wrist fractures were not related to the 'acceptability' of radiographic fracture reduction. The proportion of acceptable reductions varied by 40% depending on which index was reported. Consequently, detailed reporting of these indices in older adults with distal radius fracture may be inefficient or perhaps even unnecessary

Do radiographic indices of distal radius fracture reduction predict outcomes in older adults receiving conservative treatment?

Energy Technology Data Exchange (ETDEWEB)

Jaremko, J.L. [Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta (Canada); Lambert, R.G.W. [Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta (Canada); Rowe, B.H. [Department of Emergency Medicine, University of Alberta, Edmonton, Alberta (Canada); Department of Public Health Sciences, University of Alberta, Edmonton, Alberta (Canada); Johnson, J.A. [Department of Public Health Sciences, University of Alberta, Edmonton, Alberta (Canada); Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta (Canada); Majumdar, S.R. [Department of Public Health Sciences, University of Alberta, Edmonton, Alberta (Canada) and Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta (Canada)]. E-mail: me2.majumdar@ualberta.ca

2007-01-15

Aim: To investigate whether radiographic deformities suggesting inadequate reduction would be associated with adverse clinical outcomes. Materials and methods: Consecutive patients over 50 years of age (n = 74) with non-operatively managed distal radius fractures were enrolled in a prospective cohort study. They had radiographs at cast removal ({approx}6 weeks) and completed DASH (Disabilities of the Arm, Shoulder and Hand), SF-12 (health-related quality of life), and satisfaction surveys 6-months post-fracture. A reference-standard musculoskeletal radiologist, blinded to outcomes status, measured palmar (dorsal) tilt, radial angle, radial height, ulnar height, and intra-articular step and gap. Radiographic indices were correlated to each other and to the various patient-reported outcomes in univariate and multivariate regression analyses. DASH score was the primary study outcome. Results: Of the cohort studied (n = 74, mean age 68.5 years, primarily white women), 71% had at least one 'unacceptable' radiographic deformity by traditional criteria. Acceptable reduction varied from 60-99% depending on which single index was reported, and 44% of patients had more than two indices reported as unacceptable. Despite these radiographic findings, 6-months post-reduction, self-reported disability was low (DASH = 24 {+-} 17), health-related quality of life was near normal, and 72% were satisfied with their care. No radiographic index of wrist deformity (alone or in combination) was significantly correlated to any of the patient-reported outcomes. Conclusion: Self-reported outcomes in older adults with conservatively managed wrist fractures were not related to the 'acceptability' of radiographic fracture reduction. The proportion of acceptable reductions varied by 40% depending on which index was reported. Consequently, detailed reporting of these indices in older adults with distal radius fracture may be inefficient or perhaps even unnecessary.

The reliability of AO classification for distal radius fracture, using CT findings

International Nuclear Information System (INIS)

Nakanishi, Yasuaki; Ono, Hiroshi; Furuta, Kazuhiko; Fujitani, Ryoutarou; Ota, Hiroyoshi

2006-01-01

The purpose of this study was to assess the reliability of the AO (Association for the Study of Internal Fixation) classification of distal radius fracture, using plain radiographs and 2 cross-sectional computed tomographic (CT) surface images. Five observers independently classified 32 distal radius fractures into 9 groups under AO classification. We established 4 methods for observation. First, using only two-directional radiographs; second, four-directional radiographs; third, CT (axial view) with four-directional radiographs; and fourth, CT (axial and sagittal views) with four-directional radiographs. Kappa statistics were used to establish the relative level of agreement between the observers. Interobserver reliability was poor in both first and second methods in which only plain radiographs were used (κ=0.30 and 0.23, respectively). Furthermore, reliability did not increase in the third method with the addition of 1 CT surface image (κ=0.29). In the fourth method, with the addition of 2 cross-sectional CT surface images, the reliability increased to a moderate level (κ=0.44). Interobserver reliability of the AO system of the classification of distal radius fractures was observed on using 2 cross-sectional CT surface images with four-directional radiographs. (author)

Midterm Follow-up of Treating Volar Marginal Rim Fractures with Variable Angle Lcp Volar Rim Distal Radius Plates.

Science.gov (United States)

Goorens, Chul Ki; Geeurickx, Stijn; Wernaers, Pascal; Staelens, Barbara; Scheerlinck, Thierry; Goubau, Jean

2017-06-01

Specific treatment of the volar marginal rim fragment of distal radius fractures avoids occurance of volar radiocarpal dislocation. Although several fixation systems are available to capture this fragment, adequately maintaining internal fixation is difficult. We present our experience of the first 10 cases using the 2.4 mm variable angle LCP volar rim distal radius plate (Depuy Synthes®, West Chester, US), a low-profile volar rim-contouring plate designed for distal plate positioning and stable buttressing of the volar marginal fragment. Follow-up patient satisfaction, range of motion, grips strength, functional scoring with the QuickDASH and residual pain with a numeric rating scale were assessed. Radiological evaluation consisted in evaluating fracture consolidation, ulnar variance, volar angulation and maintenance of the volar rim fixation. The female to male ratio was 5:5 and the mean age was 52.2 (range, 17-80) years. The mean follow-up period was 11 (range, 5-19) months postoperatively. Patient satisfaction was high. The mean total flexion/extension range was 144° (range, 100-180°) compared to the contralateral uninjured side 160° (range, 95-180°). The mean total pronation/supination range was 153° (range, 140-180°) compared to the contralateral uninjured side 170° (range, 155-180°). Mean grip strength was 14 kg (range, 9-22), compared to the contralateral uninjured side 20 kg (range, 12-25 kg). Mean pre-injury level activity QuickDASH was 23 (range, 0-34.1), while post-recovery QuickDASH was 25 (range 0-43.2). Residual pain was 1.5 on the visual numerical pain rating scale. Radiological evaluation revealed in all cases fracture consolidation, satisfactory reconstruction of ulnar variance, volar angulation and volar rim. We encountered no flexor tendon complications, although plate removal was systematically performed after fracture consolidation. The 2.4 mm variable angle LCP volar rim distal radius plates is a valid treatment option for treating

Locking plate versus external fixation for type C distal radius fractures: A meta-analysis of randomized controlled trials

Directory of Open Access Journals (Sweden)

Dong Wang

2018-04-01

Full Text Available Purpose: Distal radial fracture is one of the most common fractures. Up to now, locking plates (LP and external fixation (EF are two conventional surgical approaches to type C radius fracture. Which method is superior has not yet reached a consensus. We try to assess the clinical effectiveness of the two interventions by this meta-analysis. Methods: We used network to search the PubMed, Embase, and Cochrane Medical Library of randomized controlled clinical trials about the type C distal radius fractures performed according to the search strategy mentioned in Cochrane Handbook 5.1.0 from Jan. 2005 to Jan. 2016. Patients in the experimental group were used LP, in the control group were included EF and other surgical approaches. Publication language was restricted to English. Studies that patient population and surgical indication did not define had been excluded. Studies must report at least one of the outcomes as follow: radial inclination, palmar tilt, ulnar variance, range of wrist flexion and extension, and range of wrist supination and pronation. The trials in which participants included children were excluded. We used Jadad study scores to appraise the study. Results: Seven studies included 162 patients (LP group and 190 patients (EF group. We compared the radial inclination, palmar tilt, ulnar variance, range of wrist flexion and extension, and range of wrist supination and pronation. The radial inclination were revealed a difference favoring LP over EF [WMD = 1.84, 95% CI (0.17, 3.50, p = 0.03] and the palmar tilt and ulnar variance was no significant difference between the two groups [(WMD = 3.61, 95% CI (0.00, 7.23, p = 0.05; WMD = 0.05, 95% CI (−0.99, 1.09, p = 0.93]. The functional activities of range of flexion and extension and range of supination and pronation between the two groups was no difference [WMD = 10.04, 95% CI (−6.88, 26.96, p = 0.24; WMD = 12.53, 95% CI (−9.99, 35.06, p = 0.28]. Conclusion

Analysis of the Arthroscopically Diagnosed Soft-Tissue Injuries Associated With the Distal Radius Fractures

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Katerina Katerina Kasapinova

2014-06-01

CONCLUSIONS: The frequency of the associated soft-tissue lesions in distal radius fractures is high. Ulnar styloid fracture was identified as risk factor for associated LT lesion, as well as combined lesion of both scapholunate and luntriquetral ligament.

Are distal radius fractures due to fragility or to falls? A consecutive case-control study of bone mineral density, tendency to fall, risk factors for osteoporosis, and health-related quality of life.

Science.gov (United States)

Nordvall, Helena; Glanberg-Persson, Gunhild; Lysholm, Jack

2007-04-01

A fracture of the distal radius is considered to indicate an increased risk of future fractures, especially a hip fracture. The main causes may be osteoporosis or a tendency to fall, separately or in combination. 93 women and 5 men with a recent radius fracture and the same number of controls were measured with a heel-DXL and asked to complete one questionnaire on their quality of life (SF-36), and one on risk factors. The mean T-score of the patients was -2.1, and for the controls it was -1.9 (p = 0.3). The patients aged over 64 years had a history of falling more often than the corresponding controls (p = 0.01), but there was no difference in T-score. By contrast, patients 45-64 years of age showed a non-significant, lower T-score (p = 0.09), but there was no difference concerning their history of falling. For all other risk factors, no differences were found between the patients and the controls. There were significant differences between the patients and the controls in some of the functions in the SF-36, due to the radius fracture. This study indicates that the underlying cause of a distal radius fracture may be different in patients aged 45-64 years and those who are more than 64 years old.

The International Classification of Functioning as an explanatory model of health after distal radius fracture: A cohort study

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MacDermid Joy C

2005-11-01

Full Text Available Abstract Background Distal radius fractures are common injuries that have an increasing impact on health across the lifespan. The purpose of this study was to identify health impacts in body structure/function, activity, and participation at baseline and follow-up, to determine whether they support the ICF model of health. Methods This is a prospective cohort study of 790 individuals who were assessed at 1 week, 3 months, and 1 year post injury. The Patient Rated Wrist Evaluation (PRWE, The Wrist Outcome Measure (WOM, and the Medical Outcome Survey Short-Form (SF-36 were used to measure impairment, activity, participation, and health. Multiple regression was used to develop explanatory models of health outcome. Results Regression analysis showed that the PRWE explained between 13% (one week and 33% (three months of the SF-36 Physical Component Summary Scores with pain, activities and participation subscales showing dominant effects at different stages of recovery. PRWE scores were less related to Mental Component Summary Scores, 10% (three months and 8% (one year. Wrist impairment scores were less powerful predictors of health status than the PRWE. Conclusion The ICF is an informative model for examining distal radius fracture. Difficulty in the domains of activity and participation were able to explain a significant portion of physical health. Post-fracture rehabilitation and outcome assessments should extend beyond physical impairment to insure comprehensive treatment to individuals with distal radius fracture.

The International Classification of Functioning as an explanatory model of health after distal radius fracture: A cohort study

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Harris, Jocelyn E; MacDermid, Joy C; Roth, James

2005-01-01

Background Distal radius fractures are common injuries that have an increasing impact on health across the lifespan. The purpose of this study was to identify health impacts in body structure/function, activity, and participation at baseline and follow-up, to determine whether they support the ICF model of health. Methods This is a prospective cohort study of 790 individuals who were assessed at 1 week, 3 months, and 1 year post injury. The Patient Rated Wrist Evaluation (PRWE), The Wrist Outcome Measure (WOM), and the Medical Outcome Survey Short-Form (SF-36) were used to measure impairment, activity, participation, and health. Multiple regression was used to develop explanatory models of health outcome. Results Regression analysis showed that the PRWE explained between 13% (one week) and 33% (three months) of the SF-36 Physical Component Summary Scores with pain, activities and participation subscales showing dominant effects at different stages of recovery. PRWE scores were less related to Mental Component Summary Scores, 10% (three months) and 8% (one year). Wrist impairment scores were less powerful predictors of health status than the PRWE. Conclusion The ICF is an informative model for examining distal radius fracture. Difficulty in the domains of activity and participation were able to explain a significant portion of physical health. Post-fracture rehabilitation and outcome assessments should extend beyond physical impairment to insure comprehensive treatment to individuals with distal radius fracture. PMID:16288664

Outcome of management of distal radius fractures in ...

African Journals Online (AJOL)

Background and Purpose: Distal radial fractures are common fractures of postmenopausal age group patients. They are often called fractures of osteoporosis. These fractures are considered to be one of the commonest minor injuries to cause major morbidity in the community. A lot of patient who need surgery, fail to afford ...

Classification and treatment of distal radius fractures: a survey among orthopaedic trauma surgeons and residents

NARCIS (Netherlands)

M.A.M. Mulders (Marjolein A. M.); D. Rikli; J.C. Goslings (Carel); N.W.L. Schep (Niels)

2017-01-01

textabstractPurpose: Classification, the definition of an acceptable reduction and indications for surgery in distal radius fracturemanagement are still subject of debate. The purpose of this study was to characterise current distal radius fracture management in Europe. Methods: During the European

Fragment-Specific Fixation Versus Volar Locking Plates in Primarily Nonreducible or Secondarily Redisplaced Distal Radius Fractures: A Randomized Controlled Study.

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Landgren, Marcus; Abramo, Antonio; Geijer, Mats; Kopylov, Philippe; Tägil, Magnus

2017-03-01

To compare the patient-reported, clinical, and radiographic outcome of 2 methods of internal fixation in distal radius fractures. Fifty patients, mean age 56 years (range, 21-69 years) with primarily nonreducible or secondarily redisplaced distal radius fractures were randomized to open reduction internal fixation using volar locking plates (n = 25) or fragment-specific fixation (n = 25). The patients were assessed on grip strength, range of motion, patient-reported outcome (Quick Disabilities of the Arm, Shoulder, and Hand), pain (visual analog scale), health-related quality of life (Short Form-12 [SF-12]), and radiographic evaluation. Grip strength at 12 months was the primary outcome measure. At 12 months, no difference was found in grip strength, which was 90% of the uninjured side in the volar plate group and 87% in the fragment-specific fixation group. No differences were found in range of motion and the median Quick Disabilities of the Arm, Shoulder, and Hand score was 5 in both groups. The overall complication rate was significant, 21% in the volar locking plate group, compared with 52% in the fragment-specific group. In treatment of primarily nonreducible or secondarily redisplaced distal radius fractures, volar locking plates and fragment-specific fixation both achieve good and similar patient-reported outcomes, although more complications were recorded in the fragment-specific group. Therapeutic II. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Cross-education for improving strength and mobility after distal radius fractures: a randomized controlled trial.

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Magnus, Charlene R A; Arnold, Cathy M; Johnston, Geoffrey; Dal-Bello Haas, Vanina; Basran, Jenny; Krentz, Joel R; Farthing, Jonathan P

2013-07-01

To evaluate the effects of cross-education (contralateral effect of unilateral strength training) during recovery from unilateral distal radius fractures on muscle strength, range of motion (ROM), and function. Randomized controlled trial (26-wk follow-up). Hospital, orthopedic fracture clinic. Women older than 50 years with a unilateral distal radius fracture. Fifty-one participants were randomized and 39 participants were included in the final data analysis. Participants were randomized to standard rehabilitation (Control) or standard rehabilitation plus strength training (Train). Standard rehabilitation included forearm casting for 40.4±6.2 days and hand exercises for the fractured extremity. Nonfractured hand strength training for the training group began immediately postfracture and was conducted at home 3 times/week for 26 weeks. The primary outcome measure was peak force (handgrip dynamometer). Secondary outcomes were ROM (flexion/extension; supination/pronation) via goniometer and the Patient Rated Wrist Evaluation questionnaire score for the fractured arm. For the fractured hand, the training group (17.3±7.4kg) was significantly stronger than the control group (11.8±5.8kg) at 12 weeks postfracture (P<.017). There were no significant strength differences between the training and control groups at 9 (12.5±8.2kg; 11.3±6.9kg) or 26 weeks (23.0±7.6kg; 19.6±5.5kg) postfracture, respectively. Fractured hand ROM showed that the training group had significantly improved wrist flexion/extension (100.5°±19.2°) than the control group (80.2°±18.7°) at 12 weeks postfracture (P<.017). There were no significant differences between the training and control groups for flexion/extension ROM at 9 (78.0°±20.7°; 81.7°±25.7°) or 26 weeks (104.4°±15.5°; 106.0°±26.5°) or supination/pronation ROM at 9 (153.9°±23.9°; 151.8°±33.0°), 12 (170.9°±9.3°; 156.7°±20.8°) or 26 weeks (169.4°±11.9°; 162.8°±18.1°), respectively. There were no

Stress fractures of the humerus, radius, and tibia in horses: clinical features and radiographic and/or scintigraphic appearance

International Nuclear Information System (INIS)

Mackey, V.S.; Trout, D.R.; Meagher, D.M.; Hornof, W.J.

1987-01-01

The medical records, radiographic and nuclear scintigraphic findings of 26 racing horses with 27 stress fracture episodes of the humerus, radius, or tibia were reviewed. The purposes of this study were to describe the radiographic and/or scintigraphic features of stress fractures of the humerus, radius, or tibia, and to evaluate the signalment and history of horses in which stress fracture occurred. Stress fractures of the three long bones examined were primarily seen in 2- and 3-year-old male Thoroughbred horses; commonly, the onset of lameness was immediately following training gallops or racing. There were 13 humeral stress fracture episodes in 12 horses. Ten were in the proximal caudolateral cortex, and three were in the distal craniomedial cortex. Radical stress fractures were seen in three horses, all in the midshaft radius. Tibial stress fractures were diagnosed in 11 horses. They were located in the proximal lateral tibia in six horses, the distal caudolateral tibia in three horses, and the midshaft tibia in three horses. Fifteen stress fractures were diagnosed with radiography alone, one was diagnosed with scintigraphy alone, nine were diagnosed with radiographs and scintigraphy, and, in two horses, radiographs were negative, but the scintigraphic findings were consistent with stress fracture

[Growth behaviour after fractures of the proximal radius: differences to the rest of the skeleton].

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Hell, A K; von Laer, L

2014-12-01

Fractures of the proximal end of the radius in the growth phase have three characteristics: the head of the radius articulates with two joint partners and is therefore indispensable for an undisturbed function of the elbow. The blood supply of the proximal end of the radius is via periosteal vessels in the sense of a terminal circulation which makes it extremely vulnerable. Severe trauma caused either by accidents or treatment, can result in partial or complete necrosis with deformity of the head and neck region of the radius. Radioulnar synostosis and chronic epiphysiolysis are irreversible complications which can occur after excessive physiotherapy. Despite a low potency growth plate, in young patients the proximal end of the radius shows an enormous spontaneous correction of dislocations. Side to side shifts, however, will not be remodeled. Therapy should be as atraumatic as possible. Due to the blood supply situation, with the appropriate indications the spontaneous correction and a brief period of immobilization without physiotherapy should be integrated into the therapy concept. If an operation is necessary, repeated traumatic repositioning maneuvers should be avoided and in case of doubt closed or careful open repositioning can be achieved with intramedullary nailing. In order to take the special characteristics of the proximal radius into consideration, the vulnerability and correction potential must be weighed up against each other. Therapy must be as atraumatic as possible. The spontaneous correction potential should be integrated into the primary therapy without overestimating this potential with respect to the extent and age of the patient.

Fracture configurations of the equine radius and tibia after a simulated kick

OpenAIRE

Fürst, Anton; Oswald, Susanne E; Jäggin, S; Piskoty, G; Michel, S; Auer, Jörg A

2008-01-01

The objective of this postmortem study was to determine the fracture configurations of the equine radius and tibia after a simulated kick. Fracture configurations of 35 radii and 36 tibiae from 19 adult horses were evaluated after a simulated kick in an experimental exvivo study. The bones were dissected, the proximal and distal ends were embedded in resin, fixed horizontally and preloaded in compression, and a steel impactor, designed to simulate a shod equine hoof, was dropped from a height...

AO Distal Radius Fracture Classification: Global Perspective on Observer Agreement

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Jayakumar, Prakash; Teunis, Teun; Giménez, Beatriz Bravo; Verstreken, Frederik; Di Mascio, Livio; Jupiter, Jesse B.

2016-01-01

Background The primary objective of this study was to test interobserver reliability when classifying fractures by consensus by AO types and groups among a large international group of surgeons. Secondarily, we assessed the difference in inter- and intraobserver agreement of the AO classification in relation to geographical location, level of training, and subspecialty. Methods A randomized set of radiographic and computed tomographic images from a consecutive series of 96 distal radius fractures (DRFs), treated between October 2010 and April 2013, was classified using an electronic web-based portal by an invited group of participants on two occasions. Results Interobserver reliability was substantial when classifying AO type A fractures but fair and moderate for type B and C fractures, respectively. No difference was observed by location, except for an apparent difference between participants from India and Australia classifying type B fractures. No statistically significant associations were observed comparing interobserver agreement by level of training and no differences were shown comparing subspecialties. Intra-rater reproducibility was “substantial” for fracture types and “fair” for fracture groups with no difference accounting for location, training level, or specialty. Conclusion Improved definition of reliability and reproducibility of this classification may be achieved using large international groups of raters, empowering decision making on which system to utilize. Level of Evidence Level III PMID:28119795

[Case-control study on tibetan Baimai ointment (see symbol in text) for the treatment of wrist-dysfunction after distal radius fracture].

Science.gov (United States)

Zhang, Xing-ping; Xu, Gen-rong; Xu, Shan-qiang; Lu, Ze-ming; Huang, Lei

2014-11-01

To evaluate efficacy and safety of Baimai ointment (see symbol in text) in the treatment of wrist-dysfunction after distal radius fracture. From April, 2011 to June, 2012, 43 patients with distal radius fracture were treated with plaster fixation. All the patients were divided into two group: test group and control group. Twenty-one patients in test group and 22 in control group, and the baseline was balance (P > 0.05). The 21 patients in test group were treated with Baimai ointment (see symbol in text), fomentation, functional exercises. The 22 patients in control group were treated with placebo, fomentation, functional exercises. Foment affected side wrist with wet towel in 20 min before medication, with the temperature between 50 degrees C and 60 degrees C. Smear drugs uniformly in range of 3 cm in the vicinity of palm stripes after drying (about 3 g) and take functional exercises for the activities of wrist and hand. Continuous follow the program per 8 hours once and follow-up for 8 weeks. The Wrist's pain was assessed with VAS. The wrist's activities were measured with the protractor of orthopedic. Measure The grip strength was measured with dynamometer. The wrist's function were assessed with the table of Cooney. The test group had a significantly better results than those of control group in the extent of wrist's pain throughout the treatment (P 0.05). There were no drug adverse reactions occurred. Tibetan Baimai ointment (see symbol in text) has the treatment of wrist-dysfunction after distal radius fracture for external use, which can reduce the extent of wrist's pain, promote grip strength recovery in the middle and late of process, promote wrist's function recovery latterly, and safety for external use.

Radiographical measurements for distal intra-articular fractures of the radius using plain radiographs and cone beam computed tomography images

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Suojaervi, Nora; Lindfors, N. [Helsinki University Central Hospital, Department of Hand Surgery, Helsinki (Finland); Sillat, T.; Koskinen, S.K. [HUS Helsinki Medical Imaging Center, Helsinki University Central Hospital, Department of Radiology, Helsinki (Finland)

2015-12-15

Operative treatment of an intra-articular distal radius fracture is one of the most common procedures in orthopedic and hand surgery. The intra- and interobserver agreement of common radiographical measurements of these fractures using cone beam computed tomography (CBCT) and plain radiographs were evaluated. Thirty-seven patients undergoing open reduction and volar fixation for a distal radius fracture were studied. Two radiologists analyzed the preoperative radiographs and CBCT images. Agreement of the measurements was subjected to intra-class correlation coefficient and the Bland-Altman analyses. Plain radiographs provided a slightly poorer level of agreement. For fracture diastasis, excellent intraobserver agreement was achieved for radiographs and good or excellent agreement for CBCT, compared to poor interobserver agreement (ICC 0.334) for radiographs and good interobserver agreement (ICC 0.621) for CBCT images. The Bland-Altman analyses indicated a small mean difference between the measurements but rather large variation using both imaging methods, especially in angular measurements. For most of the measurements, radiographs do well, and may be used in clinical practice. Two different measurements by the same reader or by two different readers can lead to different decisions, and therefore a standardization of the measurements is imperative. More detailed analysis of articular surface needs cross-sectional imaging modalities. (orig.)

Radiographical measurements for distal intra-articular fractures of the radius using plain radiographs and cone beam computed tomography images.

Science.gov (United States)

Suojärvi, Nora; Sillat, T; Lindfors, N; Koskinen, S K

2015-12-01

Operative treatment of an intra-articular distal radius fracture is one of the most common procedures in orthopedic and hand surgery. The intra- and interobserver agreement of common radiographical measurements of these fractures using cone beam computed tomography (CBCT) and plain radiographs were evaluated. Thirty-seven patients undergoing open reduction and volar fixation for a distal radius fracture were studied. Two radiologists analyzed the preoperative radiographs and CBCT images. Agreement of the measurements was subjected to intra-class correlation coefficient and the Bland-Altman analyses. Plain radiographs provided a slightly poorer level of agreement. For fracture diastasis, excellent intraobserver agreement was achieved for radiographs and good or excellent agreement for CBCT, compared to poor interobserver agreement (ICC 0.334) for radiographs and good interobserver agreement (ICC 0.621) for CBCT images. The Bland-Altman analyses indicated a small mean difference between the measurements but rather large variation using both imaging methods, especially in angular measurements. For most of the measurements, radiographs do well, and may be used in clinical practice. Two different measurements by the same reader or by two different readers can lead to different decisions, and therefore a standardization of the measurements is imperative. More detailed analysis of articular surface needs cross-sectional imaging modalities.

A biomechanical comparison of four fixed-angle dorsal plates in a finite element model of dorsally-unstable radius fracture.

Science.gov (United States)

Knežević, Josip; Kodvanj, Janoš; Čukelj, Fabijan; Pamuković, Frane; Pavić, Arsen

2017-11-01

To compare the finite element models of two different composite radius fracture patterns, reduced and stabilised with four different fixed-angle dorsal plates during axial, dorsal and volar loading conditions. Eight different plastic models representing four AO/ASIF type 23-A3 distal radius fractures and four AO/ASIF 23-C2 distal radius fractures were obtained and fixed each with 1 of 4 methods: a standard dorsal non-anatomical fixed angle T-plate (3.5mm Dorsal T-plate, Synthes), anatomical fixed-angle double plates (2.4mm LCP Dorsal Distal Radius, Synthes), anatomical fixed angle T-plate (2.4mm Acu-Loc Dorsal Plate, Acumed) or anatomical variable-angle dorsal T-plate (3.5mm, Dorsal Plate, Zrinski). Composite radius with plate and screws were scanned with a 3D optical scanner and later processed in Abaqus Software to generate the finite element model. All models were axially loaded at 3 points (centrally, volarly and dorsally) with 50 N forces to avoid the appearance of plastic deformations of the models. Total displacements at the end of the bone and the stresses in the bones and plates were determined and compared. Maximal von Mises stress in bone for 3-part fracture models was very similar to that in 2-part fracture models. The biggest difference between models and the largest displacements were seen during volar loading. The stresses in all models were the highest above the fracture gap. The best performance in all parameters tested was with the Zrinski plate and the most modest results were with the Synthes T-plate. There was no significant difference between 2-part (AO/ASIF type 23-A3) and 3-part (AO/ASIF 23-C2) fracture models. Maximal stresses in the plates appeared above the fracture gap; therefore, it is worth considering the development of plates without screw holes above the gap. © 2017 Elsevier Ltd. All rights reserved.

Assessment of "YouTube" Content for Distal Radius Fracture Immobilization.

Science.gov (United States)

Addar, Abdullah; Marwan, Yousef; Algarni, Nizar; Berry, Gregory

Distal radius fractures (DRFs) are the most common orthopedic fractures, with >70% of cases treated by closed immobilization using a short arm cast or a sugar tong splint. However, inadequate immobilization is a risk factor for loss of reduction requiring repeat reduction or surgical treatment. Therefore, education of clinical skills for appropriate immobilization of DRFs is important. With the increasing use of web-based information by medical learners, our aim was to assess the quality and quantity of videos regarding closed immobilization of DRFs on YouTube. Retrospective review of YouTube videos on distal radius fracture immobilization using specific search terms. Identified videos were analyzed for their educational value, quality of the technical skill demonstrated, and overall metrics. Educational value was scored on a 5-point scale, with "1" indicative of low quality and "5" of high quality. Not applicable. Among the 68,366 videos identified, 16 met our inclusion criteria of being in English; performed by a health care professional or institution; and with casting being the major theme of the educational information provided. Of these 16 videos, 6 had an educational value score of 4 or 5, with the remaining 10 having a score ≤3. Although immobilization was demonstrated by cast technician specialized in orthopedics, skills were also performed by orthopedic attendants, urgent care physicians, orthopedic residents, and nurse practitioners. The credentials of the performer in 3 videos were not identified. There is a need to promote high-quality educational videos produced by established medical school faculty members on open, web-based, portals. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Risk Factors Associated With Survival to Hospital Discharge of 54 Horses With Fractures of the Radius.

Science.gov (United States)

Stewart, Suzanne; Richardson, Dean; Boston, Ray; Schaer, Thomas P

2015-11-01

To determine (1) survival to discharge of horses with radial fractures (excluding osteochondral fragmentation of the distal aspect of the radius and stress fractures); and (2) risk factors affecting survival to hospital discharge in conservative and surgically managed fractures. Case series. Horses (n = 54). Medical records (1990-June 2012) and radiographs of horses admitted with radial fracture were reviewed. Horses with osteochondral fragmentation of the distal aspect of the radius or stress fractures were excluded. Evaluated risk factors were age, fracture configuration, surgical repair method, surgical duration, hospitalization time, implant failure rate, and surgical site infection (SSI) rate. Of 54 horses, overall survival to discharge was 50%. Thirteen (24%) were euthanatized on admission because of (1) fracture severity; (2) presence of an open fracture; or (3) financial constraints. Fourteen (26%) horses with minimally displaced incomplete fractures were conservatively managed and 12 (86%) survived to discharge. Twenty-seven (50%) horses had surgical treatment by open reduction and internal fixation (ORIF) and 15 (56%) survived to hospital discharge. Open fractures were significantly more likely to develop SSI (P = .008), which also resulted in a 17-fold increase in implant failure (P horses with an open fracture did not survive to discharge. Outcome was also adversely affected by age (P 168 minutes (P fractures is good. Young horses have a good prognosis survival to discharge for ORIF, whereas ORIF in adult horses has a poor prognosis and SSI strongly correlates with catastrophic implant failure. © Copyright 2015 by The American College of Veterinary Surgeons.

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

Patient-specific distal radius locking plate for fixation and accurate 3D positioning in corrective osteotomy.

Science.gov (United States)

Dobbe, J G G; Vroemen, J C; Strackee, S D; Streekstra, G J

2014-11-01

Preoperative three-dimensional planning methods have been described extensively. However, transferring the virtual plan to the patient is often challenging. In this report, we describe the management of a severely malunited distal radius fracture using a patient-specific plate for accurate spatial positioning and fixation. Twenty months postoperatively the patient shows almost painless reconstruction and a nearly normal range of motion.

Reliability of radiographic measurements for acute distal radius fractures

International Nuclear Information System (INIS)

Watson, Narelle J.; Asadollahi, Saeed; Parrish, Frank; Ridgway, Jacqueline; Tran, Phong; Keating, Jennifer L.

2016-01-01

The management of distal radial fractures is guided by the interpretation of radiographic findings. The aim of this investigation was to determine the intra- and inter-observer reliability of eight traditionally reported anatomic radiographic parameters in adults with an acute distal radius fracture. Five observers participated. All were routinely involved in making treatment decisions based on distal radius fracture radiographs. Observers performed independent repeated measurements on 30 radiographs for eight anatomical parameters: dorsal shift (mm), intra-articular gap (mm), intra-articular step (mm), palmar tilt (degrees), radial angle (degrees), radial height (mm), radial shift (mm), ulnar variance (mm). Intraclass correlation coefficients (ICCs) and the magnitude of retest errors were calculated. Measurement reliability was summarised as high (ICC > 0.80), moderate (0.60–0.80) or low (<0.60). Intra-observer reliability was high for dorsal shift and palmar tilt; moderate for radial angle, radial height, ulnar variance and radial shift; and low for intra-articular gap and step. Inter-observer reliability was high for palmar tilt; moderate for dorsal shift, ulnar variance, radial angle and radial height; and low for radial shift, intra-articular gap and step. Error magnitude (95 % confidence interval) was within 1–2 mm for intra-articular gap and step, 2–4 mm for ulnar variance, 4–6 mm for radial shift, dorsal shift and radial height, and 6–8° for radial angle and palmar tilt. Based on previous reports of critical values for palmar tilt, ulnar variance and radial angle, error margins appear small enough for measurements to be useful in guiding treatment decisions. Our findings indicate that clinicians cannot reliably measure values ≤1 mm for intra-articular gap and step when interpreting radiographic parameters using the standardised methods investigated in this study. As a guide for treatment selection, palmar tilt, ulnar variance and radial angle

[Complications of open reduction and internal fixation versus external fixation for unstable distal radius fractures: a meta-analysis].

Science.gov (United States)

Yang, Z; Yuan, Z Z; Ma, J X; Ma, X L

2016-12-20

Objective: To make a systematic assessment of the complications of open reduction and internal fixation versus external fixation for unstable distal radius fractures. Method: A computer-based online search of PubMed, ScienceDirect, EMBASE, BIOSIS, Springer and Cochrane Library were performed.The randomized and controlled trials of open reduction and internal fixation versus external fixation for unstable distal radius fractures were collected.The included trials were screened out strictly based on the criterion of inclusion and exclusion.The quality of included trials was evaluated.RevMan 5.0 was used for data analysis. Result: A total of 17 studies involving 1 402 patients were included.There were 687 patients with open reduction and internal fixation and 715 with external fixation.The results of Meta-analysis indicated that there were statistically significant differences with regard to the postoperatively total complications, infection, malunion, tendon rupture ( I 2 =8%, RR =0.77(95% CI 0.65-0.91, Z =3.10, P 0.05). Conclusion: Postoperative complications are present in both open reduction and internal fixation and external fixation.Compared with external fixation, open reduction and internal fixation is lower in total complications postoperatively, infection and malunion, but external fixation has lower tendon rupture incidence.

Open reduction and internal fixation versus casting for highly comminuted and intra-articular fractures of the distal radius (ORCHID): protocol for a randomized clinical multi-center trial.

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Bartl, Christoph; Stengel, Dirk; Bruckner, Thomas; Rossion, Inga; Luntz, Steffen; Seiler, Christoph; Gebhard, Florian

2011-03-22

Fractures of the distal radius represent the most common fracture in elderly patients, and often indicate the onset of symptomatic osteoporosis. A variety of treatment options is available, including closed reduction and plaster casting, K-wire-stabilization, external fixation and open reduction and internal fixation (ORIF) with volar locked plating. The latter is widely promoted by clinicians and hardware manufacturers. Closed reduction and cast stabilization for six weeks is a simple, convenient, and ubiquitously available intervention. In contrast, ORIF requires hospitalization, but allows for functional rehabilitation.Given the lack of randomized controlled trials, it remains unclear whether ORIF leads to better functional outcomes one year after injury than closed reduction and casting. ORCHID (Open reduction and internal fixation versus casting for highly comminuted intra-articular fractures of the distal radius) is a pragmatic, randomized, multi-center, clinical trial with two parallel treatment arms. It is planned to include 504 patients in 15 participating centers throughout Germany over a three-year period. Patients are allocated by a central web-based randomization tool.The primary objective is to determine differences in the Short Form 36 (SF-36) Physical Component Score (PCS) between volar locked plating and closed reduction and casting of intraarticular, comminuted distal radius fractures in patients > 65 years of age one year after the fracture. Secondary outcomes include differences in other SF-36 dimensions, the EuroQol-5D questionnaire, the Disability of the Arm, Shoulder, and Hand (DASH) instrument. Also, the range of motion in the affected wrist, activities of daily living, complications (including secondary ORIF and revision surgery), as well as serious adverse events will be assessed. Data obtained during the trial will be used for later health-economic evaluations. The trial architecture involves a central statistical unit, an independent

Changes in Depression, Health Anxiety, and Pain Catastrophizing Between Enrollment and 1 Month After a Radius Fracture.

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Golkari, Sina; Teunis, Teun; Ring, David; Vranceanu, Ana-Maria

2015-01-01

To test the difference in symptoms of (1) depression, (2) health anxiety, and (3) catastrophic thinking between 1 and 6 weeks after injury to the radius. In total, 69 adult patients with a minimally displaced radial head or distal radius fracture were prospectively enrolled. After diagnosis, we recorded demographic variables, 11-point ordinal numerical pain score, and agreement with "no pain, no gain"; Disabilities of the Arms, Shoulder, and Hand (DASH) questionnaire; Center for Epidemiologic Studies Depression Scale; the Whiteley Index; and the Pain Catastrophizing Scale. In total, 55 patients (80%) returned after 1 month to reevaluate pain, Disabilities of the Arms, Shoulder, and Hand, Center for Epidemiologic Studies Depression, Whiteley Index, and Pain Catastrophizing Scale scores. Center for Epidemiologic Studies Depression scores decreased by an average of 5 ± 9 points (p psychologic measures are used as a screening tool to predict outcome after treatment, one should account for a patient's disease phase. Prognostic level I. Copyright © 2015 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.

External fixation is more suitable for intra-articular fractures of the distal radius in elderly patients

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Ma, Chuang; Deng, Qiang; Pu, Hongwei; Cheng, Xinchun; Kan, Yuhua; Yang, Jing; Yusufu, Aihemaitijiang; Cao, Li

2016-01-01

The purpose of this study was to compare the functional outcomes, psychological impact, and complication rates associated with external fixation and volar or dorsal plating in relation to the functional parameters following treatment of intra-articular fractures of the distal radius (IFDR) in patients older than 65 years. We hypothesized that using volar or dorsal plating would improve functional outcomes, but that it would be associated with more complications and equivalent functional outcomes when compared with the external fixation group. A total of 123 consecutive patients suffering from IFDR were recruited into the study. The patients were measured for clinical, radiological, and psychosocial functioning outcomes and were followed up after 1 week and 3, 6 and 12 months. After 3 months, the plating group had better pronation (P=0.001), supination, (P=0.047) and extension (P=0.043) scores. These differences were somewhat attenuated by 6 months and disappeared at 1 year. The plating group had a greater occurrence of wound infection (P=0.043), tendonitis, (P=0.024) and additional surgery compared with the external fixation group. The only TNO-AZL Adult Quality of Life scores in the plating group that were lower than those in the external fixation group were in the “gross motor” category (walking upstairs, bending over, walking 500 yards; P=0.023). Internal fixation was more advantageous than external fixation in the early rehabilitation period; after 1 year the outcomes were similar. The plating group showed significantly higher levels of wound infection and tendonitis and had a greater need for additional surgeries. PMID:27408765

Open reduction and internal fixation versus casting for highly comminuted and intra-articular fractures of the distal radius (ORCHID: protocol for a randomized clinical multi-center trial

Directory of Open Access Journals (Sweden)

Seiler Christoph

2011-03-01

Full Text Available Abstract Background Fractures of the distal radius represent the most common fracture in elderly patients, and often indicate the onset of symptomatic osteoporosis. A variety of treatment options is available, including closed reduction and plaster casting, K-wire-stabilization, external fixation and open reduction and internal fixation (ORIF with volar locked plating. The latter is widely promoted by clinicians and hardware manufacturers. Closed reduction and cast stabilization for six weeks is a simple, convenient, and ubiquitously available intervention. In contrast, ORIF requires hospitalization, but allows for functional rehabilitation. Given the lack of randomized controlled trials, it remains unclear whether ORIF leads to better functional outcomes one year after injury than closed reduction and casting. Methods/Design ORCHID (Open reduction and internal fixation versus casting for highly comminuted intra-articular fractures of the distal radius is a pragmatic, randomized, multi-center, clinical trial with two parallel treatment arms. It is planned to include 504 patients in 15 participating centers throughout Germany over a three-year period. Patients are allocated by a central web-based randomization tool. The primary objective is to determine differences in the Short Form 36 (SF-36 Physical Component Score (PCS between volar locked plating and closed reduction and casting of intraarticular, comminuted distal radius fractures in patients > 65 years of age one year after the fracture. Secondary outcomes include differences in other SF-36 dimensions, the EuroQol-5D questionnaire, the Disability of the Arm, Shoulder, and Hand (DASH instrument. Also, the range of motion in the affected wrist, activities of daily living, complications (including secondary ORIF and revision surgery, as well as serious adverse events will be assessed. Data obtained during the trial will be used for later health-economic evaluations. The trial architecture

High-resolution-cone beam tomography analysis of bone microarchitecture in patients with acromegaly and radiological vertebral fractures.

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Maffezzoni, Filippo; Maddalo, Michele; Frara, Stefano; Mezzone, Monica; Zorza, Ivan; Baruffaldi, Fabio; Doglietto, Francesco; Mazziotti, Gherardo; Maroldi, Roberto; Giustina, Andrea

2016-11-01

Vertebral fractures are an emerging complication of acromegaly but their prediction is still difficult occurring even in patients with normal bone mineral density. In this study we evaluated the ability of high-resolution cone-beam computed tomography to provide information on skeletal abnormalities associated with vertebral fractures in acromegaly. 40 patients (24 females, 16 males; median age 57 years, range 25-72) and 21 healthy volunteers (10 females, 11 males; median age 60 years, range: 25-68) were evaluated for trabecular (bone volume/trabecular volume ratio, mean trabecular separation, and mean trabecular thickness) and cortical (thickness and porosity) parameters at distal radius using a high-resolution cone-beam computed tomography system. All acromegaly patients were evaluated for morphometric vertebral fractures and for mineral bone density by dual-energy X-ray absorptiometry at lumbar spine, total hip, femoral neck, and distal radius. Acromegaly patients with vertebral fractures (15 cases) had significantly (p acromegaly patients did not have significant differences in bone density at either skeletal site. Patients with acromegaly showed lower bone volume/trabecular volume ratio (p = 0.003) and mean trabecular thickness (p acromegaly. High-resolution cone-beam computed tomography at the distal radius may be useful to evaluate and predict the effects of acromegaly on bone microstructure.

The effects of implant composition on extensor tenosynovitis in a canine distal radius fracture model.

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Sinicropi, Stefano M; Su, Brian W; Raia, Frank J; Parisien, May; Strauch, Robert J; Rosenwasser, Melvin P

2005-03-01

Dorsal plating of distal radius fractures with titanium plates has resulted in clinically observed tenosynovitis and tendon rupture. The goal of this study was to investigate whether titanium-based implants result in more extensor tendon inflammation than matched stainless-steel implants in a canine fracture model. An osteotomy was created in the distal radius of 18 beagles and fixed with 2.7-mm 4-hole plates composed of commercially pure titanium, titanium alloy (Ti-Al6-V4), or 316L stainless steel. Animals were killed at an average of 4 months. Tendon gliding was assessed by applying a force at the extensor musculotendinous junction and noting gliding. Histologic grading (mild, moderate, severe) was based on cellular hypertrophy, hyperplasia, and leukocytic infiltration. Tendons glided freely in 100% stainless-steel specimens, 75% of titanium alloy, and 43% of commercially pure titanium groups. A severe inflammatory reaction was identified in 60% of the titanium alloy (Ti-A16-V4) group, 57% of the pure titanium group, and 0% of the stainless-steel group. Dorsal plating of the canine radius with commercially pure titanium or titanium alloy implants produced a greater inflammatory peritendinous response than matched stainless-steel implants.

Occupational therapy and Colles' fractures.

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Christensen, O M; Kunov, A; Hansen, F F; Christiansen, T C; Krasheninnikoff, M

2001-01-01

In this randomized trial, we enrolled 30 patients treated for a distal radius Colles' type fracture. The fractures were reduced if necessary and fixed in a below-elbow plaster cast for 5 weeks. One group consisting of 14 patients received instructions for shoulder; elbow and finger exercise and the other group consisting of 16 patients had occupational therapy. At 5 weeks, 3 and 9 months we measured the functional scores. There were no statistically significant differences between the groups at any time. It seems that for non-surgically treated patients with a distal radius fracture only instructions are necessary.

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

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

2017-01-01

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

The shaft fractures of the radius and ulna in children: current concepts.

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Sinikumpu, Juha-Jaakko; Serlo, Willy

2015-05-01

The incidence of forearm shaft fractures in children has increased in recent years. They are challenging to treat and they can result in several long-lasting complications. The treatment of children's fractures needs to be individualized to their needs. Nonoperative care will be satisfactory for young, preschool children and it is primarily treatment in stable fractures of children at every age. Injury mechanism must be understood to perform appropriate closed reduction. Immobilization using a long-arm cast needs to be focused against the deforming muscle forces - in particular those that rotate - in the forearm, keeping the bones in alignment until bone healing. Operative stabilization by elastic stable intramedullary nailing is the primarily method of treatment in cases of unstable fractures, in particular, in children between preschool age and adolescence. For older children near to skeletal maturity, a rigid plate and screw fixation will be justified. The most common complication after closed treatment is worsening of the alignment and need for repetitive interventions. elastic stable intramedullary nailing results usually in good outcome, and range of forearm rotation is the main feature determining the clinical result. In this article, we report the current concept of paediatric shaft fractures in the radius and ulna.

It is not just comfort: waterproof casting increases physical functioning in children with minimally angulated distal radius fractures.

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Silva, Mauricio; Avoian, Tigran; Warnock, Robert Sean; Sadlik, Gal; Ebramzadeh, Edward

2017-09-01

Waterproof casting has been reported to increase patient comfort and satisfaction, and decrease skin irritation. There are no available data on the influence of waterproof casting materials on physical function in pediatric patients. Our aim was to determine whether the use of waterproof casting would result in faster recovery of physical function while maintaining similar clinical outcomes as those obtained with nonwaterproof materials. Twenty-six children with nonangulated or minimally angulated distal radius fractures were assigned randomly to initially receive a short-arm cast made of one of two optional materials: a hybrid mesh material with a waterproof lining or fiberglass with a nonwaterproof skin protector. Two weeks later, the initial cast was removed and replaced with a short-arm cast made of the alternative option. We compared the rate of fracture displacement, physical function, pain, skin changes, itchiness, and patient satisfaction. No evidence of displacement was found in either group. The mean Activities Scale for Kids - Performance (ASK-P) (physical function) score was 10% higher during the period of time when a waterproof cast was used (P=0.04). When a waterproof cast was used during the first 2 weeks of treatment, the mean total ASK-P scores were 23% higher than that when a nonwaterproof one was used during the same period of time (P=0.003). Patients who received a waterproof cast as the initial treatment reported lower functional scores overall and in almost every domain of the ASK-P once they were in a nonwaterproof one; similarly, those who received a nonwaterproof cast as the initial treatment reported higher functional scores overall and in every domain of the ASK-P once they were in a waterproof cast. Compared with a nonwaterproof cast, the use of waterproof casting resulted in comparable levels of pain, itchiness, skin irritability, and overall patient satisfaction. The results of this randomized, cross-over trial suggest that the use of

Comparison of 2D radiography and a semi-automatic CT-based 3D method for measuring change in dorsal angulation over time in distal radius fractures

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Christersson, Albert; Larsson, Sune [Uppsala University, Department of Orthopaedics, Uppsala (Sweden); Nysjoe, Johan; Malmberg, Filip; Sintorn, Ida-Maria; Nystroem, Ingela [Uppsala University, Centre for Image Analysis, Uppsala (Sweden); Berglund, Lars [Uppsala University, Uppsala Clinical Research Centre, UCR Statistics, Uppsala (Sweden)

2016-06-15

The aim of the present study was to compare the reliability and agreement between a computer tomography-based method (CT) and digitalised 2D radiographs (XR) when measuring change in dorsal angulation over time in distal radius fractures. Radiographs from 33 distal radius fractures treated with external fixation were retrospectively analysed. All fractures had been examined using both XR and CT at six times over 6 months postoperatively. The changes in dorsal angulation between the first reference images and the following examinations in every patient were calculated from 133 follow-up measurements by two assessors and repeated at two different time points. The measurements were analysed using Bland-Altman plots, comparing intra- and inter-observer agreement within and between XR and CT. The mean differences in intra- and inter-observer measurements for XR, CT, and between XR and CT were close to zero, implying equal validity. The average intra- and inter-observer limits of agreement for XR, CT, and between XR and CT were ± 4.4 , ± 1.9 and ± 6.8 respectively. For scientific purpose, the reliability of XR seems unacceptably low when measuring changes in dorsal angulation in distal radius fractures, whereas the reliability for the semi-automatic CT-based method was higher and is therefore preferable when a more precise method is requested. (orig.)

Examination of Skill Acquisition and Grader Bias in a Distal Radius Fracture Fixation Model.

Science.gov (United States)

Putnam, Matthew D; Adams, Julie E; Lender, Paul; Van Heest, Ann E; Shanedling, Janet R; Nuckley, David J; Bechtold, Joan E

2018-03-01

Primary: Assess the ability of faculty graders to predict the objectively measured strength of distal radius fracture fixation. Secondary: Compare resident skill variation and retention related to other knowable training data. Residents were allowed 60 minutes to stabilize a standardized distal radius fracture using an assigned fixed-angle volar plate. Faculty observed and subjectively graded the residents without providing real-time feedback. Objective biomechanical evaluation (construct strength and stiffness) was compared to subjective grades. Resident-specific characteristics (sex, PGY, and ACGME case log) were also used to compare the objective data. A simulated operating room in our laboratory. Post-graduate year 2, 3, 4, and 5 orthopedic residents. Primary: Faculty were not successful at predicting objectively measured fixation, and their subjective scoring suggests confirmation bias as PGY increased. Secondary: Resident year-in-training alone did not predict objective measures (p = 0.53), but was predictive of subjective scores (p external faculty unfamiliar with tested residents, might alter these results. Copyright © 2018 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

[Frequency of diagnosis of postmenopausal osteoporosis of the spine, distant radius and extravertebral fractures in women with normal body mass, overweight and obesity].

Science.gov (United States)

Popov, A A; Izmozherova, N V; Fominykh, M I; Tagil'tseva, N V; Kozulina, E V; Gavrilova, E I

2008-01-01

To assess features and peculiarities of postmenopausal osteoporosis (OP) in women with normal body mass, overweight and obesity. Dual energy X-ray absorptiometry of the lumbal spine (Lunar DPX) and distal radius X-ray absorptiometry (DTX 200) were performed during cross-section study of 730 symptomatic postmenopausal women. OP was diagnosed in 253 (34.7%) women, 30.5% of them had normal body mass, 43.2% had overweight and 26.3% were obese. Among them 227 had atraumatic fractures at the age over 50 years. Obese OP patients had significantly higher frequency of arterial hypertension, chronic heart failure, osteoarthritis and glucose metabolism disorders than osteoporotic patients with normal body mass. Fracture frequency did not differ between groups with normal body mass, overweight and obesity. Excessive body mass did not decrease fracture risk in women with postmenopausal OP.

Effect of finite edge radius on ductile fracture ahead of the cutting tool edge in micro-cutting of Al2024-T3

International Nuclear Information System (INIS)

Subbiah, Sathyan; Melkote, Shreyes N.

2008-01-01

Evidence of ductile fracture leading to material separation has been reported recently in ductile metal cutting [S. Subbiah, S.N. Melkote, ASME J. Manuf. Sci. Eng. 28(3) (2006)]. This paper investigates the effect of finite edge radius on such ductile fracture. The basic question of whether such ductile fracture occurs in the presence of a finite edge radius is explored by performing a series of experiments with inserts of different edge radii at various uncut chip thickness values ranging from 15 to 105 μm. Chip-roots are obtained in these experiments using a quick-stop device and examined in a scanning electron microscope. Clear evidence of material separation is seen at the interface zone between the chip and machined surface even when the edge radius is large compared to the uncut chip thickness. Failure is seen to occur at the upper, middle, and/or the lower edges of the interface zone. Based on these observations, a hypothesis is presented for the events leading to the occurrence of this failure when cutting with an edge radius tool. Finite element simulations are performed to study the nature of stress state ahead of the tool edge with and without edge radius. Hydrostatic stress is seen to be tensile in front of the tool and hence favors the occurrence of ductile fracture leading to material separation. The stress components are, however lower than those seen with a sharp tool

Study protocol: non-displaced distal radial fractures in adult patients: three weeks vs. five weeks of cast immobilization: a randomized trial.

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Bentohami, Abdelali; de Korte, Niels; Sosef, Nico; Goslings, Johan Carel; Bijlsma, Taco; Schep, Niels

2014-01-20

Up to 30% of patients suffer from long-term functional restrictions following conservative treatment of distal radius fractures. Whether duration of cast immobilisation influences functional outcome remains unclear. The aim of the study is to evaluate whether the duration of immobilization of non or minimally displaced distal radial fractures can be safely reduced. We will compare three weeks of plaster cast immobilization with five weeks of plaster cast immobilization in adult patient with non or minimally displaced distal radial fractures. a prospective randomized clinical trial. adult (>18 years) (independent in activities of daily living) patients with a non/minimal displaced distal radius fracture (dorsal angulation 15°, ulnar positive variance immobilization versus five weeks of plaster cast immobilization.Main study parameters: primary outcome parameters: Patient related wrist evaluation (PRWE) Quick Disability of Arm, Shoulder and Hand (QUICKDASH) score after a one year follow-up, and secondary parameters: range of motion, pain level (VAS) and complications. The expectation of this study is that shorter duration of plaster cast immobilisation is beneficial for the patient with a distal radius fracture. This risk of specific complications is low and generally similar in both treatment options. Moreover, the burden of the study is not much higher compared to standard treatment. Follow-up is standardized according to current trauma guidelines. Literature indicates that both treatment options from the study are accepted for displaced distal radius fractures. No clear advantage for one treatment options is found at present in the literature, although there is no level I evidence present. This trial will provide level-1 evidence for the comparison of consolidation and functional outcome between two treatment options for non-displaced distal radial fractures. The gathered data may support the development of a clinical guideline for conservative treatment of

Ipsilateral dislocation of the radial head associated with fracture of distal end of the radius: a case report and review of the literature

Directory of Open Access Journals (Sweden)

Gupta Vinay

2013-06-01

Full Text Available 【Abstract】Dislocation of the radial head in adults is uncommon. A simultaneous dislocation of the radial head and fracture of the ipsilateral distal end of radius with no other associated injuries is extremely rare. As far as we know, such an injury after an unusual mode of injury has been seldom reported in the English literature. We report such a case without any associated injuries or comorbidity. Closed reduction was performed within two hours after injury and results were satisfactory. Immobilisation was continued for 3 weeks. Gradual mobilisation was started after removal of the plaster under the supervision of a physiotherapist. At 6 months’ follow-up, the patient had no residual pain at the elbow with full flexion & extension. Almost full supination with a restriction of last 10 degrees of pronation was achieved. There was no evidence of instability of the elbow. Key words: Radial heads; Dislocations; Radius fractures

Open segmental fracture of both bone forearm and dislocation of ipsilateral elbow with extruded middle segment radius

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Pawan Kumar

2013-01-01

Full Text Available Extruded middle segment of radius with open segmental fracture both bone forearm and dislocation of ipsilateral elbow is a rare injury. A 12-year-old child presented to us within 4 hours following fall from tree. The child′s mother was carrying a 12-cm-long extruded soiled segment of radius. The extruded bone was thoroughly washed. The medullary cavity was properly syringed with antiseptic solution. The bone was autoclaved and put in the muscle plane of the distal forearm after debridement of the wound. After 5 days, a 2.5-mm K-wire was introduced by retrograde method into the proximal radius by passing through the extruded segment. Another 2.5-mm K-wire was passed in ulna. The limb was evaluated clinicoradiologically every 2 weeks. The wound was healed by primary intention. At 4 months, the reposed bone appeared less dense radiologically and K-wire seemed to be out of the bone. In the subsequent months, the roentgenograms show remodeling of the extruded fragment. After 20 weeks, the K-wires were removed (first ulnar and then radial. Complete union was achieved with full range of movement except loss of few degrees of extension of elbow and thumb. This case is reported to show a good outcome following successful incorporation of an extruded segment of radius in an open fracture.

Volar plating for distal radius fractures--do not trust the image intensifier when judging distal subchondral screw length.

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Park, Derek H; Goldie, Boyd S

2012-09-01

The use of the volar plate to treat distal radius fractures is increasing but despite the theoretical advantages of a volar approach there have been reports of extensor tendon ruptures due to prominent screw tips protruding past the dorsal cortex. The valley in the intermediate column between Lister tubercle and the sigmoid notch of the distal radius makes it difficult to rely on fluoroscopy to judge screw length. Our aim was to quantify the dimensions of this valley and to demonstrate the danger of relying on intraoperative image intensification fluoroscopy to determine lengths of distal screws. We measured the depth of this valley in the intermediate column of the distal radius in 33 patients with computed tomographic (9 patients) or magnetic resonance image (24 patients) scans of the wrist. There was a consistent valley in all images examined [average 1.8 mm (95% confidence interval, 1.6-2.0 mm)]. Thirty-nine percent of wrists had a valley depth of at least 2 mm. Standard lateral views or rotation of the forearm to obtain oblique views does not identify prominent screw tips; and whatever the rotation of the forearm, screw tips protruding beyond dorsal cortex may look as if it is within the bone when in fact it is out. When drilling we suggest noting the depth at which the drill bit just penetrates dorsal cortex and routinely downsize the distal screw length by 2 mm. We caution against relying on flourosocopy when judging the length of the distal subchondral screws.

Bone strength and muscle properties in postmenopausal women with and without a recent distal radius fracture.

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Crockett, K; Arnold, C M; Farthing, J P; Chilibeck, P D; Johnston, J D; Bath, B; Baxter-Jones, A D G; Kontulainen, S A

2015-10-01

Distal radius (wrist) fracture (DRF) in women over age 50 years is an early sign of bone fragility. Women with a recent DRF compared to women without DRF demonstrated lower bone strength, muscle density, and strength, but no difference in dual-energy x-ray absorptiometry (DXA) measures, suggesting DXA alone may not be a sufficient predictor for DRF risk. The objective of this study was to investigate differences in bone and muscle properties between women with and without a recent DRF. One hundred sixty-six postmenopausal women (50-78 years) were recruited. Participants were excluded if they had taken bone-altering medications in the past 6 months or had medical conditions that severely affected daily living or the upper extremity. Seventy-seven age-matched women with a fracture in the past 6-24 months (Fx, n = 32) and without fracture (NFx, n = 45) were measured for bone and muscle properties using the nondominant (NFx) or non-fractured limb (Fx). Peripheral quantitative computed tomography (pQCT) was used to estimate bone strength in compression (BSIc) at the distal radius and tibia, bone strength in torsion (SSIp) at the shaft sites, muscle density, and area at the forearm and lower leg. Areal bone mineral density at the ultradistal forearm, spine, and femoral neck was measured by DXA. Grip strength and the 30-s chair stand test were used as estimates of upper and lower extremity muscle strength. Limb-specific between-group differences were compared using multivariate analysis of variance (MANOVA). There was a significant group difference (p lower leg, with the Fx group demonstrating 16 and 19% lower BSIc, 3 and 6% lower muscle density, and 20 and 21% lower muscle strength at the upper and lower extremities, respectively. There were no differences between groups for DXA measures. Women with recent DRF had lower pQCT-derived estimated bone strength at the distal radius and tibia and lower muscle density and strength at both extremities.

WHAT IS THE BEST RADIOGRAPHIC VIEW FOR "DIE PUNCH" DISTAL RADIUS FRACTURES? A CADAVER MODEL STUDY.

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Falcochio, Diego Figueira; Crepaldi, Bruno Eiras; Trindade, Christiano Augusto; da Costa, Antonio Carlos; Chakkour, Ivan

2012-01-01

the aim of this study is try to show the best view for distal radius fractures so called die-punch fractures. There has been used a human cadaver radius bone from the Salvador Arena Tissue Bank. This bone was cleaned up after removing the soft tissues and osteotomies created displaced lunate fossa fractures of 0, 1, 2, 3 and 5 mm. We have fixed this fragment with adhesive tape. Then the joint deviation were significantly increased with step-offs of 1 mm. Radiographs were then taken into 5 different positions: postero-anterior view, lateral view, oblique views and tangencial view for each of the deviations. The resulting lunate fossa depression in each X-ray film was analyzed by the AutoCAD 2010® software. The tangencial view was the best one to see the 1mm and 3mm bone degrees and the second one view to see the 2mm and 5 mm degrees. The pronated oblique view was the best to see the 2mm degrees and the oblique supinated view wasn't able to see the degrees between 1 and 2mm. The tangencial view was the best one to see the 1mm and 3mm bone degrees and the second one view to see the 2mm and 5 mm degrees.

Mechanism of distal radius fracture as analyzed by 3D finite element model

International Nuclear Information System (INIS)

Tomizawa, Kazuo

2007-01-01

The purpose of this study is to see the difference of distal radius fracture between normal and osteoporotic bones and in its patterns due to limb position at injury through simulation and analysis of the biomechanics using three-dimensional (3D) finite element model. CT images were taken with SIEMENS machine, of right wrist joints of 32 and 76 years old, normal healthy man and osteoporotic woman, respectively. The wrist joint angles at CT were 70 degrees both at dorsiflexion and at palmerflexion for simulating fracture at tumbling down. The 3D bone model reconstructed from CT images with Forge software (Studio PON) was trimmed to remain the distal radial-ulnar portion and proximal carpal bones to make simulation easer, and the simplified 3D model was divided to 56,622 elements and 13,274 nodal points (normal bone) or 51,760 and 12,940 (osteoporosis), respectively, in 3 areas of different bone densities calculated with Scion Image processor. This 3D finite element model was analyzed with the software ANSYS LS-DYNA 10.0 for simulating the fracture (the defined yield stress attained) by impacting the elements of carpal bones to the radial bone joint surface with a measure of Mises stress. In osteoporotic bone, fracture was found to occur at dorsal cortex closer to the joint surface. Fracture occurred at dorsal and palmer cortex at dorsiflexion and palmerflexion, respectively. (R.T.)

Risks of all-cause and site-specific fractures among hospitalized patients with COPD

Science.gov (United States)

Liao, Kuang-Ming; Liang, Fu-Wen; Li, Chung-Yi

2016-01-01

Abstract Patients with chronic obstructive pulmonary disease (COPD) have a high prevalence of osteoporosis. The clinical sequel of osteoporosis is fracture. Patients with COPD who experience a fracture also have increased morbidity and mortality. Currently, the types of all-cause and site-specific fracture among patients with COPD are unknown. Thus, we elucidated the all-cause and site-specific fractures among patients with COPD. A retrospective, population-based, cohort study was conducted utilizing the Taiwan Longitudinal Health Insurance Database. Patients with COPD were defined as those who were hospitalized with an International Classification of Diseases, Ninth Revision, Clinical Modification code of 490 to 492 or 496 between 2001 and 2011. The index date was set as the date of discharge. The study patients were followed from the index date to the date when they sought care for any type of fracture, date of death, date of health insurance policy termination, or the last day of 2013. The types of fracture analyzed in this study included vertebral, rib, humeral, radial and ulnar/wrist, pelvic, femoral, and tibial and fibular fractures. The cohort consisted of 11,312 patients with COPD. Among these patients, 1944 experienced fractures. The most common site-specific fractures were vertebral, femoral, rib, and forearm fractures (radius, ulna, and wrist) at 32.4%, 31%, 12%, and 11.8%, respectively. The adjusted hazard ratios of fracture were 1.71 [95% confidence interval (95% CI) = 1.56–1.87] for female patient with COPD and 1.50 (95% CI = 1.39–1.52) for patients with osteoporosis after covariate adjustment. Vertebral and hip fractures are common among patients with COPD, especially among males with COPD. Many comorbidities contribute to the high risk of fracture among patients with COPD. PMID:27749576

Recommendation for measuring clinical outcome in distal radius fractures: a core set of domains for standardized reporting in clinical practice and research.

Science.gov (United States)

Goldhahn, Jörg; Beaton, Dorcas; Ladd, Amy; Macdermid, Joy; Hoang-Kim, Amy

2014-02-01

Lack of standardization of outcome measurement has hampered an evidence-based approach to clinical practice and research. We adopted a process of reviewing evidence on current use of measures and appropriate theoretical frameworks for health and disability to inform a consensus process that was focused on deriving the minimal set of core domains in distal radius fracture. We agreed on the following seven core recommendations: (1) pain and function were regarded as the primary domains, (2) very brief measures were needed for routine administration in clinical practice, (3) these brief measures could be augmented by additional measures that provide more detail or address additional domains for clinical research, (4) measurement of pain should include measures of both intensity and frequency as core attributes, (5) a numeric pain scale, e.g. visual analogue scale or visual numeric scale or the pain subscale of the patient-reported wrist evaluation (PRWE) questionnaires were identified as reliable, valid and feasible measures to measure these concepts, (6) for function, either the Quick Disability of the arm, shoulder and hand questionnaire or PRWE-function subscale was identified as reliable, valid and feasible measures, and (7) a measure of participation and treatment complications should be considered core outcomes for both clinical practice and research. We used a sound methodological approach to form a comprehensive foundation of content for outcomes in the area of distal radius fractures. We recommend the use of symptom and function as separate domains in the ICF core set in clinical research or practice for patients with wrist fracture. Further research is needed to provide more definitive measurement properties of measures across all domains.

A retrospective, semi-quantitative image quality analysis of cone beam computed tomography (CBCT) and MSCT in the diagnosis of distal radius fractures

International Nuclear Information System (INIS)

Lang, H.; Neubauer, J.; Fritz, B.; Spira, E.M.; Strube, J.; Langer, M.; Kotter, E.

2016-01-01

To compare image quality and diagnostic validity of CBCT and MSCT for distal radius fractures. 35 CBCT and 33 MSCT scans were retrospectively reviewed with a visual grading scale regarding the depiction of cortical bone, trabecular bone, articular surfaces, and soft tissue. The extent and type of artefacts was analyzed. Agreement on AO classification and measurement of cortical disruption and length of the fracture gap was determined. Fracture reduction was evaluated in post-treatment x-rays. Statistical analysis was performed with visual grading characteristics (VGC), chi square tests, and Kendall's coefficient of concordance. CBCT performed significantly worse for cortical bone, articular surfaces, and especially soft tissue. Trabecular bone showed no significant difference. Significantly more CBCT images showed artefacts. Physics-based artefacts were the most common. CBCT scans also showed motion artefacts. There was no significant difference in agreement on AO classification. The agreement on measurements was substantial for both modalities. Slightly more fractures that had undergone MSCT imaging showed adequate reduction. This initial study of an orthopaedic extremity CBCT scanner showed that the image quality of a CBCT scanner remains inferior for most structures at standard settings. Diagnostic validity of both modalities for distal radius fractures seems similar. (orig.)

Radiographic evaluation of acute distal radius fracture stability: A comparative cadaveric study between a thermo-formable bracing system and traditional fiberglass casting.

Science.gov (United States)

Santoni, Brandon G; Aira, Jazmine R; Diaz, Miguel A; Kyle Stoops, T; Simon, Peter

2017-08-01

Distal radius fractures are common musculoskeletal injuries and many can be treated non-operatively with cast immobilization. A thermo-formable brace has been developed for management of such fractures, but no data exist regarding its comparative stabilizing efficacy to fiberglass casting. A worst-case distal radius fracture was created in 6 cadaveric forearms. A radiolucent loading fixture was created to apply cantilever bending/compression loads ranging from 4.5N to 66.7N across the simulated fracture in the: (1) non-stabilized, (2) braced; and (3) casted forearms, each forearm serving as its own control. Fracture fragment translations and rotations were measured radiographically using orthogonal radiographs and a 2D-3D, CT-based transformation methodology. Under 4.5N of load in the non-stabilized condition, average sagittal plane rotation and 3D center of mass translation of the fracture fragment were 12.3° and 5.3mm, respectively. At the 4.5N load step, fragment rotation with the brace (avg. 0.0°) and cast (0.1°) reduced sagittal plane rotation compared to the non-stabilized forearm (Pthermo-formable brace stabilized the fracture in a manner that was not radiographically or biomechanically different from traditional fiberglass casting. Study results support the use of the thermo-formable brace clinically. Copyright © 2017 Elsevier Ltd. All rights reserved.

WHAT IS THE BEST RADIOGRAPHIC VIEW FOR “DIE PUNCH” DISTAL RADIUS FRACTURES? A CADAVER MODEL STUDY

Science.gov (United States)

Falcochio, Diego Figueira; Crepaldi, Bruno Eiras; Trindade, Christiano Augusto; da Costa, Antonio Carlos; Chakkour, Ivan

2015-01-01

Objective: the aim of this study is try to show the best view for distal radius fractures so called die-punch fractures. Methods: There has been used a human cadaver radius bone from the Salvador Arena Tissue Bank. This bone was cleaned up after removing the soft tissues and osteotomies created displaced lunate fossa fractures of 0, 1, 2, 3 and 5 mm. We have fixed this fragment with adhesive tape. Then the joint deviation were significantly increased with step-offs of 1 mm. Radiographs were then taken into 5 different positions: postero-anterior view, lateral view, oblique views and tangencial view for each of the deviations. The resulting lunate fossa depression in each X-ray film was analyzed by the AutoCAD 2010® software. Results: The tangencial view was the best one to see the 1mm and 3mm bone degrees and the second one view to see the 2mm and 5 mm degrees. The pronated oblique view was the best to see the 2mm degrees and the oblique supinated view wasn't able to see the degrees between 1 and 2mm. Conclusion: The tangencial view was the best one to see the 1mm and 3mm bone degrees and the second one view to see the 2mm and 5 mm degrees. PMID:27027079

Treatment of reducible unstable fractures of the distal radius: randomized clinical study comparing the locked volar plate and external fixator methods: study protocol.

Science.gov (United States)

Raduan Neto, Jorge; de Moraes, Vinicius Ynoe; Gomes Dos Santos, João B; Faloppa, Flávio; Belloti, João Carlos

2014-03-05

Various treatments are available for reducible unstable fractures of the distal radius, such as closed reduction combined with fixation by external fixator (EF), and rigid internal fixation using a locked volar plate (VP). Although there are studies comparing these methods, there is no conclusive evidence indicating which treatment is best. The hypothesis of this study is that surgical treatment with a VP is more effective than EF from the standpoint of functional outcome (patient-reported). The study is randomized clinical trial with parallel groups and a blinded evaluator and involves the surgical interventions EF and VP. Patients will be randomly assigned (assignment ratio 1:1) using sealed opaque envelopes. This trial will include consecutive adult patients with an acute (up to 15 days) displaced, unstable fracture of the distal end of the radius of type A2, A3, C1, C2 or C3 by the Arbeitsgemeinschaft für Osteosynthesefragen-Association for the Study of Internal Fixation classification and type II or type III by the IDEAL32 classification, without previous surgical treatments of the wrist. The surgical intervention assigned will be performed by three surgical specialists familiar with the techniques described. Evaluations will be performed at 2, and 8 weeks, 3, 6 and 12 months, with the primary outcomes being measured by the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and measurement of pain (Visual Analog Pain Scale and digital algometer). Secondary outcomes will include radiographic parameters, objective functional evaluation (goniometry and dynamometry), and the rate of complications and method failure according to the intention-to-treat principle. Final postoperative evaluations (6 and 12 months) will be performed by independent blinded evaluators. For the Student's t-test, a difference of 10 points in the DASH score, with a 95% confidence interval, a statistical power of 80%, and 20% sampling error results in 36 patients per group

Elbow dislocation with ipsilateral fracture of the distal radius associated with a brachial artery injury: A new pathological condition of traumatic origin.

Science.gov (United States)

Trigo Lahoz, L; Lamas Gomez, C; Sarasquete Reiriz, J; de Caso Rodriguez, J; Proubasta Renart, I

Elbow dislocation associated with ipsilateral fracture of the distal radius and a brachial artery injury is an uncommon traumatic entity. The two references of this injury combination appeared in 2015, although both authors did not realise that they were the first two cases published in the medical literature. Although mentioned in the text of the articles, no mention was made of the fracture of the distal radius in the titles. The purpose of this paper is to present three cases with this new traumatic pathological entity, explaining its pathogenetic mechanism, the treatment used, and the results obtained. Copyright © 2016 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

Accuracy of specimen-specific nonlinear finite element analysis for evaluation of distal radius strength in cadaver material.

Science.gov (United States)

Matsuura, Yusuke; Kuniyoshi, Kazuki; Suzuki, Takane; Ogawa, Yasufumi; Sukegawa, Koji; Rokkaku, Tomoyuki; Takahashi, Kazuhisa

2014-11-01

Distal radius fracture, which often occurs in the setting of osteoporosis, can lead to permanent deformity and disability. Great effort has been directed toward developing noninvasive methods for evaluating the distal radius strength, with the goal of assessing fracture risk. The aim of this study was to evaluate distal radius strength using a finite element model and to gauge the accuracy of finite element model measurement using cadaver material. Ten wrists were obtained from cadavers with a mean age of 89.5 years at death. CT images of each wrist in an extended position were obtained. CT-based finite element models were prepared with Mechanical Finder software. Fracture on the models was simulated by applying a mechanical load to the palm in a direction parallel to the forearm axis, after which the fracture load and the site at which the fracture began were identified. For comparison, the wrists were fractured using a universal testing machine and the fracture load and the site of fracture were identified. The fracture load was 970.9 N in the finite element model group and 990.0 N in the actual measurement group. The site of the initial fracture was extra-articular to the distal radius in both groups. The finite element model was predictive for distal radius fracture when compared to the actual measurement. In this study, a finite element model for evaluation of distal radius strength was validated and can be used to predict fracture risk. We conclude that a finite element model is useful for the evaluation of distal radius strength. Knowing distal radius strength might avoid distal radius fracture because appropriate antiosteoporotic treatment can be initiated.

A retrospective, semi-quantitative image quality analysis of cone beam computed tomography (CBCT) and MSCT in the diagnosis of distal radius fractures

Energy Technology Data Exchange (ETDEWEB)

Lang, H.; Neubauer, J.; Fritz, B.; Spira, E.M.; Strube, J.; Langer, M.; Kotter, E. [University Medical Center Freiburg, Department of Radiology, Freiburg (Germany)

2016-12-15

To compare image quality and diagnostic validity of CBCT and MSCT for distal radius fractures. 35 CBCT and 33 MSCT scans were retrospectively reviewed with a visual grading scale regarding the depiction of cortical bone, trabecular bone, articular surfaces, and soft tissue. The extent and type of artefacts was analyzed. Agreement on AO classification and measurement of cortical disruption and length of the fracture gap was determined. Fracture reduction was evaluated in post-treatment x-rays. Statistical analysis was performed with visual grading characteristics (VGC), chi square tests, and Kendall's coefficient of concordance. CBCT performed significantly worse for cortical bone, articular surfaces, and especially soft tissue. Trabecular bone showed no significant difference. Significantly more CBCT images showed artefacts. Physics-based artefacts were the most common. CBCT scans also showed motion artefacts. There was no significant difference in agreement on AO classification. The agreement on measurements was substantial for both modalities. Slightly more fractures that had undergone MSCT imaging showed adequate reduction. This initial study of an orthopaedic extremity CBCT scanner showed that the image quality of a CBCT scanner remains inferior for most structures at standard settings. Diagnostic validity of both modalities for distal radius fractures seems similar. (orig.)

Linear intra-bone geometry dependencies of the radius: Radius length determination by maximum distal width

International Nuclear Information System (INIS)

Baumbach, S.F.; Krusche-Mandl, I.; Huf, W.; Mall, G.; Fialka, C.

2012-01-01

Purpose: The aim of the study was to investigate possible linear intra-bone geometry dependencies by determining the relation between the maximum radius length and maximum distal width in two independent populations and test for possible gender or age effects. A strong correlation can help develop more representative fracture models and osteosynthetic devices as well as aid gender and height estimation in anthropologic/forensic cases. Methods: First, maximum radius length and distal width of 100 consecutive patients, aged 20–70 years, were digitally measured on standard lower arm radiographs by two independent investigators. Second, the same measurements were performed ex vivo on a second cohort, 135 isolated, formalin fixed radii. Standard descriptive statistics as well as correlations were calculated and possible gender age influences tested for both populations separately. Results: The radiographic dataset resulted in a correlation of radius length and width of r = 0.753 (adj. R 2 = 0.563, p 2 = 0.592) and side no influence on the correlation. Radius length–width correlation for the isolated radii was r = 0.621 (adj. R 2 = 0.381, p 2 = 0.598). Conclusion: A relatively strong radius length–distal width correlation was found in two different populations, indicating that linear body proportions might not only apply to body height and axial length measurements of long bones but also to proportional dependency of bone shapes in general.

Effect of low appendicular lean mass, grip strength, and gait speed on the functional outcome after surgery for distal radius fractures.

Science.gov (United States)

Roh, Young Hak; Noh, Jung Ho; Gong, Hyun Sik; Baek, Goo Hyun

2017-12-01

Patients with low appendicular lean mass plus slow gait speed or weak grip strength are at risk for poor functional recovery after surgery for distal radius fracture, even when they have similar radiologic outcomes. Loss of skeletal muscle mass and consequent loss in muscle function associate with aging, and this condition negatively impacts the activities of daily living and increases elderly individuals' frailty to falls. Thus, patients with low appendicular lean mass would show different functional recovery compared to those without this condition after surgery for distal radius fracture (DRF). This study compares the functional outcomes after surgery for DRF in patients with or without low appendicular lean mass plus slowness or weakness. A total of 157 patients older than 50 years of age with a DRF treated via volar plate fixation were enrolled in this prospective study. A definition of low appendicular lean mass with slowness or weakness was based on the consensus of the Asian Working Group for Sarcopenia. The researchers compared functional assessments (wrist range of motion and Michigan Hand Questionnaire [MHQ]) and radiographic assessments (radial inclination, volar tilt, ulnar variance, and articular congruity) 12 months after surgery between patients with and without low appendicular lean mass plus slowness or weakness. Multivariable regression analyses were performed to determine whether appendicular lean mass, grip strength, gait speed, patient demographic, or injury characteristics accounted for the functional outcomes. Patients with low appendicular lean mass plus slowness or weakness showed a significantly lower recovery of MHQ score than those in the control group throughout 12 months. There was no significant difference in the range of motion between the groups. The radiologic outcomes showed no significant difference between groups in terms of volar tilt, radial inclination, or ulnar variance. According to multivariable regression analysis

Radiological dorsal tilt analysis of AO type A, B, and C fractures of the distal radius treated conservatively or with extra-focal K-wire plus external fixateur

Energy Technology Data Exchange (ETDEWEB)

Hoffmann, Michael [University Medical Center Hamburg-Eppendorf, Department of Trauma, Hand and Reconstructive Surgery, Hamburg (Germany); Borders General Hospital, Department for Trauma and Orthopaedic Surgery, Melrose, Roxburghshire, Scotland (United Kingdom); Schroeder, Malte; Gruber-Rathmann, Michaela; Ruecker, Andreas H. [University Medical Center Hamburg-Eppendorf, Department of Trauma, Hand and Reconstructive Surgery, Hamburg (Germany); Kossow, Kai [Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg (Germany)

2012-09-15

Fractures of the distal radius are amongst the most common injury patterns. The dorsal tilt represents an important co-factor determining functional outcome. The purpose of this study was to analyze the radiological dorsal tilt and identify critical time frames in conservative and operative treatment of distal radius fractures. Eighty-seven conservatively treated (hematoma block assisted reduction and splinting) and 37 operatively treated (reduction, extra-focal K-wire fixation, bridging external fixateur) AO type A, B, and C fractures of the distal radius in 124 females were retrospectively analyzed. The dorsal tilt at the initial, post-reduction, and 2 weeks post-reduction stages was correlated with the final radiographic outcome at 6 weeks. Mean initial dorsal tilt was 16.53 in the conservatively treated group and 26.76 in the operatively treated group. Mean dorsal tilt after 6 weeks showed significant differences from the mean initial dorsal tilt at time of presentation within both groups (both groups p < 0.000). No significant differences between the two groups were found after 6 weeks of treatment (p = 0.194) regardless of the underlying AO fracture type. Conservatively treated radius fractures showed a significantly higher slip rate within the first 2 weeks (primary slip rate), whereas the operative group presented a significantly higher slip rate between the 2-week and 6-week radiographic checks (secondary slip rate). In terms of dorsal tilt, conservative (cast immobilization) and operative (K-wire fixation plus external fixateur) treatment demonstrated no significant differences at the final radiographic examination (6 weeks) regardless of the underlying AO fracture type. Both treatment groups showed treatment-associated different primary and secondary slip rates, indicating a need for more frequent radiographic checks within these critical time frames. (orig.)

Non-operative treatment of displaced distal radius fractures leads to acceptable functional outcomes, however at the expense of 40% subsequent surgeries

NARCIS (Netherlands)

Mulders, M. A. M.; van Eerten, P. V.; Goslings, J. C.; Schep, N. W. L.

2017-01-01

Background: Although secondary displacement following closed reduction and plaster immobilisation is high, several guidelines still recommend non-operative treatment for displaced distal radius fractures with an adequate closed reduction. Purpose: The purpose of this study was to evaluate functional

Occupational therapy and Colles' fractures

OpenAIRE

Christensen, O.M.; Kunov, A.; Hansen, F.F.; Christiansen, T.C.; Krasheninnikoff, M.

2000-01-01

In this randomized trial, we enrolled 30 patients treated for a distal radius Colles' type fracture. The fractures were reduced if necessary and fixed in a below-elbow plaster cast for 5 weeks. One group consisting of 14 patients received instructions for shoulder; elbow and finger exercise and the other group consisting of 16 patients had occupational therapy. At 5 weeks, 3 and 9 months we measured the functional scores. There were no statistically significant differences between the groups ...

Role of MRI in the diagnosis and management of patients with clinical scaphoid fracture.

Science.gov (United States)

Tibrewal, Saket; Jayakumar, Prakash; Vaidya, Sujit; Ang, Swee Chai

2012-01-01

The American College of Radiologists (ACR) recognises the value of magnetic resonance imaging (MRI) as the investigation of choice in patients with a clinically suspected scaphoid fracture but normal plain radiographs. The Royal College of Radiologists (RCR) in the UK produces no similar guidelines, as evidenced by the inconsistent management of such cases in hospitals around the UK. In discussion with our musculoskeletal radiologists, we implemented new guidelines to standardise management of our patients and now report our findings. A consecutive series of 137 patients referred to the orthopaedic department with clinically suspected scaphoid fracture but normal series of plain radiographs were prospectively followed up over a two-year period. We implemented the use of early MRI for these patients and determined its incidence of detected scaphoid injury in addition to other occult injuries. We then prospectively examined results of these findings on patient management. Thirty-seven (27%) MRI examinations were normal with no evidence of a bony or soft-tissue injury. Soft-tissue injury was diagnosed in 59 patients (43.4%). Of those, 46 were triangular fibrocartilage complex (TFCC) tears (33.8%) and 18 were intercarpal ligament injuries (13.2 %). Bone marrow oedema with no distinct fracture was discovered in 55 cases (40.4%). In 17 (12.5%) cases, this involved only the scaphoid. In the remainder, it also involved the other carpal bones or distal radius. Fracture(s) were diagnosed on 30 examinations (22.0%). MRI should be regarded as the gold standard investigation for patients in whom a scaphoid fracture is suspected clinically. It allows the diagnosis of occult bony and soft-tissue injuries that can present clinically as a scaphoid fracture; it also helps exclude patients with no fracture. We believe that there is a need to implement national guidelines for managing occult scaphoid fractures.

Cuttable plate fixation for small breed dogs with radius and ulna fractures: Retrospective study of 31 dogs.

Science.gov (United States)

Watrous, Gwyneth K; Moens, Noel M M

2017-04-01

This retrospective study evaluated complication rates for radius and ulna fractures in small breed dogs in which 1.5 mm to 2.7 mm cuttable bone plates were used for internal fixation. The medical records of all cases from 2004 to 2011 that were presented to our clinic were reviewed. Inclusion criteria were: dogs with body weight dogs met the inclusion criteria. Of 25 dogs that were available for follow-up, all achieved union, minor complications occurred in 9, and major complications occurred in 8. External coaptation was responsible for complications in 8 cases and the need for coaptation needs to be investigated. Excluding minor complications, 32% of patients required at least 1 additional surgery or additional hospitalization. All but 2 of the dogs returned to full function. The 1.5 mm straight plate was successfully used in all dogs with a body weight of 0.9 to 2.6 kg.

Risk of fracture with thiazolidinediones: an individual patient data meta-analysis

Directory of Open Access Journals (Sweden)

Marloes T Bazelier

2013-02-01

Full Text Available Background: The use of thiazolidinediones (TZDs has been associated with increased fracture risks. Our aim was to estimate the risk of fracture with TZDs in three different healthcare registries, using exactly the same study design, and to perform an individual patient data meta-analysis of these three studies. Methods: Population-based cohort studies were performed utilizing the British General Practice Research Database (GPRD, the Dutch PHARMO Record Linkage System, and the Danish National Health Registers. In all three databases, the exposed cohort consisted of all patients (aged 18+ with at least one prescription of antidiabetic (AD medication. Cox proportional hazards models were used to estimate hazard ratios (HRs of fracture. The total period of follow-up for each patient was divided into periods of current exposure and past exposure, with patients moving between current and past use.Results: In all three registries, the risk of fracture was increased for women who were exposed to TZDs: HR 1.48 [1.37-1.60] in GPRD, HR 1.35 [1.15-1.58] in PHARMO and HR 1.22 [1.03-1.44] in Denmark. Combining the data in an individual patient data meta-analysis resulted, for women, in a 1.4-fold increased risk of any fracture for current TZD users versus other AD drug users (adj. HR 1.44 [1.35-1.53]. For men, there was no increased fracture risk (adj. HR 1.05 [0.96-1.14]. Risks were increased for fractures of the radius/ulna, humerus, tibia/fibula, ankle and foot, but not for hip/femur or vertebral fractures. Current TZD users with more than 25 TZD presciptions ever before had a 1.6-fold increased risk of fracture compared with other AD drug users (HR 1.59 [1.46-1.74].Conclusion: In this study, we consistently found a 1.2- to 1.5-fold increased risk of fractures for women using TZDs, but not for men, across three different healthcare registries. TZD users had an increased risk for fractures of the extremities, and risks further increased for prolonged users

Rate of Improvement following Volar Plate Open Reduction and Internal Fixation of Distal Radius Fractures

Directory of Open Access Journals (Sweden)

Chris Dillingham

2011-01-01

Full Text Available Purpose. To determine recovery timeline of unstable distal radius fractures treated by open reduction and internal fixation with a locking volar plate. Methods. Data was collected prospectively on a consecutive series of twenty-seven patients during routine post-operative visits at 2 and 6 weeks, and 3, 6, 12 and 24 months. Range of motion measures and grip strength for both wrists were recorded. Results. Greatest gains were made within the first 3 months after surgery. Supination and pronation returned more quickly than flexion or extension, with supination and pronation both at 92% of the uninjured wrist at 3 months. Only flexion improved significantly between 3 and 6 months. All wrist motions showed some improvement until 1 year. Grip strength returned to 94% of the uninjured wrist by 12 months. Conclusions. Range of motion improvement will be greatest between 2 weeks and 3 months, with improvement continuing until 12 months. Grip strength should return to near normal by one year. Function and pain will improve, but not return to normal by the end of 12 months. Clinical Relevance. These results provide the surgeon with information that can be shared with patients on the anticipated timeline for normal recovery of function and strength.

Bone density of the radius, spine, and proximal femur in osteoporosis

International Nuclear Information System (INIS)

Mazess, R.B.; Barden, H.; Ettinger, M.; Schultz, E.

1988-01-01

Bone mineral density (BMD) was measured in 140 normal young women (aged 20 to 39 years) and in 423 consecutive women over age 40 referred for evaluation of osteoporosis. Lumbar spine and proximal femur BMD was measured using dual-photon absorptiometry ( 153 Gd), whereas the radius shaft measurement used single-photon absorptiometry ( 125 I). There were 324 older women with no fractures, of which 278 aged 60 to 80 years served as age-matched controls. There were 99 women with fractures including 32 with vertebral and 22 with hip fractures. Subsequently, another 25 women with hip fractures had BMD measured in another laboratory; their mean BMD was within 2% of that of the original series. The mean age in both the nonfracture and fracture groups was 70 +/- 5 years. The BMD in the age-matched controls was 20% to 25% below that of normal young women for the radius, spine, and femur, but the Ward's triangle region of the femur showed even greater loss (35%). The mean BMD at all sites in the crush fracture cases was about 10% to 15% below that of age-matched controls. Spinal abnormality was best discriminated by spine and femoral measurements (Z score about 0.9). In women with hip fractures, the BMD was 10% below that of age-matched controls for the radius and the spine, and the BMD for the femoral sites was about 25% to 30% below that of age-matched control (Z score about 1.6). Femoral densities gave the best discrimination of hip fracture cases and even reflected spinal osteopenia. In contrast, neither the spine nor the radius reflected the full extent of femoral osteopenia in hip fracture

[Unidirectional versus multidirectional palmar locking osteosynthesis of unstable distal radius fractures: comparative analysis with LDR 2.4 mm versus 2.7 mm matrix-Smartlock].

Science.gov (United States)

Hakimi, M; Jungbluth, P; Gehrmann, S; Nowak, J; Windolf, J; Wild, M

2010-03-01

Due to advances in the development of the unidirectional locking plates there is now an increased use of multidirectional palmar locking plates in the treatment of distal radius factures. The purpose of this study was to evaluate a possible improvement of the treatment and results. This prospective cohort study investigated 40 patients with C1 and C2 Colles' fractures who had been treated with unidirectional and multidirectional locking plates. The average time for the follow-up examinations was 12.3 months (range 12-15 months) after surgery. The intra-operative functional (neutral-zero method), radiological and subjective (DASH score, VAS) results were evaluated. The intra-operative fluoroscopy time of the unidirectional group was 58 s shorter compared to the multidirectional group. All fractures healed without any complication. The radiological, subjective (DASH score) and objective results for both groups were good and showed no differences. Unidirectional palmar locking plates are equally suited for the therapy of C1 and C2 fractures as multidirectional palmar locking plates but multidirectional plates require a longer fluoroscopy time.

Daily number of fractures is associated with road temperature in an urban area

DEFF Research Database (Denmark)

Jantzen, Christopher; Jørgensen, Henrik L; Thomsen, Morten

2014-01-01

winters. MATERIAL AND METHODS: Retrospective data collection was conducted on all patients treated at Bispebjerg Hospital, Denmark, for a humeral, ankle, distal radius or hip fracture during the periods October to April 2009/2010 and 2010/2011. Patients were grouped according to age into the following......,938 fractures) were treated during the study periods. The daily number of distal radius, humeral and ankle fractures increased significantly with decreasing road surface temperature and the presence of IA. For hip fractures no significant association was found. Decreasing temperature was associated......INTRODUCTION: Different factors related to winter are known to influence the fracture incidence, but little is known about the effect of road surface temperature. This study examines the association between road surface temperature and the daily number of fractures in an urban area during two...

Open reduction and cranial bone plate fixation of fractures involving the distal aspect of the radius and ulna in miniature- and toy-breed dogs: 102 cases (2008-2015).

Science.gov (United States)

De Arburn Parent, Rebecca; Benamou, Jérôme; Gatineau, Matthieu; Clerfond, Pierre; Planté, Jérôme

2017-06-15

OBJECTIVE To determine outcomes and complication rates of open reduction and cranial bone plate fixation of fractures involving the distal aspect of the radius and ulna in miniature- and toy-breed dogs. DESIGN Retrospective case series. ANIMALS 102 miniature- and toy-breed dogs (105 fractures) weighing ≤ 7 kg (15.4 lb) that had undergone open reduction and cranial bone plate fixation of a fracture involving the distal aspect of the radius and ulna from 2008 through 2015. PROCEDURES Medical records were reviewed and information extracted regarding dog and fracture characteristics, surgical variables, and follow-up examination data (including postoperative complications). Postoperative radiographs were examined for distal fragment size, implant placement, apposition, alignment, and healing stage. A long-term follow-up questionnaire was completed by telephone interview with dog owners at least 6 months after surgery. RESULTS Mean length of the distal bone fragment in all fractures was 19.2 mm, with a mean distal-to-total radial length ratio of 0.21. At last follow-up examination (typically 6 weeks after surgery), 97 (95%) dogs had no signs of lameness; minor lameness was identified in 5 (5%) dogs. Complications developed in 26 (25%) fractures (23 [22%] minor and 3 [3%] major complications). Sixty-eight of 71 (96%) owners rated the overall and long-term outcome as excellent and 3 (4%) as good; 68 of 71 (96%) dogs reportedly had no signs of residual lameness. CONCLUSIONS AND CLINICAL RELEVANCE Open reduction and cranial bone plate fixation for the treatment of radius-ulna fractures in miniature- and toy-breed dogs provided an excellent outcome with a low complication rate.

Fracture Risk Assessment in Chronic Kidney Disease, Prospective Testing Under Real World Environments (FRACTURE: a prospective study

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West Sarah L

2010-08-01

Full Text Available Abstract Background Chronic kidney disease (CKD is associated with an increased risk of fracture. Decreased bone mass and disruption of microarchitecture occur early in the course of CKD and worsens with the progressive decline in renal function so that at the time of initiation of dialysis at least 50% of patients have had a fracture. Despite the excess fracture risk, and the associated increases in morbidity and mortality, little is known about the factors that are associated with an increase in fracture risk. Our study aims to identify prognostic factors for bone loss and fractures in patients with stages 3 to 5 CKD. Methods This prospective study aims to enroll two hundred and sixty men and women with stages 3 to 5 CKD. Subjects will be followed for 24 months and we will examine the ability of: 1 bone mineral density by dual x-ray absorptiometry at the spine, hip, and radius; 2 volumetric bone density by high resolution peripheral quantitated computed tomography at the radius and tibia; 3 serum markers of bone turnover; 4 bone formation rate by bone biopsy; and 5 muscle strength and balance to predict spine and non-spine fractures, identified by self-report and/or vertebral morphometry. All measurements will be obtained at baseline, at 12 and at 24 months with the exception of bone biopsy, which will be measured once at 12 months. Subjects will be contacted every 4 months to determine if there have been incident fractures or falls. Discussion This study is one of the first that aims to identify risk factors for fracture in early stage CKD patients. Ultimately, by identifying risk factors for fracture and targeting treatments in this group-before the initiation of renal replacement therapy - we will reduce the burden of disease due to fractures among patients with CKD.

Influence of side-groove root radius on the ductile fracture toughness of miniature C(T) specimens

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Lucon, E.; Scibetta, M.

2009-05-15

The use of miniature C(T) specimens, MC(T), for fracture toughness measurements in the upper shelf regime has been investigated at SCK-CEN since 2004, in the framework of the Electrabel/Tractebel SCK-CEN Convention (now General Framework Agreement SUEZ-SCK-CEN). This geometry has been used and validated on both unirradiated (2004-05) and irradiated (2006) materials, mainly reactor pressure vessel (RPV) steels. While side-grooved MC(T) specimens have shown in all conditions a systematically lower tearing resistance and ductile crack initiation toughness as compared to standard-size 1TC(T) samples, the only plain-sided MC(T) specimen tested in 2005 exhibited very high ductile fracture toughness, thus pointing at a strong influence of side-grooving on the upper shelf properties of MC(T) specimens. This study investigates the influence of side-grooving on the initiation toughness and tearing resistance of MC(T) specimens, as a function of the root radius of the side-groove (ranging from 0.1 to 1 mm) and in comparison with plain-sided MC(T) and reference 1TC(T) samples. The material used is the well characterized DIN 22NiMoCr37 RPV steel, which had been used in the European project which generated the famous EURO fracture toughness data set.

A prospective study on the effectiveness of cotton versus waterproof cast padding in maintaining the reduction of pediatric distal forearm fractures.

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Robert, Christopher E; Jiang, Jimmy J; Khoury, Joseph G

2011-03-01

Distal forearm fractures, one of the most common fractures seen in the pediatric population, are regularly treated by closed reduction and casting. Our study investigates the effectiveness of Gore-Tex-lined casting in maintaining the reduction of 100% displaced distal forearm fractures compared with traditional cotton-lined casts. We screened all patients from February 2007 to July 2009 who presented to Children's Hospital in Birmingham, AL with a distal radius fracture. Only patients with 100% displaced distal radius fractures were eligible to be assigned to either the cotton-lined or Gore-Tex-lined cast groups. Power analysis was performed to identify an adequate patient sample size. The mean maximum change between initial post-reduction x-rays and follow-up x-rays for anterior-posterior (AP) angulation, AP displacement, lateral angulation, and lateral displacement of the radius were calculated for both cotton and Gore-Tex groups. The rate of subsequent intervention and/or unacceptable results for each group was also analyzed. Seven hundred and twenty-two patients were treated with distal radius fractures at our hospital with 59 patients eligible for inclusion in our study. Thirty-six of our patients were treated with cotton-lined casts, and 23 patients were treated with Gore-Tex-lined cast. The mean maximum change in AP angulation, AP displacement, lateral angulation, and lateral displacement of the radius after initial reduction was 9.2 degrees, 6.9%, 13.9 degrees, and 13.6%, respectively, for the cotton-lined cast group and 7.7 degrees, 6.1%, 14.6 degrees, and 9.6%, respectively, for the Gore-Tex-lined cast group. There were no statistical differences between the means of the 4 measurements (P=0.33, 0.69, 0.73, and 0.10, respectively). There were also no significant differences between groups for final AP and lateral angulation and displacement. Subgroup analysis showed no significant differences in all measurements between cotton and Gore-Tex groups. Gore

Fractal analysis of bone architecture at distal radius

International Nuclear Information System (INIS)

Tomomitsu, Tatsushi; Mimura, Hiroaki; Murase, Kenya; Sone, Teruki; Fukunaga, Masao

2005-01-01

Bone strength depends on bone quality (architecture, turnover, damage accumulation, and mineralization) as well as bone mass. In this study, human bone architecture was analyzed using fractal image analysis, and the clinical relevance of this method was evaluated. The subjects were 12 healthy female controls and 16 female patients suspected of having osteoporosis (age range, 22-70 years; mean age, 49.1 years). High-resolution CT images of the distal radius were acquired and analyzed using a peripheral quantitative computed tomography (pQCT) system. On the same day, bone mineral densities of the lumbar spine (L-BMD), proximal femur (F-BMD), and distal radius (R-BMD) were measured by dual-energy X-ray absorptiometry (DXA). We examined the correlation between the fractal dimension and six bone mass indices. Subjects diagnosed with osteopenia or osteoporosis were divided into two groups (with and without vertebral fracture), and we compared measured values between these two groups. The fractal dimension correlated most closely with L-BMD (r=0.744). The coefficient of correlation between the fractal dimension and L-BMD was very similar to the coefficient of correlation between L-BMD and F-BMD (r=0.783) and the coefficient of correlation between L-BMD and R-BMD (r=0.742). The fractal dimension was the only measured value that differed significantly between both the osteopenic and the osteoporotic subjects with and without vertebral fracture. The present results suggest that the fractal dimension of the distal radius can be reliably used as a bone strength index that reflects bone architecture as well as bone mass. (author)

[Clinical randomized controlled trial on ultrashort wave and magnetic therapy for the treatment of early stage distal radius fractures].

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Wang, Guan-Jie; Liu, Jia

2012-07-01

To explore the effect of application of ultrashort wave and magnetic therapy instrument on the swelling regression in distal radius fractures treated by splint external fixation in initial stage. From March 2007 to May 2010,90 patients with distal radial fracture were treated by manual reduction and splint external fixation. After manual reduction and small splints external fixation, these patients were randomly divided into electrical physical therapy group, western medicine group and the control group by the order of calling number, with 30 cases each group. In control group, there were 9 males and 21 females with an average age of (61.29 +/- 1.97) years, the patients raised and exercise the limb and fingers only. The other two groups also carried out this treatment. In electrical physical therapy group, there were 9 males and 21 females with an average age of (62.37 +/- 2.48) years, the patients were treated with ultrashort wave and magnetic therapy instrument for early intervention, once a day, 5 days for a course of treatment and three cycle were operated. In western medicine group,there were 8 males and 22 females with an average age of (60.12 +/- 2.87) years, the patients were injected with beta-aescin (20 mg, intravenous injection,once a day) for 5 days, followed by Danshen injection (20 ml, intravenous injection, once a day) for 10 days. The limb swelling of patients were assessed every day for 20 days after manual reduction and small splints external fixation. The time of swelling regression in electrical physical therapy group, western medicine group and the control group were respectively (9.62 +/- 3.32), (10.05 +/- 3.05) and (14.57 +/- 2.93) days. Both of that in electrical physical therapy group and western medicine group were shorter than that in the control group (P0.05). The effective rate of swelling regression in electrical physical therapy group, western medicine group and the control group were 86.67%, 80.00%, 46.66% respectively. There was no

Perbandingan Fungsi Extremitas Atas pada Fraktur Metafise Distal Radius Intraartikuler Usia Muda Antara Tindakan Operatif Dan Non Operatif dengan Penilaian Klinis Quickdash Score

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Edi Burhan

2014-01-01

Djamil Hospital in November-December 2012 on young age patinet with the distal radius metafise intrartikular fracture who got the operative treatment in compare with non-operative groups with clinical assessment Quick Dash Score. The sample used is 30 people from 55 people who meet criteria for inclusion. Result: There is meaningful relationship the function upper extremitas with Quick Dash Score a distal radius fracture actions on intraartikuler at a young age that got an operative treatment and non-operative (p Fisher = 0,010 S. There is not meaningful relationships between Quick Dash Score with gender and diagnosis right or left. Discussion: There is significant difference between patients of intraarticuler radius distal metafise fractur who get operatif treatment, such as ORIF and the pasients who get non-operatif treatment, such as Gips.Keywords: Metafise Distal Radius Fracture, Operatif and Non Operatif Treatment, Quick Dash Score

Biomechanics of the Proximal Radius Following Drilling of the Bicipital Tuberosity to Mimic Cortical Button Distal Biceps Repair Technique.

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Oak, Nikhil R; Lien, John R; Brunfeldt, Alexander; Lawton, Jeffrey N

2018-05-01

A fracture through the proximal radius is a theoretical concern after cortical button distal biceps fixation in an active patient. The permanent, nonossified cortical defect and medullary tunnel is at risk during a fall eliciting rotational and compressive forces. We hypothesized that during simulated torsion and compression, in comparison with unaltered specimens, the cortical button distal biceps repair model would have decreased torsional and compressive strength and would fracture in the vicinity of the bicipital tuberosity bone tunnel. Sixteen fourth-generation composite radius Sawbones models were used in this controlled laboratory study. A bone tunnel was created through the bicipital tuberosity to mimic the exact bone tunnel, 8 mm near cortex and 3.2 mm far cortex, made for the BicepsButton distal biceps tendon repair. The radius was then prepared and mounted on either a torsional or compression testing device and compared with undrilled control specimens. Compression tests resulted in average failure loads of 9015.2 N in controls versus 8253.25 N in drilled specimens ( P = .074). Torsional testing resulted in an average failure torque of 27.3 Nm in controls and 19.3 Nm in drilled specimens ( P = .024). Average fracture angle was 35.1° in controls versus 21.1° in drilled. Gross fracture patterns were similar in compression testing; however, in torsional testing all fractures occurred through the bone tunnel in the drilled group. There are weaknesses in the vicinity of the bone tunnel in the proximal radius during biomechanical stress testing which may not be clinically relevant in nature. In cortical button fixation, distal biceps repairs creates a permanent, nonossified cortical defect with tendon interposed in the bone tunnel, which can alter the biomechanical properties of the proximal radius during compressive and torsional loading.

High prevalence of simultaneous rib and vertebral fractures in patients with hip fracture.

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Lee, Bong-Gun; Sung, Yoon-Kyoung; Kim, Dam; Choi, Yun Young; Kim, Hunchul; Kim, Yeesuk

2017-02-01

The purpose was to evaluate the prevalence and location of simultaneous fracture using bone scans in patients with hip fracture and to determine the risk factors associated with simultaneous fracture. One hundred eighty two patients with hip fracture were reviewed for this study. Clinical parameters and bone mineral density (BMD) of the lumbar vertebra and femoral neck were investigated. To identify acute simultaneous fracture, a bone scan was performed at 15.4±4.1days after hip fracture. The prevalence and location of simultaneous fracture were evaluated, and multivariate logistic regression analysis was performed to determine the risk factors. Simultaneous fracture was observed in 102 of 182 patients, a prevalence of 56.0%. Rib fracture was the most common type of simultaneous fracture followed by rib with vertebral fracture. The BMD of the lumbar vertebra was significantly lower in patients with simultaneous fracture (p=0.044) and was identified as an independent risk factor (odds ratio: OR 0.05, 95% confidence interval: CI 0.01-0.57). The prevalence of simultaneous fracture was relatively high among patients with hip fracture, and BMD was significantly lower in patients with simultaneous fracture than in patients without it. Surgeons should be aware of the possibility of simultaneous fracture in patients with hip fracture. Copyright © 2016 Elsevier Ltd. All rights reserved.

Study protocol: non-displaced distal radial fractures in adult patients: three weeks vs. five weeks of cast immobilization: a randomized trial

NARCIS (Netherlands)

Bentohami, Abdelali; de Korte, Niels; Sosef, Nico; Goslings, Johan Carel; Bijlsma, Taco; Schep, Niels

2014-01-01

Up to 30% of patients suffer from long-term functional restrictions following conservative treatment of distal radius fractures. Whether duration of cast immobilisation influences functional outcome remains unclear. The aim of the study is to evaluate whether the duration of immobilization of non or

[True/Flex intramedullary nailing for forearm shaft fractures. Long-term results].

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Trlica, J; Počepcov, I; Kočí, J; Frank, M; Holeček, T; Dědek, T

2012-01-01

Presentation of technical experience and the clinical and functional results of intramedullary fixation of forearm shaft fractures. Between January 1994 and December 2009, a total of 96 patients with 144 radial and/or ulnar fractures (ulna, 33; radius,15; both, 48) were treated by nailing (True/Flex®). According to the AO classification there were 22-A, 22-B and 22-C type fractures in 39 (41%), 44 (46%) and 13 (13%).cases, respectively. Of these, 82 (85%) were closed (types: 0, 48; I, 33; II, 1) and 14 (15%) were open (types: I, 13; II, 1; III, 0) fractures. Seventy-eight patients (81%) were followed up and their functional outcomes were evaluated according to the criteria of Anderson et al. The average interval between the operation and final follow-up was 28 months (15 to 96 months) The average time to surgery was 2.2 days (0 to 25 days). Early complications were recorded in 4% of the patients (1x bursitis olecrani; 1x end cup replacement; 1x bending of nails) and late complications in 15% (5x non-union; 2x delay union; 4x bursitis olecrani; 1x ruptured tendon). Bone healing was achieved in 95% of the cases and took on average 16 weeks (7 to 34 weeks). No infection, refracture or synostosis occurred. Primary loss of reduction was recorded in four cases due to distraction in one, bent nails in two and a wrong size of the implant in one; secondary loss of reduction was found in three cases, with two cases of radius shortening and one 10°malrotation. No primary malrotation was recorded, but secondary loss of alignment was seen in the distal part of the radius and the proximal part of the ulna. Functional results according to the Anderson criteria were excellent and good in 87% of the cases. Intramedullary mailing provides good stability to mid- and distal-third shaft fractures of the ulna and mid- and proximalthird shaft fractures of the radius, particularly in AO type A and type B fractures. The technical aspects of the method are analysed in detail in this paper

Diagnostic accuracy of ultrasound in upper and lower extremity long bone fractures of emergency department trauma patients.

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Frouzan, Arash; Masoumi, Kambiz; Delirroyfard, Ali; Mazdaie, Behnaz; Bagherzadegan, Elnaz

2017-08-01

Long bone fractures are common injuries caused by trauma. Some studies have demonstrated that ultrasound has a high sensitivity and specificity in the diagnosis of upper and lower extremity long bone fractures. The aim of this study was to determine the accuracy of ultrasound compared with plain radiography in diagnosis of upper and lower extremity long bone fractures in traumatic patients. This cross-sectional study assessed 100 patients admitted to the emergency department of Imam Khomeini Hospital, Ahvaz, Iran with trauma to the upper and lower extremities, from September 2014 through October 2015. In all patients, first ultrasound and then standard plain radiography for the upper and lower limb was performed. Data were analyzed by SPSS version 21 to determine the specificity and sensitivity. The mean age of patients with upper and lower limb trauma were 31.43±12.32 years and 29.63±5.89 years, respectively. Radius fracture was the most frequent compared to other fractures (27%). Sensitivity, specificity, positive predicted value, and negative predicted value of ultrasound compared with plain radiography in the diagnosis of upper extremity long bones were 95.3%, 87.7%, 87.2% and 96.2%, respectively, and the highest accuracy was observed in left arm fractures (100%). Tibia and fibula fractures were the most frequent types compared to other fractures (89.2%). Sensitivity, specificity, PPV and NPV of ultrasound compared with plain radiography in the diagnosis of upper extremity long bone fractures were 98.6%, 83%, 65.4% and 87.1%, respectively, and the highest accuracy was observed in men, lower ages and femoral fractures. The results of this study showed that ultrasound compared with plain radiography has a high accuracy in the diagnosis of upper and lower extremity long bone fractures.

A case report of an isolated fracture through the radial bicipital tuberosity

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Kanta Imao

Full Text Available Introduction: Generally, anatomical reduction of shaft fractures through operative treatment is necessary to restore the anatomical relationship of the forearm bones. However, a number of nerves and vessels are located in the proximal radius, which complicates surgery. In this study, we aimed to reduce postoperative complications by using a posterior approach. Presentation of case: We describe an isolated fracture through the radial bicipital tuberosity in a 69-year-old man caused by direct blunt force and our management of the fracture. The patient underwent an operation for the fracture under brachial plexus block. The injury was explored using the posterior approach, and plate fixation was performed after confirming the absence of obstacles to rotation on pronation and supination. One year later, the patient did not have any difficulties in activities of daily living. Discussion: Since an isolated fracture through the radial bicipital tuberosity is more distal than the radial head and neck and more proximal than a common radius diaphysis fracture, we had to consider a different operative approach. The nerve and blood vessels of the forearm, such as the radial nerve and artery, run in a complicated fashion around the proximal radius; thus, we chose the posterior approach because of its simpler surgical technique and lower complication risk, compared with the anterior approach. Conclusion: Surgeons can obtain a favorable treatment result using the posterior approach to the fracture and reduce complications by ensuring with rigid fixation using a locking plate. Keywords: Radial bicipital tuberosity, Posterior approach, Posterior interosseous nerve, Shaft fracture

Distal radius fracture arthroscopic intraarticular displacement measurement after open reduction and internal fixation from a volar approach.

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Ono, Hiroshi; Furuta, Kazuhiko; Fujitani, Ryotaro; Katayama, Takeshi; Akahane, Manabu

2010-07-01

The purpose of this study was to assess articular surface reduction arthroscopically after volar locked-plate fixation of distal radius fractures (DRFs) via fluoroscopyguided open reduction/internal fixation. We also aimed to develop preoperative radiographic criteria to help assist in determining which DRFs may need arthroscopic evaluation. A total of 31 consecutive patients with DRF were prospectively enrolled. Posteroanterior (PA) and lateral radiographs as well as axial, coronal, and sagittal CT scans were obtained just after attempted reduction of the DRF. The widest articular displacement at the radiocarpal joint surface of the distal radius (preopD) was then measured using a digital radiography imaging system. The DRF was reduced under fluoroscopy, and a volar locked plate was applied. The degree of residual articular displacement was then measured arthroscopically, and the maximum displacement (postopD) was measured with a calibrated probe. Of the 31 patients, 7 had an arthroscopically assessed maximum postopD of > or = 2 mm after internal fixation. The correlation coefficients between each preopD and postopD of all radiographs and CTs were statistically significant. The cutoff values were 0.5 mm for PA radiographs, 2.10 mm for lateral radiographs, 2.15 mm for axial CT scans, 3.15 mm for coronal CT scans, and 1.20 mm for sagittal CT scans. All cutoff values for PA and lateral radiographs and for axial, coronal, and sagittal CT scans were unsuitable as screening criteria for arthroscopic reduction of DRF because of their low sensitivities and specificities. The cutoff value of the new preopD (the sum of the preopDs determined by lateral radiography and coronal CT scan) was 5.80 mm, and its sensitivity and specificity were 100% and 83.3%, respectively. Because a new preopD cutoff value of 5.80 mm is a good indicator for residual articular displacement after internal fixation of >2 mm, it is also a good indicator for the need for arthroscopic evaluation after

Distal radius fracture arthroscopic intraarticular displacement measurement after open reduction and internal fixation from a volar approach

International Nuclear Information System (INIS)

Ono, Hiroshi; Furuta, Kazuhiko; Fujitani, Ryotaro; Katayama, Takeshi; Akahane, Manabu

2010-01-01

The purpose of this study was to assess articular surface reduction arthroscopically after volar locked-plate fixation of distal radius fractures (DRFs) via fluoroscopy-guided open reduction/internal fixation. We also aimed to develop preoperative radiographic criteria to help assist in determining which DRFs may need arthroscopic evaluation. A total of 31 consecutive patients with DRF were prospectively enrolled. Posteroanterior (PA) and lateral radiographs as well as axial, coronal, and sagittal CT scans were obtained just after attempted reduction of the DRF. The widest articular displacement at the radiocarpal joint surface of the distal radius (preopD) was then measured using a digital radiography imaging system. The DRF was reduced under fluoroscopy, and a volar locked plate was applied. The degree of residual articular displacement was then measured arthroscopically, and the maximum displacement (postopD) was measured with a calibrated probe. Of the 31 patients, 7 had an arthroscopically assessed maximum postopD of ≥2 mm after internal fixation. The correlation coefficients between each preopD and postopD of all radiographs and CTs were statistically significant. The cutoff values were 0.5 mm for PA radiographs, 2.10 mm for lateral radiographs, 2.15 mm for axial CT scans, 3.15 mm for coronal CT scans, and 1.20 mm for sagittal CT scans. All cutoff values for PA and lateral radiographs and for axial, coronal, and sagittal CT scans were unsuitable as screening criteria for arthroscopic reduction of DRF because of their low sensitivities and specificities. The cutoff value of the new preopD (the sum of the preopDs determined by lateral radiography and coronal CT scan) was 5.80 mm, and its sensitivity and specificity were 100% and 83.3%, respectively. Because a new preopD cutoff value of 5.80 mm is a good indicator for residual articular displacement after internal fixation of >2 mm, it is also a good indicator for the need for arthroscopic evaluation after

Incidence of Treatment for Infection of Buried Versus Exposed Kirschner Wires in Phalangeal, Metacarpal, and Distal Radial Fractures.

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Ridley, Taylor J; Freking, Will; Erickson, Lauren O; Ward, Christina Marie

2017-07-01

To determine whether there is a difference in the incidence of infection between exposed and buried K-wires when used to treat phalangeal, metacarpal, and distal radius fractures. We conducted a retrospective review identifying all patients aged greater than 16 years who underwent fixation of phalangeal, metacarpal, or distal radius fractures with K-wires between 2007 and 2015. We recorded patient demographic data, fracture location, number of K-wires used, whether K-wires were buried or left exposed, and duration of K-wire placement. A total of 695 patients met inclusion criteria. Surgeons buried K-wires in 207 patients and left K-wires exposed in 488. Infections occurred more frequently in exposed K-wire cases than in buried K-wire ones. Subgroup analysis based on fracture location revealed a significantly increased risk of being treated for infection when exposed K-wires were used for metacarpal fractures. Patients with exposed K-wires for fixation of phalangeal, metacarpal, or distal radius fractures were more likely to be treated for a pin-site infection than those with K-wires buried beneath the skin. Metacarpal fractures treated with exposed K-wires were 2 times more likely to be treated for a pin-site infection (17.6% of exposed K wire cases vs 8.7% of buried K wire cases). Therapeutic IV. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Routine functional assessment for hip fracture patients

DEFF Research Database (Denmark)

Pedersen, Tonny J; Lauritsen, Jens M

2016-01-01

Background and purpose - Pre-fracture functional level has been shown to be a consistent predictor of rehabilitation outcomes in older hip fracture patients. We validated 4 overall pre-fracture functional level assessment instruments in patients aged 65 or more, used the prediction of outcome at 4...... months post-fracture, and assessed cutoff values for decision making in treatment and rehabilitation. Patients and methods - 165 consecutive patients with acute primary hip fracture were prospectively included in the study. Pre-fracture Barthel-20, Barthel-100, cumulated ambulation score, and new...... investigation of usage for guidance of clinical and rehabilitation decisions concerning hip fracture patients is warranted....

Post-surgical rehabilitative approach to fragility fractures.

Science.gov (United States)

Gimigliano, F; Iolascon, G; Riccio, I; Frizzi, L; Gimigliano, R

2013-10-01

Osteoporosis is a skeletal disorder characterized by compromised bone strength predisposing to an increased risk of fracture. The most frequent sites of fragility fractures are the hip, the distal radius, the spine, the proximal humerus, and the ankle. In most cases, a surgical approach with subsequent rehabilitative treatment is required. The general aims of rehabilitation are to increase functioning and improve patients' activities, participation level, and quality of life.

LOW-TRAUMATIC FRACTURES IN PATIENTS WITH ENDOGENOUS HYPERCORTISOLISM. PREDICTORS AND RISK FACTORS, THE IMPACT ON QUALITY OF LIFE

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Zh E Belaya

2013-12-01

Full Text Available The objective of this study was to investigate the prevalence of low traumatic fractures, the factors influencing fractures in endogenous Cushing’s syndrome (CS of various etiologies and their contributions into functional abilities and quality of life in patients with CS. Materials and methods: the retrospective data of patients, who had received treatment due to endogenous CS, (2001-2011, was evaluated. All enrolled patients underwent standard spinal radiographs in lateral positions of the vertebrae Th4-L4. Recent low traumatic non-vertebral fractures were recorded in the medical cards. Bone mineral density (BMD was measured by DXA GE Lunar Prodigy. Serum samples on octeocalcin (OC, carboxyterminal cross-linked telopeptide of type I collagen (CTx, latenight cortisol in serum were assayed by electrochemiluminescence (ECLIA. 24h urinary free cortisol (24hUFC was measured by an immunochemiluminescence assay (extraction with diethyl ether. Functional assessment was performed using «chair rising», «up and go» and «tandem» tests. Universal pain assessment tool (verbal descriptor scale, Wong-Baker facial grimace scale, activity tolerance scale, EQ-5D and ECOS-16 questionnaires were given to patients and they self-reported their conditions. Results: Among 215 patients, 178 were females and 37 males, median age 35 (Q25-Q75 27-48; 88patients (40,9% had low traumatic fractures, including vertebral fractures in 76 cases (in 60 cases multiple vertebral fractures and non-vertebral fractures in 27 cases (17 patients had rib fractures, 3 -fractures of metatarsal bones, 2 fractures of radius, 2 fractures of tibia and fibula, 1 humerus, 1 breastbone; 1 hip fracture. Patients with fractures had higher 24hUFC, late-night cortisol in serum, lower OC, Total Hip BMD, but did not differ in age, BMI, CTx or etiology of CS. After applying the logistic regression analysis (adjusted for sex, age, BMI, BMD, OC, the main predictor of fractures was late-night serum

Effective management of bone fractures with the IlluminOss® photodynamic bone stabilization system: initial clinical experience from the European Union registry

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Thomas Gausepohl

2017-02-01

Full Text Available The IlluminOss® system (IS uses a light-curable polymer contained within an inflatable balloon catheter, forming a patient customized intramedullary implant. A registry was established in Germany and The Netherlands to prospectively collect technical and clinical outcomes in patients treated with IS for fractures of the phalange, metacarpal, radius, ulna, distal radius, fibula, clavicle and/or olecranon. Humeral, femoral, tibial and pelvic fractures were included under compassionate use. Procedural success included successful placement of the device at the target fracture site and achievement of fracture stabilization. Clinical and radiographic assessments were made postoperatively through 12 months. One hundred thirty two patients (149 fractures were enrolled with most fractures (85% resulting from low-energy trauma. Simple fractures predominated (47% followed by complex (23% and wedge (16% fractures. Procedural success was achieved in all patients and no implants required removal or revision. Normal range of motion was realized in 87% of fractures. Radiographically, there was substantial cortical bridging, total dissolution of the fracture line, and complete fracture healing. Across a variety of fracture types, the IS provides a safe and effective approach for rapid healing and functional recovery.

Evaluation of an Image-Based Tool to Examine the Effect of Fracture Alignment and Joint Congruency on Outcomes after Wrist Fracture.

Science.gov (United States)

Lalone, Emily A; Grewal, Ruby; King, Graham W; MacDermid, Joy C

2015-01-01

Some mal-alignment of the wrist occurs in up to 71% of patients following a distal radius fracture. A multiple case study was used to provide proof of principle of an image-based technique to investigate the evolution and impact of post-traumatic joint changes at the distal radioulnar joint. Participants who had a unilateral distal radius fracture who previously participated in a prospective study were recruited from a single tertiary hand center. Long term follow-up measures of pain, disability, range of motion and radiographic alignment were obtained and compared to joint congruency measures. The inter-bone distance, a measure of joint congruency was quantified from reconstructed CT bone models of the distal radius and ulna and the clinical outcome was quantified using the patient rated wrist evaluation. In all four cases, acceptable post-reduction alignment and minimal pain/disability at 1-year suggested good clinical outcomes. However, 10 years following injury, 3 out of 4 patients had radiographic signs of degenerative changes occurring in their injured wrist (distal radioulnar joint/radio-carpal joint). Proximity maps displaying inter-bone distances showed asymmetrical congruency between wrists in these three patients. The 10-year PRWE (patient rated wrist evaluation) varied from 4 to 60, with 3 reporting minimal pain/disability and one experiencing high pain/disability. These illustrative cases demonstrate long-term joint damage post-fracture is common and occurs despite positive short-term clinical outcomes. Imaging and functional outcomes are not necessarily correlated. A novel congruency measure provides an indicator of the overall impact of joint mal-alignment that can be used to determine predictors of post-traumatic arthritis and is viable for clinical or large cohort studies.

Injuries of the scapholunate and lunotriquetral ligaments as well as the TFCC in intra-articular distal radius fractures. Prevalence assessed with MDCT arthrography

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Klempka, A.; Wagner, M.; Fodor, S.; Schmitt, R. [Cardiovascular Center Bad Neustadt an der Saale, Department of Diagnostic and Interventional Radiology, Bad Neustadt an der Saale (Germany); Prommersberger, K.J. [Clinic for Hand Surgery, Bad Neustadt an der Saale (Germany); Uder, M. [Friedrich-Alexander-University Erlangen-Nuernberg (FAU), Department of Diagnostic Radiology, Erlangen (Germany)

2016-03-15

To evaluate the prevalence of injuries of the scapholunate and lunotriquetral interosseous ligaments (SLIL, LTIL) as well as the triangular fibrocartilage complex (TFCC) in intra-articular distal radius fractures (iaDRF). Two hundred and thirty-three patients with acute iaDRF underwent MDCT arthrography. The SLIL and LTIL were described as normal, partially or completely ruptured. Major injuries of the SLIL were defined as completely ruptured dorsal segments, those of the LTIL as completely ruptured palmar segments. The TFCC was judged as normal or injured. Interobserver variability was calculated. Injury findings were correlated with the types of iaDRF (AO classification). In 159 patients (68.2 %), no SLIL injuries were seen. Minor SLIL injuries were detected in 54 patients (23.2 %), major injuries in 20 patients (8.6 %). No correlation was found between the presence of SLIL lesions and the types of iaDRF. Minor LTIL injuries were seen in 23 patients (9.9 %), major injuries in only 5 patients (2.2 %). The TFCC was altered in 141 patients (60.5 %). Interobserver variability was high for MDCT arthrography in assessing SLIL and TFC lesions, and fair for LTIL lesions. In iaDRF, prevalence of major injuries of the most relevant SLIL is about 9 % as evaluated with CT arthrography. (orig.)

Equine ulnar fracture repair with locking compression plates can be associated with inadvertent penetration of the lateral cortex of the radius.

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Kuemmerle, Jan M; Kühn, Karolin; Bryner, Marco; Fürst, Anton E

2013-10-01

To evaluate if the use of locking head screws (LHS) in the distal holes of a locking compression plate (LCP) applied to the caudal aspect of the ulna to treat equine ulnar fractures is associated with a risk of injury to the lateral cortex of the radius. Controlled laboratory study. Cadaveric equine forelimbs (n = 8 pair). After transverse ulnar osteotomy, osteosynthesis was performed with a narrow 10-13 hole 4.5/5.0 LCP applied to the caudal aspect of each ulna. The distal 3 holes were filled with 4.5 mm cortex screws (CS) in 1 limb (group 1) and with 5.0 mm LHS contralaterally (group 2). CS were inserted in an angle deemed appropriate by the surgeon and LHS were inserted perpendicular to the plate. Implant position and injury to the lateral cortex of the radius were assessed by radiography, CT, and limb dissection. In group 1, injury of the lateral radius cortex did not occur. In group 2, 4 limbs and 6/24 LHS were associated with injury of the lateral radius cortex by penetration of a LHS. This difference was statistically significant. CS were inserted with a mean angle of 17.6° from the sagittal plane in a caudolateral-craniomedial direction. Use of LHS in the distal part of a LCP applied to the caudal aspect of the ulna is associated with a risk of inadvertent injury to the lateral cortex of the radius. © Copyright 2013 by The American College of Veterinary Surgeons.

Fragility non-hip fracture patients are at risk.

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Gosch, M; Druml, T; Nicholas, J A; Hoffmann-Weltin, Y; Roth, T; Zegg, M; Blauth, M; Kammerlander, C

2015-01-01

Fragility fractures are a growing worldwide health care problem. Hip fractures have been clearly associated with poor outcomes. Fragility fractures of other bones are common reasons for hospital admission and short-term disability, but specific long-term outcome studies of non-hip fragility fractures are rare. The aim of our trial was to evaluate the 1-year outcomes of non-hip fragility fracture patients. This study is a retrospective cohort review of 307 consecutive older inpatient non-hip fracture patients. Patient data for analysis included fracture location, comorbidity prevalence, pre-fracture functional status, osteoporosis treatments and sociodemographic characteristics. The main outcomes evaluated were 1-year mortality and post-fracture functional status. As compared to the expected mortality, the observed 1-year mortality was increased in the study group (17.6 vs. 12.2 %, P = 0.005). After logistic regression, three variables remained as independent risk factors for 1-year mortality among non-hip fracture patients: malnutrition (OR 3.3, CI 1.5-7.1), Charlson comorbidity index (CCI) (OR 1.3, CI 1.1-1.5) and the Parker Mobility Score (PMS) (OR 0.85, CI 0.74-0.98). CCI and PMS were independent risk factors for a high grade of dependency after 1 year. Management of osteoporosis did not significantly improve after hospitalization due to a non-hip fragility fracture. The outcomes of older non-hip fracture patients are comparable to the poor outcomes of older hip fracture patients, and appear to be primarily related to comorbidities, pre-fracture function and nutritional status. The low rate of patients on osteoporosis medications likely reflects the insufficient recognition of the importance of osteoporosis assessment and treatment in non-hip fracture patients. Increased clinical and academic attention to non-hip fracture patients is needed.

HIP FRACTURES IN THE ELDERLY PATIENT

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Franci Koglot

2001-11-01

Full Text Available Background. Hip fractures are typical of the ageingpopulation. They represent a severe trauma for the elderlypatient due to significant impact on life quality and morbidity.We analyzed the characteristics of patients with hip fractures,the methods and success of treatment. In conclusion, theimportance of continuous team approach and surgical treatmentwithin 24 hours are stressed. Methods. We retrospectively evaluated patients admitted forfemoral neck and intertrochanteric fractures between 1994–1999. The incidence of these fractures, patient age and sex, comorbidity,methods of treatment, hospital stay and success oftreatment with regard to ambulatory status were established.Results. 662 patients were treated in the above mentioned period,yielding a 1‰ annual incidence for the choosen population.The mean patient age was 76 years; there were 426 female(64% and 236 male patients (36%. 336 patients (51%had a history of accompanying disease, in 73 patients (11%additional fractures were diagnosed. 30 patients (4.5% weretreated conservatively, 632 (95.5% underwent surgery. Themean hospital stay length was 17 days. Success of treatmentwas evaluated as good in 441 patients (67%, satisfactory in112 patients (17% and poor in 78 patients (12%. 31 patients(5% died during hospital admission. Conclusions. Patients with hip fractures represent 10% of allin-hospital trauma patients; with hospital stays twice as longas average trauma patients and considering the financial demandsof surgical treatment they are a challenge in traumawards organization and management in the Slovenian environment.Here as well as abroad the number of these patientsis increasing, along with their mean age and co-morbidity. Itis evident that hip fractures, regardless the way of treatment,implicate a partial or complete loss of ambulancy and henceloss of life-quality in one-third of patients. We advise early aspossible surgery –within 24 h– where not absolutely

Isolated rib fractures in geriatric patients

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Elmistekawy, Elsayed M.; Hammad, Abd Almohsen M.

2007-01-01

Introduction: The goal of this study was to investigate the short-term outcomes in patients older than 60 years with isolated rib fractures and admitted to emergency hospital. Materials and Methods: This study included patients who were 60 years old or more and sustained blunt chest injury and had isolated rib fractures. The following data were obtained from the medical records: age, gender, number of fracture ribs, side of fracture ribs, mechanism and nature of injury, preexisting medical...

Hip fracture in hospitalized medical patients.

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Zapatero, Antonio; Barba, Raquel; Canora, Jesús; Losa, Juan E; Plaza, Susana; San Roman, Jesús; Marco, Javier

2013-01-08

The aim of the present study is to analyze the incidence of hip fracture as a complication of admissions to internal medicine units in Spain. We analyzed the clinical data of 2,134,363 adults who had been admitted to internal medicine wards. The main outcome was a diagnosis of hip fracture during hospitalization.Outcome measures included rates of in-hospital fractures, length of stay and cost. A total of 1127 (0.057%) admittances were coded with an in-hospital hip fracture. In hospital mortality rate was 27.9% vs 9.4%; p patients with a hip fracture (20.7 days vs 9.8 days; p hip-fracture patients (6927€ per hospitalization vs 3730€ in non fracture patients). Risk factors related to fracture were: increasing age by 10 years increments (OR 2.32 95% CI 2.11-2.56), female gender (OR 1.22 95% CI 1.08-1.37), admission from nursing home (OR 1.65 95% CI 1.27-2.12), dementia (1.55 OR 95% CI1.30-1.84), malnutrition (OR 2.50 95% CI 1.88-3.32), delirium (OR 1.57 95% CI 1.16-2.14), and anemia (OR 1.30 95%CI 1.12-1.49). In-hospital hip fracture notably increased mortality during hospitalization, doubling the mean length of stay and mean cost of admission. These are reasons enough to stress the importance of designing and applying multidisciplinary plans focused on reducing the incidence of hip fractures in hospitalized patients.

Late leaflet fracture and embolization of a Duromedics mitral prosthesis.

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Sudo, K; Sasagawa, N; Ide, H; Nunokawa, M; Fujiki, T; Tonari, K

2000-08-01

A case of leaflet fracture and embolization of a mitral prosthetic valve is described. A 54-year-old man had received mitral valve replacement with an Edwards-Duromedics 29M prosthetic valve, at 10 years ago. Emergency mitral valve replacement was performed because the patient had severe congestive left heart failure with severe acute mitral regurgitation caused by a fracture in one of the mitral valve leaflets. The leaflet, which was fractured into 2 pieces, was removed from the right common iliac artery at 3 months after valve replacement. Visual inspection revealed that the leaflet contained a midline fracture. The fracture originated within a cavitary erosion pit near the major radius of the leaflet. The patient recovered from acute renal failure, requiring hemodialysis for 80 days, and is currently without complaints. We have used a Duromedics mitral valve in 11 patients, from April 1987 to April 1988. No subsequent valve failure has occurred. The diagnosis, treatment and cause of a mechanical valve fracture are discussed.

Full title: Biomechanical comparison between stainless steel, titanium and carbon-fiber reinforced polyetheretherketone volar locking plates for distal radius fractures.

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Mugnai, Raffaele; Tarallo, Luigi; Capra, Francesco; Catani, Fabio

2018-05-25

As the popularity of volar locked plate fixation for distal radius fractures has increased, so have the number and variety of implants, including variations in plate design, the size and angle of the screws, the locking screw mechanism, and the material of the plates. carbon-fiber reinforced polyetheretherketone (CFR-PEEK) plate features similar biomechanical properties to metallic plates, representing, therefore, an optimal alternative for the treatment of distal radius fractures. three different materials-composed plates were evaluated: stainless steel volar lateral column (Zimmer); titanium DVR (Hand Innovations); CFR-PEEK DiPHOS-RM (Lima Corporate). Six plates for each type were implanted in sawbones and an extra-articular rectangular osteotomy was created. Three plates for each material were tested for load to failure and bending stiffness in axial compression. Moreover, 3 constructs for each plate were evaluated after dynamically loading for 6000 cycles of fatigue. the mean bending stiffness pre-fatigue was significantly higher for the stainless steel plate. The titanium plate yielded the higher load to failure both pre and post fatigue. After cyclic loading, the bending stiffness increased by a mean of 24% for the stainless steel plate; 33% for the titanium; and 17% for the CFR-PEEK plate. The mean load to failure post-fatigue increased by a mean of 10% for the stainless steel and 14% for CFR-PEEK plates, whereas it decreased (-16%) for the titanium plate. Statistical analysis between groups reported significant values (p plastic deformation, and lower load to failure. N/A. Copyright © 2018. Published by Elsevier Masson SAS.

[Clinical pathway for hip fracture patients].

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Sáez López, Pilar; Sánchez Hernández, Natalia; Paniagua Tejo, Sonsoles; Valverde García, José Antonio; Montero Díaz, Margarita; Alonso García, Noelia; Freites Esteve, Alfonso

2015-01-01

Hip fracture in the elderly often occurs in patients with high co-morbidity. Effective management requires a comprehensive and multidisciplinary approach. To evaluate the effect of a quality improvement intervention in the detection and treatment of complications in elderly patients admitted for hip fracture. A comparative study was conducted between two groups of patients admitted for hip fracture prior to 2010, and after a quality improvement intervention in 2013. The intervention consisted of implementing improved multidisciplinary measures in accordance with recent scientific evidence. The degree of compliance of the implemented measures was quantified. Patients admitted due to hip fracture in 2010 (216 patients) and 2013 (196 patients) were similar in age, sex, Barthel Index, and a reduced Charlson Index, although there were more comorbidities in 2013. After implementation of the protocols, the detection of delirium, malnutrition, anemia, and electrolyte disturbances increased. A larger number of patients in 2013 were precribed intravenous iron (24% more) and osteoporosis treatment (61.3% more). The average stay was reduced by 45.3% and surgical delay by 29.4%, achieving better functional efficiency. The implementation of a clinical pathway in geriatric patients with hip fracture is useful to detect and treat complications at an early stage, and to reduce pre-operative and overall stay, all without a negative clinical or functional impact. Copyright © 2014 SEGG. Published by Elsevier Espana. All rights reserved.

Screw elastic intramedullary nail for the management of adult forearm fractures

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Wasudeo Gadegone

2012-01-01

Full Text Available Background: The failure of the conventional nailing of both forearm bones or isolated fractures of radius and ulna pose a potential problem of nail migration and rotational instability, despite the best reduction. The purpose of this paper is to evaluate the results of screw elastic intramedullary nail for the treatment of adult diaphyseal fractures of both forearm bones, which effectively addresses the problems associated with the conventional nailing systems for the forearm fractures. Materials and Methods: Seventy-six adults with forearm fractures (radius and ulna or isolated fracture of the single bone were retrospectively evaluated. Fifty males and 26 females with the mean age of 38 years (range, 18-70 years underwent closed reduction and screw intramedullary nail fixation. Ten patients required limited open reduction. The fractures were classified according to the AO/OTA system. The average followup was 12 months (range, 6 to 18 months. Results: The mean surgical time was 45 minutes (35 to 65 minutes. The meantime to union was 14 weeks (10-21 weeks. The results were graded as excellent in 50, good in 18 patients, and acceptable in eight patients, using the criteria of Grace and Eversman. We had superficial infection in three cases, one case of delayed infection, painful bursa in two cases, delayed union in two cases, malunion with dislocation of the DRUJ in two cases, injury to the extensor tendon of the thumb in one case, and one case of incomplete radioulnar synostosis. Conclusion: Closed reduction and internal fixation of forearm fractures by screw intramedullary nails reestablishes the near normal relationship of the fractured fragments. Screw intramedullary nail effectively controls both rotatory forces and the migration of the nail. It produces excellent clinical results in isolated fractures of either bones, as well as both bones of the forearm in adults.

Computer-assisted versus non-computer-assisted preoperative planning of corrective osteotomy for extra-articular distal radius malunions: a randomized controlled trial

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Stockmans Filip

2010-12-01

Full Text Available Abstract Background Malunion is the most common complication of distal radius fracture. It has previously been demonstrated that there is a correlation between the quality of anatomical correction and overall wrist function. However, surgical correction can be difficult because of the often complex anatomy associated with this condition. Computer assisted surgical planning, combined with patient-specific surgical guides, has the potential to improve pre-operative understanding of patient anatomy as well as intra-operative accuracy. For patients with malunion of the distal radius fracture, this technology could significantly improve clinical outcomes that largely depend on the quality of restoration of normal anatomy. Therefore, the objective of this study is to compare patient outcomes after corrective osteotomy for distal radius malunion with and without preoperative computer-assisted planning and peri-operative patient-specific surgical guides. Methods/Design This study is a multi-center randomized controlled trial of conventional planning versus computer-assisted planning for surgical correction of distal radius malunion. Adult patients with extra-articular malunion of the distal radius will be invited to enroll in our study. After providing informed consent, subjects will be randomized to two groups: one group will receive corrective surgery with conventional preoperative planning, while the other will receive corrective surgery with computer-assisted pre-operative planning and peri-operative patient specific surgical guides. In the computer-assisted planning group, a CT scan of the affected forearm as well as the normal, contralateral forearm will be obtained. The images will be used to construct a 3D anatomical model of the defect and patient-specific surgical guides will be manufactured. Outcome will be measured by DASH and PRWE scores, grip strength, radiographic measurements, and patient satisfaction at 3, 6, and 12 months

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

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

2013-01-01

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

Isolated rib fractures in geriatric patients

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Elmistekawy Elsayed

2007-01-01

Full Text Available Introduction: The goal of this study was to investigate the short-term outcomes in patients older than 60 years with isolated rib fractures and admitted to emergency hospital. Materials and Methods: This study included patients who were 60 years old or more and sustained blunt chest injury and had isolated rib fractures. The following data were obtained from the medical records: age, gender, number of fracture ribs, side of fracture ribs, mechanism and nature of injury, preexisting medical conditions, complications, admission to intensive care unit (ICU, need for mechanical ventilation, length of ICU and hospital stay and mortality. Results: For the study, 39 patients who were 60 years old or more and admitted to the hospital because of isolated rib fractures were enrolled. There were 28 males (71.7% and 11 females (28.3% with mean age of (66.84 ± 4.7 years. No correlation was found between comorbidities and hospital outcomes except in those who were diabetic (P-value = 0.005 and those with chronic lung disease (P-value = 0.006. Pulmonary complications were the most frequent complications encountered in those patients. Pulmonary complications were: lung contusion in 8 patients (20.5% and pulmonary infection in 6 patients (15.8%. Conclusion: Elderly patients sustaining blunt chest trauma had significant morbidity and potential for mortality.

Subtrochanteric fractures in bisphosphonate-naive patients

DEFF Research Database (Denmark)

Adachi, Jonathan D; Lyles, Kenneth; Boonen, Steven

2011-01-01

Our purpose was to characterize the risks of osteoporosis-related subtrochanteric fractures in bisphosphonate-naive individuals. Baseline characteristics of patients enrolled in the HORIZON-Recurrent Fracture Trial with a study-qualifying hip fracture were examined, comparing those who sustained ...

Profile and procedures for fractures among 1323 fracture patients from the 2010 Yushu earthquake, China.

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Kang, Peng; Tang, Bihan; Liu, Yuan; Liu, Xu; Shen, Yan; Liu, Zhipeng; Yang, Hongyang; Zhang, Lulu

2016-11-01

The injuries caused by earthquakes are often complex and of various patterns. Our study included all fracture inpatients from the Yushu earthquake (1323 in total), to learn more about the incidence and distribution of fractures during earthquakes. A retrospective study of the clinical characteristics of hospitalized fracture patients after the 2010 Yushu earthquake was conducted from December 20 to 25, 2010.We reviewed medical records of hospitalized patients who had been evacuated from the Yushu earthquake area between April 14 and June 15, 2010, from 57 hospitals, and also reviewed more than 100 documents assembled from daily medical rescue and disease prevention reports submitted by the frontline rescue organizations. In total, 78.0% of fracture patients were admitted to the hospital within 3 days after the earthquake. There were 1323 patients who presented with 1539 fractures. The most common fracture occurred in the lower limbs, followed by spinal, pelvic, and shoulder-upper limb fractures. The end of the thoracic vertebra and the lumbar vertebra were the high-risk sites for vertebral fractures. A total of 38 patients became paraplegic. A 2-level spatial clustering was detected among the 193 patients presenting with 2 fractures. Analysis profiles of the injuries and clinical features of patients with earthquake-related fractures will positively impact rescue efforts and the treatment of fracture injuries caused by possible future natural disasters. We should assemble orthopedic-related medications and surgical equipment, and allocate them promptly after a major earthquake. Copyright © 2016 Elsevier Inc. All rights reserved.

Early functional postoperative therapy of distal radius fracture with a dynamic orthosis: results of a prospective randomized cross-over comparative study.

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Fabian M Stuby

Full Text Available This study was conducted according to GCP criteria as a prospective randomized cross-over study. The primary goal of the study was to determine clinical findings and patient satisfaction with postoperative treatment. 29 patients with a distal radius fracture that was surgically stabilized from volar and who met the inclusion criteria were enrolled over a 12-month period. Each patient randomly received either a dorsal plaster splint or a vacuum-fit flexible but blocked orthosis applied postoperatively in the operating theatre to achieve postoperative immobilization. After one week all patients were crossed over to the complementary device maintaining the immobilization until end of week 2. After week 2 both groups were allowed to exercise wrist mobility with a physiotherapist, in the orthosis group the device was deblocked, thus allowing limited wrist mobility. After week 4 the devices were removed in both groups. Follow-up exams were performed after postoperative weeks 1, 2, 4 and 12.Results were determined after week 1 and 2 using SF 36 and a personally compiled questionnaire; after weeks 4 and 12 with a clinical check-up, calculation of ROM and the DASH Score. Comparison of the two groups showed a significant difference in ROM for volar flexion after 4 weeks, but no significant differences in DASH Score, duration of disability or x-ray findings. With regard to satisfaction with comfort and hygiene, patients were significantly more satisfied with the dynamic orthosis, and 23 of the 29 patients would prefer the flexible vacuum orthosis in future.German Clinical Trials Register (DRKS DRKS00006097.

Clinical Utility of Chest Computed Tomography in Patients with Rib Fractures CT Chest and Rib Fractures.

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Chapman, Brandon C; Overbey, Douglas M; Tesfalidet, Feven; Schramm, Kristofer; Stovall, Robert T; French, Andrew; Johnson, Jeffrey L; Burlew, Clay C; Barnett, Carlton; Moore, Ernest E; Pieracci, Fredric M

2016-12-01

Chest CT is more sensitive than a chest X-ray (CXR) in diagnosing rib fractures; however, the clinical significance of these fractures remains unclear. The purpose of this study was to determine the added diagnostic use of chest CT performed after CXR in patients with either known or suspected rib fractures secondary to blunt trauma. Retrospective cohort study of blunt trauma patients with rib fractures at a level I trauma center that had both a CXR and a CT chest. The CT finding of ≥ 3 additional fractures in patients with ≤ 3 rib fractures on CXR was considered clinically meaningful. Student's t-test and chi-square analysis were used for comparison. We identified 499 patients with rib fractures: 93 (18.6%) had CXR only, 7 (1.4%) had chest CT only, and 399 (79.9%) had both CXR and chest CT. Among these 399 patients, a total of 1,969 rib fractures were identified: 1,467 (74.5%) were missed by CXR. The median number of additional fractures identified by CT was 3 (range, 4 - 15). Of 212 (53.1%) patients with a clinically meaningful increase in the number of fractures, 68 patients underwent one or more clinical interventions: 36 SICU admissions, 20 pain catheter placements, 23 epidural placements, and 3 SSRF. Additionally, 70 patients had a chest tube placed for retained hemothorax or occult pneumothorax. Overall, 138 patients (34.5%) had a change in clinical management based upon CT chest. The chest X-ray missed ~75% of rib fractures seen on chest CT. Although patients with a clinical meaningful increase in the number of rib fractures were more likely to be admitted to the intensive care unit, there was no associated improvement in pulmonary outcomes.

CT findings in patient with skull fractures

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Jo, Han Gi; Suh, Won Hyuck [Korea University College of Medicine, Seoul (Korea, Republic of)

1988-12-15

CT scan has been inevitable method for patient with head trauma. CT scans of 94 cases, which were confirmed skull fracture by plain film, were reviewed for better and useful dealing of CT. The results were as follows: 1. Car accident was the most frequent cause of head injury. 2. No evidence of intracranial abnormality in CT scan of skull fractures on plane film was 45.7%, and alert mentality was 46.8% of skull fracture on skull fracture on simple film. 3. Detection rate on CT scan to skull fractures was 27.7%, but detection rate to depression fractures of skull fracture was 70.2%. 4. Mortality rate of patients with skull fracture was 10.6%. 5. Associated CT findings were pneumocephalus on CT scan 3.2%, contusion of edema 4.2%, epidural hematoma 16.0%, subdural hematoma 17.0%, subdural hygroma 2.1%, intracerebral hemorrhage 4.9%, and subarachnoid hemorrhage 2.0%.

A position statement of the Traumatology Society of Slovenia on the treatment of fragility fractures of the pelvic ring

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Drago Brilej

2016-11-01

Full Text Available Because of the ageing crisis in western world the fragility fractures of the pelvic ring joint the big four group of typical fractures in osteoporotic elderly patients: fractures of the proximal femur, fractures of the proximal humerus, fractures of the distal radius and thoracic and lumbar low energy spinal fractures. All these fractures are the result of low energy with the typical fall of the patient from the standing height. The Slovenian recommendations include Rommens classification for non-displaced and displaced fractures of the anterial and posterial pelvic ring with the operative indications. The recommendations were launched at the Slovenian society of trauma surgeons meeting in November 7th, 2015.

Pressure ulcer risk in hip fracture patients

NARCIS (Netherlands)

Houwing, R. H.; Rozendaal, M; Wouters-Wesseling, W; Buskens, E.; Keller, P; Haalboom, JRE

Hip fracture patients have a high risk of pressure ulcers (PU). We followed 121 hip fracture patients for the development of pressure ulcers and evaluated a risk assessment tool for sensitivity and specificity. More than half of the patients presented with PU, mostly stage I. Risk factors for PU

Diagnosis and Treatment of Osteoporosis Before and After Fracture: A Side-by-Side Analysis of Commercially Insured and Medicare Advantage Osteoporosis Patients.

Science.gov (United States)

Weaver, Jessica; Sajjan, Shiva; Lewiecki, E Michael; Harris, Steven T

2017-07-01

) in the Commercial group. Pre-index treatment rates were similarly low, ranging from 9.4% (hip) to 16.6% (vertebral) among Medicare patients, and 7.5% (NHNV) to 14.4% (vertebral) in Commercial patients. Osteoporosis treatment rates improved significantly in the postfracture year, ranging from 12.5% (NHNV) to 26.5% (vertebral) among Medicare patients, and 8.3% (NHNV) to 21.4% (vertebral) in Commercial patients. Larger increases in diagnosis rates and smaller increases in treatment rates were observed in stratified analyses of men and women and of different age groups, with women and older patients having higher overall rates of diagnosis and treatment before and after fracture. In men and women, osteoporosis diagnosis rates were low before the index fracture and improved substantially after the fracture, yet still remained low overall (under 50%). Osteoporosis treatment rates among patients experiencing a fracture were low before the index fracture and improved only minimally afterwards. This study was funded by Merck & Co. Other than through the employer relationship disclosed here, Merck & Co. did not have a role in the study design, data collection, interpretation of the data, in writing of the manuscript, or in the decision to submit the manuscript for publication. Weaver is an employee of Merck & Co. Sajjan was an employee of Merck & Co. and owned stock in the company at the time of the study. Lewiecki has received consulting and/or speaker honoraria from Merck & Co., AbbVie, AgNovos Healthcare, Alexion Pharmaceuticals, Amgen, Eli Lilly and Company, Radius Health, Shire, and TheraNova, along with research grant support from Merck & Co., Amgen, and Eli Lilly and Company, and serves as a board member for the National Osteoporosis Foundation, the International Society for Clinical Densitometry, and the Osteoporosis Foundation of New Mexico. Harris has received consulting honoraria from Merck & Co., Alexion Pharmaceuticals, Amgen, Eli Lilly and Company, Gilead

The influence of renal dialysis and hip fracture sites on the 10-year mortality of elderly hip fracture patients

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Hung, Li-Wei; Hwang, Yi-Ting; Huang, Guey-Shiun; Liang, Cheng-Chih; Lin, Jinn

2017-01-01

Abstract Hip fractures in older people requiring dialysis are associated with high mortality. Our study primarily aimed to evaluate the specific burden of dialysis on the mortality rate following hip fracture. The secondary aim was to clarify the effect of the fracture site on mortality. A retrospective cohort study was conducted using Taiwan's National Health Insurance Research Database to analyze nationwide health data regarding dialysis and non-dialysis patients ≥65 years who sustained a first fragility-related hip fracture during the period from 2001 to 2005. Each dialysis hip fracture patient was age- and sex-matched to 5 non-dialysis hip fracture patients to construct the matched cohort. Survival status of patients was followed-up until death or the end of 2011. Survival analyses using multivariate Cox proportional hazards models and the Kaplan-Meier estimator were performed to compare between-group survival and impact of hip fracture sites on mortality. A total of 61,346 hip fracture patients were included nationwide. Among them, 997 dialysis hip fracture patients were identified and matched to 4985 non-dialysis hip fracture patients. Mortality events were 155, 188, 464, and 103 in the dialysis group, and 314, 382, 1505, and 284 in the non-dialysis group, with adjusted hazard ratios (associated 95% confidence intervals) of 2.58 (2.13–3.13), 2.95 (2.48–3.51), 2.84 (2.55–3.15), and 2.39 (1.94–2.93) at 0 to 3 months, 3 months to 1 year, 1 to 6 years, and 6 to 10 years after the fracture, respectively. In the non-dialysis group, survival was consistently better for patients who sustained femoral neck fractures compared to trochanteric fractures (0–10 years’ log-rank test, P fractures was better than that of patients with trochanteric fractures only within the first 6 years post-fracture (0–6 years’ log-rank, P fracture patients. Survival outcome was better for non-dialysis patients with femoral neck fractures compared to those with

Vertebral artery injury in patients with isolated transverse process fractures.

Science.gov (United States)

Bonney, Phillip A; Burks, Joshua D; Conner, Andrew K; Glenn, Chad A; Baker, Cordell M; Cheema, Ahmed A; Archer, Jacob B; Buster, Bryan E; Albrecht, Roxie M; Bohnstedt, Bradley N

2017-07-01

We sought to assess the rate of CTA-diagnosed vertebral artery injury in patients with isolated transverse process fractures, with and without extension into the transverse foramen, in the blunt-trauma population served by our hospital. We queried our universities trauma registry between January 2009 and July 2014 for ICD-9 codes pertaining to cervical spine fractures. Of 330 patients identified, 45 patients had fractures limited to the transverse process and were selected for the study population. For each patient identified, demographics, injury mechanism, imaging reports, angiography findings, and treatments were recorded. In total, 69 fractures were identified in 45 patients. Of the 45 patients, 15 (33%) had transverse process fractures at multiple cervical levels. 23/45 (51%) patients had at least one fracture extending into TF. Four patients with transverse process fractures and one patient without transverse process fractures were diagnosed with vertebral artery injury by CT angiogram (17.4% vs. 4.5%, p=0.35). The number of transverse process fractures in patients with VAI was greater than those without VAI (3.0 vs. 1.4, p<0.001). None of the 30 patients with any one-level TPF (with or without extension into TF) was diagnosed with VAI (p=0.003). None of 17 patients with isolated C7-level TPFs were diagnosed with VAI (p=0.15). The incidence of cervical VAI was greater in patients with multiple-level TPFs than in patients with single-level TPFs. While patients with a single, isolated TPF have a low probability of VAI, patients with numerous TPF fractures may benefit from CTA. Copyright © 2017 Elsevier Ltd. All rights reserved.

Increased fracture risk assessed by fracture risk assessment tool in Greek patients with Crohn's disease.

Science.gov (United States)

Terzoudis, Sotirios; Zavos, Christos; Damilakis, John; Neratzoulakis, John; Dimitriadi, Daphne Anna; Roussomoustakaki, Maria; Kouroumalis, Elias A; Koutroubakis, Ioannis E

2013-01-01

The World Health Organization has recently developed the fracture risk assessment tool (FRAX) based on clinical risk factors and bone mineral density (BMD) for evaluation of the 10-year probability of a hip or a major osteoporotic fracture. The aim of this study was to evaluate the use of the FRAX tool in Greek patients with inflammatory bowel disease (IBD). FRAX scores were applied to 134 IBD patients [68 Crohn's disease (CD); 66 ulcerative colitis (UC)] who underwent dual-energy X-ray absorptiometry scans at the femoral neck and lumbar spine during the period 2007-2012. Calculation of the FRAX scores, with or without BMD, was made through a web-based probability model used to compute individual fracture probabilities according to specific clinical risk factors. The median 10-year probability of a major osteoporotic fracture for IBD patients based on clinical data was 7.1%, and including the BMD was 6.2%. A significant overestimation with the first method was found (P = 0.01). Both scores with and without BMD were significantly higher in CD patients compared with UC patients (P = 0.02 and P = 0.005, respectively). The median 10-year probability of hip fracture based on clinical data was 0.8%, and including the BMD was 0.9%. The score with use of BMD was significantly higher in CD compared with UC patients (P = 0.04). CD patients have significantly higher FRAX scores and possibly fracture risk compared with UC patients. The clinical FRAX score alone seems to overestimate the risk of osteoporotic fracture in Greek IBD patients.

Non union of the neck of radius: a case report and review of the ...

African Journals Online (AJOL)

Fractures of the neck of radius are frequent in trauma. They happen without being noticed at the moment of injury of the elbow or in the context of polytrauma. A case of non union of the radius neck occurring in a young person due to ignorance, during first consultation has been reported by the authors. They insist on the ...

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

Directory of Open Access Journals (Sweden)

Shota Ikegami

2009-10-01

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

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

Science.gov (United States)

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

2009-10-10

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

Patients with eating disorders. A high-risk group for fractures

DEFF Research Database (Denmark)

Vestergaard, Peter; Emborg, C.; Stoving, R.K.

2003-01-01

PURPOSE: To analyze fracture risk and bone mineral density in patients with eating disorders (anorexia nervosa, bulimia nervosa, and other eating disorders). DESIGN: Clinical overview. FINDINGS: Bone mineral density is decreased and fracture risk increased in patients with anorexia nervosa....... In patients with bulimia nervosa, bone mineral is only marginally decreased and fracture risk marginally increased. In patients with other eating disorders (eating disorders not otherwise specified), bone mineral density is decreased and fracture risk increased. CONCLUSIONS: Fracture risk is increased...

Factors affecting functional prognosis of patients with hip fracture

DEFF Research Database (Denmark)

Kristensen, M T

2011-01-01

to just one or two single factors. The current article reviews important factors affecting the functional prognosis, and clinicians are encouraged to include all factors potentially influencing the outcome of patients with hip fracture in their individualised treatment and rehabilitation plan. Especially......Having a hip fracture is considered one of the most fatal fractures for elderly people, resulting in impaired function, and increased morbidity and mortality. This challenges clinicians in identifying patients at risk of worse outcome, in order to optimise and intensify treatment in these patients....... A variety of factors such as age, prefracture function and health status, fracture type, pain, anaemia, muscle strength, and the early mobility level have been shown to influence patient outcome. Thus, the outcome of patients with hip fracture is considered multi-factorial, and can therefore not be related...

Complications of ankle fracture in patients with diabetes.

Science.gov (United States)

Chaudhary, Saad B; Liporace, Frank A; Gandhi, Ankur; Donley, Brian G; Pinzur, Michael S; Lin, Sheldon S

2008-03-01

Ankle fractures in patients with diabetes mellitus have long been recognized as a challenge to practicing clinicians. Complications of impaired wound healing, infection, malunion, delayed union, nonunion, and Charcot arthropathy are prevalent in this patient population. Controversy exists as to whether diabetic ankle fractures are best treated noninvasively or by open reduction and internal fixation. Patients with diabetes are at significant risk for soft-tissue complications. In addition, diabetic ankle fractures heal, but significant delays in bone healing exist. Also, Charcot ankle arthropathy occurs more commonly in patients who were initially undiagnosed and had a delay in immobilization and in patients treated nonsurgically for displaced ankle fractures. Several techniques have been described to minimize complications associated with diabetic ankle fractures (eg, rigid external fixation, use of Kirschner wires or Steinmann pins to increase rigidity). Regardless of the specifics of treatment, adherence to the basic principles of preoperative planning, meticulous soft-tissue management, and attention to stable, rigid fixation with prolonged, protected immobilization are paramount in minimizing problems and yielding good functional outcomes.

Osteoporosis and fall risk in patients with fragility fractures

OpenAIRE

van Helden, SH; Nieuwenhuijzen-Kruseman, AC; Dinant, G; Pijpers, E; ten Broeke, R; Brink, PR; GEUSENS, Piet

2005-01-01

Low BMD and fall risk are well-documented risk factors for fractures. The prevalence of both risk factors has only scarcely been reported in the same population of patients with recent clinical fractures. Methods : 261 consecutive patients (women and men of 50 years and older) admitted to the hospital with a recent clinical fracture were included and had extensive evaluation of bone mineral density (BMD) and fall risk (135 patients with fracture of the upper limb, 94 of the lower limb, 12 of...

Orthogeriatric Service Reduces Mortality in Patients With Hip Fracture

DEFF Research Database (Denmark)

Stenqvist, Charlotte; Madsen, Christian Medom; Riis, Troels

2016-01-01

INTRODUCTION: Orthogeriatric service has been shown to improve outcomes in patients with hip fracture. The purpose of this study is to evaluate the effect of orthogeriatrics at Bispebjerg University Hospital, Denmark. The primary outcome is mortality inhospital and after 1, 3, and 12 months...... for patients with hip fracture. The secondary outcome is mortality for home dwellers and nursing home inhabitants. MATERIALS AND METHODS: This is a retrospective clinical cohort study with an historic control group including all patients with hip fracture admitted from 2007 to 2011. Patients with hip fracture...... = .009) after orthogeriatrics. However, when adjusting for age, gender, and American Society of Anaesthesiologists (ASA) score in a multivariate analysis, including all patients with hip fracture, we find significantly reduced mortality inhospital (odds ratio [OR] 0.35), after 30 [OR 0.66] and 90 days...

Complications and functional outcome after internal fixation of dorsally displaced distal radial fractures

DEFF Research Database (Denmark)

Bove, Jeppe; Viberg, Bjarke; Wied Greisen, Pernille

Background: Recently there has been an increasing interest in open reduction and internal fixation of distal radius fractures. Even so further studies are still needed. Purpose: To document the functional outcome and identify complica- tions among patients treated with a volar locking plate (DVR...

Testing the validity of preventing chronic regional pain syndrome with vitamin C after distal radius fracture. [Corrected].

Science.gov (United States)

Malay, Sunitha; Chung, Kevin C

2014-11-01

The American Academy of Orthopaedic Surgeons recommends the use of vitamin C to prevent complex regional pain syndrome (CRPS) for patients with distal radius fractures (DRFs). We hypothesized that the evidence for supporting this recommendation is weak, based on epidemiological principles of association and causality. The specific aim of this project was to test the validity of this recommendation. We conducted a literature review to retrieve articles reporting on the use of vitamin C to prevent CRPS. Data collected included sample size, study design type, dose of vitamin C used, and outcome measures of association expressed as relative risk (RR) and odds ratio. We then applied Hill criteria to evaluate the relationship between vitamin C and CRPS. We obtained 225 articles from the database search. After the exclusion of duplicates, unrelated articles, editorial letters, and commentaries, we found 4 articles and 1 systematic review relevant to our topic. Six of the 9 Hill criteria were met, and an earlier meta-analysis showed a quantified reduction in CRPS risk. However, criteria like biological plausibility, specificity, and coherence were not met. The number of causal/association criteria met was adequate to support the scientific premise of the effect of vitamin C in preventing CRPS after DRF. Furthermore, vitamin C administration is of relatively low cost and has few complications unless administered in large doses. Owing to sufficient epidemiological evidence availability, the American Academy of Orthopaedic Surgeons recommendation of vitamin C to prevent CRPS has practical merit. Therapeutic II. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

The risk of fractures among patients with cirrhosis or chronic pancreatitis.

Science.gov (United States)

Bang, Ulrich Christian; Benfield, Thomas; Bendtsen, Flemming; Hyldstrup, Lars; Beck Jensen, Jens-Erik

2014-02-01

Cirrhosis and chronic pancreatitis (CP) are accompanied by inflammation and malnutrition. Both conditions can have negative effects on bone metabolism and promote fractures. We evaluated the risk of fractures among patients with CP or cirrhosis and determined the effect of fat malabsorption on fracture risk among patients with CP. We performed a retrospective cohort study using the Danish National Patient Register to identify patients diagnosed with CP or cirrhosis. We analyzed data collected from January 1, 1995, to December 31, 2010, on 20,769 patients (35.5% women with cirrhosis and 11,972 patients (33.5% women) with CP. Each patient was compared with 10 age- and sex-matched controls. We also assessed the risk of fractures among patients with CP who received pancreatic enzyme substitution (PES) for fat malabsorption. During the study period, bone fractures occurred in 3954 patients with cirrhosis and 2594 patients with CP. The adjusted hazard ratio (HR) for any fracture was 2.4 in patients with cirrhosis (95% confidence interval [CI], 2.2-2.5) and 1.7 in patients with CP (95% CI, 1.6-1.8). The relative risk of low-trauma fractures was highest among individuals younger than 50 years old. Alcohol as an etiology was associated with an increased risk of fracture compared with patients with nonalcoholic cirrhosis (HR, 2.4 vs 1.5; P risk of fractures than other CP patients (HR, 0.8; 95% CI, 0.7-0.9). However, increasing the duration of treatment with PES was associated with an increased risk of fracture. Patients, especially younger patients, with cirrhosis or CP have an increased risk of fractures of all types. Copyright © 2014 AGA Institute. Published by Elsevier Inc. All rights reserved.

Design and evaluation of a portable intra-operative unified-planning-and-guidance framework applied to distal radius fracture surgery.

Science.gov (United States)

Magaraggia, Jessica; Wei, Wei; Weiten, Markus; Kleinszig, Gerhard; Vetter, Sven; Franke, Jochen; John, Adrian; Egli, Adrian; Barth, Karl; Angelopoulou, Elli; Hornegger, Joachim

2017-01-01

During a standard fracture reduction and fixation procedure of the distal radius, only fluoroscopic images are available for planning of the screw placement and monitoring of the drill bit trajectory. Our prototype intra-operative framework integrates planning and drill guidance for a simplified and improved planning transfer. Guidance information is extracted using a video camera mounted onto a surgical drill. Real-time feedback of the drill bit position is provided using an augmented view of the planning X-rays. We evaluate the accuracy of the placed screws on plastic bones and on healthy and fractured forearm specimens. We also investigate the difference in accuracy between guided screw placement versus freehand. Moreover, the accuracy of the real-time position feedback of the drill bit is evaluated. A total of 166 screws were placed. On 37 plastic bones, our obtained accuracy was [Formula: see text] mm, [Formula: see text] and [Formula: see text] in tip position and orientation (azimuth and elevation), respectively. On the three healthy forearm specimens, our obtained accuracy was [Formula: see text] mm, [Formula: see text] and [Formula: see text]. On the two fractured specimens, we attained: [Formula: see text] mm, [Formula: see text] and [Formula: see text]. When screw plans were applied freehand (without our guidance system), the achieved accuracy was [Formula: see text] mm, [Formula: see text], while when they were transferred under guidance, we obtained [Formula: see text] mm, [Formula: see text]. Our results show that our framework is expected to increase the accuracy in screw positioning and to improve robustness w.r.t. freehand placement.

Paediatric post-traumatic cortical defects of the distal radius

International Nuclear Information System (INIS)

Roach, Richard T.; Summers, Bruce N.; Cassar-Pullicino, Victor

2002-01-01

Paediatric post-traumatic cortical defects, although rare, are predominately seen affecting the distal radius following a greenstick or torus fracture. We review the literature and present a further two cases supported by CT and MRI. Images from an acute greenstick fracture are also presented to help understand the pathogenesis. Defects are typically solitary on plain radiographs and are usually noticed late, proximal to the site of compression. They are non-expansile in an otherwise healthy child. CT and MRI may reveal smaller multiple subperiosteal defects. Typical defects require no further management other than reassurance and advice that they may occasionally cause discomfort but resolve with time. (orig.)

Osteoporosis management in older patients who experienced a fracture

Directory of Open Access Journals (Sweden)

Oertel MJ

2016-08-01

Full Text Available Mark J Oertel,1 Leland Graves,1 Eyad Al-Hihi,2 Vincent Leonardo,3 Christina Hopkins,2 Kristin DeSouza,2 Rajib K Bhattacharya1 1Division of Endocrinology, Metabolism and Genetics, Department of Medicine, 2Department of Internal Medicine, 3Department of Enterprise Analytics, University of Kansas Medical Center, Kansas City, KS, USA Background: Fractures in older patients are common, morbid, and associated with increased risk of subsequent fractures. Inpatient and outpatient management and treatment of fractures can be costly. With more emphasis placed on quality care for Medicare beneficiaries, we studied if patients were receiving proper screening for osteoporosis and treatment after diagnosis of fracture. This study aims to determine if adequate screening and treatment for osteoporosis occurs in the postfracture period.Methods: A retrospective analysis of Medicare beneficiaries aged 67 years or older was gathered from a single institution in both inpatient and outpatient visits. Based on International Classification of Diseases ninth revision codes, primary diagnosis of fractures of neck and trunk, upper limb, and lower limb were obtained in addition to current procedural terminology codes for fracture procedures. We studied patients who had been screened for osteoporosis with a bone mineral study or received osteoporosis treatment after their fracture.Results: Medicare beneficiaries totaling 1,375 patients were determined to have an inclusion fracture between June 1, 2013 and November 30, 2014. At the time of our analysis on December 1, 2014, 1,219 patients were living and included in the analysis. Of these patients, 256 (21.0% either received osteoporosis testing with bone mineral density or received treatment for osteoporosis. On sex breakdown, 208/820 (25.4% females received proper evaluation or treatment of osteoporosis in comparison to 48/399 (12.0% males. This is in comparison to the Centers for Medicare and Medicaid Services’ national

Comparing fracture healing disorders and long-term functional outcome of polytrauma patients and patients with an isolated displaced midshaft clavicle fracture.

Science.gov (United States)

Ferree, Steven; Hietbrink, Falco; van der Meijden, Olivier A J; Verleisdonk, Egbert Jan M M; Leenen, Luke P H; Houwert, Roderick M

2017-01-01

Although clavicle fractures are a common injury in polytrauma patients, the functional outcome of displaced midshaft clavicle fractures (DMCFs) in this population is unknown. Our hypothesis was that there would be no differences in fracture healing disorders or functional outcome in polytrauma patients with a DMCF compared with patients with an isolated DMCF, regardless of the treatment modality. A retrospective cohort study of patients (treated at our level I trauma center) with a DMCF was performed and a follow-up questionnaire was administered. Polytrauma patients, defined as an Injury Severity Score ≥16, and those with an isolated clavicle fracture were compared. Fracture healing disorders (nonunion and delayed union) and delayed fixation rates were determined. Functional outcome was assessed by the Quick Disability of the Arm, Shoulder, and Hand questionnaire. A total of 152 patients were analyzed, 71 polytrauma patients and 81 patients with an isolated DMCF. Questionnaire response of 121 patients (80%) was available (mean, 53 months; standard deviation, 22 months). No differences were found between polytrauma patients and those with an isolated DMCF with regard to nonunion (7% vs. 5%, respectively), delayed union (4% vs. 4%), and delayed fixation rate (13% vs. 13%). Polytrauma patients had an overall worse functional outcome, regardless of initial nonoperative treatment or delayed operative fixation. Polytrauma patients had a similar nonunion and delayed fixation rate but had an overall worse functional outcome compared with patients with an isolated DMCF. For polytrauma patients, a wait and see approach can be advocated without the risk of decreased upper extremity function after delayed fixation. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Hip fracture in hospitalized medical patients

Directory of Open Access Journals (Sweden)

Zapatero Antonio

2013-01-01

Full Text Available Abstract Background The aim of the present study is to analyze the incidence of hip fracture as a complication of admissions to internal medicine units in Spain. Methods We analyzed the clinical data of 2,134,363 adults who had been admitted to internal medicine wards. The main outcome was a diagnosis of hip fracture during hospitalization. Outcome measures included rates of in-hospital fractures, length of stay and cost. Results A total of 1127 (0.057% admittances were coded with an in-hospital hip fracture. In hospital mortality rate was 27.9% vs 9.4%; p  Conclusions In-hospital hip fracture notably increased mortality during hospitalization, doubling the mean length of stay and mean cost of admission. These are reasons enough to stress the importance of designing and applying multidisciplinary plans focused on reducing the incidence of hip fractures in hospitalized patients.

Teaching the Basics: Development and Validation of a Distal Radius Reduction and Casting Model.

Science.gov (United States)

Seeley, Mark A; Fabricant, Peter D; Lawrence, J Todd R

2017-09-01

Approximately one-third of reduced pediatric distal radius fractures redisplace, resulting in further treatment. Two major modifiable risk factors for loss of reduction are reduction adequacy and cast quality. Closed reduction and immobilization of distal radius fractures is an Accreditation Council for Graduate Medical Education residency milestone. Teaching and assessing competency could be improved with a life-like simulation training tool. Our goal was to develop and validate a realistic distal radius fracture reduction and casting simulator as determined by (1) a questionnaire regarding the "realism" of the model and (2) the quantitative assessments of reduction time, residual angulation, and displacement. A distal radius fracture model was created with radiopaque bony segments and articulating elbows and shoulders. Simulated periosteum and internal deforming forces required proper reduction and casting techniques to achieve and maintain reduction. The forces required were estimated through an iterative process through feedback from experienced clinicians. Embedded monofilaments allowed for quantitative assessment of residual displacement and angulation through the use of fluoroscopy. Subjects were asked to perform closed reduction and apply a long arm fiberglass cast. Primary performance variables assessed included reduction time, residual angulation, and displacement. Secondary performance variables consisted of number of fluoroscopic images, casting time, and cast index (defined as the ratio of the internal width of the forearm cast in the sagittal plane to the internal width in the coronal plane at the fracture site). Subject grading was performed by two blinded reviewers. Interrater reliability was nearly perfect across all measurements (intraclass correlation coefficient range, 0.94-0.99), thus disagreements in measurements were handled by averaging the assessed values. After completion the participants answered a Likert-based questionnaire regarding the

Hip Fracture-Related Pain Strongly Influences Functional Performance of Patients With an Intertrochanteric Fracture Upon Discharge From the Hospital

DEFF Research Database (Denmark)

Kristensen, Morten Tange

2013-01-01

.7 seconds to perform the TUG. No significant differences were observed in baseline characteristics or pain medication given for patients with a cervical versus an intertrochanteric fracture (P ≥ .22), but patients with an intertrochanteric fracture presented more often with moderate to severe pain during......OBJECTIVE: To examine whether functional performance upon hospital discharge is influenced by pain in the region of the hip fracture or related to the fracture type. DESIGN: Prospective observational study. SETTING: A 20-bed orthopedic hip fracture unit. PATIENTS: Fifty-five cognitively intact...... patients (20 men and 35 women; ages 75.8 ± 10 years), 33 with a cervical hip fracture and 22 with an intertrochanteric hip fracture, all of whom were allowed to bear full weight after surgery. METHODS: All patients were evaluated upon discharge from the hospital to their own homes at a mean of 10 ± 6 days...

Compression fractures in patients undergoing spinal manipulative therapy

NARCIS (Netherlands)

Haldeman, S.; Rubinstein, S M

Increasing numbers of elderly patients are currently seeking chiropractic care. One condition commonly seen in the elderly is osteoporosis of the spine, which carries with it the risk of compression fractures. We present four cases in which patients were noted to have compression fractures following

FUNCTIONAL RECOVERY AFTER MINIMALLY INVASIVE OSTEOSYNTHESIS IN FRACTURES OF THE SHAFT OF THE RADIUS AND ULNA

Directory of Open Access Journals (Sweden)

A. N. Chelnokov

2016-01-01

Full Text Available Introduction. Closed intramedullary nailing and external fixation are minimally invasive treatment options in radial and ulnar shaft fractures. We found no comparative studies of these methods in the current literature. Objective. A comparative analysis of both methods in radial and ulnar shaft fractures treated by closed intramedullary nailing and external fixation. Material and methods. 63 patients with forearm shaft fractures treated by closed intramedullary nailing (group I; 24 patients treated by external fixation (group II. All patients were operated within 30 days after injury. Postoperatively, all patients were evaluated clinically (range of motion of elbow and wrist, rotation of the forearm and radiologically. Disability of the Arm, Shoulder and Hand (DASH score was used to assess the functional status and quality of life. Results. The average time of radiological bone union in the group I and group II was 12,6 ± 1,4 weeks. and 12,7 ± 0,6 weeks, accordingly. Statistically significant differences in range of motion in the elbow and wrist occurred in 1 month after the surgery with the advantage in Group I. Restoration of rotation was faster in Group I up to 1 year after surgery. DASH scores in 2 month after the surgery were 11,2±1,96 in the nailing group (as in healthy population and 45,2±6,7 in the external fixation group. In 6 months after surgery the subjective assessment of the quality of life did not differ in both groups. Conclusion. Both minimally invasive methods of surgical stabilization provide restoration of anatomy of the forearm and complete functional recovery in final outcome, but closed intramedullary nailing results with significantly more rapid restoration of range of motions and quality of life measures.

Rib fractures in trauma patients: does operative fixation improve outcome?

Science.gov (United States)

Majak, Peter; Næss, Pål A

2016-12-01

Renewed interest in surgical fixation of rib fractures has emerged. However, conservative treatment is still preferred at most surgical departments. We wanted to evaluate whether operative treatment of rib fractures may benefit severely injured patients. Several studies report a reduction in mechanical ventilation time, ICU length of stay (LOS), hospital LOS, pneumonia, need for tracheostomy, pain and costs in operatively treated patients with multiple rib fractures compared with patients treated nonoperatively. Although patient selection and timing of the operation seem crucial for successful outcome, no consensus exists. Mortality reduction has only been shown in a few studies. Most studies are retrospective cohort and case-control studies. Only four randomized control trials exist. Conservative treatment, consisting of respiratory assistance and pain control, is still the treatment of choice in the vast majority of patients with multiple rib fractures. In selected patients, operative fixation of fractured ribs within 72 h postinjury may lead to better outcome. More randomized control trials are needed to further determine who benefits from surgical fixation of rib fractures.

Complications associated with distraction plate fixation of wrist fractures.

Science.gov (United States)

Hanel, Douglas P; Ruhlman, Scott David; Katolik, Leo I; Allan, Christopher H

2010-05-01

This article discusses the major and minor complications of distal plating in the light of a cohort study carried out by the authors, who reviewed all patients undergoing bridge distraction plate fixation of distal radius fractures by three surgeons in a single level I trauma center. The article discusses the effectiveness and the complication rates associated with the technique. Copyright (c) 2010 Elsevier Inc. All rights reserved.

Comparing fracture healing disorders and long-term functional outcome of polytrauma patients and patients with an isolated displaced midshaft clavicle fracture

NARCIS (Netherlands)

Ferree, Steven; Hietbrink, Falco; van der Meijden, Olivier A J; Verleisdonk, Egbert Jan M M; Leenen, Luke P.H.; Houwert, Roderick M.

2017-01-01

Background Although clavicle fractures are a common injury in polytrauma patients, the functional outcome of displaced midshaft clavicle fractures (DMCFs) in this population is unknown. Our hypothesis was that there would be no differences in fracture healing disorders or functional outcome in

Cardiovascular Risk Factor Analysis in Patients with a Recent Clinical Fracture at the Fracture Liaison Service

Directory of Open Access Journals (Sweden)

Caroline E. Wyers

2014-01-01

Full Text Available Patients with a low bone mineral density have an increased risk of cardiovascular diseases (CVD and venous thromboembolic events (VTE. The aim of our retrospective chart review was to investigate the prevalence of CVD, VTE, hypertension (HT, and diabetes mellitus type 2 (DM2 in patients with a recent clinical fracture visiting the Fracture Liaison Service (FLS. Out of 3057 patients aged 50–90 years, 1359 consecutive patients, who agreed and were able to visit the FLS for fracture risk evaluation, were included (71.7% women; mean age 65.2 yrs. Based on medical history, 29.9% had a history of CVD (13.7%, VTE (1.7%, HT (14.9%, and DM2 (7.1% or a combination. Their prevalence increased with age (21% in patients aged 50–59 years to 48% in patients aged >80 years and was higher in men than in women (36% versus 27%, but independent of bone mineral density and fracture type. Careful evaluation of medical history with respect to these risk factors should be performed in patients with a recent clinical fracture before starting treatment with medications that increase the risk of VTE or cardiovascular events, such as raloxifene, strontium ranelate, or NSAIDs.

Potential Benefits of Rib Fracture Fixation in Patients with Flail Chest and Multiple Non-flail Rib Fractures.

Science.gov (United States)

Qiu, Meiguang; Shi, Zhanjun; Xiao, Jun; Zhang, Xuming; Ling, Shishui; Ling, Hao

2016-12-01

The purpose of this study is to evaluate the potential benefits of rib fracture fixation in patients with flail chest and multiple non-flail rib fractures versus conventional treatment modalities. A retrospective reviewed study compared 86 cases which received surgical treatment between June 2009 and May 2013 to 76 cases which received conservative treatment between January 2006 and May 2009. The patients were divided into the flail chest ( n  = 38) and multiple non-flail rib fracture groups ( n  = 124). In the flail chest group, the mechanical ventilation time, ICU monitoring time, tracheostomies, thoracic deformity, and impaired pulmonary function and return to full-time employment were compared. In the multiple non-flail rib fracture group, fracture healing, visual analog scale (VAS) pain score, inpatient length of stay, atelectatic, pulmonary complications, and normal activity-returning time were compared. Patients in the flail chest operative fixation group had significantly shorter ICU stay, decreased ventilator requirements, fewer tracheostomies, less thoracic deformity and impaired pulmonary function, and more returned to full-time employment. Patients in the multiple non-flail rib fracture operative fixation had shorter hospital stay, less pain, earlier return to normal activity, more fracture healing, less atelectasis, and fewer pulmonary infections. This study demonstrates the potential benefits of surgical stabilization of flail chest and multiple non-flail rib fractures with plate fixation. When compared with conventional conservative management, operatively managed patients demonstrated improved clinical outcomes.

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.

Treatment outcomes of intertrochanteric femur fractures treated with DLT™ nail

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Mehmet Arıcan

2015-12-01

Full Text Available Objective: Intramedullary nails frequently use in proximal femur fractures. In this study, 49 patients with intertrochanteric fractures were evaluated clinical and radiological results treated with dyna locking trochanteric (DLT™ nail retrospectively. Methods: Twenty-two (44.9% patients were male and 27 (55.1% patients were female. Mean age was 74.29±1.98 (28-99 years and Followed up for a mean of 14.35±3.43 (9-24 months. Thirty-seven (75.6% of the fractures resulted from simple falls while 6 (12.2% caused from traffic accidents and 6 (12.2% fall down from height. There were 24 (49.0% left and 25 (51.0% right lower extremities fractured. According to Orthopaedic Trauma Association classification system; 21 (42.9%, 21 (42.9% and 7 (14.2% fractures were classified as 31A1, 31A2, and 31A3 respectively. One (2.0% patient had claviculae fracture, 3 (6.1% patients had radius distal fracture and 1 (2.0% patient had total knee arthroplasty. After surgery, X-ray was used for radiological results and functional outcomes were evaluated according to the Harris hip scoring system. Results: The average waiting time for the surgery was 2.02±0.18 (1-7 days and hospitalization time was 6.23±0.29 (4-15 days. Mean fracture healing time was 11.74±1.82 (8-15 weeks. Three patients had screw cut-out in the follow-up time and performed hemiarthroplasty. The average Harris hip score was 88.02±1.21 (42-97 points and included 29 (59.2% excellent cases, 17 (34.7% good and 3 (6.1% poor. Conclusion: DLT ™ nail is a safe and successful method because of low complication rates, and capability of detection.

The risk of fracture in incident multiple sclerosis patients

DEFF Research Database (Denmark)

Bazelier, Marloes T; Bentzen, Joan; Vestergaard, Peter

2012-01-01

Patients with multiple sclerosis (MS) may be at increased risk of fractures owing to osteoporosis and falling.......Patients with multiple sclerosis (MS) may be at increased risk of fractures owing to osteoporosis and falling....

The economic burden of fracture patients with osteoporosis in western China.

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Qu, B; Ma, Y; Yan, M; Wu, H-H; Fan, L; Liao, D-F; Pan, X-M; Hong, Z

2014-07-01

To study the cost of osteoporotic fracture in China, we performed a prospective study and compared the costs of the disease in referral patients with fractures in three of the most common sites. Our results indicated that the economic burden of osteoporotic fracture to both Chinese patients and the nation is heavy. This paper aims to study the cost of osteoporotic fracture in China and thus to provide essential information about the burden of this disease to individuals and society. This prospective observational data collection study assessed the cost related to hip, vertebral, and wrist fracture 1 year after the fracture based on a patient sample consisting of 938 men and women. Information was collected using patient records, registry sources, and patient interviews. Both direct medical, direct non-medical, and indirect non-medical costs were considered. The annual total costs were highest in hip fracture patients (renminbi, RMB 27,283 or USD 4,330, with confidence interval (RMB 25715, 28851)), followed by patients with vertebral fracture (RMB 21,474 or USD 3,409, with confidence interval (RMB 20082, 22866)) and wrist fracture (RMB 8,828 or USD 1,401, with confidence interval (RMB 7829, 9827)). The direct medical care costs averaged approximately RMB 17,007 per year per patient, of which inpatient costs, drugs, and investigations accounted for the majority of the costs. Nonmedical direct costs were much less compared to direct healthcare costs and averaged approximately RMB 1,846. These results indicate that the economic burden of osteoporotic fracture to both Chinese patients and China was heavy, and the proportion of the costs in China demonstrated many similar features and some significant differences compared to other countries.

A new method for classifying distal radius fracture: the IDEAL classification Um novo método de classificação para as fraturas da extremidade distal do rádio – a classificação IDEAL

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João Carlos Belloti

2013-01-01

Full Text Available OBJECTIVES: To describe the new IDEAL method from classifying distal radius fractures. METHODS: IDEAL classification system is based on the most important literature evidences about clinical and radiographic characteristics that influence in the treatment and prognosis for patients that suffered from a distal radius fractures. In this method, we classify the fracture in patients first consultation, in which we collect demographical (age and trauma energy and radiographic characteristics ( fracture deviation, articular fracture, and associated lesions. For each feature a score is attributed for grouping purposes. Group I - Stable fractures, good prognosis; Group II - potentially unstable fractures, commonly treated by surgical methods. Prognosis depends on surgeons' success after method choice. Group III - complex and instable fractures, poor outcome is expected. CONCLUSION: IDEAL classification staging rationale was presented, which is based on the best available evidence. The evidence of its scientific plausibility will be settled with the assessment of the classification reliability and its capacity to aid in therapeutical decisions and as a tool to predict prognosis. Further studies are under development to support these properties. OBJETIVOS: Descrição do método de Classificação IDEAL - para as fraturas da extremidade distal do rádio. MÉTODOS: O sistema de classificação IDEAL fundamenta-se nas principais evidências da literatura sobre fatores clínicos e radiográficos que influenciam o tratamento e prognóstico das fraturas do rádio distal. Classificamos as fraturas no atendimento inicial do paciente mediante a verificação de dois dados epidemiológicos e três dados radiográficos: Idade do paciente, energia do trauma, desvio dos fragmentos, incongruência articular e lesões associadas. RESULTADOS: Conforme a pontuação obtida, agrupamos os casos em três grupos: Grupo I - fraturas estáveis com bom prognóstico, Grupo II

Is warfarin usage a risk factor for osteoporotic fractures? A cohort study in the emergency department

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Genady Drozdinsky

2017-04-01

Full Text Available Background Several studies have examined the association between warfarin sodium use and risk of osteoporotic fractures with conflicting results. Our study addresses this question, for the first time regarding patients attending emergency department (ED. Aims The aim of this study was to retrospectively detect whether there is higher rate of usage of warfarin sodium in patients with osteoporotic fractures attending an ED. Methods This is a retrospective study from patients' computerized charts. All individuals >65 years old who had an osteoporotic fracture and attended an ED in a tertiary hospital were compared with a similar group of elderly individuals >65 years old without an osteoporotic fracture who attended the ED for a cause other than an osteoporotic fracture. Results This study included 328 patients who were evaluated in the years 2005–2016. Overall, 164 individuals with a typical osteoporotic fracture (hip -66 patients (40 per cent, spine- 92 patients (56 per cent, humerus -4 patients (2 per cent, radius -13 patients (8 per cent were identified and compared with a matched group of elderly individuals who were evaluated in the ED for other complaints. Warfarin sodium was used in 61 individuals (19 per cent in the entire cohort, 34 in the fracture group and 27 in the non-fracture group (p=0.324. Conclusion In elderly patients, attending an ED, warfarin sodium use does not seem to be a risk factor for an osteoporotic fracture

Neck osteotomy for malunion of neglected radial neck fractures in children: a report of 2 cases.

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Ceroni, Dimitri; Campos, José; Dahl-Farhoumand, Agnes; Holveck, Jérôme; Kaelin, André

2010-01-01

Radial neck fractures are a common injury in children as a result of a fall on an extended and supinated outstretched hand. We present 2 cases of osteotomy of the neck of the radius performed in 2 children with neglected radial neck fractures. Preoperatively, both patients complained of pain and severely reduced mobility of the elbow. Surgery was performed at 6 weeks and 3 months, respectively, after the initial injury and the 2 children were reviewed at 6 and 16 months follow-up. Osteotomies healed within the usual time and no avascular necrosis of the radial head, proximal radioulnar synostosis, or myositis ossificans were observed. The Mayo Elbow Performance Index Score improved significantly after the operation with the 2 patients rated as excellent. In this small series, we present a novel technique of proximal osteotomy of the radius to correct this deformity in children. Case series, level IV evidence.

Risk of falling in patients with a recent fracture

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Willems Gittie

2007-06-01

Full Text Available Abstract Background Patients with a history of a fracture have an increased risk for future fractures, even in short term. The aim of this study was to assess the number of patients with falls and to identify fall risk factors that predict the risk of falling in the first three months after a clinical fracture. Methods Prospective observational study with 3 months of follow-up in a large European academic and regional hospital. In 277 consenting women and men aged ≥ 50 years and with no dementia and not receiving treatment for osteoporosis who presented to hospital with a clinical fracture, fall risk factors were assessed according to the guidelines on fall prevention in the Netherlands. Follow-up information on falls and fractures was collected by monthly telephone interview. Incidence of falls and odds ratio's (OR, with 95% confidence intervals were calculated. Results 512 consecutive patients with a fracture were regarded for analysis, 87 were not eligible for inclusion and 137 patients were excluded. No follow-up data were available for 11 patients. Therefore full analysis was possible in 277 patients. A new fall incident was reported by 42 patients (15%, of whom five had a fracture. Of the 42 fallers, 32 had one new fall and 10 had two or more. Multivariate analysis in the total group with sex, age, ADL difficulties, urine incontinence and polypharmacy showed that sex and ADL were significant fall risk factors. Women had an OR of 3.02 (95% CI 1.13–8.06 and patients with ADL-difficulties had an OR of 2.50 (95% CI 1.27–4.93. Multivariate analysis in the female group with age, ADL difficulties, polypharmacy and presence of orthostatic hypotension indicated that polypharmacy was the predominant risk factor (OR 2.51; 95% CI: 1.19 – 5.28. The incidence of falls was 35% in women with low ADL score and polypharmacy compared to 15% in women without these risk factors (OR 3.56: CI 1.47 – 8.67. Conclusion 15% of patients reported a new fall

Frequency of ipsilateral femoral neck fractures in patients with ...

African Journals Online (AJOL)

Background: Ipsilateral associated femoral neck and shaft fractures are reported to occur in 2.5-6% of all femoral shaft fractures. Objective: To establish the frequency of ipsilateral femoral neck fractures amongst all patients presenting with femoral shaft fractures in Mulago Hospital. Methodology: This was a descriptive ...

The management of ankle fractures in patients with diabetes.

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Wukich, Dane K; Kline, Alex J

2008-07-01

Patients with diabetes mellitus have higher complication rates following both open and closed management of ankle fractures. Diabetic patients with neuropathy or vasculopathy have higher complication rates than both diabetic patients without these comorbidities and nondiabetic patients. Unstable ankle fractures in diabetic patients without neuropathy or vasculopathy are best treated with open reduction and internal fixation with use of standard techniques. Patients with neuropathy or vasculopathy are at increased risk for both soft-tissue and osseous complications, including delayed union and nonunion. Careful soft-tissue management as well as stable, rigid internal fixation are crucial to obtaining a good outcome. Prolonged non-weight-bearing and subsequently protected weight-bearing are recommended following both operative and nonoperative management of ankle fractures in patients with diabetes.

Concomitant upper limb fractures and short-term functional recovery in hip fracture patients: does the site of upper limb injury matter?

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Di Monaco, Marco; Castiglioni, Carlotta; Vallero, Fulvia; Di Monaco, Roberto; Tappero, Rosa

2015-05-01

The aim of this study was to evaluate functional recovery in a subgroup of hip fracture patients who sustained a simultaneous fracture at the upper limb, taking into account the site of upper limb injury. Of 760 patients admitted consecutively to the authors' rehabilitation hospital because of a fall-related hip fracture, 700 were retrospectively investigated. Functional outcome was assessed using Barthel Index scores. In 49 of the 700 patients, a single fall resulted in both a hip fracture and a fracture of either wrist (n = 34) or proximal humerus (n = 15). The patients with concomitant shoulder fractures had lower median Barthel Index scores after rehabilitation (70 vs. 90, P = 0.003), lower median Barthel Index effectiveness (57.1 vs. 76.9, P = 0.018), and prolonged median length of stay (42 vs. 36 days, P = 0.011) than did the patients with isolated hip fractures. Significant differences persisted after adjustment for six potential confounders. The adjusted odds ratio for achieving a Barthel Index score lower than 85 was 6.71 (95% confidence interval, 1.68-26.81; P = 0.007) for the patients with concomitant shoulder fractures. Conversely, no prognostic disadvantages were associated with concomitant wrist fractures. Data show a worse functional recovery and a prolonged length of stay in the subgroup of hip fracture patients who sustained a concomitant fracture at the proximal humerus, but not at the wrist.

Detection of neurological deficits by computed tomography in sacral fracture patients

International Nuclear Information System (INIS)

Nakai, Daisuke; Numazaki, Shin; Katsumura, Tetsu; Tamaru, Tomohiko; Sugiyama, Mitsugi; Nakamura, Jun-ichiro; Saitoh, Tomoyuki

2006-01-01

The purpose of this study is to evaluate the correlation between sacral fractures and neurological deficits as complications. From November 2002 to February 2005, 12 patients (15 fractures) were found to have sacral fractures without other spinal injuries or brain injuries and were evaluated by plain CT scans immediately after trauma. This group included 6 males and 6 females, whose age ranged from 17 to 67 years with mean of 39.9±17.4. All patients were classified according to AO (Arbeitsgemeinschaft fuer Osteosynthesefragen) classification (pelvic ring fracture) and Denis's classification. Displacements of sacral fractures were evaluated by plain CT scans for all patients. We defined displacements using the key slice in CT scans that included the first foramen in the sacrum. Five cases, including 2 with bi-lateral sacral fractures, were complicated with neurological deficits. There was one case with a neurological deficit of 7 Type B fractures (14%) and 4 cases with neurological deficits of 5 Type C fractures (80%) in the AO classification. There were 6 fractures with neurological deficits of 12 Zone II fractures (50%) and one fracture with neurological deficits of one Zone III fractures (100%) in Denis's classification. There was a significant correlation between the extent in the displacement of the sacral fractures and neurological deficits. For more than 3 mm displacements in the medial or lateral or anterior directions, neurological deficits increased significantly. In emergency medicine, it is difficult to evaluate the neurological findings of patients with impaired consciousness. Our evaluation using CT scan is valuable as a predictor of neurological deficits and for an optimal reduction in sacral fractures in patients with in impaired consciousness. (author)

Percutaneous treatment of insufficiency fractures. Principles, technique and review of literature

International Nuclear Information System (INIS)

Beall, Douglas P.; Datir, Abhijit; D'Souza, Sharon L.; D'Souza, Logan S.; Gunda, Divya; Morelli, John; Johnson, Michael Brandon; Nabavizadeh, Nima

2010-01-01

Insufficiency fractures of the pelvis, sacrum, spine, and long bones are painful, debilitating, and are common consequences of osteoporosis. Conventional treatment for these fractures varies from conservative therapy to surgery with plate and screw fixation. The former fails to address the underlying problem of fracture and frequently does not alleviate symptoms, while the latter is invasive and not always possible in older populations with low bone density and numerous co-morbidities. Osseous augmentation with polymethylmethacrylate (PMMA) has been used for over two decades to treat fractures related to osteoporosis, but has not been commonly used to treat fractures outside of the vertebral bodies. Osseous augmentation with PMMA is an image-guided procedure and various techniques have been utilized to treat fracture in different locations. We describe various techniques for image-guided osseous augmentation and treatment of insufficiency fractures with bothPMMA and allograft bone for fractures of the pelvis including sacrum, acetabulum, pubic symphysis, pubic rami ilium; appendicular skeleton including distal radius, proximal femur, and vertebral body. We also describe the potential risks and complications associated with percutaneous treatment of insufficiency fractures and techniques to avoid the pitfalls of the various procedures. We will present the process for patient follow-up and data regarding the pre- and postprocedure pain response in patients undergoing treatment for pelvic insufficiency fractures. (orig.)

Reabilitação das fraturas do rádio distal Rehabilitation of distal radius fractures

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Patrícia Silva Hampe Barbosa

2009-01-01

Full Text Available O objetivo deste estudo foi avaliar a evidência do efeito e eleição da conduta terapêutica nas fraturas do rádio distal. A revisão sistemática utilizou as bases de dados PubMed, Lilacs, Pedro, Cochrane, Scielo, OTseeker, sem restrições de período de publicação, com as seguintes palavras chaves: fraturas do rádio, reabilitação, terapia ocupacional, fisioterapia, incluindo línguas inglesa, espanhola, francesa e portuguesa. Os estudos encontrados foram avaliados independentemente pelos dois autores utilizando critérios da escala PEDro. Estudos não experimentais foram incluídos em busca de esclarecimentos sobre a reabilitação. Foram encontrados 22 estudos, sendo 14 ensaios clínicos controlados randomizados (ECRs. Dentre eles, quatro compararam mobilização precoce com tratamento convencional apresentando evidência moderada a favor da primeira; sete confrontaram tratamento baseado em exercícios domiciliares com tratamento em consultório apontando evidência conflitiva (um deles também comprovou eficácia de mobilização acessória passiva; e três analisaram eficácia de procedimentos terapêuticos: campo eletromagnético pulsado, drenagem linfática, ultra-som, indicando evidências limitadas. Os nove estudos não experimentais encontrados não apresentaram informações suficientes sobre os questionamentos desta pesquisa. Observou-se uma tendência dos autores em utilizar os princípios gerais da reabilitação ao elaborar condutas terapêuticas, mas os procedimentos utilizados não estão bem atestados pela literatura.The aim of this study was to assess the evidence regarding the adoption and effectiveness of therapeutic procedures employed for rehabilitation of distal radius fractures. This systematic review used the following databases: PubMed, Lilacs, PEDro, Cochrane, Scielo and OTseeker, without time restrictions. The following keywords were searched for: distal radius fracture, rehabilitation, occupational therapy

Low evaluation rate for osteoporosis among patients presenting with a rib fracture.

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Kim, Whang; Gong, Hyun Sik; Lee, Seung Hoo; Park, Jin Woo; Kim, Kahyun; Baek, Goo Hyun

2017-12-01

This study in a regional hospital setting found a low evaluation rate for osteoporosis among patients presenting with a rib fracture. Increased emphasis or education for osteoporosis evaluation may be necessary in case of rib fractures. Rib fractures from a low-energy trauma are common in the elderly, and a history of rib fracture has been reported to increase the risk for a subsequent osteoporotic fracture. The purpose of this study was to evaluate how many of the patients presenting with an isolated rib fracture were being evaluated for osteoporosis and the risk for a subsequent fracture. We retrospectively reviewed all patients aged 50 years or older who were diagnosed with a rib fracture between January 2011 and April 2016 at a regional tertiary care university hospital near Seoul, South Korea. We excluded those who had been treated for osteoporosis or those with other concomitant fractures or fractures from a motor vehicle accident or cancer. We evaluated the frequency of dual energy X-ray absorptiometry (DXA) scan examinations in these patients. There were 231 patients with isolated rib fractures (132 men and 99 women). The mean age was 65 years. Rib fractures were most commonly diagnosed at the emergency department and most of the patients were referred to the department of thoracic surgery for follow-up evaluations. Of these 231 patients, 29 (12%) had DXA examinations after the injury, and only 9 (4%) of them did so within 6 months. Physicians specializing in orthopedic surgery, family medicine, internal medicine, rehabilitation medicine, and emergency medicine were ordering the examination. This study in a regional hospital setting found a low evaluation rate for osteoporosis among patients presenting with a rib fracture. This study suggests that increased emphasis or education for osteoporosis evaluation may be necessary for physicians who are often referred to for care of rib fractures.

Frequency of extradural haematoma in patients with linear skull fracture

International Nuclear Information System (INIS)

Aurangzeb, A.; Afridi, E.A.K.; Khan, S.A.

2015-01-01

Apparently normal looking patients after traumatic brain injury can have serious neurological deterioration, and one of the common causes of such deterioration is extradural haematomas. This study was conducted to determine the frequency of extradural hematoma and common types of trauma leading to it among patients presenting with skull fracture due to head injury. Methods: This cross-sectional study was conducted in the department of Neurosurgery Ayub Medical College, Abbottabad from June 2011 to June 2012. All patients who were suspected to have Skull fracture on X-ray skull, during the study period, were included in study after informed consent and later on CT-Scan brain was done to see for extradural hematoma. Findings were recorded on a predesigned proforma including demographic data, radiological findings and the type of head trauma. Results: Out of 114 patients 85 (74.5%) were males and 29 (225.4%) were females. Age ranged from 2 to 70 years (18.23 ± 16.5 years). Among these patients the most important cause of head injury was fall from height in 65(57%), followed by road traffic accidents in 39 (34.2%), and assault in 10 (8.8%) patients. The most common site of fracture was parietal in 49 (43%) of patients, followed by frontal bone in 28 (24.6%) of patients, occipital bone in 24 (21.1%) of patients, and temporal bone in 23 (20.2%) of patients. Frequency of extradural hematoma among linear skull fracture was in 34 (29.8%) patients. Extradural hematoma was most common with parietotemporal linear skull fractures (73.5%). Conclusion: Extradural haematoma occurs commonly with linear skull fractures, so patients with linear skull fracture should be properly evaluated with CT brain. (author)

Evaluation of scale effects on hydraulic characteristics of fractured rock using fracture network model

International Nuclear Information System (INIS)

Ijiri, Yuji; Sawada, Atsushi; Uchida, Masahiro; Ishiguro, Katsuhiko; Umeki, Hiroyuki; Sakamoto, Kazuhiko; Ohnishi, Yuzo

2001-01-01

It is important to take into account scale effects on fracture geometry if the modeling scale is much larger than the in-situ observation scale. The scale effect on fracture trace length, which is the most scale dependent parameter, is investigated using fracture maps obtained at various scales in tunnel and dam sites. We found that the distribution of fracture trace length follows negative power law distribution in regardless of locations and rock types. The hydraulic characteristics of fractured rock is also investigated by numerical analysis of discrete fracture network (DFN) model where power law distribution of fracture radius is adopted. We found that as the exponent of power law distribution become larger, the hydraulic conductivity of DFN model increases and the travel time in DFN model decreases. (author)

Increased Mortality in Elderly Patients with Sarcopenia and Acetabular Fractures.

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Deren, Matthew E; Babu, Jacob; Cohen, Eric M; Machan, Jason; Born, Christopher T; Hayda, Roman

2017-02-01

Sarcopenia is a condition of clinically relevant loss of muscle mass and function. Acetabular fractures in elderly patients are common and difficult to treat. This study aimed to determine if sarcopenia is common in elderly patients with acetabular fractures and correlates with lower-energy mechanisms of injury, higher rates of complications, and higher mortality than patients with normal muscle mass. The Rhode Island Hospital Trauma Database was queried for patients who were ≥60 years of age from 2005 to 2014 using the International Classification of Diseases, Ninth Revision, code for closed acetabular fracture, 808.0. Charts were retrospectively reviewed for demographic data, operative intervention, mechanism of injury, mortality, comorbidities, and other factors. Computed tomography (CT) was used to determine the muscle cross-sectional area and to calculate the skeletal muscle index. The database revealed 192 patients coded for acetabular fracture; of these, 181 were correctly diagnosed. Ninety-nine patients had recorded body mass index (BMI) and adequate CT scans to measure the skeletal muscle index. Forty-two patients (42.4%) had sarcopenia, and 57 patients (57.6%) did not have sarcopenia. There were no significant differences in demographic characteristics between the groups with the exception of BMI and sex. BMI was higher in patients who did not have sarcopenia (31.7 kg/m) than it was in patients with sarcopenia (23.6 kg/m) (p sarcopenia at 76.2% (32 of 42 patients) than in patients without sarcopenia at 50.9% (29 of 57 patients). Fractures in patients without sarcopenia were associated with a higher-energy mechanism of injury in 78.9% of cases compared with 52.4% of cases of patients with sarcopenia (p = 0.005). Sarcopenia was significantly associated (p = 0.0419) with increased 1-year mortality (28.6%) compared with the absence of sarcopenia (12.3%). This association was even stronger if in-hospital mortality was excluded (p = 0.00074). Finally

[Malnutrition as a prognostic factor in elderly patients with hip fractures].

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Montero Pérez-Barquero, Manuel; García Lázaro, Milagros; Carpintero Benítez, Pedro

2007-05-19

Hip fracture occurs frequently in elderly patients, with devastating effects on the quality of life due to the high financial burden and the high mortality rate in patients with this condition. Malnutrition is prevalent in the elderly and it can negatively influence patients' recovery from hip fracture. Our proposal was to assess the relationship between malnutrition and the recovery of patients with hip fracture. A total of 110 patients with hip fractures who were admitted to the orthopedic unit at the Reina Sofía Hospital were reassessed one year after discharge. A prospective cohort design and logistic regression analysis was used. Mean age was 81.4, and 80% of patients were women. After one year 19.7% of patients had died. A multivariate analysis showed a significant relationship between a poor functional recovery and age (odds ratio [OR] = 1.19), caloric malnutrition (OR = 290), protein malnutrition (OR = 125); and there was a significant relationship between being confined to bed and a worse situation before fracture (OR = 10.02); caloric malnutrition (OR = 9.57) and protein malnutrition (OR = 15.23). Caloric and protein malnutrition were associated with a worse functional recovery in elderly patients with hip fracture.

Does osteoporosis increase complication risk in surgical fracture treatment? A protocol combining new endpoints for two prospective multicentre open cohort studies

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Marent Marta

2010-11-01

Full Text Available Abstract Background With an ever-increasing elderly population, orthopaedic surgeons are faced with treating a high number of fragility fractures. Biomechanical tests have demonstrated the potential role of osteoporosis in the increased risk of fracture fixation complications, yet this has not been sufficiently proven in clinical practice. Based on this knowledge, two clinical studies were designed to investigate the influence of local bone quality on the occurrence of complications in elderly patients with distal radius and proximal humerus fractures treated by open reduction and internal fixation. Methods/Design The studies were planned using a prospective multicentre open cohort design and included patients between 50 and 90 years of age. Distal radius and proximal humerus fractures were treated with locking compression 2.4 mm and proximal humerus internal locking plates, respectively. Follow-up examinations were planned for 6 weeks, 3 and 12 months as well as a telephone interview at 6 months. The primary outcome focuses on the occurrence of at least one local bone quality related complication. Local bone quality is determined by measuring bone mineral density and bone mineral content at the contralateral radius. Primary complications are categorised according to predefined factors directly related to the bone/fracture or the implant/surgical technique. Secondary outcomes include the documentation of soft tissue/wound or general/systemic complications, clinical assessment of range of motion, and patient-rated evaluations of upper limb function and quality of life using both objective and subjective measures. Discussion The prospective multicentre open cohort studies will determine the value of local bone quality as measured by bone mineral density and content, and compare the quality of local bone of patients who experience a complication (cases following surgery with that of patients who do not (controls. These measurements are novel and

Isolated fracture of pisiform: case report of a rare injury of wrist

African Journals Online (AJOL)

Arun Kumar Agnihotri

ABSTRACT: Isolated fracture of the pisiform is an extremely rare injury. Generally fractures of the pisiform are associated with fractures of other carpal bones or the distal radius. Fractures of the carpals and metacarpals account for roughly 6% of all fractures. The average incidence of pisiform fractures is 0.2% of all carpal ...

PROXIMAL DISABILITY AND SPINAL DEFORMITY INDEX IN PATIENTS WITH PROXIMAL FEMUR FRACTURES

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Sylvio Mistro Neto

2015-12-01

Full Text Available Objective : To evaluate the quality of life related to the spine in patients with proximal femoral fractures. Methods : Study conducted in a tertiary public hospital in patients with proximal femoral fractures caused by low-energy trauma, through the Oswestry Disability Index questionnaire to asses complaints related to the spine at the time of life prior to the femoral fracture. The thoracic and lumbar spine of patients were also evaluated applying the radiographic index described by Gennant (Spinal Deformity Index, which assesses the number and severity of fractures. Results : Seventeen subjects completed the study. All had some degree of vertebral fracture. Patients were classified in the categories of severe and very severe disability in the questionnaire about quality of life. It was found that the higher SDI, the better the quality of life. Conclusion : There is a strong association of disability related to the spine in patients with proximal femoral fracture, and this complaint must be systematically evaluated in patients with appendicular fracture.

Epidural analgesia in patients with traumatic rib fractures

DEFF Research Database (Denmark)

Duch, P; Møller, M H

2015-01-01

BACKGROUND: Traumatic rib fractures are a common condition associated with considerable morbidity and mortality. Observational studies have suggested improved outcome in patients receiving continuous epidural analgesia (CEA). The aim of the present systematic review of randomised controlled trials...... (RCTs) was to assess the benefit and harm of CEA compared with other analgesic interventions in patients with traumatic rib fractures. METHODS: We performed a systematic review with meta-analysis and trial sequential analysis (TSA). Eligible trials were RCTs comparing CEA with other analgesic...... interventions in patients with traumatic rib fractures. Cumulative relative risks (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were estimated, and risk of systematic and random errors was assessed. The predefined primary outcome measures were mortality, pneumonia and duration...

Predictors of mortality subsequent to a fracture in diabetes mellitus patients

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Jakob eStarup-Linde

2015-04-01

Full Text Available Background: Type-1 and type-2 Diabetes Mellitus (DM is associated with an increased fracture risk and possibly an increased risk of death following a fracture.Aim: To investigate the association between diabetes related drugs and mortality following a fracture. Methods: A nested case-control study was conducted. Cases were patients with DM who died following a fracture; controls were DM patients not dying after a fracture. We identified DM patients using the Danish National Hospital Discharge Register (1977-2011 and included information on date of DM diagnosis, date of fracture and comorbidities. From the Danish Cause of Death Register the date of death was collected (2008-2011. From the Central Region of Jutland, Denmark, medication use was collected (2008-2011. Analysis was performed by unconditional logistic regression.Results: 2,621 diabetes patients with a fracture following the diabetes diagnosis and with information on medication use were included. Of these 229 died. In a multivariate analysis, statin use (n= 1,106 (42% statin users, odds ratio (OR = 0.60, 95 % confidence interval, p=0.012 decreased the risk of dying subsequent to a fracture. Male gender (OR=1.57, p=0.005, increasing age (OR=1.08, p<0.001, a diagnosis of retinopathy (OR=2.12, p=0.008, heart failure (OR= 1.68, p=0.004 and use of glucocorticoids (OR=2.22, p=0.001 were associated with an increased risk of death. None of the antidiabetics; biguanides, glucagon-like receptor agonists, β-cell stimulants, glitazones, and insulin were associated with mortality.Conclusion: Co-morbidity reflected by late onset complications, heart failure and glucocorticoid use was associated with an increased risk of mortality subsequent to a fracture. Statin use may reduce mortality subsequent to a fracture in diabetes patients. Clinical trials are needed to determine whether diabetes patients with a fracture should initiate statin treatment.

Studies on hip fracture patients : effects of nutrition and rehabilitation

OpenAIRE

Flodin, Lena

2015-01-01

Hip fracture in the elderly is a serious condition associated with increased mortality. Survivors experience an increase in morbidity and disability that affect their independence and quality of life; the outcome for patients with dementia is particularly poor. Many hip fracture patients have signs of malnutrition already on admission and this patient group has been shown to have a lower body mass index (BMI) than aged-matched controls. A catabolic state develops following hip fracture, chara...

Incidence of fractures in patients with multiple sclerosis: the Danish National Health Registers

DEFF Research Database (Denmark)

Bazelier, Marloes T; de Vries, Frank; Bentzen, Joan

2012-01-01

Background: Patients with multiple sclerosis (MS) are potentially at high risk of fracture due to falls and osteoporosis. Objective: To estimate incidence rates of fractures in MS patients, stratified by fracture type, sex and age, and to compare these rates with controls. Methods: The case...... population consisted of all patients with an accepted diagnosis of MS in the Danish MS Registry (1949-2007). Data were linked to the National Hospital Discharge Register (1977-2007). Patients with MS (n = 11,157) were 1: 6 matched by year of birth, gender, calendar time and region to persons without MS...... (controls). Incidence rates of fracture were estimated as the number of fractures per 1000 person-years. Incidence rate ratios (IRRs) were calculated by dividing fracture rates in MS patients by fracture rates in controls. Results: Among patients with MS, the incidence rate of any fracture yielded 22.8 per...

Excess of all-cause mortality after a fracture in type 2 diabetic patients

DEFF Research Database (Denmark)

Martinez-Laguna, D; Nogues, Xavier; Abrahamsen, B

2017-01-01

Post-fracture mortality in type 2 diabetes mellitus (T2DM) patients has been poorly studied. We report an absolute and relative excess all-cause mortality following a fracture in these patients compared to non-diabetic patients. INTRODUCTION: T2DM and osteoporotic fractures are independently...... ≥50 years old T2DM patients registered in SIDIAP in 2006-2013 and two diabetes-free controls matched on age, gender, and primary care center were selected. Study outcome was all-cause mortality following incident fractures. Participants were followed from date of any fracture (AF), hip fracture (HF...... associated with a reduced lifespan, but it is unknown if T2DM confers an excess post-fracture mortality compared to non-diabetic fracture patients. We report post-fracture all-cause mortality according to T2DM status. METHODS: This is a population-based cohort study using data from the SIDIAP database. All...

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

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Sindhuja G

2017-06-01

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

Computer simulation of ductile fracture

International Nuclear Information System (INIS)

Wilkins, M.L.; Streit, R.D.

1979-01-01

Finite difference computer simulation programs are capable of very accurate solutions to problems in plasticity with large deformations and rotation. This opens the possibility of developing models of ductile fracture by correlating experiments with equivalent computer simulations. Selected experiments were done to emphasize different aspects of the model. A difficult problem is the establishment of a fracture-size effect. This paper is a study of the strain field around notched tensile specimens of aluminum 6061-T651. A series of geometrically scaled specimens are tested to fracture. The scaled experiments are conducted for different notch radius-to-diameter ratios. The strains at fracture are determined from computer simulations. An estimate is made of the fracture-size effect

Cervical spine fractures in elderly patients with hip fracture after low-level fall: an opportunity to refine prehospital spinal immobilization guidelines?

Science.gov (United States)

Boland, Lori L; Satterlee, Paul A; Jansen, Paul R

2014-02-01

Conventional prehospital spine-assessment approaches based on low index of suspicion and mechanism of injury (MOI) result in the liberal application of spinal immobilization in trauma patients. A painful distracting injury (DI), such as a suspected hip fracture, historically has been a sufficient condition for immobilization, even in an elderly patient who suffers a simple fall from standing and exhibits no other risk factors for spinal injury. Because the elderly are at increased risk of hip fracture from low-level falls, and are also particularly susceptible to the discomfort and morbidity associated with immobilization, the prevalence of cervical spine (c-spine) fracture in this patient population was examined. Hospital billing records were used to identify all cases of traumatic femur fracture in Minnesota (USA) in 2010-2011. Concurrent diagnosis and external cause codes were used to estimate the prevalence of c-spine fracture by age and MOI. Among 1,394 patients with femur fracture, 23 (1.7%) had a c-spine fracture. When the MOI was a fall from standing or sitting height and the patient age was ≥ 65, the prevalence dropped to 0.4% (2/565). The prevalence was similar when the definition of hip fracture additionally included pelvis fractures (0.5%; 11/2,441). Eight of the 11 patients with c-spine fracture had diagnosis codes indicative of criteria other than the DI that likely would have resulted in immobilization (eg, head injury and compromised mental status). C-spine fracture is extremely rare in elderly patients who sustain hip fracture as a result of a low-level fall, and appears to be accompanied frequently by other known predictors of spinal injury besides DI. More research is needed to determine whether conservative use of spinal immobilization may be warranted in elderly patients with hip fracture after low-level falls when the only criteria for immobilization is the distracting hip injury.

Fear of falling in older patients after hip fracture

NARCIS (Netherlands)

Visschedijk, Johannes Hermanus Maria (Jan)

2016-01-01

FoF is possibly one of the most important factors in patients after hip fracture, with a substantial impact on the final results of the rehabilitation process. Moreover, patients with hip fracture who rehabilitate in a SNF with high rates of comorbidity and complications, may have even worse

Angular deformation of radius and ulna treated by dynamic percutaneus osteogenesis distraction. Case report

International Nuclear Information System (INIS)

Rezende, C.M.F.; Melo, E.G.; Lamas, M.C.S.; Silva, C.A.

2000-01-01

The clinical exam of a male mongrel dog, 4-month-old, and 5.7kg of live weight, showed that the dog supported with the elbows and it was observed accentuated bilateral rotacional deformity of the radius and ulna. Radiographs of the radius and ulna revealed proximal fracture of the radius. After clinical and radiographic evaluation it was indicated the corrective osteotomy and distraction osteogenesis of the left foremember. The surgical procedure consisted in osteotomy in the diaphysis of the radius and ulna, and the utilization of external fixators composed by four Kirschner’s pins and two metallic thread bars, configuring a fixator type II, bilateral uniplanar dynamic. Before the fixation of the pins with acrylic, the fractured bony fragments were separated in approximately 0.5cm. Starting 10 days post surgery, the radial osteotomy site was distracted at a rate of 1.0mm every day for 30 days. The consolidation of the osteotomy site was observed radiographically 67 days after the intervention, when the fixator was removed. Similar procedure was accomplished in the right foremember at the age of 16 months. At this moment, it was necessary to remove a coins bony of approximately 1.0cm for correction of the limb angulation. At present, the dog shows normal function and support of the left foremember and light valgus deformity of the right foremember due to the broken implants [pt

A 72-year-old patient with bilateral Maisonneuve fractures

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Thomas Dienstknecht

2012-07-01

Full Text Available Maisonneuve fractures result from a disruption of the medial ankle structures and a proximal fibular fracture. Patient complaints can be misleading and there is a significant rate of delayed diagnosed injuries. We present a case of bilateral Maisonneuve fractures after a fall due to a syncopal collapse. A precise clinical examination led to this rare diagnosis. The injuries were treated with syndesmotic screw fixation, removal of hardware followed after 6 weeks. The patient was asymptomatic at threemonths follow up. Patients with bilateral injuries undergoing standard surgical treatment can gain full recovery, but high suspicion in clinical examination is needed to detect this uncommon bilateral injury.

Prevalence of silent vertebral fractures detected by vertebral fracture assessment in young Portuguese men with hyperthyroidism.

Science.gov (United States)

Barbosa, Ana Paula; Rui Mascarenhas, Mário; Silva, Carlos Francisco; Távora, Isabel; Bicho, Manuel; do Carmo, Isabel; de Oliveira, António Gouveia

2015-02-01

Hyperthyroidism is a risk factor for reduced bone mineral density (BMD) and osteoporotic fractures. Vertebral fracture assessment (VFA) by dual-energy X-ray absorptiometry (DXA) is a radiological method of visualization of the spine, which enables patient comfort and reduced radiation exposure. This study was carried out to evaluate BMD and the prevalence of silent vertebral fractures in young men with hyperthyroidism. We conducted a cross-sectional study in a group of Portuguese men aged up to 50 years and matched in hyperthyroidism (n=24) and control (n=24) groups. A group of 48 Portuguese men aged up to 50 years was divided and matched in hyperthyroidism (n=24) and control (n=24) groups. BMD (g/cm(2)) at L1-L4, hip, radius 33%, and whole body as well as the total body masses (kg) were studied by DXA. VFA was used to detect fractures and those were classified by Genant's semiquantitative method. No patient had previously been treated for hyperthyroidism, osteoporosis, or low bone mass. Adequate statistical tests were used. The mean age, height, and total fat mass were similar in both groups (P≥0.05). The total lean body mass and the mean BMD at lumbar spine, hip, and whole body were significantly decreased in the hyperthyroidism group. In this group, there was also a trend for an increased prevalence of reduced BMD/osteoporosis and osteoporotic vertebral fractures. The results obtained using VFA technology (confirmed by X-ray) suggest that the BMD changes in young men with nontreated hyperthyroidism may lead to the development of osteoporosis and vertebral fractures. This supports the pertinence of using VFA in the routine of osteoporosis assessment to detect silent fractures precociously and consider early treatment. © 2015 European Society of Endocrinology.

Femur Neck Fracture in a Young Marfan Syndrome Patient.

Science.gov (United States)

Kwon, Yong-Uk; Kong, Gyu-Min; Park, Jun-Ho

2016-12-01

Marfan syndrome is an autosomal dominant and could decrease bone mineral density. So patients with Marfan syndrome could vulnerable to trauma in old ages. We present the first report, to the best of our knowledge, of a rare fracture of the femoral neck with a minor traumatic history in a juvenile Marfan syndrome patient whose physis is still open. Although the patient is young, her bone mineral density was low and the geometry of femur is changed like old ages. The femur neck fracture in children is very rare and only caused by high energy trauma, we concluded that the Marfan syndrome makes the bone weaker in young age and preventative medications to avoid fractures in younger Marfan syndrome patients are necessary in early ages.

Rib fractures in coronary bypass patients: radionuclide detection

International Nuclear Information System (INIS)

Greenwald, L.V.; Baisden, C.E.; Symbas, P.N.

1983-01-01

Sternal retraction can cause the first rib to be fractured posteriorly, injuring the brachial plexus. The authors conducted bone scans of 24 consecutive open-heart surgery patients and found an unexpectedly high number of rib fractures which in all but one case had not been seen on the chest radiograph. Bone scans are recommended whenever there is unexplained non-incisional pain in a patient who has undergone sternal retraction

Two new methods for the determination of hydraulic fracture ...

African Journals Online (AJOL)

2008-09-15

Sep 15, 2008 ... Flow is radial and divergent. • There is only a single fracture within the test segment. • The fracture and rock mass are rigid and the matrix is imper- meable. • The fracture aperture varies along the radius and is radically symmetrical about the borehole. • Advection, dispersion and diffusion are negligible due ...

Clinical assessment tools identify functional deficits in fragility fracture patients

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Ames TD

2016-05-01

Full Text Available Tyler D Ames,1 Corinne E Wee,1 Khoi M Le,1 Tiffany L Wang,1 Julie Y Bishop,2 Laura S Phieffer,2 Carmen E Quatman2 1The Ohio State University College of Medicine, 2Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA Purpose: To identify inexpensive, noninvasive, portable, clinical assessment tools that can be used to assess functional performance measures that may put older patients at risk for falls such as balance, handgrip strength, and lumbopelvic control.Patients and methods: Twenty fragility fracture patients and 21 healthy control subjects were evaluated using clinical assessment tools (Nintendo Wii Balance Board [WBB], a handheld dynamometer, and an application for the Apple iPod Touch, the Level Belt that measure functional performance during activity of daily living tasks. The main outcome measurements were balance (WBB, handgrip strength (handheld dynamometer, and lumbopelvic control (iPod Touch Level Belt, which were compared between fragility fracture patients and healthy controls.Results: Fragility fracture patients had lower scores on the vertical component of the WBB Torso Twist task (P=0.042 and greater medial–lateral lumbopelvic sway during a 40 m walk (P=0.026 when compared to healthy controls. Unexpectedly, the fracture patients had significantly higher scores on the left leg (P=0.020 and total components (P=0.010 of the WBB Single Leg Stand task as well as less faults during the left Single Leg Stand task (P=0.003.Conclusion: The clinical assessment tools utilized in this study are relatively inexpensive and portable tools of performance measures capable of detecting differences in postural sway between fragility fracture patients and controls. Keywords: fall risk, geriatric fracture, Nintendo Wii Balance Board, Level Belt, fragility fracture

Introducing a Clinical Practice Guideline Using Early CT in the Diagnosis of Scaphoid and Other Fractures

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Pincus, Steven

2009-11-01

Full Text Available Objective: We developed and implemented clinical practice guideline (CPG using computerized tomography (CT as the initial imaging method in the emergency department management of scaphoid fractures. We hypothesized that this CPG would decrease unnecessary immobilization and lead to earlier return to work.Methods: This observational study evaluated implementation of our CPG, which incorporated early wrist CT in patients with “clinical scaphoid fracture”: a mechanism of injury consistent with scaphoid fracture, anatomical snuff box tenderness, and normal initial plain x-rays. Outcome measures were the final diagnosis as determined by orthopaedic review of the clinical and imaging data. Patient outcomes included time to return to work and patient satisfaction as determined by telephone interview at ten days.Results: Eighty patients completed the study protocol in a regional emergency department.In this patient population CT detected 28 fractures in 25 patients, including six scaphoid fractures, five triquetral fractures, four radius fractures, and 13 other related fractures. Fifty-three patients had normal CT. Eight of these patients had significant ongoing pain at follow up and had an MRI, with only two bone bruises identified. The patients with normal CTs avoided prolonged immobilization (mean time in plaster 2.7 days and had no or minimal time off work (mean 1.6 days. Patient satisfaction was an average 4.2/5.Conclusion: This CPG resulted in rapid and accurate management of patients with suspected occult scaphoid injury, minimized unnecessary immobilization and was acceptable to patients.[WestJEM. 2009;10(4:227-232.

Postoperative hemoglobin level in patients with femoral neck fracture.

Science.gov (United States)

Nagra, Navraj S; Van Popta, Dmitri; Whiteside, Sigrid; Holt, Edward M

2016-01-01

The aim of this study was to analyze the changes of hemoglobin levels in patients undergoing fixation for femoral neck fracture. Peroperative hemoglobin levels of patients who underwent either dynamic hip screw (DHS) fixation (n=74; mean age: 80 years) or hip hemiarthroplasty (n=104; mean age: 84 years) for femoral neck fracture was monitored. There was a statistically and clinically significant mean drop of 31.1 g/L between the preoperative (D0) and postoperative Day 5 Hb levels (pmeasurement, DHS patients had lower hemoglobin values over hemiarthroplasty patients (p=0.046). The decrease in hemoglobin in the first 24-hour postoperative period (D0 to Day 1) is an underestimation of the ultimate lowest value in hemoglobin found at Day 2. Relying on the Day 1 hemoglobin level could be detrimental to patient care. We propose a method of predicting patients likely to be transfused and recommend a protocol for patients undergoing femoral neck fracture surgery to standardize postoperative hemoglobin monitoring.

Does bone measurement on the radius indicate skeletal status. Concise communication

International Nuclear Information System (INIS)

Mazess, R.B.; Peppler, W.W.; Chesney, R.W.; Lange, T.A.; Lindgren, U.; Smith, E. Jr.

1984-01-01

Single-photon (I-125) absorptiometry was used to measure bone mineral content (BMC) of the distal third of the radius, and dual-photon absorptiometry (Gd-153) was used to measure total-body bone mineral (TBBM), as well as the BMC of major skeletal regions. Measurements were done in normal females, normal males, osteoporotic females, osteoporotic males, and renal patients. The BMC of the radius predicted TBBM well in normal subjects, but was less satisfactory in the patient groups. The spinal BMC was predicted with even lower accuracy from radius measurement. The error in predicting areal density (bone mass per unit projected skeletal area) of the lumbar and thoracic spine from the radius BMC divided by its width was smaller, but the regressions differed significantly among normals, osteoporotics, and renal patients. There was a preferential spinal osteopenia in the osteoporotic group and in about half of the renal patients. Bone measurements on the radius can indicate overall skeletal status in normal subjects and to a lesser degree in patients, but these radius measurements are inaccurate, even on the average, as an indicator of spinal state

Results of operative fixation of unstable ankle fractures in geriatric patients.

Science.gov (United States)

Pagliaro, A J; Michelson, J D; Mizel, M S

2001-05-01

It is widely accepted that operative fixation of unstable ankle fractures yields predictably good outcomes in the general population. The current literature, however reports less acceptable results in the geriatric population age 65 years and older. The current study analyzes the outcome of the surgical treatment of unstable ankle fractures in patients at least 65 years old. Twenty three patient over 65 years old were surgically treated after sustaining 21 (91%) closed and 2 (9%) open grade II unstable ankle fractures. Fractures were classified according to the Danis-Weber and Lauge-Hansen schemes. Fracture type was predominantly Weber B (21/23, 91%), or supination external rotation stage IV (21/23, 91%). Fracture union rate was 100%. There were three significant complications including a lateral wound dehiscence with delayed fibular union in an open fracture dislocation, and two below knee amputations, neither of which was directly related to the fracture treatment. There were three minor complications; one superficial wound infection and two cases of prolonged incision drainage, all of which resolved without further surgical intervention. Complications were associated with open fractures and preexisting systemic disease. These results indicate that open reduction and internal fixation of unstable ankle fractures in geriatric patients is an efficacious treatment regime that with results that are comparable to the general population.

Cementless Stem for Femoral Neck Fractures in a Patient's 10th Decade of Life: High Rate of Periprosthetic Fractures.

Science.gov (United States)

Kabelitz, Method; Fritz, Yannick; Grueninger, Patrick; Meier, Christoph; Fries, Patrick; Dietrich, Michael

2018-01-01

Subsidence of cementless femoral stems in hemiarthroplasty (HA) and increased fracture rates are ongoing concerns of orthopedic surgeons when treating fractures in very old patients. Additionally, bone cement implantation syndrome may result in perioperative cardiac or pulmonary complications, especially in older patients, leading to morbidity and mortality. This study was performed to analyze possible subsidence and intraoperative fractures in a cohort of very old patients treated with cementless stems. We retrospectively analyzed a consecutive cohort of patients aged ≥90 years with femoral neck fractures treated by uncemented HA and an anterior minimally invasive approach. Immediate full-weight bearing was allowed postoperatively. Pelvic radiographs were examined for subsidence immediately postoperatively and 6 weeks later. We treated 109 patients (74% women; mean age, 93 years; range, 90-102 years) by HA from January 2010 to March 2016. The 30-day mortality rate was 16%, and the morbidity rate was 47%. There were 11 (12%) intraoperative fractures: 8 (Vancouver B 2 ) had to be addressed immediately during the primary operation, while 3 (1 Vancouver B 1 and 2 Vancouver A G ) were treated conservatively. One periprosthetic femoral fracture (Vancouver B 1 ) was documented during follow-up. In 17 patients, subsidence of >2.0 mm (median, 3.9 mm; range, 2.5-9.0 mm) was documented. Early subsidence was low in this very old cohort treated with an uncemented stem and not showing a periprosthetic fracture. The risk of intraoperative periprosthetic fractures was high. The use of uncemented implants in osteoporotic bone continues to be an intervention with high risk and should only be performed by experienced surgeons. Level III, Therapeutic study.

Quality of life in old patients with proximal femoral fractures

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T A Raskina

2012-01-01

Full Text Available Objective: to study quality of life in Kemerovo old patients with proximal femoral fractures. Patients and methods. Quality of life in osteoporotic fractures was analyzed in 219 patients (173 women and 46 men who had sustained the injury in January 2004 to December 2008. Results. In the patients with hip fractures, the lowest (41.94+31.16 scores values were recorded by the physical functioning scale reflecting the degree to which their health limited the performance of physical exercises (self-service, walking, going upstairs, weight carriage, etc.. The role functioning and life activity scales showed the highest values (50.96+19.04 and 51.44+26.51 scores, respectively. The mean value of the physical component scale was 46.42+28.26 scores. That of the psychological component scale was 49.56+19.55 scores. Conclusion. The patients with proximal femoral fractures were found to have lower scores on all SF-36 dimensions.

Fracture of fusion mass after hardware removal in patients with high sagittal imbalance.

Science.gov (United States)

Sedney, Cara L; Daffner, Scott D; Stefanko, Jared J; Abdelfattah, Hesham; Emery, Sanford E; France, John C

2016-04-01

As spinal fusions become more common and more complex, so do the sequelae of these procedures, some of which remain poorly understood. The authors report on a series of patients who underwent removal of hardware after CT-proven solid fusion, confirmed by intraoperative findings. These patients later developed a spontaneous fracture of the fusion mass that was not associated with trauma. A series of such patients has not previously been described in the literature. An unfunded, retrospective review of the surgical logs of 3 fellowship-trained spine surgeons yielded 7 patients who suffered a fracture of a fusion mass after hardware removal. Adult patients from the West Virginia University Department of Orthopaedics who underwent hardware removal in the setting of adjacent-segment disease (ASD), and subsequently experienced fracture of the fusion mass through the uninstrumented segment, were studied. The medical records and radiological studies of these patients were examined for patient demographics and comorbidities, initial indication for surgery, total number of surgeries, timeline of fracture occurrence, risk factors for fracture, as well as sagittal imbalance. All 7 patients underwent hardware removal in conjunction with an extension of fusion for ASD. All had CT-proven solid fusion of their previously fused segments, which was confirmed intraoperatively. All patients had previously undergone multiple operations for a variety of indications, 4 patients were smokers, and 3 patients had osteoporosis. Spontaneous fracture of the fusion mass occurred in all patients and was not due to trauma. These fractures occurred 4 months to 4 years after hardware removal. All patients had significant sagittal imbalance of 13-15 cm. The fracture level was L-5 in 6 of the 7 patients, which was the first uninstrumented level caudal to the newly placed hardware in all 6 of these patients. Six patients underwent surgery due to this fracture. The authors present a case series of 7

Determinants of outcome in hip fracture patient care

NARCIS (Netherlands)

Vochteloo, Anne Jochem Hendrik

2013-01-01

In this thesis, clinical and functional outcomes of a large cohort of hip fracture patients are described, with regards to anemia, blood transfusion, concomitant fractures, loss of mobility and place of residence. Secondly, risk factors for poor outcome, both in a clinical and a functional

[Nutritional status in elderly patients with a hip fracture].

Science.gov (United States)

Pérez Durillo, F T; Ruiz López, M D; Bouzas, P R; Martín-Lagos, A

2010-01-01

Undernutrition is very common in elderly patients with a hip fracture. Malnutrition is associated with increased risk of complications after surgery. Few data exist about the presence of nutritional risk in these patients. The aim of this study was to evaluate the prevalence of undernutrition and the nutritional risk in elderly patients with a hip fracture admitted to a hospital. A cross sectional study assessing the nutritional status of 80 patients with hip fracture (mean age 80 years) was carried out. Functional capacity, anthropometric measurements, biochemical markers and dietary intake were evaluated. The Mini Nutritional Assessment test has been used to detect nutritional risk. 8.8% of patients were undernourished. 43.7% at risk of malnutrition and 47.5% well-nourished according to MNA test. If only BMI was considered the prevalence of malnutrition was 5%. Energy and micronutrient intake was low and could contribute to the development of complications after surgery. Our study shows a high prevalence of nutritional risk in elderly patients with a hip fracture. The inclusion of MNA in the preoperative evaluation could contribute to a better nutritional intervention during their stay in the hospital and to provide specific dietary advices to avoid malnutrition after surgery.

Antero-medial approach to the wrist: anatomic basis and new application in cases of fracture of the lunate facet.

Science.gov (United States)

Uzel, A-P; Bulla, A; Laurent-Joye, M; Caix, P

2011-08-01

The Henry approach is the classical anterolateral surgical exposure of the volar aspect of the distal radius. This approach does not allow good access to the medial side of the volar distal radius (lunate facet) and the distal radio-ulnar joint, unless it is extended proximally, retracting the tendons and the median nerve medially, which can cause some trauma. The purpose of our study was to investigate the anatomic basis and to outline the advantages of the unusual anteromedial approach, reporting our experience in the treatment of 4 distal radius fractures, with a 90° or 180° twist of the lunate facet, and 10 wrist dissections on cadavers. The average follow-up was 68.8 months (range 18 to 115 months). In our series, this approach did not cause any nerve injuries or any sensory loss of the distal forearm and the palm. All the fractures of the lunate facet and of the radial styloid process healed. One patient with an ulnar styloid process fracture associated showed pseudarthrosis, but with no instability of the distal radio-ulnar joint or pain on the ulnar side. Using the criteria of Green and O'Brien, modified by Cooney, the results were: excellent in two cases, good in one case, and average in another. The evaluation of arthritis according to Knirk and Jupiter's classification showed grade 0 in three cases and grade 3 in one case with osteochondral sclerosis. We showed that the anteromedial approach is reliable and convenient in the case of fractures situated in the antero-medial portion of the radius, for the double objective of reducing the fracture under direct control and checking the congruence of the distal radio-ulnar joint.

Improving consent in patients undergoing surgery for fractured neck of femur.

Science.gov (United States)

Thiruchandran, Gajendiran; McKean, Andrew R; Rudran, Branavan; Imam, Mohamed A; Yeong, Keefai; Hassan, Abdel

2018-05-02

Background Neck of femur fractures and their subsequent operative fixation are associated with high rates of perioperative morbidity and mortality. Consenting in this setting is suboptimal with the Montgomery court ruling changing the perspective of consent. This quality improvement project assessed the adequacy of consenting against British Orthopaedic Association-endorsed guidance and implemented a series of changes to improve the documentation of risks associated with surgery for fractured neck of femur. Methods Seventy consecutive patients who underwent any operative fixation of a neck of femur fracture were included over a 6-month period at a single centre. Patients unable to consent or without electronic notes were excluded. Consent forms were analysed and the documented potential risks or complications associated with surgery were compared to British Orthopaedic Association-endorsed guidance. A series of changes (using the plan, do study, act (PDSA) approach) was implemented to improve the adequacy of consent. Results Documentation of four out of 12 potential risks or complications was recorded in <50% of cases for patients with intracapsular fractures (n=35), and documentation of seven out of 12 potential risks or complications was recorded in <50% of cases for patients with extracapsular fractures (n=35). Re-audit following raising awareness and attaching consent guidance showed 100% documentation of potential risks or complications in patients with intracapsular and extracapsular fractures (n=70). A neck of femur fracture-specific consent form has been implemented which will hopefully lead to sustained improvement. Conclusions Consenting patients with fractured neck of femur for surgery in the authors' unit was suboptimal when compared to British Orthopaedic Association-endorsed consent guidance. This project has shown that ensuring such guidance is readily available has improved the adequacy of consent. The authors hope that introduction of a neck of

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.

Locking plates in distal humerus fractures: study of 43 patients

Directory of Open Access Journals (Sweden)

Gupta Rakesh Kumar

2013-08-01

Full Text Available 【Abstract】Objective: The treatment of multi-fragmentary, intraarticular fractures of the distal humerus is difficult, even in young patients with bone of good quality. Small distal fragment, diminished bone mineral quality and increased trauma-associated joint destruction make stable joint reconstruction more problematic. The anatomically preshaped locking plates allow angular stable fixation for these complex fractures. We evaluated functional results of patients treated with open reduction and internal fixation with distal humerus locking plates for complex distal hu-merus fractures. Methods: Forty-three consecutive patients with ar-ticular fractures of the distal humerus were treated by open reduction and internal fixation with AO distal humerus plate system and locking reconstruction plates. Forty patients were available for the final outcome analysis. According to AO/ASIF classification, there were 2 cases of type A2, 4 cases of type A3, 1 case of type B1, 1 case of type B2, 14 cases of type C1, 7 cases of type C2 and 11 cases of type C3. Open reduction with triceps splitting technique was used in all patients. The clinical and radiographic follow-up was performed and outcome measures included pain assessment, range of motion, and Mayo elbow performance score. Results: Forty patients were available for the final outcome analysis. There were 29 males and 11 females with an average age of 38.4 years (18-73 years. Clinical and ra-diological consolidation of the fracture was observed in all cases at an average of 11.6 weeks (9-14 weeks. The average follow-up was 12 months (10-18 months. Using the Mayo elbow performance score the results obtained were graded as excellent or good results in 33 patients (82.5%. One pa-tient had superficial infection, and 4 had myositis ossificans. There were no cases of primary malposition or secondary displacement, implant failure or ulnar neuropathy. Conclusion: Anatomically preshaped distal humerus locking

Bone scan as a screening test for missed fractures in severely injured patients.

Science.gov (United States)

Lee, K-J; Jung, K; Kim, J; Kwon, J

2014-12-01

In many cases, patients with severe blunt trauma have multiple fractures throughout the body. These fractures are not often detectable by history or physical examination, and their diagnosis can be delayed or even missed. Thus, screening test fractures of the whole body is required after initial management. We performed this study to evaluate the reliability of bone scans for detecting missed fractures in patients with multiple severe traumas and we analyzed the causes of missed fractures by using bone scan. A bone scan is useful as a screening test for fractures of the entire body of severe trauma patients who are passed the acute phase. We reviewed the electronic medical records of severe trauma patients who underwent a bone scan from September 2009 to December 2010. Demographic and medical data were compared and statistically analyzed to determine whether missed fractures were detected after bone scan in the two groups. A total of 382 patients who had an injury severity score [ISS] greater than 16 points with multiple traumas visited the emergency room. One hundred and thirty-one patients underwent bone scan and 81 patients were identified with missed fractures by bone scan. The most frequent location for missed fractures was the rib area (55 cases, 41.98%), followed by the extremities (42 cases, 32.06%). The missed fractures that required surgery or splint were most common in extremities (11 cases). In univariate analysis, higher ISS scores and mechanism of injury were related with the probability that missed fractures would be found with a bone scan. The ISS score was statistically significant in multivariate analysis. Bone scan is an effective method of detecting missed fractures among patients with multiple severe traumas. Level IV, retrospective study. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Diagnostic strategies in patients with high fracture risk

NARCIS (Netherlands)

Malgo, F.

2018-01-01

This thesis describes the results of data collected from patients who were referred to our Fracture Liaison Service in a 2-year time period for screening for increased fracture risk, and also describes the results of our clinical studies performed using the impact microindentation technique, a new

Risks of all-cause and site-specific fractures among hospitalized patients with COPD

OpenAIRE

Liao, Kuang-Ming; Liang, Fu-Wen; Li, Chung-Yi

2016-01-01

Abstract Patients with chronic obstructive pulmonary disease (COPD) have a high prevalence of osteoporosis. The clinical sequel of osteoporosis is fracture. Patients with COPD who experience a fracture also have increased morbidity and mortality. Currently, the types of all-cause and site-specific fracture among patients with COPD are unknown. Thus, we elucidated the all-cause and site-specific fractures among patients with COPD. A retrospective, population-based, cohort study was conducted u...

Clinical Utility of Chest Computed Tomography in Patients with Rib Fractures CT Chest and Rib Fractures

OpenAIRE

Chapman, Brandon C.; Overbey, Douglas M.; Tesfalidet, Feven; Schramm, Kristofer; Stovall, Robert T.; French, Andrew; Johnson, Jeffrey L.; Burlew, Clay C.; Barnett, Carlton; Moore, Ernest E.; Pieracci, Fredric M.

2016-01-01

Background Chest CT is more sensitive than a chest X-ray (CXR) in diagnosing rib fractures; however, the clinical significance of these fractures remains unclear. Objectives The purpose of this study was to determine the added diagnostic use of chest CT performed after CXR in patients with either known or suspected rib fractures secondary to blunt trauma. Methods Retrospective coho...

Incidence rate of mild traumatic brain injury among patients who have suffered from an isolated limb fracture: Upper limb fracture patients are more at risk.

Science.gov (United States)

Jodoin, Marianne; Rouleau, Dominique M; Charlebois-Plante, Camille; Benoit, Benoit; Leduc, Stéphane; Laflamme, G-Yves; Gosselin, Nadia; Larson-Dupuis, Camille; De Beaumont, Louis

2016-08-01

This study compares the incidence rate of mild traumatic brain injury (mild TBI) detected at follow-up visits (retrospective diagnosis) in patients suffering from an isolated limb trauma, with the incidence rate held by the hospital records (prospective diagnosis) of the sampled cohort. This study also seeks to determine which types of fractures present with the highest incidence of mild TBI. Retrospective assessment of mild TBI among orthopaedic monotrauma patients, randomly selected for participation in an Orthopaedic clinic of a Level I Trauma Hospital. Patients in the remission phase of a limb fracture were recruited between August 2014 and May 2015. No intervention was done (observational study). Standardized semi-structured interviews were conducted with all patients to retrospectively assess for mild TBI at the time of the fracture. Emergency room related medical records of all patients were carefully analyzed to determine whether a prospective mild TBI diagnosis was made following the accident. A total of 251 patients were recruited (54% females, Mean age=49). Study interview revealed a 23.5% incidence rate of mild TBI compared to an incidence rate of 8.8% for prospective diagnosis (χ(2)=78.47; plimb monotrauma (29.6%; n=42/142) are significantly more at risk of sustaining a mild TBI compared to lower limb fractures (15.6%; n=17/109) (χ(2)=6.70; p=0.010). More specifically, patients with a proximal upper limb injury were significantly more at risk of sustaining concomitant mild TBI (40.6%; 26/64) compared to distal upper limb fractures (20.25%; 16/79) (χ(2)=7.07; p=0.008). Results suggest an important concomitance of mild TBI among orthopaedic trauma patients, the majority of which go undetected during acute care. Patients treated for an upper limb fracture are particularly at risk of sustaining concomitant mild TBI. Copyright © 2016 Elsevier Ltd. All rights reserved.

Economic burden of illness among US patients experiencing fracture nonunion

Directory of Open Access Journals (Sweden)

Wu N

2013-03-01

Full Text Available Ning Wu,1 Yuan-chi Lee,1 Daniel Segina,2 Hallie Murray,3 Teresa Wilcox,1 Luke Boulanger1 1United BioSource Corporation, Lexington, MA, USA; 2Department of Orthopaedics, Holmes Regional Trauma Center, Melbourne, FL, USA; 3Biomet Spine and Bone Healing Technologies, Parsippany, NJ, USA Objectives: To compare economic outcomes in a real-world study of patients with fracture nonunion receiving non-invasive electrical bone growth stimulation (EBGS, low-intensity pulsed ultrasound stimulation (LIPUS, or other non-stimulation fracture management interventions (No-stim. Methods: Medical and pharmacy claims from a US commercially-insured population were analyzed to select adult patients newly diagnosed with a fracture nonunion between July 2006 and September 2009. The date of initial nonunion diagnosis was set as the index date. Three cohorts were constructed based on the first treatment prescribed post index date: EBGS, LIPUS, or No-stim. Baseline demographics, clinical characteristics, and health care costs 9 months before and 1 year after the index date were assessed. Multivariate regression analyses were performed to compare health care costs between cohorts in the post index period. Results: 11,628 patients (mean age 45.4 years; 45.7% males with a fracture nonunion were identified within the three treatment groups (EBGS: 29.5%, LIPUS: 12.3%, and No-stim: 58.2%. In the post-index period, EBGS patients were significantly less likely to receive fracture-related treatments when compared to the LIPUS (33.6% vs 42.2%, P < 0.01 and the No-stim (33.6% vs 60.3%, P < 0.01 cohorts. Additionally, after adjusting for demographic and clinical characteristics, the EBGS cohort had significantly lower predicted health care-associated costs 1 year post index date when compared to the LIPUS (mean: $21,632 vs $23,964, P < 0.01 and the No-stim (mean: $21,632 vs $23,843, P < 0.01 cohorts. Furthermore, the predicted fracture-related costs (FRC of EBGS patients were also

Elderly patients with maxillofacial trauma: study of mandibular condyle fractures.

Science.gov (United States)

Nogami, Shinnosuke; Yamauchi, Kensuke; Yamashita, Toshio; Kataoka, Yoshihiro; Hirayama, Bunichi; Tanaka, Kenko; Takahashi, Tetsu

2015-02-01

The aim of this study was to investigate the trends and characteristic features of mandibular condyle fractures in elderly patients in terms of etiology, patterns, and treatment modalities. Records of 201 patients aged 65 years and older, who were treated for maxillofacial fractures at the Department of Oral and Maxillofacial Surgery, Kyushu Dental University, and Tohoku University from January 2002 to December 2013, were retrospectively analyzed. Patient records and radiographs were examined, with the following information: relevant medical history, cause of fracture, the presence and state of premolars and molars in the maxilla and mandible, number and location of mandible fracture, and method of treatment. As for the state of premolars and molars, premolars or molars in the mandible in contact with the maxilla were regarded as contacted. A fall was responsible for the majority of the fractures (173/201). With condyle fractures, there was a significant difference between the contacted and non-contacted group in regard to incidence. Furthermore, there was a significantly greater number of cases with symphysis and condyle combination fractures in the non-contacted group (70.9%) than in the contacted group (51.9%). As for the method of treatment, arthrocentesis was the most commonly employed. The present findings suggest that contacted molars in the maxilla and mandible have an influence on condyle fractures in elderly individuals. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Development of stress-modified fracture strain criterion for ductile fracture of API X65 steel

International Nuclear Information System (INIS)

Oh, Chang Kyun; Kim, Yun Jae; Park, Jin Moo; Kim, Woo Sik; Baek, Jong Hyun

2005-01-01

This paper presents a stress-modified fracture strain for API X65 steel used for gas pipeline, as a function of stress triaxiality. To determine the stress-modified fracture strain, tension test of bars with four different notch radii, made of API X65 steel, is firstly performed, from which true fracture strains are determined as a function of notch radius. Then detailed elastic-plastic, large strain Finite Element (FE) analyses are performed to estimate variations of stress triaxiality in the notched bars with load. Combining experimental with FE results provides the true fracture strain as a function of stress triaxiality, which is regarded as a criterion of ductile fracture. Application of the developed stress-modified fracture strain to failure prediction of gas pipes made of API X65 steel with various types of defects is discussed

Locking plate fixation in distal metaphyseal tibial fractures: series of 79 patients.

Science.gov (United States)

Gupta, Rakesh K; Rohilla, Rajesh Kumar; Sangwan, Kapil; Singh, Vijendra; Walia, Saurav

2010-12-01

Open reduction and internal fixation in distal tibial fractures jeopardises fracture fragment vascularity and often results in soft tissue complications. Minimally invasive osteosynthesis, if possible, offers the best possible option as it permits adequate fixation in a biological manner. Seventy-nine consecutive adult patients with distal tibial fractures, including one patient with a bilateral fracture of the distal tibia, treated with locking plates, were retrospectively reviewed. The 4.5-mm limited-contact locking compression plate (LC-LCP) was used in 33 fractures, the metaphyseal LCP in 27 fractures and the distal medial tibial LCP in the remaining 20 fractures. Fibula fixation was performed in the majority of comminuted fractures (n = 41) to maintain the second column of the ankle so as to achieve indirect reduction and to prevent collapse of the fracture. There were two cases of delayed wound breakdown in fractures fixed with the 4.5-mm LC-LCP. Five patients required primary bone grafting and three patients required secondary bone grafting. All cases of delayed union (n = 7) and nonunion (n = 3) were observed in cases where plates were used in bridge mode. Minimally invasive plate osteosynthesis (MIPO) with LCP was observed to be a reliable method of stabilisation for these fractures. Peri-operative docking of fracture ends may be a good option in severely impacted fractures with gap. The precontoured distal medial tibial LCP was observed to be a better tolerated implant in comparison to the 4.5-mm LC-LCP or metaphyseal LCP with respect to complications of soft tissues, bone healing and functional outcome, though its contour needs to be modified.

Indentation deformation and fracture of thin polystyrene films

International Nuclear Information System (INIS)

Li Min; Palacio, Manuel L.; Barry Carter, C.; Gerberich, William W.

2002-01-01

Nanoindentation-induced deformation and fracture of thin polystyrene (PS) films on glass substrates were characterized using visible-light microscopy and atomic force microscopy (AFM). Two film thicknesses, 2 and 3.5 μm were studied. It was difficult to induce delamination in the 2-μm film while the 3.5-μm film delaminated easily under indentation loads of 150 mN and higher. AFM cross-section analysis of the deformation and fracture geometry revealed that the ratio of the delamination radius to contact radius was between 3 and 4. Analysis of the fracture surface on the glass side indicates that substrate cracking acts as a trigger for initiation and propagation of interfacial cracks. Crack-arrest marks and process-zone marks were also observed by AFM imaging. The interfacial fracture toughness, or practical work of adhesion, was evaluated following two methods based on the indentation-induced delamination and a process-zone analysis. The fracture toughness was found to be approximately 0.6 J/m 2 for the 3.5-μm PS film on glass. AFM examination of the glass surface after indentation also showed fine flow lines around the indentation impression, indicating plastic deformation of glass

Indentation deformation and fracture of thin polystyrene films

Energy Technology Data Exchange (ETDEWEB)

Li Min; Palacio, Manuel L.; Barry Carter, C.; Gerberich, William W

2002-09-02

Nanoindentation-induced deformation and fracture of thin polystyrene (PS) films on glass substrates were characterized using visible-light microscopy and atomic force microscopy (AFM). Two film thicknesses, 2 and 3.5 {mu}m were studied. It was difficult to induce delamination in the 2-{mu}m film while the 3.5-{mu}m film delaminated easily under indentation loads of 150 mN and higher. AFM cross-section analysis of the deformation and fracture geometry revealed that the ratio of the delamination radius to contact radius was between 3 and 4. Analysis of the fracture surface on the glass side indicates that substrate cracking acts as a trigger for initiation and propagation of interfacial cracks. Crack-arrest marks and process-zone marks were also observed by AFM imaging. The interfacial fracture toughness, or practical work of adhesion, was evaluated following two methods based on the indentation-induced delamination and a process-zone analysis. The fracture toughness was found to be approximately 0.6 J/m{sup 2} for the 3.5-{mu}m PS film on glass. AFM examination of the glass surface after indentation also showed fine flow lines around the indentation impression, indicating plastic deformation of glass.

Alterations of bone density, microstructure, and strength of the distal radius in male patients with rheumatoid arthritis: a case-control study with HR-pQCT.

Science.gov (United States)

Zhu, Tracy Y; Griffith, James F; Qin, Ling; Hung, Vivian W; Fong, Tsz-Ning; Au, Sze-Ki; Li, Martin; Lam, Yvonne Yi-On; Wong, Chun-Kwok; Kwok, Anthony W; Leung, Ping-Chung; Li, Edmund K; Tam, Lai-Shan

2014-09-01

In this cross-sectional study, we investigated volumetric bone mineral density (vBMD), bone microstructure, and biomechanical competence of the distal radius in male patients with rheumatoid arthritis (RA). The study cohort comprised 50 male RA patients of average age of 61.1 years and 50 age-matched healthy males. Areal BMD (aBMD) of the hip, lumbar spine, and distal radius was measured by dual-energy X-ray absorptiometry. High-resolution peripheral quantitative computed tomography (HR-pQCT) of the distal radius provided measures of cortical and trabecular vBMD, microstructure, and biomechanical indices. aBMD of the hip but not the lumbar spine or ultradistal radius was significantly lower in RA patients than controls after adjustment for body weight. Total, cortical, and trabecular vBMD at the distal radius were, on average, -3.9% to -23.2% significantly lower in RA patients, and these differences were not affected by adjustment for body weight, testosterone level, or aBMD at the ultradistal radius. Trabecular microstructure indices were, on average, -8.1% (trabecular number) to 28.7% (trabecular network inhomogeneity) significantly inferior, whereas cortical pore volume and cortical porosity index were, on average, 80.3% and 63.9%, respectively, significantly higher in RA patients. RA patients also had significantly lower whole-bone stiffness, modulus, and failure load, with lower and more unevenly distributed cortical and trabecular stress. Density and microstructure indices significantly correlated with disease activity, severity, and levels of pro-inflammatory cytokines (interleukin [IL] 12p70, tumor necrosis factor, IL-6 and IL-1β). Ten RA patients had focal periosteal bone apposition most prominent at the ulnovolar aspect of the distal radius. These patients had shorter disease duration and significantly higher cortical porosity. In conclusion, HR-pQCT reveals significant alterations of bone density, microstructure, and strength of the distal radius in

Radioisotopic and Radiological Evaluation in Patient with Stress Fracture

International Nuclear Information System (INIS)

Ko, Kwang Seop; Kim, Jai Young; Kang, Sung Koo; Kim, So Yon; Lee, Gwon Jun

1987-01-01

The stress fracture is a disease caused by and abnormal stress to the normal bone with constant, repeated pull. Early detection of stress fracture plays an important role in treatment and prevention of its complication. Bone scintigraphy was performed to evaluate 18 patients with stress fracture of the lower extremities from May, 1985 to April, 1987, in the Department of Internal Medicine of National Police Hospital. The results were as follows: 1) Seventeen of the 18 cases showed positive bone scans at the initial study performed from 1 week to 5 months after the onset of symptom. 2) Ten of the 18 patients had findings of stress fracture at the initial X-ray film. Two out of 8 negative case revealed positive findings in the follow-up studies. 3) The bone scans in the 2 cases taken 5 months after the onset of symptom; the one showed only slightly increased radio uptake, the other showed no abnormal findings. In conclusion, bone scanning is a more sensitive indicator of early stress fracture than radiologic study, The healing phase is characterized by a gradual decline in radioactivity at the fracture site in concordance with subsidence of symptom.

Locking plate fixation in distal metaphyseal tibial fractures: series of 79 patients

OpenAIRE

Gupta, Rakesh K.; Rohilla, Rajesh Kumar; Sangwan, Kapil; Singh, Vijendra; Walia, Saurav

2009-01-01

Open reduction and internal fixation in distal tibial fractures jeopardises fracture fragment vascularity and often results in soft tissue complications. Minimally invasive osteosynthesis, if possible, offers the best possible option as it permits adequate fixation in a biological manner. Seventy-nine consecutive adult patients with distal tibial fractures, including one patient with a bilateral fracture of the distal tibia, treated with locking plates, were retrospectively reviewed. The 4.5-...

Radiation-induced femoral neck fracture in patients cured of cervical carcinoma

Energy Technology Data Exchange (ETDEWEB)

Lukowska, K; Zomer-Drozda, J; Kielbinska, S [Instytut Onkologii, Warsaw (Poland)

1976-01-01

In the years 1948-1967 8275 patients with cervical carcinoma in various grades of progression were treated at the Institute of Oncology in Warsaw by radiotherapy from external fields. Five-year survival without signs of recurrence was obtained in 4204 cases, 3863 of them were irradiated from external fields with X-rays under conventional conditions, while 341 received Co/sup 60/ radiotherapy. In 43 patients treated with X-rays and radium and regarded as cured radiological evidence of femoral neck fracture was obtained. These patients account for 1.1% of all cured patients. In the group treated with Co/sup 60/ radiation in only 1 case femoral neck fracture was observed (0.3%). In the group of cured patients with femoral neck fracture the method of irradiation from external fields, the age, clinical course, radiological appearance of radiation-induced changes and the method of fracture management were analysed.

Femoral Geometry in Male Patients with Atraumatic Hip Fracture - Original Investigation

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Gülten Tan

2007-03-01

Full Text Available Aims: Hip fracture is the most serious complication of osteoporosis and the most disabling type of fracture. In this study, we aimed to compare femoral geometry in hip fractured male patients aged more than 65 years old with age matched controls. Patients and Methods: 20 male patients with a history of nontraumatic hip fracture and 19 age-matched healthy controls were included in this study. Bone mineral density of neck and trochanter of hip were measured by DEXA. In addition to BMD, an experienced radiologist measured proximal femur geometric parameters potentially involved in bone strength. Results: Mean BMDs of trochanteric region were not significantly different between groups, but mean BMDs of neck region were statistically significantly lower in the hip fractured group. Neck shaft angle and femur shaft width were the geometric parameters found to be significantly higher in the hip fractured group. The correlation between femur geometric and the anthropometric measurements was present only in the kontrol group. Conclusion: We concluded that besides femur geometric measurements, correlation between these measurements might be an important factors for the fracture risk. (From the World of Osteoporosis 2007;13:15-8

High perceived caregiver burden for relatives of patients following hip fracture surgery

DEFF Research Database (Denmark)

Ariza-Vega, Patrocinio; Ortiz-Piña, Mariana; Kristensen, Morten Tange

2018-01-01

treatment strategies such as the support and training of the caregivers in patient handling during hospital stay could be carried out to reduce caregiver burden. Implications for rehabilitation The main caregiver of a hip fracture patient is usually a woman who is the daughter of the patient, and reducing...... her burden of care should be included as one of the objectives of rehabilitation treatment. The caregivers of hip fracture patients must be considered as part of the treatment during the patient's recovery period, and patient handling training should be provided to the caregivers of hip fracture......PURPOSE: To determine the profile of the main informal caregivers, the evolution of the caregiver burden, and the influencing factors of caregiver burden at 1-year after hip fracture surgery. METHODS: In this prospective cohort study, a total of 172 informal caregivers of patients were interviewed...

Traumatic Fracture in a patient of Osteopoikilosis with review of literature

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Rohan Bansal

2013-04-01

Full Text Available Introduction: Osteopoikilosis or osteopathia condensans disseminata is a rare hereditary autosomal dominant sclerosing bone dysplasia. Patients are usually asymptomatic and the diagnosis is usually made incidentally on radiographs which show presence of symmetric, multiple, well defined, small ovoid areas of increased radiodensity clustered in peri-articular osseous regions with propensity for epiphyseal and metaphyseal involvement. There are no increased risks of pathological fracture in a case of osteopoikilosis and traumatic fracture healing in a case of osteopoikilosis is similar to fracture occurring in other normal patients. Case Report: A 34 years male, electrician came with history of accidental fall from height while working in office leading to development of pain and swelling over left lower leg and ankle diagnosed with Ruedi-Allgower classification type I pilon fracture(without fibula fracture no distal neuro-vascular deficit. Patient was offered surgical treatment in form of open reduction and internal fixation of tibial fracture by plate osteosynthesis using antero-medial approach , showed complete union and was followed up for eight months. Conclusion: Osteopoikilosis has a benign course and it should always be kept as a possible differential diagnosis for osteoblastic metastasis to avoid diagnositic dilemma. Diagnosis can be settled by routine x-rays ( for type ,extent and site of lesions, bones affected, clinical features of patient , histopathology and other systemic or pre-existing conditions. Keywords: Fracture , Osteopoikilosis , union, Pilon, Osteoblastic metastasis

Paratrooper's ankle fracture: posterior malleolar fracture.

Science.gov (United States)

Young, Ki Won; Kim, Jin-su; Cho, Jae Ho; Kim, Hyung Seuk; Cho, Hun Ki; Lee, Kyung Tai

2015-03-01

We assessed the frequency and types of ankle fractures that frequently occur during parachute landings of special operation unit personnel and analyzed the causes. Fifty-six members of the special force brigade of the military who had sustained ankle fractures during parachute landings between January 2005 and April 2010 were retrospectively analyzed. The injury sites and fracture sites were identified and the fracture types were categorized by the Lauge-Hansen and Weber classifications. Follow-up surveys were performed with respect to the American Orthopedic Foot and Ankle Society ankle-hindfoot score, patient satisfaction, and return to preinjury activity. The patients were all males with a mean age of 23.6 years. There were 28 right and 28 left ankle fractures. Twenty-two patients had simple fractures and 34 patients had comminuted fractures. The average number of injury and fractures sites per person was 2.07 (116 injuries including a syndesmosis injury and a deltoid injury) and 1.75 (98 fracture sites), respectively. Twenty-three cases (41.07%) were accompanied by posterior malleolar fractures. Fifty-five patients underwent surgery; of these, 30 had plate internal fixations. Weber type A, B, and C fractures were found in 4, 38, and 14 cases, respectively. Based on the Lauge-Hansen classification, supination-external rotation injuries were found in 20 cases, supination-adduction injuries in 22 cases, pronation-external rotation injuries in 11 cases, tibiofibular fractures in 2 cases, and simple medial malleolar fractures in 2 cases. The mean follow-up period was 23.8 months, and the average follow-up American Orthopedic Foot and Ankle Society ankle-hindfoot score was 85.42. Forty-five patients (80.36%) reported excellent or good satisfaction with the outcome. Posterior malleolar fractures occurred in 41.07% of ankle fractures sustained in parachute landings. Because most of the ankle fractures in parachute injuries were compound fractures, most cases had to

Preliminary experience with biodegradable implants for fracture fixation

Directory of Open Access Journals (Sweden)

Dhillon Mandeep

2008-01-01

Full Text Available Background: Biodegradable implants were designed to overcome the disadvantages of metal-based internal fixation devices. Although they have been in use for four decades internationally, many surgeons in India continue to be skeptical about the mechanical strength of biodegradable implants, hence this study. Materials and Methods: A prospective study was done to assess the feasibility and surgeon confidence level with biodegradable implants over a 12-month period in an Indian hospital. Fifteen fractures (intra-articular, metaphyseal or small bone fractures were fixed with biodegradable implants. The surgeries were randomly scheduled so that different surgeons with different levels of experience could use the implants for fixation. Results: Three fractures (one humeral condyle, two capitulum, were supplemented by additional K-wires fixation. Trans-articular fixator was applied in two distal radius and two pilon fractures where bio-pins alone were used. All fractures united, but in two cases the fracture displaced partially during the healing phase; one fibula due to early walking, and one radius was deemed unstable even after bio-pin and external fixator. Conclusions: Biodegradable -implants are excellent for carefully selected cases of intra-articular fractures and some small bone fractures. However, limitations for use in long bone fractures persist and no great advantage is gained if a "hybrid" composite is employed. The mechanical properties of biopins and screws in isolation are perceived to be inferior to those of conventional metal implants, leading to low confidence levels regarding the stability of reduced fractures; these implants should be used predominantly in fracture patterns in which internal fixation is subjected to minimal stress.

Adolescent Volar Barton Fracture with Open Physis treated with Volar Plating using Buttressing Principle

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Shah H

2015-07-01

Full Text Available Objective: The objective of the study was to assess the outcome of Salter- Harris type III distal radius fracture fixed using the principle of buttressing and avoiding screw insertion through the physis. Materials and Method: Eight school going children in the age group of 11-16 years with volar Barton fractures were treated with a volar plate using the buttress principle without inserting screws in the distal fragment. Patients were evaluated over a period of 18 months. Clinical evaluation was done using the Green O’Brien criteria and radiological evaluation using the Sarmiento criteria. Results: The average union time was two months. All the patients had good to excellent functional outcome with full extension and flexion. Conclusion: Buttress plating of volar Barton fractures in the adolescent age group is an excellent technique to achieve satisfactory outcome without violation of the physis.

Prediction of postoperative morbidity, mortality and rehabilitation in hip fracture patients

DEFF Research Database (Denmark)

Foss, Nicolai B; Kristensen, Morten T; Kehlet, Henrik

2006-01-01

To validate the cumulated ambulation score as an early postoperative predictor of short-term outcome in hip fracture patients.......To validate the cumulated ambulation score as an early postoperative predictor of short-term outcome in hip fracture patients....

ULNAR NEURITIS ASSOCIATED WITH GUN STOCK DEFORMITY FOLLOWING SUPRACONDYLAR FRACTURE OF HUMERUS

Directory of Open Access Journals (Sweden)

Sunita Morhan

2014-04-01

Full Text Available Background: This case report describes a patient who was referred to physiotherapist from a hand surgeon. Among the fractures around the elbow joint, radial head fracture and fracture of distal end of radius are common among adults. The occurrence of Supracondylar fractures are more commonly seen in children when compared to adults. One of the complications of this fracture is malunion resulting in Gun stock deformity. The main Purpose of this case report is to explore, 1. The complication associated with gunstock deformity 2. Chances of iatrogenic nerve injury after manipulation under anesthesia. 3.Long term supervised rehabilitation approach. Case Description: A 40 years old male patient referred to our Physiotherapy department by a hand surgeon. After the initial evaluation, findings revealed limitation in right elbow movement and tingling and numbness sensation in little and half of ring fingers in his right side. This patient underwent ulnar nerve transposition surgery followed by rehabilitation. His physiotherapy session includes electrotherapeutic agents for pain relief, passive mobilization of elbow and strengthening program for his flexors and extensors of elbow for a period of one year. Outcome: The outcome of the long term rehabilitation approach for a patient with ulnar neuropathy secondary to gunstock deformity after ulnar nerve transposition surgery is good. The patients tingling and numbness decreased and the range of elbow movement improved significantly. Discussion: Most common complications of fracture of distal end of humerus include malunion,ischemic contracture and nerve injuries. The relative incidence of iatrogenic nerve injuries associatedwith this fracture has been reported as being 2%-6%. Nerve injuries after Supracondylar humeral fractures occur primarily due to tenting or entrapment of the nerve on the sharp proximal humeral fragment, while iatrogenic injuries occur either during closed manipulation or percutaneous

Guideline-Driven Care Improves Outcomes in Patients with Traumatic Rib Fractures.

Science.gov (United States)

Flarity, Kathleen; Rhodes, Whitney C; Berson, Andrew J; Leininger, Brian E; Reckard, Paul E; Riley, Keyan D; Shahan, Charles P; Schroeppel, Thomas J

2017-09-01

There is no established national standard for rib fracture management. A clinical practice guideline (CPG) for rib fractures, including monitoring of pulmonary function, early initiation of aggressive loco-regional analgesia, and early identification of deteriorating respiratory function, was implemented in 2013. The objective of the study was to evaluate the effect of the CPG on hospital length of stay. Hospital length of stay (LOS) was compared for adult patients admitted to the hospital with rib fracture(s) two years before and two years after CPG implementation. A separate analysis was done for the patients admitted to the intensive care unit (ICU). Over the 48-month study period, 571 patients met inclusion criteria for the study. Pre-CPG and CPG study groups were well matched with few differences. Multivariable regression did not demonstrate a difference in LOS (B = -0.838; P = 0.095) in the total study cohort. In the ICU cohort (n = 274), patients in the CPG group were older (57 vs 52 years; P = 0.023) and had more rib fractures (4 vs 3; P = 0.003). Multivariable regression identified a significant decrease in LOS for those patients admitted in the CPG period (B = -2.29; P = 0.019). Despite being significantly older with more rib fractures in the ICU cohort, patients admitted after implementation of the CPG had a significantly reduced LOS on multivariable analysis, reducing LOS by over two days. This structured intervention can limit narcotic usage, improve pulmonary function, and decrease LOS in the most injured patients with chest trauma.

Tibial Fractures in Alpine Skiing and Snowboarding in Finland: A Retrospective Study on Fracture Types and Injury Mechanisms in 363 Patients.

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Stenroos, A; Pakarinen, H; Jalkanen, J; Mälkiä, T; Handolin, L

2016-09-01

Alpine skiing and snowboarding share the hazards of accidents accounting for tibial fractures. The aim of this study was to evaluate the fracture patterns and mechanisms of injury of tibial fractures taking place in downhill skiing and snowboarding. All patients with tibial fracture due to alpine skiing or snowboarding accident treated in four trauma centers next to the largest ski resorts in Finland were analyzed between 2006 and 2012. The hospital records were retrospectively reviewed for data collection: equipment used (skis or snowboard), age, gender, and mechanism of injury. Fractures were classified according to AO-classification. There were 342 skiing and 30 snowboarding related tibial fractures in 363 patients. Tibial shaft fracture was the most common fracture among skiers (n = 215, 63%), followed by proximal tibial fractures (n = 92, 27%). Snowboarders were most likely to suffer from proximal tibial fracture (13, 43%) or tibial shaft fracture (11, 37%). Snowboarders were also more likely than skiers to suffer complex AO type C fractures (23% vs 9%, p jumping (46%). The most important finding was the relatively high number of the tibial plateau fractures among adult skiers. The fracture patterns between snowboarding and skiing were different; the most common fracture type in skiers was spiral tibial shaft fracture compared to proximal tibial fractures in snowboarders. Children had more simple fractures than adults. © The Finnish Surgical Society 2016.

Lower limb fractures in adult patients with residua of poliomyelitis ...

African Journals Online (AJOL)

Few studies have been published in the literature regarding fractures of limbs in patients with poliomyelitis. We have conducted a retrospective study from 1992 to 2004 in order to present our data on fractures of lower limbs in adult patients with residua of poliomyelitis. During the thirteen-year period under study, only eight ...

Fracture Mechanics Assessment for Different Notch Sizes Using Finite Element Analysis Based on Ductile Failure Simulation

Energy Technology Data Exchange (ETDEWEB)

Bae, Keun Hyung; Jeon, Jun Young; Han, Jae Jun; Nam, Hyun Suk; Lee, Dae Young; Kim, Yun Jae [Korea Univ., Seoul (Korea, Republic of)

2016-08-15

In this study, notch defects are evaluated using fracture mechanics. To understand the effects of notch defects, FE analysis is conducted to predict the limit load and J-integral for middle-cracked and single-edge cracked plates with various sizes of notch under tension and bending. As the radius of the notch increases, the energy release rate also increases, although the limit load remains constant. The values of fracture toughness(J{sub IC}) of SM490A are determined for various notch radii through FE simulation instead of conducting an experiment. As the radius of the notch increases, the energy release rate also increases, together with a more significant increase in fracture toughness. To conclude, as the notch radius increases, the resistance to crack propagation also increases.

The Risk of Fractures Among Patients With Cirrhosis or Chronic Pancreatitis

DEFF Research Database (Denmark)

Bang, Ulrich Christian; Benfield, Thomas; Bendtsen, Flemming

2014-01-01

BACKGROUND & AIMS: Cirrhosis and chronic pancreatitis (CP) are accompanied by inflammation and malnutrition. Both conditions can have negative effects on bone metabolism and promote fractures. We evaluated the risk of fractures among patients with CP or cirrhosis and determined the effect of fat...... individuals younger than 50 years old. Alcohol as an etiology was associated with an increased risk of fracture compared with patients with nonalcoholic cirrhosis (HR, 2.4 vs 1.5; P

Sarcopenia in patients with hip fracture: A multicenter cross-sectional study

OpenAIRE

Steihaug, Ole Martin; Gjesdal, Clara Gram; Bogen, Bård Erik; Kristoffersen, Målfrid Holen; Lien, Gunhild; Ranhoff, Anette Hylen

2017-01-01

Background: Sarcopenia is prevalent in older persons and is a risk factor for falls, fractures, and mortality. The aim of this study was to determine a) the feasibility of determining sarcopenia in patients with acute hip fracture, b) the prevalence of sarcopenia and c) associations of sarcopenia with nutritional status and comorbidities. Methods: A multicenter cross-sectional study on sarcopenia in male and female patients with acute hip fracture. Participants were previously ambulatory a...

Mexican patients with HIV have a high prevalence of vertebral fractures

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José Antonio Mata-Marín

2018-04-01

Full Text Available Low bone mineral density (BMD and fragility fractures are common in individuals infected with HIV, who are undergoing antiretroviral therapy (ART. In high-income countries, dual energy X-ray absorptiometrry is typically used to evaluate osteopenia or osteoporosis in HIV infected individuals. However, this technology is unavailable in low and-middle income countries, so a different approach is needed. The aim of this study was to use X-ray scans of the spine to determine the prevalence of and associated risk factors for vertebral fractures in HIV-infected patients in a tertiary-care hospital in Mexico. We conducted a cross-sectional study of outpatients who were >40 years old and receiving ART at the Hospital de Infectología, La Raza National Medical Center in Mexico City, Mexico. We used semi-quantitative morphometric analysis of centrally digitized X-ray images to assess vertebral deformities in the spine. Anterior, middle and posterior vertebral heights were measured, and height ratios were calculated. For each vertebral body, fractures were graded on the basis of height ratio reductions, and a spine deformity index’ (SDI value was calculated by summing the grades of the vertebral deformities: An SDI>1 was indicative of a vertebral fracture. We included 104 patients, 87% of whom were men. The median age was 49 years [interquartile range (IQR 42-52]. Themost common stage of HIV infection, as defined by the Centers for Disease Control,was B2 in 40 (39% of patients. Forty seven (45% patients were on ART regimens that included protease inhibitors (PIs and 100 (96% being treated with tenofovir. The median time of ART was 6.5 years (IQR1.6-9.0. Of the 104 patients in our study, 83 (80% had undetectable viral load, as assessed by HIV-1 RNA levels, 32 (31% showed evidence of a previous fracture, 4 (4% were co-infected with hepatitis C virus, and 57 (55% had a history of corticosteroid treatment. The prevalence of vertebral fractures was 25%, 95

Assessment of radiological vertebral fractures in HIV-infected patients: clinical implications and predictive factors.

Science.gov (United States)

Gazzola, L; Savoldi, A; Bai, F; Magenta, A; Dziubak, M; Pietrogrande, L; Tagliabue, L; Del Sole, A; Bini, T; Marchetti, G; d'Arminio Monforte, A

2015-10-01

The aim of this study was to evaluate the clinical impact of including lateral spine X-ray in the screening of bone diseases in HIV-positive patients. A total of 194 HIV-positive patients underwent dual-energy X-ray absorptiometry (DEXA), lateral spine X-ray and bone biochemical analysis. Vertebral fractures were identified using a morphometric analysis of X-rays and classified using the semiquantitative scoring system of Genant et al. For each patient, a spine deformity index (SDI) score was calculated by summing the grades of vertebral deformities. Reductions in vertebral body height of > 25% were considered vertebral fractures, and those Risk factors associated with vertebral fractures were evaluated by univariate and multivariate analysis. Vertebral fractures were detected in 24 patients (12.4%) and vertebral deformities in 17 patients (8.7%); 153 patients (78.9%) did not show any vertebral deformity. Among patients with fractures, only two with SDI > 10 reported lumbar pain; the remaining were asymptomatic. Patients over 50 years old showed a higher prevalence of vertebral fracture [24.4% versus 11.8% in patients 41-50 years old (P = 0.05) and 1.9% in patients ≤ 40 years old (P = 0.04)]. No significant increase in the prevalence according to bone mineral density (BMD) reduction was observed, and 70% of fractures were diagnosed in nonosteoporotic patients. Older age [adjusted odds ratio 1.09; 95% confidence interval (CI) 1.03-1.13; P = 0.001] and steroid use (adjusted odds ratio 3.64; 95% CI 1.29-10.3; P = 0.01) were independently associated with vertebral fracture; no association was found with HIV- or highly active antiretroviral therapy (HAART)-related variables. A prevalence of vertebral fractures of 12.4% was observed in our HIV-positive cohort. Given that two-thirds of fractures occurred in nonosteoporotic patients, spine X-ray may be considered in patients at increased risk, irrespective of BMD; that is, in elderly patients

Atypical Femur Fractures in Patients Treated with Bisphosphonates: Identification, Management, and Prevention

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Judith Sarah Bubbear

2016-10-01

Full Text Available Osteoporosis is a common condition with significant health care costs. First-line therapy is with bisphosphonates, which have proven anti-fracture efficacy. Around 10 years after the introduction of bisphosphonates reports began to be published of atypical femoral fractures (AFFs that may be associated with this therapy. These fractures are associated with significant morbidity although lower mortality than the more common osteoporotic neck-of-femur fractures. A case definition has been described to allow identification of this class of fracture. Further work has established a high relative risk of AFFs in patients treated with bisphosphonates, but a low absolute risk in comparison to that of osteoporotic fractures. Proposed pathological mechanisms include low bone turnover states leading to stress/insufficiency fractures. Clinicians should be aware of the risk of AFFs and in particular the high rate of prodromal thigh/groin pain that warrants investigation in a patient receiving a bisphosphonate. If an incomplete fracture is diagnosed then bisphosphonate therapy needs to be stopped and prophylactic surgery may be considered. Due to these rare side effects patients on bisphosphonates require regular review, and this is particularly advised after 5 years of oral or 3 years of intravenous therapy.

Mortality in patients with pelvic fractures

DEFF Research Database (Denmark)

Hauschild, Oliver; Strohm, Peter C; Culemann, Ulf

2008-01-01

hospitals were evaluated for age, gender, Injury Severity Score (ISS), Hannover Polytrauma Score (PTS), fracture type (using Tile's classification), peripelvic soft tissue injury, need for emergency measures, mortality, cause of death, and need for operative stabilization. We compared the patients...

Assessment of fracture risk in a cohort of Egyptian female Systemic Lupus erythematosus patients

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Eman A. Hafez

2018-04-01

Full Text Available Aim of the work: To assess the fracture risk in a cohort of Egyptian systemic lupus erythematosus (SLE females in correlation to some disease variables. Patients and methods: Seventy female SLE patients ≥40 years old were enrolled with detailed history taking, assessment of disease activity and damage index. Measurement of Serum calcium, phosphorus and alkaline phosphatase, bone mineral density (BMD by dual emission X-ray absorptiometry (DEXA at lumbar spine (LS and femoral neck (FN, serum osteocalcin level and World Health Organization (WHO fracture risk assessment tool (FRAX®. Results: 20% of the patients had LS osteoporosis, 35.7% LS osteopenia, 8.6% FN osteoporosis, and 42.9% FN osteopenia. Ten-year risk of major and hip fractures was high in SLE patients evidenced by FRAX-Major ≥20% in 10% of patients, and FRAX-Hip ≥3% in 27.1% of patients. Serum osteocalcin level was significantly decreased in SLE patients with lower BMD than those with normal BMD, and significantly decreased in patients with osteoporosis than those with osteopenia. A significant negative correlation was found between osteocalcin level and age of patients, disease duration, disease activity and damage index scores, current intravenous pulse and cumulative steroids, immunosuppressants, anticoagulants, but there was a positive correlation with antimalarials and calcium supplements. Conclusion: Ten-year risk of major and hip fractures was high in SLE patients. Increasing age, disease duration, high anti-DNA titres, higher disease activity and damage index were associated with a higher fracture risk. FRAX predicted fractures among SLE patients with normal and low bone mass not just those with frank osteoporosis. Physicians should be alerted to the higher risk of future fractures in SLE patients for periodic monitoring. Keywords: Systemic lupus erythematosus, Bone mineral density, Osteoporosis, Fracture risk, Fracture risk assessment tool

Unilateral Pedicle Stress Fracture in a Long-Term Hemodialysis Patient with Isthmic Spondylolisthesis

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Keishi Maruo

2015-01-01

Full Text Available Most unilateral pedicle stress fractures occur on the contralateral side of patients with unilateral spondylolysis. However, there are few reports of unilateral pedicle stress fractures in patients with bilateral spondylolysis and spondylolisthesis. We report a unique case of unilateral pedicle stress fracture in a long-term hemodialysis patient with isthmic spondylolisthesis. A 65-year-old man who had undergone hemodialysis presented with lower back pain that had persisted for several years. The patient experienced severe right lower extremity pain with no history of trauma. Computed tomography revealed unilateral pedicle fracture with bilateral L5 spondylolysis and spondylolisthesis with progression of scoliosis. The patient underwent Gill laminectomy of L5 with pedicle screw fixation at L4-S1 and interbody fusion at L5-S1. The patient’s leg pain ceased immediately, and he began walking without leg pain. In our present patient, development of scoliosis caused by destructive spondyloarthropathy may have contributed to a unilateral pedicle fracture.

Risk of vertebral compression fractures in multiple myeloma patients

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Anitha, D.; Thomas, Baum; Jan, Kirschke S.; Subburaj, Karupppasamy

2017-01-01

Abstract The purpose of this study was to develop and validate a finite element (FE) model to predict vertebral bone strength in vitro using multidetector computed tomography (MDCT) images in multiple myeloma (MM) patients, to serve as a complementing tool to assess fracture risk. In addition, it also aims to differentiate MM patients with and without vertebral compression fractures (VCFs) by performing FE analysis on vertebra segments (T1?L5) obtained from in vivo routine MDCT imaging scans....

Risk Factors of the Hip Fractures in Elderly Patients

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Ali Reza Nik-Tab'e

2001-12-01

Full Text Available Objective: The hip fractures are the most frequent cause of traumatic death after the age of 75 years, occurring more frequently in women that will make a negative impact of the patient's life style. The purpose of this research was to evaluate the risk factors of the hip fractures in elderly hospitalized in centers of education and treatment of Kerman and Rafsanjan cities in 1998-2000. Methods and Materials & Methods: This study was a descriptive method of sampling during 27 months (from 19 April 1998 to 21 July 2000 in hospitalized patients of orthopedic wards of Ali ebne Abitaleb hospital of Rafsanjan and Shahid bahonar hospital of Kerman. 257 patients who were afflicted with hip fracture were evaluated by a questionnaire with 20 statements (risk factors of hip fractures that was used to recorded information about this study: This risk factors were including age, sex, type of fracture, osteoporosis, milk consumption, muscle atrophy, environmental hazards, body mass index diseases, diabetes, previous fracture, smoking, antidepressant and anti convulsion drugs, heart disease, low mobility and activity perception disorders, age of menopause, impaired visual and nonuse external hip protector (padding. Results: The results of this study showed that many of above risk factors were effective (>50% than others. These factors were including environmental hazards (81.7%, muscle atrophy (72.8%, previous fractures (52.1%, low mobility and activity (70.8%, low milk consumption (100%, low BMI (79.8%, osteoporosis (52.1% and nonuse external hip protector (100%. Conclusion: The results of this study recommend that environmental hazards of elderly should be modified (e.g. well lighted, stair case with secure hand rail to prevent from falling Exercise and faradic current prevent muscle atrophy and improve physical fitness, muscle strength, balance and coordination. Treatment of impaired visual is important because risk of falling is decreased. Regular load

Monteggia fracture dislocation equivalents - analysis of eighteen cases treated by open reduction and internal fixation

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Singh Ajay Pal

2012-02-01

Full Text Available 【Abstract】 Objective: Monteggia fracture dislocation equivalent, though already described by Bado, is still an unclassified entity. We aimed to retrospectively analyze 18 cases of Monteggia variants and discuss the injury mechanisms, management, and outcome along with a review of the literature. Methods: A retrospective record of Monteggia fracture dislocation (2003-2008 was reviewed from medical record department of our institute. Classic Monteggia fracture dislocation, children below 12 years or adults over 50 years, as well as open grade II & III cases were excluded from this study. Monteggia variant inclusion criteria included fracture of the proximal ulna together with a fracture of the radial head or neck and skeletal maturity. Totally 26 patients were identified with Monteggia variants and 18 were available for follow-up, including 11 males and 7 females with the mean age of 35 years. The ulna fracture was treated by compression plating along with tension band wiring. Radial head/neck was reconstructed in 12 patients while excised in 6 patients. Results: Follow-up ranged from 1-4 years, mean 2.6 years. Patients were assessed clinicoradiologically. Mayo Elbow Performance Score was employed to assess the outcomes. At final follow-up, the results were excellent in 10 patients, good in 4, fair in 2 and poor in 2. Mean range of motion of the elbow was 20°, 116°, 50° and 55° for extension, flexion, pronation and supination, respectively. Two patients had complications in the form of heterotopic ossification and stiffness of the elbow. One nonunion ulna, primarily treated by tension band wiring, was managed by refixation with locking reconstruction plate and bone grafting. Bone grafting was only required in this patient for nonunion. Another patient had implants removed on his request. The results in our series closely correlated with extent of intraarticular damage, coronoid fracture and comminuted fractures. Conclusions: Monteggia

Risk factors for fractures in patients with rheumatoid arthritis (preliminary results of the multicenter program «Osteoporosis in rheumatoid arthritis: Diagnosis, risk factors, fractures, treatment»

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Marina Mikhailovna Podvorotova

2013-01-01

Full Text Available In patients with rheumatoid arthritis (RA, bone fractures occur 1.5-2 times more frequently than in the population. They often lead to reduced quality of life, to disability and death in the patients. It should be noted that risk factors (RFs for fractures have not been studied on a sufficient sample in Russia; there are no recommendations on the prevention of fractures in this category of patients. Objective: to compare groups of RA patients with and without a history of fractures to further identify possible RFs for fractures. Subjects and methods. The trial included 254 patients aged 18 to 85 years, diagnosed with RA, from the database of the multicenter program «Osteoporosis in rheumatoid arthritis: Diagnosis, risk factors, fractures, treatment», who had been followed up in 2010 to 2011. The patients were divided into two groups: 1 101 (39.8% patients with a history of low-trauma fractures and 2 153 (60.2% patients without a history of fractures. In Group 1, the patients were older than in Group 2 (mean age 59.8 and 56.1 years, respectively. Menopause was recorded in 88.1 and 77.8% of cases, respectively. The groups differed in the duration of RA an average of 15.5 and 11.5 years, respectively Results. The fractures in the history were associated with the use of glucocorticoids (GC, their higher cumulative dose and use duration. In Group 1 patients, the bone mineral density (BMD was lower in all study skeleton portions and more frequently corresponded to osteoporosis. RA complications, such as amyloidosis and osteonecrosis, were more common in the patients with a history of fractures. Conclusion. In RA patients, the most likely RFs of fractures are age, the long-term intake of large-dose GC, low BMD, the severe course of RA, and the presence of its complications.

Pre-hospital dietary intake correlates with muscle mass at the time of fracture in older hip fractured patients

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Riccardo eCalvani

2014-11-01

Full Text Available Background. Failure to meet an adequate dietary intake is involved in the pathogenesis of sarcopenia and osteoporosis, which in turn increase the risk for falls and fractures, respectively. Older people with hip fracture are often protein-malnourished at hospitalization. Whether low protein-energy intake is associated with muscle atrophy in hip fractured patients is presently unknown. This information is necessary for the development of novel strategies to manage this especially vulnerable patient population. The aim of this study was therefore to explore the relationship between dietary intake and muscle mass in older hip fractured patients.Methods. Analyses were conducted in hip fractured elderly admitted to an orthopedic and trauma surgery ward (University Hospital. Muscle mass was estimated by bioelectrical impedance analysis within 24 h from admission. Dietary information was collected via 24-h dietary recall and nutrient intakes calculated by a nutrition software.Results. Among 62 hip fractured patients (mean age 84.6±7.6 years, 84% women, the average energy intake was 929.2±170.3 Kcal/day, with higher values reported by men (1.046.8±231.4 Kcal/day relative to women (906.5±148.3 Kcal/day; p=0.01. Absolute and normalized protein intake was 50.0±13.5 g/day and 0.88±0.27 g/kg (body weight/day, respectively, with no gender differences. A positive correlation was determined between total energy intake and muscle mass (r=0.384; p=0.003. Similarly, protein and leucine consumption was positively correlated with muscle mass (r=0.367 and 0.311, respectively; p=0.005 for both.Conclusions. A low intake of calories, protein and leucine is associated with reduced muscle mass in hip fractured elderly. Given the relevance of sarcopenia as a risk factor for adverse outcomes in this patient population, our findings highlight the importance of a comprehensive dietary assessment for the detection of nutritional deficits predisposing to or aggravating

Identification of risk factors for neurological deficits in patients with pelvic fractures

DEFF Research Database (Denmark)

Schmal, Hagen; Hauschild, Oliver; Culemann, Ulf

2010-01-01

This multicenter register study was performed to define injury and fracture constellations that are at risk to develop pelvic associated neural lesions. Data of 3607 patients treated from 2004 to 2009 for pelvic fractures were evaluated for neurological deficits depending on Tile classification......, pelvic injury configuration, and treatment.In 223 patients (6.5%), neurological lesions were diagnosed on the day of discharge from the hospital. The degree of instability of the pelvic fracture correlated with occurrence of nerve lesions. Rate of neurological dysfunction increased from 1.5% in type...... A fractures to 14.4% in type C fractures (PPatients sustaining complex pelvic trauma (7.85%) suffered from significantly more neurological...

When Should Abdominal Computed Tomography Be Considered in Patients with Lower Rib Fractures?

Science.gov (United States)

Jeroukhimov, Igor; Hershkovitz, Yehuda; Wiser, Itay; Kessel, Boris; Ayyad, Mohammed; Gatot, Inbar; Shapira, Zahar; Jeoravlev, Svetlana; Halevy, Ariel; Lavy, Ron

2017-05-01

Lower rib fractures are considered as a marker of intra-abdominal organ injury. Abdominal computed tomography (CT) is the "gold standard" examination for patients with lower rib fractures. However, the reported incidence of concomitant intra-abdominal injuries (IAI) is 20%-40%. The purpose of this study was to evaluate the incidence of intra-abdominal organ injuries in blunt trauma patients with lower rib fractures. Medical charts and radiology reports of patients with lower rib (from the 8th to 12th rib) fractures admitted to our center during a 6-year period were retrospectively reviewed. Patients were divided into two groups. Group I included patients with intra-abdominal injury (IAI) diagnosed either by CT or on urgent laparotomy, and Group II included those with normal abdominal CT scans. Data included demographics, mechanism of injury, laboratory tests, radiology results including number and location of fractured ribs, and incidence of IAI. Overall 318 patients were included in the study. Fifty-seven patients (17.9%) had 71 IAIs compared with 265 (82.1%) patients with no IAI. Logistic regression identified age younger than 55 years (relative risk [RR] = 7.2; 95% confidence interval [CI] 3.1-16.8; p = 0.001), bilateral rib fractures (RR = 3.9; 95% CI 1.1-13.5; p = 0.03) and decreased levels of hematocrit (RR = 2.4; 95% CI 1.2-4.8; p = 0.016) as independent risk factors for the presence of IAI. Abdominal CT should be considered in blunt trauma patients with lower rib fractures who are younger than 55 years of age and have bilateral rib fractures and decreased levels of hematocrit on admission. Copyright © 2016 Elsevier Inc. All rights reserved.

Fracture toughness evaluation of small notched specimen in consideration of notch effect and loading rate

International Nuclear Information System (INIS)

Lee, Baik Woo; Kwon, Dong Il; Jang, Jae Il

2000-01-01

Notch effect and loading rate dependency on fracture toughness were considered when evaluating fracture toughness of small notched specimens using the instrumented impact test. Notch effect was analyzed into stress redistribution effect and stress relaxation with a viewpoint of stress triaxiality. Stress redistribution effect was corrected by introducing effective crack length, which was the sum of actual crack length and plastic zone size. Stress relaxation effect was also corrected using elastic stress concentration factor, which would decrease if plastic deformation occurred. As a result, corrected fracture toughness of the notched specimen was very consistent with the reference fracture toughness obtained using precracked specimen. In addition, limiting notch root radius, below which fracture toughness was independent of notch radius, was observed and discussed. Loading rate dependency on fracture toughness, which was obtained from the static three point bending test and the instrumented impact test, was also discussed with stress field in plastic zone ahead of a notch and fracture based on stress control mechanism. (author)

Life impact of ankle fractures: qualitative analysis of patient and clinician experiences.

Science.gov (United States)

McPhail, Steven M; Dunstan, Joel; Canning, Julie; Haines, Terry P

2012-11-21

Ankle fractures are one of the more commonly occurring forms of trauma managed by orthopaedic teams worldwide. The impacts of these injuries are not restricted to pain and disability caused at the time of the incident, but may also result in long term physical, psychological, and social consequences. There are currently no ankle fracture specific patient-reported outcome measures with a robust content foundation. This investigation aimed to develop a thematic conceptual framework of life impacts following ankle fracture from the experiences of people who have suffered ankle fractures as well as the health professionals who treat them. A qualitative investigation was undertaken using in-depth semi-structured interviews with people (n=12) who had previously sustained an ankle fracture (patients) and health professionals (n=6) that treat people with ankle fractures. Interviews were audio-recorded and transcribed. Each phrase was individually coded and grouped in categories and aligned under emerging themes by two independent researchers. Saturation occurred after 10 in-depth patient interviews. Time since injury for patients ranged from 6 weeks to more than 2 years. Experience of health professionals ranged from 1 year to 16 years working with people with ankle fractures. Health professionals included an Orthopaedic surgeon (1), physiotherapists (3), a podiatrist (1) and an occupational therapist (1). The emerging framework derived from patient data included eight themes (Physical, Psychological, Daily Living, Social, Occupational and Domestic, Financial, Aesthetic and Medication Taking). Health professional responses did not reveal any additional themes, but tended to focus on physical and occupational themes. The nature of life impact following ankle fractures can extend beyond short term pain and discomfort into many areas of life. The findings from this research have provided an empirically derived framework from which a condition-specific patient-reported outcome

Life impact of ankle fractures: Qualitative analysis of patient and clinician experiences

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McPhail Steven M

2012-11-01

Full Text Available Abstract Background Ankle fractures are one of the more commonly occurring forms of trauma managed by orthopaedic teams worldwide. The impacts of these injuries are not restricted to pain and disability caused at the time of the incident, but may also result in long term physical, psychological, and social consequences. There are currently no ankle fracture specific patient-reported outcome measures with a robust content foundation. This investigation aimed to develop a thematic conceptual framework of life impacts following ankle fracture from the experiences of people who have suffered ankle fractures as well as the health professionals who treat them. Methods A qualitative investigation was undertaken using in-depth semi-structured interviews with people (n=12 who had previously sustained an ankle fracture (patients and health professionals (n=6 that treat people with ankle fractures. Interviews were audio-recorded and transcribed. Each phrase was individually coded and grouped in categories and aligned under emerging themes by two independent researchers. Results Saturation occurred after 10 in-depth patient interviews. Time since injury for patients ranged from 6 weeks to more than 2 years. Experience of health professionals ranged from 1 year to 16 years working with people with ankle fractures. Health professionals included an Orthopaedic surgeon (1, physiotherapists (3, a podiatrist (1 and an occupational therapist (1. The emerging framework derived from patient data included eight themes (Physical, Psychological, Daily Living, Social, Occupational and Domestic, Financial, Aesthetic and Medication Taking. Health professional responses did not reveal any additional themes, but tended to focus on physical and occupational themes. Conclusions The nature of life impact following ankle fractures can extend beyond short term pain and discomfort into many areas of life. The findings from this research have provided an empirically derived

Risk factors associated with outcomes of hip fracture surgery in elderly patients.

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Kim, Byung Hoon; Lee, Sangseok; Yoo, Byunghoon; Lee, Woo Yong; Lim, Yunhee; Kim, Mun-Cheol; Yon, Jun Heum; Kim, Kye-Min

2015-12-01

Hip fracture surgery on elderly patients is associated with a high incidence of morbidity and mortality. The aim of this study is to identify the risk factors related to the postoperative mortality and complications following hip fracture surgery on elderly patients. In this retrospective study, the medical records of elderly patients (aged 65 years or older) who underwent hip fracture surgery from January 2011 to June 2014 were reviewed. A total of 464 patients were involved. Demographic data of the patients, American Society of Anesthesiologists physical status, preoperative comorbidities, type and duration of anesthesia and type of surgery were collected. Factors related to postoperative mortality and complications; as well as to intensive care unit admission were analyzed using logistic regression. The incidence of postoperative mortality, cardiovascular complications, respiratory complications and intensive care unit (ICU) admission were 1.7, 4.7, 19.6 and 7.1%, respectively. Postoperative mortality was associated with preoperative respiratory comorbidities, postoperative cardiovascular complications (P bedridden state (P elderly patients undergoing hip fracture surgery.

Percutaneous tracheostomy in patients with cervical spine fractures--feasible and safe.

Science.gov (United States)

Ben Nun, Alon; Orlovsky, Michael; Best, Lael Anson

2006-08-01

The aim of this study is to evaluate the short and long-term results of percutaneous tracheostomy in patients with documented cervical spine fracture. Between June 2000 and September 2005, 38 consecutive percutaneous tracheostomy procedures were performed on multi-trauma patients with cervical spine fracture. Modified Griggs technique was employed at the bedside in the general intensive care department. Staff thoracic surgeons and anesthesiologists performed all procedures. Demographics, anatomical conditions, presence of co-morbidities and complication rates were recorded. The average operative time was 10 min (6-15). Two patients had minor complications. One patients had minor bleeding (50 cc) and one had mild cellulitis. Nine patients had severe paraparesis or paraplegia prior to the PCT procedure and 29 were without neurological damage. There was no PCT related neurological deterioration. Twenty-eight patients were discharged from the hospital, 21 were decannulated. The average follow-up period was 18 months (1-48). There was no delayed, procedure related, complication. These results demonstrate that percutaneous tracheostomy is feasible and safe in patients with cervical spine fracture with minimal short and long-term morbidity. We believe that percutaneous tracheostomy is the procedure of choice for patients with cervical spine fracture who need prolonged ventilatory support.

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

International Nuclear Information System (INIS)

Nachtrab, O.; Cassar-Pullicino, V.N.; Lalam, R.; Tins, B.; Tyrrell, P.N.M.; Singh, J.

2012-01-01

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.

Lidocaine patches reduce pain in trauma patients with rib fractures.

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Zink, Karen A; Mayberry, John C; Peck, Ellen G; Schreiber, Martin A

2011-04-01

Rib fracture pain is notoriously difficult to manage. The lidocaine patch is effective in other pain scenarios with an excellent safety profile. This study assesses the efficacy of lidocaine patches for treating rib fracture pain. A prospectively gathered cohort of patients with rib fracture was retrospectively analyzed for use of lidocaine patches. Patients treated with lidocaine patches were matched to control subjects treated without patches. Subjective pain reports and narcotic use before and after patch placement, or equivalent time points for control subjects, were gathered from the chart. All patients underwent long-term follow-up, including a McGill Pain Questionnaire (MPQ). Twenty-nine patients with lidocaine patches (LP) and 29 matched control subjects (C) were analyzed. During the 24 hours before patch placement, pain scores and narcotic use were similar (LP 5.3, C 4.6, P = 0.19 and LP 51, C 32 mg morphine, P = 0.17). In the 24 hours after patch placement, LP patients had a greater decrease in pain scores (LP 1.2, C 0.0, P = 0.01) with no change in narcotic use (LP -8.4, C 0.5-mg change in morphine, P = 0.25). At 60 days, LP patients had a lower MPQ pain score (LP 7.7, C 12.2, P rib fracture pain. Lidocaine patches resulted in a sustained reduction in pain, outlasting the duration of therapy.

Identification and management of patients at increased risk of osteoporotic fracture

DEFF Research Database (Denmark)

Kanis, J A; Cooper, C; Rizzoli, R

2017-01-01

where the risk of a subsequent fracture following a first fracture is high. Consequently, there is a significant treatment gap between those who would benefit from treatment and those who receive it, which urgently needs to be addressed so that the burden of disease can be reduced. Conclusions......Summary: Osteoporosis represents a significant and increasing healthcare burden in Europe, but most patients at increased risk of fracture do not receive medication, resulting in a large treatment gap. Identification of patients who are at particularly high risk will help clinicians target...... appropriate treatment more precisely and cost-effectively, and should be the focus of future research. Introduction: The purpose of the study was to review data on the identification and treatment of patients with osteoporosis at increased risk of fracture. Methods: A working group convened by the European...

Postoperative hemoglobin level in patients with femoral neck fracture

OpenAIRE

Nagra, Navraj; van Popta, Dmitri; Whiteside, Sigrid; Holt, Edward

2018-01-01

Objective: The aim of this study was to analyze the changes of hemoglobin levels in patients undergoing fixation for femoral neck fracture.Methods: Peroperative hemoglobin levels of patients who underwent either dynamic hip screw (DHS) fixation (n=74; mean age: 80 years) or hip hemiarthroplasty (n=104; mean age: 84 years) for femoral neck fracture was monitored.Results: There was a statistically and clinically significant mean drop of 31.1 g/L between the preoperative (D0) and postoperative D...

Determinants of time to surgery for patients with hip fracture.

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Zeltzer, Justin; Mitchell, Rebecca J; Toson, Barbara; Harris, Ian A; Close, Jacqueline

2014-09-01

Guidelines for hip fracture care suggest that patients with hip fracture should undergo surgery on the day of or day after admission to hospital. This study examined factors affecting time to surgery for hip fracture extracted from existing administrative datasets in New South Wales (NSW), Australia. A retrospective analysis of patients with hip fracture aged 65 years and over undergoing surgical intervention in NSW public hospitals between 1 July 2000 and 30 June 2011. A multinomial logistic model was used to identify factors impacting on time to surgery from 1 July 2006 to 30 June 2011. A total of 49,317 hip fracture procedures were recorded during 2000-2001 to 2010-2011. Sixty-four per cent of patients received operative treatment on the day of or day after admission. Co-morbidity, type of surgical procedure and day of presentation all impacted significantly on time to surgery. Fourteen per cent required an inter-hospital transfer prior to receiving operative intervention. Transferred patients were 2.6 (95% confidence interval (CI): 2.31-2.85) times more likely to wait 2-4 days and 3.2 times more likely to wait 5 or more days (95% CI: 2.77-3.76) for surgery compared with patients presenting to an operating hospital. Significant variation exists between hospitals in the time to surgery that is not solely explained by measures of case mix or geography. Opportunities exist to consider other factors contributing to this variation and to ensure timely access to surgical intervention in the future. © 2014 Royal Australasian College of Surgeons.

Results of Closed Intramedullary Nailing using Talwarkar Square Nail in Adult Forearm Fractures

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Nadeem A Lil

2012-07-01

Full Text Available The aim of the study was to evaluate results of closed intramedullary nailing using Talwarkar square nails in adult forearm fractures. We prospectively evaluated 34 patients with both bone forearm fractures. The average time to union was 12.8 (SD +3.2 weeks with cast support for a mean of 8.2 weeks. Union was achieved in 31 out of 34 patients. Using the Grace and Eversmann rating system, 17 patients were excellent, 10 were good, and 4 had an acceptable result. Three patients had non-unions, 2 for the radius and one for the ulna. There were two cases of superficial infection, one subject had olecranon bursitis, and one case of radio-ulnar synostosis. Complication rates associated with the use of square nails were lower compared to plate osteosynthesis and locked intramedullary nails. To control rotation post- operatively, there is a need for application of an above-elbow cast after nailing.

Simulation of complex fracture networks influenced by natural fractures in shale gas reservoir

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Zhao Jinzhou

2014-10-01

Full Text Available When hydraulic fractures intersect with natural fractures, the geometry and complexity of a fracture network are determined by the initiation and propagation pattern which is affected by a number of factors. Based on the fracture mechanics, the criterion for initiation and propagation of a fracture was introduced to analyze the tendency of a propagating angle and factors affecting propagating pressure. On this basis, a mathematic model with a complex fracture network was established to investigate how the fracture network form changes with different parameters, including rock mechanics, in-situ stress distribution, fracture properties, and frac treatment parameters. The solving process of this model was accelerated by classifying the calculation nodes on the extending direction of the fracture by equal pressure gradients, and solving the geometrical parameters prior to the iteration fitting flow distribution. With the initiation and propagation criterion as the bases for the propagation of branch fractures, this method decreased the iteration times through eliminating the fitting of the fracture length in conventional 3D fracture simulation. The simulation results indicated that the formation with abundant natural fractures and smaller in-situ stress difference is sufficient conditions for fracture network development. If the pressure in the hydraulic fractures can be kept at a high level by temporary sealing or diversion, the branch fractures will propagate further with minor curvature radius, thus enlarging the reservoir stimulation area. The simulated shape of fracture network can be well matched with the field microseismic mapping in data point range and distribution density, validating the accuracy of this model.

EPIDEMIOLOGICAL PROFILE OF PATIENTS WITH TRAUMATIC SPINAL FRACTURE

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MATEUS BERGAMO LOMAZ

Full Text Available ABSTRACT Objective: To analyze the epidemiological profile of patients with spinal fractures and the characteristics of the population at risk attended at a university hospital. Methods: The study population is composed of 202 patients diagnosed and treated for vertebral fracture due to trauma. The variables were correlated with each other and the correlations with p<0.05 were considered statistically significant. Results: The ratio of incidence of trauma between the sexes was 3:1 for males. The mean age was 37 years and the age group with the highest incidence was between 20 and 39 years. Traffic accidents were the most frequent mechanism (51.2% and secondly, falls (33.2%. There was a statistical correlation between trauma mechanisms to age group and region of the spine. The first lumbar vertebra (L1 fracture alone accounted for 21.5% of all cases studied associated with the fall mechanism. Spinal cord injury was recorded in 33.7% of the individuals in the sample. A total of 57.3% of the patients were submitted to surgical treatment and 41.7% to the conservative treatment. The mean hospitalization time was 15 days. Conclusions: Spinal fractures are important determinants of morbidity and mortality in the population with a major impact on economically active individuals, especially males. They are directly associated to traffic accidents in the young population and to falls in the higher age brackets. Primary prevention of trauma is the main mechanism for change in this scenario.

Unstable intertrochanteric femur fractures in geriatric patients treated with the DLT trochanteric nail.

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Temiz, Aytun; Durak, Aslihan; Atici, Teoman

2015-07-01

To evaluate clinical-functional and radiological results of geriatric patients with unstable intertrochanteric femur fracture treated with intramedullary nail. Thirty-two patients treated with intramedullary nail (DLT trochanteric nail) due to unstable intertrochanteric femur fractures were reviewed retrospectively. Fractures 31-A2 and 31-A3 (AO classification) were evaluated. Operation time, blood loss, and blood transfusion requirements, hospitalization period, time to fracture union were evaluated and perioperative and postoperative complications were recorded. According to the modified Baumgaertner criteria fracture reduction was analyzed radiologically, and nail tip-apex distance was measured. Femoral neck-shaft angle was also evaluated. Harris Hip Score for clinical evaluation and Kyo criteria for walking capacity were used. The mean age was 72 years (65-81), mean follow up time was 18.3 months (12-26). Nineteen patients had type 31-A2 and 13 had type 31-A3 fractures. Mean operation time was 36.3min (25-45), blood loss 185.9ml (100-250). Blood transfusion was required in 7 patients. The average hospitalization duration was 6 days (4-14) while the time to surgery from admission was 2.9 days (2-6). Radiologically, in 21 of the cases fracture reduction was well (65.6%), acceptable in 9 (28.1%), and poor in 2 (6.3%). In early postoperative period, the mean collo-diaphyseal angle was 129.1° (120-140°), mean tip-apex distance was 15.5mm (10-27). The mean Harris Hip Score was 63.4 (38-90). Two patients (6.3%) had excellent, 21 patients (65.6%) had good, 7 patients (21.8%) had moderate, and 2 patients (6.3%) had poor results. Walking capacity in the last follow-up in 20 of the cases (62.5%) was pre-fracture level. While complications were observed in seventeen patients (53.1%) (5 superficial wound infections, 5 fractures of the greater trochanter, 3 cases of secondary varus angulation and 4 cases of heterotopic ossification) none of them required additional surgery

Distal radius plate of CFR-PEEK has minimal effect compared to titanium plates on bone parameters in high-resolution peripheral quantitative computed tomography: a pilot study.

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de Jong, Joost J A; Lataster, Arno; van Rietbergen, Bert; Arts, Jacobus J; Geusens, Piet P; van den Bergh, Joop P W; Willems, Paul C

2017-02-27

Carbon-fiber-reinforced poly-ether-ether-ketone (CFR-PEEK) has superior radiolucency compared to other orthopedic implant materials, e.g. titanium or stainless steel, thus allowing metal-artifact-free postoperative monitoring by computed tomography (CT). Recently, high-resolution peripheral quantitative CT (HRpQCT) proved to be a promising technique to monitor the recovery of volumetric bone mineral density (vBMD), micro-architecture and biomechanical parameters in stable conservatively treated distal radius fractures. When using HRpQCT to monitor unstable distal radius fractures that require volar distal radius plating for fixation, radiolucent CFR-PEEK plates may be a better alternative to currently used titanium plates to allow for reliable assessment. In this pilot study, we assessed the effect of a volar distal radius plate made from CFR-PEEK on bone parameters obtained from HRpQCT in comparison to two titanium plates. Plates were instrumented in separate cadaveric human fore-arms (n = 3). After instrumentation and after removal of the plates duplicate HRpQCT scans were made of the region covered by the plate. HRpQCT images were visually checked for artifacts. vBMD, micro-architectural and biomechanical parameters were calculated, and compared between the uninstrumented and instrumented radii. No visible image artifacts were observed in the CFR-PEEK plate instrumented radius, and errors in bone parameters ranged from -3.2 to 2.6%. In the radii instrumented with the titanium plates, severe image artifacts were observed and errors in bone parameters ranged between -30.2 and 67.0%. We recommend using CFR-PEEK plates in longitudinal in vivo studies that monitor the healing process of unstable distal radius fractures treated operatively by plating or bone graft ingrowth.

Intertrochanteric fractures in elderly high risk patients treated with Ender nails and compression screw

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Gangadharan Sidhartha

2010-01-01

Full Text Available Background: Ender and Simon Weidner popularized the concept of closed condylocephlic nailing for intertrochanteric fractures in 1970. The clinical experience of authors revealed that Ender nailing alone cannot provide secure fixation in elderly patients with osteoporosis. Hence we conducted a study to evaluate the efficacy of a combined fixation procedure using Ender nails and a cannulated compression screw for intertrochanteric fractures. Materials and Methods: 76 patients with intertrochanteric fractures were treated using intramedullary Ender nails and cannulated compression screw from January 2004 to December 2007. The mean age of the patients was 80 years (range 70-105 years.Using the Evan′s system of classification 49 were stable and 27 unstable fractures. Inclusion criteria was high risk elderly patients (age > 70 years with intertrochanteric fracture. The exclusion criteria included patients with pressure sores over the trochanteric region. Many patients had pre-existing co-morbidities like diabetes mellitus, hypertension, COPD, ischemic heart disease, CVA and coronary artery bypass surgery. The two Ender nails of 4.5mm each were passed across the fracture site into the proximal neck. This was reinforced with a 6.5 mm cannulated compression screw passed from the sub trochanteric region, across the fracture into the head. Results: The mean follow-up was 14 months (range 9-19 months Average time to fracture union was 10 weeks (range 6-16 weeks. The mean knee ROM was 130o (± 5o. There was no case of nail penetration into hip joint. In five cases with advanced osteoporosis there was minimal migration of Ender nails distally. Conclusions: The Ender nailing combined with compression screw fixation in cases of intertrochanteric fractures in high risk elderly patients could achieve reliable fracture stability with minimal complications.

Soft-plastic brace for lower limb fractures in patients with spinal cord injury.

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Uehara, K; Akai, M; Kubo, T; Yamasaki, N; Okuma, Y; Tobimatsu, Y; Iwaya, T

2013-04-01

Retrospective study at a rehabilitation center. Patients with spinal cord injury, even if they are wheelchair users, sometimes suffer from fractures of the lower limb bones. As their bones are too weak to have surgery, and because a precise reduction is not required for restoration, such patients are often indicated for conservative treatment. This case series study investigated the use of a hinged, soft-plastic brace as a conservative approach to treating fractures of the lower extremities of patients with spinal cord injury. National Rehabilitation Center, Japan. Fifteen patients (male, n=10; female, n=5; average age, 52.7 years) with 19 fractures of the femur or the tibia who were treated with a newly-developed hinged, soft-plastic brace were studied. All of them used wheelchairs. We analyzed the time taken for fracture union and for wearing orthotics, degree of malalignment, femorotibial angle and side effects. The fractures in this series were caused by relatively low-energy impact. The average time taken for fracture union was 80.1 (37-189) days, and the average amount of time spent wearing orthotics was 77.9 (42-197) days. On final X-ray imaging, the average femorotibial angle was 176.9° (s.d. ±8.90), and 15° of misalignment in the sagittal plane occurred in one patient. A hinged, soft-plastic brace is a useful option as a conservative approach for treating fractures of the lower extremities in patients with spinal cord injury.

Periodic Hydraulic Testing for Discerning Fracture Network Connections

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Becker, M.; Le Borgne, T.; Bour, O.; Guihéneuf, N.; Cole, M.

2015-12-01

Discrete fracture network (DFN) models often predict highly variable hydraulic connections between injection and pumping wells used for enhanced oil recovery, geothermal energy extraction, and groundwater remediation. Such connections can be difficult to verify in fractured rock systems because standard pumping or pulse interference tests interrogate too large a volume to pinpoint specific connections. Three field examples are presented in which periodic hydraulic tests were used to obtain information about hydraulic connectivity in fractured bedrock. The first site, a sandstone in New York State, involves only a single fracture at a scale of about 10 m. The second site, a granite in Brittany, France, involves a fracture network at about the same scale. The third site, a granite/schist in the U.S. State of New Hampshire, involves a complex network at scale of 30-60 m. In each case periodic testing provided an enhanced view of hydraulic connectivity over previous constant rate tests. Periodic testing is particularly adept at measuring hydraulic diffusivity, which is a more effective parameter than permeability for identify the complexity of flow pathways between measurement locations. Periodic tests were also conducted at multiple frequencies which provides a range in the radius of hydraulic penetration away from the oscillating well. By varying the radius of penetration, we attempt to interrogate the structure of the fracture network. Periodic tests, therefore, may be uniquely suited for verifying and/or calibrating DFN models.

Long-term patient outcomes after surgical stabilization of rib fractures.

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Majercik, Sarah; Cannon, Quinn; Granger, Steven R; VanBoerum, Don H; White, Thomas W

2014-07-01

Rib fractures are common, and can be disabling. Recently, there has been increased interest in surgical stabilization of rib fractures (SSRF). It is difficult to define long-term benefits of the procedure. This is a descriptive study of patient outcomes after SSRF. SSRF patients between April 2010 and August 2012 at a Level I trauma center were identified. Data were collected from the medical records. A telephone survey asking about pain, satisfaction, and employment was administered to patients after hospital discharge. One hundred-one patients met inclusion criteria. Fifty (50%) patients completed the survey. Indications for SSRF included flail chest, displaced fractures, pain, and inability to wean from mechanical ventilation. Pain was gone at 5.4 ± 1.1 weeks post discharge. Satisfaction with SSRF on a scale of 1 to 10 was 9.2 ± .2. Ninety percent of employed patients returned to the same work at 8.5 ± 1.2 weeks. SSRF patients are satisfied and are able to return to normal activity with few limitations. A prospective study using modern rib fixation technology is needed to further define benefits. Copyright © 2014 Elsevier Inc. All rights reserved.

Celiac Disease Does Not Influence Fracture Risk in Young Patients with Type 1 Diabetes

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Reilly, Norelle R; Lebwohl, Benjamin; Mollazadegan, Kaziwe; Michaëlsson, Karl; Green, Peter HR; Ludvigsson, Jonas F

2015-01-01

Objectives To examine the risk of any fractures in patients with both type 1 diabetes (T1D) and celiac disease (CD) vs patients with T1D only. Study design We performed a population-based cohort study. We defined T1D as individuals aged ≤30 years who had a diagnosis of diabetes recorded in the Swedish National Patient Register between 1964–2009. Individuals with CD were identified through biopsy report data between 1969–2008 from any of Sweden’s 28 pathology departments. Some 958 individuals had both T1D and CD and were matched for sex, age and calendar period with 4,598 reference individuals with T1D only. We then used a stratified Cox regression analysis, where CD was modeled as a time-dependent covariate, to estimate the risk of any fractures and osteoporotic fractures (hip, distal forearm, thoracic and lumbar spine, and proximal humerus) in patients with both T1D and CD compared with that in patients with T1D only. Results During follow-up, 12 patients with T1D and CD had a fracture (1 osteoporotic fracture). CD did not influence the risk of any fracture (adjusted Hazard Ratio=0.77; 95%CI=0.42–1.41) or osteoporotic fractures (adjusted Hazard Ratio=0.46; 95%CI=0.06–3.51) in patients with T1D. Stratification for time since CD diagnosis did not affect risk estimates. Conclusion Having a diagnosis of CD does not seem to influence fracture risk in young patients with T1D. Follow-up in this study was, however, too short to ascertain osteoporotic fractures which traditionally occur in old age. PMID:26589343

Case report of right hamate hook fracture in a patient with previous fracture history of left hamate hook: is it hamate bipartite?

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Norton Sandra

2006-10-01

Full Text Available Abstract Background Hamate hook fracture is a common fracture in golfers and others who play sports that involve rackets or sticks such as tennis or hockey. This patient had a previous hamate fracture in the opposing wrist along with potential features of hamate bipartite. Case presentation A 19 year old male presented with a complaint of right wrist pain on the ulnar side of the wrist with no apparent mechanism of injury. The pain came on gradually one week before being seen in the office and he reported no prior care for the complaint. His history includes traumatic left hamate hook fracture with surgical excision. Conclusion The patient was found to have marked tenderness over the hamate and with a prior fracture to the other wrist, computed tomography of the wrist was ordered revealing a fracture to the hamate hook in the right wrist. He was referred for surgical evaluation and the hook of the hamate was excised. Post-surgically, the patient was able to return to normal activity within eight weeks. This case is indicative of fracture rather than hamate bipartite. This fracture should be considered in a case of ulnar sided wrist pain where marked tenderness is noted over the hamate, especially after participation in club or racket sports.

Stress fractures in athletes

International Nuclear Information System (INIS)

Steingruber, I.E.; Wolf, C.; Gruber, H.; Czermak, B.V.; Mallouhi, A.; Jaschke, W.; Gabriel, M.

2002-01-01

Stress fractures may pose a diagnostic dilemma for radiologists since they are sometimes difficult to demonstrate on plain films and may simulate a tumour. They were first described in military personnel and professional athletes. Recently, there is an increasing incidence in the general population due to increasing sportive activities. Stress fractures occur most often in the lower extremities, especially in the tibia, the tarsal bone, the metatarsal bone, the femur and the fibula. In the upper extremities, they are commonly found in the humerus, the radius and the ulna. Some fractures of the lower extremities appear to be specific for particular sports, for example, fractures of the tibia affect mostly distance runners. Whereas stress fractures of the upper extremities are generally associated with upper limb-dominated sports. A correct diagnosis requires a careful clinical evaluation. The initial plain radiography may be normal. Further radiological evaluation could be performed by means of computerised tomography, magnetic resonance imaging and bone scanning. The latter two techniques are especially helpful for establishing a correct initial diagnosis. (orig.) [de

The pattern and prevalence of vertebral artery injury in patients with cervical spine fractures

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Farzanah Ismail

2013-06-01

Method: A retrospective review of patients who had undergone CTA of the vertebral arteries was undertaken. Reports were reviewed to determine which patients met the inclusion criteria of having had both cervical spine fractures and CTA of the vertebral arteries. Images of patients who met the inclusion criteria were analysed by a radiologist. Results: The prevalence of vertebral artery injury was 33%. Four out of the 11 patients who had vertebral artery injury, had post-traumatic spasm of the artery, with associated thrombosis or occlusion of the vessel. In terms of blunt carotid vertebral injury (BCVI grading, most of the patients sustained grade IV injuries. Four patients who had vertebral artery injury had fractures of the upper cervical vertebrae, i.e. C1 to C3. Fifteen transverse process fractures were associated with vertebral artery injury. No vertebral artery injury was detected in patients who had facet joint subluxations. Conclusion: Patients with transverse process fractures of the cervical spine and upper cervical vertebral body fractures should undergo CTA to exclude vertebral artery injury.

Digital Tomosynthesis to Evaluate Fracture Healing: Prospective Comparison With Radiography and CT.

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Ha, Alice S; Lee, Amie Y; Hippe, Daniel S; Chou, Shinn-Huey S; Chew, Felix S

2015-07-01

Radiography, currently the standard for postoperative fracture imaging, is limited by overlapping bone and hardware. Tomosynthesis has the benefit of level-by-level imaging without the disadvantages of metal artifacts, increased radiation, and higher costs of CT, the current problem-solving tool. The purpose of this study was to compare tomosynthesis with radiography for evaluating fracture healing. In a prospective study, patients within 1 year of wrist hardware fixation underwent radiography, tomosynthesis, and CT, and the images were interpreted by three readers. The diagnostic accuracy of radiology and tomosynthesis was assessed with ROC curves, and interreader agreement was assessed with Cohen kappa. Fracture scores were correlated with Disabilities of the Arm, Shoulder, and Hand (DASH) and pain scores. The study participants were 49 patients with 51 fractures. The most common fracture sites were distal radius (43%), scaphoid (18%), and metacarpals (18%). Rates of cortex obscuration by hardware were 2% for CT, 8% for tomosynthesis, and 15% for radiography (p tomosynthesis than with radiography (AUC, 0.84 vs 0.76, p = 0.01). Inter-reader agreement was moderate for both radiography and tomosynthesis (κ = 0.44 vs 0.55, p = 0.051). There was no significant correlation between fracture scores and DASH scores. There was significant correlation between reported pain levels and both tomosynthesis (r = 0.28, p = 0.03) and CT (r = 0.29, p = 0.04) fracture scores. Tomosynthesis provides diagnostic information superior to that of ra diography in postoperative evaluation of wrist fractures with lower cost and radiation than CT and should be considered in fracture follow-up imaging of other bones.

Functional and nutritional status correlation in elderly patients with hip fracture

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Gonzalo Ramón González González

2012-06-01

Full Text Available Introduction: Hip fractures in elderly patients are related to several factors, among which nutrition and functionality stand out. The presence of alterations in the nutritional state has been related directly with the functional state. Objective: To determine the previous functional state of the patient with a hip fracture, the nutritional state at the moment of admittance and the correlation between both parameters as risk factors for the fracture. Materials and methods: 78 elderly patients with a hip fractured were studied from February 1st, 2009 to December 31st of 2009. The functional and nutritional stated were analyzed. Descriptive statistics and inferential analysis were used with contingency tables to test association with c2. Results: 46.1% were functionally independent and 53.9% had functional impairment. 14.1% presented malnourishment, 48.7% were at risk of malnutrition and 37.2% had normal nutrition. Only the 36.7% with the “nutritional problem” (MNA24 who were independent.

Fracture following lower limb lengthening in children: a series of 58 patients.

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Launay, F; Younsi, R; Pithioux, M; Chabrand, P; Bollini, G; Jouve, J-L

2013-02-01

Fracture is one of the main complications following external fixator removal used in cases of progressive lower limb lengthening; rates as high as 50% are found in the literature. The aim of this study was to determine the factors influencing this complication. One hundred and eleven cases of lower limb lengthening were performed in 58 patients (40 femurs and 71 tibias). The mean age at surgery was 10.1years old. Lengthening was performed in all cases with an external fixator alone, associated in 39.6% of cases with intramedullary nailing. The patients were divided into three groups according to disease etiology (congenital, achondroplasia and other). The fractures were classified according to the Simpson classification. Twenty fractures were recorded (18%). Sixteen fractures were found in patients with congenital disease, four with achondroplasia and none in the group of other etiologies. The fracture was more often in the femur (27.5%) than in the tibia (12.7%). The rate of fracture is influenced by different factors depending on the etiology of disease. In congenital diseases, the fracture rate is higher when there is lengthening of more than 15% of the initial length and a delay between surgery and the beginning of lengthening of less than 7days. In patients with achondroplasia, the influence of a relative percentage of lengthening is less important than in those with congenital disease. However, to avoid fractures, lengthening should not be started in children under the age of nine. Moreover, lengthening should begin at least 7days after the fixator has been placed. Retrospective. Level IV. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

Affective functioning after delirium in elderly hip fracture patients.

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Slor, Chantal J; Witlox, Joost; Jansen, René W M M; Adamis, Dimitrios; Meagher, David J; Tieken, Esther; Houdijk, Alexander P J; van Gool, Willem A; Eikelenboom, Piet; de Jonghe, Jos F M

2013-03-01

Delirium in elderly patients is associated with various long-term sequelae that include cognitive impairment and affective disturbances, although the latter is understudied. For a prospective cohort study of elderly patients undergoing hip fracture surgery, baseline characteristics and affective and cognitive functioning were assessed preoperatively. During hospital admission, presence of delirium was assessed daily. Three months after hospital discharge, affective and global cognitive functioning was evaluated again in patients free from delirium at the time of this follow-up. This study compared baseline characteristics and affective functioning between patients with and without in-hospital delirium. We investigated whether in-hospital delirium is associated with increased anxiety and depressive levels, and post-traumatic stress disorder (PTSD) symptoms three months after discharge. Among 53 eligible patients, 23 (43.4%) patients experienced in-hospital delirium after hip fracture repair. Patients who had experienced in-hospital delirium showed more depressive symptoms at follow-up after three months compared to the 30 patients without in-hospital delirium. This association persisted in a multivariate model controlling for age, baseline cognition, baseline depressive symptoms, and living situation. The level of anxiety and symptoms of PTSD at follow-up did not differ between both groups. This study suggests that in-hospital delirium is associated with an increased burden of depressive symptoms three months after discharge in elderly patients who were admitted to the hospital for surgical repair of hip fracture. Symptoms of depression in patients with previous in-hospital delirium cannot be fully explained by persistent (sub)syndromal delirium or baseline cognitive impairment.

Determinants of prevalent vertebral fractures and progressive bone loss in long-term hemodialysis patients.

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Mares, Jan; Ohlidalova, Kristina; Opatrna, Sylvie; Ferda, Jiri

2009-01-01

Skeletal fractures are common in hemodialysis (HD) patients. However, consensus regarding technique and site of bone examination has not been reached in HD patients. Seventy-two patients (44% females) aged 65 (1.4) years, treated with HD for 43 (4.6) months were examined with quantitative computed tomography and 53 of them re-examined after 1 year. Bone mineral density (BMD) of lumbar spine was established separately for cortical and trabecular bone, prevalent vertebral fractures were determined. Data are given as mean (standard error). At least one vertebral fracture was discovered in 15 (21%) patients. In a logistic regression model, fractures were best predicted by cortical BMD: OR 0.96 (CI 0.94, 0.99), p multiple regression analysis, time on dialysis was found to be independently correlated to cortical BMD (R = 0.35, p decrement may impose an increased risk of fractures on long-term dialysis patients.

Cervical hip fractures do not occur in arthrotic joints. A clinicoradiographic study of 256 patients.

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Dretakis, E K; Steriopoulos, K A; Kontakis, G M; Giaourakis, G; Economakis, G; Dretakis, K E

1998-08-01

We studied endogenic factors for the occurrence of cervical hip fractures in 256 patients. 230 underwent hemiarthroplasty, and 26 were treated with internal fixation or without surgery. The condition of the fractured hip and of the ipsilateral knee, as well as the mobility of the patient before the fracture, were studied in all 256 patients. The removed femoral heads were examined, photographed and radiographs were taken with sensitive film. The acetabulum and the femoral head were macroscopically normal in all 230 cases and there was no radiographic evidence of arthrosis. 64% of the patients were fully mobile before the fracture, 34% were mobile with the aid of a cane and 2% were dependent. In 88%, the ipsilateral knee was normal both clinically and radiographically, and in 12%, there was moderate arthrosis. When comparing the mobility before the fracture and the condition of the ipsilateral hip and knee in 100 patients having a cervical fracture with 100 patients having a trochanteric fracture matched for age and sex, we found that a normal hip joint was sine qua non while a normal ipsilateral knee and a fully mobile individual were important additional conditions for the occurrence of a cervical hip fracture, instead of a trochanteric one, after a fall in an elderly person.

The number of displaced rib fractures is more predictive for complications in chest trauma patients.

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Chien, Chih-Ying; Chen, Yu-Hsien; Han, Shih-Tsung; Blaney, Gerald N; Huang, Ting-Shuo; Chen, Kuan-Fu

2017-02-28

Traumatic rib fractures can cause chest complications that need further treatment and hospitalization. We hypothesized that an increase in the number of displaced rib fractures will be accompanied by an increase in chest complications. We retrospectively reviewed the trauma registry between January 2013 and May 2015 in a teaching hospital in northeastern Taiwan. Patients admitted with chest trauma and rib fractures without concomitant severe brain, splenic, pelvic or liver injuries were included. The demographic data, such as gender, age, the index of coexistence disease, alcohol consumption, trauma mechanisms were analyzed as potential predictors of pulmonary complications. Pulmonary complications were defined as pneumothorax, hemothorax, flail chest, pulmonary contusion, and pneumonia. In the 29 months of the study period, a total of 3151 trauma patients were admitted to our hospital. Among them, 174 patients were enrolled for final analysis. The most common trauma mechanism was road traffic accidents (58.6%), mainly motorbike accidents (n = 70, 40.2%). Three or more displaced rib fractures had higher specificity for predicting complications, compared to three or more total rib fractures (95.5% vs 59.1%). Adjusting the severity of chest trauma using TTSS and Ribscore by multivariable logistic regression analysis, we found that three or more rib fractures or any displaced rib fracture was the most significant predictor for developing pulmonary complication (aOR: 5.49 95% CI: 1.82-16.55). Furthermore, there were 18/57 (31.6%) patients with fewer than three ribs fractures developed pulmonary complications. In these 18 patients, only five patients had delayed onset complications and four of them had at least one displaced rib fracture. In this retrospective cohort study, we found that the number of displaced or total rib fractures, bilateral rib fractures, and rib fractures in more than two areas were associated with the more chest complications. Furthermore

Factors influencing period from surgery to discharge in patients with femoral trochanteric fractures

OpenAIRE

Shinoda, Soichiro; Mutsuzaki, Hirotaka; Watanabe, Arata; Morita, Hidetaka; Kamioka, Yumiko

2017-01-01

[Purpose] The purpose of this study was to investigate factors influencing the period from surgery to discharge in patients with femoral trochanteric fractures. [Subjects and Methods] Sixty patients with femoral trochanteric fractures were investigated retrospectively. Based on the mean period from surgery to discharge (85.6 ± 26.6 days), the patients were divided into two groups: an under-85-day group (range, 29–78 days) and an over-85-day group (87–128 days). Age, gender, fracture type, pre...

Comprehensive care program for elderly patients over 65 years with hip fracture.

Science.gov (United States)

Fernández-Moyano, A; Fernández-Ojeda, R; Ruiz-Romero, V; García-Benítez, B; Palmero-Palmero, C; Aparicio-Santos, R

2014-01-01

To report the health outcomes of a multidisciplinary care program for patients over 65 years with hip fracture. We have developed a care coordination model for the comprehensive care of hip fracture patients. It establishes what, who, when, how and where orthopedists, internists, family physicians, emergency, intensive care, physiotherapists, anesthetists, nurses and workers social intervene. All elderly patients over 65 years admitted with the diagnosis of hip fracture (years 2006 to 2010) were retrospectively evaluated. One thousand episodes of hip fracture, corresponding to 956 patients, were included. Mean age was 82 years and mean stay 6.7 days. This was reduced by 1.14 days during the 5 years of the program. A total of 85.1% were operated on before 72 yours, and 91.2% during the program. Incidence of surgical site infection was 1.5%. In-hospital mortality was 4.5%, (24.2% at 12 months). Readmissions at one years was 14.9%. Independence for basic activity of daily living was achieved by 40% of the patients. This multidisciplinary care program for hip fracture patients is associated with positive health outcomes, with a high percentage of patients treated early (more than 90%), reduced mean stay (less than 7 days), incidence of surgical site infections, readmissions and inpatient mortality and at one year, as well as adequate functional recovery. Copyright © 2012 Elsevier España, S.L. All rights reserved.

A Pronounced Inflammatory Activity Characterizes the Early Fracture Healing Phase in Immunologically Restricted Patients

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Hoff, Paula; Gaber, Timo; Strehl, Cindy; Jakstadt, Manuela; Hoff, Holger; Schmidt-Bleek, Katharina; Lang, Annemarie; Röhner, Eric; Huscher, Dörte; Matziolis, Georg; Burmester, Gerd-Rüdiger; Schmidmaier, Gerhard; Perka, Carsten; Duda, Georg N.; Buttgereit, Frank

2017-01-01

Immunologically restricted patients such as those with autoimmune diseases or malignancies often suffer from delayed or insufficient fracture healing. In human fracture hematomas and the surrounding bone marrow obtained from immunologically restricted patients, we analyzed the initial inflammatory phase on cellular and humoral level via flow cytometry and multiplex suspension array. Compared with controls, we demonstrated higher numbers of immune cells like monocytes/macrophages, natural killer T (NKT) cells, and activated T helper cells within the fracture hematomas and/or the surrounding bone marrow. Also, several pro-inflammatory cytokines such as Interleukin (IL)-6 and Tumor necrosis factor α (TNFα), chemokines (e.g., Eotaxin and RANTES), pro-angiogenic factors (e.g., IL-8 and Macrophage migration inhibitory factor: MIF), and regulatory cytokines (e.g., IL-10) were found at higher levels within the fracture hematomas and/or the surrounding bone marrow of immunologically restricted patients when compared to controls. We conclude here that the inflammatory activity on cellular and humoral levels at fracture sites of immunologically restricted patients considerably exceeds that of control patients. The initial inflammatory phase profoundly differs between these patient groups and is probably one of the reasons for prolonged or insufficient fracture healing often occurring within immunologically restricted patients. PMID:28282868

Notch constraint effects on the dynamic fracture toughness of an unaged beta titanium alloy

International Nuclear Information System (INIS)

Rack, H.J.

1975-01-01

The influence of notch included angle and root radius on the apparent dynamic fracture toughness of an unaged metastable beta titanium alloy, Ti--3Al--8V--6Cr--4Zr--4Mo, has been examined. The apparent fracture toughness, K/sub Id/(rho), increases with both notch radius, rho and included angle, ω. These results have been compared with the theoretical predictions of Tetelman, et al. and Smith. The comparisons show that neither theory accurately describes the effect of varying notch constraint on the apparent dynamic fracture toughness. Although preliminary considerations indicate that qualitative descriptions of notch acuity effects may be given by recent finite element analysis of the stress and strain distributions below a notch root, there is presently no quantitative basis for determining the true dynamic fracture toughness of materials from the results of blunt notch experiments. (auth)

Total elbow arthroplasty in distal humerus fracture in patients older than 65 years.

Directory of Open Access Journals (Sweden)

Gerardo Gallucci

2016-05-01

Full Text Available Objective To report the clinical-functional results of the treatment of humeral distal fractures with a total elbow prosthesis in patients older than 65 years old. Material and methods This retrospective paper was performed in two surgical centers. Criteria inclusion were: patients with humeral distal fractures, > 65 years, operated on with Coonrad-Morrey prostheses, and with a follow-up of  >1 year. Twenty-one patients were included. Twenty were women with an average age of 79 years old. According to AO classification, 13 fractures were type C3, 7 C2 and 1 A2. All patientes were operated on without desinsertion of the extensor mechanism. Average follow-up was 40 months. Results Flexo-extension was 123-17°, with a total arc of mobility of 106° (80 % of the contralateral side. Pain according to AVE was 1. The MEPI was 83 points: 8 patients had excellent results, 11 good, 1 regular and 1 bad. Average DASH score was 24 points. Conclusion Treatment of humeral distal fractures with total elbow arthoplasty in patients older than 65 years old, may lead to a good option of treatment, but indications must be limited to patients with complex fractures, bad bone quality, with osteoporosis and low functional demands.

Radius of Care in Secondary Schools in the Midwest: Are Automated External Defibrillators Sufficiently Accessible to Enable Optimal Patient Care?

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Osterman, Michael; Claiborne, Tina; Liberi, Victor

2018-04-25

  Sudden cardiac arrest is the leading cause of death among young athletes. According to the American Heart Association, an automated external defibrillator (AED) should be available within a 1- to 1.5-minute brisk walk from the patient for the highest chance of survival. Secondary school personnel have reported a lack of understanding about the proper number and placement of AEDs for optimal patient care.   To determine whether fixed AEDs were located within a 1- to 1.5-minute timeframe from any location on secondary school property (ie, radius of care).   Cross-sectional study.   Public and private secondary schools in northwest Ohio and southeast Michigan.   Thirty schools (24 public, 6 private) volunteered.   Global positioning system coordinates were used to survey the entire school properties and determine AED locations. From each AED location, the radius of care was calculated for 3 retrieval speeds: walking, jogging, and driving a utility vehicle. Data were analyzed to expose any property area that fell outside the radius of care.   Public schools (37.1% ± 11.0%) possessed more property outside the radius of care than did private schools (23.8% ± 8.0%; F 1,28 = 8.35, P = .01). After accounting for retrieval speed, we still observed differences between school types when personnel would need to walk or jog to retrieve an AED ( F 1.48,41.35 = 4.99, P = .02). The percentages of school property outside the radius of care for public and private schools were 72.6% and 56.3%, respectively, when walking and 34.4% and 12.2%, respectively, when jogging. Only 4.2% of the public and none of the private schools had property outside the radius of care when driving a utility vehicle.   Schools should strategically place AEDs to decrease the percentage of property area outside the radius of care. In some cases, placement in a centralized location that is publicly accessible may be more important than the overall number of AEDs on site.

Knee-extension strength, postural control and function are related to fracture type and thigh edema in patients with hip fracture

DEFF Research Database (Denmark)

Kristensen, Morten T; Bandholm, Thomas; Bencke, Jesper

2008-01-01

BACKGROUND: Post-surgery thigh edema, loss of knee-extension strength, and reduced physical performance are common following a hip fracture. It is not known if knee-extension strength and physical performance are related to the edema and fracture type. The aim of this study was to examine...... the influence of fracture type and post-surgery edema on physical performances in patients with hip fracture. METHODS: Fifteen women and five men admitted from their own home to an acute orthopedic hip fracture unit were examined. Ten had cervical and ten had intertrochanteric fractures. Correlations between...... fracture type and thigh edema in the fractured limb (% non-fractured) to physical performances of basic mobility, postural control (sway), and isometric knee-extension strength were examined. All measures, except those of basic mobility, were conducted at the time of discharge, 8.5 days post...

Mode II brittle fracture: recent developments

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A. Campagnolo

2017-10-01

Full Text Available Fracture behaviour of V-notched specimens is assessed using two energy based criteria namely the averaged strain energy density (SED and Finite Fracture Mechanics (FFM. Two different formulations of FFM criterion are considered for fracture analysis. A new formulation for calculation of the control radius Rc under pure Mode II loading is presented and used for prediction of fracture behaviour. The critical Notch Stress Intensity Factor (NSIF at failure under Mode II loading condition can be expressed as a function of notch opening angle. Different formulations of NSIFs are derived using the three criteria and the results are compared in the case of sharp V-notched brittle components under in-plane shear loading, in order to investigate the ability of each method for the fracture assessment. For this purpose, a bulk of experimental data taken from the literature is employed for the comparison among the mentioned criteria

The detection of patients with 'fragility fractures' in fracture clinic - an audit of practice with reference to recent British Orthopaedic Association guidelines.

Science.gov (United States)

Gidwani, S; Davidson, N; Trigkilidas, D; Blick, C; Harborne, R; Maurice, H D

2007-03-01

The British Orthopaedic Association published guidelines on the care of fragility fracture patients in 2003. A section of these guidelines relates to the secondary prevention of osteoporotic fractures. The objective of this audit was to compare practice in our fracture clinic to these guidelines, and take steps to improve our practice if required. We retrospectively audited the treatment of all 462 new patients seen in January and February 2004. Using case note analysis, 38 patients who had sustained probable fragility fractures were selected. Six months' post-injury, a telephone questionnaire was administered to confirm the nature of the injury and to find out whether the patient had been assessed, investigated or treated for osteoporosis. A second similar audit was conducted a year later after steps had been taken to improve awareness amongst the orthopaedic staff and prompt referral. During the first audit period, only 5 of 38 patients who should have been assessed and investigated for osteoporosis were either referred or offered referral. This improved to 23 out of 43 patients during the second audit period. Improvements in referral and assessment rates of patients at risk of further fragility fractures can be achieved relatively easily by taking steps to increase awareness amongst orthopaedic surgeons, although additional strategies and perhaps the use of automated referral systems may be required to achieve referral rates nearer 100%.

One-year health and care costs after hip fracture for home-dwelling elderly patients in Norway: Results from the Trondheim Hip Fracture Trial

OpenAIRE

Hektoen, Liv Faksvåg; Saltvedt, Ingvild; Sletvold, Olav; Helbostad, Jorunn L.; Lurås, Hilde; Halsteinli, Vidar

2016-01-01

Aim: The aim of this study was to estimate the one-year health and care costs related to hip fracture for home-dwelling patients aged 70 years and older in Norway, paying specific attention to the status of the patients at the time of fracture and cost differences due to various patient pathways after fracture. Methods: Data on health and care service provision were extracted from hospital and municipal records and from national registries; data on unit costs were collected from the municipal...

High prevalence of hypovitaminosis D and K in patients with hip fracture.

Science.gov (United States)

Nakano, Tetsuo; Tsugawa, Naoko; Kuwabara, Akiko; Kamao, Maya; Tanaka, Kiyoshi; Okano, Toshio

2011-01-01

Although hip fracture is considered to be associated with hypovitaminosis D and K, few reports have previously studied both of them. We have studied the vitamin D- and K-status as well as the general nutritional status in ninety-nine patients with hip fracture. Mean serum concentration of 25hydroxy-vitamin D (25OH-D) in female fractured patients was only approximately 9 ng/mL, suggesting severe vitamin D deficiency. There was no significant difference between the two groups in serum concentration of intact parathyroid hormone in both genders and serum 25OH-D levels in the male subjects. Plasma concentrations of phylloquinone (vitamin K1; PK) and menaquinone-7 (MK-7) were significantly lower in the fractured group than in the control group in both genders. Logistic regression analysis indicated that circulating concentrations of albumin, PK and 25OH-D were the significant and independent determinants of fracture risk, with their higher concentrations associated with decreased fracture risk. Finally, principal component analysis (PCA) was performed to summarize the clinical parameters into smaller numbers of independent components. Three components were obtained, each representing the overall nutritional status, the vitamin D status, and the vitamin K status. In conclusion, our study has shown that patients with hip fracture have vitamin D and K deficiency independent of general malnutrition.

The risk of fracture in patients with multiple sclerosis: The UK general practice research database

DEFF Research Database (Denmark)

Bazelier, Marloes T; van Staa, Tjeerd; Uitdehaag, Bernard Mj

2011-01-01

Patients with multiple sclerosis (MS) may be at an increased risk of fracture owing to a greater risk of falling and decreased bone mineral density when compared with the general population. This study was designed to estimate the relative and absolute risk of fracture in patients with MS. We...... were used to derive adjusted hazard ratios (HRs) for fracture associated with MS. Time-dependent adjustments were made for age, comorbidity, and drug use. Absolute 5- and 10-year risks of fracture were estimated for MS patients as a function of age. Compared with controls, MS patients had an almost...... threefold increased risk of hip fracture [HR = 2.79,95% confidence interval (CI) 1.83-4.26] and a risk of osteoporotic fracture that was increased 1.4-fold (HR = 1.35,95% CI 1.13-1.62). Risk was greater in patients who had been prescribed oral/intravenous glucocorticoids (GCs; HR = 1.85, 95% CI 1...

Thoracolumbar spine fractures in the geriatric fracture center : early ambulation leads to good results on short term and is a successful and safe alternative compared to immobilization in elderly patients with two-column vertebral fractures

NARCIS (Netherlands)

Weerink, L B M; Folbert, E C; Kraai, M; Smit, R S; Hegeman, J H; van der Velde, D

INTRODUCTION: Thoracolumbar spine fractures are common osteoporotic fractures among elderly patients. Several studies suggest that these fractures can be treated successfully with a nonoperative management. The aim of this study is to evaluate the conservative treatment of elderly patients with a