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Sample records for supracondylar fractures treated

  1. A PROSPECTIVE STUDY OF SUPRACONDYLAR FRACTURES OF THE HUMERUS IN CHILDREN TREATED BY CLOSED REDUCTION

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    Ch. Imobi

    2015-08-01

    Full Text Available There is no universal agreement regarding the management of displaced supracondylar fracture of the humerous in children. According to some orthopaedic surgeon almost all supracondylar humeral fractures should be treated operatively by reduction and pinning. While according to others closed reduction and pinning should be used for Gartland type II and some type III fractures. We present 50 cases of displaced supracondylar fracture treated by closed manipulative reduction under G.A. and immobilization with a posterior plaster of paris slab and collar and cuff. OBJECTIVE : T o assess the functional results of the injured elbow and to study the incidence of change in the carrying angle of the elbow. MATERIALS AND METHODS: This prospective study was conducted in 50 patients with extension type of displaced supracondylar fractures of humerus in children (Gartland type II and type III treated by closed manipulative reduction and immobilization in flexion of the elbow with a posterior plaster of paris slab and collar and cuff. Patients were followed up for 6 months. Flexion type of supracondylar fracture and those fractures which are absolutely indicated for operative intervention, Viz an open fracture and severe vascular compromise were excluded from the study. The range of movement and carrying angle was measured with the help of a Goniometer and Flynn criteria were used for functional assessment. RESULTS: At the end of follow up period, the end results were graded as excellent in 40%, good in 42%, fair in 12% and poor in 6%. A satisfactory result was therefore obtained in 94% and unsatisfactory result in 6% of the 50 patients who were followed and evaluated. CONCLUSION: This closed method of treatment for all practical proposes produces least complications, shorter hospital stay, can be expected to yield reproducible consistent satisfactory results not surpassed by any other method of treatment.

  2. OUTCOME OF GARTLAND TYPE – II SUPRACONDYLAR FRACTURES OF HUMERUS TREATED BY CONSERVATIVE METHOD

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    Dinesh Mitra

    2015-08-01

    Full Text Available BACKGROUND: The current literatures recommend operative method (closed reduction and pinning for type II supracondylar fractures of humerus. But some surgeons still prefer conservative method for type II supracondylar fractures of humerus. We pr esent results of 14 cases of type II supracondylar fractures treated with CR and AE POP immobilization . The purpose of this study is to evaluate the outcome of conservative treatment in management of type II supracondylar fracture of humerus. MATERIALS AND METHODS: Fourteen children treated by conservative methods (CR & AE POP between January 2013 and December 2014 is included in this study. The mean age group is 6.8 years (3 years - 11 years. The patient follow up is done for a minimum of 10 - 12 weeks. Treatment outcome is based on final clinical and radiological assessments and grading of results was done using Flynn’s criteria. RESULTS: Gartland type II fracture gives 82% excellent results and 28 % good results as per Flynn’s criteria. Of the 14 patien ts only two cases required re manipulation. Surgical intervention was not needed for any of the patients. No patients in this study developed compartment syndrome / cubitus varus deformity. CONCLUSION: Satisfactory results can be obtained with conservative treatment (closed reduction and above elbow POP if proper selection of the patient and careful clinical and radiological follow up is done

  3. SUPRACONDYLAR FRACTURE OF THE HUMERUS IN CHILDREN

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    Nikola Bojović

    2012-09-01

    Full Text Available Humeral supracondylar fractures are the second most common fractures seen in children and young teenagers (16.6%. They represent 60-70% of all the elbow fractures. The maximum incidence is found between the fifth and seventh year of age, slightly more often in boys and on non-dominant hand. We performed a retrospective study in our clinic which included 105 patients admitted to our facility during the period from January, 2008 to April, 2012. The included patients had humeral supracondylar fracture either type 2 or type 3 (Gartland classification. At the moment of admission the median age was 7.26 years. All the patients were treated during the first 12 hours, with no more than two attempts of closed reposition. Sixteen patients with type 2 fracture were treated by analgosedation, closed reduction followed by cast immobilization. All other patients were treated after induction of general anesthesia. Sixteen patients were treated by percutaneous fixation of the fragments after closed reduction and 73 were treated with open reduction and pinning with different number and positions of „К“ wires. None of the patients had deep tissue infection; four patients had pin site infection. Three patients had cubitus varus deformity, two patients had elbow contracture, five patients had temporary limitation in extension, and one patient had iatrogenic lesion of the ulnar nerve. This makes 14.2% complication rate in our series. All the fractures healed in the expected period (3–4 weeks. Bauman’s angle, carrying angle and functional factor were measured postoperatively. Closed reposition with pinning, using radiographic control, for the dislocated supracondylar humeral fractures is the safest, as well as the least time consuming and cost-effective method. We also suggest treating these fractures within 12 hours and conversion of closed into open reposition in case of lacking crepitations (possibility of interposition of soft tissues between fragments.

  4. Fracture of supracondylar process of the humerus.

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    Suresh, S S

    2008-07-01

    The supracondylar process of the humerus is a rare skeletal anomaly, which is usually an incidental finding while an X-ray is done for some other purpose. The process can fracture resulting in pain and tender mobile swelling over the medial aspect of the arm, and consequent neurovascular symptoms, or entrapment neuropathies. The anomaly, which fractured in a clinical situation, is described, followed by a review of the literature.

  5. Fracture of Supracondylar Process of the Humerus

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    Suresh, S S

    2008-01-01

    The supracondylar process of the humerus is a rare skeletal anomaly, which is usually an incidental finding while an X-ray is done for some other purpose. The process can fracture resulting in pain and tender mobile swelling over the medial aspect of the arm, and consequent neurovascular symptoms, or entrapment neuropathies. The anomaly, which fractured in a clinical situation, is described, followed by a review of the literature.

  6. Avascular Necrosis of Trochlea After Supracondylar Humerus Fractures in Children.

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    Etier, Brian E; Doyle, J Scott; Gilbert, Shawn R

    2015-10-01

    Avascular necrosis (AVN) is a rare but important complication after supracondylar humerus fractures. Posttraumatic humerus deformity was first reported in 1948 and sporadically thereafter. AVN deformity has been classified as type A (AVN of the lateral ossification center) and type B (AVN of the entire medial crista and a metaphyseal portion). In this article, we present 5 cases of AVN after supracondylar humerus fracture, discuss the importance of late clinical findings, and postulate a mechanism of AVN in nondisplaced fractures. Five cases of AVN after supracondylar humerus fracture were reviewed from the Children's of Alabama database. Four of the 5 patients were female. Four patients sustained a Gartland type III fracture, and 1 patient sustained a nondisplaced Gartland type I fracture. Age at time of injury ranged from 5 years to 10 years. All patients had an asymptomatic clinical period after treatment and re-presented 6 months to 7 years later with elbow pain or loss of motion. All patients were treated symptomatically. AVN of the trochlea has a late clinical presentation. The cause of this complication is interruption of the trochlea blood supply. In displaced fractures, the medial and/or lateral vessels are injured, leading to type A or type B deformity. In nondisplaced fractures, the lateral vessels are interrupted by tamponade because of encased fracture hematoma; this presents as a type A deformity. Both type A and type B deformities can be clinically significant. AVN of the trochlea should be considered in patients with late presentation of pain or loss of motion after treatment of supracondylar humerus fractures.

  7. A distal femoral supra-condylar plate: biomechanical comparison with condylar plate and first clinical application for treatment of supracondylar fracture.

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    Liang, Bowei; Ding, Zhenqi; Shen, Junguo; Zhai, Wenliang; Kang, Liangqi; Zhou, Liang; Sha, Mo; Liang, Dongzhu

    2012-08-01

    An anatomical supra-condylar plate is designed and analysed by biomechanical testing. The biomechanical properties of the supra-condylar and condylar plate were compared in six matched pairs of cadaveric femurs. A transverse osteotomy gap was created to simulate an OTA/AO type A3 supracondylar fracture. The left and right specimens were fitted with supra-condylar and condylar plate, respectively. Nondestructive axial compression, three-point bending and torsion tests were performed, and the peak load of the bone-implant construction was measured. The fracture site suitable for supra-condylar plate application and its correlation with femoral length were calculated. The gender influence on it was also discussed. The difference of stiffness between the supra-condylar and condyle groups were not significant (P > 0.05) at 363.4 and 362.5 N/mm for compression, 229.5 and 237.6 N/mm in the sagittal plane and 195.5 and 188.4 N/mm in the coronal plane for three-point bending, and 7.5 and 7.9 Nm/deg for axial torsion, respectively. The peak load was 4438 ± 136.15 N and 5215 ± 174.33 N, respectively, for the two groups. The average extent of the fracture site suitable for the application of the supra-condylar plate was 70.86 ± 4.61 mm. The femoral length and gender showed no influence on it. Despite the limited bone contact area provided by the supra-condylar plate, its construct stiffness is comparable to the condylar plate. The supra-condylar plate can be used to treat carefully-selected extra-articular supracondylar fractures.

  8. Medial supracondylar stress fracture in an adolescent pitcher

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    Chang, Eric Y.; Chung, Christine B. [VA San Diego Healthcare System, San Diego, CA (United States); University of California, San Diego Medical Center, San Diego, CA (United States); Fronek, Jan [Scripps Healthcare, La Jolla, CA (United States)

    2014-01-15

    We report the occurrence of a medial supracondylar stress fracture in an adolescent pitcher. To our knowledge, this fracture has not been described in the literature, and awareness of this entity allows initiation of therapy and precludes further unnecessary work-up. The radiographic, computed tomography, and magnetic resonance imaging appearances are reviewed and the mechanism of injury is discussed. (orig.)

  9. Surgical treatment of supracondylar humerus fractures in children

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    Reising, K; Schmal, H; Kohr, M

    2011-01-01

    received physiotherapy during the course of treatment. Slight varization was found in 11% of children and an unsatisfactory range of motion in 13%. Satisfactory outcomes were recorded for 83% of patients. CONCLUSION: K-wire osteosynthesis is associated with a low complication rate and continues......PURPOSE OF THE STUDY: Surgical techniques for the treatment of supracondylar fractures in children are repeatedly the subject of discussion. The aim of the present study was to compare experience with the technique of crossed Kirschner wires at our own hospital with current literature. PATIENTS...... AND METHODS: In the period from 2000-2006 a total of 86 children aged 1.7 to 12.7 years were treated by means of crossed K-wire osteosynthesis. Follow up was conducted at an average of 32 months. Outcomes were evaluated based on von Laer's criteria. RESULTS: Reported complications were migration of the K...

  10. COHORT STUDY OF DISPLACED SUPRACONDYLAR FRACTURE TREATED IN TERTIARY CARE INSTITUTE IN PONDICHERY WITH RADIOLOGICAL ASSISTANCE WITH MEDIAL ‘K’ WIRE FIRST FROM 2008-2016

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    Aravindan Kalamegam

    2017-10-01

    Full Text Available BACKGROUND Supracondylar fracture in children when it is displaced, it is very difficult to reduce the fracture. That too after reduction, maintaining the reduction is very difficult. While reducing the fracture in closed reduction with lateral pinning first the result is not predictably good. Cross pinning will be giving mechanically stable fixation than lateral pinning alone. Lateral pinning alone imparts less rotational stability of fracture. Our aim of study is to prevent rotational instability by putting medial pinning first by avoiding the ulnar nerve injury using radiological assistance followed by lateral pinning. MATERIALS AND METHODS One hundred and six cases of displaced supracondylar fracture were included in study. The mean age of the patient was 7 yrs. (3-12 yrs., the male and female patient ratio was 72:34 and left side was involved in 63 patients whereas right side in 43 patients. The most common mode of trauma was fall from height on outstretched hand with elbow in extension. All the 106 patients were consecutively admitted. Patient had extension type of injury with 63 patients had Gartland type III fracture and 43 had Gartland type II fracture. Posteromedial displacement was noted in 63 patients whereas posterolateral displacement noted in 43 patients. In all cases, medial K wire was first inserted after closed reduction, then after stabilising the fractured rotation using image guidance. Lateral K-wire was removed on 3 weeks (21 days and follow up was done at 6 weeks and 12 weeks when they were evaluated according to Flynn’s criteria. RESULTS Results were graded according to Flynn’s criteria. CONCLUSION Medial K wire technique provides stable fixation and rotational stability has been correlated according to this technique.

  11. SUPRACONDYLAR FRACTURE FEMUR T REATED WITH INTRAMEDULLARY NAIL : A PROSPECTIVE STUDY

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    Venkateswara Rao; Chaitanya; Anvesh

    2015-01-01

    BACKGROUND: Supracondylar fractures are one of the commonest fractures encountered in high velocity trauma which are associated with high morbidity and mortality . 1 Isolated fracture can itself lead to complications such as ARDS and pulmonary embo lism 1 . This necessitates early stabilization of fractures. Internal fixation is the choice of treatment in supracondylar fractures (AO type – A) . 2 Retrograde supracondylar nail has shown to giv...

  12. Complications of the surgical treatment early and tardy of supracondylar fractures of the humerus in children: a retrospective study of 111 patients treated at the Hospital Nacional de Ninos Carlos Saenz Herrera in the period January 2010 to January 2011

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    Zuniga Blanco, Adrian

    2012-01-01

    Supracondylar fractures of the humerus up much of the emergency consultation of any pediatric orthopedic service, of them, Gartland III fractures are usually treated by closed reduction and percutaneous fixation with nails smooth. Often treatment has been delayed by factors such as the unavailability of an orthopedic specialist or local anesthesia or an operating room. At other times, the patient has come belatedly to consult. This retrospective study has analyzed whether a delay greater than 12 hours in the surgical treatment of supracondylar fractures of the humerus in children is associated with an increased risk of perioperative complications. Of 111 children who have been treated surgical in national children's hospital, underwent 59 surgeries before 12 hours from the trauma and 52 underwent surgery after 12 hours of trauma. The groups have developed without significant differences in terms of iatrogenic neurological injury, tract infection of the nails, vascular complications and compartment syndrome. Surgical time and hospital stay neither have had differences. In 2 cases of the tardy treatment group has been necessary to perform a opened reduction. As for the bad union, 9 cases (8%) have been of elbow varus radiological and clinical, of these 5 cases (4.5%) have occurred in the tardy treatment group and 4 cases (3,5) in the group early treatment. Findings of similar studies are confirmed in which the rate of perioperative complications is significantly unchanged if the surgical treatment is carried out before 12 hours or after 12 hours after the trauma. (author) [es

  13. Complications after pinning of supracondylar distal humerus fractures.

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    Bashyal, Ravi K; Chu, Jennifer Y; Schoenecker, Perry L; Dobbs, Matthew B; Luhmann, Scott J; Gordon, J Eric

    2009-01-01

    Supracondylar distal humerus fractures are one of the most common skeletal injuries in children. The current treatment of choice in North America is closed reduction and percutaneous pin fixation. Often surgeons leave the pins exposed beneath a cast but outside the skin. Great variation exists with respect to preoperative skin preparation, and perioperative antibiotic administration. Few data exist regarding the rate of infection and other complications. The purpose of this study is to review a large series of children to evaluate the rate of infection and other complications. A retrospective review was carried out of all patients treated at our institution over an 11-year period. A total of 622 patients were identified that were followed for a minimum of 2 weeks after pin removal. Seventeen patients had flexion-type fractures, 294 had type II fractures, and 311 had type III fractures. Seventy-four fractures (11.9%) had preoperative nerve deficits with anterior interosseous palsies being the most common (33 fractures, 5.3%). Preoperative antibiotics were given to 163 patients (26.2%). Spray and towel draping were used in 362 patients, paint and towel draping were used in 65 patients, alcohol paint and towel draping were used in 146 patients, and a full preparation and draping were used in 13 patients. The pins were left exposed under the cast in 591 fractures (95%), and buried beneath the skin in 31 fractures (5.0%). A medial pin was placed in 311 fractures with a small incision made to aid placement in 18 of these cases. The most common complication was pin migration necessitating unexpected return to the operating room for pin removal in 11 patients (1.8%). One patient developed a deep infection with septic arthritis and osteomyelitis (0.2%). Five additional patients had superficial skin infections and were treated with oral antibiotics for a total infection rate of 6 of 622 patients (1.0%). One patient ultimately had a malunion and 4 others returned to the

  14. Bilateral femoral supracondylar stress fractures in a cross country runner.

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    Ross, Kate; Fahey, Mark

    2008-08-01

    Several high-risk factors lead to stress fractures. They include excessive training in athletes leading to overuse injuries, nutritional deficiencies, and endocrine disorders. While stress fractures are common, bilateral stress fractures are rarely seen. Few cases have been reported of bilateral femoral stress fractures in young athletes. This article presents a case of a 14-year-old cross country runner with a bilateral femoral supracondylar stress fracture. He presented with bilateral supracondylar stress fractures from running. The patient followed a strict vegan diet, but his parents stated that, to their knowledge, he was getting adequate protein and calcium. Treatment consisted of decreased activity to pain-free levels with acetaminophen for pain. Low-impact conditioning such as swimming and bicycling was allowed. Hamstring and quadricep stretching was suggested. Nutritional consultation was obtained to ensure appropriate nutrition on a vegan diet. At 1-month follow-up, he was pain free and allowed to proceed with a gradual return to running activities. In this case, the onset of a new workout routine was intolerable for this patient's low bone density, causing insufficiency fractures. Appropriate vegan diets were not associated with stress fracture in our literature review. He may have had an inadequate diet prior to this injury. As in this case, full recovery can be made after this rest period, and the patient may return to his or her original activity safely. In young athletes, diet and nutrition must be kept in mind.

  15. An inconvenient truth: treatment of displaced paediatric supracondylar humeral fractures.

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    Donnelly, M

    2012-06-01

    The need for emergent management of displaced paediatric supracondylar humeral fractures is being questioned in the literature. Open reduction rates of up to 46% have been reported in the non-emergent management of these injuries. At our institution these fractures are managed as operative emergencies by senior personnel. To examine the ongoing need for this policy we reviewed our results. All patients managed over a five year period with Gartland type IIB or III paeditric supracondylar humeral fractures were identified and a comprehensive chart and radiographic review undertaken. The mean time from injury to fracture reduction and stabilization was 6.6 h. Consultants performed or supervised 90% of cases. Open reduction was necessary in 5% of cases. Complications included a perioperative nerve injury rate of 6% and a superficial pin site infection rate of 3%. This study suggests that, despite the challenge to trauma on-call rostering, the emergency management of these injuries is advantageous to patients in units of our size. Based on the data presented here we continue our practice of emergent management. We suggest that units of a similar size to our own would show a benefit from an analogous policy albeit an inconvenient truth.

  16. Utility of Postoperative Antibiotics After Percutaneous Pinning of Pediatric Supracondylar Humerus Fractures.

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    Schroeder, Nicholas O; Seeley, Mark A; Hariharan, Arun; Farley, Frances A; Caird, Michelle S; Li, Ying

    2017-09-01

    Pediatric supracondylar humerus fractures are common injuries that are often treated surgically with closed reduction and percutaneous pinning. Although surgical-site infections are rare, postoperative antibiotics are frequently administered without evidence or guidelines for their use. With the increasing prevalence of antibiotic-resistant organisms and heightened focus on health care costs, appropriate and evidence-based use of antibiotics is needed. We hypothesized that postoperative antibiotic administration would not decrease the rate of surgical-site infection. A billing query identified 951 patients with operatively treated supracondylar humerus fractures at our institution over a 15-year period. Records were reviewed for demographic data, perioperative antibiotic use, and the presence of surgical-site infection. Exclusion criteria were open fractures, open reduction, pathologic fractures, metabolic bone disease, the presence of other injuries that required operative treatment, and follow-up <2 weeks after pin removal. χ and Fisher exact test were used to compare antibiotic use to the incidence of surgical-site infection. Six hundred eighteen patients met our inclusion criteria. Two hundred thirty-eight patients (38.5%) received postoperative antibiotics. Eleven surgical-site infections were identified for an overall rate of 1.8%. The use of postoperative antibiotics was not associated with a lower rate of surgical-site infection (P=0.883). Patients with a type III fracture (P<0.001), diminished preoperative vascular (P=0.001) and neurological status (P=0.019), and postoperative hospital admission (P<0.001) were significantly more likely to receive postoperative antibiotics. Administration of postoperative antibiotics after closed reduction and percutaneous pinning of pediatric supracondylar humerus fractures does not decrease the rate of surgical-site infection. Level III-therapeutic.

  17. Pulseless supracondylar humeral fractures in children: vascular complications in a ten year series.

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    Cambon-Binder, Adeline; Jehanno, Pascal; Tribout, Laurent; Valenti, Philippe; Simon, Anne-Laure; Ilharreborde, Brice; Mazda, Keyvan

    2018-04-01

    The management of pulseless supracondylar fractures remains controversial. The aims of this study were to: (1) analyse functional and vascular outcomes of conservative treatment for cases with absent pulse before reduction, whether patients showed limb ischaemia or not; and (2) identify factors associated with vascular complications. Twenty-seven children with absent pulses on presentation were treated consecutively between 1999 and 2009. The brachial artery was surgically explored in cases of persistent signs of ischaemia after reduction. Signs of vascular impairment were recorded in the early post-operative period and at a mean final follow-up of 3.5 years. Recurrent ischaemia with a compartment syndrome occurred in a patient with initial ischaemia and a pink, pulseless hand after reduction. Patients with an initially well-perfused hand and those with pre-operative ischaemia and palpable pulses after reduction had satisfactory outcomes, as did patients with early arterial exploration. No patient showed signs of chronic vascular impairment. The need for vascular repair was significantly correlated with open fracture, initial ischaemia and nerve impairment. Conservative management of supracondylar fractures with absent pulses avoided long-term vascular complications provided that patients with a pulseless, well-perfused hand on presentation were closely monitored after reduction. Further study is necessary to determine whether a forearm Doppler would help identify children with absent pulses after reduction who need surgical revascularisation due to an insufficient collateral circulation.

  18. A comparison of more and less aggressive bone debridement protocols for the treatment of open supracondylar femur fractures.

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    Ricci, William M; Collinge, Cory; Streubel, Philipp N; McAndrew, Christopher M; Gardner, Michael J

    2013-12-01

    This study compared results of aggressive and nonaggressive debridement protocols for the treatment of high-energy, open supracondylar femur fractures after the primary procedure, with respect to the requirement for secondary bone grafting procedures, and deep infection. Retrospective review. Level I and level II trauma centers. Twenty-nine consecutive patients with high-grade, open (Gustilo types II and III) supracondylar femur fractures (OTA/AO 33A and C) treated with debridement and locked plating. Surgeons at 2 different level I trauma centers had different debridement protocols for open supracondylar femur fractures. One center used a more aggressive (MA) protocol in their patients (n = 17) that included removal of all devitalized bone and placement of antibiotic cement spacers to fill large segmental defects. The other center used a less aggressive (LA) protocol in their patients (n = 12) that included debridement of grossly contaminated bone with retention of other bone fragments and no use of antibiotic cement spacers. All other aspects of the treatment protocol at the 2 centers were similar: definitive fixation with locked plates in all cases, IV antibiotics were used until definitive wound closure, and weight bearing was advanced upon clinical and radiographic evidence of fracture healing. Healing after the primary procedure, requirement for secondary bone grafting procedures, and the presence of deep infection. Demographics were similar between included patients at each center with regard to age, gender, rate of open fractures, open fracture classification, mechanism, and smoking (P > 0.05). Patients at the MA center were more often diabetic (P debridement (35% vs. 0%, P debridement (71% vs. 8%, P debridement (92% vs. 35%, P debrided after a high-energy, high-grade, open supracondylar femur fracture is a matter of surgeon judgment and falls along a continuous spectrum. Based on the results of the current study, the theoretic trade-off between infection

  19. Is Closed Manipulative Reduction and Percutaneous Kirschner Wiring of Supracondylar Humeral Fracture in Children as Day-Care Surgery a Safe Procedure ?

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    Ashok R Nayak

    2013-07-01

    Full Text Available INTRODUCTION: Supracondylar fracture of the humerus is a common injury in children. It accounts for 60% of fractures around the elbow children. If the fracture is not treated properly it may give rise to many complications like malunion, Volkmann’s ischemic contracture, nerve injury, arterial injury, skin slough, heterotopic bone formation , and stiffness of elbow. The management of displaced supracondylar fracture of the elbow is one of the most difficult of the many fractures seen in children. The purpose of the study was to evaluate the anatomical and functional results of treatment of supracondylar fractures of humerus with closed reduction and percutaneous ‘K’ wire fixation as a day care procedure and record associated complications, thus decreasing the cost of treating these fractures and hospitalization. METHODS: Fifty displaced closed extension type supracondylar fractures (Gartland’s type III of the humerus in children were treated by closed reduction and percutaneous fixation with Kirschner wires. All the patients selected for this study had been treated in a day care unit and were discharged in the same evening and followed up at 3 and 6 weeks and 3 months. Open fractures, fractures with neurovascular complications and children older than 15 yrs were excluded. The final results were evaluated by Flynn’s criteria. RESULTS: The majority (72%, of the patients had fracture displaced posteomedially, Fourty one of the fifty patients had satisfactory results. The majority of the patients were male, and the average age was 8-9 years. CONCLUSION: Percutaneous fixation of supracondylar humerus done as a day care procedure is an acceptable modality of treatment and reduces the duration of hospital stay for the patient.

  20. [Vascular and neurological complications of supracondylar humeral fractures in children].

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    Masár, J

    2007-10-01

    The author reports two cases of pediatric patients with supracondylar humeral fractures complicated by concomitant vascular injury. One of the patients also presented with neurological symptoms from compression of the ulnar and median nerves. In the case of vascular injury only, it was necessary to resect a 1-cm segment of the brachial artery which was thrombosed due to intimal disruption. In the other case, surgery was not indicated immediately; however, liberation of the nervus ulnaris and nervus medianus was later required because of nerve compression by the scar and bone. The author considers the exact diagnosis, precise reduction and stable fixation of a fracture to be most important for a good outcome of treatment. Any associated vascular injury is indicated for surgery only after a thorough diagnostic consideration, and may not be needed in every case. The most decisive factor is the clinical presentation. Injury to the nerve system is indicated for surgical treatment at a later period, at 3 months post-injury at the earliest.

  1. Emergency or Delayed Surgical Treatment of Unstable Supracondylar Humeral Fractures in Children?

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    Stefanovic Branko

    2017-06-01

    Full Text Available Supracondylar humeral fractures (SCHF are the most common elbow fractures in children, representing 3% of all paediatric fractures. Treatment options for SCHF in children are based on the Gartland classification. Treatment of non-displaced fractures (type I is non-operative. Plaster immobilization for 3 to 4 weeks is recommended, depending on the age of the child and fracture healing. Treatments of displaced supracondylar fractures (type II and III of the humerus in children are still undefined in clinical practice. Because of divided opinions, the aim of this study was to evaluate whether delayed or immediate surgical treatment has an advantage in the treatment of supracondylar fractures in children. This is a prospective – retrospective clinical study. This study included 64 patients from 5 to 15 years old; 47 (73.4% were boys and 17 (26.6% were girls. The most common age range (59.4% in this study was 5-8 years old. All patients were diagnosed with supracondylar fractures at the Institute for Orthopaedic Surgery “Banjica”. We analysed 17 parameters, which were obtained either from direct patient interviews or from their medical history. All patients were divided into two groups with matched characteristics. Group I consisted of 26 patients who had immediate operations. Group II consisted of 38 patients who had delayed operations.

  2. Near-infrared spectroscopy for detection of vascular compromise in paediatric supracondylar fractures

    International Nuclear Information System (INIS)

    Skowno, Justin J; De Lima, Jonathan; Quick, Tom J; Carpenter, Eleanor C; Gibbons, Paul J; Little, David G

    2014-01-01

    Children suffering supracondylar fractures of the humerus are at risk of vascular compromise, which is currently assessed clinically, although other modalities such as angiography, pulse oximetry, Doppler ultrasound and magnetic resonance angiography have been used. We sought to ascertain whether tissue haemoglobin oxygenation (StO 2 ) measurement could distinguish between patients with and without clinical vascular compromise following supracondylar fractures of the humerus. We prospectively observed StO 2  using near-infrared spectroscopy in 29 paediatric patients with supracondylar fractures requiring operative manipulation. The injured and uninjured volar forearm compartments were monitored immediately before and after fracture reduction. The relationship between StO 2  in the injured and uninjured limb, and the presence of pre-operative vascular compromise was assessed. Seven out of 29 children presented with vascular compromise. Patients with clinical vascular compromise had significantly lower pre-reduction StO 2  (63.5% ± 15%, mean ± standard deviation), compared to those without compromise (80.9% ± 10%). StO 2  normalized following surgery in all children with vascular compromise. These improvements in muscle StO 2  were associated, in all patients, with the clinical return of pulses and resolution of neurological symptoms if present. StO 2  monitoring can identify patients with clinical vascular compromise, can identify the return of adequate perfusion following operative correction of supracondylar fractures, and may be a useful adjunct to clinical assessment. (paper)

  3. Close reduction and per cutaneous pinning of supracondylar fractures of humerus in children

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    Iqbal, S.; Maqbool, N.

    2014-01-01

    The purpose of this study was to assess outcome and complications associated with closed reduction and internal fixation of supracondylar fractures type III of humerus in children. Study Design: Quasi - experimental. Place and Duration of Study: Department of Orthopedics, Fauji Foundation Hospital Rawalpindi and Railway General Hospital (RGH), Rawalpindi, from June 2011 to August 2012. Material and Method: The study group included 16 boys and 8 girls aged 4-12 years with supracondyle Type III fractures of humerus, having no neurovascular injury and no appreciable edema. Relevant history and clinical details were taken. All those cases having any neurovascular injury or moderate to severe edema at elbow and presenting late more than two weeks were excluded. These cases were treated with closed reduction and internal fixation. Follow up was done for 6 months to assess the level of cosmetic and function according to the system described by Flynn's et al as excellent, good, fair and poor. Results: Study was completed on 24 patients (16 males and 8 females). All fractures were united in acceptable alignment. At final assessment there were 16 excellent, 5 good, 3 fair. No one was poor. The fair clinical outcome was higher in children above 10 years of age. Conclusion: Closed reduction and internal fixation with cast stabilization can provide precise and good fracture reduction, maintains stabilization for fracture healing, results in good cosmetic outcome, cost effective and facilitates easy removal of implants after treatment. (author)

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

    LENUS (Irish Health Repository)

    Queally, Joseph M

    2010-06-01

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

  5. Utility of the AAOS Appropriate Use Criteria (AUC) for Pediatric Supracondylar Humerus Fractures in Clinical Practice.

    Science.gov (United States)

    Ibrahim, Talal; Hegazy, Abdelsalam; Abulhail, Safa I S; Ghomrawi, Hassan M K

    2017-01-01

    The American Academy of Orthopaedic Surgeons (AAOS) recently developed an Appropriate Use Criteria (AUC) for pediatric supracondylar humerus fractures (PSHF). The AUC is intended to improve quality of care by informing surgeon decision making. The aim of our study was to cross-reference the management of operatively treated PSHF with the AAOS-published AUC. The AUC for PSHF include 220 patient scenarios, based on different combinations of 6 factors. For each patient scenario, 8 treatment options are evaluated as "appropriate," "maybe appropriate," and "rarely appropriate." We retrospectively reviewed the medical charts and radiographs of all operatively treated PSHF at our hospital from January 2013 to December 2014 and determined the appropriateness of the treatment. Over the study period, 94 children (mean age: 5.2 y; 51 male, 43 female) were admitted with PSHF and underwent a surgical procedure (type IIA: 7, type IIB: 14, type III: 70, flexion type: 3). Only 8 of the 220 scenarios were observed in our patient cohort. The most frequent scenario was represented by a type III fracture, palpable distal pulse, no nerve injury, closed soft-tissue envelope, no radius/ulna fracture, and typical swelling. Of the 94 fractures, the AUC was "appropriate" for 84 cases and "maybe appropriate" for 9 cases. There was only 1 case of "rarely appropriate" management. Closed reduction with lateral pinning and immobilization was the most prevalent treatment option (58.5%). The rate of appropriateness was not affected by the operating surgeon. However, the definition of a case as emergent had a significant impact on the rate of appropriateness. Application of the AUC to actual clinical data was relatively simple. The majority of operatively treated PSHF (89.4%) were managed appropriately. With the introduction of electronic medical charts, an AUC application becomes attractive and easy for orthopaedic surgeons to utilize in clinical practice. However, validity studies of the AUC in

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

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    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

  7. Predictive factors determining outcomes in pulseless limb in paediatric supracondylar fractures of humerus.

    Science.gov (United States)

    Chaturvedi, Hemant; Khanna, Vikram; Bhargava, Rakesh; Vaishya, Raju

    2018-03-01

    Amongst all the complications associated with paediatric supracondylar humerus fractures, significant vascular injury is reported in only 1% cases, of which, less than 1% develop Volkmann's ischemic contracture. This study evaluates factors, like delay in presentation of the injury, limb perfusion and pulse, in determining functional outcome in a supracondylar humerus fractures with pulseless limb. Twenty-one paediatric patients with a pulseless supracondylar humerus fracture presenting from 2012 to 2014 were included. The patients were divided into 3 groups with Group A (pulse returned post-reduction, n = 13), Group B (pink pulseless hand, n = 7) and Group C (white pulseless hand, n = 1). 11 patients in group A and 4 patients in Group B presented within 6 h. of injury while the remaining patients presented after 6 h. The primary outcome was vascular status as indicated by radial pulse and perfusion, and secondary outcomes included functional parameters assessed with Mayo Elbow Performance Score and Flynn criteria. Mean peripheral SpO2 in Group A patients was higher than Group B and Group C had a non-recordable oxygen saturation. Mean capillary refill time was more in Group A than Group B whereas in Group C patient had blanching and no capillary refill was seen. Mean Mayo Elbow Performance Score of Group A patients was highest as compared to Group B and Group C. Patients presenting within 6 h. of injury had a higher mean Mayo Elbow Performance score as compared to the patients presenting after 6 h of injury. Functional outcome as measured by Flynn Criteria was excellent in 13 patients. 6 patients had a good, 2 had fair outcome. A moderate negative corrélation (R = -0.5798) was seen between the time elapsed from the injury and the Mayo Elbow Performance score. Duration to presentation since injury, limb perfusion and presence of peripheral pulses seem to be important predictive factors determining the outcomes in pulseless supracondylar fracture humerus.

  8. Supracondylar fracture in children. Rehabilitation in occupational therapy. Yes or no?

    Science.gov (United States)

    Costa, Maria J.; Pires, Mafalda; Neves, Cassiano; Tavares, Delfin; Quintas, Alexandra M.; Ferreira, Ana I.; Espirito Santo, M. J.; Castro, Alexandra; Cabral, M. Salomé; João Gomes, J. F.

    2013-10-01

    The aim of this study was to evaluate the recovery time of elbow range of motion after treatment of Gartland's type II and III supracondylar fractures of distal humerus in children who attended a program of occupational therapy (OT). A randomized control design (RCD) was conducted to compare the two groups (OT group and Control group) and several statistical methodologies have been used to compare them. In all the cases the results point out to a faster recover in the OT group. All the analysis were performed using the package R version 3.0.1.

  9. Closed Versus Open Supracondylar Fractures of the Humerus in Children: A Comparison of Clinical and Radiographic Presentation and Results.

    Science.gov (United States)

    Lewine, Eliza; Kim, Jaehon M; Miller, Patricia E; Waters, Peter M; Mahan, Susan T; Snyder, Brian; Hedequist, Daniel; Bae, Donald S

    2018-02-01

    The purpose of this investigation was to compare the presentation and postoperative results of children treated for open and closed, completely displaced type III supracondylar humerus fractures (SCFs). Thirty patients with open and 66 patients with closed, completely displaced type III SCFs were evaluated. Open fractures underwent irrigation and debridement, and all patients were treated by open or closed reduction and pin fixation. Medical records were reviewed to obtain demographic information as well as preoperative and postoperative clinical data regarding mechanism of injury, neurovascular status, associated injuries, postoperative range of motion, infections, and pain. Radiographs were evaluated to quantify displacement, Baumann's angle, humeral capitellar angle, position of the anterior humeral line, and adequacy of reduction. Outcomes were assessed using Flynn criteria. Mean clinical follow-up for the open and closed fracture groups was 8.9 and 5.7 months, respectively. Both groups were similar with respect to age, sex distribution, weight and body mass index, laterality of involvement, and mechanism of injury. At presentation, 35% of closed SCFs and 23% of open SCFs presented with abnormal neurovascular status. There was a higher prevalence of diminished/absent pulses or distal limb ischemia in patients with open injuries (27%) compared with closed fractures (18%). Conversely, severely displaced closed fractures were more commonly associated with nerve injury/palsy at presentation (35%) than those with open fractures (23%). Spontaneous nerve recovery was seen in 87% within 3 to 6 months. Postoperative loss of reduction and malunion were more common in the closed fracture group. However, 84% of patients achieved good-to-excellent results by Flynn criteria, with no appreciable difference based upon open versus closed fractures. With timely wound and fracture treatment, the clinical and radiographic results of children treated for open SCFs is similar to

  10. Clinical study of emergency treatment and selective closed reduction for the treatment of supracondylar humerus fracture in children

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    Wei Zhong

    2016-11-01

    Full Text Available Objective: To study the effect of emergency treatment, selective closed reduction combined with percutaneous Kirschner wire fixation on the treatment of Gartland type-II and type-III supracondylar humerus fracture. Methods: Children who sustained the Gartland type-II and type-III supracondylar fractures of humerus treated with selective closed reduction combined with percutaneous Kirschner wire fixation in our hospital from May 2012 to August 2015 were analyzed retrospectively. They were divided into group A (emergency operation group and group B (selective operation group according to different operation timing. Perioperative situation, blood biochemical parameters, swelling degree and elbow joint function of affected limb were compared between two groups. Results: Operation time for patients of group A was significantly shorter than that of group B [(17.19 ± 2.85 vs. (21.43 ± 3.91 min], and frequency of fluoroscopy during operation of group A was obviously less than that of group B [(6.03 ± 0.95 vs. (7.61 ± 0.92 times]. Swelling index of affected limb in group A at 3 days, 5 days and 7 days after injury was all significantly lower than that in group B [(1.20 ± 0.17 vs. (1.38 ± 0.14, (1.13 ± 0.13 vs. (1.30 ± 0.18, (1.02 ± 0.15 vs. (1.22 ± 0.15]. Hospital for special surgery score at 1 week, 2 weeks, 3 and 4 weeks after removing Kirschner wire had no significant difference between group A and B (88.75 ± 10.18 vs. (89.14 ± 10.52, (94.22 ± 10.85 vs. (93.85 ± 11.08, (95.52 ± 11.27 vs. (95.92 ± 12.19, (95.43 ± 10.96 vs. (96.02 ± 11.38. Contents of serum alanine transaminase, aspertate aminotransferase, total protein, albumin and C-reactive protein in perioperative period had no obvious difference between patients in group A and B. Conclusions: Emergency closed reduction combined with percutaneous Kirschner wire fixation for Gartland type-II and type-III supracondylar humerus fracture in children has less trauma, low swelling degree

  11. The Role of Nerve Exploration in Supracondylar Humerus Fracture in Children with Nerve Injury

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    Anuar RIM

    2015-11-01

    Full Text Available The supracondylar humerus fracture (SCHF in children is common and can be complicated with nerve injury either primarily immediate post-trauma or secondarily posttreatment. The concept of neurapraxic nerve injury makes most surgeons choose to ‘watch and see’ the nerve recovery before deciding second surgery if the nerve does not recover. We report three cases of nerve injury in SCHF, all of which underwent nerve exploration for different reasons. Early reduction in the Casualty is important to release the nerve tension before transferring the patient to the operation room. If close reduction fails, we proceed to explore the nerve together with open reduction of the fracture. In iatrogenic nerve injury, we recommend nerve exploration to determine the surgical procedure that is causing the injury. Primary nerve exploration will allow early assessment of the injured nerve and minimize subsequent surgery.

  12. Extraarticular bony ankylosis in a child with supracondylar fracture of humerus

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    Naranje Sameer

    2012-11-01

    Full Text Available 【Abstract】 Myositis ossificans is defined as forma-tion of bone at the site of injured muscle. It is one of the rare complications of supracondylar fracture of humerus in children. Myositis mass usually develops on the anterior aspect in the brachialis muscle and produces restriction of range of motion, but complete ankylosis is rare. To the best of our knowledge, this is the first case to be reported in the literature as a consequence of myositis ossificans traumatica. In this case, a six-year-old child presented to the casualty department with pain in the right elbow after a fall on out-stretched hand during play. After surgical excision through the anterior approach, the child had no symptoms referable to the elbow and a residual flexion deformity of 15 degrees with further painless flexion up to 100 degrees at last follow-up of one year after surgery. Key words: Humerus; Fractures, Bone; Myositis; Ankylosis

  13. Multicenter Study of Pin Site Infections and Skin Complications Following Pinning of Pediatric Supracondylar Humerus Fractures.

    Science.gov (United States)

    Combs, Kristen; Frick, Steven; Kiebzak, Gary

    2016-12-03

    Pediatric supracondylar humerus fractures are the most common elbow fractures in pediatric patients. Surgical fixation using pins is the primary treatment for displaced fractures. Pin site infections may follow supracondylar humerus fracture fixation; the previously reported incidence rate in the literature is 2.34%, but there is significant variability in reported incidence rates of pin site infection. This study aims to define the incidence rate and determine pre-, peri-, and postoperative factors that may contribute to pin site infection following operative reduction, pinning, and casting. A retrospective chart analysis was performed over a one-year period on patients that developed pin site infection. A cast care form was added to Nemours' electronic medical records (EMR) system (Epic Systems Corp., Verona, WI) to identify pin site infections for retrospective review. The cast care form noted any inflamed or infected pins. Patients with inflamed or infected pin sites underwent a detailed chart review. Preoperative antibiotic use, number and size of pins used, method of postoperative immobilization, pin dressings, whether postoperative immobilization was changed prior to pin removal, and length of time pins were in place was recorded. A total of 369 patients underwent operative reduction, pinning, and casting. Three patients developed a pin site infection. The pin site infection incidence rate was 3/369=0.81%. Descriptive statistics were reported for the three patients that developed pin site infections and three patients that developed pin site complications. Pin site infection development is low. Factors that may contribute to the development of pin site infection include preoperative antibiotic use, length of time pins are left in, and changing the cast prior to pin removal.

  14. Early Vessels Exploration of Pink Pulseless Hand in Gartland III Supracondylar Fracture Humerus in Children: Facts and Controversies

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    Tunku-Naziha TZ

    2017-03-01

    Full Text Available The management of pink pulseless limbs in supracondylar fractures has remained controversial, especially with regards to the indication for exploration in a clinically well-perfused hand. We reviewed a series of seven patients who underwent surgical exploration of the brachial artery following supracondylar fracture. All patients had a non-palpable radial artery, which was confirmed by Doppler ultrasound. CT angiography revealed complete blockage of the artery with good collateral and distal run-off. Two patients were more complicated with peripheral nerve injuries, one median nerve and one ulnar nerve. Only one patient had persistent arterial constriction which required reverse saphenous graft. The brachial arteries were found to be compressed by fracture fragments, but were in continuity. The vessels were patent after the release of obstruction and the stabilization of the fracture. There was no transection of major nerves. The radial pulse was persistently present after 12 weeks, and the nerve activity returned to full function.

  15. Open Reduction and Internal Fixation of displaced Supracondylar Fractures of Humerus with Crossed K-wires via Medial Approach

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    S Hussain

    2014-07-01

    Full Text Available This study aimed at evaluating the medial approach for open reduction and internal fixation of Gartland type 3 displaced supracondylar fractures of humerus in children. A prospective, single centre study of on displaced supracondylar humerus fractures in 42 children was carried out at our institute. All fractures were managed with open reduction and internal fixation with crossed K-wires via medial approach. The mean follow-up was 12 months and patients were assessed according to Flynn’s criteria. No patients had post-operative ulnar nerve injury. Cubitus varus was not seen in any patient. Superficial pin tract infection occurred in three patients that subsided with anti-septic dressings and antibiotics. No deep infection occurred. 88.09 % patients showed satisfactory results as per Flynn’s criteria. The medial approach provides an excellent view of the supracondylar area. The approach is convenient due to a lower risk for ulnar nerve injury and better acceptability of the medial incisional scar.

  16. The value of modified DASH questionnaire for evaluation of elbow function after supracondylar fractures in children

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    Čolović Hristina

    2008-01-01

    Full Text Available Background/Aim. The Disabilities of the Arm, Shoulder and Hand (DASH Outcome Questionnaire represents a region- specific instrument for functional outcome measurement of hand function. The aim of the study was to analyze the correlation between the values of modified DASH questionnaire and change of elbow function after supracondylar fracture (SCF of humerus and to analyze the effects of early rehabilitation. Methods. The study included 35 schoolaged children with flexion of SCF of humerus without lesion of nerves. The patients were divided into two groups: group A in which rehabilitation started up to 14 days after the removal of fixation (20 children, and group B in which rehabilitation started after 15 days and more (15 children. The effects of the applied rehabilitation procedures were analyzed by measuring the range of motion of elbow and using modified DASH questionnaire. Testing was performed during the first examination, on the first day of rehabilitation (retest and after the rehabilitation. Pearson's coefficient of liner correlation was applied. Results. Statistically significant negative correlation of DASH score and extension was verified in all three measurements. The values for the first test and for the final test were highly significant (p < 0.001, as well as negative correlation of DASH score and flexion on the first test and retest (p < 0.01, and at the end of rehabilitation (p < 0.001 in the group B. For all three tests in the group A negative correlation without significant differences for DASH score and flexion was found. Conclusion. A modified DASH questionnaire correlates with objective parameters of final status of elbow after SCF in children and it is applicable to small series of patients. A positive effect of early rehabilitation of children with SCF was found.

  17. Triceps-sparing approach for open reduction and internal fixation of neglected displaced supracondylar and distal humeral fractures in children.

    Science.gov (United States)

    Rizk, Ahmed Shawkat

    2015-06-01

    Supracondylar humeral fractures are one of the most common skeletal injuries in children. In cases of displacement and instability, the standard procedure is early closed reduction and percutaneous Kirschner wire fixation. However, between 10 and 20 % of patients present late. According to the literature, patients with neglected fractures are those patients who presented for treatment after 14 days of injury. The delay is either due to lack of medical facilities or social and financial constraints. The neglected cases are often closed injuries with no vascular compromise. However, the elbow may still be tense and swollen with abrasions or crusts. In neglected cases, especially after early appearance of callus, there is no place for closed reduction and percutaneous pinning. Traditionally, distal humeral fractures have been managed with surgical approaches that disrupt the extensor mechanism with less satisfactory functional outcome due to triceps weakness and elbow stiffness. The aim of this study is to evaluate the outcome of delayed open reduction using the triceps-sparing approach and Kirschner wire fixation for treatment of neglected, displaced supracondylar and distal humeral fractures in children. This prospective study included 15 children who had neglected displaced supracondylar and distal humeral fractures. All patients were completely evaluated clinically and radiologically before intervention, after surgery and during the follow-up. The follow-up period ranged from 8 to 49 months, with a mean period of 17 months. Functional outcome was evaluated according to the Mayo Elbow Performance Index (MEPI) and Mark functional criteria. All fractures united in a mean duration of 7.2 weeks (range 5-10 weeks) with no secondary displacement or mal-union. Excellent results were found at the last follow-up in 13 of the 15 patients studied (86.66 %), while good results were found in two patients (13.33 %) according to the MEPI scale. According to the Mark

  18. Surgical Interventions for the Treatment of Supracondylar Humerus Fractures in Children: Protocol of a Systematic Review.

    Science.gov (United States)

    Carrazzone, Oreste Lemos; Belloti, João Carlos; Matsunaga, Fabio Teruo; Mansur, Nacime Salomão Barbachan; Matsumoto, Marcelo Hide; Faloppa, Flavio; Tamaoki, Marcel Jun Sugawara

    2017-11-21

    The treatment of supracondylar humerus fracture in children (SHFC) is associated with complications such as functional deficit, residual deformity, and iatrogenic neurological damage. The standard treatment is closed reduction and percutaneous Kirschner wire fixation with different configurations. Despite this fact, there is still no consensus on the most effective technique for the treatment of these fractures. The aim of this systematic review will be to evaluate the effect of surgical interventions on the treatment of Gartland type II and III SHFC by assessing function, complications, and error as primary outcomes. Clinical outcomes such as range of motion and pain and radiographic outcomes will also be judged. A systematic review of randomized controlled trials or quasi-randomized controlled trials evaluating the surgical treatment of SHFC will be carried out in the Cochrane Central Register of Controlled Trials, PubMed, Literatura Latino-Americana e do Caribe em Ciências da Saúde, and Excerpta Medica Database. The search will also occur at ongoing and recently completed clinical trials in selected databases. Data management and extraction will be performed using a data withdrawal form and by analyzing the following: study method characteristics, participant characteristics, intervention characteristics, results, methodological domains, and risk of bias. To assess the risk of bias of the included trials, the Cochrane Risk of Bias Tool will be used. Dichotomous outcome data will be analyzed as risk ratios, and continuous outcome data will be expressed as mean differences, both with 95% confidence intervals. Also, whenever possible, subgroup analysis, sensitivity analysis, and assessment of heterogeneity will be performed. Following the publication of this protocol, searches will be run and included studies will be deeply analyzed. We hope to obtain final results in the next few months and have the final paper published by the end of 2018. This study was funded

  19. Simulation-Based Educational Module Improves Intern and Medical Student Performance of Closed Reduction and Percutaneous Pinning of Pediatric Supracondylar Humeral Fractures.

    Science.gov (United States)

    Butler, Bennet A; Lawton, Cort D; Burgess, Jamie; Balderama, Earvin S; Barsness, Katherine A; Sarwark, John F

    2017-12-06

    Simulation-based education has been integrated into many orthopaedic residency programs to augment traditional teaching models. Here we describe the development and implementation of a combined didactic and simulation-based course for teaching medical students and interns how to properly perform a closed reduction and percutaneous pinning of a pediatric supracondylar humeral fracture. Subjects included in the study were either orthopaedic surgery interns or subinterns at our institution. Subjects all completed a combined didactic and simulation-based course on pediatric supracondylar humeral fractures. The first part of this course was an electronic (e)-learning module that the subjects could complete at home in approximately 40 minutes. The second part of the course was a 20-minute simulation-based skills learning session completed in the simulation center. Subject knowledge of closed reduction and percutaneous pinning of supracondylar humeral fractures was tested using a 30-question, multiple-choice, written test. Surgical skills were tested in the operating room or in a simulated operating room. Subject pre-intervention and post-intervention scores were compared to determine if and how much they had improved. A total of 21 subjects were tested. These subjects significantly improved their scores on both the written, multiple-choice test and skills test after completing the combined didactic and simulation module. Prior to the module, intern and subintern multiple-choice test scores were significantly worse than postgraduate year (PGY)-2 to PGY-5 resident scores (p < 0.01); after completion of the module, there was no significant difference in the multiple-choice test scores. After completing the module, there was no significant difference in skills test scores between interns and PGY-2 to PGY-5 residents. Both tests were validated using the scores obtained from PGY-2 to PGY-5 residents. Our combined didactic and simulation course significantly improved intern and

  20. FUNCTIONAL OUTCOME OF SUPRACONDYLAR FRACTURES OF FEMUR MANAGED BY OPEN REDUCTION AND INTERNAL FIXATION WITH LOCKING COMPRESSION PLATE

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    Madhusudhana

    2015-10-01

    Full Text Available INTRODUCTION : Incidence of distal femur fractures is approximately 37 per 1 , 00,000 person - years.¹Distal femoral fractures has two different injury mechanisms, high energy trauma and low energy trauma. In high - energy trauma, the problem of restoring the function in a destroyed knee joint persists. Complex knee ligament injuries frequently occur additionally to extensive cartilage injuries. In elderly patients, extreme osteoporosis represents a particular problem for anchoring the implant. 2 Supracondylar and inter condylar fractures often are unstable and comminuted and tend to occur in the elderly or those with multiple injuries. Treatment options are many with varied results. The final outcome would depend upon the type of fracture, stabilization of fixation and and perhaps patient general condition. 3 The options for operative treatment are traditional plating techniques that require compression of the implant to the femoral shaft (blade plate, Dynamic Condylar Screw, non - locking condylar buttress plate, antegrade nailing fixation, retrograde nailing, sub muscular locked internal fixation and external fixation. 4 However, as the complexity of fractures needing treatment has changed from simple extra - articular supra - condylar types to inter - condylar and metaphyseal comminuted types, these implants may not be ideal. Double plating, and more recently, locked plating techniques have been advocated 5 . However with double plating there is often extensive soft tissue stripping on both sides of the femur, resulting in reduced blood supply and potential non - union and failure of the implants 6 . The LCP is a single beam construct where the strength of its fixation is equal to the sum of all screw - bone interfaces rather than a single screw’s axial stiffness or pullout resistance as seen in unlocked plates 7,8 . Its unique biomechanical function is based on splinting rather than compression resulting in flexible stabilization

  1. Fraturas supracondilares tipo III do úmero em crianças: tratamento com braço reto Type III supracondylar fractures of the humerus in children: straight-arm treatment

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    Jamish Gandhi

    2010-01-01

    Full Text Available INTRODUÇÃO: As fraturas supracondilares de Gartland tipo III são as lesões comuns em crianças. Apresentamos um método de redução manipulativa, imobilização e fixação usando gesso-de-Paris, com o cotovelo em extensão total (braço reto. MÉTODO: Estudo retrospectivo analisando todos os pacientes com fraturas supracondilares de Gartland tipo III no Wellington Public Hospital, durante o período de fevereiro de 1999 a março de 2007. Os sete pacientes foram tratados pela técnica do braço reto, e os desfechos clínicos foram revisados neste estudo. RESULTADO: Todos os pais ficaram satisfeitos com os resultados. Usando os critérios de Flynn,6 seis pacientes atingiram excelentes resultados e um teve resultado bom quando se analisou o ângulo de alinhamento. Ao verificar a amplitude de movimento, quatro pacientes tiveram resultados bons, um moderado e dois, ruim. CONCLUSÃO: O tratamento com braço reto das fraturas supracondilares de Gartland tipo III parece ser uma alternativa não-invasiva e segura da fixação com fio K.OBJECTIVE: Gartland type III supracondylar fractures are a common injury in children. We present a method of manipulative reduction, immobilization and fixation using Plaster of Paris with the elbow in full extension (straight-arm. METHOD: Retrospective study analyzing all patients with Gartland type III supracondylar fractures at the Wellington Public Hospital during the period from February 1999 to March 2007. The seven patients had been treated with the straight-arm technique, and the clinical outcomes are reviewed in this study. RESULT: All the parents were satisfied with the results. Using the Flynn criteria6, six patients achieved excellent results and one good, in relation to the carrying angle. With regard to the range of motion, four patients had good results, one fair, and two poor. CONCLUSION: Straight-arm treatment of Gartland type III supracondylar fractures appears to be a non-invasive and safe

  2. Comparison between a multicentre, collaborative, closed-loop audit assessing management of supracondylar fractures and the British Orthopaedic Association Standard for Trauma 11 (BOAST 11) guidelines.

    Science.gov (United States)

    Goodall, R; Claireaux, H; Hill, J; Wilson, E; Monsell, F; Boast Collaborative; Tarassoli, P

    2018-03-01

    Aims Supracondylar fractures are the most frequently occurring paediatric fractures about the elbow and may be associated with a neurovascular injury. The British Orthopaedic Association Standards for Trauma 11 (BOAST 11) guidelines describe best practice for supracondylar fracture management. This study aimed to assess whether emergency departments in the United Kingdom adhere to BOAST 11 standard 1: a documented assessment, performed on presentation, must include the status of the radial pulse, digital capillary refill time, and the individual function of the radial, median (including the anterior interosseous), and ulnar nerves. Materials and Methods Stage 1: We conducted a multicentre, retrospective audit of adherence to BOAST 11 standard 1. Data were collected from eight hospitals in the United Kingdom. A total of 433 children with Gartland type 2 or 3 supracondylar fractures were eligible for inclusion. A centrally created data collection sheet was used to guide objective analysis of whether BOAST 11 standard 1 was adhered to. Stage 2: We created a quality improvement proforma for use in emergency departments. This was piloted in one of the hospitals used in the primary audit and was re-audited using equivalent methodology. In all, 102 patients presenting between January 2016 and July 2017 were eligible for inclusion in the re-audit. Results Stage 1: Of 433 patient notes audited, adherence to BOAST 11 standard 1 was between 201 (46%) and 232 (54%) for the motor and sensory function of the individual nerves specified, 318 (73%) for radial pulse, and 247 (57%) for digital capillary refill time. Stage 2: Of 102 patient notes audited, adherence to BOAST 11 standard 1 improved to between 72 (71%) and 80 (78%) for motor and sensory function of the nerves, to 84 (82%) for radial pulse, and to 82 (80%) for digital capillary refill time. Of the 102 case notes reviewed in stage 2, only 44 (43%) used the quality improvement proforma; when the proforma was used

  3. Comparative endurance testing of the Biomet Matthews Nail and the Dynamic Compression Screw, in simulated condylar and supracondylar femoral fractures

    Directory of Open Access Journals (Sweden)

    Davies Benjamin M

    2008-01-01

    Full Text Available Abstract Background The dynamic compression screw is a plate and screws implant used to treat fractures of the distal femur. The Biomet Matthews Nail is a new retrograde intramedullary nail designed as an alternative surgical option to treat these fractures. The objective of this study was to assess the comparative endurance of both devices. Method The dynamic compression screw (DCS and Biomet Matthews Nail (BMN were implanted into composite femurs, which were subsequently cyclically loaded using a materials testing machine. Simulated fractures were applied to each femur prior to the application of load. Either a Y type fracture or a transverse osteotomy was prepared on each composite femur using a jig to enable consistent positioning of cuts. Results The Biomet Matthews Nail demonstrated a greater endurance limit load over the dynamic compression screw in both fracture configurations. Conclusion The distal locking screws pass through the Biomet Matthews Nail in a unique "cruciate" orientation. This allows for greater purchase in the bone of the femoral condyle and potentially improves the stability of the fracture fixation. As these fractures are usually in weak osteoporotic bone, the Biomet Matthews Nail represents a favourable surgical option in these patients.

  4. Orthopaedic resident preparedness for closed reduction and pinning of pediatric supracondylar fractures is improved by e-learning: a multisite randomized controlled study.

    Science.gov (United States)

    Hearty, Thomas; Maizels, Max; Pring, Maya; Mazur, John; Liu, Raymond; Sarwark, John; Janicki, Joseph

    2013-09-04

    There is a need to provide more efficient surgical training methods for orthopaedic residents. E-learning could possibly increase resident surgical preparedness, confidence, and comfort for surgery. Using closed reduction and pinning of pediatric supracondylar humeral fractures as the index case, we hypothesized that e-learning could increase resident knowledge acquisition for case preparation in the operating room. An e-learning surgical training module was created on the Computer Enhanced Visual Learning platform. The module provides a detailed and focused road map of the procedure utilizing a multimedia format. A multisite prospective randomized controlled study design compared residents who used a textbook for case preparation (control group) with residents who used the same textbook plus completed the e-learning module (test group). All subjects completed a sixty-question test on the theory and methods of the case. After completion of the test, the control group then completed the module as well. All subjects were surveyed on their opinion regarding the effectiveness of the module after performing an actual surgical case. Twenty-eight subjects with no previous experience in this surgery were enrolled at four academic centers. Subjects were randomized into two equal groups. The test group scored significantly better (p < 0.001) and demonstrated competence on the test compared with the control group; the mean correct test score (and standard deviation) was 90.9% ± 6.8% for the test group and 73.5% ± 6.4% for the control group. All residents surveyed (n = 27) agreed that the module is a useful supplement to traditional methods for case preparation and twenty-two of twenty-seven residents agreed that it reduced their anxiety during the case and improved their attention to surgical detail. E-learning using the Computer Enhanced Visual Learning platform significantly improved preparedness, confidence, and comfort with percutaneous closed reduction and pinning of a

  5. Ipsilateral Femoral Fracture Non-Union and Delayed Union Treated By Hybrid Plate Nail Fixation and Vascularized Fibula Bone Grafting: A Case Report

    Directory of Open Access Journals (Sweden)

    CK Chan

    2013-07-01

    Full Text Available Non-union is a well recognized complication of femoral neck fractures. The decision whether to attempt fracture fixation or to resort to hip replacement is particularly difficult in patients in the borderline age group in whom complex attempts at gaining union may fail and later present a difficult revision. On the other hand the patient may be young enough that arthroplasty best be avoided . Besides, presence of ipsilateral femoral shaft fracture with delayed union in addition to the femoral neck non-union will pose major problems at operation. We share our experience in treating a femoral neck fracture non-union with ipsilateral femoral shaft delayed union in the shaft and in the distal femur in a fifty years old patient. The fracture was treated with an angle blade plate and supracondylar nail supplemented with a free vascularised fibular bone grafting and autologous cancellous graft. There was radiological union at fourth month. At sixth months, the patient was free of pain and able to walk without support. Thus, we would like to suggest that vascularised fibula bone grafting with supracondylar nailing is a viable option for this pattern of fracture.

  6. "Floating arm" injury in a child with fractures of the proximal and distal parts of the humerus: a case report

    Directory of Open Access Journals (Sweden)

    Güven Melih

    2009-09-01

    Full Text Available Abstract Introduction Simultaneous supracondylar humerus fracture and ipsilateral fracture of the proximal humerus in children is rare. Case presentation A 10-year-old Turkish boy with an extension type supracondylar humerus fracture and ipsilateral fracture at the proximal metaphyseal-diaphyseal junction of the humerus was treated by closed reduction and percutaneous Kirschner wire fixation. Closed reduction was performed using a Kirschner wire as a "joystick" to manipulate the humeral shaft after some swelling occurred around the elbow and shoulder. Conclusion The combination of fractures at the proximal and distal parts of the humerus can be termed as "floating arm" injury. Initial treatment of this unusual injury should be focused on the supracondylar humerus fracture. However, closed reduction can be difficult to perform with the swelling around the elbow and shoulder. A temporary Kirschner wire can be used as a "joystick" to fix and reduce the fracture.

  7. Fratura supracondiliana de úmero em crianças: fixação com dois fios de Kirschner cruzados Supracondylar fracture of the humerus in children: fixation with two crossed Kirschner wires

    Directory of Open Access Journals (Sweden)

    Roni Azevedo Carvalho

    2012-01-01

    Full Text Available OBJETIVO: Analisar e apresentar os resultados de fraturas supracondilianas instáveis de úmero em crianças, tratadas cirurgicamente com redução e fixação percutânea com dois fios de Kirschner cruzados. MÉTODOS: Foi realizado estudo transversal com 20 crianças, considerando sexo, idade na época da fratura e no momento da análise, lateralidade, tipo e mecanismo de fratura, complicações pós-operatórias, variáveis radiográficas e clínicas. RESULTADOS: Observaram-se 10 fraturas à esquerda e 10 à direita. A idade na fratura variou de dois a 13 anos (média 5,9 anos ± 2,48. Três fraturas foram classificadas como tipo II e 17 do tipo III. O tempo de seguimento variou de quatro meses a três anos. O ângulo de Baumann variou de 69 a 100 (média 78,3, sendo observada a presença de cúbito varo em quatro pacientes (com valores variando de 84 a 100. Segundo os critérios de Flynn modificados, obtiveram-se 20 casos satisfatórios, 17 excelentes (85%, dois bons (10% e um regular (5%. Dois pacientes apresentaram déficit da amplitude de movimento, dois parestesia no território cubital e uma criança apresentou neuropraxia transitória do nervo ulnar por seis semanas. CONCLUSÃO: A fixação percutânea com dois fios de Kirschner cruzados, quando realizada com visualização direta e isolamento do nervo ulnar, permite bons resultados.OBJECTIVE: To analyze and present the surgical results from unstable supracondylar fractures of the humerus in children, treated by means of reduction and percutaneous fixation using two crossed Kirschner wires. METHODS: A cross-sectional study was conducted on 20 children, taking into consideration sex, age at the time of the fracture, age at the time of the assessment, side affected, type and mechanism of trauma, postoperative complications and radiographic and clinic variables. RESULTS: Ten fractures were observed in the left arm and ten in the right arm. The age at the time of the fracture ranged from 2

  8. Fratura supracondiliana do fêmur durante salto após reconstrução artroscópica do ligamento cruzado anterior Supracondylar emur fracture during jump after anterior cruciate ligament arthroscopic reconstruction

    Directory of Open Access Journals (Sweden)

    Thiago Yukio Fukuda

    2009-04-01

    with the established protocol. The patient presented good control and sensory-motor stability when he suffered a supracondylar femur fracture. This fracture occurred during a jump in the physical therapy treatment. The ligament reconstruction was done with the tendon graft of the knee flexors muscles, and the fracture caused later, was reduced and stabilized with plate and screw. Ten months after open reduction and internal fixation of the fracture, the patient showed regular function in the Lysholm scale, normal range of movement and muscular force grade V for knee flexors and extensors. DISCUSSION: Few case reports similar to the present one were found in the literature. The majority presented femur fracture after ACL reconstruction with patellar tendon. The present case shows significance by the association between supracondylar femur fracture with ligament reconstruction with flexors tendon, since only one case followed this direction. Two of the possible causes of this fracture are bone fragility for disuse and femoral tunnel bone bigger than the normal, despite not being a consensus. A hypothesis suggested by the authors of this paper is that the bone tunnel of graft fixation could have been a stress booster to the site of the fracture.

  9. Avulsion Fracture: How Is It Treated?

    Science.gov (United States)

    ... way to treat an avulsion fracture in a young athlete? Answers from Edward R. Laskowski, M.D. ... Clinic does not endorse any of the third party products and services advertised. Advertising and sponsorship policy ...

  10. Trochanteric Stress Fracture in a Female Window Cleaner

    OpenAIRE

    Lee, Bong-Jin; Song, Jyewon

    2016-01-01

    Stress fractures may occur at various sites in the femur including the head, neck, shaft, supracondylar and condylar regions. To the best of our knowledge, stress fracture occurring in the trochanteric region has not been previously reported. We report here a case of trochanteric stress fracture in a 53-year-old female window cleaner treated with hip nailing without adverse consequences. Careful consideration of this entity is needed when evaluating patients who have repetitive jumping up and...

  11. Advances in treating exposed fractures.

    Science.gov (United States)

    Nogueira Giglio, Pedro; Fogaça Cristante, Alexandre; Ricardo Pécora, José; Partezani Helito, Camilo; Lei Munhoz Lima, Ana Lucia; Dos Santos Silva, Jorge

    2015-01-01

    The management of exposed fractures has been discussed since ancient times and remains of great interest to present-day orthopedics and traumatology. These injuries are still a challenge. Infection and nonunion are feared complications. Aspects of the diagnosis, classification and initial management are discussed here. Early administration of antibiotics, surgical cleaning and meticulous debridement are essential. The systemic conditions of patients with multiple trauma and the local conditions of the limb affected need to be taken into consideration. Early skeletal stabilization is necessary. Definitive fixation should be considered when possible and provisional fixation methods should be used when necessary. Early closure should be the aim, and flaps can be used for this purpose.

  12. Displaced tibial shaft fractures treated with ASIF compression internal fixation

    DEFF Research Database (Denmark)

    Gebuhr, Peter Henrik; Larsen, T K; Petersen, O C

    1990-01-01

    Fifty-one tibial shaft fractures treated by ASIF compression osteosynthesis were seen at follow-up at a median time of 46 weeks after injury. Twenty-four were open fractures and the patients received prophylactic antibiotics. The median stay in hospital was 15 days for open fractures and 6 days f...... for closed fractures. There were complications in 26 cases, with deep infection in 9 cases. At present we cannot advocate the use of ASIF compression osteosynthesis for displaced tibial fractures....

  13. Displaced tibial shaft fractures treated with ASIF compression internal fixation

    DEFF Research Database (Denmark)

    Gebuhr, Peter Henrik; Larsen, T K; Petersen, O C

    1990-01-01

    Fifty-one tibial shaft fractures treated by ASIF compression osteosynthesis were seen at follow-up at a median time of 46 weeks after injury. Twenty-four were open fractures and the patients received prophylactic antibiotics. The median stay in hospital was 15 days for open fractures and 6 days f...

  14. Basic principles of fracture treatment in children.

    Science.gov (United States)

    Ömeroğlu, Hakan

    2018-04-01

    This review aims to summarize the basic treatment principles of fractures according to their types and general management principles of special conditions including physeal fractures, multiple fractures, open fractures, and pathologic fractures in children. Definition of the fracture is needed for better understanding the injury mechanism, planning a proper treatment strategy, and estimating the prognosis. As the healing process is less complicated, remodeling capacity is higher and non-union is rare, the fractures in children are commonly treated by non-surgical methods. Surgical treatment is preferred in children with multiple injuries, in open fractures, in some pathologic fractures, in fractures with coexisting vascular injuries, in fractures which have a history of failed initial conservative treatment and in fractures in which the conservative treatment has no/little value such as femur neck fractures, some physeal fractures, displaced extension and flexion type humerus supracondylar fractures, displaced humerus lateral condyle fractures, femur, tibia and forearm shaft fractures in older children and adolescents and unstable pelvis and acetabulum fractures. Most of the fractures in children can successfully be treated by non-surgical methods.

  15. Fractures of the Distal Tibia Treated with Polyaxial Locking Plating

    OpenAIRE

    Gao, Hong; Zhang, Chang-Qing; Luo, Cong-Feng; Zhou, Zu-Bin; Zeng, Bing-Fang

    2008-01-01

    We evaluated the healing rate, complications, and functional outcomes in 32 adult patients with very short metaphyseal fragments in fractures of the distal tibia treated with a polyaxial locking system. The average distance from the distal extent of the fracture to the tibial plafond was 11 mm. All fractures healed and the average time to union was 14 weeks. Six patients (19%) reported occasional local disturbance over the medial malleolus. There were two cases of postoperative superficial in...

  16. ediatric femoral shaft fractures treated by flexible intramedullary nailing.

    Science.gov (United States)

    Kapil Mani, K C; Dirgha Raj, R C; Parimal, Acharya

    2015-01-01

    Nowadays pediatric femoral fractures are more commonly managed with operative treatment rather than conservative treatment because of more rapid recovery and avoidance of prolonged immobilization. Children between the ages of 5-13 years are treated either by traction plus hip spica and flexible/elastic stable retrograde intramedullary nail, or external fixators in the case of open fractures. The aim of this study is to evaluate the outcome of pediatric femoral shaft fractures treated by stainless steel flexible intramedullary nail in children between 5 and 13 years of age. There were 32 cases of femoral shaft fractures which were all fixed with stainless steel flexible intramedullary nail under fluoroscopy. Long leg cast was applied at the time of fixation. Partial weight bearing was started 2 weeks after surgery. Patients were evaluated in follow-up study to observe the alignment of fracture, infection, delayed union, nonunion, limb length discrepancy, motion of knee joint, and time to unite the fracture. We were able to follow up 28 out of 32 patients. The patients were 8.14 years of age on average. The mean hospital stay after operation was 4 days and fracture union time was 9.57 weeks. There were 3 cases of varus angulation, 2 cases of anterior angulation, and 4 cases of limb lengthening. Patients aged between 5 and 13 years treated with flexible intramedullary nail for closed femoral shaft fracture have rapid union and recovery, short rehabilitation period, less immobilization and psychological impact, and cost-effective.

  17. OUTCOME OF INTERTROCHANTERIC FRACTURES TREATED WITH SHORT FEMORAL NAIL

    Directory of Open Access Journals (Sweden)

    Yadkikar Shriniwas V, Yadkikar Vishnu S, Patel Mayank, Dhruvilkumar Gandhi, Kunkulol Rahul

    2015-07-01

    Full Text Available Aim: To study the functional and anatomical outcome of Inter trochanteric fractures of femur treated with Short femoral nail. Method: This was retrospective study carried out in which 60 patients (50 Male & 10 Female of 5th to 8th decade of life who underwent Short femoral nail fixation for both Stable & unstable Inter Trochanteric fractures. From the records each patient data was assessed for time required for mobilization, average fracture healing time, degree and grade of hip range of movements, complications, anatomical reduction achieved using Short femoral nail fixation. Results: 55 cases achieved Anatomical reduction. Good to Excellent Hip range of Motion was in 55 (90 % cases. Fracture union was seen in all cases. No evidence of Z Effect, AVN of femoral head, Implant failure, Fracture of femoral shaft below the Nail tip was seen in any case, However Reverse Z Effect was seen in 4 & shortening of less than 2 cm was seen in 2 cases, External rotation of 10 degree was seen in1 case. Average fracture Union time was 14 weeks. Conclusion: Short femoral nail appears to be better implant for fixation of both Stable & unstable Inter Trochanteric fractures as it fulfills the biomechanical demands being minimally invasive, less blood loss , it prevents excessive varus collapse at fracture site, produces less stress riser effect below the nail tip, Short operative time, Facilitates early mobilization & functional recovery of patients. But Anatomical fracture reduction & optimal implant placement are absolutely must for better results.

  18. Pediatric mandibular fractures treated by rigid internal fixation.

    Science.gov (United States)

    Wong, G B

    1993-09-01

    Mandibular fractures in the pediatric patient population are relatively uncommon. These patients present with their own unique treatment requirements. Most fractures have been treated conservatively by dental splints. Closed reduction techniques with maxillomandibular fixation (MMF) in very young children can pose several concerns, including cooperation, compliance and adequate nutritional intake. Rigid internal fixation of unstable mandibular fractures using miniplates and screws circumvents the need for MMF and allows immediate jaw mobilization. At major pediatric trauma institutions, there has been an increasing trend toward the use of this treatment when open reduction is necessary. This article presents a report of a five-year-old child who presented with bilateral mandibular fractures and was treated by rigid internal fixation and immediate mandibular mobilization.

  19. Direct and indirect costs of surgically treated pelvic fractures.

    Science.gov (United States)

    Aprato, Alessandro; Joeris, Alexander; Tosto, Ferdinando; Kalampoki, Vasiliki; Stucchi, Alessandro; Massè, Alessandro

    2016-03-01

    Pelvic fractures requiring surgical fixation are rare injuries but present a great societal impact in terms of disability, as well as economic resources. In the literature, there is no description of these costs. Main aim of this study is to describe the direct and indirect costs of these fractures. Secondary aims were to test if the type of fracture (pelvic ring injury or acetabular fracture) influences these costs (hospitalization, consultation, medication, physiotherapy sessions, job absenteeism). We performed a retrospective study on patients with surgically treated acetabular fractures or pelvic ring injuries. Medical records were reviewed in terms of demographic data, follow-up, diagnosis (according to Letournel and Tile classifications for acetabular and pelvic fractures, respectively) and type of surgical treatment. Patients were interviewed about hospitalization length, consultations after discharge, medications, physiotherapy sessions and absenteeism. The study comprised 203 patients, with a mean age of 49.1 ± 15.6 years, who had undergone surgery for an acetabular fracture or pelvic ring injury. The median treatment costs were 29.425 Euros per patient. Sixty percent of the total costs were attributed to health-related work absence. Median costs (in Euros) were 2.767 for hospitalization from trauma to definitive surgery, 4.530 for surgery, 3.018 for hospitalization in the surgical unit, 1.693 for hospitalization in the rehabilitation unit, 1.920 for physiotherapy after discharge and 402 for consultations after discharge. Total costs for treating pelvic ring injuries were higher than for acetabular fractures, mainly due to the significant higher costs of pelvic injuries regarding hospitalization from trauma to definitive surgery (p fractures are associated with both high direct costs and substantial productivity loss.

  20. Fractures of the distal tibia treated with polyaxial locking plating.

    Science.gov (United States)

    Gao, Hong; Zhang, Chang-Qing; Luo, Cong-Feng; Zhou, Zu-Bin; Zeng, Bing-Fang

    2009-03-01

    We evaluated the healing rate, complications, and functional outcomes in 32 adult patients with very short metaphyseal fragments in fractures of the distal tibia treated with a polyaxial locking system. The average distance from the distal extent of the fracture to the tibial plafond was 11 mm. All fractures healed and the average time to union was 14 weeks. Six patients (19%) reported occasional local disturbance over the medial malleolus. There were two cases of postoperative superficial infections and evidence of delayed wound healing. Using the American Orthopaedic Foot and Ankle Society ankle score, the average functional score was 87.3 points (of 100 total possible points). Our results show the polyaxial locking plates, which offer more fixation versatility, may be a reasonable treatment option for distal tibia fractures with very short metaphyseal segments.

  1. Stress Fractures of Tibia Treated with Ilizarov External Fixator.

    Science.gov (United States)

    Górski, Radosław; Żarek, Sławomir; Modzelewski, Piotr; Górski, Ryszard; Małdyk, Paweł

    2016-08-30

    Stress fractures are the result of cyclic loading of the bone, which gradually becomes damaged. Most often they are treated by rest or plaster cast and, in rare cases, by internal fixation. There is little published data on initial reposition followed by stabilization with the Ilizarov apparatus in such fractures. Six patients were treated with an external fixator according to the Ilizarov method for a stress fracture of the tibia between 2007 and 2015. Three patients were initially treated conservatively. Due to increasing tibial deformation, they were qualified for surgical treatment with external stabilization. In the other patients, surgery was the first-line treatment. All patients demonstrated risk factors for a stress fracture. After the surgery, they fully loaded the operated limb. No patient developed malunion, nonunion, infection or venous thrombosis. The average time from the first operation to the removal of the external fixator was 19 weeks. Radiographic and clinical outcomes were satisfactory in all patients. 1. The Ilizarov method allows for successful stabilization of stress fractures of the tibia. 2. It may be a good alternative to internal stabilization, especially in patients with multiple comorbidities which affect bone quality and may impair soft tissue healing.

  2. Outcomes of nonoperatively treated displaced scapular body fractures.

    Science.gov (United States)

    Dimitroulias, Apostolos; Molinero, Kenneth G; Krenk, Daniel E; Muffly, Matthew T; Altman, Daniel T; Altman, Gregory T

    2011-05-01

    Displaced scapular body fractures most commonly are treated conservatively. However there is conflicting evidence in the literature regarding the outcomes owing to retrospective design of studies, different classification systems, and diverse outcome tools. The functional outcome after nonoperative management of displaced scapular body fractures was assessed by change in the DASH (Disability of Arm, Shoulder and Hand) score; (2) the radiographic outcome was assessed by the change of the glenopolar angle (GPA); and (3) associated scapular and extrascapular injuries that may affect outcome were identified. Forty-nine consecutive patients were treated with early passive and active ROM exercises for a displaced scapular body fracture. We followed 32 of these patients (65.3%) for a minimum of 6 months (mean, 15 months; range, 6-33 months). Mean age of the patients was 46.9 years (range, 21-84 years) and the mean Injury Severity Score (ISS) was 21.5 (range, 5-50). Subjective functional results (DASH score) and radiographic assessment (fracture union, glenopolar angle) were measured. All fractures healed uneventfully. The mean change of glenopolar angle was 9° (range, 0°-20°). The mean change of the DASH score was 10.2, which is a change with minimal clinical importance. There was a correlation between the change in this score with the ISS and presence of rib fractures. Satisfactory outcomes are reported with nonoperative treatment of displaced scapular body fractures. We have shown that the severity of ISS and the presence of rib fractures adversely affect the clinical outcome.

  3. Application of biodegradable plates for treating pediatric mandibular fractures.

    Science.gov (United States)

    An, Jingang; Jia, Pengcheng; Zhang, Yi; Gong, Xi; Han, Xiaodong; He, Yang

    2015-05-01

    We assessed the clinical results of a biodegradable plate system for the internal fixation of mandibular fractures in children, and observed the imaging features of fracture healing and bone changes around the biodegradable plates and screws during follow-up. We enrolled 39 patients (22 male, 17 female, average age 4 years 10 months) with different mandibular fractures. We used 2.0-mm resorbable plates to repair the fractures. Postoperative follow-up ranged from 6 months to 5 years; average follow-up was 1 year 2 months. The outcome measures identified and assessed included facial symmetry, mouth opening, occlusal relationship, infection, nonunion, malunion, and plate dehiscence. We fixed 42 fractures with 43 resorbable plates; the fracture site of one patient (aged 11 years 3 months) was fixed with two plates. Two patients developed small fistulas at the intraoral incision 2 months after surgery; the fistulas healed after 1 month without special treatment. In the other patients, the incision healed well, there was facial symmetry, mouth opening was >35 mm, and occlusion was good. Follow-up computed tomography examination data were available for 20 cases, and revealed different degrees of radiolucency indicating that osteolysis had occurred. Radiolucency was observed around the resorbable plates 1 month after the surgery. The extent and depth of the radiolucent region were obvious within 1 year of surgery. In the second year, there were obvious repairs, with the bony defect areas becoming shallower. After 2 years, the bony defect areas had almost disappeared. Biodegradable fixation devices are safe and efficient for treating pediatric mandibular fractures. Osteolysis commonly follows biodegradable fixation of pediatric mandibular fractures, and has no adverse effect on fracture healing. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  4. Vertebral fractures in patients with rheumatoid arthritis treated with corticosteroids

    NARCIS (Netherlands)

    Lems, W. F.; Jahangier, Z. N.; Jacobs, J. W.; Bijlsma, J. W.

    1995-01-01

    To examine the relationship between roentgenological deformities of the vertebral column and clinical manifestations of vertebral fractures in patients with RA, treated with glucocorticosteroids (Cs). In all outpatients of Utrecht University Hospital with RA, who were currently using Cs (n = 52),

  5. Applying Bioaugmentation to Treat DNAPL Sources in Fractured Rock

    Science.gov (United States)

    2017-03-27

    Figure 1. This ESTCP demonstration was focused in the vicinity of Building 8595, adjacent to the location of a reported surface release of PCE ( Earth ...electron donor source, such as vegetable oil, is typically used in passive approaches. When treating a DNAPL source area in fractured rock, there are... vegetable oil) are used. Hydrogen The generation of hydrogen can be used to verify fermentation of electron donor. Metals (Fe, Mn, As) Increase

  6. Outcomes of Distal Femur Fracture Treated with Dynamic Condylar Screw

    International Nuclear Information System (INIS)

    Razaq, M. N. U.; Muhammad, T.; Ahmed, A.; Adeel, M.; Ahmad, S.; Ahmad, S.; Sultan, S.

    2016-01-01

    Background: Implants for open reduction and internal fixation of distal femoral fracture includes angle blade plate, rush nails, enders nail and interlocking nails. But all these devices are technically demanding and less effective in providing inter-fragmentary compression in osteoporotic bones. These problems can be solved with dynamic condylar screw (DCS).The objective of the study was to determine the frequency of different outcomes of distal femoral fracture treated with dynamic condylar screw Methods: This case series study was carried out in the Department of Trauma and Orthopaedics, Ayub Teaching Hospital Abbottabad from 1st October 2014 to August 2015, after approval of the ethical committee of the institution. Data of all patients with distal femoral fractures aged 20-70 years, recruited through emergency, OPD or consultant clinic collected on a proforma. Standard treatment of trauma was given to the patients. Detailed history was taken including the past medical and surgical history. Detailed examination including air-way, breathing and circulation, general physical examination and abdomino-pelvic examination was done in each patient. Investigations including urinalysis, haemoglobin percent, full blood count, X-ray (both AP and lateral view) of the involved femur (including hip and knee) was done. Results: Mean age of the patients was 43.18±14.647 ranging from 20 to 70 years. Mean duration of hospital stay in days was 2.21±1.111 ranging from 1 to 6 days. Patients follow-up assessment after 4 months of surgery for union of femoral fracture treated with dynamic condylar screw was found in 96 (94.1 percent), wound infection was found in 7 (6.9 percent), knee stiffness was found in 21 (20.6 percent) and limb shortening was found in 7 (6.9 percent). Conclusion: Dynamic condylar screw is an easy, scientifically less difficult and satisfying method of treatment for fractures of femur. (author)

  7. Enhanced chondrogenesis and Wnt signaling in PTH-treated fractures.

    Science.gov (United States)

    Kakar, Sanjeev; Einhorn, Thomas A; Vora, Siddharth; Miara, Lincoln J; Hon, Gregory; Wigner, Nathan A; Toben, Daniel; Jacobsen, Kimberly A; Al-Sebaei, Maisa O; Song, Michael; Trackman, Philip C; Morgan, Elise F; Gerstenfeld, Louis C; Barnes, George L

    2007-12-01

    Studies have shown that systemic PTH treatment enhanced the rate of bone repair in rodent models. However, the mechanisms through which PTH affects bone repair have not been elucidated. In these studies we show that PTH primarily enhanced the earliest stages of endochondral bone repair by increasing chondrocyte recruitment and rate of differentiation. In coordination with these cellular events, we observed an increased level of canonical Wnt-signaling in PTH-treated bones at multiple time-points across the time-course of fracture repair, supporting the conclusion that PTH responses are at least in part mediated through Wnt signaling. Since FDA approval of PTH [PTH(1-34); Forteo] as a treatment for osteoporosis, there has been interest in its use in other musculoskeletal conditions. Fracture repair is one area in which PTH may have a significant clinical impact. Multiple animal studies have shown that systemic PTH treatment of healing fractures increased both callus volume and return of mechanical competence in models of fracture healing. Whereas the potential for PTH has been established, the mechanism(s) by which PTH produces these effects remain elusive. Closed femoral fractures were generated in 8-wk-old male C57Bl/6 mice followed by daily systemic injections of either saline (control) or 30 microg/kg PTH(1-34) for 14 days after fracture. Bones were harvested at days 2, 3, 5, 7, 10, 14, 21, and 28 after fracture and analyzed at the tissue level by radiography and histomorphometry and at the molecular and biochemical levels level by RNase protection assay (RPA), real-time PCR, and Western blot analysis. Quantitative muCT analysis showed that PTH treatment induced a larger callus cross-sectional area, length, and total volume compared with controls. Molecular analysis of the expression of extracellular matrix genes associated with chondrogenesis and osteogenesis showed that PTH treated fractures displayed a 3-fold greater increase in chondrogenesis relative to

  8. Treatment outcomes of intertrochanteric femur fractures treated with DLT™ nail

    Directory of Open Access Journals (Sweden)

    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.

  9. Outcomes of The Isolated Closed Tibial Shaft Fractures Treated Nonsurgically

    Directory of Open Access Journals (Sweden)

    Dawood Jafari

    2011-05-01

    Full Text Available Background: Fractures of the tibia are important for their commonness and controversy in their management. Both conservative and surgical techniques have been introduced in an effort to speed time to union while minimizing the occurrence of complications. Standard treatment for low-energy tibial shaft fractures includes closed reduction and cast immobilization.The purpose of our study was to analyze retention of reduction after cast immobilization of simple isolated closed tibial fractures.Methods:All cases of the diagnosed isolated closed tibial shaft fracture treated non-surgically at Shafa Yahyaeian Hospital, between 2006 and 2009 were retrieved from medical records. We reviewed all medical records and radiographs of these patients to inquire about the patients’ demographic data used to analyze the outcomes of the non-surgical treatment.Results:Of the 26 patients examined, males were more commonly affected. The mean age was 27.46   (SD=7.58.The most common causes of injury were direct blow and motorcycle to pedestrian accident. Followup duration for each patient had an average of 9.12 months (SD=2.36. Using AO/OTA classification, distributed as 38.5% A1.1, 26.9% A2.1 and 34.6% A3.1 fractures. Most fractures were sustained in the lower third of the tibia (53.85%. All fractures eventually healed in an average of 13.7 weeks (SD=3.24. There was one case of delayed union in the 22nd week. In 92.3% of patients, shortening of bone was less than 1 cm, while in 7.7% patients, was more than 1.5 cm. We observed an anterior or posterior angulation > 10 ° in 2 (7.69% patients. Moreover, in 4 (15.38% patients we found varus angulation > 5°. Therefore, final deformity was observed in 8 (30.77% patients. No patient had non-union, rotational malalignment of more than 10 degrees, an infection, or a compartment syndrome.Conclusion : Our non-surgical treatment’s outcomes were not satisfactory, despite applying all principles for conservative treatment and

  10. Internal antecubital fold line: A new useful anatomical repair to identify the medial epicondyle and avoid iatrogenic ulnar nerve injury in patients with supracondylar fracture of the humerus Línea del pliegue antecubital interno: Un nuevo reparo anatómico útil para identificar la epitróclea y evitar lesiones iatrogénicas del nervio ulnar en pacientes con fractura supracondílea del humero

    Directory of Open Access Journals (Sweden)

    Luis José Cespedes

    2012-12-01

    Full Text Available Introduction: The supracondylar fracture of the distal humerus is the most common pediatric fracture around the elbow. The currently accepted techniques of fixation are two lateral parallel wires , crosswiring technique from the lateral side, two divergent wires laterally and two retrograde crossed wires. The retrograde crossed wires provide the best mechanical stability. Many children with this fracture have swelling around the elbow, making difficult the feeling of the anatomic landmarks for percutaneous pinning, increasing the risk of ulnar nerve injury. Objective: To evaluate the correspondence of the internal antecubital fold line with the internal epicondyle in patients with supracondylar fracture and the incidence of iatrogenic ulnar nerve injuries . Methods: We conducted a series of clinical cases. In the first group we included 56 children with supracondylar fracture Gartland type III, from August 2000 to September 2007, who underwent closed reduction and crossed retrograde nail fixation. In the second group we included 241 (481 elbows outpatients with no anatomic abnormality. We used the extension of antecubital fold line to find the internal epicondyle in both groups. Results: The prolongation of the antecubital fold line intersected the medial epicondyle in all participants of the first group. In 96.3% of the participants in the second group, the extension of antecubital fold line intersected the internal epicondyle. None patient had iatrogenic ulnar nerve injury. Conclusions: The use of the antecubital internal fold line may be useful to identify the internal epicondyle and thus avoid iatrogenic ulnar nerve injury. Salud UIS 2012; 44 (2: 9-14La fractura supracondílea del húmero distal es la más común alrededor del codo en niños. Las técnicas actualmente aceptadas de fijación son dos clavos laterales paralelos, dos clavos cruzados laterales, dos clavos laterales divergentes y dos clavos retrógrados cruzados. Los clavos retr

  11. Type III odontoid fractures: A subgroup analysis of complex, high-energy fractures treated with external immobilization

    Directory of Open Access Journals (Sweden)

    Thomas E Niemeier

    2018-01-01

    Conclusions: Complex Type III odontoid fractures are distinctly different from low-energy injuries. In the current study, 21% of patients were unsuccessfully treated nonoperatively with external immobilization and required surgery. For complex Type III fractures, we recommend initial conservative treatment, while maintaining close monitoring throughout patient recovery and fracture union.

  12. Navicular stress fractures treated with minimally invasive fixation

    Directory of Open Access Journals (Sweden)

    Korula Mani Jacob

    2013-01-01

    Early intervention with minimally invasive surgery has significantly less morbidity and a reliable early return to active sports and is therefore the best option in high-performance athletes. Materials and Methods: Nine athletes with ten stress fractures of the navicular treated at our institution between April 1991 and October 2000. The mean age of the patients was 22.8 years (range 18-50 years. All patients were treated by minimally invasive screw fixation and early weight bearing mobilization without a cast. The average followup was 7 years (range 2-11 years. Results: Seven of the nine patients returned to their pre-fracture level of sporting activity at an average of 5 months (range 3-9 months. One patient returned to full sporting activity following a delay of 2 years due to an associated tibial stress fracture and one patient had an unsatisfactory result. Long term review at an average of 7 years showed that six of these eight patients who returned to sports remained symptom free with two patients experiencing minimal intermittent discomfort after prolonged activity. Conclusions: We recommend percutaneous screw fixation as a reliable, low morbidity procedure allowing early return to full sporting activity without long term complications or recurrences.

  13. Interventions for treating proximal humeral fractures in adults.

    Science.gov (United States)

    Handoll, Helen H G; Brorson, Stig

    2015-11-11

    .Different methods of surgical management were tested in 12 trials. One trial (57 participants) comparing two types of locking plate versus a locking nail for treating two-part surgical neck fractures found some evidence of slightly better function after plate fixation but also of a higher rate of surgically-related complications. One trial (61 participants) comparing a locking plate versus minimally invasive fixation with distally inserted intramedullary K-wires found little difference between the two implants at two years. Compared with hemiarthroplasty, one trial (32 participants) found similar results with locking plate fixation in function and re-operation rates, whereas another trial (30 participants) reported all five re-operations occurred in the tension-band fixation group. One trial (62 participants) found better patient-rated (Quick DASH) and composite shoulder function scores at a minimum of two years follow-up and a lower incidence of re-operation and complications after reverse shoulder arthroplasty (RSA) compared with hemiarthroplasty.No important between-group differences were found in one trial (120 participants) comparing the deltoid-split approach versus deltopectoral approach for non-contact bridging plate fixation, and two trials (180 participants) comparing 'polyaxial' and 'monaxial' screws in locking plate fixation. One trial (68 participants) produced some preliminary evidence that tended to support the use of medial support locking screws in locking plate fixation. One trial (54 participants) found fewer adverse events, including re-operations, for the newer of two types of intramedullary nail. One trial (35 participants) found better functional results for one of two types of hemiarthroplasty. One trial (45 participants) found no important effects of tenodesis of the long head of the biceps for people undergoing hemiarthroplasty.Very limited evidence suggested similar outcomes from early versus later mobilisation after either surgical fixation (one trial

  14. A Removable Long-arm Soft Cast to Treat Nondisplaced Pediatric Elbow Fractures: A Randomized, Controlled Trial.

    Science.gov (United States)

    Silva, Mauricio; Sadlik, Gal; Avoian, Tigran; Ebramzadeh, Edward

    2018-04-01

    The ideal type of immobilization for nondisplaced pediatric elbow fractures has not been established. We hypothesized that the use of a long-arm cylinder made of soft cast material will result in similar outcomes to those obtained with a traditional long-arm hard cast. We randomly assigned 100 consecutive children who presented with a closed, nondisplaced, type I supracondylar humeral fracture or an occult, closed, acute elbow injury, to 1 of 2 groups: group A (n=50) received a long-arm, traditional fiberglass (hard) cast. Group B (n=50) received a long-arm, soft fiberglass cast. After 4 weeks, the cast was removed in group A by a member of our staff using a cast saw, and in group B by one of the patient's parents by rolling back the soft fiberglass material. We compared the amount of fracture displacement and/or angulation, recovery of range of motion, elbow pain, and patient satisfaction. There were no instances of unplanned removal of the cast by the patient or parent. No evidence of fracture displacement or angulation was seen in either group. The final carrying angle of the affected elbow was nearly identical of that of the normal, contralateral elbow in both groups (P=0.64). At the latest follow-up appointment, elbows in groups A and B had a similar mean arc of motion (156 vs. 154 degrees; P=0.45), and had achieved identical relative arc of motion of 99.6% and 99.5% of that of the normal, contralateral side, respectively (P=0.94). Main pain scores were low and comparable over the study period. All patients in both groups reported the highest rate of satisfaction at the eighth week of follow-up. The results indicate that children with nondisplaced supracondylar humeral fractures can be successfully managed with the use of a removable long-arm soft cast, maintaining fracture alignment and resulting in comparable rates of range of motion, pain, and patient satisfaction. The use of a removable immobilization that can reliably maintain fracture alignment and

  15. Interventions for treating proximal humeral fractures in adults.

    Science.gov (United States)

    Handoll, Helen H G; Ollivere, Benjamin J; Rollins, Katie E

    2012-12-12

    displaced and/or complex fractures, compared surgical versus conservative treatment. Pooled results of patient-reported functional scores at one year from three trials (153 participants) showed no statistically significant difference between the two groups (standardised mean difference -0.10, 95% CI -0.42 to 0.22; negative results favour surgery). Quality of life based on the EuroQol results scores from three trials (153 participants) showed non-statistically significant differences between the two groups at three time points up to 12 months. However, the pooled EuroQol results at two years (101 participants) from two trials run concurrently from the same centre were significantly in favour of the surgical group. There was no significant difference between the two groups in mortality (8/98 versus 5/98; RR 1.55, 95% CI 0.55 to 4.36; 4 trials). Significantly more surgical group patients had additional or secondary surgery (18/112 versus 5/111; RR 3.36, 95% CI 1.33 to 8.49; 5 trials). This is equivalent to an extra operation in one of every nine surgically treated patients.Different methods of surgical management were tested in seven small trials. One trial comparing two types of locking plate versus a locking nail for treating two-part surgical neck fractures found some evidence of better function after plate fixation but also of a higher rate of surgically-related complications. One trial comparing a locking plate versus minimally invasive fixation with distally inserted intramedullary nails found some evidence of a short-term benefit for the nailing group. Compared with hemiarthroplasty, tension-band fixation of severe injuries using wires was associated with a higher re-operation rate in one trial. Two trials found no important differences between 'polyaxial' and 'monaxial' screws combined with locking plate fixation. One trial produced some preliminary evidence that tended to support the use of medial support locking screws in locking plate fixation. One trial found

  16. Early Weightbearing After Operatively Treated Ankle Fractures: A Biomechanical Analysis.

    Science.gov (United States)

    Tan, Eric W; Sirisreetreerux, Norachart; Paez, Adrian G; Parks, Brent G; Schon, Lew C; Hasenboehler, Erik A

    2016-06-01

    No consensus exists regarding the timing of weightbearing after surgical fixation of unstable traumatic ankle fractures. We evaluated fracture displacement and timing of displacement with simulated early weightbearing in a cadaveric model. Twenty-four fresh-frozen lower extremities were assigned to Group 1, bimalleolar ankle fracture (n=6); Group 2, trimalleolar ankle fracture with unfixed small posterior malleolar fracture (n=9); or Group 3, trimalleolar ankle fracture with fixed large posterior malleolar fracture (n=9) and tested with axial compressive load at 3 Hz from 0 to 1000 N for 250 000 cycles to simulate 5 weeks of full weightbearing. Displacement was measured by differential variable reluctance transducer. The average motion at all fracture sites in all groups was significantly less than 1 mm (P fracture was 0.1±0.1 mm and 0.4±0.4 mm, respectively. Group 2 displacement of the lateral, medial, and posterior malleolar fracture was 0.6±0.4 mm, 0.5±0.4 mm, and 0.5±0.6 mm, respectively. Group 3 displacement of the lateral, medial, and posterior malleolar fracture was 0.1±0.1 mm, 0.5±0.7 mm, and 0.5±0.4 mm, respectively. The majority of displacement (64.0% to 92.3%) occurred in the first 50 000 cycles. There was no correlation between fracture displacement and bone mineral density. No significant fracture displacement, no hardware failure, and no new fractures occurred in a cadaveric model of early weightbearing in unstable ankle fracture after open reduction and internal fixation. This study supports further investigation of early weightbearing postoperative protocols after fixation of unstable ankle fractures. © The Author(s) 2016.

  17. Interventions for treating femoral shaft fractures in children and adolescents.

    Science.gov (United States)

    Madhuri, Vrisha; Dutt, Vivek; Gahukamble, Abhay D; Tharyan, Prathap

    2014-12-01

    Fractures of the femoral shaft in children are relatively uncommon but serious injuries that disrupt the lives of children and their carers and can result in significant long-term disability. Treatment involves either surgical fixation, such as intramedullary nailing or external fixation, or conservative treatment involving prolonged immobilisation, often in hospital. To assess the effects (benefits and harms) of interventions for treating femoral shaft fractures in children and adolescents. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (accessed 16 August 2013), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2013 Issue 7), MEDLINE (1946 to August Week 1 2013), EMBASE (1980 to 2012 week 9), CINAHL (16 August 2013), clinical trials registries, conference proceedings and reference lists; and contacted trial authors and experts in the field. Randomised and quasi-randomised controlled trials comparing conservative and surgical interventions for diaphyseal fractures of the femur in children under 18 years of age. Our primary outcomes were functional outcome measures, unacceptable malunion, and serious adverse events. Two authors independently screened and selected trials, assessed risk of bias and extracted data. We assessed the overall quality of the evidence for each outcome for each comparison using the GRADE approach. We pooled data using a fixed-effect model. We included 10 trials (six randomised and four quasi-randomised) involving a total of 527 children (531 fractures). All trials were at some risk of bias, including performance bias as care provider blinding was not practical, but to a differing extent. Just one trial was at low risk of selection bias. Reflecting both the risk of bias and the imprecision of findings, we judged the quality of evidence to be 'low' for most outcomes, meaning that we are unsure about the estimates of effect. Most trials failed to report on self-assessed function or when

  18. Ipsilateral proximal femur and shaft fractures treated with hip screws and a reamed retrograde intramedullary nail.

    Science.gov (United States)

    Ostrum, Robert F; Tornetta, Paul; Watson, J Tracy; Christiano, Anthony; Vafek, Emily

    2014-09-01

    Although not common, proximal femoral fractures associated with ipsilateral shaft fractures present a difficult management problem. A variety of surgical options have been employed with varying results. We investigated the use of hip screws and a reamed retrograde intramedullary (IM) nail for the treatment of this combined fracture pattern in terms of postoperative alignment (malunion), nonunion, and complications. Between May 2002 and October 2011, a total of 95 proximal femoral fractures with associated shaft fractures were treated at three participating Level 1 trauma centers; all were treated with hip screw fixation (cannulated screws or sliding hip screws) and retrograde reamed IM nails. The medical records of these patients were reviewed retrospectively for alignment, malunion, nonunion, and complications. Followup was available on 92 of 95 (97%) of the patients treated with hip screws and a retrograde nail. Forty were treated with a sliding hip screw, and 52 were treated with cannulated screws. There were five proximal malunions in this series (5%). The union rate was 98% (90 of 92) for the femoral neck fractures and 91.3% (84 of 92) for the femoral shaft fractures after the initial surgery. There were two nonunions of comminuted femoral neck fractures after cannulated screw fixation. There was no difference in femoral neck union or alignment when comparing cannulated screws to a sliding hip screw. Four open comminuted femoral shaft fractures went on to nonunion and required secondary surgery to obtain union, and one patient developed symptomatic avascular necrosis. The treatment of ipsilateral proximal femoral neck and shaft fractures with hip screw fixation and a reamed retrograde nail demonstrated a high likelihood of union for the femoral neck fractures and a low risk of malunion. Comminution and initial displacement of the proximal femoral fracture may still lead to a small incidence of malunion or nonunion, and open comminuted femoral shaft fractures

  19. Preventing and Treating Compression Fractures of the Spine

    Science.gov (United States)

    ... with OI the spine is particularly vulnerable to injury. Some activities such as contact sports obviously increase the risk of fracture. Other activities that may not seem to be dangerous may pose a “hidden” threat. The most common injury is a vertebral compression fracture. What is ...

  20. Evaluation of Fracture Resistance in Root Canal-Treated Teeth ...

    African Journals Online (AJOL)

    2018-06-11

    Jun 11, 2018 ... Objective: This study aimed to evaluate the effects of different coronal restoration techniques on fracture ... Therefore, the application of horizontal fiber posts in. MOD cavities has .... Table 1: Median and 25% and 75% quartile values of the groups n ..... restorations on fracture resistance and failure mode of.

  1. Interventions for treating proximal humeral fractures in adults

    DEFF Research Database (Denmark)

    Handoll, Helen H G; Brorson, Stig

    2015-01-01

    supervised exercise in a swimming pool plus home exercise.Eight trials, involving 567 older participants, evaluated surgical intervention for displaced fractures. There was high quality evidence of no clinically important difference in patient-reported shoulder and upper-limb function at one- or two......BACKGROUND: Fracture of the proximal humerus, often termed shoulder fracture, is a common injury in older people. The management of these fractures varies widely. This is an update of a Cochrane Review first published in 2001 and last updated in 2012. OBJECTIVES: To assess the effects (benefits...... and harms) of treatment and rehabilitation interventions for proximal humeral fractures in adults. SEARCH METHODS: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and other databases, conference...

  2. Can we assess healing of surgically treated long bone fractures on radiograph?

    Science.gov (United States)

    Perlepe, V; Omoumi, P; Larbi, A; Putineanu, D; Dubuc, J-E; Schubert, T; Vande Berg, B

    2018-06-01

    To determine the frequency and causes for limitations in the radiographic evaluation of surgically treated long bone fractures. Six readers separately scored 140 sets of antero-posterior (AP) and lateral radiographs of surgically treated long bone fractures, using a radiographic union score (RUS). We determined the rate of assessability of the fracture edges at each of the four cortical segments (n=560) seen tangentially on the two radiographs and the causes for non-assessability. The rate of feasibility of the RUS (more than two fracture edges assessable per fracture) was determined and compared according to different parameters. Fracture edges were visible in 71% to 81% of the 560 cortical segments. Metal hardware superimposition was the most frequent cause for non-assessability (79-95%). RUS values could be calculated in 58% to 75% of fractures. Scoring was statistically significantly less frequently calculable in plated (31-56%) than in nailed fractures (90-97%), in distal (47-61%) than in proximal (78-89%) bones and in upper (27-49%) than in lower (76-91%) limb bones (P≤0.01). The type of stabilization hardware is the main limiting factor in the radiographic assessment of surgically treated long bone fractures. Scoring was feasible in only 31% to 56% of plated fractures. Copyright © 2018 Société française de radiologie. Published by Elsevier Masson SAS. All rights reserved.

  3. Investigation of Mechanical Properties and Fracture Simulation of Solution-Treated AA 5754

    Science.gov (United States)

    Kumar, Pankaj; Singh, Akhilendra

    2017-10-01

    In this work, mechanical properties and fracture toughness of as-received and solution-treated aluminum alloy 5754 (AA 5754) are experimentally evaluated. Solution heat treatment of the alloy is performed at 530 °C for 2 h, and then, quenching is done in water. Yield strength, ultimate tensile strength, impact toughness, hardness, fatigue life, brittle fracture toughness (K_{Ic} ) and ductile fracture toughness (J_{Ic} ) are evaluated for as-received and solution-treated alloy. Extended finite element method has been used for the simulation of tensile and fracture behavior of material. Heaviside function and asymptotic crack tip enrichment functions are used for modelling of the crack in the geometry. Ramberg-Osgood material model coupled with fracture energy is used to simulate the crack propagation. Fracture surfaces obtained from various mechanical tests are characterized by scanning electron microscopy.

  4. Epidemiological analysis of mandibular fractures treated in Sao Paulo, Brazil

    Directory of Open Access Journals (Sweden)

    Kelly Marinho

    2015-10-01

    Conclusion: The treatment of mandibular fractures should be aimed at restoring the occlusion and mastication function, with surgery being the most indicated treatment, using reduction and internal fixation with the use of a plates and screws system based on the experience of the authors. Knowledge of surgical techniques and methods of reduction and fixation of fractures, and periodic monitoring allow these patients to receive the appropriate treatment.

  5. Fracture risk in perimenopausal women treated with beta-blockers

    DEFF Research Database (Denmark)

    Rejnmark, Lars; Vestergaard, Peter; Kassem, M.

    2004-01-01

    beta2-Adrenergic receptors have been identified on human osteoblastic and osteoclastic cells, raising the question of a sympathetic regulation of bone metabolism. We investigated effects of treatment with beta-adrenergic receptor antagonists (beta-blockers) on bone turnover, bone mineral density...... (BMD), and fracture risk. Within the Danish Osteoporosis Prevention Study (DOPS) a population based, comprehensive cohort study of 2016 perimenopausal women, associations between treatment with beta-blockers and bone turnover and BMD were assessed in a cross-sectional design at the start of study....... Moreover, in a nested case-control design, fracture risk during the subsequent 5 years was assessed in relation to treatment with beta-blockers at baseline. Multiple regression- and logistic regression-analyses were performed. Treatment with beta-blockers was associated with a threefold increased fracture...

  6. Treating Simple Tibia Fractures with Poly-DL-Lactic Acid Screw as a ...

    African Journals Online (AJOL)

    Purpose: To investigate the curative effect of poly-DL-lactic acid (PDLLA) absorbable screw as a locked intramedullary nail for simple tibia fractures. Methods: In this study, 35 patients treated with the PDLLA screw were observed, and another 35 patients treated with a traditional locking intramedullary nail were treated as ...

  7. Outcome of humeral shaft fractures treated by functional cast brace

    Directory of Open Access Journals (Sweden)

    Jitendra Nath Pal

    2015-01-01

    Conclusion: Modified functional cast brace is one of the options in treatment for humeral shaft fractures as it can be applied on the 1 st day of the presentation in most of the situations. Simple objective scoring system was useful particularly in uneducated patients.

  8. An interdisciplinary approach to treat crown‑root‑fractured tooth ...

    African Journals Online (AJOL)

    Restoration of a crown‑root subgingival fractured tooth, especially at anterior aesthetic zones is still a great challenge for restorative dentists. Crown lengthening procedure alone has the disadvantage of high gingival curve of the final restoration, which was not discontinuous to adjacent teeth and thus compromise cosmetic ...

  9. Fracture Resistance and Failure Mode of Endodontically Treated Premolars Restored with Different Adhesive Restorations

    Directory of Open Access Journals (Sweden)

    Nasrin Sarabi

    2015-03-01

    Full Text Available Introduction: The restoration of endodontically treated teeth is a topic that has been studied extensively but it is still a challenge for dental practitioners. The aim of this study was to evaluate fracture resistance, fracture patterns and fracture location of endodontically treated human maxillary premolars restored with direct and indirect composite resin and ceramic restoration. Methods: Eighty non-carious maxillary premolars were selected and divided into four groups (n=20. Endodontic treatment and mesio-occluso-distal preparations were carried out in all the groups except for the control group (group I. Subsequently, the prepared teeth were restored as follows: group II: indirect composite restoration; group III: ceramic restoration; group IV: direct composite restoration. The specimens were subjected to compressive axial loading until fracture occurred. The mode of failure was also recorded. Results: Group I had higher fracture resistance (1196.82±241.74 than the other groups (P

  10. A FUNCTIONAL EVALUATION STUDY OF DISTAL FEMORAL FRACTURES FIXED WITH DISTAL FEMORAL LOCKING PLATE

    Directory of Open Access Journals (Sweden)

    Manikumar C. J

    2017-04-01

    Full Text Available BACKGROUND Fractures of the distal femur present considerable challenges in management. Older patients especially women sustain fractures due to osteoporosis. Supracondylar fractures of femur have a bimodal distribution. They account for 6% of all femur fractures and 31% if hip fractures were excluded. Nearly, 50% of distal femur intra-articular fractures are open fractures. Before 1970, most supracondylar fractures were treated nonoperatively; however, difficulties were often encountered including persistent angulatory deformity, knee joint incongruity, loss of knee motion and delayed mobilisation. The trend of open reduction and internal fixation has become evident in recent years with good results being obtained with AO blade plate, dynamic condylar screw, intramedullary supracondylar nail and locking compression plate. Elderly patients and osteoporosis pose difficulty in treating intra-articular fractures of the lower end of femur. Loss of stable fixation is of great concern in these cases. Hence, locking compression plate use has an advantage in these patients. MATERIALS AND METHODS In this study, 20 patients with closed fracture of distal femur were studied. All the cases were treated at the Department of Orthopaedics, Rangaraya Medical College/Government General Hospital, Kakinada, Andhra Pradesh, between November 2013 and November 2015. The method used for fracture fixation was open reduction and internal fixation with distal femoral locking plate. The duration of follow up ranged from 3 months to 24 months. All the fractures in this series were posttraumatic. The patients were functionally evaluated with Neer’s scoring system. 1 RESULTS Twenty distal femoral fractures were treated with distal femoral locking plates. 15 patients were males and 5 patients were females. The median age was 47 years ranging from 28-70 years. 16 of the fractures were caused by road traffic accidents and 2 were due to fall, 2 were due to assault. 12 patients

  11. Numerical Fracture Analysis of Cryogenically Treated Alloy Steel Weldments

    International Nuclear Information System (INIS)

    Rasool Mohideen, S; Thamizhmanii, S; Muhammed Abdul Fatah, M.M; Saidin, W. Najmuddin W.

    2016-01-01

    Cryogenic treatment is being used commercially in the industries in the last two decades for improving the life of many engineering component such as bearings and cutting tools. Though their influence in improving the wear resistance of tool materials is well established, the effect of treatment on weldments is not much investigated. In the present work, a two dimensional finite element analysis was carried out on the compact tension specimen model for simulating the treatment process and to study the fracture behaviour. The weldments were modelled by thermo- mechanical coupled field analysis for simulating he temperature distribution in the model during weld pool cooling and introducing thermal stresses due to uneven contraction and cooling. The model was subjected to cryogenic treatment by adopting radiation effect. The fracture analysis was carried out using Rice's J- Integral approach. The analysis produced a similar outcome of experimental results i.e. Increase in the fracture toughness of the specimen after cryogenic treatment in the heat affected zone of weldment. (paper)

  12. Fracture behaviour of a magnesium–aluminium alloy treated by selective laser surface melting treatment

    International Nuclear Information System (INIS)

    Taltavull, C.; López, A.J.; Torres, B.; Rams, J.

    2014-01-01

    Highlights: • β-Mg 17 Al 12 presents fragile fracture behavior decreasing the ductility of AZ91D. • SLSM treatment only modifies the β-Mg 17 Al 12 phase whilst α-Mg remains unaltered. • In-situ SEM bending test allows to observe and data record of the crack propagation. • Eutectic microestructure of modified β-phase presents ductile fracture behaviour. • Fracture toughness of laser treated specimen is 40% greater than as-received alloy. - Abstract: Fracture behaviour of AZ91D magnesium alloy is dominated by the brittle fracture of the β-Mg 17 Al 12 phase so its modification is required to improve the toughness of this alloy. The novel laser treatment named as Selective Laser Surface Melting (SLSM) is characterized by the microstructural modification of the β-Mg 17 Al 12 phase without altering the α-Mg matrix. We have studied the effect of the selected microstructural modification induced by the laser treatment in the fracture behaviour of the alloy has been studied using in situ Scanning Electron Microscopy bending test. This test configuration allows the in situ observation of the crack progression and the record of the load–displacement curve. It has been observed that the microstructural modification introduced by SLSM causes an increase of 40% of the fracture toughness of the treated specimen. This phenomenon can be related with the transition from brittle to ductile fracture behaviour of the laser modified β-phase

  13. Effect of amalgam cuspal coverage on the fracture resistance of endodontically treated teeth

    Directory of Open Access Journals (Sweden)

    Mahshid Mohammdi Basir

    2013-05-01

    Full Text Available   Background and Aims: Endodontically treated teeth are prone to fracture because they loose a big amount of their structure. The treatment plan of those teeth is completed when they are rehabilitated with a strong and functional restoration. The purpose of this study was to evaluate the fracture resistance of endodontically treated teeth restored with amalgam cuspal coverage in comparison with other restorative techniques.   Materials and Methods: 40 human healthy maxillary premolars were divided into 4 groups: group1 (S: sound teeth, group 2(Co: endodontically treated teeth with MOD cavity restored with bonding and composite, group 3(Am-B: endodontically treated teeth with MOD cavity restored with bonding and amalgam and group 4 (Am-CC: endodontically treated teeth with MOD cavity restored with amalgam cuspal coverage. Then the restorations were stored in water and room temperature for 100 days at then thermocycled for 500 cycles between water baths at (5.5 ± 1 and (55 ± 1 0 C. The fracture resistance was evaluated by universal testing machine (Instron, 1195 UK with the compressive force of about 2000 N in 0.5 mm/min. The fracture modes were evaluated in four groups by a stereomicroscope. Statistical analysis (Scheffe test was done for all groups (P0.05. The lowest fracture resistance was found in group 2 (Co (384 ± 137.4 N that had no significant difference with group 3 (Am-B (P>0.05. The fracture resistance in group 4 was significantly higher than group 2 (Co and 3 (Am-B. The fracture mode in group 1 was cohesive within tooth and in group 2 (Co and 3 (Am-B was mixed cohesive and adhesive, and in group 4 was cohesive within in restorative material.   Conclusion: The highest fracture resistance was found in teeth that received amalgam cuspal coverage.

  14. Fracture analysis of cement treated demolition waste using a lattice model

    NARCIS (Netherlands)

    Xuan, D.; Schlangen, H.E.J.G.; Molenaar, A.A.A.; Houben, L.J.M.

    2013-01-01

    Fracture properties of cement treated demolition waste were investigated using a lattice model. In practice the investigated material is applied as a cement treated road base/subbase course. The granular aggregates used in this material were crushed recycled concrete and masonry. This results in six

  15. Acoustic Emission Methodology to Evaluate the Fracture Toughness in Heat Treated AISI D2 Tool Steel

    Science.gov (United States)

    Mostafavi, Sajad; Fotouhi, Mohamad; Motasemi, Abed; Ahmadi, Mehdi; Sindi, Cevat Teymuri

    2012-10-01

    In this article, fracture toughness behavior of tool steel was investigated using Acoustic Emission (AE) monitoring. Fracture toughness ( K IC) values of a specific tool steel was determined by applying various approaches based on conventional AE parameters, such as Acoustic Emission Cumulative Count (AECC), Acoustic Emission Energy Rate (AEER), and the combination of mechanical characteristics and AE information called sentry function. The critical fracture toughness values during crack propagation were achieved by means of relationship between the integral of the sentry function and cumulative fracture toughness (KICUM). Specimens were selected from AISI D2 cold-work tool steel and were heat treated at four different tempering conditions (300, 450, 525, and 575 °C). The results achieved through AE approaches were then compared with a methodology proposed by compact specimen testing according to ASTM standard E399. It was concluded that AE information was an efficient method to investigate fracture characteristics.

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

    Directory of Open Access Journals (Sweden)

    Sang Yang Lee

    2013-01-01

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

  17. Progression of a fracture site impaction as a prognostic indicator of impacted femoral neck fracture treated with multiple pinning.

    Science.gov (United States)

    Yoon, Pil Whan; Shin, Young Ho; Yoo, Jeong Joon; Yoon, Kang Sup; Kim, Hee Joong

    2012-03-01

    We evaluated the clinical and radiologic results of impacted femoral neck fractures treated with multiple pinning and determined the influence of the progression of impaction at the fracture site on clinical outcome. There were 34 patients with a mean age of 65.5 years. The mean follow-up period was 3.4 years. Progression of fracture site impaction was measured using an articulo-trochanteric distance index and the percentage decrease in the articulo-trochanteric distance index between follow-up intervals. The failure of treatment was clarified as non-union and avascular necrosis. Other characteristics of the patients, including mean waiting time for surgery, preoperative Singh index score, and body mass index, were also measured to evaluate the influence on the clinical outcome of surgery. There were 6 fractures which were not treated successfully (3 non-union, 8.8% and 3 avascular necrosis, 8.8%). The mean percentage decrease of the articulo-trochanteric distance index within the first 6 weeks after surgery was 4.5% in the successful group and 25.1% in the failure group (p articulo-trochanteric distance index between 6 weeks and 3 months (p articulo-trochanteric distance index between the successful group and the failure group, we could not verify it as a risk factor for failure of treatment because the odds ratio was not statistically significant.

  18. A Conservative Method for Treating Severely Displaced Pediatric Mandibular Fractures: An Effective Alternative Technique

    OpenAIRE

    Sahand Samieirad; Saeedeh khajehahmadi; Elahe Tohidi; Meysam Pakravan

    2016-01-01

    Pediatric mandibular fractures have been successfully managed in various ways. The use of a lingual splint is an option. This article presents a 4-year old boy who was treated by an alternative conservative method with a combination of an arch bar plus a lingual splint, circum-mandibular wiring and IMF for the reduction, stabilization and fixation of a severely displaced bilateral man‌dibular body fracture. This technique is a reliable, noninvasive procedure; it also limits the discomfort and...

  19. An assessment of maxillofacial fractures treated in a sub- urban ...

    African Journals Online (AJOL)

    McRoy

    2014-12-31

    Dec 31, 2014 ... ... which permits unrestricted, non-commercial, share-alike use, distribution, and .... treated resulted in a successful outcome while 12 ... likely to engage in driving and motor bike ... drive and ride motor bikes around the towns.

  20. Atrial fibrillation in fracture patients treated with oral bisphosphonates

    DEFF Research Database (Denmark)

    Abrahamsen, B; Eiken, P; Brixen, K

    2009-01-01

    OBJECTIVES: To determine if patients receiving oral bisphosphonates are at excess risk of atrial fibrillation (AF), stroke and myocardial infarction. DESIGN: Register-based restricted cohort study. SETTING: National Hospital Discharge Register and National Prescriptions Database (1995-2005). SUBJ......OBJECTIVES: To determine if patients receiving oral bisphosphonates are at excess risk of atrial fibrillation (AF), stroke and myocardial infarction. DESIGN: Register-based restricted cohort study. SETTING: National Hospital Discharge Register and National Prescriptions Database (1995...... to adherence. There was no increased risk of ischaemic stroke and an increased risk of myocardial infarction was not significant after adjustment for comorbidity. CONCLUSIONS: The increased occurrence of AF in fracture patients who are users of oral bisphosphonates should be attributed to targeting...

  1. The outcome of surgically treated traumatic unstable pelvic fractures by open reduction and internal fixation

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    Keykhosro Mardanpour

    2013-07-01

    Full Text Available BACKGROUND: This study was performed to evaluate functional and radiological results of pelvic ring fractures treatment by open reduction and internal fixation. METHOD: Thirty eight patients with unstable pelvic fractures, treated from 2002 to 2008 were retrospectively reviewed. The mean patients’ age was 37 years (range 20 to 67. Twenty six patients were men (4patients with type B and 22 patients with type C fracture and 12 women (7 patients with type B and 5 patients with type C fracture. The commonest cause was a road traffic accident (N=37, about 97%. Internal fixation was done by plaque with ilioinguinal and kocher-langenbeek approaches for anterior, posterior pelvic wall and acetabulum fracture respectively. Quality of reduction was graded according to Majeed score system. RESULTS: There were 11 type-C and 27 type-B pelvic fractures according to Tile’s classification. Thirty six patients sustained additional injuries. the commonest additional injury was lower extremity fracture. The mean follow-up was 45.6 months (range 16 to 84 months.The functional outcome was excellent in 66%, good in 15%, fair in 11% and poor in 7% of the patients with type B pelvic fractures and functional outcome was excellent in 46%, good in 27%, fair in 27% and poor in 0% of the patients with type C pelvic fractures. There were four postoperative infections. No sexual functional problem was reported. Neurologic problem like Lateral cutaneous nerve of thigh injury recovered completely in 2 patients and partially in 2 patients. There was no significant relation between functional outcome and the site of fracture (P greater than 0.005. CONCLUSION: Unstable pelvic ring fracture injuries should be managed surgically by rigid stabilization. It must be carried out as soon as the general condition of the patient permits, and even up to two weeks

  2. 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.

  3. Surgical interventions for treating fractures of the olecranon in adults.

    Science.gov (United States)

    Matar, Hosam E; Ali, Amjid A; Buckley, Simon; Garlick, Nicholas I; Atkinson, Henry D

    2014-11-26

    Fractures of the olecranon (the bony tip of the elbow) account for approximately 1% of all upper extremity fractures. Surgical intervention is often required to restore elbow function. Two key methods of surgery are tension band wire fixation and plate fixation. To assess the effects (benefits and harms) of different surgical interventions in the treatment of olecranon fractures in adults. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (22 September 2014), the Cochrane Central Register of Controlled Trials (CENTRAL, 2014, Issue 8), MEDLINE (1946 to September week 2 2014), EMBASE (1980 to 19 September 2014), trial registers, conference proceedings and reference lists of articles. Randomised controlled trials (RCT) and quasi-RCTs that compared different surgical interventions for the treatment of olecranon fractures in adults. Two review authors independently performed study selection, risk of bias assessment and data extraction. The primary outcomes of this review were function, pain and adverse events. We included six small trials involving 244 adults with olecranon fractures. Of these, four were RCTs and two were quasi-RCTs; both of were at high risk of selection bias. All six trials were at high risk of performance bias, reflecting lack of blinding, and four trials were at high risk of detection bias. The quality of the evidence for most outcomes was generally very low because of limitations in study design and implementation, and either imprecision of the results or inadequate outcome measures. Thus, we are very uncertain about the estimates of effect.One trial (41 participants) comparing plate fixation with standard tension band wiring provided very low quality evidence at 16 to 86 weeks' follow-up of a better clinical outcome after plate fixation (good outcome (little pain or loss of elbow motion): 19/22 versus 9/19, risk ratio (RR) 1.82 favouring plate fixation, 95% confidence interval (CI) 1.10 to 3.01). There was very low

  4. Comparison of Early and Delayed Open Reduction and Internal Fixation for Treating Closed Tibial Pilon Fractures.

    Science.gov (United States)

    Tang, Xin; Liu, Lei; Tu, Chong-qi; Li, Jian; Li, Qi; Pei, Fu-xing

    2014-07-01

    The timing of surgery for osteosynthesis of type C pilon (AO/OTA) fractures remains controversial. The aim of this study was to determine the outcome of early and delayed open reduction and internal fixation (ORIF) for treating closed type C pilon fractures. Forty-six patients with closed type C pilon fractures matched according to age, gender, soft tissue conditions, and fracture pattern were divided into group A (early group: underwent surgery within 36 hours of the injury) or group B (delayed group: underwent surgery 10 days to 3 weeks postinjury after the soft tissue swelling subsided). In the delayed group, 9 patients were treated first by temporary external fixation. All the closed fractures were managed by ORIF with locking plates. At follow-up, the clinical and radiographic results were retrospectively analyzed. The mean follow-up time was 25.8 months (range, 14 to 48 months) in group A and 26.0 months (range, 15 to 44 months) in group B. There was no significant difference (P > .05) between the 2 groups regarding the rate of soft tissue complication, the rate of fracture union, and the final functional score. The patients in group A had a significantly shorter mean time to fracture union (21.5 ± 4.0 weeks vs 23.3 ± 3.7 weeks, P fractures can be safe and effective, with similar rates of wound complication, fracture union, and final good functional recovery but shorter operative time, union time, and hospital stay. These results favorably compare with delayed ORIF treatment. Level III, retrospective comparative study. © The Author(s) 2014.

  5. 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

  6. 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.

  7. Fracture resistance of endodontically treated teeth restored with a bulkfill flowable material and a resin composite.

    Science.gov (United States)

    Isufi, Almira; Plotino, Gianluca; Grande, Nicola Maria; Ioppolo, Pietro; Testarelli, Luca; Bedini, Rossella; Al-Sudani, Dina; Gambarini, Gianluca

    2016-01-01

    To determine and compare the fracture resistance of endodontically treated teeth restored with a bulk fill flowable material (SDR) and a traditional resin composite. Thirty maxillary and 30 mandibular first molars were selected based on similar dimensions. After cleaning, shaping and filling of the root canals and adhesive procedures, specimens were assigned to 3 subgroups for each tooth type (n=10): Group A: control group, including intact teeth; Group B: access cavities were restored with a traditional resin composite (EsthetX; Dentsply-Italy, Rome, Italy); Group C: access cavities were restored with a bulk fill flowable composite (SDR; Dentsply-Italy), except 1.5 mm layer of the occlusal surface that was restored with the same resin composite as Group B. The specimens were subjected to compressive force in a material static-testing machine until fracture occurred, the maximum fracture load of the specimens was measured (N) and the type of fracture was recorded as favorable or unfavorable. Data were statistically analyzed with one-way analysis of variance (ANOVA) and Bonferroni tests (Pcomposite and with a bulk fill flowable composite (SDR) was similar in both maxillary and mandibular molars and showed no significant decrease in fracture resistance compared to intact specimens. No significant difference was observed in the mechanical fracture resistance of endodontically treated molars restored with traditional resin composite restorations compared to bulk fill flowable composite restorations.

  8. Anterior tibial stress fractures treated with anterior tension band plating in high-performance athletes.

    Science.gov (United States)

    Cruz, Alexandre Santa; de Hollanda, João Paris Buarque; Duarte, Aires; Hungria Neto, José Soares

    2013-06-01

    The non-surgical treatment of anterior tibial cortex stress fractures requires long periods of abstention from sports activities and often results in non-union. Many different surgical techniques have already been previously described to treat these fractures, but there is no consensus on the best treatment. We describe the outcome of treatment using anterior tibial tension band plating in three high-performance athletes (4 legs) with anterior tibial cortex stress fractures. Tibial osteosynthesis with a 3.5-mm locking compression plate in the anterolateral aspect of the tibia was performed in all patients diagnosed with anterior tibial stress fracture after September 2010 at Santa Casa Hospital. All of the fractures were consolidated within a period of 3 months after surgery, allowing for an early return to pre-injury levels of competitive sports activity. There were no infection, non-union, malunion or anterior knee pain complications. Anterior tibial tension band plating leads to prompt fracture consolidation and is a good alternative for the treatment of anterior tibial cortex stress fractures. Bone grafts were shown to be unnecessary.

  9. [Intramedullary nailing combined with cannulated screw in treating femoral condyles fractures].

    Science.gov (United States)

    Shen, Guo-Qing; Zhang, Hao; Long, Da-Fu; Li, Zheng-Wen; Tan, Ying-Dong

    2017-07-25

    To observe the clinical effects of retrograde intramedullary nailing and cannulated screws in the treatment of femoral condylar fracture. From June 2009 to June 2015, 13 patients with femoral condyles fracture were treated by retrograde intramedullary nailing and cannulated screws including 6 males and 7 females with an average age of 46.1 years old ranging from 16 to 76 years old. There were 10 cases of closed fractures, 3 cases of open fraetures. According to AO classification criteriam, 4 cases were type C1, 7 cases were type C2, 2 cases were type C3. Postoperative reduction of fracture and the knee joint function recovery were observed. All patients were followed up for 12 to 36 months with a mean of 24 months. X-ray examination showed that the union time of fracture was 18 to 24 weeks, 21 weeks on average. There were no cases of loosening, breakage of internal fixators and re-fracture. Hospital for Special Surgery(HSS) knee score was 90.07±4.99 at 1 year after the operation. The clinical efficacy for retrograde intramedullary nailing and cannulated screw for the treatment of femoral condyles fracture was excellent. It can improve the anatomical reattachment rate and reduce the complications and promote the knee functional recovery.

  10. Local and Widespread Hyperalgesia After Isolated Tibial Shaft Fractures Treated with Intramedullary Nailing

    DEFF Research Database (Denmark)

    Larsen, Peter; Elsøe, Rasmus; Graven-Nielsen, Thomas

    2016-01-01

    OBJECTIVES: Knee pain is accepted as a common complication to intramedullary nailing of tibial fractures. However, no studies have systematically studied the pain sequel following tibial fractures. The objective of this study was to assess pain and hyperalgesia from 6 weeks to 12 months postopera...... fracture treated with intramedullary nailing, although no widespread (extrasegmental) hyperalgesia was detected. Such observations may be important for developing the most adequate rehabilitation procedure following a tibial fracture.......OBJECTIVES: Knee pain is accepted as a common complication to intramedullary nailing of tibial fractures. However, no studies have systematically studied the pain sequel following tibial fractures. The objective of this study was to assess pain and hyperalgesia from 6 weeks to 12 months...... postoperatively after intramedullary nailing of tibial shaft fracture. METHODS: A total of 39 patients were included in this 12-month follow-up study. After 6 weeks, 3, 6, and 12 months postoperatively the pain intensity was measured on a visual analog scale (VAS) and the pressure pain sensitivity was assessed...

  11. Rate of displacement for Jakob Type 1 lateral condyle fractures treated with a cast.

    Science.gov (United States)

    Zale, C; Winthrop, Z A; Hennrikus, W

    2018-04-01

    The aim of this retrospective study is to report the rate of displacement of Jakob Type 1 lateral condyle fractures that were initially treated in a cast. We performed a retrospective review of all patients that were treated for a non-displaced (Jakob Type 1 displaced and were converted to a closed pinning treatment plan with a conversion rate of 8.5%. There was a mean of 13.2 days (4 to 21) between treatment by initial casting and closed pinning. This study demonstrates an 8.5% displacement and conversion rate from cast treatment to closed pinning for initially non-displaced Jakob Type 1 lateral condyle fractures of the humerus. The internal oblique radiograph is most accurate to determine displacement. We recommend obtaining an internal oblique view at initial evaluation and at follow-up in the cast for lateral condyle fractures. To minimize movement at the fracture site, we recommend treating Jakob Type 1 lateral condyle fractures with a long arm cast with the elbow at 90° and the forearm in the supine position with a sling-loop design. IV - retrospective therapeutic study.

  12. Delay in weight bearing in surgically treated tibial shaft fractures is associated with impaired healing: a cohort analysis of 166 tibial fractures.

    Science.gov (United States)

    Houben, I B; Raaben, M; Van Basten Batenburg, M; Blokhuis, T J

    2018-04-09

    The relation between timing of weight bearing after a fracture and the healing outcome is yet to be established, thereby limiting the implementation of a possibly beneficial effect for our patients. The current study was undertaken to determine the effect of timing of weight bearing after a surgically treated tibial shaft fracture. Surgically treated diaphyseal tibial fractures were retrospectively studied between 2007 and 2015. The timing of initial weight bearing (IWB) was analysed as a predictor for impaired healing in a multivariate regression. Totally, 166 diaphyseal tibial fractures were included, 86 cases with impaired healing and 80 with normal healing. The mean age was 38.7 years (range 16-89). The mean time until IWB was significantly shorter in the normal fracture healing group (2.6 vs 7.4 weeks, p bearing is independently associated with impaired fracture healing in surgically treated tibial shaft fractures. Unlike other factors such as fracture type or soft tissue condition, early resumption of weight bearing can be influenced by the treating physician and this factor therefore has a direct clinical relevance. This study indicates that early resumption of weight bearing should be the treatment goal in fracture fixation. 3b.

  13. Reduced survival for uncemented compared to cemented total hip arthroplasty after operatively treated acetabular fractures.

    Science.gov (United States)

    Clarke-Jenssen, John; Westberg, Marianne; Røise, Olav; Storeggen, Stein Arne Øvre; Bere, Tone; Silberg, Ingunn; Madsen, Jan Erik

    2017-11-01

    Post traumatic arthritis and avascular necrosis of the femoral head are common complications after operatively treated acetabular fractures. This may cause severe disabilities for the patient, necessitating a total hip arthroplasty. Even though an arthroplasty may provide good symptomatic relief, the long-term results are more uncertain and no consensus exists according to preferred prosthetic designs. With this cohort study, we aimed to investigate the medium to long term arthroplasty survival and clinical results of total hip arthroplasty after operatively treated acetabular fractures. We included 52 patients treated with a secondary total hip arthroplasty at a median of 2.4 (0.1-14.1) years after an operatively treated acetabular fracture. The median age was 54 (11-82) years. Cemented arthroplasty was used for 33 patients, 10 patients had an uncemented arthroplasty and 9 patients received a hybrid arthroplasty. Average follow up was 8.0 (SD 5.0) years. Ten-year revision free arthroplasty survival was 79%. Uncemented arthroplasties had a significantly worse 10-year survival of 57%. Arthroplasties performed at a centre without a pelvic fracture service also had a significantly worse 10-years survival of 51%. Cox regression showed similar results with an 8-fold increase in risk of revision for both uncemented arthroplasties and operations performed at a non-pelvic trauma centre. Total hip arthroplasty secondary to an operatively treated acetabular fracture provides good symptomatic relief. These patients are, however, complex cases and are probably best treated at specialist centres with both pelvic trauma surgeons and arthroplasty surgeons proficient in complex revisions present. Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. Combined three-part humeral anterior fracture-dislocation and humeral shaft fracture treated with one-stage long stem shoulder hemiarthroplasty in an active elderly patient

    Directory of Open Access Journals (Sweden)

    Herzberg Guillaume

    2017-01-01

    Full Text Available Introduction: Injuries combining a humeral head fracture-dislocation and a shaft fracture of the ipsilateral humerus are very rare. They should be separated from extended fractures of the humeral head to the shaft [1]. Case report: We present the case of an active 84-year-old man who sustained a three-part fracture-dislocation of the proximal humerus combined with a long spiral humeral middle third diaphyseal fracture, after a ski fall. We were unable to find a similar case in the literature. He was treated with a long stem hemiarthroplasty, associated with screw osteosynthesis of the long spiral shaft fracture. The result after 30 months of follow-up was excellent, with good shoulder range of motion, good bone integration of the prosthesis and uneventful healing of the fracture. Conclusion: This treatment allowed this intrepid elderly patient to recover a normal quality of life, including driving his car and to return to skiing.

  15. Fishtail deformity - a delayed complication of distal humeral fractures in children

    Energy Technology Data Exchange (ETDEWEB)

    Narayanan, Srikala [Massachusetts General Hospital, Department of Radiology, Division of Pediatric Imaging, Boston, MA (United States); University of Pittsburgh Medical Center, Department of Radiology, Pittsburgh, PA (United States); Shailam, Randheer; Nimkin, Katherine [Massachusetts General Hospital, Department of Radiology, Division of Pediatric Imaging, Boston, MA (United States); Grottkau, Brian E. [Massachusetts General Hospital, Department of Orthopaedics, Pediatric Orthopaedics, Boston, MA (United States)

    2015-06-15

    Concavity in the central portion of the distal humerus is referred to as fishtail deformity. This entity is a rare complication of distal humeral fractures in children. The purpose of this study is to describe imaging features of post-traumatic fishtail deformity and discuss the pathophysiology. We conducted a retrospective analysis of seven cases of fishtail deformity after distal humeral fractures. Seven children ages 7-14 years (five boys, two girls) presented with elbow pain and history of distal humeral fracture. Four of the seven children had limited range of motion. Five children had prior grade 3 supracondylar fracture treated with closed reduction and percutaneous pinning. One child had a medial condylar fracture and another had a lateral condylar fracture; both had been treated with conservative casting. All children had radiographs, five had CT and three had MRI. All children had a concave central defect in the distal humerus. Other imaging features included joint space narrowing with osteophytes and subchondral cystic changes in four children, synovitis in one, hypertrophy or subluxation of the radial head in three and proximal migration of the ulna in two. Fishtail deformity of the distal humerus is a rare complication of distal humeral fractures in children. This entity is infrequently reported in the radiology literature. Awareness of the classic imaging features can result in earlier diagnosis and appropriate treatment. (orig.)

  16. Fishtail deformity - a delayed complication of distal humeral fractures in children

    International Nuclear Information System (INIS)

    Narayanan, Srikala; Shailam, Randheer; Nimkin, Katherine; Grottkau, Brian E.

    2015-01-01

    Concavity in the central portion of the distal humerus is referred to as fishtail deformity. This entity is a rare complication of distal humeral fractures in children. The purpose of this study is to describe imaging features of post-traumatic fishtail deformity and discuss the pathophysiology. We conducted a retrospective analysis of seven cases of fishtail deformity after distal humeral fractures. Seven children ages 7-14 years (five boys, two girls) presented with elbow pain and history of distal humeral fracture. Four of the seven children had limited range of motion. Five children had prior grade 3 supracondylar fracture treated with closed reduction and percutaneous pinning. One child had a medial condylar fracture and another had a lateral condylar fracture; both had been treated with conservative casting. All children had radiographs, five had CT and three had MRI. All children had a concave central defect in the distal humerus. Other imaging features included joint space narrowing with osteophytes and subchondral cystic changes in four children, synovitis in one, hypertrophy or subluxation of the radial head in three and proximal migration of the ulna in two. Fishtail deformity of the distal humerus is a rare complication of distal humeral fractures in children. This entity is infrequently reported in the radiology literature. Awareness of the classic imaging features can result in earlier diagnosis and appropriate treatment. (orig.)

  17. Paediatric diaphyseal femur fracture treated with intramedullary titanium elastic nail system

    Directory of Open Access Journals (Sweden)

    Shrawan Kumar Thapa

    2015-11-01

    Full Text Available noBackground & Objectives: Over the few years there has been a marked increase in the use of intramedullary fixation in the management of fracture of shaft of femur in children. The goals should be to stabilize the fracture, to control length and alignment, to promote bone healing and to minimize the morbidity and complications for the child. In this prospective study we intend to evaluate the functional and radiological outcome of diaphyseal fracture of shaft of femur treated with elastic intramedullary nail.Materials & Methods: All 56 patients with diaphyseal fracture shaft of femur were treated with titanium elastic nail and followed for period of 32 weeks.Results: The In this study, outcome was assessed by using Flynn’s criteria of titanium flexible nail outcome score and we found excellent result in 49 cases, satisfactory in six cases and poor in one case. We faced one major complication in form of implant failure and six minor complications inform of superficial wound infection.Conclusion: Elastic intramedullary nail used in treatment of diaphyseal fracture shaft of femur yield excellent functional and radiological outcome. It is easy and simple procedure has low rate of complication. It is physeal-protective, cost effective, does not involve heavy instrumentation and can be performed in small set up. It has minimal risk of infection and no risk of injury to the neurovascular structure.JCMS Nepal. 2015; 11(2:20-22

  18. HEMISECTION: A TREATMENT OPTION FOR AN ENDODONTICALLY TREATED MOLAR WITH VERTICAL ROOT FRACTURE

    Directory of Open Access Journals (Sweden)

    Anitha

    2015-05-01

    Full Text Available Vertical root fractures in endodontically treated teeth have long been reported and pose diagnostic difficulties. A h emisection/Root resection procedure which removes the fractured fragments completely, and retains a portion of the compromised tooth offers a predictable treatment option. The key to this rests in ideal case selection invol ving balancing all indications and contraindications. The success of the treatment depends on careful case selection based on a firm set of guidelines. This article presents a case with vertical root fracture in an endodontic treated molar. This article de scribes the case of a 60 - year - old man with a vertical root fracture on the mesial root and a healthy periodontium supporting the distal root making it ideal for retention as well as restoration and support of the final prosthesis. Also, the patient was mot ivated to try and save as much of the tooth as possible. Post - operatively no untoward complication was reported making it an alternative treatment option in patients with vertical root fracture in a molar, willing to retain the remaining tooth portion. Wit h all other factors balanced, it allows for retaining the remaining intact portion of the tooth structure.

  19. Outcomes of the distal intraarticular humeral fractures treated by olecranon osteotomy

    Directory of Open Access Journals (Sweden)

    Erhan Yılmaz

    2009-01-01

    Full Text Available Objectives: To evaluate the management and outcome of intraarticular fractures of the distal humerus treated by open reduction and internal fixation using the olecranon osteotomy technique. Materials and methods: Twenty-one patients with in-traarticular fractures of the distal humerus were treated by open reduction and internal fixation. The mean age of the patients was 41.6 years and the mean follow-up pe-riod was 25.3 months. All fractures were type C accord-ing to the AO/ASIF fracture classification system. Chev-ron type olecranon osteotomy was performed within 12-24 h after the injury in all cases but 4 of them. Physical and radiological examination of patients with the appro-priate range checks were made.Results: All fractures united within average duration of 3.2 months. Excellent or good results were found in pa-tients less than 50 years-old, in women, when passing time from injury to surgery was within 12 hours and when early mobilization was achieved. The complica-tions were seen as 2 (9.6% transient neuropraxia of the ulnar nerve, 2 (9.6% failure of fixation, 1 (4.8% het-erotopic ossification and 1 (4.8% olecranon non-union. Fracture type (C1 and time from occurrence of injury to surgery (<12 hours are the main prognostic factors for achieving the excellent/ good functional results.Conclusions: The critical factors for a successful out-come of intraarticular fractures of the distal humerus in-cluded meticulous surgical technique, stable internal fix-ation, surgical experimentation and early controlled postoperative mobilization.

  20. Effect of inadequate ferrule segment location on fracture resistance of endodontically treated teeth

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    Satheesh B Haralur

    2018-01-01

    Full Text Available Introduction: The circumferential 2 mm ferrule during the fabrication of the crown is strongly advocated for the long-term clinical success. During the routine clinical practice, the dentist encounters the endodontically treated tooth (ETT with inadequacy of the ferrule in some segment due to caries, abrasion, and erosions. The aim of this in vitro study was to investigate the consequence of inadequate segmental ferrule location on fracture strength of the root canal-treated anterior and posterior teeth. Materials and Methods: Fifty each maxillary canine and mandibular premolar intact human teeth were root canal treated and sectioned at 2 mm above the cementum-enamel junction. The teeth samples were divided into 5 groups of 10 each. The G-I and G-V samples had the 360° ferrule and complete absence of the ferrule, respectively. The G-II had the inadequate ferrule on the palatal surface, while G-III and G-IV had inadequate ferrule at buccal and proximal area. Teeth samples were subsequently restored with glass-reinforced fiber post, composite core, and full veneer metal crown. The samples were tested with universal testing machine under static load to record the fracture resistance. The acquired data were subjected to ANOVA and Tukey's post hoc statistical analysis. Results: The G-I with circumferential ferrule showed the higher fracture resistance. The teeth samples with lack of the ferrule had the least fracture resistance. Among the segmental absence of ferrule, teeth samples with lack of the proximal ferrule were least affected. Deficiency of a ferrule on the lingual wall significantly affected the fracture strength in both anterior and posterior ETT. Conclusions: The ETT with sectional inadequacy of the ferrule is significantly more effective in resisting the fracture in comparison to the complete absence of the ferrule.

  1. Functional Results of Unstable (Type 2 Distal Clavicle Fractures Treated with Superior Anterior Locking Plate

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    Rajesh Govindasamy

    2017-11-01

    Full Text Available Background: The treatment of distal clavicle fracture is always a challenge, as it is mostly unstable and has higherrate of delayed union, malunion, non-union and associated acromioclavicular arthritis. So the management of thesefractures remains controversial. The purpose of this study is to evaluate the functional results of Type 2 distal endclavicle fractures treated with superior anterior locking plate.Methods: From June 2011 to August 2015 a retrospective study of12 male patients (mean age of 41.3 years 11 withunilateral and 1 with bilateral distal clavicle fractures treated with superior anterior locking plate was done. They wereevaluated at regular intervals with mean follow up of 14 months(12-18 months.Those with minimum one year followup were included in our study. All were evaluated for the functioning of the shoulder joint by both Oxford shoulder scoreand Quick DASH scores, rate of bone union, complications and earliest time for return to work.Results: All fractures union seen within 6-8 weeks (mean time: 7.1 weeks.All had good shoulder range of motion. Theaverage oxford shoulder and Quick DASH score were 46.2 and 6.5.There were no major complications in our studyviz. non-union, plate failure, secondary fracture. But one patient had superficial wound infection. All patients returned towork within 3 months of postoperative period.Conclusion: Displaced distal clavicle fractures treated with superior anterior locking plates achieved excellent resultsin terms of bony union with rarely any complications and demonstrate promising results with this novel technique.

  2. Paediatric tibial shaft fractures treated by open reduction and stabilization with monolateral external fixation.

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    Simon, A-L; Apostolou, N; Vidal, C; Ferrero, E; Mazda, K; Ilharreborde, B

    2018-02-01

    Elastic stable intramedullary nailing is increasingly used for surgical treatment of tibial shaft fractures, but frequently requires immobilization and delayed full weight-bearing. Therefore, external fixation remains interesting. The aim was to report clinico-radiological outcomes of monolateral external fixation for displaced and unstable tibial shaft fractures in children. All tibial fractures consecutively treated by monolateral external fixation between 2008 and 2013 were followed. Inclusion criteria included skeletal immaturity and closed and open Gustilo I fractures caused by a direct impact. Patients were seen until two years postoperatively. Demographics, mechanism of injury, surgical data and complications were recorded. Anteroposterior and lateral side radiographs were performed at each visit. Full-limb 3D reconstructions using biplanar stereroradiography was performed for final limb length and alignment measures. A total of 45 patients (mean age 9.7 years ± 0.5) were included. In all, 17 were Gustilo I fractures, with no difference between open and closed fractures for any data. Mean time to full weight bearing was 18.2 days ± 0.7. After 15 days, 39 patients returned to school. Hardware removal (mean time to union 15.6 weeks ± 0.8) was performed during consultation under analgesic gas. There were no cases of nonunion. No fracture healed with > 10° of angulation (mean 5.1° ± 0.4°). Leg-length discrepancy > 10 mm was found for six patients. This procedure can be a safe and simple surgical treatment for children with tibial shaft fractures. Few complications and early return to school were reported, with the limitations of non-comparative study. IV.

  3. Paediatric tibial shaft fractures treated by open reduction and stabilization with monolateral external fixation

    Science.gov (United States)

    Simon, A.-L.; Apostolou, N.; Vidal, C.; Ferrero, E.; Mazda, K.; Ilharreborde, B.

    2018-01-01

    Abstract Purpose Elastic stable intramedullary nailing is increasingly used for surgical treatment of tibial shaft fractures, but frequently requires immobilization and delayed full weight-bearing. Therefore, external fixation remains interesting. The aim was to report clinico-radiological outcomes of monolateral external fixation for displaced and unstable tibial shaft fractures in children. Methods All tibial fractures consecutively treated by monolateral external fixation between 2008 and 2013 were followed. Inclusion criteria included skeletal immaturity and closed and open Gustilo I fractures caused by a direct impact. Patients were seen until two years postoperatively. Demographics, mechanism of injury, surgical data and complications were recorded. Anteroposterior and lateral side radiographs were performed at each visit. Full-limb 3D reconstructions using biplanar stereroradiography was performed for final limb length and alignment measures. Results A total of 45 patients (mean age 9.7 years ± 0.5) were included. In all, 17 were Gustilo I fractures, with no difference between open and closed fractures for any data. Mean time to full weight bearing was 18.2 days ± 0.7. After 15 days, 39 patients returned to school. Hardware removal (mean time to union 15.6 weeks ± 0.8) was performed during consultation under analgesic gas. There were no cases of nonunion. No fracture healed with > 10° of angulation (mean 5.1° ± 0.4°). Leg-length discrepancy > 10 mm was found for six patients. Conclusions This procedure can be a safe and simple surgical treatment for children with tibial shaft fractures. Few complications and early return to school were reported, with the limitations of non-comparative study. Level of Evidence IV PMID:29456750

  4. 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

  5. A Conservative Method for Treating Severely Displaced Pediatric Mandibular Fractures: An Effective Alternative Technique

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    Sahand Samieirad

    2016-06-01

    Full Text Available Pediatric mandibular fractures have been successfully managed in various ways. The use of a lingual splint is an option. This article presents a 4-year old boy who was treated by an alternative conservative method with a combination of an arch bar plus a lingual splint, circum-mandibular wiring and IMF for the reduction, stabilization and fixation of a severely displaced bilateral man‌dibular body fracture. This technique is a reliable, noninvasive procedure; it also limits the discomfort and morbidity associated with maxillomandibular fixation or open reduction and internal fixation in pediatric patients

  6. Comparing hospital outcomes between open and closed tibia fractures treated with intramedullary fixation.

    Science.gov (United States)

    Smith, Evan J; Kuang, Xiangyu; Pandarinath, Rajeev

    2017-07-01

    Tibial shaft fractures comprise a large portion of operatively treated long bone fractures, and present with the highest rate of open injuries. Intramedullary fixation has become the standard of care for both open and closed injuries. The rates of short term complications and hospital length of stay for open and closed fractures treated with intramedullary fixation is not fully known. Previous series on tibia fractures were performed at high volume centers, and data were not generalizable, further they did not report on length of stay and the impact of preoperative variables on infections, complications and reoperation. We used a large surgical database to compare these outcomes while adjusting for preoperative risk factors. Data were extracted from the ACS-NSQIP database from 2005 to 2014. Cases were identified based on CPT codes for intramedullary fixation and categorized as closed vs open based on ICD9 code. In addition to demographic and case data, primary analysis examined correlation between open and closed fracture status with infection, complications, reoperation and hospital length of stay. Secondary analysis examined preoperative variables including gender, race, age, BMI, and diabetes effect on outcomes. There were 272 cases identified. There were no significant demographic differences between open and closed tibia fracture cases. Open fracture status did not increase the rate of infection, 30day complications, reoperation, or length of stay. The only preoperative factor that correlated with length of stay was age. There was no correlation between BMI, presence of insulin dependent and nondependent diabetes, and any outcome measure. When considering the complication rates for open and closed tibial shaft fractures treated with intramedullary fixation, there is no difference between 30-day complication rate, length of stay, or return to the operating room. Our reported postoperative infection rates were comparable to previous series, adding validity to

  7. Comparison of Short vs Long Anti-rotation in Treating Trochanteric Fractures

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    Raval P

    2016-03-01

    Full Text Available Introduction: A comparative evaluation of the surgical treatment and outcome of patients with pertrochanteric fractures treated with short versus long proximal femoral nail antirotation. Materials and methods: A retrospective review was conducted of patients with pertrochanteric fractures treated between January 2011 and June 2012. In all 80 patients were enrolled in the study, of which 40 were treated with short PFNA and the remaining with long PFNA. Comparative analyses of demographic data, peri-operative outcome and complications were carried out. Results: There was no significant difference noted in the two groups with regards to Arbeitsgemeinschaft fur Osteosynthesefragen (AO fracture classification, time from injury to surgery, blood transfusion post surgery and hospital stay. The surgical duration for a short PFNA procedure was significantly less (58 minutes when compared to that of a long PFNA (87 minutes. Similarly intra-operative blood loss was significantly higher in the long PFNA group as compared to the short PFNA. Conclusions: A relatively quicker surgical time of just under an hour , lesser blood loss and better learning curve with trainee surgeons make short PFNA a better implant choice in the treatment of pertrochanteric fractures.

  8. Comparing two intramedullary devices for treating trochanteric fractures: A prospective study

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    Kontogeorgakos Vasileios

    2010-02-01

    Full Text Available Abstract Background Intertrochanteric fractures are surgically treated by using different methods and implants. The optional type of surgical stabilization is still under debate. However, between devices with the same philosophy, different design characteristics may substantially influence fracture healing. This is a prospective study comparing the complication and final functional outcome of two intramedullary devices, the intramedullary hip screw (IMHS and the ENDOVIS nail. Materials and methods Two hundred fifteen patients were randomized on admission in two treatment groups. Epidemiology features and functional status was similar between two treatment groups. Fracture stability was assessed according to the Evan's classification. One hundred ten patients were treated with IMHS and 105 with ENDOVIS nail. Results There were no significant statistical differences between the two groups regarding blood loss, transfusion requirements and mortality rate. In contrast, the number of total complications was significantly higher in the ENDOVIS nail group. Moreover, the overall functional and walking competence was superior in the patients treated with the IMHS nail. Conclusions These results indicate that the choice of the proper implant plays probably an important role in the final outcome of surgical treatment of intertrochanteric fractures. IMHS nail allows for accurate surgical technique, for both static and dynamic compression and high rotational stability. IMHS nail proved more reliable in our study regarding nail insertion and overall uncomplicated outcome.

  9. Displaced trochanteric fragments lead to poor functional outcome in pertrochanteric fractures treated by cephalomedullary nails.

    Science.gov (United States)

    Studer, Patrick; Suhm, Norbert; Wang, Qing; Rosenthal, Rachel; Saleh, Hatem Al-Fadel; Jakob, Marcel

    2015-12-01

    The importance of the greater trochanter and its attached abductor muscles for physiological gait is well accepted. However the influence of a displaced greater trochanter fracture after a pertrochanteric fracture is unknown. The aim of this study is to determine if there is an association between the greater trochanter position and the level of patient mobility following internal fixation of pertrochanteric fractures. One hundred and thirty-three consecutive elderly patients with a median age of 85 (interquartile range [IQR] 79-91) years, who were treated for pertrochanteric fractures at a level I trauma centre, were recruited. AO 31 A3.1 and A3.2 fracture types were excluded from the statistical analysis. Patient mobility was prospectively assessed before the fracture and one year following fracture treatment using the Parker mobility score. In a multivariable analysis, the influence of a displaced greater trochanter on patient mobility at one-year follow-up was assessed. The analysis was adjusted for age, gender, body mass index, Charlson comorbidity index, AO fracture classification, varus-/valgus malposition of the neck-shaft fragments, and Parker mobility score before fracture. Post-operative X-rays were available in 125 patients, out of which 66 (53%) patients were identified with a displaced or migrated greater trochanter. One year mortality rate was 22% (n=27). In the 82 patients who had functional assessment one year post-operatively, the median Parker mobility score before fracture and at one-year follow-up was 7 (IQR 4-9) and 7 (IQR 3-9) in patients without, and 7 (IQR 4-9) and 3 (IQR 2-5) in patients with a displaced greater trochanter. In multivariable analysis, a displaced greater trochanter was significantly associated with a lower Parker mobility score (-1.74, 95% confidence interval -2.37, -1.12, pfractures with a cephalomedullary nail is associated with a poor functional outcome. Greater attention to achieve adequate reduction and stabilisation

  10. 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.

  11. Computed tomography of thoracic and lumbar spine fractures that have been treated with Harrington instrumentation

    International Nuclear Information System (INIS)

    Golimbu, C.; Firooznia, H.; Rafii, M.; Engler, G.; Delman, A.

    1984-01-01

    Twenty patients with fractures of the thoracic and lumbar spine underwent computed tomography (CT) following Harrington distraction instrumentation and a spinal fusion. CT was done to search for a cause of persistent cord or nerve root compression in those patients who failed to improve and completely recover their partial neurologic deficit (14 cases). The most common abnormality was the presence of residual bone fragments originating in the burst fracture of a vertebral body displaced posteriorly, into the spinal canal. In patients with complications in the late recovery period, CT found exuberant callus indenting the canal or lack of fusion of the bone grafts placed in the anterolateral aspect of the vertebral bodies. This experience indicates that CT is the modality of choice for spinal canal evaluation in those patients who fail to have an optimal clinical course following fractures of the thoracic and lumbar spine treated with Harrington rods

  12. [Pedicle flap transfer combined with external fixator to treat leg open fracture with soft tissue defect].

    Science.gov (United States)

    Luo, Zhongchun; Lou, Hua; Jiang, Junwei; Song, Chunlin; Gong, Min; Wang, Yongcai

    2008-08-01

    To investigate the clinical results of treating leg open fracture with soft tissue defect by pedicle flap transfer in combination with external fixator. From May 2004 to June 2007, 12 cases of leg open fracture with soft tissue defect, 9 males and 3 females aged 18-75 years, were treated. Among them, 8 cases were caused by traffic accidents, 2 crush, 1 falling and 1 mechanical accident. According to the Gustilo Classification, there were 2 cases of type II, 5 of type IIIA and 5 of type IIIB. There were 2 cases of upper-tibia fracture, 3 of middle-tibia and 7 of middle-lower. The sizes of soft tissue defect ranged from 5 cm x 3 cm to 22 cm x 10 cm.The sizes of exposed bone ranged from 3 cm x 2 cm to 6 cm x 3 cm. The course of the disease was 1-12 hours. Fracture fixation was reached by external fixators or external fixators and limited internal fixation with Kirschner wire. The wounds with exposed tendons and bones were repaired by ipsilateral local rotation flap, sural neurocutaneous flap and saphenous nerve flap. The size of selected flap ranged from 5 cm x 4 cm to 18 cm x 12 cm. Granulation wounds were repaired by skin grafting or direct suture. All patients were followed up for 6 months to 2 years. All patients survived, among whom 2 with the wound edge infection and 1 with the distal necrosis were cured by changing the dressing, 8 with pin hole infection were treated by taking out the external fixator, 1 with nonunion received fracture healing after bone graft in comminuted fracture of lower tibia, 2 suffered delayed union in middle-lower tibia fracture. The ROM of ankle in 3 cases was mildly poor with surpass-joint fixation, with plantar extension of 0-10 degrees and plantar flexion of 10-30 degrees, while the others had plantar extension of 10-20 degrees and plantar flexion of 30-50 degrees. The method of pedicle flap transfer combined with external fixator is safe and effective for the leg open fracture with soft tissue defect.

  13. Outcomes of trochanteric femoral fractures treated with proximal femoral nail: an analysis of 100 consecutive cases.

    Science.gov (United States)

    Korkmaz, Mehmet Fatih; Erdem, Mehmet Nuri; Disli, Zeliha; Selcuk, Engin Burak; Karakaplan, Mustafa; Gogus, Abdullah

    2014-01-01

    In this study, we aimed to report the results of a retrospective study carried out at our institute regarding cases of patients who had suffered proximal femoral fractures between January 2002 and February 2007, and who were treated with a proximal femoral nail. One hundred consecutive cases were included in the study. A case documentation form was used to obtain intraoperative data including age, sex, mechanism of injury, type of fracture according to Association for Osteosynthesis/Association for the Study of Internal Fixation (AO/ASIF) classification and the American Society of Anesthesiologists' (ASA) physical status classification (ASA grade). Clinical and radiographic examinations were performed at the time of admission and at the 6th week; subsequent visits were organized on the 3rd month, 6th month, and 12th month, and in patients with longer follow-up and annually postoperatively. The Harris score of hip function was used, and any change in the position of the implants and the progress of the fracture union, which was determined radiologically, was noted. The mean age of the patients was 77.66 years (range: 37-98 years), and the sex distribution was 32 males and 68 females. Seventy-three fractures were reduced by closed means, whereas 27 needed limited open reduction. The mean follow-up time for the study group was 31.3 months (range: 12-75 months). Postoperative radiographs showed a near-anatomical fracture reduction in 78% of patients. The Harris hip score was negatively correlated with the ASA score and patient age. No cases of implant failure were observed. Three patients died before discharge (one due to pulmonary embolism, two due to cardiac arrest), and five patients died due to unrelated medical conditions within the first 3 months of the follow-up. Our study showed that proximal femoral nail is a reliable fixation with good fracture union, and it is not associated with major complications in any type of trochanteric femoral fracture.

  14. [Effects of Surgically Treated Pelvic Ring and Acetabular Fractures on Postural Control].

    Science.gov (United States)

    Lang, P; Schnegelberger, A; Riesner, H-J; Stuby, F; Friemert, B; Palm, H-G

    2016-04-01

    The aim of surgical treatment of pelvic ring and acetabular fractures is to allow rapid mobilisation of patients in order to restore stance and gait stability (postural control), as this significantly correlates with a positive outcome. The regulation of postural stability is mainly controlled by transmission of proprioceptive stimuli. In addition, the pelvis serves as a connection between the legs and the spine and thus is also of great importance for mechanical stabilisation. It remains unclear whether surgical treatment of pelvic ring and acetabular fractures affects the regulation of postural control. Therefore, the aim of this study was to examine the impact of surgically treated pelvic ring and acetabular fractures on postural stability by means of computerised dynamic posturography (CDP) after a mean of 35 months and to compare the results with a healthy control group. A retrospective case control study of 38 patients with surgically treated pelvic ring and acetabular fractures and 38 healthy volunteers was carried out using CDP. The average time of follow-up was 35 (12-78) months. The most important outcome parameter in this investigation was the overall stability index (OSI). Hip joint mobility, the health-related quality of life (SF-12) and pain were supplementary outcome parameters. It was found that surgically treated pelvic ring and acetabular fractures had no influence on postural stability. The OSI was 2.1 ° in the patient group and 1.9 ° in the control group. There was no significant difference between the groups in hip joint mobility. A total of 52 % of patients showed no or only mild pain. Mean health-related quality of life was the same as in the total population. Surgically treated pelvic ring and acetabular fractures do not lead to deterioration in postural control in the mid term. This is of high prognostic importance for rapid mobilisation of the patients. Therefore no increase in the risk of falling is expected after successfully

  15. Multidisciplinary Portuguese recommendations on DXA request and indication to treat in the prevention of fragility fractures.

    Science.gov (United States)

    Marques, Andréa; Rodrigues, Ana M; Romeu, José Carlos; Ruano, Afonso; Barbosa, Ana Paula; Simões, Eugénia; Águas, Fernanda; Canhão, Helena; Alves, José Delgado; Lucas, Raquel; Branco, Jaime Cunha; Laíns, Jorge; Mascarenhas, Mário; Simões, Susete; Tavares, Viviana; Lourenço, Oscar; da Silva, José António Pereira

    2016-01-01

    To establish Portuguese recommendations regarding the indication to perform DXA and to initiate medication aimed at the prevention of fragility fractures. A multidisciplinary panel, representing the full spectrum of medical specialties and patient associations devoted to osteoporosis, as well as national experts in this field and in health economics, was gathered to developed recommendations based on available evidence and expert consensus. Recently obtained data on the Portuguese epidemiologic, economic and quality-of-life aspects of fragility fractures were used to support decisions. 10 recommendations were developed covering the issues of whom to investigate with DXA and whom to treat with antifracture medications. Thresholds for assessment and intervention are based on the cost-effectiveness analysis of interventions at different thresholds of ten-year probability of osteoporotic fracture, calculated with the Portuguese version of FRAX® (FRAX®Port), and taking into account Portuguese epidemiologic and economic data. Limitations of FRAX® are highlighted and guidance for appropriate adjustment is provided, when possible. Cost-effectiveness thresholds for DXA examination and drug intervention aiming at fragility fracture prevention are now provided for the Portuguese population. These are practical, based on national epidemiological and economic data, evidence-based and supported by a wide scope multidisciplinary panel of experts and scientific societies. Implementation of these recommendations holds great promise in assuring the most effective use of health resources in the prevention of osteoporotic fractures in Portugal.

  16. In vitro fracture resistance of endodontically treated central incisors with varying ferrule heights and configurations.

    Science.gov (United States)

    Tan, Philip L B; Aquilino, Steven A; Gratton, David G; Stanford, Clark M; Tan, Swee Chian; Johnson, William T; Dawson, Deborah

    2005-04-01

    The in vitro effectiveness of a uniform circumferential ferrule has been established in the literature; however, the effect of a nonuniform circumferential ferrule height on fracture resistance is unknown. This in vitro study investigated the resistance to static loading of endodontically treated teeth with uniform and nonuniform ferrule configurations. Fifty extracted intact maxillary human central incisors were randomly assigned to 1 of 5 groups: CRN, no root canal treatment (RCT), restored with a crown; RCT/CRN, no dowel/core, restored with a crown; 2 FRL, 2-mm ferrule, cast dowel/core and crown; 0.5/2 FRL, nonuniform ferrule (2 mm buccal and lingual, 0.5 mm proximal), cast dowel/core and crown; and 0 FRL, no ferrule, cast dowel/core and crown. The teeth were prepared to standardized specifications and stored for 72 hours in 100% humidity prior to testing. Testing was conducted with a universal testing machine with the application of a static load, and the load (N) at failure was recorded. Statistical analysis was performed with a 1-way analysis of variance and the Tukey Honestly Significant Difference test (alpha=.05). The mode of fracture was noted by visual inspection for all specimens. There was strong evidence of group differences in mean fracture strength ( P <.0001). Following adjustment for all pairwise group comparisons, it was found that the lack of a ferrule resulted in a significantly lower mean fracture strength (0 FRL: 264.93 +/- 78.33 N) relative to all other groups. The presence of a nonuniform (0.5 to 2-mm vertical height) ferrule (0.5/2 FRL: 426.64 +/- 88.33 N) resulted in a significant decrease ( P =.0001) in mean fracture strength when compared with the uniform 2-mm vertical ferrule (2 FRL: 587.23 +/- 110.25 N), the group without RCT (CRN: 583.67 +/- 86.09 N), and the RCT-treated tooth with a crown alone (CRN/RCT: 571.04 +/- 154.86 N). The predominant mode of failure was an oblique fracture extending from the lingual margin to the facial

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

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

    2016-01-15

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

  18. Functional outcome of Schatzker type V and VI tibial plateau fractures treated with dual plates

    Directory of Open Access Journals (Sweden)

    G Thiruvengita Prasad

    2013-01-01

    Full Text Available Background: Dual plate fixation in comminuted bicondylar tibial plateau fractures remains controversial. Open reduction and internal fixation, specifically through compromised soft tissues, has historically been associated with major wound complications. Alternate methods of treatment have been described, each with its own merits and demerits. We performed a retrospective study to evaluate the functional outcome of lateral and medial plate fixation of Schatzker type V and VI fractures through an anterolateral approach, and a medial minimally invasive approach or a posteromedial approach. Materials and Methods: We treated 46 tibial plateau fractures Schatzker type V and VI with lateral and medial plates through an anterolateral approach and a medial minimal invasive approach over an 8 years period. Six patients were lost to followup. Radiographs in two planes were taken in all cases. Immediate postoperative radiographs were assessed for quality of reduction and fixation. The functional outcome was evaluated according to the Oxford Knee Score criteria on followup. Results: Forty patients (33 men and 7 women who completed the followup were included in the study. There were 20 Schatzker type V fractures and 20 Schatzker type VI fractures. The mean duration of followup was 4 years (range 1-8 years. All patients had a satisfactory articular reduction defined as ≤2 mm step-off or gap as assessed on followup. All patients had a good coronal and sagittal plane alignment, and articular width as assessed on supine X-rays of the knee in the anteroposterior (AP and lateral views. The functional outcome, as assessed by the Oxford Knee Score, was excellent in 30 patients and good in 10 patients. All patients returned to their pre-injury level of activity and employment. There were no instances of deep infection. Conclusions: Dual plate fixation of severe bicondylar tibial plateau fractures is an excellent treatment option as it provides rigid fixation and

  19. [Clinical experience with various techniques integrated treat the wounded with gunshot fractures of limbs].

    Science.gov (United States)

    Kozlov, V K; Akhmedov, B G; Chililov, A M

    To increase an efficiency of complex treatment of patients with diaphyseal gunshot fractures of long bones by introduction of modern minimally invasive surgical techniques of internal osteosynthesis into clinical practice of civil health care and to improve the outcomes in victims. Prospective comparative clinical trial included 104 victims from the Republic of Yemen with gunshot wounds of limbs of various severity for the period 2009-2011. There were diaphyseal fractures of long bones of limbs associated with soft tissue injuries. Men were predominant (80.7%). Age ranged from 15 to 80 years (mean 38,5 ± 5,7 years). Various surgical techniques of simultaneous and staged treatment were used for gunshot fractures of long bones of limbs. Additional immune therapy was prescribed to prevent infectious complications in the most severe cases. Victims were comprehensively treated according to different staged treatment: conventional surgical treatment with external fixation devices or early primary minimally invasive functionally stable osteosynthesis with LCP/BIOS plates were applied for low-energy fractures; in case of high-energy fractures the first stage included external fixation devices deployment followed by their subsequent replacement during delayed minimally invasive osteosynthesis. The essence of improvement is pursuit to simultaneous minimally invasive surgery by using of current plates for osteosynthesis and preventive immunotherapy of immune dysfunction to eliminate infectious complications. As a result, we obtained 2-fold decrease of surgical invasiveness (r≤0,01) and hospital-stay (r≤0,01). Repeated osteosynthesis was not made. Also 4-fold and 40-fold reduction of infectious and noninfectious complications was observed. This management was accompanied by reduced rehabilitation tine and significantly improved quality of life. Improved technique and algorithm of complex treatment of diaphyseal gunshot fractures of long bones of limbs were described

  20. Fracture of the medial intercondylar eminence of the tibia in horses treated by arthroscopic fragment removal (21 horses)

    OpenAIRE

    Rubio‐Martínez, L. M.; Redding, W. R.; Bladon, B.; Wilderjans, H.; Payne, R. J.; Tessier, C.; Geffroy, O.; Parker, R.; Bell, C.; Collingwood, F. A.

    2017-01-01

    Summary Background Fractures of the medial intercondylar eminence of the tibia (MICET) are scarcely reported in horses. Objectives To report the clinical and diagnostic findings, surgical treatment and outcome in a series of horses presented with MICET fracture and treated with arthroscopic fragment removal. Study design Multicentre retrospective case series. Methods Case records of horses diagnosed with MICET fractures that had undergone surgical treatment were reviewed. Follow‐up informatio...

  1. Fracture resistance of endodontically-treated teeth: effect of combination bleaching and an antioxidant.

    Science.gov (United States)

    Khoroushi, Maryam; Feiz, Atieh; Khodamoradi, Roghayeh

    2010-01-01

    This in vitro study assessed the fracture resistance of endodontically-treated teeth undergoing combination bleaching with 38% and 9.5% hydrogen peroxide gels as in-office and at-home bleaching techniques, respectively. In addition, the effect of an antioxidizing agent, sodium ascorbate, was investigated. Sixty maxillary premolars were endodontically-treated, received a glass ionomer barrier as a mechanical seal and were embedded in acrylic resin up to the cemento-enamel junction. The specimens were divided into four groups (n = 15) as follows: G I: no bleaching, access cavity restored with resin composite (negative control); G II: bleached for three weeks daily using 9.5% hydrogen peroxide for two hours and three sessions of in-office bleaching using 38% hydrogen peroxide every seven days, then restored (positive control); G III: bleached similar to G II and restored after one week; G IV: bleached similar to G II, along with the use of an antioxidizing agent for 24 hours, then restored. In each in-office and at-home bleaching session, the whitening gels were applied to the buccal surface of the tooth and placed inside the pulp chamber (inside/outside bleaching technique). Finally, the specimens underwent fracture resistance testing; the data were analyzed using ANOVA and Scheffé's test (alpha = 0.05). Significant differences were observed among the study groups (p 0.05). Within the limitations of the current study, it can be concluded that the fracture resistance of endodontically-treated teeth decreases after combination bleaching. The use of sodium ascorbate can reverse decreased fracture resistance.

  2. The clinical application of absorbable intramedullary nail and claw plate on treating multiple rib fractures.

    Science.gov (United States)

    Chai, X; Lin, Q; Ruan, Z; Zheng, J; Zhou, J; Zhang, J

    2013-08-01

    The absorption intramedullary nail and claw plate indications and efficacy were investigated in the treatment of a life-threatening multiple rib fractures. A retrospective analysis of 248 surgically treated rib fracture patients was performed who admitted to our hospital from March 2007 to December 2012. Intramedullary nailing was performed in 28 cases, a claw-type bone plate was fixed in 141 cases, and a combination of both was fixed in 79 cases. All internal fixation patients were clinically cured except 1 patient died 14 days after a massive pulmonary embolism. The patients with flail chest and floating chest wall causing respiratory and circulatory disorders were promptly corrected. Routine follow-up was from 1 to 2 years, displaced fractures were in 2 cases, and there were 11 cases of internal fixation and extraction. Internal fixation is a simple and reliable method for the treatment of multiple rib fractures. Both internal fixation materials have their pros and cons but the claw bone plate is more robust. The actual selection of appropriate treatment options helps to improve the treatment efficacy.

  3. Fractures and Osteomalacia in a Patient Treated With Frequent Home Hemodialysis.

    Science.gov (United States)

    Hanudel, Mark R; Froch, Larry; Gales, Barbara; Jüppner, Harald; Salusky, Isidro B

    2017-09-01

    Bone deformities and fractures are common consequences of renal osteodystrophy in the dialysis population. Persistent hypophosphatemia may be observed with more frequent home hemodialysis regimens, but the specific effects on the skeleton are unknown. We present a patient with end-stage renal disease treated with frequent home hemodialysis who developed severe bone pain and multiple fractures, including a hip fracture and a tibia-fibula fracture complicated by nonunion, rendering her nonambulatory and wheelchair bound for more than a year. A bone biopsy revealed severe osteomalacia, likely secondary to chronic hypophosphatemia and hypocalcemia. Treatment changes included the addition of phosphate to the dialysate, a higher dialysate calcium concentration, and increased calcitriol dose. Several months later, the patient no longer required a wheelchair and was able to ambulate without pain. Repeat bone biopsy revealed marked improvements in bone mineralization and turnover parameters. Also, with increased dialysate phosphate and calcium concentrations, as well as increased calcitriol, circulating fibroblast growth factor 23 levels increased. Copyright © 2017 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  4. Outcomes of trochanteric femoral fractures treated with proximal femoral nail: an analysis of 100 consecutive cases

    Directory of Open Access Journals (Sweden)

    Korkmaz MF

    2014-04-01

    Full Text Available Mehmet Fatih Korkmaz,1 Mehmet Nuri Erdem,2 Zeliha Disli,3 Engin Burak Selcuk,4 Mustafa Karakaplan,1 Abdullah Gogus5 1Department of Orthopedics and Traumatology, Inonu University School of Medicine, Malatya, Turkey; 2Department of Orthopedics and Traumatology, Nisantasi University School of Medicine, Istanbul, Turkey; 3Department of Anesthesiology, Malatya Government Hospital, Malatya, Turkey; 4Department of Family Medicine, Inonu University School of Medicine, Malatya, Turkey; 5Department of Orthopedics and Traumatology, Florence Nightingale Hospital, Istanbul, Turkey Purpose: In this study, we aimed to report the results of a retrospective study carried out at our institute regarding cases of patients who had suffered proximal femoral fractures between January 2002 and February 2007, and who were treated with a proximal femoral nail. Materials and methods: One hundred consecutive cases were included in the study. A case documentation form was used to obtain intraoperative data including age, sex, mechanism of injury, type of fracture according to Association for Osteosynthesis/Association for the Study of Internal Fixation (AO/ASIF classification and the American Society of Anesthesiologists' (ASA physical status classification (ASA grade. Clinical and radiographic examinations were performed at the time of admission and at the 6th week; subsequent visits were organized on the 3rd month, 6th month, and 12th month, and in patients with longer follow-up and annually postoperatively. The Harris score of hip function was used, and any change in the position of the implants and the progress of the fracture union, which was determined radiologically, was noted. Results: The mean age of the patients was 77.66 years (range: 37–98 years, and the sex distribution was 32 males and 68 females. Seventy-three fractures were reduced by closed means, whereas 27 needed limited open reduction. The mean follow-up time for the study group was 31.3 months (range

  5. The functional outcome of surgically treated unstable pelvic ring fractures by open reduction, internal fixation

    Directory of Open Access Journals (Sweden)

    Kaykhosro Mardanpour

    2011-07-01

    Full Text Available Background:Unstable Pelvic fracture,a result of high energy antero-posterior compression injury, has been managed based on internal fixation and open reduction. The mode of fixation in Unstable Pelvic fracture has, however, been a subject of controversy and some authors have proposed a need to address the issue of partial breach of the pelvic ring elements in these injuries. This study was performed to evaluate the functional and radiological results of treatment of pelvic ring fractures by open reduction, internal fixation. Methods: Thirty eight patients with unstable pelvic fractures, treated from 2002 to2008 were retrospectively reviewed. The mean age of patients’ was 37 years old (range 20 to 67. Twenty six patients were men and 12 women. The most common cause was a road traffic accident (N=37, 97%. There were 11 type-C and 27 type-B fractures according to Tile’s classification. Thirty six patients sustained additional injuries. The most prevalent additional injuries were lower extremity fractures. Open reduction, internal fixation as a definite management was applied for all patients. Quality of reduction was graded according to the grades proposed by Matta and Majeed’s score was used to assess the clinical outcome. The mean period of follow-up was 25 months (ranged from 6 to 109 months. About 81.6% of patients had either good or excellent radiological reduction. Results: The functional outcome was excellent in 66%, good in 15%, fair in 11% and poor in 7% of the patients. There were 4 postoperative infections. No sexual function problem was reported. Nerve deficits recovered completely in 2 and partially in 3 of 11 patients with preoperative neurologic deficiency. There was no significant relation between functional outcome and the site of fracture Conclusion: Unstable pelvic ring fracture injuries should be managed surgically by rigid stabilization that must be carried out as soon as the general ndition of the patient permits, and

  6. Resistance of Bonded Composite Restorations on Fractures of Endodontically Treated Teeth

    Directory of Open Access Journals (Sweden)

    AR Daneshkazemi

    2005-01-01

    Full Text Available Introduction: This study was performed to evaluate the effect of dentine bonding agents and Glass Ionomer cement beneath composite restorations and its resistance on fractures of endodontically treated teeth. Material and Methods: Forty sound maxillary teeth were selected; ten of them for positive control, and on the rest, RCT and MOD cavity preparations were done with standard methods. Then, the teeth were divided to four groups: 1-Sound teeth for positive control. 2-Prepared without any restoration for negative control. 3-Prepared and restored with Vitrabond(3M, USA, Single bond(3M, USA and Z100(3M, USA resin composite. 4-Prepared and restored by Single bond and Z100 resin composite. Specimens were subjected to compressive load by Instron 8502 until fracture occurred. Results: Group 1 showed the highest resistance to compressive forces followed by group 4,3&2 respectively. ANOVA, t test and Chi-square tests indicated significant difference between all the groups. Conclusion: Use of dentine bonding agents and resin composite increases resistance of endodontically treated teeth to fractures more than teeth restored with sandwich of glass ionomer cements, dentine bonding agents and resin composite.

  7. Impact of attention deficit hyperactivity disorder therapy on fracture risk in children treated in German pediatric practices.

    Science.gov (United States)

    Jacob, L; Kostev, K

    2017-04-01

    Two thousand eight hundred ninety-four children and adolescents treated by 243 pediatricians were analyzed. Patients receiving attention deficit hyperactivity disorder (ADHD) medications were at a lower risk of fractures than patients without ADHD medications. The strongest impact was in the age group of 6-9 years. Finally, there was a significant association between therapy duration and fracture risk. The aim of this study was to analyze the impact of ADHD therapy on fracture risk in children treated by German pediatricians. Children and adolescents initially diagnosed with ADHD and fractures between 2010 and 2015 were identified by 243 pediatricians. In this nested case-control study, each ADHD case with a fracture was matched (1:1) to an ADHD control without a fracture for age, gender, index year, and physician. In total, 2894 individuals were available for analysis. The main outcome of the study was the risk of fracture as a function of ADHD therapy. Multivariate logistic regression models were created to determine the effect of ADHD therapy on the risk of fracture in the entire population and in three age-specific subgroups. Patients receiving ADHD medications were at a lower risk of fracture than patients without ADHD medications (OR = 0.61). The impact of ADHD therapy on the risk of fracture was stronger in the age group of 6-9 years (OR = 0.41) than in the age groups of 10-13 years (OR = 0.68) and 14-17 years (OR = 0.74). Finally, a significant correlation was found between therapy duration and fracture risk (OR = 0.71 per month). ADHD therapy was associated with a decrease in the risk of fracture in children and adolescents treated by German pediatricians.

  8. Predictors for perioperative blood transfusion in elderly patients with extra capsular hip fractures treated with cephalo-medullary nailing

    Directory of Open Access Journals (Sweden)

    M. Ali Fazal

    2018-02-01

    Conclusion: Patient age, ASA grade, preoperative haemoglobin and length of nail are reliable predictors for perioperative blood transfusion in extra capsular hip fractures in elderly patients treated with cephalo-medullary nailing and reinforce a selective transfusion policy.

  9. Comparison of Outcomes of Operatively Treated Bicondylar Tibial Plateau Fractures by External Fixation and Internal Fixation

    Directory of Open Access Journals (Sweden)

    CC Chan

    2012-03-01

    Full Text Available The outcome of bicondylar tibial plateau fractures treated with either external fixation (35 patients or internal fixation (24 patients was reviewed. Outcome measures included the Rasmussen score, clinical complications, development of osteoarthritis and the requirement for total knee replacement (TKR. Twenty-two (92% anatomical reductions were achieved in the internal fixation group compared to 27 (77% in the external fixation group. Infective complications were more common in the external fixation group (9 patients, 26% due to pin tract infection. There were no deep infections in the internal fixation group. The mean Rasmussen score was not significantly different (mean score 32 in external fixation and 29 in internal fixation between the two groups and the incidence of osteoarthritis was the same in both groups. Four patients in the external fixation group underwent a TKR compared to 5 patients in the internal fixation group. Bicondylar tibial plateau fractures have similar outcomes following external or internal fixation.

  10. Promising Effect Of Intraarticular Ropivacaine In Femoral Neck Fractures Treated With Internal Fixation (Best Poster Award)

    DEFF Research Database (Denmark)

    Bech, Rune Dueholm

    2008-01-01

     Promising Effect Of Intraarticular Ropivacaine In Femoral Neck Fractures Treated With Internal Fixation Rune Bech*, Jens Lauritsen*+,Tine Dimon*, Ole Ovesen*, Claus Emmeluth, Søren Overgaard*. *:Dept. Ortopaedic Surgery, Odense University Hospital, +:Institute of Public Health-dept. biostatistics...... underwent osteosynthesis with 2 canulated hip screws and were prescribed regular paracetamol and supplementary opioid rescue analgesia as necessary. Pilot group: 11 patients received one peroperative (30 mL=100 mg) and 6 postoperative bolus installations  (10 mL=100 mg) of open label Ropivacaine through......-74) (p=0.012).   CONCLUSION This pilot-study suggests that intraarticular application of Ropivacaine may reduce opioid requirement after osteosynthesis of femoral neck fracture. However, this is an open pilot study with few patients. We find the results promising and have initiated a double...

  11. The effect of canal fill on paediatric femur fractures treated with titanium elastic nails.

    Science.gov (United States)

    Nielsen, E; Bonsu, N; Andras, L M; Goldstein, R Y

    2018-02-01

    Traditional teaching for fixation of paediatric femur fractures recommends 80% nail diameter/medullary canal diameter ratio (ND/MCD) for successful maintenance of reduction. Prior studies have investigated this with stainless steel Enders nails. Our aim was to assess the impact of ND/MCD on maintenance of reduction and malunion rates in paediatric femur fractures treated with flexible intramedullary nails (FINs). Retrospective data was collected on all paediatric patients treated with FINs for diaphyseal femur fractures at a single tertiary care institution over a ten-year period. Patients with co-morbidities affecting bone quality were excluded. Patients were subdivided into groups based on ND/MCD. A total of 66 patients met inclusion criteria. Mean ND/MCD was 76.3% (32.9% to 98.8%, SD 14.3). In all, 50% (n = 33/66) of patients had > 80% ND/MCD, and only 13.6% (n = 9/66) of patients had less than 60% ND/MCD. When controlling for fracture stability, ND/MCD had no correlation with mean shortening (p = 0.07) There was no correlation between ND/MCD and angulation in the sagittal (p = 0.96) or coronal plane (p = 0.20). Three patients fit malunion criteria. ND/MCD for these patients were 40%, 67% and 79%. There was no correlation between ND/MCD and shortening or malangulation. The majority of patients in this series with less than 80% fill with FIN healed within acceptable parameters. III.

  12. Should fractures in massive intercalary bone allografts of the lower limb be treated with ORIF or with a new allograft?

    Science.gov (United States)

    Aponte-Tinao, Luis A; Ayerza, Miguel A; Muscolo, D Luis; Farfalli, Germán L

    2015-03-01

    Massive bone allografts have been used for limb salvage of bone tumor resections as an alternative to endoprostheses, although they have different outcomes and risks. There is no general consensus about when to use these alternatives, but when it is possible to save the native joints after the resection of a long bone tumor, intercalary allografts offer some advantages despite complications, such as fracture. The management and outcomes of this complication deserve more study. The purposes of this study were to (1) analyze the fracture frequency in a group of patients treated with massive intercalary bone allografts of the femur and tibia; (2) compare the results of allografts treated with open reduction and internal fixation (ORIF) with those treated with resection and repeat allograft reconstruction; and (3) determine the likelihood that treatment of a fracture resulted in a healed intercalary reconstruction. We reviewed patients treated with intercalary bone allografts between 1991 and 2011. During this period, patients were generally treated with intercalary allografts when after tumor resection at least 1 cm of residual epiphysis remained to allow fixation of the osteotomy junction. To obtain a homogeneous group of patients, we excluded allograft-prosthesis composites and osteoarticular and hemicylindrical intercalary allografts from this study. We analyzed the fracture rate of 135 patients reconstructed with segmental intercalary bone allografts of the lower extremities (98 femurs and 37 tibias). In patients whose grafts fractured were treated either by internal fixation or a second allograft, ORIF generally was attempted but after early failures in femur fractures, these fractures were treated with a second allograft. Using a chart review, we ascertained the frequency of osseous union, complications, and reoperations after the treatment of fractured intercalary allografts. Followup was at a mean of 101 months (range, 24-260 months); of the original 135

  13. Long-term outcome of pronation-external rotation ankle fractures treated with syndesmotic screws only.

    Science.gov (United States)

    Lambers, Kaj T A; van den Bekerom, Michel P J; Doornberg, Job N; Stufkens, Sjoerd A S; van Dijk, C Niek; Kloen, Peter

    2013-09-04

    There is sparse information in the literature on the outcome of Maisonneuve-type pronation-external rotation ankle fractures treated with syndesmotic screws. The primary aim of this study was to determine the long-term results of such treatment of these fractures as indicated by standardized patient-based and physician-based outcome measures. The secondary aim was to identify predictors of the outcome with use of bivariate and multivariate statistical analysis. Fifty patients with pronation-external rotation (predominantly Maisonneuve) fractures were treated with open reduction and internal fixation of the syndesmosis utilizing only one or two screws. The results were evaluated at a mean of twenty-one years after the fracture utilizing three standardized outcomes instruments: (1) the Foot and Ankle Ability Measure (FAAM), (2) the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale, and (3) the Center for Epidemiologic Studies-Depression (CES-D) Scale. Osteoarthritis was graded according to the van Dijk and revised Takakura radiographic scoring systems. Bivariate and multivariate analyses were performed to identify predictors of long-term outcome. Forty-four (92%) of forty-eighty patients had good or excellent AOFAS scores, and forty-four (90%) of forty-nine had good or excellent FAAM scores. Arthrodesis for severe osteoarthritis was performed in two patients. Radiographic evidence of osteoarthritis was observed in twenty-four (49%) of forty-nine patients. Multivariate analysis identified pain as the most important independent predictor of long-term ankle function as indicated by the AOFAS and FAAM scores, explaining 91% and 53% of the variation in scores, respectively. Analysis of pain as the dependent variable in bivariate analyses revealed that depression, ankle range of motion, and a subsequent surgery were significantly correlated with higher pain scores. No firm conclusions could be drawn after multivariate analysis of predictors of pain

  14. MR imaging of occult fractures of the knee

    International Nuclear Information System (INIS)

    Mink, J.H.; Deutsch, A.L.

    1988-01-01

    The authors encountered 65 radiographically occult fractures that they classified into five types. Bone bruises were a result of direct trauma or were associated with ligamentous injury. They were characterized by geographic foci of decreased signal on short repetition time (TR), short echo time (TE) sequences. Stress fractures were linear or globular foci of low signal on short TR, short TE sequences. Osteochondral fractures were displaced or impacted types; the latter were often associated with an anterior cruciate ligament tear. Tibial fractures were minimally displaced, vertically oriented fractures extending into the plateaus. Femoral fractures were Y-shaped, extending across the supracondylar region

  15. Compartment Syndrome following Open Femoral Fracture with an Isolated Femoral Vein Injury Treated with Acute Repair

    Directory of Open Access Journals (Sweden)

    David Walmsley

    2014-01-01

    Full Text Available Acute compartment syndrome is a surgical emergency and its diagnosis is more difficult in obtunded or insensate patients. We present the case of a 34-year-old woman who sustained a Gustilo-Anderson grade III open midshaft femur fracture with an isolated femoral vein injury treated with direct repair. She developed lower leg compartment syndrome at 48 hours postoperatively, necessitating fasciotomies. She was subsequently found to have a DVT in her femoral vein at the level of the repair and was started on therapeutic anticoagulation. This case highlights the importance of recognition of isolated venous injuries in a trauma setting as a risk factor for developing compartment syndrome.

  16. [Early results of proximal femoral fractures treated with FENIX modular hemiarthroplasty].

    Science.gov (United States)

    Görski, Radosław; Górecki, Andrzej; Olszewski, Paweł; Biedrzycki, Jerzy; Skowronek, Paweł

    2010-01-01

    The article discusses preliminary clinical results in patients with proximal femoral fractures treated with hemiarthroplasty using a FENIX implant. The study group comprised 41 subjects aged 69 to 97 (median age 82.3 year). The follow-up study provided data on 26 subjects (63.4%), among which 15 attended the check-up, 5 subjects refused to visit at the Department and 6 subjects were reported as deceased. Median follow-up period amounted to 6.8 month (1 to 22 months). General hospitalization-related complications occurred in 8 patients (19.5%). During hospitalization no deaths occurred, in the deceased group 3 patients died within 12 months after surgery, while another 3 died after the twelve-month postoperative period (median of 13.3%). According to Merle d'Aubigne-Postel score favorable long-term results were observed in 9 patients (59.9%), 13 patients regained the level of motor function similar to the functional ability prior to fracture. The need to postpone the surgery due to general health status and impaired pre-operative motor function are significant negative prognostic factors. The results obtained were compared with previous efficacy studies on femoral fracture treatment using an Austin-Moore implant. Functional ability and self-reliance was higher in the FENIX group. FENIX arthroplasty effectively helps patients regain self-reliance and motor function thanks to its modular characteristics and anatmoical construction.

  17. Malleolar fractures and their ligamentous injury equivalents have similar outcomes in supination-external rotation type IV fractures of the ankle treated by anatomical internal fixation.

    Science.gov (United States)

    Berkes, M B; Little, M T M; Lazaro, L E; Sculco, P K; Cymerman, R M; Daigl, M; Helfet, D L; Lorich, D G

    2012-11-01

    It has previously been suggested that among unstable ankle fractures, the presence of a malleolar fracture is associated with a worse outcome than a corresponding ligamentous injury. However, previous studies have included heterogeneous groups of injury. The purpose of this study was to determine whether any specific pattern of bony and/or ligamentous injury among a series of supination-external rotation type IV (SER IV) ankle fractures treated with anatomical fixation was associated with a worse outcome. We analysed a prospective cohort of 108 SER IV ankle fractures with a follow-up of one year. Pre-operative radiographs and MRIs were undertaken to characterise precisely the pattern of injury. Operative treatment included fixation of all malleolar fractures. Post-operative CT was used to assess reduction. The primary and secondary outcome measures were the Foot and Ankle Outcome Score (FAOS) and the range of movement of the ankle. There were no clinically relevant differences between the four possible SER IV fracture pattern groups with regard to the FAOS or range of movement. In this population of strictly defined SER IV ankle injuries, the presence of a malleolar fracture was not associated with a significantly worse clinical outcome than its ligamentous injury counterpart. Other factors inherent to the injury and treatment may play a more important role in predicting outcome.

  18. Surgical interventions to treat humerus shaft fractures: A network meta-analysis of randomized controlled trials.

    Directory of Open Access Journals (Sweden)

    Jia-Guo Zhao

    Full Text Available There are three main surgical techniques to treat humeral shaft fractures: open reduction and plate fixation (ORPF, intramedullary nail (IMN fixation, and minimally invasive percutaneous osteosynthesis (MIPO. We performed a network meta-analysis to compare three surgical procedures, including ORPF, IMN fixation, and MIPO, to provide the optimum treatment for humerus shaft fractures.MEDLINE, EMBASE, Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, and Cochrane library were researched for reports published up to May 2016. We only included randomized controlled trials (RCTs comparing two or more of the three surgical procedures, including the ORPF, IMN, and MIPO techniques, for humeral shaft fractures in adults. The methodological quality was evaluated based on the Cochrane risk of bias tool. We used WinBUGS1.4 to conduct this Bayesian network meta-analysis. We used the odd ratios (ORs with 95% confidence intervals (CIs to calculate the dichotomous outcomes and analyzed the percentages of the surface under the cumulative ranking curve.Seventeen eligible publications reporting 16 RCTs were included in this study. Eight hundred and thirty-two participants were randomized to receive one of three surgical procedures. The results showed that shoulder impingement occurred more commonly in the IMN group than with either ORPF (OR, 0.13; 95% CI, 0.03-0.37 or MIPO fixation (OR, 0.08; 95% CI, 0.00-0.69. Iatrogenic radial nerve injury occurred more commonly in the ORPF group than in the MIPO group (OR, 11.09; 95% CI, 1.80-124.20. There were no significant differences among the three procedures in nonunion, delayed union, and infection.Compared with IMN and ORPF, MIPO technique is the preferred treatment method for humeral shaft fractures.

  19. Closed Tibial shaft fractures treated with the Ilizarov method: A ten year case series.

    Science.gov (United States)

    May, Jonathan David; Paavana, Thumri; McGregor-Riley, Jonathan; Royston, Simon

    2017-07-01

    To review the outcomes of patients treated with the Ilizarov method for an isolated, closed, simple diaphyseal, Tibial fracture at our institution over the last decade. The Ilizarov frame database was used to identify 76 skeletally mature patients who sustained an isolated, closed, extra-articular, simple, diaphyseal Tibial fracture; the injury also known as a "nail-able Tibial fracture." The average age of the patient was 38 (17-70). All 76 patients progressed to union. The average time until union was 148 (55-398) days. The coronal and sagittal alignment was 3° (0-17°) and 4° (0-14°) respectively. No patient suffered from compartment syndrome. No patient developed septic arthritis. No patient had documented anterior knee pain or secondary knee specialist input post frame removal. On average, there were 9(4-29) follow up appointments and 10(5-26) radiographs post frame application. There is a 59% chance of a patient having a difficulty post frame application. The malunion rate was 5%. Persisting pinsite infection post frame removal occurred in 5 patients (6.5%). Drilling of the pinsite sequestrum resolved the infection in four of these patients, giving a deep infection rate of 1.3%. The Ilizarov method has a role to play in the treatment of simple closed Tibial shaft fractures in patients who need to kneel. Patient education is a priority however; the patient must be made aware of the difficulty rate associated with the Ilizarov method when compared to the complication profile of alternative treatments. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  20. Postpartum Osteoporosis and Thoracic Vertebral Fracture in a Patient Treated with Heparin During Pregnancy

    Directory of Open Access Journals (Sweden)

    Ayse Aydemir Ekim

    2016-05-01

    Full Text Available Postpartum osteoporosis (PPO is a rare form of osteoporosis related to pregnancy. We report the case of a 35-year-old woman who consulted for severe low-back pain one week after her delivery. This woman had a personal history of protein C deficiency and was treated with low-molecular-weight heparin (LMWH 40 mg/day during her pregnancy. Her body mass index was 19.8 and she had only gained 8 kg during pregnancy. Magnetic resonance imaging (MRI revealed a fracture of thoracic 11. Dual-energy X-ray absorptiometry (DEXA measured T score = - 4,9 and Z score = -4,8 in Lumbar 1-4 vertebrae. These findings suggest that PPO may be one of the causes of severe back pain in postpartum patients. We think that PPO risk is higher in those patients with low BMI who were treated with LMWH during pregnancy.

  1. Distal tibial fracture treated by minimally invasive plate osteosynthesis after external fixation Retrospective clinical and radiographic assessment

    Directory of Open Access Journals (Sweden)

    Al. Șerban

    2014-02-01

    Full Text Available Fractures of the horizontal surface of the distal tibia are known commonly as pylon or plafond fractures, and represent 1-5% of lower extremity fractures, 7-10% of all tibial fractures. The protocol consisted of immediate (within eight to 24 hours open reduction and internal fixation of the fibula, using a fibular plate or one third tubular plate and application of an external fixator spanning the ankle joint. In the second stage, the treatment of proximal and distal tibial fractures with close reduction and MIPPO technique can preserve soft tissue, simplify operative procedure and decrease wound, obtain rigid internal fixation and guarantee early function exercises of ankle joint. In this study we evaluated 22 patients treated in Clinical Emergency Hospital Constanta between April 2012 - July 2013 diagnosed with multifragmentary fractures of the distal tibia. This study evaluates the treatment of complex fractures of distal tibia with locked plate after external fixation. There were 17 males and 5 females of mean age 51,7 years (31-68. The mean follow-up period was 14 weeks. (Ranging from 9-16 weeks. All patients were fully weight bearing at 16 weeks (ranging 9-16 weeks showing radiological union. There were no cases of failures of fixation, or rotational misalignment. No significant complication was observed in our patients. MIPO is an effective method of treatment for distal tibial fractures, reduce surgical trauma and maintain a more biologically favorable environment for fracture healing, reducing risks of infection and nonunion.

  2. Mortality and morbidity in elderly patients with fracture neck of femur treated by hemi arthroplasty

    International Nuclear Information System (INIS)

    Ahmad, I.

    2006-01-01

    To determine mortality and morbidity in elderly patients with fracture neck of femur treated by hemiarthroplasty (Austin Moore Prosthesis) during one year postoperatively. During the study period, all patients with fracture neck of femur, who were 65 years of age or above and treated by Austin Moore Prosthesis (AMP), were included. The patients were followed for one year at intervals of 2 weeks, 4 weeks, 6 months, and one year. All surviving patients were assessed for complications, both general and mechanical, related to the implant. The mortality and morbidity were compared for various age subgroups, and in patients with and without systemic co-morbidities.Chi square test was applied to see the significance of results. The total number of patients was 46 with average age of 70 years. Male to female ratio was 1:2. There were 70% patients who had one or more associated systemic disease. The mortality at 2 weeks was 4.3%, 17.4% at 6 months and 26% at one year. The overall dislocation rate was 4.3%. Two patients had infection and 17.4% patients had thigh pain at one year. The mortality and morbidity was high in patients with systemic comorbidities, and those above 70 years of age, but this was statistically not significant (p value >0.05). The functional assessment of surviving patients at one year was graded as excellent or good in 76.4% of patients. (author)

  3. Should lower limb fractures be treated surgically in patients with chronic spinal injuries? Experience in a reference centre.

    Science.gov (United States)

    Barrera-Ochoa, S; Haddad, S; Rodríguez-Alabau, S; Teixidor, J; Tomás, J; Molero, V

    To report the outcomes of surgical treatment of lower limb fractures in patients with chronic spinal cord injuries. A total of 37 lower limb fractures were treated from 2003 to 2010, of which 25 fractures were treated surgically and 12 orthopaedically. Patients of the surgical group had better clinical results, range of motion, bone consolidation, and less pressure ulcers and radiological misalignment. No differences were detected between groups in terms of pain, hospital stay, and medical complications. There is no currently consensus regarding the management of lower limb fractures in patients with chronic spinal cord injuries, but the trend has been conservative treatment due to the high rate of complications in surgical treatment. Chronic spinal cord injuries patients with lower limb fractures who are treated surgically achieved a more reliable consolidation, practically a free range of motion, low rate of cutaneous complications, and pain associated with the fracture. This allows a quick return to the previous standard of living, and should be considered as an alternative to orthopaedic treatment in these patients. Copyright © 2016 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  4. Effects of a training program after surgically treated ankle fracture: a prospective randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Ekdahl Charlotte S

    2009-09-01

    Full Text Available Abstract Background Despite conflicting results after surgically treated ankle fractures few studies have evaluated the effects of different types of training programs performed after plaster removal. The aim of this study was to evaluate the effects of a 12-week standardised but individually suited training program (training group versus usual care (control group after plaster removal in adults with surgically treated ankle fractures. Methods In total, 110 men and women, 18-64 years of age, with surgically treated ankle fracture were included and randomised to either a 12-week training program or to a control group. Six and twelve months after the injury the subjects were examined by the same physiotherapist who was blinded to the treatment group. The main outcome measure was the Olerud-Molander Ankle Score (OMAS which rates symptoms and subjectively scored function. Secondary outcome measures were: quality of life (SF-36, timed walking tests, ankle mobility tests, muscle strength tests and radiological status. Results 52 patients were randomised to the training group and 58 to the control group. Five patients dropped out before the six-month follow-up resulting in 50 patients in the training group and 55 in the control group. Nine patients dropped out between the six- and twelve-month follow-up resulting in 48 patients in both groups. When analysing the results in a mixed model analysis on repeated measures including interaction between age-group and treatment effect the training group demonstrated significantly improved results compared to the control group in subjects younger than 40 years of age regarding OMAS (p = 0.028, muscle strength in the plantar flexors (p = 0.029 and dorsiflexors (p = 0.030. Conclusion The results of this study suggest that when adjusting for interaction between age-group and treatment effect the training model employed in this study was superior to usual care in patients under the age of 40. However, as only three

  5. Inguinal Abnormalities in Male Patients with Acetabular Fractures Treated Using an Ilioinguinal Exposure

    Directory of Open Access Journals (Sweden)

    Reza Firoozabadi

    2015-09-01

    Full Text Available Purpose: Surgeons performing an ilioinguinal exposure for acetabular fracture surgery need to be aware of aberrant findings such as inguinal hernias and spermatic cord lesions. The purpose of this study is to report these occurrences in a clinical series of adult males undergoing acetabular fracture fixation and a series of adult male cadavers. The secondary aim is to characterize these abnormalities to aid surgeons in detecting these abnormalities preoperatively and coordinating a surgical plan with a general surgeon.Methods: Clinical study- Retrospective review of treated acetabular fractures through an ilioinguinal approach. Incidence of inguinal canal and spermatic cord abnormalities requiring general surgery consultation were identified. Corresponding CT scans were reviewed and radiographic characteristics of the spermatic cord abnormalities and/or hernias were noted.Cadaveric study- 18 male cadavers dissected bilaterally using an ilioinguinal exposure. The inguinal canal and the contents of the spermatic cord were identified and characterized.Results: Clinical Study- 5.7% (5/87 of patients had spermatic cord lesion and/or inguinal hernia requiring general surgical intervention. Preoperative pelvic CT scan review identified abnormalities noted intraoperatively in four of the five patients. Cord lipomas visualized as enlargements of the spermatic cord with homogeneous density. Hernias visualized as enlarged spermatic cords with heterogeneous density. Cadaver Study- 31% (11/36 of cadavers studied had spermatic cord and/or inguinal canal abnormalities. Average cord diameter in those with abnormalities was 24.9 mm (15-28 compared to 16 mm (11-22 in normal cords, which was statistically significant.Conclusion: The clinical and cadaveric findings emphasize the importance of understanding inguinal abnormalities and the value of detecting them preoperatively. The preoperative pelvic CT scans were highly sensitive in detecting inguinal abnormalities.

  6. Orbital fractures treated in Auckland from 2010-2015: review of patient outcomes.

    Science.gov (United States)

    Anand, Lanit; Sealey, Christopher

    2017-07-07

    The purpose of this study was to review patient outcomes from surgical reconstruction of isolated orbital fractures, performed by the Auckland District Health Board (ADHB) Oral and Maxillofacial Surgery service (OMFS), from 2010 to 2015. In particular, we wished to assess titanium as an orbital reconstructive material and compare outcomes with the international literature. Hospital records for 103 adults (>18 years old) who underwent repair of isolated orbital fractures by the OMFS department at Middlemore Hospital, between 2010 and 2015, were reviewed. Information collected included patient characteristics, cause of injury, type of reconstruction material used and post-operative complications. Patients were then followed up by means of a verbal telephone questionnaire. The majority of patients were male in the 18-30 year age group, with interpersonal violence being the leading cause of injury. Titanium was the preferred choice of reconstructive material. Seven patients required return to theatre to resolve post-operative complications. Sixty-four patients could be contacted by telephone (12 months to six years follow-up). Thirty patients, who could not be contacted by telephone, did attend clinic follow-up and were assessed from their hospital records (minimum of one month follow-up). Ten patients could not be contacted by telephone and had not attended clinic follow-up. Problems with diplopia, paraesthesia and cosmesis were within complication rates reported in the literature. Patients with isolated orbital fractures, treated by the Oral and Maxillofacial Surgery Department in Auckland from 2010-2015, were reviewed. Titanium was the most commonly used reconstructive material and proved to be well tolerated. Complication rates were within international norms.

  7. Use of transfixation pin casts to treat adult horses with comminuted phalangeal fractures: 20 cases (1993-2003).

    Science.gov (United States)

    Joyce, Jolynn; Baxter, Gary M; Sarrafian, Tiffany L; Stashak, Ted S; Trotter, Gayle; Frisbie, Dave

    2006-09-01

    To determine the clinical applications, short and long-term survival, and complications of using transfixation pin casts for treatment of comminuted phalangeal fractures in adult horses. Retrospective case series. 20 horses. Medical records were reviewed to obtain information regarding signalment, fracture location, treatment methods, complications, and short-term survival (discharge from hospital). Long-term follow-up information was obtained via contact with owners or trainers. 12 fractures were in a hind limb, and 8 were in a forelimb. Fourteen fractures occurred in a middle phalanx, and 6 occurred in a proximal phalanx. Eleven fractures were treated with internal fixation combined with transfixation pin casts, and 9 fractures were treated with transfixation pin casts alone. Transfixation pin casts were maintained for a mean of 52 days (median, 49 days; range, 1 to 131 days). Fourteen (70%) horses were discharged from the hospital, whereas 6 (30%) were euthanized during the treatment period. Reasons for euthanasia included secondary fracture of the third metacarpal or metatarsal bone, avascularity of the distal aspect of the limb associated with an open fracture, and displacement of the fracture after transfixation pin cast removal. A significantly greater number of horses was discharged from the hospital when the transfixation pin cast was maintained for > 40 days, compared with those in which the transfixation pin cast was maintained for horses should be maintained in a transfixation pin cast for a minimum of 40 days, as this was associated with an increase in short-term survival without an increased risk of catastrophic failure.

  8. Intramedullary nail versus dynamic compression plate fixation in treating humeral shaft fractures: grading the evidence through a meta-analysis.

    Directory of Open Access Journals (Sweden)

    JianXiong Ma

    Full Text Available There is a debate regarding the choice of operative intervention in humeral shaft fractures that require surgical intervention. The choices for operative interventions include intramedullary nailing (IMN and dynamic compression plate (DCP. This meta-analysis was performed to compare fracture union, functional outcomes, and complication rates in patients treated with IMN or DCP for humeral shaft fractures and to develop GRADE (Grading of Recommendations, Assessment, Development, and Evaluation-based recommendations for using the procedures to treat humeral shaft fractures. A systematic search of all the studies published through December 2012 was conducted using the Medline, Embase, Sciencedirect, OVID and Cochrane Central databases. The randomized controlled trials (RCTs and quasi-RCTs that compared IMN with DCP in treating adult patients with humeral shaft fractures and provided data regarding the safety and clinical effects were identified. The demographic characteristics, adverse events and clinical outcomes were manually extracted from all of the selected studies. Ten studies that included a total of 448 patients met the inclusion criteria. The results of a meta-analysis indicated that both IMN and DCP can achieve similar fracture union with a similar incidence of radial nerve injury and infection. IMN was associated with an increased risk of shoulder impingement, more restriction of shoulder movement, an increased risk of intraoperative fracture comminution, a higher incidence of implant failure, and an increased risk of re-operation. The overall GRADE system evidence quality was very low, which reduces our confidence in the recommendations of this system. DCP may be superior to IMN in the treatment of humeral shaft fractures. Because of the low quality evidence currently available, high-quality RCTs are required.

  9. UNSTABLE INTERTROCHANTERIC FRACTURE IN ELDERLY TREATED WITH CEMENTED BIPOLAR HEMIARTHROPLASTY AND TROCHANTERIC RECONSTRUCTION

    Directory of Open Access Journals (Sweden)

    Jagadeesh Kumar

    2015-06-01

    Full Text Available INTRODUCTION : Unstable inter - trochanteric fracture in the geriatric population is a common injury and is associated with poor bone quality, excessive collapse, loss of fixation, and cut - out of the lag screw, are the common problems of attempts to fix these fractures. Pr esent study is an attempt to evaluate the functional outcome of primary cemented bipolar hemiarthroplasty and trochanter reconstruction in these patients. MATERIALS AND METHOD S : This prospective study included 30 cases of elderly osteoporotic patients with mean age of 65.4 years who sustained comminuted inter - trochanteric femur fracture treated with cemented bipolar hemiarthroplasty& tension band wiring for greater trochanter rec onstruction. It is an essential technical step to avoid complication like abductor lurch gait. W e here describe a technique of reconstruction and fixation of greater trochanter using tension band wiring in figure of eight pattern. The patients were followe d up at six week, three month, six month and one year postoperatively and assessed using Harris Hip Score (HHS. RESULTS : The mean HHS score was was 85.6+SD 9.5 (range from 74 to 96. B y the end of one year. The main clinical measures were early post - opera tive full weight bearing, post - operative complication & functional outcome. The time to full weight bearing, the rate of post - operative complications & functional outcome was significantly better in cemented bipolar arthroplasty group . DISCUSSION : The chan ges in HHS up to six months periods are much greater which starts showing a stable trend thereafter. Fair to good scores were observed in all the patients. The purpose of its use was that while Harris Hip Score (HHS provides information on a multitude of factors. Superficial infection in 2 patients, anterior thigh pain in a patient, shortening less than 2cms in 2 patients, abductor lurch in a patient are the complications noted in post - operative period, but no patient required

  10. Fracture resistance of endodontically treated permanent anterior teeth restored with three different esthetic post systems: An in vitro study

    Directory of Open Access Journals (Sweden)

    Ameet J Kurthukoti

    2015-01-01

    Full Text Available Background: Esthetic coronal reconstruction of fractured anterior teeth is often performed using intra radicular posts. Most of the commonly used commercially esthetic post systems do not exhibit similar physical properties as dentin resulting in failures. Aim: To evaluate and compare the fracture resistance and mode of failure of simulated traumatized permanent central incisors restored with three different post systems including biologic dentin posts. Materials and Methods: A total of 40 recently extracted human maxillary central incisors with similar dimensions were decoronated 2 mm above the cemento-enamel junction and endodontically treated. Ten specimens were randomly selected as the Group I - Control group (core built teeth without intraradicular posts. The remaining 30 teeth were equally divided and restored with zirconia (Group II, n = 10, fiber re-inforced composite (FRC (Group III, n = 10 and biologic dentin posts (Group IV, n = 10 using resin bonded cement and their cores built-up. These samples were embedded in acrylic resin and then secured in a Universal Testing Machine and subjected to fracture resistance testing. The location of failure in the specimens was evaluated using a stereomicroscope. Results: Intergroup comparison revealed that the control group and zirconia post group (522 ± 110 N demonstrated the least fracture resistance, while dentin post group (721 ± 127 N the highest. There was no statistically significant difference between fiber post and dentin post groups. Fractures that were repairable were observed in fiber post and dentin post groups, whereas mostly unrestorable, catastrophic fractures were observed in the zirconia post group. Conclusion: Teeth restored with the biologic dentin post system demonstrated the highest fracture resistance and repairable fractures, closely followed by FRC post system. The least fracture resistance and most catastrophic fractures were demonstrated by the zirconia post system.

  11. Treating Simple Tibia Fractures with Poly-DL-Lactic Acid Screw as a ...

    African Journals Online (AJOL)

    ) absorbable screw as a ... fractures. Keywords: Simple tibia fracture, Fracture healing time Poly-DL-lactic acid, Poly-DL-Lactic Acid, ..... bilateral cortex of the bone due to the weak anti- ... Hu YL, Yuan WQ, Wang LF, Liu HF, Jin D. A prospective.

  12. The experiences of physiotherapists treating people with dementia who fracture their hip.

    Science.gov (United States)

    Hall, A J; Watkins, R; Lang, I A; Endacott, R; Goodwin, V A

    2017-04-20

    It is estimated that people with dementia are approximately three times more likely to fracture their hip than sex and age matched controls. A report by the Chartered Society of Physiotherapy found that this population have poor access to rehabilitation as inpatients and in the community. A recent scoping review found a paucity of research in this area, indeed there has been no qualitative research undertaken with physiotherapists. In order to address this evidence gap, the aim of this current study was to explore the experiences of physiotherapists treating this population. Semi-structured interviews with physiotherapists were undertaken in order to gain an in-depth understanding of how they manage this population. Physiotherapists were recruited from all over the UK and a purposive sampling strategy was employed. Thematic analysis was utilised. A total of 12 physiotherapists were interviewed, at which stage data saturation was reached as no new themes were emerging. The participants had a broad range of experience both in physical and mental health settings. Analysis identified three separate themes: challenges, "thinking outside the box" and realising potential. Physiotherapists felt significant pressures and challenges regarding many aspects of the management of this population. Mainly this was the result of pressures placed on them by guidelines and targets that may not be achievable or appropriate for those with dementia. The challenges and importance of risk taking was also highlighted for this population with an appreciation that standard treatment techniques may need adapting. "Rehabilitation potential" was highlighted as an important consideration, but challenging to determine. Interventions for the management of people with dementia and hip fracture need to consider that a traditional biomedical physiotherapy approach may not be the most appropriate approach to use with this population. However physiotherapists reported feeling pressurised to conform to

  13. Detection of vertical root fractures in vivo in endodontically treated teeth by cone-beam computed tomography scans

    NARCIS (Netherlands)

    Metska, M.E.; Aartman, I.H.A.; Wesselink, P.R.; Özok, A.R.

    2012-01-01

    Introduction The presence of a vertical root fracture (VRF) in an endodontically treated tooth has an immense impact on the treatment’s outcome. Early diagnosis of a VRF is imperative to avoid overtreatment and extensive bone loss. Our study aimed to examine the validity of 2 cone-beam computed

  14. Effect of different composite core materials on fracture resistance of endodontically treated teeth restored with FRC posts

    OpenAIRE

    PANITIWAT, Prapaporn; SALIMEE, Prarom

    2017-01-01

    Abstract Objective This study evaluated the fracture resistance of endodontically treated teeth restored with fiber reinforced composite posts, using three resin composite core build-up materials, (Clearfil Photo Core (CPC), MultiCore Flow (MCF), and LuxaCore Z-Dual (LCZ)), and a nanohybrid composite, (Tetric N-Ceram (TNC)). Material and Methods Forty endodontically treated lower first premolars were restored with quartz fiber posts (D.T. Light-Post) cemented with resin cement (Panavia F2...

  15. Unusual proximal femur fracture in children treated with PHILOS plate and review of literature

    Directory of Open Access Journals (Sweden)

    Mukesh Kumar

    2017-01-01

    Full Text Available Fractures of the hip are uncommon in children with incidence is less than 1% in all paediatrics fracture. It requires careful attention because of the incidence of complications is high. There is no consensus over ideal treatment of each group, but there are different options for each group has been described in literature, we report a case of unusual proximal femur fracture in ten-year-old girl which is not described in literature in best of our knowledge. A 10 years old girl was brought to us with pain in right hip joint and inability to bear weight on right lower limb after road traffic accident (child was hit by a car while walking on the road. Evaluated and found to have fracture of proximal femur. fracture was fixed with long PHILOS plate, which united in eight weeks duration, implant was removed at 10 month. At present after 14 months, she is able to perform her routine activities comfortably. and her Harris hip score is 95. We propose to add this type of fracture as 5th type of Delbet's classification as the fracture pattern in my patient was not fitting in any group of Delbet's classification and it belongs to proximal femur group and anatomically this fracture pattern was next to type IV fracture. Uncommon fracture of hip in children can be expected, this type of fracture can be added as 5th type in Delbet's classification. Long term outcome and ideal treatment yet to be described.

  16. [Treatment of pediatric distal femur fractures by external fixator combined with limited internal fixation].

    Science.gov (United States)

    Wei, Sheng-wang; Shi, Zhan-ying; Hu, Ju-zheng; Wu, Hao

    2016-03-01

    To discuss the clinical effects of external fixator combined with limited internal fixation in the treatment of pediatric distal femur fractures. From January 2008 to June 2014, 17 children of distal femur fractures were treated by external fixator combined with limited internal fixation. There were 12 males and 5 females, aged from 6 to 13 years old with an average of 10.2 years, ranged in the course of disease from 1 h to 2 d. Preoperative diagnoses were confirmed by X-ray films in all children. There were 11 patients with supracondylar fracture , and 6 patients with intercondylar comminuted fracture. According to AO/ASIF classification, 9 fractures were type A1, 5 cases were type A2,and 3 cases were type C1. The intraoperative and postoperative complications, postoperative radiological examination, lower limbs length and motion of knee joints were observed. Knee joint function was assessed by KSS score. All the patients were followed up from 6 to 38 months with an average of 24.4 months. No nerve or blood vessel injury was found. One case complicated with the external fixation loosening, 2 cases with the infection of pin hole and 3 cases with the leg length discrepancy. Knee joint mobility and length measurement (compared with the contralateral), the average limited inflexion was 10 degrees (0 degrees to 20 degrees), the average limited straight was 4 degrees (0 degrees to 10), the average varus or valgus angle was 3 degrees (0 degrees to 5 degrees). KSS of the injured side was (96.4 +/- 5.0) points at final follow-up, 16 cases got excellent results and 1 good. All fractures obtained healing and no epiphyseal closed early was found. External fixator combined with limited internal fixation has advantages of simple operation, reliable fixation, early functional exercise in treating pediatric distal femurs fractures.

  17. Effect of different composite core materials on fracture resistance of endodontically treated teeth restored with FRC posts.

    Science.gov (United States)

    Panitiwat, Prapaporn; Salimee, Prarom

    2017-01-01

    This study evaluated the fracture resistance of endodontically treated teeth restored with fiber reinforced composite posts, using three resin composite core build-up materials, (Clearfil Photo Core (CPC), MultiCore Flow (MCF), and LuxaCore Z-Dual (LCZ)), and a nanohybrid composite, (Tetric N-Ceram (TNC)). Forty endodontically treated lower first premolars were restored with quartz fiber posts (D.T. Light-Post) cemented with resin cement (Panavia F2.0). Samples were randomly divided into four groups (n=10). Each group was built-up with one of the four core materials following its manufacturers' instructions. The teeth were embedded in acrylic resin blocks. Nickel-Chromium crowns were fixed on the specimens with resin cement. The fracture resistance was determined using a universal testing machine with a crosshead speed of 1 mm/min at 1350 to the tooth axis until failure occurred. All core materials used in the study were subjected to test for the flexural modulus according to ISO 4049:2009. One-way ANOVA and Bonferroni multiple comparisons test indicated that the fracture resistance was higher in the groups with CPC and MCF, which presented no statistically significant difference (p>0.05), but was significantly higher than in those with LCZ and TNC (paligned with the same tendency of fracture loads. Among the cores used in this study, the composite core with high filler content tended to enhance fracture thresholds of teeth restored with fiber posts more than others.

  18. In Vitro Evaluation of the Effect of Tooth Structure Loss on Fracture Resistance of Endodontically Treated Teeth

    Directory of Open Access Journals (Sweden)

    Shirinzad M

    2017-06-01

    Full Text Available Introduction: Since preserving the structure of treated teeth is a critical success factor, studying the effects of tooth structure loss on fracture resistance of the tooth tissue appears necessary. The aim of this study was to evaluate the consequences of the loss of different tissues regarding fracture resistance of teeth undergoing root canal treatment without the use of indirect restorations. Methods :In this experimental study, 70 healthy maxillary first premolar teeth were randomly divided into 7 groups of 10 members, including control group, endodontic access preparation only, MOD cavity preparation, cutting buccal cusp, cutting palatal cusp, cutting buccal cusp and marginal ridge, and cutting the palatal cusp and marginal ridge. The coronal section of teeth was restored incrementally with light cure composite. Finally, samples underwent compressive load with 45˚ angle from each cusp slope in the middle of cusp with an instant speed of 1 mm per min in the Instron machine. Fracture resistance was measured and samples were examined under stereo-microscope to evaluate the mode of failure. Results: The resistance to fracture in root canal treated teeth in different groups in order from first to seventh was 797.13 ± 52.92, 722.50 ± 131.40, 432.15 ± 203.20, 592.66 ± 195.86 124.53 ± 33.09, 85.17 ± 18.45, and 26.03 ± 5.21 Newton. ANOVA test showed statistically significant differences between the groups in terms of their fracture resistance (P = 0.000. Conclusions: The results showed that fracture resistance levels of teeth were significantly affected by amount of their tissue loss. In this study, removal of teeth palatal cusp and marginal ridge had a significant effect on decreasing the fracture resistance, while removing the buccal cusps alone cannot have a significant effect.

  19. Fracture resistance of structurally compromised and normal endodontically treated teeth restored with different post systems: An in vitro study

    Directory of Open Access Journals (Sweden)

    Vajihesadat Mortazavi

    2012-01-01

    Full Text Available Background: With the aim of developing methods that could increase the fracture resistance of structurally compromised endodontically treated teeth, this study was conducted to compare the effect of three esthetic post systems on the fracture resistance and failure modes of structurally compromised and normal roots. Materials and Methods: Forty five extracted and endodontically treated maxillary central teeth were assigned to 5 experimental groups (n=9. In two groups, the post spaces were prepared with the corresponding drills of the post systems to be restored with double taper light posts (DT.Light-Post (group DT.N and zirconia posts (Cosmopost (group Zr.N. In other 3 groups thin wall canals were simulated to be restored with Double taper Light posts (DT.W, double taper Light posts and Ribbond fibers (DT+R.W and Zirconia posts (Zr.W. After access cavity restoration and thermocycling, compressive load was applied and the fracture strength values and failure modes were evaluated. Data were analyzed using two-way ANOVA, Tukey and Fisher exact tests (P<0.05. Results: The mean failure loads (N were 678.56, 638.22, 732.44, 603.44 and 573.67 for groups DT.N, Zr.N, DT.W, DT+R.W and Zr.w respectively. Group DT+R.W exhibited significantly higher resistance to fracture compared to groups Zr.N, DT.W and Zr.w (P<0.05. A significant difference was detected between groups DT.N and Zr.W (P=0.027. Zirconia posts showed significantly higher root fracture compared to fiber posts (P=0.004. Conclusion: The structurally compromised teeth restored with double taper light posts and Ribbond fibers showed the most fracture resistance and their strengths were comparable to those of normal roots restored with double taper light posts. More desirable fracture patterns were observed in teeth restored with fiber posts.

  20. A new angle and its relationship with early fixation failure of femoral neck fractures treated with three cannulated compression screws.

    Science.gov (United States)

    Zhang, Y L; Zhang, W; Zhang, C Q

    2017-04-01

    The Pauwels angle has been used widely, however an accurate evaluation of this angle is difficult because of deformity of the affected lower extremity. Therefore we designed a new measurement of the orientation of femoral neck fracture and applied this in a retrospective study to assess: (1) its reproducibility, (2) its advantages compared with the Pauwels angle, (3) its relationship with the short-term prognosis treated with three cannulated compression screws. This new measurement is reproducible and has some reference meaning for the treatment of femoral neck fractures. Two hundred and twenty-eight patients with femoral neck fractures treated with three cannulated compression screws were retrospectively analyzed. The VN angle, which was the angle between the fracture line and the vertical of the neck axis, and the Pauwels angle were measured respectively. The method of ICC was performed to assess the reproducibility of the two angles, and the absolute value of difference in pre-operative and post-operative radiographs was used to evaluate the uniformity of the two angles. These fractures were divided into four groups according to VN angle (VN50°) were respectively 0%, 1.46% (95% CI: 1.42-1.50) and 36.24% (95% CI: 34.93-37.54). The VN angle has a good inter-rater reproducibility, a higher reliability than the Pauwels angle and is closely related to the short-term prognosis of femoral neck fractures treated with cannulated compression screws. Level IV, retrospective diagnostic study. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  1. Effects of the Ratio between Pigment and Bleaching Gel on the Fracture Resistance and Dentin Microhardness of endodontically treated Teeth.

    Science.gov (United States)

    Galloza, Marina Og; Jordão-Basso, Keren Cf; Bandeca, Matheus C; Costa, Samuel O; Borges, Alvaro H; Tonetto, Mateus R; Tirintan, Fabio C; Keine, Kátia C; Kuga, Milton C

    2017-11-01

    The aim of this study was to evaluate the effects of bleaching gel using 35% hydrogen peroxide (HP), associated with red carmine pigment (RC), in the 3:1 or 1:1 ratio, on fracture resistance and dentin microhardness of endodontically treated teeth. A total of 40 lower incisors were endodontically treated and divided into four groups (n = 10), according to the bleaching protocol: G1 (HP3), 35% HP + RC (3:1); G2 (HP1), 35% HP + RC (1:1); G3 (positive), 38% HP; and G4 (negative), unbleached. Four dental bleaching sessions were performed. The dental crowns were restored after the last session and submitted to the fracture resistance test. Totally, 60 specimens from the endodontically treated lower incisor crowns were prepared to evaluate the effects on dentin microhardness. The analysis was measured (in Knoop) prior to and after the last dental bleaching session using similar bleaching protocols. G2 presented the lowest fracture resistance (p 0.05). No difference was observed in the reduction of dentin microhardness among the groups (p > 0.05). A 1:1 ratio (bleaching gel:pigment) caused a significant fracture resistance reduction in relation to the other protocols. No effect on the dentin microhardness reduction was observed. The pigment addition to the bleaching agent accelerates the bleaching chemical reaction. However, no studies have evaluated the ideal proportion to optimize tooth bleaching.

  2. Predictors for perioperative blood transfusion in elderly patients with extra capsular hip fractures treated with cephalo-medullary nailing.

    Science.gov (United States)

    Fazal, M Ali; Bagley, Caroline; Garg, Parag

    2018-02-01

    The aim of our study was to determine predictive factors and requirement for perioperative blood transfusion in elderly patients with extra capsular hip fractures treated with cephalo-medullary device. Seventy-nine patients with extra capsular hip fractures treated with cephalo-medullary nailing were included in the study. Age, sex, ASA grade, timing of surgery, preoperative and postoperative haemoglobin, length of hospital stay, fracture type, number of units transfused and 30-day mortality were recorded. The mean age was 82.3 years. Forty-seven patients underwent a short nail and 32 patients a long nail; 53.4% patients required blood transfusion postoperatively. Transfusion was required in 71.8% of the long nails (p  0.05). Length of hospital stay in non-transfusion group was 13 days and in transfusion group was 19 days (p  0.05). Thirty-day mortality in patients needing blood transfusion was 5% and in non-transfusion group was 3.7% (p > 0.05). Patient age, ASA grade, preoperative haemoglobin and length of nail are reliable predictors for perioperative blood transfusion in extra capsular hip fractures in elderly patients treated with cephalo-medullary nailing and reinforce a selective transfusion policy. Copyright © 2017 Daping Hospital and the Research Institute of Surgery of the Third Military Medical University. Production and hosting by Elsevier B.V. All rights reserved.

  3. Mini-interfacial Fracture Toughness of a Multimode Adhesive Bonded to Plasma-treated Dentin.

    Science.gov (United States)

    Ayres, Ana Paula Almeida; Pongprueksa, Pong; De Munck, Jan; Gré, Cristina Parise; Nascimento, Fábio Dupart; Giannini, Marcelo; Van Meerbeek, Bart

    2017-01-01

    To investigate the bonding efficacy of a multimode adhesive to plasma-treated and -untreated (control) dentin using a mini-interfacial fracture toughness (mini-iFT) test. Twenty human molars were used in a split-tooth design (n = 10). The adhesive Scotchbond Universal (SBU; 3M ESPE) was applied in etch-and-rinse (E&R) and self-etch (SE) modes. Mid-coronal dentin was exposed and covered with a standardized smear layer ground to 320 grit. One half of each dentin surface received 15 s of non-thermal atmospheric plasma (NTAP), while the other half was covered with a metallic barrier and kept untreated. Following the E&R mode, dentin was plasma treated immediately after phosphoric acid etching. SBU and a resin-based composite were applied to dentin following the manufacturer's instructions. Six mini-iFT specimens were prepared per tooth (1.5 x 2.0 x 16 to 18 mm), and a single notch was prepared at the adhesive-dentin interface using a 150-μm diamond blade under water cooling. Half of the mini-iFT specimens were immediately loaded until failure in a 4-point bending test, while the other half were first stored in distilled water for 6 months. After testing, the exact dimensions of the notch were measured with a measuring optical microscope, from which ΚIc was determined. Three-way ANOVA revealed higher mini-iFT for SBU applied in E&R than SE mode for both storage times, irrespective of NTAP treatment. Overall, mini-iFT did not decrease for any of the experimental groups upon 6-month aging, while plasma treatment did not show a direct beneficial effect on mini-iFT of SBU applied in either E&R or SE mode.

  4. A novel computer algorithm for modeling and treating mandibular fractures: A pilot study.

    Science.gov (United States)

    Rizzi, Christopher J; Ortlip, Timothy; Greywoode, Jewel D; Vakharia, Kavita T; Vakharia, Kalpesh T

    2017-02-01

    To describe a novel computer algorithm that can model mandibular fracture repair. To evaluate the algorithm as a tool to model mandibular fracture reduction and hardware selection. Retrospective pilot study combined with cross-sectional survey. A computer algorithm utilizing Aquarius Net (TeraRecon, Inc, Foster City, CA) and Adobe Photoshop CS6 (Adobe Systems, Inc, San Jose, CA) was developed to model mandibular fracture repair. Ten different fracture patterns were selected from nine patients who had already undergone mandibular fracture repair. The preoperative computed tomography (CT) images were processed with the computer algorithm to create virtual images that matched the actual postoperative three-dimensional CT images. A survey comparing the true postoperative image with the virtual postoperative images was created and administered to otolaryngology resident and attending physicians. They were asked to rate on a scale from 0 to 10 (0 = completely different; 10 = identical) the similarity between the two images in terms of the fracture reduction and fixation hardware. Ten mandible fracture cases were analyzed and processed. There were 15 survey respondents. The mean score for overall similarity between the images was 8.41 ± 0.91; the mean score for similarity of fracture reduction was 8.61 ± 0.98; and the mean score for hardware appearance was 8.27 ± 0.97. There were no significant differences between attending and resident responses. There were no significant differences based on fracture location. This computer algorithm can accurately model mandibular fracture repair. Images created by the algorithm are highly similar to true postoperative images. The algorithm can potentially assist a surgeon planning mandibular fracture repair. 4. Laryngoscope, 2016 127:331-336, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  5. Detection of vertical root fractures in endodontically treated teeth by a cone beam computed tomography scan

    NARCIS (Netherlands)

    Hassan, B.; Metska, M.E.; Özok, A.R.; van der Stelt, P.; Wesselink, P.R.

    2009-01-01

    Our aim was to compare the accuracy of cone beam computed tomography (CBCT) scans and periapical radiographs (PRs) in detecting vertical root fractures (VRFs) and to assess the influence of root canal filling (RCF) on fracture visibility. Eighty teeth were endodontically prepared and divided into

  6. Determinants of outcome in operatively and non-operatively treated Weber-B ankle fractures

    NARCIS (Netherlands)

    van Schie-van der Weert, E. M.; van Lieshout, E. M. M.; de Vries, M. R.; van der Elst, M.; Schepers, T.

    2012-01-01

    Treatment of ankle fractures is often based on fracture type and surgeon's individual judgment. Literature concerning the treatment options and outcome are dated and frequently contradicting. The aim of this study was to determine the clinical and functional outcome after AO-Weber B-type ankle

  7. Determinants of outcome in operatively and non-operatively treated Weber-B ankle fractures

    NARCIS (Netherlands)

    E.M. van Schie- van der Weert; E.M.M. van Lieshout (Esther); M.R. de Vries (Mark); M. van der Elst (Maarten); T. Schepers (Tim)

    2012-01-01

    textabstractIntroduction: Treatment of ankle fractures is often based on fracture type and surgeon's individual judgment. Literature concerning the treatment options and outcome are dated and frequently contradicting. The aim of this study was to determine the clinical and functional outcome after

  8. Influence of intracanal irrigants on coronal fracture resistance of endodontically treated and bleached teeth: An In vitro Study

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    Maryam Khoroushi

    2017-01-01

    Full Text Available Background: Irrigation has a key role in the success of endodontic treatment. Intracanal irrigant solutions have adverse effects on the physical properties of dentin. Aim: The present study aimed to evaluate the effect of different irrigation protocols on coronal fracture resistance of endodontically treated teeth undergoing bleaching treatment. Design and Materials and Methods: Access cavities were prepared in 120 maxillary premolars which were divided into two groups (n = 60 – Group A: nonbleached, Group B: bleached (B. Each group was subdivided into five subgroups based on irrigation protocol (n = 12; G1: normal saline (NS, G2: 2.5% sodium hypochlorite (NaOCl, G3: 10% citric acid (CA, G4: 17% ethylene diamine tetra acetic acid, and G5: NaOCl plus CA. In Group B, the teeth were bleached using 38% hydrogen peroxide and 20% carbamide peroxide gels as in-office and at-home bleaching techniques for 3 weeks. All the teeth were restored with composite resin, thermocycled, and incubated for 24 h. The specimens underwent fracture resistance tests. Data were analyzed with ANOVA, Tukey honestly significant difference test, t-test, and Chi-squared test (α =0.05. Results: T-test showed significant differences between each two corresponding subgroups (P < 0.0001. In Group A, NS demonstrated significantly higher fracture resistance compared to others; however, minimum fracture resistance recorded in G2. In Group B, the maximum fracture resistance was recorded in G1, with the minimum being recorded in G5. Samples irrigated with NaOCl and NaOCl plus CA exhibited significantly lower fracture resistance compared to NS subgroup (P < 0.05. Conclusions: Within the limitations of this study, it can be concluded that the irrigation protocol used during endodontic treatment with/without bleaching can affect the coronal fracture resistance.

  9. Outcome of nonunion fractures in dogs treated with fixation, compression resistant matrix, and recombinant human bone morphogenetic protein-2.

    Science.gov (United States)

    Massie, Anna M; Kapatkin, Amy S; Fuller, Mark C; Verstraete, Frank J M; Arzi, Boaz

    2017-03-20

    To report the use of compression resistant matrix (CRM) infused with recombinant human bone morphogenetic protein (rhBMP-2) prospectively in the healing of nonunion long-bone fractures in dogs. A longitudinal cohort of dogs that were presented with nonunion fractures were classified and treated with CRM soaked with rhBMP-2 and fracture fixation. They were followed with serial radiographs and evaluated for healing times and complications according to the time frame and definitions previously established for orthopaedic clinical cases. Eleven nonunion fractures in nine dogs were included. Median healing time was 10 weeks (range: 7-20 weeks). Major perioperative complications due to bandage morbidity were encountered in two of 11 limbs and resolved. All other complications were minor. They occurred perioperatively in eight of 11 limbs. Minor follow-up complications included short-term in one of two limbs, mid-term in one of three, and long-term in four of five limbs. Nine limbs returned to full function and two limbs returned to acceptable function at the last follow-up. Nonunion fractures given a poor prognosis via standard-of-care treatment were successfully repaired using CRM with rhBMP-2 accompanying fixation. These dogs, previously at high risk of failure, returned to full or acceptable function.

  10. Fracture resistance of endodontically treated roots filled with resilon and guttapercha - A comparative in-vitro study

    Directory of Open Access Journals (Sweden)

    Rajesh R Shetty

    2009-01-01

    Full Text Available Aims and objectives: The purpose of this study was to evaluate and compare in vitro the fracture resistance of endodontically treated roots filled with Resilon and Gutta-percha. Methodology: Eighty extracted single canal teeth were selected and randomly assigned to five groups of sixteen teeth each. Teeth were sectioned using a diamond disc so as to obtain a root length of 14±1 mm. Roots were instrumented using .04 taper Profile rotary system to an apical size of 40 and obturated using .04 taper single cone (size 40 as follows: Group 1: Resilon .04 taper cone and Epiphany Self etching sealer, Group 2: .04 taper gutta-percha cone and AH Plus sealer ,Group 3: .04 taper gutta-percha cone and Roeko Seal Automix sealer, Group 4: .04 taper gutta-percha cone and Zinc oxide Eugenol sealer , Group 5: .04 taper gutta-percha cone without the use of a sealer. Following obturation, teeth were mounted in Poly Vinyl Chloride jigs using self cure acrylic resin such that 9mm of the root remained exposed. Fracture resistance testing was done using Instron testing machine using a vertical load applied perpendicular to the root surface. Statistical analysis was done using ANOVA, Tukey HSD and Student′s ′t′ test. Results: Very highly significant difference was observed between the groups (P=.001. Resilon with Epiphany group demonstrated highest mean fracture resistance value and gutta-percha without sealer displayed the least, comparative results were highly significant. Resilon compared to gutta-percha with Roeko Seal Automix (P=.037 and Zinc Oxide Eugenolsealers (P=.029 showed statistically significant difference. AH plus group showed significantly higher value compared to gutta-percha without sealer. Conclusions: Filling the root canals with Resilon increased the in vitro fracture resistance of endodontically treated roots compared to standard gutta-percha techniques. Adhesive sealers are more beneficial in increasing the fracture resistance of

  11. Effect of fiber post length and abutment height on fracture resistance of endodontically treated premolars prepared for zirconia crowns.

    Science.gov (United States)

    Lin, Jie; Matinlinna, Jukka Pekka; Shinya, Akikazu; Botelho, Michael George; Zheng, Zhiqiang

    2018-04-01

    The purpose of this study was to compare the fracture resistance, mode of fracture, and stress distribution of endodontically treated teeth prepared with three different fiber post lengths and two different abutment heights, using both experimental and finite element (FE) approaches. Forty-eight human maxillary premolars with two roots were selected and endodontically treated. The teeth were randomly distributed into six equally sized groups (n = 8) with different combinations of post lengths (7.5, 11, and 15 mm) and abutment heights (3 and 5 mm). All the teeth restored with glass fiber post (Rely X Fiber Post, 3M ESPE, USA) and a full zirconia crown. All the specimens were thermocycled and then loaded to failure at an oblique angle of 135°. Statistical analysis was performed for the effects of post length and abutment height on failure loads using ANOVA and Tukey's honestly significant difference test. In addition, corresponding FE models of a premolar restored with a glass fiber post were developed to examine mechanical responses. The factor of post length (P abutment height (P > 0.05) did not have a significant effect on failure load. The highest mean fracture resistance was recorded for the 15 mm post length and 5 mm abutment height test group, which was significantly more resistant to fracture than the 7.5 mm post and 5 mm abutment height group (P abutment heights.

  12. 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

  13. Pelvic insufficiency fractures in postmenopausal woman with advanced cervical cancer treated by radiotherapy

    International Nuclear Information System (INIS)

    Ogino, Ichiro; Okamoto, Naoyuki; Ono, Yoshimi; Kitamura, Tatsuo; Nakayama, Hiroki

    2003-01-01

    Purpose: To assess the predisposing factors and clinical characteristics of pelvic insufficiency fractures (PIF) in postmenopausal women with pelvic irradiation. Material and methods: A total 335 postmenopausal patients with cervical cancer of the intact uterus treated with radiation therapy between 1983 and 1998 were reviewed. Total external dose was delivered between 45 and 50.4 Gy with parallel opposed anteroposterior portals. Total brachytherapy dose at point A was delivered between 10 and 36 Gy. PIF were diagnosed by bone scintigraphy and confirmed by computed tomography. The cumulative incidence of symptomatic PIF was estimated by actuarial methods. Potential risk factors (age, weight, type II diabetes, delivery, menopause, total external dose, total brachytherapy dose) were assessed. Results: Fifty-seven (17.0%) of 335 patients were diagnosed as having PIF. Forty-seven patients were symptomatic and ten were asymptomatic. Parameters carrying a significant association with PIF were body weight 49 kg or below (P=0.044) in stepwise logistic regression analysis. The cumulative incidence of symptomatic PIF at 5 years was 17.9% calculated by the Kaplan-Meier method. A body weight of 49 kg or below and more than three deliveries were identified as having a significant effect on symptomatic PIF in univariate analysis (P=0.021, P=0.003, log-rank test) and Cox life table regression analysis (P=0.038, P=0.013). Five patients required narcotic agents and eight patients required hospital admission. Conclusions: We should consider reducing the dose contribution to the sacrum and sacroilac joints, without underdosing the tumor, especially in postmenopausal women with many deliveries or low body weight

  14. Emergency department recidivism in adults older than 65 years treated for fractures.

    Science.gov (United States)

    Southerland, Lauren T; Richardson, Daniel S; Caterino, Jeffrey M; Essenmacher, Alex C; Swor, Robert A

    2014-09-01

    Fractures in older adults are a commonly diagnosed injury in the emergency department (ED). We performed a retrospective medical record review to determine the rate of return to the same ED within 72 hours (returns) and the risk factors associated with returning. A retrospective medical record review of patients at least 65 years old discharged from a large, academic ED with a new diagnosis of upper extremity, lower extremity, or rib fractures was performed. Risk factors analyzed included demographic data, type of fracture, analgesic prescriptions, assistive devices provided, other concurrent injuries, and comorbidities (Charlson Comorbidity Index). Our primary outcome was return to the ED within 72 hours. Three hundred fifteen patients qualified. Most fractures were in the upper extremity (64% [95% confidence interval {CI}, 58%-69%]). Twenty patients (6.3% [95% CI, 3.9%-9.6%]) returned within 72 hours. Most returns (15/20, 75%) were for reasons associated with the fracture itself, such as cast problems and inadequate pain control. Only 3 (fractures had higher return rates (10.7% vs 4.5%, P = .03), and most commonly returned for cast or splint problems. Age, sex, other injuries, assistive devices, and Charlson Comorbidity Index score (median, 1 [interquartile range, 1-2] for both groups) did not predict 72-hour returns. Older adults with distal forearm fractures may have more unscheduled health care usage in the first 3 days after fracture diagnosis than older adults with other fracture types. Overall, revisits for cardiac reasons or repeat falls were rare (<1%). Copyright © 2014 Elsevier Inc. All rights reserved.

  15. Periprosthetic fracture-dislocation in a loosened total knee replacement treated by knee arthrodesis

    International Nuclear Information System (INIS)

    Lozano Moreno, Francisco Jose

    2004-01-01

    We present a patient who was operated four years before performing a total knee replacement. She fell down resulting a periprosthetic femoral fracture and a prosthetic dislocation. After evaluating different treatments, we decided to do prosthetic removal and a knee arthrodesis using an intramedullar nail. The femoral fracture was fixed with wire cerclages. Knee arthrodesis is a procedure uses as a last option for the treatment of infected or loosed arthroplasties. In our case it was difficult to consider any other reconstructive procedure due to the association of fracture, dislocation and loosening. The evolution has been satisfactory with good functional result and without pain

  16. Comparative study of W-shaped angular plate and reconstruction plate in treating posterior wall fractures of the acetabulum.

    Directory of Open Access Journals (Sweden)

    Qi Zhang

    Full Text Available OBJECTIVE: This study aims to assess the medium-term results of the reconstruction of posterior wall fractures using a W-shaped acetabular angular plate (WAAP compared to those fixed using a reconstruction plate. METHODS: Between July 2006 and March 2009, we performed a retrospective study, which collected data for any patient treated for a posterior acetabular wall fracture. At the time of treatment, patients were either treated using a WAAP or a pelvic reconstruction plate. The intraoperative fluoroscopic images for both groups were compared. The quality of reduction and radiological grading were assessed according to the criteria developed by Matta. The clinical assessment was based on a modified Merle d'Aubigne and Postel scoring. RESULTS: 53 patients met the inclusion criteria and were followed up for an average of 38 months. 25 patients were treated with a WAAP (study group, and 28 patients were treated with a pelvic reconstruction plate (control group. The intraoperative fluoroscopic images of the study group confirmed extra-articular screw placement in all cases. In the control group, intra-articular screw placement was observed intraoperatively in 5 patients (17.86%, and the definitive location of the periarticular hardware could not be determined in 4 patients (14.29% during the operation. The differences between the two groups were statistically significant (p = 0.002. In contrast, the quality of fracture reduction, clinical outcomes, and radiological grading in the study group were not significantly different from those of the control group (p>0.05. The radiographic grade was strongly associated with the clinical outcomes in both the study and control groups (p<0.05. CONCLUSION: Reconstruction of posterior wall fractures of the acetabulum using a WAAP can help avoid screw penetration of the hip joint, provide a stable fixation of the posterior wall, and ensure good clinical outcomes.

  17. Effect of different composite core materials on fracture resistance of endodontically treated teeth restored with FRC posts

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    Prapaporn PANITIWAT

    Full Text Available Abstract Objective This study evaluated the fracture resistance of endodontically treated teeth restored with fiber reinforced composite posts, using three resin composite core build-up materials, (Clearfil Photo Core (CPC, MultiCore Flow (MCF, and LuxaCore Z-Dual (LCZ, and a nanohybrid composite, (Tetric N-Ceram (TNC. Material and Methods Forty endodontically treated lower first premolars were restored with quartz fiber posts (D.T. Light-Post cemented with resin cement (Panavia F2.0. Samples were randomly divided into four groups (n=10. Each group was built-up with one of the four core materials following its manufacturers’ instructions. The teeth were embedded in acrylic resin blocks. Nickel-Chromium crowns were fixed on the specimens with resin cement. The fracture resistance was determined using a universal testing machine with a crosshead speed of 1 mm/min at 1350 to the tooth axis until failure occurred. All core materials used in the study were subjected to test for the flexural modulus according to ISO 4049:2009. Results One-way ANOVA and Bonferroni multiple comparisons test indicated that the fracture resistance was higher in the groups with CPC and MCF, which presented no statistically significant difference (p>0.05, but was significantly higher than in those with LCZ and TNC (p<0.05. In terms of the flexural modulus, the ranking from the highest values of the materials was aligned with the same tendency of fracture loads. Conclusion Among the cores used in this study, the composite core with high filler content tended to enhance fracture thresholds of teeth restored with fiber posts more than others.

  18. Out with the old, in with the new: a novel approach to treating pain associated with rib fractures.

    Science.gov (United States)

    Truitt, Michael S; Mooty, R Clark; Amos, Joseph; Lorenzo, Manuel; Mangram, Alicia; Dunn, Ernest

    2010-10-01

    Rib fractures continue to be a challenging problem from both a pulmonary and analgesia standpoint. As a result, numerous modalities have been used to treat this condition, but none has proven universally available and efficacious. The objective of this pilot study was to assess the efficacy of a novel technique for placing an elastomeric infusion pump (EIP) catheter (On-Q; Lake Forest, CA, USA) in the extrathoracic paraspinous space to create a continuous intercostal nerve block. This was a prospective, nonrandomized study conducted in the surgical intensive care unit (SICU) of an urban level II trauma center. We developed a novel technique for placing EIP catheters in the extrathoracic paraspinous space to provide continuous intercostal nerve blockade. We subsequently evaluated 30 consecutive blunt trauma patients with three or more unilateral rib fractures. The catheters were infused with local anesthetic, and the dose was titrated to achieve adequate analgesia. For each patient, preplacement numeric pain scale scores (NPSs) and sustained maximum inspiration (SMI) lung volumes were determined. Sixty minutes following placement of the catheters, the NPS and SMI were repeated. The patients were monitored for any procedural or drug-related complications. The mean age of the patients was 65 years (22-92 years); the mean ISS was 14 (9-16); and the mean number of rib fractures was 4.4 (3-8). Overall, the mean NPS significantly improved (preplacement NPS 9.03, postplacement NPS 3.06; p pain secondary to rib fractures.

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

    Science.gov (United States)

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

    2011-08-01

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

  20. Nonunited humerus shaft fractures treated by external fixator augmented by intramedullary rod

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    Mahmoud A El-Rosasy

    2012-01-01

    Full Text Available Background: Nonunion of humeral shaft fractures after previously failed surgical treatment presents a challenging therapeutic problem especially in the presence of osteoporosis, bone defect, and joint stiffness. It would be beneficial to combine the use of external fixation technique and intramedullary rod in the treatment of such cases. The present study evaluates the results of using external fixator augmented by intramedullary rod and autogenous iliac crest bone grafting (ICBG for the treatment of humerus shaft nonunion following previously failed surgical treatment. Materials and Methods: Eighteen patients with atrophic nonunion of the humeral shaft following previous implant surgery with no active infection were included in the present study. The procedure included exploration of the nonunion, insertion of intramedullary rod (IM rod, autogenous ICBG and application of external fixator for compression. Ilizarov fixator was used in eight cases and monolateral fixator in ten cases. The monolateral fixator was preferred for females and obese patients to avoid abutment against the breast or chest wall following the use of Ilizarov fixator. The fixator was removed after clinical and radiological healing of the nonunion, but the IM rod was left indefinitely. The evaluation of results included both bone results (union rate, angular deformity and limb shortening and functional outcome using the University of California, Los Angeles (UCLA rating scale. Results: The mean follow-up was 35 months (range 24 to 52 months. Bone union was obtained in all cases. The functional outcome was satisfactory in 15 cases (83% and unsatisfactory in 3 cases (17% due to joint stiffness. The time to bone healing averaged 4.2 months (range 3 to 7 months. The external fixator time averaged 4.5 months (range 3.2 to 8 months. Superficial pin tract infection occurred in 39% (28/72 of the pins. No cases of nerve palsy, refracture, or deep infection were encountered

  1. The Floating Upper Limb: Multiple Injuries Involving Ipsilateral, Proximal, Humeral, Supracondylar, and Distal Radial Limb.

    Science.gov (United States)

    Manaan, Qazi; Bashir, Adil; Zahoor, Adnan; Mokhdomi, Taseem A; Danish, Qazi

    2016-09-01

    Floating arm injury represents a common yet complicated injury of the childhood severely associated with limb deformation and even morbidity, if not precisely addressed and credibly operated. Here, we report a rare floating upper limb case of a 9-year-old boy with multiple injuries of ipsilateral proximal humeral, supracondylar and distal radial limb. This is the first report to document such a combined floating elbow and floating arm injury in the same limb. In this report, we discuss the surgical procedures used and recovery of the patient monitored to ascertain the effectiveness of the method in limb reorganisation.

  2. Perioperative mortality in hip fracture patients treated with cemented and uncemented hemiprosthesis: a register study of 11,210 patients.

    Science.gov (United States)

    Talsnes, Ove; Vinje, Tarjei; Gjertsen, Jan Erik; Dahl, Ola E; Engesæter, Lars B; Baste, Valborg; Pripp, Are Hugo; Reikerås, Olav

    2013-06-01

    Adverse events associated with the use of bone cement for fixation of prostheses is a known complication. Due to inconclusive results in studies of hip fracture patients treated with cemented and uncemented hemiprostheses, this study was initiated. Our study is based on data reported to the Norwegian Hip Fracture Register on 11,210 cervical hip fractures treated with hemiprostheses (8,674 cemented and 2,536 uncemented). Significantly increased mortality within the first day of surgery was found in the cemented group (relative risk 2.9, 95 % confidence interval 1.6-5.1, p=0.001). The finding was robust giving the same results after adjusting for independent risk factors such as age, sex, cognitive impairment and comorbidity [American Society of Anesthesiologists (ASA) score]. For the first post-operative day the number needed to harm was 116 (one death for every 116 cemented prosthesis). However, in the most comorbid group (ASA worse than 3), the number needed to harm was only 33. We found increased mortality for the cemented hemiprosthesis the first post-operative day compared to uncemented procedures. This increased risk is closely related to patient comorbidity estimated by the patient's ASA score.

  3. A STUDY OF UNSTABLE INTERTROCHANTERIC FEMORAL FRACTURES TREATED BY TROCHANTERIC FEMORAL NAIL

    Directory of Open Access Journals (Sweden)

    Sreenivasa Neikar

    2017-11-01

    Full Text Available BACKGROUND Intertrochanteric fracture is one of the most common fracture of the hip especially in the elderly. The incidence of intertrochanteric fracture is rising because of the increase in number of elderly population along with superadded osteoporosis. MATERIALS AND METHODS Study included cases of unstable intertrochanteric fractures (AO and OTA Classification 31-A2 and 31-A3 fracture patterns that were operated with the short trochanteric femoral nail, which fitted into the inclusion criteria done in medical college hospital, Vijayanagara Institute of Medical Sciences, Bellary, from February 2015 to September 2016. RESULTS The age distribution was from 40 to 80 years. The largest group of patients were from 61 to 70 years. The average age was 60.5 years. The number of male patients in our series was 20 (66.7% and female was 10 (33.3%. Right side was affected in 11 cases (36.7% and left side in 19 cases (63.3%. Good reduction was achieved in 23 patients (76.7%. Acceptable reduction was achieved in 7 (23.3% patients due to severe comminution. In our study, 25 patients (83.33% had no complications. We encountered one intraoperative complication in the form of greater trochanter splintering, while inserting the nail. In our study, we encountered following postoperative complications. We noticed one case of delayed union, one case of Z effect and 2 cases of varus malunion. CONCLUSION We conclude that short trochanteric femoral nail provides good fixation for unstable intertrochanteric fractures if proper preoperative planning, good reduction and surgical technique are followed leading to high rate of bone union and minimal soft tissue damage especially for Asian patients with relatively small femora.

  4. Ten-year incidence and risk factors of bone fractures in a cohort of treated HIV1-infected adults

    Science.gov (United States)

    Collin, Fidéline; Duval, Xavier; Lemoing, Vincent; Piroth, Lionel; Al Kaied, Firas; Massip, Patrice; Villes, Virginie; Chêne, Geneviève; Raffi, François

    2009-01-01

    In the ANRS CO8 APROCO-COPILOTE cohort of patients treated with combination antiretroviral therapy since 1997–1999, the incidence density of bone fractures was 3.3 for 1,000 patient-years (95% CI: 2.0–4.6). Rate was 2.9-fold (95% CI: 1.3–6.5) higher among patients with excessive alcohol consumption and 3.6-fold (95% CI: 1.6–8.1) higher in those with Hepatitis C virus (HCV) co-infection. Specific monitoring of HCV/HIV-coinfected patients and active promotion of alcohol cessation should be recommended for the prevention of bone fractures. PMID:19300202

  5. Ununited fracture neck of femur treated with closed reduction and internal fixation with cancellous screw and fibular strut graft

    Directory of Open Access Journals (Sweden)

    Singh Daria

    2006-01-01

    Full Text Available Background: Ununited fracture neck of femur in young adults has been tackled in various ways. Methods: Twenty five patients of ununited fracture neck of femur in age group 21-55 years were treated by closed reduction, cancellous screw fixation and fibular strut graft and followed up for 2-6 years. Time gap between injury and operation was 6 weeks to 58 weeks. Five cases were previously fixed with various fixation devices. Results: Osseous union was achieved in 24 cases with average time of 18.16 weeks. Main complication encountered in follow-up was avascular necrosis of femoral head, others were joint stiffness and shortening. Functional end results were good to excellent in 24 cases. Conclusion: Closed reduction with internal fixation by cancellous screw and fibular strut grafting is easy and useful procedure.

  6. Advantages of external hybrid fixators for treating Schatzker V-VI tibial plateau fractures: A retrospective study of 40 cases.

    Science.gov (United States)

    Gross, J-B; Gavanier, B; Belleville, R; Coudane, H; Mainard, D

    2017-10-01

    Proximal tibia fractures make up 1% of all fractures in adults. The fractures classified as Schatzker V and VI fractures can compromise knee structure and function. They are challenging to treat and often have complications. While plate fixation is the gold standard, the resulting infection rate has led us to favor external hybrid fixation. The aims of this study were to assess the radiographic and functional outcomes along with the complication rate when using this method and to compare them to historical plate fixation data. This was a retrospective study of 40 patients. The complications, quality of reduction, IKS, Lysholm and Rasmussen functional scores at the latest follow-up and factors affecting the functional outcome were evaluated. These parameters were compared to published results from plate fixation studies. The deep infection rate was 2.5%. The union rate was 80%. Satisfactory reduction was obtained in 70% of cases; however, 52% of patients had malunion. The mean IKS score was 73.74, the mean Rasmussen score was 22.85 and the mean Lysholm score was 75.53. Age, reduction at latest follow-up, mechanical axis and anteroposterior laxity had a significant effect on the functional outcome. Despite the malunion rate being higher than other studies, the functional outcomes were nearly identical based on the variables measured. There are several advantages associated with using a hybrid external fixator: shorter operative time, less bleeding, shorter hospital stays and lower infection rate. Hybrid external fixation is a reliable fracture fixation method that leads to satisfactory functional outcomes, while reducing the infection rate and allowing arthroplasty to be performed in the future if needed. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  7. Articular congruity is associated with short-term clinical outcomes of operatively treated SER IV ankle fractures.

    Science.gov (United States)

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

    2013-10-02

    With regard to supination-external rotation type-IV (SER IV) ankle fractures, there is no consensus regarding which patient, injury, and treatment variables most strongly influence clinical outcome. The purpose of this investigation was to examine the impact of articular surface congruity on the functional outcomes of operatively treatment of SER IV ankle fractures. A prospectively generated database consisting of operatively treated SER IV ankle fractures was reviewed. Postoperative computed tomography (CT) scans were used to assess ankle joint congruity. Ankles were considered incongruent in the presence of >2 mm of articular step-off, intra-articular loose bodies, or an articular surface gap of >2 mm (despite an otherwise anatomic reduction) due to joint impaction and comminution. Patients with at least one year of clinical follow-up were eligible for analysis. The primary and secondary outcome measures were the Foot and Ankle Outcome Score (FAOS) and ankle motion. One hundred and eight SER IV fractures met our inclusion criteria. The average duration of follow-up was twenty-one months. Seventy-two patients (67%) had a congruent ankle joint, and thirty-six (33%) had elements of articular surface incongruity on postoperative CT scanning. These two groups were similar with regard to comorbidities and injury and treatment variables. At the time of the final follow-up, the group with articular incongruity had a significantly worse FAOS with regard to symptoms (p = 0.012), pain (p = 0.004), and activities of daily living (p = 0.038). Those with articular incongruity had worse average scores in the FAOS sport domain as well. No significant differences in ankle motion were found between the two groups. In this population of patients with an operatively treated SER IV ankle fracture, the presence of postoperative articular incongruity correlated with inferior early clinical outcomes. Orthopaedic surgeons should scrutinize ankle fracture reductions and strive for

  8. Epidemiology and treatment outcome of surgically treated mandibular condyle fractures. A five years retrospective study.

    Science.gov (United States)

    Zrounba, Hugues; Lutz, Jean-Christophe; Zink, Simone; Wilk, Astrid

    2014-09-01

    Surgical management of mandibular condyle fractures is still controversial. Although it provides better outcome than closed treatment questions still remain about the surgical approach and the osteosynthesis devices to be used. Between 2005 and 2010, we managed 168 mandibular condyle fractures with open treatment. Two surgical approaches were used in this study, a pre-auricular and a high submandibular approach (one or the other or as a combined approach). Internal fixation was performed using TCP(®) plates (Medartis, Basel, Switzerland) or with two lag screws (15 and 17 mm). Delta plates were used in 15 cases (8.9%). We report the epidemiology of these fractures and the outcomes of the surgical treatment. We assessed the complications related to the surgical procedure and those related to the osteosynthesis material. The facial nerve related complication rate was very low and the osteosynthesis materials used proved to be strong enough to realize a stable fixation. The two approaches used in this study appeared to be safe with good aesthetic results. Most of the surgical procedure failures occurred in high subcondylar fractures especially when bilateral. Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  9. Atypical femoral fracture in an osteogenesis imperfecta patient successfully treated with teriparatide

    DEFF Research Database (Denmark)

    Holm, Jakob; Eiken, Pia; Hyldstrup, Lars

    2014-01-01

    OBJECTIVE: We report a case of a successfully healed atypical femoral fracture (AFF) following treatment with teriparatide in a patient with osteogenesis imperfecta (OI). To our knowledge, no successful treatment of AFFs with teriparatide in this subpopulation has ever been described. METHODS...

  10. Periprosthetic Vancouver type B1 and C fractures treated by locking-plate osteosynthesis

    DEFF Research Database (Denmark)

    Froberg, Lonnie; Troelsen, Anders; Brix, Michael

    2012-01-01

    Historically, the treatment of periprosthetic femoral fractures (PFFs) has been associated with a high frequency of complications and reoperations. The preferred treatment is internal fixation, a revision of the femoral stem, or a combination of both. An improved understanding of plate use during...

  11. Fracture resistance and histological findings of immature teeth treated with mineral trioxide aggregate

    DEFF Research Database (Denmark)

    Hatibovic-Kofman, S.; Raimundo, L.; Zheng, L.

    2008-01-01

    The objective of the present study was to test the hypothesis that the fracture strength of calcium hydroxide and mineral trioxide aggregate (MTA)-filled immature teeth decreased over time. Immature mandibular incisors from sheep were extracted and the pulps were extirpated using an apical approach...

  12. Outcomes of osteoporotic trochanteric fractures treated with cement-augmented dynamic hip screw

    Science.gov (United States)

    Gupta, Rakesh Kumar; Gupta, Vinay; Gupta, Navdeep

    2012-01-01

    Background: Dynamic hip screw (DHS) has been the standard treatment for stable trochanteric fracture patterns, but complications of lag screw cut out from a superior aspect, due to inadequate bone anchorage, occur frequently in elderly osteoporotic patients. Polymethylmethacrylate (PMMA) has been used as an augmentation tool to facilitate fixation stability in cadaveric femora for biomechanical studies and in pathological fractures. However, there are very few reports on the utilization of PMMA cement to prevent these complications in fresh intertrochanteric fractures. A prospective study was conducted to evaluate the outcome and efficacy of PMMA augmented DHS in elderly osteoporotic patients with intertrochanteric fractures. Materials and Methods: The study included 64 patients (AO type31-A2.1 in eight, A2.2 in 29, A2.3 in 17 patients, and 31-A3.1 in five, A3.2 in three, and A3.3 in two patients) with an average age of 72 years (60 – 94 years) of which 60 were available for final followup. PMMA augmentation of DHS was performed in all cases by injecting PMMA cement into the femoral head with a custommade gun designed by the authors. The clinical outcome was rated as per the Salvati and Wilson scoring system at the time of final followup of one year. Results were graded as excellent (score > 31), good (score 24 – 31), fair (score 16 – 23), and poor (score < 16). Results: Fracture united in all patients and the average time to union was 13.8 weeks (range 12 – 16 weeks). At an average followup of 18 months (range 12 – 24 months), no incidence of varus collapse or superior screw cut out was observed in any of the patients in spite of weightbearing ambulation from the early postoperative period. There was no incidence of avascular necrosis (AVN) or cement penetration into the joint in our series. Most of the patients were able to regain their prefracture mobility status with a mean hip pain score of 8.6. Conclusion: Cement augmentation of DHS appears to be an

  13. Outcomes of osteoporotic trochanteric fractures treated with cement-augmented dynamic hip screw

    Directory of Open Access Journals (Sweden)

    Rakesh Kumar Gupta

    2012-01-01

    Full Text Available Background: Dynamic hip screw (DHS has been the standard treatment for stable trochanteric fracture patterns, but complications of lag screw cut out from a superior aspect, due to inadequate bone anchorage, occur frequently in elderly osteoporotic patients. Polymethylmethacrylate (PMMA has been used as an augmentation tool to facilitate fixation stability in cadaveric femora for biomechanical studies and in pathological fractures. However, there are very few reports on the utilization of PMMA cement to prevent these complications in fresh intertrochanteric fractures. A prospective study was conducted to evaluate the outcome and efficacy of PMMA augmented DHS in elderly osteoporotic patients with intertrochanteric fractures. Materials and Methods: The study included 64 patients (AO type31-A2.1 in eight, A2.2 in 29, A2.3 in 17 patients, and 31-A3.1 in five, A3.2 in three, and A3.3 in two patients with an average age of 72 years (60 − 94 years of which 60 were available for final followup. PMMA augmentation of DHS was performed in all cases by injecting PMMA cement into the femoral head with a custommade gun designed by the authors. The clinical outcome was rated as per the Salvati and Wilson scoring system at the time of final followup of one year. Results were graded as excellent (score > 31, good (score 24 − 31, fair (score 16 − 23, and poor (score < 16. Results: Fracture united in all patients and the average time to union was 13.8 weeks (range 12 − 16 weeks. At an average followup of 18 months (range 12 − 24 months, no incidence of varus collapse or superior screw cut out was observed in any of the patients in spite of weightbearing ambulation from the early postoperative period. There was no incidence of avascular necrosis (AVN or cement penetration into the joint in our series. Most of the patients were able to regain their prefracture mobility status with a mean hip pain score of 8.6. Conclusion: Cement augmentation of DHS appears

  14. Bone fractures among postmenopausal patients with endocrine-responsive early breast cancer treated with 5 years of letrozole or tamoxifen in the BIG 1-98 trial

    DEFF Research Database (Denmark)

    Rabaglio, M; Sun, Z; Price, K N

    2009-01-01

    of letrozole or tamoxifen in the BIG 1-98 trial who received at least some study medication (median follow-up 60.3 months). Bone fracture information (grade, cause, site) was collected every 6 months during trial treatment. RESULTS: The incidence of bone fractures was higher among patients treated......BACKGROUND: To compare the incidence and timing of bone fractures in postmenopausal women treated with 5 years of adjuvant tamoxifen or letrozole for endocrine-responsive early breast cancer in the Breast International Group (BIG) 1-98 trial. METHODS: We evaluated 4895 patients allocated to 5 years...... with letrozole [228 of 2448 women (9.3%)] versus tamoxifen [160 of 2447 women (6.5%)]. The wrist was the most common site of fracture in both treatment groups. Statistically significant risk factors for bone fractures during treatment included age, smoking history, osteoporosis at baseline, previous bone...

  15. Skin puckering an uncommon sign of underlying humeral neck fracture: a case report.

    LENUS (Irish Health Repository)

    Davarinos, N

    2012-01-31

    Skin puckering is a sign that is well associated with certain fractures such as supracondylar humeral fractures in children. To our knowledge, there has been only one clinical report of skin puckering associated with fractured neck of humerus of an adult. This is a second such case of fractured proximal humerus in an adult presenting with skin puckering and the first from the Republic of Ireland. Skin puckering is suggestive of soft tissue interposition and may be an important clinical sign indicating the need for internal fixation.

  16. Low bone mineral density is not related to failure in femoral neck fracture patients treated with internal fixation

    DEFF Research Database (Denmark)

    Viberg, Bjarke; Ryg, Jesper; Overgaard, Søren

    2014-01-01

    the importance of low bone mineral density (BMD). Patients and methods - 140 consecutive patients (105 females, median age 80) treated with IF had a dual-energy X-ray absorptiometry (DXA) scan of the hip performed median 80 days after treatment. The patients' radiographs were evaluated for fracture displacement......, implant positioning, and quality of reduction. From a questionnaire completed during admission, 2 variables for comorbidity and walking disability were chosen. Primary outcome was low hip BMD (amount of mineral matter per square centimeter of hip bone) compared to hip failure (resection, arthroplasty...

  17. Pregnancy-associated osteoporosis with eight fractures in the vertebral column treated with kyphoplasty and bracing: a case report.

    Science.gov (United States)

    Bonacker, J; Janousek, M; Kröber, M

    2014-02-01

    Pregnancy-associated osteoporosis is a rare condition, which imposes multiple symptoms in the musculoskeletal system. Common complaints announced by patients are severe pain in the lower back, hips and the joints of the lower extremities with a reduced and less mobility status in general. Most of the patients' problems occur in the last trimester of pregnancy or postpartum and are often not diagnosed as side effects of osteoporosis but as problems associated with pregnancy. Although vertebral fractures are rare complications of pregnancy-associated osteoporosis, they should be always considered in women presenting with an acute pain syndrome in peripregnancy period. This case presents a 40-year-old primagravid woman who developed pain in hips and severe pain in the lower back causing an immobilization diagnosed with a pregnancy-associated osteoporosis with eight compression fractures in the thoracic and lumbar spine. Because of sagittal imbalance of the spine, she was treated with kyphoplasty at the four lumbar fractures and with bracing for the upper, thoracic ones, additional to the conservative anti-osteoporotic therapy. The authors discuss pregnancy-associated osteoporosis and its clinical presentation, as well as the indications of kyphoplasty, spinal alignment and the risk of single conservative treatment.

  18. A Study of Inflammatory/Necrosis Biomarkers in the Fracture of the Femur Treated with Proximal Femoral Nail Antirotation

    Directory of Open Access Journals (Sweden)

    Mariapaola Marino

    2015-01-01

    Full Text Available Pertrochanteric fractures are common injuries in adults and source of morbidity and mortality among the elderly. Different surgical techniques were recommended for their treatment but undoubtedly they add an additional inflammatory trauma along the fracture itself. Many attempts to quantify the degree of approach-related trauma are carried out through measurements of systemic inflammatory parameters. In this study we prospectively analyzed laboratory data of 20 patients over eighty with pertrochanteric fracture of the femur treated with proximal femoral nail antirotation (PFNA. This is an excellent device for osteosynthesis because it can be easily and quickly inserted by a mini-incision providing stable fixation and early full mobilization. Serum tumor necrosis factor-alpha (TNF-α, interleukin-6 (IL-6, C-reactive protein (CRP, and plasma creatin kinase (CK were evaluated 1 hour preoperatively and 24 hours postoperatively. Our results show that PFNA did not induce significant increments in serum levels of inflammatory cytokines TNF-α and IL-6; CRP was elevated preoperatively in correlation with waiting time for surgery; CRP and CK showed a significant increment in the first postoperatory day; CK increment was correlated with surgical time length. We conclude that, for the markers we analyzed, PFNA shows a low biomechanical-inflammatory profile that represents an advantage over other techniques.

  19. Complicated Crown-Root Fracture Treated Using Reattachment Procedure: A Single Visit Technique

    Directory of Open Access Journals (Sweden)

    Akhil Rajput

    2011-01-01

    Full Text Available Complicated crown-root fracture of maxillary central and lateral incisors is common in case of severe trauma or sports-related injury. It happens because of their anterior positioning in oral cavity and protrusive eruptive pattern. On their first dental visit, these patients are in pain and need emergency care. Because of impaired function, esthetics, and phonetics, such patients are quite apprehensive during their emergency visit. Successful pain management with immediate restoration of function, esthetics and phonetics should be the prime objective while handling such cases. This paper describes immediate treatment of oblique crown root fracture of maxillary right lateral incisor with reattachment procedure using light transmitting fiber post. After two and half years, the reattached fragment still has satisfying esthetics and excellent function.

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

    Science.gov (United States)

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

    2017-07-01

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

  1. Management and Followup of Complicated Crown Fractures in Young Patients Treated with Partial Pulpotomy

    Directory of Open Access Journals (Sweden)

    Francisco Ojeda-Gutierrez

    2013-01-01

    Full Text Available Two cases of young patients with traumatized permanent teeth having complicated crown fractures are reported. Endodontic management included partial pulpotomy by the Cvek technique; restorative management included resin restoration and reattachment of the teeth fragments. Treatments were considered successful in all cases according to the following criteria: absence of clinical symptoms, absence of X-ray signs of pathology, and presence of pulpal vitality 6 to 25 months after treatment.

  2. [Comparing clinical effects of titanic elastic nail and locking compression pine fixation in treating subtrochanteric fractures in older children].

    Science.gov (United States)

    Zhu, Kang-xiang; Yin, Shan-qing

    2013-12-01

    To explore optimal choice of surgical treatment for subtrochanteric fractures in older children. A retrospective study of 36 older children with subtrochanteric fractures was performed between January 2010 and January 2012. Among them, 18 patients (11 males and 7 females) aged from 7 to 13 years old with an average of 9.4 were treated with titanic elastic nail (TEN) fixation, 4 cases were Type II A, 3 cases were II B, 2 cases were II C, 4 cases were III A, 3 cases were III B according to Seinsheimer classification. Eighteen patients (10 males and 8 females) aged was from 8 to 13 years with an average of 9.6 were treated with locking compression pine (LCP) fixation, and 3 cases were Type II A, 4 cases were II B, 3 cases were II C, 4 cases were IIIA, 2 cases were III B. Fracture healing time, postoperative complications (including wound infection, failure and breakage of internal fixtion, deformities of angular on the sagittal view, deformities of coxa vara) and recovery of hip joint function were observed and recorded. All children were followed up from 15 to 36 months with an average of 21. Fracture were all healed, the time ranged from 7 to 16 weeks (mean 9.5). Three cases in TEN group occurred mild deformities of angular on the sagittal view, 3 cases occurred deformities of coxa vara and 2 cases occurred limb shortening; while 1 case occurred mild deformities of angular on the sagittal view, and no deformities of coxa vara and limb shortening occurred in LCP group. No early close of epiphyseal injury, avascular necrosis of femoral head occurred. Clinical efficacy were evaluated by Sanders standard, 14 cases got excellent results, 3 cases were moderate in LCP group, while 9 cases in excellent, 4 in moderate in TEN group. There were no significant differences between two group in recovery of hip joint function and complications. For the treatment of subtrochanteric fractures in older children,the efficacy of LCP fixation is better than that of TFN fixation, which

  3. Fracture of the medial intercondylar eminence of the tibia in horses treated by arthroscopic fragment removal (21 horses).

    Science.gov (United States)

    Rubio-Martínez, L M; Redding, W R; Bladon, B; Wilderjans, H; Payne, R J; Tessier, C; Geffroy, O; Parker, R; Bell, C; Collingwood, F A

    2018-01-01

    Fractures of the medial intercondylar eminence of the tibia (MICET) are scarcely reported in horses. To report the clinical and diagnostic findings, surgical treatment and outcome in a series of horses presented with MICET fracture and treated with arthroscopic fragment removal. Multicentre retrospective case series. Case records of horses diagnosed with MICET fractures that had undergone surgical treatment were reviewed. Follow-up information was obtained from re-examination visits and/or owners. Twenty-one cases were identified at 9 equine hospitals between 2004 and 2016. A history of trauma and acute onset of lameness was reported in 12 horses. All cases underwent fracture removal via arthroscopy of the medial femorotibial joint. The cranial cruciate ligament was intact in 6 horses and damaged in 15 horses (damage was ≤25% [n = 9], 25-50% [n = 4] or ≥50% [n = 2] of the cross-sectional area). The cranial ligament of the medial meniscus was damaged in 11 horses (≤25% [n = 8], 25-50% [n = 3]). The medial meniscus was damaged in 5 horses and articular cartilage damage was identified in 14 horses (mild [n = 8], moderate [n = 6]). Follow-up information (median 14 months; 4 months-6 years) was available for 20 cases; 2 horses were sound but convalescing; 13 horses were sound and returned to their previous or expected use. Of the 4 horses with the most severe changes to the articular soft tissue structures, 2 remained lame and 2 were subjected to euthanasia because of persistent lameness. The retrospective, multicentre nature of this study and the limited number of horses are the main limitations. Fractures of the MICET are commonly associated with a traumatic event. Prompt diagnosis and early arthroscopic removal of the fracture are recommended. © 2017 The Authors. Equine Veterinary Journal published by John Wiley & Sons Ltd on behalf of EVJ Ltd.

  4. Distal tibial pilon fractures (AO/OTA type B, and C treated with the external skeletal and minimal internal fixation method

    Directory of Open Access Journals (Sweden)

    Milenković Saša

    2013-01-01

    Full Text Available Background/Aim. Distal tibial pilon fractures include extra-articular fractures of the tibial metaphysis and the more severe intra-articular tibial pilon fractures. There is no universal method for treating distal tibial pilon fractures. These fractures are treated by means of open reduction, internal fixation (ORIF and external skeletal fixation. The high rate of soft-tissue complications associated with primary ORIF of pilon fractures led to the use of external skeletal fixation, with limited internal fixation as an alternative technique for definitive management. The aim of this study was to estimate efficacy of distal tibial pilon fratures treatment using the external skeletal and minimal internal fixation method. Methods. We presented a series of 31 operated patients with tibial pilon fractures. The patients were operated on using the method of external skeletal fixation with a minimal internal fixation. According to the AO/OTA classification, 17 patients had type B fracture and 14 patients type C fractures. The rigid external skeletal fixation was transformed into a dynamic external skeletal fixation 6 weeks post-surgery. Results. This retrospective study involved 31 patients with tibial pilon fractures, average age 41.81 (from 21 to 60 years. The average follow-up was 21.86 (from 12 to 48 months. The percentage of union was 90.32%, nonunion 3.22% and malunion 6.45%. The mean to fracture union was 14 (range 12-20 weeks. There were 4 (12.19% infections around the pins of the external skeletal fixator and one (3.22% deep infections. The ankle joint arthrosis as a late complication appeared in 4 (12.90% patients. All arthroses appeared in patients who had type C fractures. The final functional results based on the AOFAS score were excellent in 51.61%, good in 32.25%, average in 12.90% and bad in 3.22% of the patients. Conclusion. External skeletal fixation and minimal internal fixation of distal tibial pilon fractures is a good method for

  5. Distal tibial pilon fractures (AO/OTA type B, and C) treated with the external skeletal and minimal internal fixation method.

    Science.gov (United States)

    Milenković, Sasa; Mitković, Milorad; Micić, Ivan; Mladenović, Desimir; Najman, Stevo; Trajanović, Miroslav; Manić, Miodrag; Mitković, Milan

    2013-09-01

    Distal tibial pilon fractures include extra-articular fractures of the tibial metaphysis and the more severe intra-articular tibial pilon fractures. There is no universal method for treating distal tibial pilon fractures. These fractures are treated by means of open reduction, internal fixation (ORIF) and external skeletal fixation. The high rate of soft-tissue complications associated with primary ORIF of pilon fractures led to the use of external skeletal fixation, with limited internal fixation as an alternative technique for definitive management. The aim of this study was to estimate efficacy of distal tibial pilon fratures treatment using the external skeletal and minimal internal fixation method. We presented a series of 31 operated patients with tibial pilon fractures. The patients were operated on using the method of external skeletal fixation with a minimal internal fixation. According to the AO/OTA classification, 17 patients had type B fracture and 14 patients type C fractures. The rigid external skeletal fixation was transformed into a dynamic external skeletal fixation 6 weeks post-surgery. This retrospective study involved 31 patients with tibial pilon fractures, average age 41.81 (from 21 to 60) years. The average follow-up was 21.86 (from 12 to 48) months. The percentage of union was 90.32%, nonunion 3.22% and malunion 6.45%. The mean to fracture union was 14 (range 12-20) weeks. There were 4 (12.19%) infections around the pins of the external skeletal fixator and one (3.22%) deep infections. The ankle joint arthrosis as a late complication appeared in 4 (12.90%) patients. All arthroses appeared in patients who had type C fractures. The final functional results based on the AOFAS score were excellent in 51.61%, good in 32.25%, average in 12.90% and bad in 3.22% of the patients. External skeletal fixation and minimal internal fixation of distal tibial pilon fractures is a good method for treating all types of inta-articular pilon fractures. In

  6. Conservative treatment of Malgaigne fracture in young female - case report

    Directory of Open Access Journals (Sweden)

    Vukašinović Zoran

    2013-01-01

    Full Text Available Introduction. Pelvic ring injuries usually result from high­energy trauma, and cranial and abdominal multiple injuries are frequently present. Malgaigne fracture is referred to pelvic ring disruption at two sites, and is often treated surgically for its instability. We present a case of nonoperative treatment of Malgaigne pelvic fracture. Case Outline. A 17­year­old girl sustained a Malgaigne fracture falling off a horse. After ruling out urgent multiple trauma in local hospital, she was then transferred to Pediatric Orthopedic and Trauma Service at the Institute of Orthopedic Surgery «Banjica» Belgrade, with provisional cutaneous traction of 2 kg applied to her right leg. After the status evaluation, the supracondylar femoral traction was applied for three months, combined with pelvic cradle for first 73 days. Weight of traction was gradually adjusted according to x­ray check­up, ranging from 1­16 kg (1/4 of body weight. Antibiotic prophylaxis was administered for 10 days, and thromboprophylaxis for two months. After the removal of traction, physical therapy was applied and the patient achieved full weight bearing four months after the injury. Treatment outcome was a symmetric and stable pelvic ring, equal leg length, full range of motion in both hip joints and normal walking. Conclusion. Traction therapy, combined with gravitational suspension in pelvic cradle, resulted in excellent clinical result. Although significantly longer and more loaded than usual, normal weight bearing and walking were promptly achieved using intensive physical therapy. [Projekat Ministarstva nauke Republike Srbije, br. III 41004

  7. 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.)

  8. Is fusion necessary for thoracolumbar burst fracture treated with spinal fixation? A systematic review and meta-analysis.

    Science.gov (United States)

    Diniz, Juliete M; Botelho, Ricardo V

    2017-11-01

    OBJECTIVE Thoracolumbar fractures account for 90% of spinal fractures, with the burst subtype corresponding to 20% of this total. Controversy regarding the best treatment for this condition remains. The traditional surgical approach, when indicated, involves spinal fixation and arthrodesis. Newer studies have brought the need for fusion associated with internal fixation into question. Not performing arthrodesis could reduce surgical time and intraoperative bleeding without affecting clinical and radiological outcomes. With this study, the authors aimed to assess the effect of fusion, adjuvant to internal fixation, on surgically treated thoracolumbar burst fractures. METHODS A search of the Medline and Cochrane Central Register of Controlled Trials databases was performed to identify randomized trials that compared the use and nonuse of arthrodesis in association with internal fixation for the treatment of thoracolumbar burst fractures. The search encompassed all data in these databases up to February 28, 2016. RESULTS Five randomized/quasi-randomized trials, which involved a total of 220 patients and an average follow-up time of 69.1 months, were included in this review. No significant difference between groups in the final scores of the visual analog pain scale or Low Back Outcome Scale was detected. Surgical time and blood loss were significantly lower in the group of patients who did not undergo fusion (p < 0.05). Among the evaluated radiological outcomes, greater mobility in the affected segment was found in the group of those who did not undergo fusion. No significant difference between groups in the degree of kyphosis correction, loss of kyphosis correction, or final angle of kyphosis was observed. CONCLUSIONS The data reviewed in this study suggest that the use of arthrodesis did not improve clinical outcomes, but it was associated with increased surgical time and higher intraoperative bleeding and did not promote significant improvement in radiological

  9. The cost of infection in severe open tibial fractures treated with a free flap

    DEFF Research Database (Denmark)

    Olesen, Ulrik Kähler; Pedersen, Nicolas Jones; Eckardt, Henrik

    2017-01-01

    procedures performed, including medications and intensive care. We analysed indirect cost in terms of absenteeism and unemployment benefits. The primary goal was to establish the extra cost incurred by an infection. RESULTS: We analysed 46 injuries in 45 patients. Infection increased the LOS from 41 to 74...... rate from 60 to 27 %. CONCLUSIONS: Severe open tibial fractures covered with free flaps, cause over a year of absenteeism. Infection increases direct cost of treatment over 60 % and roughly doubles LOS. Early soft-tissue cover and correct antibiotics have been shown to improve outcomes...

  10. Functional Improvement in Geriatric Hip Fractures: Does Vitamin D Deficiency Affect the Functional Outcome of Patients With Surgically Treated Intertrochanteric Hip Fractures.

    Science.gov (United States)

    Seng, W R D; Belani, M H; Ramason, R; Naidu, G; Doshi, H K

    2015-09-01

    The "Integrated Care Pathway" for geriatric intertrochanteric (IT) fractures in Singapore's Tan Tock Seng Hospital has shown significant functional recovery in patients' activities of daily living. However, the influence of preoperative vitamin D on functional recovery remains equivocal. This retrospective study therefore aims to determine whether patients with preoperative vitamin D deficiency have poorer functional outcomes. A total of 171 patients who had surgical treatment for IT fractures were recruited in the study. They were categorized into group A (vitamin D deficient) and group B (normal vitamin D). Charlson Comorbidity Index (CCI) score and nutritional parameters including hemoglobin, albumin, and adjusted calcium levels on admission were recorded. The Modified Barthel Index (MBI) score was used to measure functional recovery at the following time intervals: at pre-fall, at discharge after surgery, at 6 months, and at 1-year follow-up. The mean age of both the groups (A: 79.7 years, n = 45; B: 83.0 years, n = 126) was statistically different (P < .05). However, the mean CCI (A: 9.42 and B: 10.13), hemoglobin (A: 12.4 and B 11.1), adjusted calcium (A: 2.39 and B: 2.38), and mean albumin (A: 33.6 and B: 33.0) of the groups were not significantly different. Furthermore, the MBI scores were not significantly different for both groups at preinjury (A: 91.5 and B: 89.4), at discharge (A: 55.2 and B: 58.9), at 6 months (A: 70.9 and B: 75.1), and at 1 year (A: 75.8 and B: 79.4). In our cohort, patients with vitamin D deficiency were younger. However, vitamin D deficiency at time of injury had no significant influence on functional recovery in patients with surgically treated hip fracture in our Integrated Care Pathway. In addition, patients who had a normal vitamin D levels had similar functional scores and improvement postoperatively and at 1 year (A: 82.8% and B: 88.9%).

  11. Biocompatibility of Bespoke 3D-Printed Titanium Alloy Plates for Treating Acetabular Fractures

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    Xuezhi Lin

    2018-01-01

    Full Text Available Treatment of acetabular fractures is challenging, not only because of its complicated anatomy but also because of the lack of fitting plates. Personalized titanium alloy plates can be fabricated by selective laser melting (SLM but the biocompatibility of these three-dimensional printing (3D-printed plates remains unknown. Plates were manufactured by SLM and their cytocompatibility was assessed by observing the metabolism of L929 fibroblasts incubated with culture medium extracts using a CCK-8 assay and their morphology by light microscopy. Allergenicity was tested using a guinea pig maximization test. In addition, acute systemic toxicity of the 3D-printed plates was determined by injecting extracts from the implants into the tail veins of mice. Finally, the histocompatibility of the plates was investigated by implanting them into the dorsal muscles of rabbits. The in vitro results suggested that cytocompatibility of the 3D-printed plates was similar to that of conventional plates. The in vivo data also demonstrated histocompatibility that was comparable between the two manufacturing techniques. In conclusion, both in vivo and in vitro experiments suggested favorable biocompatibility of 3D-printed titanium alloy plates, indicating that it is a promising option for treatment of acetabular fractures.

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

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    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

  13. Retrospective analysis of extra-articular distal humerus shaft fractures treated with the use of pre-contoured lateral column metaphyseal LCP by triceps-sparing posterolateral approach

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    Yatinder Kharbanda

    2016-11-01

    Full Text Available Abstract Management of extra-articular distal humerus fractures presents a challenge to the treating surgeon due to the complex anatomy of the distal part of the humerus and complicated fracture morphology. Although surgical treatment has shown to provide a more stable reduction and alignment and predictable return to function, it has been associated with complications like iatrogenic radial nerve palsy, infection, non-union and Implant failure. We in the present series retrospectively analysed 20 patients with extra-articular distal humerus shaft fractures surgically treated using the extra-articular distal humeral locking plate approached by the triceps-sparing posterolateral approach. The outcome was assessed using the DASH score, range of motion at the elbow and the time to union. The mean time to radiographic fracture union was 12 weeks.

  14. Retrospective analysis of extra-articular distal humerus shaft fractures treated with the use of pre-contoured lateral column metaphyseal LCP by triceps-sparing posterolateral approach.

    Science.gov (United States)

    Kharbanda, Yatinder; Tanwar, Yashwant Singh; Srivastava, Vishal; Birla, Vikas; Rajput, Ashok; Pandit, Ramsagar

    2017-04-01

    Management of extra-articular distal humerus fractures presents a challenge to the treating surgeon due to the complex anatomy of the distal part of the humerus and complicated fracture morphology. Although surgical treatment has shown to provide a more stable reduction and alignment and predictable return to function, it has been associated with complications like iatrogenic radial nerve palsy, infection, non-union and Implant failure. We in the present series retrospectively analysed 20 patients with extra-articular distal humerus shaft fractures surgically treated using the extra-articular distal humeral locking plate approached by the triceps-sparing posterolateral approach. The outcome was assessed using the DASH score, range of motion at the elbow and the time to union. The mean time to radiographic fracture union was 12 weeks.

  15. Omnidirectional Internal Fixation by Double Approaches for Treating Rüedi-Allgöwer Type III Pilon Fractures.

    Science.gov (United States)

    Dai, Chong-Hua; Sun, Jun; Chen, Kun-Quan; Zhang, Hui-Bo

    In the present study, we explored the effectiveness and complications of omnidirectional internal fixation using a double approach for treating Rüedi-Allgöwer type III pilon fractures. A retrospective analysis was performed of 19 cases of Rüedi-Allgöwer type III unilateral closed pilon fracture. With preoperative preparation and correct surgical timing, the reduction was performed using anteromedial and posterolateral approaches, and the fracture fragments were fixed by omnidirectional internal fixation. Imaging evaluation was performed using the Burwell-Charnley scoring system. The Johner-Wruhs scoring system was used to assess the functional status of the patients. A comprehensive evaluation of efficacy was performed using a 5-point Likert score. The complications were also recorded and analyzed. All patients were followed up for an average of 16.2 months. The operative incisions of 15 cases healed by primary intent and with delayed healing in 4. All patients had achieved bony union at an average of 16 weeks postoperatively. No deep infection, broken nail or withdrawn nail, exposed plate, or skin flap necrosis occurred. The Burwell-Charnley imaging evaluation showed that 14 patients had anatomic reduction of the articular surface and 5 had acceptable reduction. Using the Johner-Wruhs scoring system, the results were excellent for 8, good for 7, fair for 2, and poor for 2 patients; the combined rate of excellent and good results was 78.9%. The Likert score of efficacy self-reported by the patients was 3 to 4 points for 12 patients, 2 points for 4 patients, and 0 to 1 point for 3 patients. The Likert score of therapeutic efficacy reported by the physicians was 3 to 4 points for 10 patients, 2 points for 5 patients, and 0 to 1 point for 4 patients. Omnidirectional internal fixation using double approaches was an effective method to treat Rüedi-Allgöwer type III pilon fractures with satisfactory reduction and rigid fixation, good joint function recovery, and

  16. [Long-Term Outcomes of the Treatment of Pediatric Femoral Shaft Fractures Treated with Bryant's Vertical Traction].

    Science.gov (United States)

    Urban, J; Toufar, P; Kloub, M

    2017-01-01

    PURPOSE OF THE STUDY The paper aimed to evaluate the long-term outcomes of the treatment of diaphyseal femur fractures in children treated with Bryant's vertical traction. Moreover, we also assessed the size of overgrowth in the injured femur. MATERIAL AND METHODS The study included 23 patients with 23 femoral shaft fractures treated with Bryant's vertical traction at our department in 2009-2014. The following parameters were assessed: sex, ïnjured side, weight, age, mechanism of injury, potential abuse, type of fracture, duration of traction, and total length of hospital stay. The healing time of the fracture was the same as the duration of traction. Also assessed was the size of femoral shortening after the removal of traction, the presence of skin complications in the course of treatment and potential development of compartment syndrome. At the mean follow-up of 47.8 months (range 22-85 months) from the date of injury the patients were evaluated clinically and radiologically for: length of limbs, presence of rotational deformity, range of motion of knee and hip joints, potential pain or limping, potential scoliosis of the spine and presence of scars after traction. Finally, through a questionnaire we learned about the opinions of parents as to the treatment method and about the possibility of home traction. RESULTS All the fractures healed. There was a total of 17 injured boys and 6 injured girls. Whereas 12 patients sustained a fracture of the left femur, 11 patients sustained a fracture of the right femur. The mean weight of patients at the time of injury was 13.9 kg (range 5-20 kg). The mean age at the time of traction was 30.8 months (range 1-70 months). The injury most frequently occurred from various falls, altogether in 15 cases (65.2%). Traffic accidents were registered as the cause of injury in 3 cases (13%). No abuse was confirmed. The average duration of traction was 19.8 days (range 8-26 days). The total length of hospital stay took on average 23

  17. Fracture resistance of endodontically treated teeth restored with Zirconia filler containing composite core material and fiber posts.

    Science.gov (United States)

    Jeaidi, Zaid Al

    2016-01-01

    To assess the fracture resistance of endodontically treated teeth with a novel Zirconia (Zr) nano-particle filler containing bulk fill resin composite. Forty-five freshly extracted maxillary central incisors were endodontically treated using conventional step back preparation and warm lateral condensation filling. Post space preparation was performed using drills compatible for fiber posts (Rely X Fiber Post) on all teeth (n=45), and posts were cemented using self etch resin cement (Rely X Unicem). Samples were equally divided into three groups (n=15) based on the type of core materials, ZirconCore (ZC) MulticCore Flow (MC) and Luxacore Dual (LC). All specimens were mounted in acrylic resin and loads were applied (Universal testing machine) at 130° to the long axis of teeth, at a crosshead speed of 0.5 mm/min until failure. The loads and the site at which the failures occurred were recorded. Data obtained was tabulated and analyzed using a statistical program. The means and standard deviations were compared using ANOVA and Multiple comparisons test. The lowest and highest failure loads were shown by groups LC (18.741±3.02) and MC (25.16±3.30) respectively. Group LC (18.741±3.02) showed significantly lower failure loads compared to groups ZC (23.02±4.21) and MC (25.16±3.30) (pcomposite cores was comparable to teeth restored with conventional Zr free bulk fill composites. Zr filled bulk fill composites are recommended for restoration of endodontically treated teeth as they show comparable fracture resistance to conventional composite materials with less catastrophic failures.

  18. [Clinical analysis of LPFP, PFNA and BPH in treating femoral intertrochanteric fractures in elderly patients].

    Science.gov (United States)

    Zhu, Li-Jun; Li, Xiao-Fei; Liu, Chao; Lyu, Cheng-Yu

    2017-07-25

    To evaluate the clinical results of locking proximal femur plate(LPFP), proximal femoral nail antirotation(PFNA) and bipolar hemiarthroplasty(BPH) in the treatment of femoral intertrochanteric fractures in elderly patients. Retrospective analysis of the 86 elderly patients with femoral intertrochanteric fractures during June 2011 and August 2016 were enrolled in this study. The patients were divided into 3 groups: 26 cases in LPFP group included 10 males and 16 females with an average age of (72.54±4.78) years old, 5 cases of type II of Evans, 12 cases of type III and 9 cases of type IV; 39 cases in PFNA group included 17 males and 22 females with an average age of 74.41±5.65, 11 cases of type II, 18 cases of type III and 10 cases of type IV; 21 cases in BPH group included 9 males and 12 females with an average age of 76.23±6.97, 1 case of type II, 10 cases of type III and 10 cases of type IV. The data of three groups were collected for statistical analysis on the following aspects: operation time, intraoperative blood loss, the length of hospital stay, postoperative complications and Harris score of the hip joint function. The wound healed well and no complication occurred. Eighty-four cases were follow-up, while 2 cases were lost, the follow-up rate was 97.6%. The patients were followed up for 22 to 41 months with an average of 26.3 months. For comparison of operation time and time of the hospital stay, BPH group was shorter than the LPFP and PFNA group( F =19.782, 21.981, P BPH group was less blood loss than the LPFP and PFNA group( F =12.976, P 0.05). For comparison of the postoperative complications, LPFP group was higher than BHP and PFNA group( F =30.976, P 0.05). For comparison of the Harris score of the hip joint at 1 year after operation, BPH and PFNA group were both higher than LPFP group( F =19.692, P BPH and PFNA group ( t =4.971, P >0.05). For elder patient with femoral intertrochanteric fracture, BPH could be the best optional for the shorter

  19. A new measurement for posterior tilt predicts reoperation in undisplaced femoral neck fractures: 113 consecutive patients treated by internal fixation and followed for 1 year

    DEFF Research Database (Denmark)

    Palm, Henrik; Gosvig, Kasper; Krasheninnikoff, Michael

    2009-01-01

    BACKGROUND AND PURPOSE: Preoperative posterior tilt in undisplaced (Garden I-II) femoral neck fractures is thought to influence rates of reoperation. However, an exact method for its measurement has not yet been presented. We designed a new measurement for posterior tilt on preoperative lateral...... radiographs and investigated its association with later reoperation. PATIENTS AND METHODS: A consecutive series of 113 patients, > or = 60 years of age with undisplaced (Garden I-II) femoral neck fractures treated with two parallel implants, was assessed regarding patient characteristics, radiographs...... and able to predict reoperation in patients with undisplaced (Garden I-II) femoral neck fractures....

  20. Resistance to fracture of endodontically treated premolars restored with glass ionomer cement or acid etch composite resin: An in vitro study

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    B Ranga

    2010-01-01

    Full Text Available Aim: Due to the weakness of endodontically treated posterior teeth requires more strengthened restoration to withstand occlusal forces. The purpose of the present study was to determine and compare the resistance to fracture of endodontically treated maxillary 1 st premolars restored with different materials in mesio-occluso-distal (MOD cavity preparations. Materials and Methods: MOD cavity preparations in 80 endodontically treated maxillary 1 st premolars were restored using four different methods. Fiber rings were filled with stone plaster and the teeth were placed into the plaster up to the level of cemento-enamel junction. The teeth were grouped according to restorative method, mounted in an Instrom T.T. machine, and the buccal walls subjected to a slowly increasing compressive force until fracture occurred. Result: The force of fracture of the walls of each tooth was recorded and the results in the various groups compared. All teeth fractured in a similar manner irrespective of the restorative method used. Conclusion: The resistance to the fracture of the teeth was the same when they were stored with glass ionomer cement as a base over which composite resin was placed. When the entire cavities were filled with glass ionomer cement, the resistance to fracture of the teeth decreased significantly compared with the acid etch resin technique.

  1. A COMPARATIVE STUDY OF FUNCTIONAL OUTCOMES OF FRACTURE SHAFT HUMERUS IN ADULTS TREATED WITH DYNAMIC COMPRESSION PLATING AND INTERLOCKING NAILING

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    Nagesh Desai

    2015-02-01

    Full Text Available INTRODUCTION: Opti m al m ethod of hu m eral shaft f r acture f i xation remains in debate till date. Two techniq u es under study include i n tra m edullary nailing and dyna m ic co m pression plate fixation. Plating provides satisfactory results but requires extensive dissection and m eticulous radial nerve protection. Theoretical advantage of intra m ed u llary nailing included less invasive surgery, undisturbed fractu r e hemato m a and use of load sharing device support. Purpose of this study is to co m p are o u tco m es of each m ethod of fixation for fracture shaft of humerus. MATERIALS AND METHODS: P atients with diaphyseal fractures of the hu m erus were divided in two groups of 20 treated with dynam i c co m pression plate or w i th i n tra m edullary interlocking nail. Postoperatively both groups received sa m e type of physiotherapy. They were followed up regularly . T i me taken for radiological union in two groups was co m pared. After satisfactory radiological un i on, functional out c o m e was assessed by “Disabilities of Hand, Shoulder and Elbow (DASH Questionnaire”. RESULTS: F unctional outco m e was better in DCP group co m pared to int e rloc ki ng nailing group which was statistically significant ( P = 0.062. Rate of healing was marginally better in DCP group as compared to I.M nail. CONCLUSION: W e are of opi n i on that when s u r ge r y is opted as a c h oice of treat m ent, both modalities of treat m ent i.e. dyn a m i c co m pression plating and interlocking nailing are good as far as union of fracture is concerned, but considering number of co m plications and functional outco m e, we opine that d y na m i c co m p ression plating o f f ers bett e r result than anteg r ade i n te r l ocking nailing with respect to pain and function of shoulder joint

  2. [Calcaneal fractures treated by open reduction and internal fixation with a locking compression plate (LCP). A prospective study. part I: basic analysis of the group].

    Science.gov (United States)

    Svatoš, F; Bartoška, R; Skála-Rosenbaum, J; Douša, P; Pacovský, V; Krbec, M

    2011-01-01

    In a prospective study of patients with calcaneal fractures treated by open reduction from an extensile lateral approach and LCP osteosynthesis, the authors evaluated the basic epidemiological data, mechanism of injury, type of fracture, essential data on surgery, days of hospital stay and the number of complications. In the period from September 1, 2006 to July 31, 2010, a total of 230 patients with 243 calcaneal fractures were treated. The fractures were classified as either open or closed and according to the Essex-Lopresti system. Of the total number of patients, 135 (55.6 % of all fractures) were indicated for conservative treatment and 108 (44.4% of all fractures) for surgical intervention. Indications for surgery based on the generally accepted criteria enabled us to select 77 patients with 82 fractures (33.7 % of all fractures) for treatment by the method of open reduction and LCP osteosynthesis. These patients constituted the group evaluated here. The other patients were treated using other techniques (21 fractures, i.e., 8.6 % of all fractures, by the Stehlík-Štulík transfixation method and further five [2.1 %] by screw osteosynthesis). Six surgeons were involved in the treatment of this group. For the diagnosis of fractures, plain radiographs in lateral and axial projection and axial and coronal CT images were used. All fractures were treated after subsidence of oedema by the method of open reduction and LCP fixation from an extensile lateral approach, with the use of a tourniquet. The follow-up period for the evaluation of functional outcome and bone union was 3 to 48 months. Fifty patients were followed up for over one year. The group evaluated comprised 58 men (75.3 %) with 63 fractures (76.8 %) and 19 women (24.7 %) with 19 fractures (23.2 %). The average age of the group was 42 years, with 41 years (range, 22-61 years) in men and 47 years (range, 30-70 years) in women. The most frequent cause of injury was a fall from a height below 1 metre and

  3. Effect of immobilization on urine calcium excretion in orthopedic patients with pelvic fracture treated by skin traction.

    Science.gov (United States)

    Derakhshan, Ali; Derakhshan, Nima; Namazi, Hamid; Ghaffarpasand, Fariborz

    2015-03-31

    To determine the effects on urine calcium excretion of immobilization by skin traction in patients with pelvic fracture. In a prospective study, a consecutive series of patients with pelvic fracture treated by skin traction were enrolled. Serum (calcium, phosphorous, alkaline phosphatase, sodium, potassium, uric acid, BUN, creatinine) and fasting urine calcium, creatinine, sodium, potassium and uric acid were checked within 48 hours of hospitalization and at 7, 14 and 21 days of immobilization and then after 3 months of mobilization. Trends in changes of variables were recorded. Fifty five patients were enrolled in this study; they were 45 (81.8%) males and 10 (18.2%) females with a mean age 19.4 ± 12.7 years. We found that serum levels of calcium (p = 0.004), phosphorous (p = 0.047) and alkaline phosphatase (p = 0.001) increased significantly during the 3 weeks of immobilization. In the same way, urine calcium/ urine creatinine ratio increased significantly in the study period (p = 0.004). No symptomatic renal stone formation was observed during the study period. Immobilization even in short term causes hypercalciuria in orthopedic patients. Although it is transient and improves with subsequent mobilization, it is needed to be considered specifically by the team caring for this group of patients.

  4. Femoral Medialization, Fixation Failures, and Functional Outcome in Trochanteric Hip Fractures Treated With Either a Sliding Hip Screw or an Intramedullary Nail From Within a Randomized Trial.

    Science.gov (United States)

    Bretherton, Christopher P; Parker, Martyn J

    2016-12-01

    The aim of this study was to determine if femoral medialization influences residual pain and mobility and to determine if fixation method or fracture pattern influences the tendency to medialize. This study used data from within a randomized controlled trial. Peterborough City Hospital, UK. Eight hundred forty-four patients presenting with a trochanteric hip fracture were randomized. Five hundred thirty-eight were available for 1-year follow-up. Fractures were classified according to OTA/AO classification as 31 A1, A2, and A3. Randomized to fixation with a Targon proximal femoral nail or sliding hip screw (SHS). Femoral medialization was calculated from follow-up x-rays at a minimum of 28 days post-fixation. Pain and mobility scores were assessed at 1 year by an independent blinded observer. Fixation failure and revision procedures were assessed at a minimum of 1 year from injury. Patients with >50% medialization had worse pain (P = 0.012) and mobility scores (P = 0.013) at 1 year. They also had more fracture healing complications (P = 0.021) and required more revision procedures (P = 0.014). Fractures treated with SHS were more likely to medialize >50% compared with intramedullary nail (P fractures were more likely to medialize, and A3 fractures were more likely to undergo >50% medialization (P fractures treated with SHS to undergo femoral medialization and correlates this with worse functional outcomes. It supports the use of intramedullary nails for A3 fractures, which have a significant tendency to medialize. Prognostic level II. See Instructions for Authors for a complete description of levels of evidence.

  5. Fracture Resistance of Endodontically Treated Teeth Restored with 2 Different Fiber-reinforced Composite and 2 Conventional Composite Resin Core Buildup Materials: An In Vitro Study.

    Science.gov (United States)

    Eapen, Ashly Mary; Amirtharaj, L Vijay; Sanjeev, Kavitha; Mahalaxmi, Sekar

    2017-09-01

    The purpose of this in vitro study was to comparatively evaluate the fracture resistance of endodontically treated teeth restored with 2 fiber-reinforced composite resins and 2 conventional composite resin core buildup materials. Sixty noncarious unrestored human maxillary premolars were collected, endodontically treated (except group 1, negative control), and randomly divided into 5 groups (n = 10). Group 2 was the positive control. The remaining 40 prepared teeth were restored with various direct core buildup materials as follows: group 3 teeth were restored with dual-cure composite resin, group 4 with posterior composite resin, group 5 with fiber-reinforced composite resin, and group 6 with short fiber-reinforced composite resin. Fracture strength testing was performed using a universal testing machine. The results were statistically analyzed by 1-way analysis of variance and the post hoc Tukey test. Fracture patterns for each sample were also examined under a light microscope to determine the level of fractures. The mean fracture resistance values (in newtons) were obtained as group 1 > group 6 > group 4 > group 3 > group 5 > group 2. Group 6 showed the highest mean fracture resistance value, which was significantly higher than the other experimental groups, and all the fractures occurred at the level of enamel. Within the limitations of this study, a short fiber-reinforced composite can be used as a direct core buildup material that can effectively resist heavy occlusal forces against fracture and may reinforce the remaining tooth structure in endodontically treated teeth. Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  6. Medial Condyle Fracture (Kilfoyle Type III of the Distal Humerus with Transient Fishtail Deformity after Surgery

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    Motoki Sonohata

    2017-01-01

    Full Text Available A “Fishtail deformity” is one of the well-known complications following pediatric lateral condyle or supracondylar fractures of the humerus. We herein report a case of medial condyle fracture (Kilfoyle type III in an 11-year-old boy. He had a transient “fishtail deformity” of the trochlear groove after open reduction and internal fixation. As occurred in the current case, the bone remodeling and the improvement of ischemia of the trochlea after medial condyle fracture may be associated with the likelihood of recovery from transient “fishtail deformity.”

  7. Middle-term follow-up results of Pipkin type IV femoral head fracture patients treated by reconstruction plate and bioabsorbable screws

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    Shan-Xi Wang

    2018-06-01

    Full Text Available Purpose: To investigate the mid-term curative effects of the treatment of Pipkin type IV femoral head fractures using a reconstruction plate and bioabsorbable screws and provide the evidence for clinical practice. Methods: From February 2010 to September 2014, 21 patients with Pipkin type IV femoral head fractures were treated surgically. There were 13 males and 8 females with an average age of 41.1 years (range, 20–65 years. The causes of the fractures included traffic accidents (13 cases, falls from a height (four cases, heavy lifting injuries (three cases, and sport injury (one case. All patients were followed up with radiography and three-dimensional reconstruction computed tomography and other checks and any complications were actively managed. Closed reduction of fracture-dislocation of the hip was attempted under general anesthesia using the Kocher-Langenbeck approach. Femoral head fractures were treated with internal fixation or excision based on the size of the fracture fragments, whereas acetabular fractures were fixed with a reconstruction plate and screws following anatomic reduction. Results: The incisions healed by primary intention in all patients after surgery, without any infection, deep venous thrombosis, or other complications. All 21 patients were followed up for 36–76 months, with an average follow-up duration of 49 months. Postoperative imaging data showed that all dislocations and fractures were anatomically reduced, and bony union of the fractures was achieved. Heterotopic ossification was found in four patients, post-traumatic osteoarthritis in three, and avascular necrosis of the femoral head in two. At the final follow-up, the assessment of hip joint function according to the Thompson-Epstein scoring scale was excellent in 10 cases, good in six cases, fair in three cases, and poor in two cases. The rate of excellent and good functional outcomes was 76.1%. Conclusion: The mid-term curative effects of a

  8. A PROSPECTIVE STUDY ON FUNCTIONAL OUTCOME OF HUMERUS SHAFT FRACTURES TREATED WITH OPEN REDUCTION AND INTERNAL FIXATION WITH DYNAMIC COMPRESSION PLATE AND SCREWS

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    Vidyadhar S. Donimath

    2017-12-01

    Full Text Available BACKGROUND Fracture of the humerus shaft accounts to 3% to 5% of all fractures. Majority of the fractures are unstable due to distraction force of the gravity in the upper limb and strong muscle contraction leading to displacement. Internal fixation and early mobilisation is more stressed on than splinting and prolonged immobilisation to allow earlier mobilisation and rapid return to work. The aim of the study was to study the union rates and the functional outcome and complications associated with shaft humerus fractures in KIMS Hospital. MATERIALS AND METHODS A prospective study which was carried out from October 2015 to September 2017 in Karnataka Institute of Medical Sciences, Hubballi, Karnataka State, India. In this study period, 25 cases of fracture shaft of the humerus were treated by open reduction and internal fixation using DCP. Skeletally mature patients with fresh humerus diaphysis fractures were included in the study. Pathological fractures and Tscherne grade 2 and above, Gustilo Anderson type2 and above were excluded from the study. RESULTS In our series of 25 cases, there were 21 men and 4 women with average age of 42.5 years. Sixteen (64% cases were due to RTA and with predominance of right side. Transverse fractures were most common that is 15 (60% patients. Eleven (31% cases were having associated injuries. 92% of the fractures united with good to excellent outcome. There were 2 (8% cases of non-union due to infection and comminution. CONCLUSION Open reduction and internal fixation with dynamic compression plate is still the standard treatment of choice for fracture shaft of humerus achieving excellent to good functional outcome.

  9. Results of Patello-Tibial Cerclage Wire Technique for Comminuted Patella Fractures Treated with Partial Patellectomy

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    Ender Alagöz

    2014-12-01

    Full Text Available Aim: Partial patellectomy and patellotibial cerclage technique used in comminuted inferior pole patellar fractures were evaluated and the results were discussed. Methods: Thirteen patients who have undergone partial distal patellar excision were evaluated in the study. In all patients, the inferior pole of the patella was resected, patellar tendon was sutured to the proximal patellar fragment and patellotibial cerclage was performed. At the last visit, the patients were evaluated using measurement of the distance between the superior pole of the patella and the tibial tubercle, the Lysholm knee scoring scale, knee range of motion and thigh circumference measurement. Results: The mean flexion value was 131.10 (±4.6 in normal knees and 117.20 (±8.0 in operated knees. The mean thigh diameter was 49.5 (±3.7 cm and 46.4 (±4.5 cm in normal knees and in operated knees, respectively. The mean Lysholm knee score in the patient group was 84.3 (±17.1 points. The mean distance between the superior pole of the patella and the tibial tubercle was 10.6 (±1.0 cm in normal knees and 10.1 (±1.2 cm in operated knees. The exstensor mechanism was intact in all patients and no revision surgery was performed. Conclusion: Patellotibial cerclage technique performed after partial patellectomy permits early motion and protects patients from harmful effects of immobilization; and good functional results are obtained if patients start early knee motion.

  10. EVALUATION OF FUNCTIONAL OUTCOME AFTER OPEN REDUCTION AND INTERNAL FIXATION OF DISTAL FEMUR FRACTURES BY LOCKING COMPRESSION PLATE

    Directory of Open Access Journals (Sweden)

    L. Lokanadha Rao

    2016-09-01

    Full Text Available BACKGROUND In the supra and intercondylar fractures of femur particularly with intra articular extension, patient may develop stiffness of knee, shortening, rotational deformities, internal derangement of knee with instability, varus and valgus deformities which affect patient’s routine lifestyle. If these cases were treated with locking compression plate, the results obtained were successful, superior, timesaving providing early ambulation and least disability improving the functional outcome. MATERIALS AND METHODS This is a prospective interventional study. This study includes 25 supracondylar and intercondylar fractures of femur (both Muller’s Type ‘A’, Type B and Type ‘C’ fractures treated with open reduction and internal fixation by Locking Compression Plate in the Department of Orthopaedics, King George Hospital, Visakhapatnam from September 2013 to September 2015. There are 16 males and 9 females with age ranging from 20 to 80 years with an average of 44.6 years. Average age for males is 28.9 years and average age for females is 25 years. 18 fractures were due to road traffic accidents and 6 cases are due to fall from significant heights, 1 case due to simple fall from standing (osteoporosis. 15 cases were in right femur (60% and 10 cases were in left femur (40%. RESULTS 25 cases were included in the study. There is an increase in the rate of union, decreased time taken for union, increased knee range of motion, decreased time for weight-bearing, postoperative complications and duration for hospital stay. CONCLUSION LCP proved to be a good implant which could take the challenges like poor bone stock, severe comminution both metaphyseal and articular and prove successful. The locking head screws distally have prevented varus collapse, even in cases of osteoporosis. The Condylar LCP can be used in either an open or a minimally invasive manner.

  11. Survival Rates from Fracture of Endodontically Treated Premolars Restored with Full-coverage Crowns or Direct Resin Composite Restorations: A Retrospective Study.

    Science.gov (United States)

    Suksaphar, Warattama; Banomyong, Danuchit; Jirathanyanatt, Titalee; Ngoenwiwatkul, Yaowaluk

    2018-02-01

    The aim of the present study was to compare the survival rates against fracture of premolar endodontically treated teeth (ETT) restored with resin composite or crowns and to identify risk factors associated with the fracture. Data from dental records and radiographs of premolar ETT with postendodontic restorations (ie, resin composite or crowns) were collected between 2012 and 2016 and selected following selected inclusion and exclusion criteria. Tooth location, type of restoration, number of proximal contacts, and amount of tooth surface loss were recorded. The incidence and restorability of postendodontic fractures were identified. Survival rates against fracture of the 2 restoration types were calculated using Kaplan-Meier survival analysis. Any potential factors associated with fractures were identified using Cox proportional hazards models. The survival rate against fracture of ETT restored with crowns (95.1%) was higher than resin composite (77.0%). ETT restored with resin composite with 1 or 2 tooth surface losses and 2 proximal contacts had a high survival rate of 88.5% that was not significantly different from ETT with crowns. A higher incidence of restorability after fracture was observed in teeth restored with resin composite than crowns. The type of restoration and number of proximal contacts were identified as potential risk factors associated with fracture incidence. The survival rate against fracture of ETT restored with crowns was higher than resin composite. However, ETT with 1 or 2 tooth surface losses and 2 proximal contacts and restored with resin composite showed a high survival rate that was comparable with ETT restored with crowns. Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  12. The Fracture of Plasma-Treated Polyurethane Surface under Fatigue Loading

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    Ilya A. Morozov

    2018-02-01

    Full Text Available Plasma treatment of soft polymers is a promising technique to improve biomedical properties of the materials. The response to the deformation of such materials is not yet clear. Soft elastic polyurethane treated with plasma immersion ion implantation is subjected to fatigue uniaxial loading. The influence of the strain amplitude and the plasma treatment regime on damage character is discussed. Surface defects are studied in unloaded and stretched states of the material. As a result of fatigue loading, transverse cracks (with closed overlapping edges as well as with open edges deeply propagating into the polymer and longitudinal folds which are break and bend inward, appear on the surface. Hard edges of cracks cut the soft polymer which is squeezed from the bulk to the surface. The observed damages are related to the high stiffness of the modified surface and its transition to the polymer substrate.

  13. [Efficacy of Sacroiliac Joint Anterior Approach with Double Reconstruction Plate and Computer Assisted Navigation Percutaneous Sacroiliac Screw for Treating Tile C1 Pelvic Fractures].

    Science.gov (United States)

    Tan, Zhen; Fang, Yue; Zhang, Hui; Liu, Lei; Xiang, Zhou; Zhong, Gang; Huang, Fu-Guo; Wang, Guang-Lin

    2017-09-01

    To compare the efficacy of sacroiliac joint anterior approach with double reconstruction plate and computer assisted navigation percutaneous sacroiliac screw for treating Tile C1 pelvic fractures. Fifty patients with pelvic Tile C1 fractures were randomly divided into two groups ( n =25 for each) in the orthopedic department of West China Hospital of Sichuan University from December 2012 to November 2014. Patients in group A were treated by sacroiliac joint dislocation with anterior plate fixation. Patients in group B were treated with computerized navigation for percutaneous sacroiliac screw. The operation duration,intraoperative blood loss,incision length,and postoperative complications (nausea,vomiting,pulmonary infection,wound complications,etc.) were compared between the two groups. The postoperative fracture healing time,postoperative patient satisfaction,and postoperative fractures MATTA scores (to evaluate fracture reduction),postoperative MAJEED function scores,and SF36 scores of the patients were also recorded and compared. No significant differences in baseline characteristics were found between the two groups of patients. All of the patients in both groups had their operations successfully completed. Patients in group B had significantly shorter operations and lower intraoperative blood loss,incision length and postoperative complications than those in group A ( P 0.05). Sacroiliac joint anterior approach with double reconstruction plate and computer assisted navigation percutaneous sacroiliac screws are both effective for treating Tile C1type pelvic fractures,with similar longterm efficacies. However,computer assisted navigation percutaneous sacroiliac screw has the advantages of less trauma,less bleeding,and quicker.

  14. [Early application of the antibiotic-laden bone cement (ALBC) combined with the external fixation support in treating the open fractures of lower limbs complicated with bone defect].

    Science.gov (United States)

    Xiao, Jian; Mao, Zhao-Guang; Zhu, Hui-Hua; Guo, Liang

    2017-03-25

    To discuss the curative effect of the early application of the antibiotic-laden bone cement (ALBC) combined with the external fixation support in treating the open fractures of lower limbs complicated with bone defect. From December 2013 to January 2015, 36 cases of lower limb open comminuted fractures complicated with bone defects were treated by the vancomycin ALBC combined with the external fixation support, including 26 males and 10 females with an average age of 38.0 years old ranging from 19 to 65 years old. The included cases were all open fractures of lower limbs complicated with bone defects with different degree of soft tissue injuries. Among them, 25 cases were tibial fractures, 11 cases were femoral fractures. The radiographs indicated a presence of bone defects, which ranged from 3.0 to 6.1 cm with an average of 4.0 cm. The Gustilo classification of open fractures:24 cases were type IIIA, 12 cases were typr IIIB. The percentage of wound infection, bone grafting time, fracture healing time and postoperative joint function of lower limb were observed. The function of injured limbs was evaluated at 1 month after the clinical healing of fracture based on Paley evaluation criterion. All cases were followed up for 3 to 24 months with an average of (6.0±3.0) months. The wound surface was healed well, neither bone infections nor unhealed bone defects were presented. The reoperation of bone grafting was done at 6 weeks after the patients received an early treatment with ALBC, some of them were postponed to 8 weeks till the approximate healing of fractures, the treatment course lasted for 4 to 8 months with an average of(5.5±1.5) months. According to Paley and other grading evaluations of bone and function, there were 27 cases as excellent, 5 cases as good, 3 cases as ordinary. The ALBC combined with external fixation support was an effective method for early treatment to treat the traumatic lower limb open fractures complicated with bone defects. This method

  15. Superficial Dorsal Venous Rupture of the Penis: False Penile Fracture That Needs to be Treated as a True Urologic Emergency.

    Science.gov (United States)

    Truong, Hong; Ferenczi, Basil; Cleary, Ryan; Healy, Kelly A

    2016-11-01

    A 38-year-old man with history of repaired penile fracture presented with rapid detumescence, penile pain, and ecchymosis during vaginal sexual intercourse concerning for recurrent fracture. Surgical exploration revealed ruptured superficial dorsal vein of the penis, which was subsequently ligated. Patients with traumatic penile vascular injuries often present with clinical features indistinguishable from a true penile fracture. Gradual detumescence and an absence of characteristic popping sound may indicate a vascular injury but they cannot safely rule out a true penile fracture. Both true and false penile fractures require emergent surgical exploration and repair to prevent long-term complications. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Total medical costs of treating femoral neck fracture patients with hemi- or total hip arthroplasty: a cost analysis of a multicenter prospective study

    NARCIS (Netherlands)

    P.T.P.W. Burgers (Paul); M. Hoogendoorn (Martine); E.A.C. Van Woensel; R.W. Poolman (Rudolf); M. Bhandari (Mohit); P. Patka (Peter); E.M.M. van Lieshout (Esther)

    2016-01-01

    textabstractSummary: The aim of this study was to determine the total medical costs for treating displaced femoral neck fractures with hemi- or total hip arthroplasty in fit elderly patients. The mean total costs per patient at 2 years of follow-up were €26,399. These results contribute to cost

  17. Surface-enhanced Raman scattering study of the healing of radial fractures treated with or without Huo-Xue-Hua-Yu decoction therapy

    Science.gov (United States)

    Chen, Weiwei; Huang, Hao; Chen, Rong; Feng, Shangyuan; Yu, Yun; Lin, Duo; Lin, Jia

    2014-11-01

    This study aimed to assess, through surface-enhanced Raman scattering (SERS) spectroscopy, the incorporation of calcium hydroxyapatite (CHA ~960 cm-1) and other biochemical substances in the repair of complete radial fractures in rabbits treated with or without Huo-Xue-Hua-Yu decoction (HXHYD) therapy. A total of 18 rabbits with complete radial fractures were randomly divided into two groups; one group was treated with HXHYD therapy and the other without therapy acted as a control. The animals were sacrificed at 15, 30 and 45 d after surgery. Specimens were routinely prepared for SERS measurement and high quality SERS spectra from a mixture of bone tissues and silver nanoparticles were obtained. The mineral-to-matrix ratios from the control and treated groups were calculated. Results showed that both deposition content of CHA measured by SERS spectroscopy and the mineral-to-matrix ratio in the treated group were always greater than those of the control group during the experiment, demonstrating that HXHYD therapy is effective in improving fracture healing and that SERS spectroscopy might be a novel tool to assess fracture healing.

  18. Surface-enhanced Raman scattering study of the healing of radial fractures treated with or without Huo–Xue–Hua–Yu decoction therapy

    International Nuclear Information System (INIS)

    Chen, Weiwei; Huang, Hao; Yu, Yun; Lin, Duo; Chen, Rong; Feng, Shangyuan; Lin, Jia

    2014-01-01

    This study aimed to assess, through surface-enhanced Raman scattering (SERS) spectroscopy, the incorporation of calcium hydroxyapatite (CHA ∼960 cm −1 ) and other biochemical substances in the repair of complete radial fractures in rabbits treated with or without Huo–Xue–Hua–Yu decoction (HXHYD) therapy. A total of 18 rabbits with complete radial fractures were randomly divided into two groups; one group was treated with HXHYD therapy and the other without therapy acted as a control. The animals were sacrificed at 15, 30 and 45 d after surgery. Specimens were routinely prepared for SERS measurement and high quality SERS spectra from a mixture of bone tissues and silver nanoparticles were obtained. The mineral-to-matrix ratios from the control and treated groups were calculated. Results showed that both deposition content of CHA measured by SERS spectroscopy and the mineral-to-matrix ratio in the treated group were always greater than those of the control group during the experiment, demonstrating that HXHYD therapy is effective in improving fracture healing and that SERS spectroscopy might be a novel tool to assess fracture healing. (letter)

  19. A comparison between the effect of zirconia-coated FRC and glass fiber posts on the fracture resistance of endodontically treated teeth

    Directory of Open Access Journals (Sweden)

    Ezatollah Jalalian

    2014-04-01

    Full Text Available   Background and Aims : The root fracture resistance of endodontically treated teeth depends on the types of posts. The aim of this study was to compare the effect of two types of bonded non-metallic posts with different elasticity modulus on the fracture resistance of endodontically treated teeth under compressive loads.   Materials and Methods: In this in vitro experimental study, 20 fresh extracted mandibular premolars were selected and sectioned adjacent to the CEJ and then were endodontically treated. The specimens were randomly divided into two groups (n=10. After post space preparations, the fiber RTD Light posts (R.T.D, France and zirconia coated fiber posts (ICE light, Danville were cemented into the root canals. Composite resin (Lumiglass R.T.D, France cores were built up. Aluminium foil was used to mimic the PDL, and the specimens were embedded in acrylic resin and tested in a Universal Testing Machine. A compressive load was applied at a 90 degree angle until fracture at a crosshead speed of 1mm/min. Data were analyzed using one-way ANOVA and T test .   Results: The mean fracture resistance of R.T.D group was (1083.11 ± 156.74 (N and the mean of ICE light group was (865.18 ± 106.24 (N. The highest mean fracture resistance was observed in RTD fiberglass and a statistically significant difference was observed between the two groups (P<0.001.   Conclusion: FRC posts with zirconia coating due to unfavorable fractures of the teeth should be used with caution, and thus, fiber posts are preferred.

  20. Bimalleolar ankle fracture with proximal fibular fracture

    NARCIS (Netherlands)

    Colenbrander, R. J.; Struijs, P. A. A.; Ultee, J. M.

    2005-01-01

    A 56-year-old female patient suffered a bimalleolar ankle fracture with an additional proximal fibular fracture. This is an unusual fracture type, seldom reported in literature. It was operatively treated by open reduction and internal fixation of the lateral malleolar fracture. The proximal fibular

  1. Subtrochanteric femoral fractures treated with the Long Gamma3® nail: A historical control case study versus Long trochanteric Gamma nail®.

    Science.gov (United States)

    Georgiannos, D; Lampridis, V; Bisbinas, I

    2015-10-01

    Gamma nail was developed for the treatment of subtrochanteric hip fractures. Despite its advantages over extramedullary devices, gamma nail has been historically related to significant complications (implant breakage, femoral fractures at the tip of the nail). There is limited data to determine if the rate of these complications was minimized by using a new design of the gamma nail. Therefore we performed a case control study between the long gamma3 nail (LG3N) and the long trochanteric gamma nail (LTGN) to assess if: (1) the complication rate in the treatment of subtrochanteric fractures using the LG3N was lower than the one using the LTGN; (2) the reoperation rate was lower after using the LG3N. The complication rate after fixation of subtrochanteric fracture of the femur is lower with LG3N than with the LTGN. This study prospectively recorded the intra- and postoperative complications of 75 patients with subtrochanteric fractures treated with the LG3N and compared them with those of a historical cohort of 83 patients treated with the LTGN. The two groups were matched regarding age, gender and fracture type. Patients with open, pathological, or impending fractures were excluded. Intraoperative complications in the LG3N group were lower (4 cases, 5.3%) compared with those in the LTGN group (9 cases, 10.8%; P=0.04). The major intraoperative complication encountered with the use of LTGN was fracture of the femur in 3 cases. We encountered in total 9 postoperative complications in LG3N (12%) and 20 in group LTGN (24%). The most frequent complication in both groups was the cut out of the lag screw (3 cases in LG3N and 7 cases in LTGN group). The overall reoperation rate was higher in LTGN group (20.4% vs 10.6%; P=0.03). As a result of the improvement of its mechanical characteristics, LG3N has proved a safe and efficient implant for the treatment of subtochanteric fractures. The new design seems superior to previous generation, giving promising outcomes, reduced

  2. Decreased fracture rate, pharmacogenetics and BMD response in 79 Swedish children with osteogenesis imperfecta types I, III and IV treated with Pamidronate.

    Science.gov (United States)

    Lindahl, K; Kindmark, A; Rubin, C-J; Malmgren, B; Grigelioniene, G; Söderhäll, S; Ljunggren, Ö; Åström, E

    2016-06-01

    Osteogenesis imperfecta (OI) is an inherited heterogeneous bone fragility disorder, usually caused by collagen I mutations. It is well established that bisphosphonate treatment increases lumbar spine (LS) bone mineral density (BMD), as well as improves vertebral geometry in severe OI; however, fracture reduction has been difficult to prove, pharmacogenetic studies are scarce, and it is not known at which age, or severity of disease, treatment should be initiated. COL1A1 and COL1A2 were analyzed in 79 children with OI (type I n=33, type III n=25 and type IV n=21) treated with Pamidronate. Data on LS BMD, height, and radiologically confirmed non-vertebral and vertebral fractures were collected prior to, and at several time points during treatment. An increase in LS BMD Z-score was observed for all types of OI, and a negative correlation to Δ LS BMD was observed for both age and LS BMD Z-score at treatment initiation. Supine height Z-scores were not affected by Pamidronate treatment, The fracture rate was reduced for all OI types at all time points during treatment (overall p4yrs Pamidronate. Twice as many boys as girls with OI type I were treated with Pamidronate, and the fracture rate the year prior treatment was 2.2 times higher for boys (p=0.0236). Greater Δ LS BMD, but smaller Δ fracture numbers were observed on Pamidronate for helical glycine mutations in COL1A1 vs. COL1A2. Vertebral compression fractures did not progress in any individual during treatment; however, they did not improve in 9%, and these individuals were all >11years of age at treatment initiation (p<0.0001). Pamidronate treatment in children with all types of OI increased LS BMD, decreased fracture rate, and improved vertebral compression fractures. Fracture reduction was prompt and maintained during treatment, irrespective of age at treatment initiation and collagen I mutation type. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Characteristics of foot fractures in HIV-infected patients previously treated with tenofovir versus non-tenofovir-containing highly active antiretroviral therapy

    Directory of Open Access Journals (Sweden)

    Horizon AA

    2011-06-01

    Full Text Available Arash A Horizon1, Robert J Joseph2, Qiming Liao3, Steven T Ross3, Gary E Pakes31Center for Rheumatology, 2Surgical Podiatry, Los Angeles, CA, USA; 3GlaxoSmithKline, Research Triangle Park, NC, USASummary: In a retrospective case series study, medical records were evaluated for all male patients infected with human immunodeficiency virus (HIV diagnosed over a one-year period with foot fractures (n = 30 confirmed by magnetic resonance imaging at a Los Angeles outpatient private practice rheumatology clinic. Proportionally more patients had received tenofovir prefracture (17 [57%] than those who had not (13 [43%]. At fracture diagnosis, these two groups were similar in median age (49 versus 48 years, HIV-1 RNA (both 1.7 log10 copies/mL, CD4 count (300 versus 364/mm3, time between HIV diagnosis and foot fracture (both 17 years, family history of degenerative bone disease (24% versus 23%, prevalence of malabsorption syndrome, renal failure, calcium deficiency, or vitamin D deficiency, and concurrent use of bisphosphonates, calcitonin, and diuretics. However, more tenofovir-treated patients had osteoporosis (35% versus 8%, stress-type fractures (53% versus 31%, concurrent fractures (12% versus 0%, wasting syndrome (29% versus 15%, truncal obesity (18% versus 8%, smoked cigarettes (more than one pack/day for more than one year; 35% versus 8%, dual energy X-ray absorptiometry (DEXA T scores <–2.4 (denoting osteoporosis at the femur (24% versus 9% and spine (47% versus 36%, and had received protease inhibitors (71% versus 46%, non-nucleoside reverse transcriptase inhibitors (24% versus 0%, prednisone (24% versus 0%, testosterone (47% versus 23%, and teriparatide (29% versus 8%. Median time from tenofovir initiation until fracture was 2.57 (range 1.17–5.69 years. In conclusion, more foot fractures were observed in tenofovir-treated patients than in non-tenofovir-treated patients with HIV infection. Comorbidities and/or coadministered drugs may have

  4. Subtrochanteric and diaphyseal femur fractures in patients treated with alendronate: a register-based national cohort study

    DEFF Research Database (Denmark)

    Abrahamsen, Bo; Eiken, Pia; Eastell, Richard

    2009-01-01

    Alendronate (aln) is a potent bisphosphonate with a prolonged duration of action. Recent reports have found long-term aln use to be common in patients with subtrochanteric or proximal diaphyseal femur fracture, raising concerns that these fractures could be a consequence of excessive suppression...

  5. Subtrochanteric hip fractures treated with cerclage cables and long cephalomedullary nails: a review of 17 consecutive cases over 2 years.

    LENUS (Irish Health Repository)

    Kennedy, Muiris T

    2011-11-01

    The conflict between the anatomist and biologist surgeons is exemplified by the debate about subtrochanteric hip fractures. Closed intramedullary nailing is biologically friendly but may result in prolonged procedures and malunion. By contrast, accurate anatomical open reduction may disturb the biological composition of the fracture environment.

  6. A computational study on the effect of fracture intrusion distance in three- and four-part trochanteric fractures treated with Gamma nail and sliding hip screw.

    Science.gov (United States)

    Goffin, Jérôme M; Pankaj, Pankaj; Simpson, A Hamish

    2014-01-01

    Using finite element analysis, the behaviors of the Gamma nail and the sliding hip screw (SHS) were compared in an osteoporotic bone model for the fixation of three- and four-part trochanteric fractures (31-A2 in the AO classification, types IV and V in Evans' classification). The size of the medial fragment was varied based on clinical data, and the case of a fractured greater trochanter was also considered. Our results showed that for Evans' type V stabilized with a Gamma nail and for Evans' types IV and V with the SHS, cancellous bone around the lag screw is susceptible to yielding, thus indicating a risk of cut-out. The volume of bone susceptible to yielding increases with an increase in size of the medial fragment. Conversely, Evans' type IV with a Gamma nail was not predicted to cut out. Our findings suggest that future clinical trials investigating fixation of unstable proximal fractures should include the size of the medial fragment and the integrity of the greater trochanter as covariables and be powered to evaluate whether intramedullary devices are superior to SHSs for Evans' type IV fractures and inferior/equivalent for type V. © 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  7. Orthopedic infections in equine long bone fractures and arthrodeses treated by internal fixation: 192 cases (1990-2006).

    Science.gov (United States)

    Ahern, Benjamin J; Richardson, Dean W; Boston, Raymond C; Schaer, Thomas P

    2010-07-01

    To determine the rate of postoperative infection (POI) for internal fixation repaired equine long bone fractures and arthrodeses and identify associated risk factors. Case series. Horses (n=192) with fracture repair of the third metacarpal and metatarsal bones, radius, ulna, humerus, tibia, and femur, or arthrodesis with internal fixation. Medical records (1990-2006) were reviewed for signalment, anatomic location, fracture classification and method of repair, technique and surgical duration, bacterial species isolated, postoperative care, onset of POI, and outcome. Of 192 horses (171 [89%] closed, 21 [11%] open fractures), 157 (82%) were discharged from the hospital. Infection occurred in 53 (28% horses), of which 31 (59%) were discharged. Repairs without POI were 7.25 times more likely to be discharged from the hospital. Closed fractures were 4.23 times more likely to remain uninfected and 4.59 times more likely to be discharged from the hospital compared with open fractures. Closed reduction and internal fixation was associated with a 2.5-fold reduction in rate of POI and a 5.9 times greater chance for discharge from the hospital compared with open reduction and internal fixation. Females had a strong trend for increased POI when compared with colts and stallion but not geldings. Overall rate of POI was 28%. Fracture classification, method of repair, gender, and surgical duration were significant risk factors.

  8. Trans trochanteric approach with coronal osteotomy of the great trochanter: A new technique for extra-capsular trochanteric fracture patients treated by total hip arthroplasty (THA) in elderly.

    Science.gov (United States)

    Steffann, Francois; Prudhon, Jean-Louis; Puch, Jean-Marc; Ferreira, André; Descamps, Loys; Verdier, Régis; Caton, Jacques

    2015-06-05

    Several surgical approaches could be used in hip arthroplasty or trauma surgery: anterior, anterolateral, lateral, posterior (with or without trochanterotomy), using or not an orthopedic reduction table. Subtrochanteric and extra-capsular trochanteric fractures (ECTF) are usually treated by internal fixation with mandatory restrictions on weight bearing. Specific complications have been widely described. Mechanical failures are particularly high in unstable fractures. Hip fractures are a major public health issue with a mortality rate of 12%-23% at 1 year. An alternative option is to treat ECTF by total hip arthroplasty (THA) to prevent decubitus complications, to help rapid recovery, and to permit immediate weight bearing as well as quick rehabilitation. However, specific risks of THA have to be considered such as dislocation or cardiovascular failure. The classical approach (anterior or posterior) requires the opening of the joint and capsule, weakening hip stability and the repair of the great trochanter is sometimes hazardous. For 15 years, we have been treating unstable ECTF by THA with cementless stem, dual mobility cup (DMC), greater trochanter (GT) reattachment, and a new surgical approach preserving capsule, going through the fracture and avoiding joint dislocation. Bombaci first described a similar approach in 2008; our trans fractural digastric approach (medial gluteus and lateral vastus) is different. A coronal GT osteotomy is performed when there is no coronal fracture line. It allows easy access to the femoral neck and acetabulum. The THA is implanted without femoral internal rotation to avoid extra bone fragment displacement. With pre-operative planning, cup implantation is easy and stem positioning is adjusted referring to the top of the GT after trial reduction and preoperative planning. The longitudinal osteotomy and trochanteric fracture are repaired with wires and the digastric incision is closed. This variant of Bombaci approach could be use

  9. A new mini-invasive technique in treating pediatric diaphyseal forearm fractures by bioabsorbable elastic stable intramedullary nailing: a preliminary technical report.

    Science.gov (United States)

    Sinikumpu, J-J; Keränen, J; Haltia, A-M; Serlo, W; Merikanto, J

    2013-01-01

    fractures by bioabsorbable elastic stable intramedullary nailing. Our clinical experience suggests that the procedure combined with long-arm casting is feasible in treating the pediatric forearm fractures. The technique may bring benefits to handling these challenging fractures. The disadvantages of metallic implants may be avoided. In addition, removal of the implant will not be required. There was one refracture in the series, but it was due to new high-energy trauma. According to our understanding, it was not related to the type of former osteosynthesis. However, ignoring the good preliminary experience, still we do not have results of the superiority of the procedure over traditional elastic stable intramedullary nailing. Our ongoing randomized multicenter study is aimed to determine its long-term outcome against the present golden standard. Nevertheless, due to encouraging preliminary results, we see it necessary to report the technique.

  10. Complex tibial fractures are associated with lower social classes and predict early exit from employment and worse patient-reported QOL: a prospective observational study of 46 complex tibial fractures treated with a ring fixator.

    Science.gov (United States)

    Elsoe, Rasmus; Larsen, Peter; Petruskevicius, Juozas; Kold, Søren

    2018-04-01

    The long-term outcomes following complex fractures of the tibia are reported to carry a risk of knee pain, malalignment, articular injury and post-traumatic osteoarthritis. The main objective of this study was to account for the patient-reported quality of life (QOL) 12 months after ring fixator removal in patients with a complex tibial fracture. Secondary objectives included a review of the socio-economic characteristics of the patient group and the rate of return to work in the study period. A prospective follow-up study was conducted of 60 patients with complex fractures of the tibia treated with ring external fixation. Patient-reported outcomes, radiological outcomes and socio-economic status including employment status of the patients were obtained 12 months after frame removal. Forty-six patients completed the assessment 12 months after frame removal (77%). The mean age of the patient at the time of fracture was 54.6 years (range 31-86). There were 19 males and 27 females. At 12 months after frame removal, the mean EQ5D-5L index was 0.66 (CI 0.60-0.72). The mean EQ5D-5L VAS was 69 (CI 61-76). When this was compared to the established reference population from Denmark, the study population showed a significantly worse EQ5D-5L index. The majority of patients (87%) were in the lower social classes suggesting a higher degree of social deprivation in the study population. Twenty-seven per cent of patients who were employed prior to injury had returned to employment at approximately 19 months following fracture. The onset of post-traumatic osteoarthritis was present in the knee joint in 29% of patients following a proximal intra-articular fracture, whereas osteoarthritis was present at the ankle joint in 35% of patients following a distal intra-articular fracture 12 months after frame removal. This study indicates that at 12 months after frame removal there are poorer patient-reported QOL as when compared to reference populations. Furthermore, this study

  11. Fracture Resistance of Endodontically Treated Teeth Restored with Biodentine, Resin Modified GIC and Hybrid Composite Resin as a Core Material.

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    Subash, Dayalan; Shoba, Krishnamma; Aman, Shibu; Bharkavi, Srinivasan Kumar Indu; Nimmi, Vijayan; Abhilash, Radhakrishnan

    2017-09-01

    The restoration of a severely damaged tooth usually needs a post and core as a part of treatment procedure to provide a corono - radicular stabilization. Biodentine is a class of dental material which possess high mechanical properties with excellent biocompatibility and bioactive behaviour. The sealing ability coupled with optimum physical properties could make Biodentine an excellent option as a core material. The aim of the study was to determine the fracture resistance of Biodentine as a core material in comparison with resin modified glass ionomer and composite resin. Freshly extracted 30 human permanent maxillary central incisors were selected. After endodontic treatment followed by post space preparation and luting of Glass fibre post (Reforpost, Angelus), the samples were divided in to three groups based on the type of core material. The core build-up used in Group I was Biodentine (Septodont, France), Group II was Resin-Modified Glass Ionomer Cement (GC, Japan) and Group III was Hybrid Composite Resin (TeEconom plus, Ivoclar vivadent). The specimens were subjected to fracture toughness using Universal testing machine (1474, Zwick/Roell, Germany) and results were compared using One-way analysis of variance with Tukey's Post hoc test. The results showed that there was significant difference between groups in terms of fracture load. Also, composite resin exhibited highest mean fracture load (1039.9 N), whereas teeth restored with Biodentine demonstrated the lowest mean fracture load (176.66 N). Resin modified glass ionomer exhibited intermediate fracture load (612.07 N). The primary mode of failure in Group I and Group II was favourable (100%) while unfavourable fracture was seen in Group III (30%). Biodentine, does not satisfy the requirements to be used as an ideal core material. The uses of RMGIC's as a core build-up material should be limited to non-stress bearing areas. Composite resin is still the best core build-up material owing to its high fracture

  12. The new concept of the monitoring and appraisal of bone union inflexibility of fractures treated by Dynastab DK external fixator.

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    Lenz, Gerhard P; Stasiak, Andrzej; Deszczyński, Jarosław; Karpiński, Janusz; Stolarczyk, Artur; Ziółkowski, Marcin; Szczesny, Grzegorz

    2003-10-30

    Background. This work focuses on problems of heuristic techniques based on artificial intelligence. Mainly about artificial non-linear and multilayer neurons, which were used to estimate the bone union fractures treatment process using orthopaedic stabilizers Dynastab DK. Material and methods. The author utilizes computer software based on multilayer neuronal network systems, which allows to predict the curve of the bone union at early stages of therapy. The training of the neural net has been made on fifty six cases of bone fracture which has been cured by the Dynastab stabilizers DK. Using such trained net, seventeen fractures of long bones shafts were being examined on strength and prediction of the bone union as well. Results. Analyzing results, it should be underlined that mechanical properties of the bone union in the slot of fracture are changing in nonlinear way in function of time. Especially, major changes were observed during the forth month of the fracture treatment. There is strong correlation between measure number two and measure number six. Measure number two is more strict and in the matter of fact it refers to flexion, as well as the measure number six, to compression of the bone in the fracture slot. Conclusions. Consequently, deflection loads are especially hazardous for healing bone. The very strong correlation between real curves and predicted curves shows the correctness of the neuronal model.

  13. How evolution of the nailing system improves results and reduces orthopedic complications: more than 2000 cases of trochanteric fractures treated with the Gamma Nail System.

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    Pascarella, R; Fantasia, R; Maresca, A; Bettuzzi, C; Amendola, L; Violini, S; Cuoghi, F; Sangiovanni, P; Cerbasi, S; Boriani, S; Tigani, D S

    2016-04-01

    The incidence of trochanteric fractures has increased significantly during the last few decades, especially in elderly patients with osteoporosis. The dynamic/sliding hip screw and the cephalomedullary nail are the most commonly used fixation methods to treat trochanteric fractures. The improvements in the Gamma Nail System (GNS) associated with a correct surgical technique reduced the postoperative orthopedic complications. The purpose of this study was to compare the results of the different Gamma Nails. The present study is a retrospective analysis of 2144 patients treated with GNS between January 1997 and December 2011 for trochanteric fractures, classified according to AO classification method. The patients were divided into three groups according to the nailing system: 525 were treated with Standard Gamma Nail (SGN), 422 with Trochanteric Gamma Nail (TGN) and 1197 with Gamma3 Nail. The overall incidence of intra-operative complications was 1.21 %; the incidence of intra-operative complications for each group was 1.71 % for SGN group, 0.47 % for TGN group and 1.25 % for Gamma3 Nail group. The overall incidence of postoperative complications was 5.48 %, and the incidence for each group was 10.73 % for SGN group, 9.92 % for TGN group and 2.92 % for Gamma3 Nail group. The GNS is a safe device with a low rate of intra-operative complications. The evolution of this nail system reduces postoperative complications, thus improving the results at follow-up and confirming that the Gamma3 Nail is a safe and predictable device to fix trochanteric fracture.

  14. A CURRENT 4-YEARS RETROSPECTIVE SURVEY OF 64 SURGICALLY TREATED ZYGOMA COMPLEX FRACTURES IN DEPARTMENT OF MAXILLO-FACIAL SURGERY, UNIVERSITY HOSPITAL ‘ST. ANNA’, SOFIA, BULGARIA.

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    Elitsa G. Deliverska

    2013-04-01

    Full Text Available Purpose: The goal of this material was to be an example of the complications that can occur in cases of zygoma fractures and to draw the attention of the clinicians to the need of accurate diagnose and early treatment of the associated with zygoma fractures traumas. Materials and methods: Medical records of 276 patients with different traumas in face and neck area treated in our department ware reviewed. Of those 64 suffered from zygoma fractures and they ware classified according to age, sex, cause of trauma, presence or absence of associated trauma, etc.Results: As other studies also show, we determined that the most common cause of injury was assault and road accidents, fallowed by sport, industrial, etc. Males between 20 and 40 years old ware the biggest group of patients, often after alcohol consumption.Associated traumas occurred more frequently in cases of motor vehicle accident than in other cases and ware presented by closed head trauma, ophthalmologic problems, extremities fractures, etc.Conclusion: Delayed treatment of zygoma injuries is feasible and yields in good results when the severity of trauma needs it, but early repair of such injuries prevent late complications and should be preferred when possible.

  15. Finite element analysis of intramedullary nailing and double locking plate for treating extra-articular proximal tibial fractures.

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    Chen, Fancheng; Huang, Xiaowei; Ya, Yingsun; Ma, Fenfen; Qian, Zhi; Shi, Jifei; Guo, Shuolei; Yu, Baoqing

    2018-01-16

    Proximal tibia fractures are one of the most familiar fractures. Surgical approaches are usually needed for anatomical reduction. However, no single treatment method has been widely established as the standard care. Our present study aims to compare the stress and stability of intramedullary nails (IMN) fixation and double locking plate (DLP) fixation in the treatment of extra-articular proximal tibial fractures. A three-dimensional (3D) finite element model of the extra-articular proximal tibial fracture, whose 2-cm bone gap began 7 cm from the tibial plateau articular surface, was created fixed by different fixation implants. The axial compressive load on an adult knee during single-limb stance was imitated by an axial force of 2500 N with a distribution of 60% to the medial compartment, while the distal end was fixed effectively. The equivalent von Mises stress and displacement of the model was used as the output measures for analysis. The maximal equivalent von Mises stress value of the system in the IMN model was 293.23 MPa, which was higher comparing against that in the DLP fixation model (147.04 MPa). And the mean stress of the model in the IMN model (9.25 MPa) was higher than that of the DLP fixation system in terms of equivalent von Mises stress (EVMS) (P tibial fractures of young patients.

  16. Heterotopic ossification of the elbow after closed reduction and retrograde intramedullary nailing for radial neck fracture treated by anconeus interposition.

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    Sreenivas, T; Menon, Jagdish; Nataraj, A R

    2013-12-01

    Heterotopic ossification around the elbow can lead to considerable functional disability. We describe a case of a 42-year-old man who developed heterotopic ossification of his elbow after closed reduction of the elbow dislocation and radial neck fracture and retrograde intramedullary nailing for radial neck fracture. During the follow-up after initial surgery, movements of the elbow were gradually deteriorated and diagnosed as heterotopic ossification of the elbow. Implant removal, radial head excision along with heterotopic mass, and also interposition of the anconeus muscle resulted in improvement of his elbow mobility. At 18 months of follow-up, patient had elbow flexion arc of 15°-110°, 70° of supination, and 50° of pronation without recurrence of heterotopic ossification. The uniqueness of this case lies in the treatment of heterotopic ossification of the elbow to prevent its recurrence, which was developed after retrograde intramedullary nailing for radial neck fracture following closed reduction.

  17. Avulsion Fracture of the Calcaneus Treated With a Soft Anchor Bridge and Lag Screw Technique: A Report of Two Cases.

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    Yoshida, Kazushige; Kasama, Kentaro; Akahane, Tsutomu

    2016-01-01

    The displaced extra-articular avulsion fracture of the calcaneus has been classified as a Böhler type 1c calcaneal fracture, and most cases will require surgical repair. In the present report, we describe 2 patients in whom we performed the soft anchor bridge technique using single loaded suture anchors with lag screws for the repair of Böhler type 1c avulsion fractures of the calcaneus. In one of these patients, clinically relevant osteoporosis complicated the injury. In both cases, bone union was achieved, and by 1.5 months after surgery satisfactory recovery was observed. To our knowledge, the soft anchor bridge technique was first used for the treatment of rotator cuff tears, and the greatest merit of this technique is the ability to generate vertical compression force to the pulled out rotator cuff through the use of knotting sutures. In recent years, the soft anchor bridge technique using 4 suture anchors has also been used for fractures of the greater tuberosity of the humerus, an injury that poses operative difficulties similar to those encountered with an avulsion fracture of the calcaneus owing to the traction force of the rotator cuff and relative weakness of adjacent bone. The outcomes of our patients suggest that the soft anchor bridge technique combined with adjunct lag screws is useful in the fixation of avulsion fractures of the calcaneus. In addition, the result in the elderly patient indicates the possibility of using this technique for patients with osteoporosis. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  18. [Treatment of multi-segment fracture of complex femoral shaft with instrument-assisted reduction combined with intramedullary interlocking nail fixation].

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    Fan, Ke-Jie; Chen, Ke; Ma, Wen-Long; Tian, Ke-Wei; Ye, Ye; Chen, Hong-Gan; Tang, Yan-Feng; Cai, Hong-Min

    2018-05-25

    To investigate the effect of minimally invasive mini-incision and instrumented reduction combined with interlocking intramedullary nailing in the treatment of patients with multi-segment fracture of complex femoral shaft. From January 2013 to January 2016, 32 patients with multiple fractures segments of femoral shaft were treated with instrumentation-assisted reduction combined with interlocking intramedullary nailing, including 22 males and 10 females with an average age of 45 years old ranging 17 to 68 years old. The time from injured to operation was 5 to 10 days with an average of 7 days. After admission, routine tibial tubercle or supracondylar bone traction was performed. The patient's general condition was evaluated, the operation time and intraoperative blood loss were recorded. According to Thorsen femoral fracture morphology evaluation criteria and Hohl knee function evaluation of postoperative efficacy, postoperative fracture healing, complications and postoperative recovery of limb function were observed. All patients were followed up for 6 to 24 months with an average of 12 months. The operative time ranged from 48 to 76 minutes with an average of 67 min. The intraoperative blood loss was 150 to 400 ml with an average of 220 ml. The surgical incisions all achieved grade A healing. The fractures reached the clinical standard of healing. The fracture healing time ranged from 4.2 to 10.8 months with an average of 5.7 months. There were no nonunion, incision infection and internal fixation fracture, failure and other complications. According to Thorsen femoral fracture morphology evaluation criteria, the result was excellent in 28 cases, good in 3 cases, fair in 1 case. According to Hohl knee function evaluation criteria, the result was excellent in 30 cases, good in 2 cases. Instrument-assisted reduction combined with interlocking intramedullary nail fixation is a safe and effective method for the treatment of complex femoral shaft fractures. It has

  19. Fracture resistance of endodontically treated teeth restored with short fiber composite used as a core material-An in vitro study.

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    Garlapati, Tejesh Gupta; Krithikadatta, Jogikalmat; Natanasabapathy, Velmurugan

    2017-10-01

    This in-vitro study tested the fracture resistance of endodontically treated molars with Mesial-Occluso-Distal (MOD) cavities restored with fibre reinforced composite material everX posterior in comparision with hybrid composite and ribbond fiber composite. Fifty intact freshly extracted human mandibular first molars were collected and were randomly divided into five groups (n=10). Group 1: positive control (PC) intact teeth without any endodontic preparation. In groups 2 through 6 after endodontic procedure standard MOD cavities were prepared and restored with their respective core materials as follows: group 2, negative control (NC) left unrestored or temporary flling was applied. Group 3, Hybrid composite (HC) as a core material (Te-Econom Plus Ivoclar Vivadent Asia) group 4, Ribbond (Ribbond; Seattle, WA, USA)+conventional composite resin (RCR) group 5, everX posterior (everX Posterior GC EUROPE)+conventional composite resin (EXP) after thermocycling fracture resistance for the samples were tested using universal testing machine. The results were analysed using ANOVA and Tukey's HSD post hoc tests. Mean fracture resistance (in Newton, N) was group 1: 1568.4±221.71N, group 2: 891.0±50.107N, group 3: 1418.3±168.71N, group 4:1716.7±199.51N and group 5: 1994.8±254.195N. Among the materials tested, endodontically treated teeth restored with everX posterior fiber reinforced composite showed superior fracture resistance. Copyright © 2017 Japan Prosthodontic Society. Published by Elsevier Ltd. All rights reserved.

  20. Complex tibial plateau fractures treated by hybrid external fixation system: A correlation of followup computed tomography derived quality of reduction with clinical results

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    Konstantinos Kateros

    2018-01-01

    Full Text Available Background: Tibial plateau fractures are common due to high energy injuries. The principles of treatment include respect for the soft tissues, restoring the congruity of the articular surface and reduction of the anatomic alignment of the lower limb to enable early movement of the knee joint. There are various surgical fixation methods that can achieve these principles of treatment. Recognition of the particular fracture pattern is important, as this guides the surgical approach required in order to adequately stabilize the fracture. This study evaluates the results of the combined treatment of external fixator and limited internal fixation along with the advantages using postoperative computed tomography (CT scan after implant removal. Materials and Methods: 55 patients with a mean age of 42 years (range 17–65 years with tibial plateau fracture, were managed in our institution between October 2010 and September 2013., Twenty fractures were classified as Schatzker VI and 35 as Schatzker V. There were 8 open fractures (2 Gustilo Anderson 3A and 6 Gustilo Anderson 2. All fractures were treated with closed reduction and hybrid external fixation (n = 21/38.2% or with minimal open reduction internal fixation and a hybrid system (n = 34/61.8%. After the removal of the fixators, CT-scan was programmed for all the cases, for correlation with the results. At final followup, the American Knee Society Score (AKSS was administered. Results: All patients were evaluated with a minimum of 12 months (range 12–21 months followup. Average time to union was 15.5 weeks (range 13–19 weeks. The postoperative joint congruity as evaluated in the postoperative CT-scan was 5° in 19 cases (35%. Patients with residual joint depression 4.5 mm displayed a 100% chance of getting poor-fair scores both in AKSS knee and AKSS function score. The association of a postoperative mechanical axis within 5° of the contralateral limb and improved knee scores was statistically

  1. Barriers to nutritional intake in patients with acute hip fracture: time to treat malnutrition as a disease and food as a medicine?

    Science.gov (United States)

    Bell, Jack; Bauer, Judith; Capra, Sandra; Pulle, Chrys Ranjeev

    2013-06-01

    Inadequate energy and protein intake leads to malnutrition; a clinical disease not without consequence post acute hip fracture. Data detailing malnutrition prevalence, incidence, and intake adequacy varies widely in this patient population. The limited success of reported interventional strategies may result from poorly defined diagnostic criteria, failure to address root causes of inadequate intake, or errors associated with selection bias. This pragmatic study used a sequential, explanatory mixed methods design to identify malnutrition aetiology, prevalence, incidence, intake adequacy, and barriers to intake in a representative sample of 44 acute hip fracture patients (73% female; mean age, 81.7 ± 10.8 years). On admission, malnutrition prevalence was 52.2%. Energy and protein requirements were only met twice in 58 weighed 24 h food records. Mean daily patient energy intake was 2957 kJ (50.9 ± 36.1 kJ·kg(-1)) and mean protein intake was 22.8 g (0.6 ± 0.46 g·kg(-1)). This contributed to a further in-patient malnutrition incidence of 11%. Barriers to intake included patient perceptions that malnutrition and (or) inadequate intake were not a problem, as well as patient and clinician perceptions that treatment for malnutrition was not a priority. Malnutrition needs to be treated as a disease not without consequence, and food should be considered as a medicine after acute hip fracture.

  2. Intramedullary screw fixation with bone autografting to treat proximal fifth metatarsal metaphyseal-diaphyseal fracture in athletes: a case series

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    Tsukada Sachiyuki

    2012-07-01

    Full Text Available Abstract Background Delayed unions or refractures are not rare following surgical treatment for proximal fifth metatarsal metaphyseal-diaphyseal fractures. Intramedullary screw fixation with bone autografting has the potential to resolve the issue. The purpose of this study was to evaluate the result of the procedure. Methods The authors retrospectively reviewed 15 athletes who underwent surgical treatment for proximal fifth metatarsal metaphyseal-diaphyseal fracture. Surgery involved intramedullary cannulated cancellous screw fixation after curettage of the fracture site, followed by bone autografting. Postoperatively, patients remain non weight-bearing in a splint or cast for two weeks and without immobilization for an additional two weeks. Full weight-bearing was allowed six weeks postoperatively. Running was permitted after radiographic bone union, and return-to-play was approved after gradually increasing the intensity. Results All patients returned to their previous level of athletic competition. Mean times to bone union, initiation of running, and return-to-play were 8.4, 8.8, and 12.1 weeks, respectively. Although no delayed unions or refractures was observed, distal diaphyseal stress fractures at the distal tip of the screw occurred in two patients and a thermal necrosis of skin occurred in one patient. Conclusions There were no delayed unions or refractures among patients after carrying out a procedure in which bone grafts were routinely performed, combined with adequate periods of immobilization and non weight-bearing. These findings suggest that this procedure may be useful option for athletes to assuring return to competition level.

  3. Compartment syndrome like picture in metaphyseal comminuted fracture of tibia treated by locking plate due to tight closure

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    Prafulla Herode

    2013-01-01

    Full Text Available A 22-year-old male came to casualty on 5 th May 2012 after a fall from motorcycle. He complained of excruciating pain and swelling over right knee. There was an open wound of 7 × 2 cm over supra-patellar region and diffuse swelling over knee joint with severe tenderness over proximal aspect of right tibia. X-ray showed intra-articular fracture of proximal tibia extending to diaphysis classified as type 6 by Schatzker classification for proximal tibia, with fibula shaft transverse fracture. The skin over the fracture was contused. Debridement with primary wound closure was done in emergency. Skeletal traction was applied through a lower tibial Steinman pin. Patient was operated after 15 days when wound healed and swelling subsided. Locking plate was applied on medial aspect using Minimally invasive percutaneous plate osteosysthesis (MIPPO technique. Post-operatively over 4 hours patient developed severe pain and swelling in operated leg which mimicked compartment syndrome. Suture removal was done immediately in the ward from the distal aspect, which relieved the symptoms but lead to exposure of the plate. A rotational flap was done to cover the plate in coordination with a plastic surgeon on the next day.

  4. Accelerated rehabilitation compared with a standard protocol after distal radial fractures treated with volar open reduction and internal fixation: a prospective, randomized, controlled study.

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    Brehmer, Jess L; Husband, Jeffrey B

    2014-10-01

    There are relatively few studies in the literature that specifically evaluate accelerated rehabilitation protocols for distal radial fractures treated with open reduction and internal fixation (ORIF). The purpose of this study was to compare the early postoperative outcomes (at zero to twelve weeks postoperatively) of patients enrolled in an accelerated rehabilitation protocol with those of patients enrolled in a standard rehabilitation protocol following ORIF for a distal radial fracture. We hypothesized that patients with accelerated rehabilitation after volar ORIF for a distal radial fracture would have an earlier return to function compared with patients who followed a standard protocol. From November 2007 to November 2010, eighty-one patients with an unstable distal radial fracture were prospectively randomized to follow either an accelerated or a standard rehabilitation protocol after undergoing ORIF with a volar plate for a distal radial fracture. Both groups began with gentle active range of motion at three to five days postoperatively. At two weeks, the accelerated group initiated wrist/forearm passive range of motion and strengthening exercises, whereas the standard group initiated passive range of motion and strengthening at six weeks postoperatively. Patients were assessed at three to five days, two weeks, three weeks, four weeks, six weeks, eight weeks, twelve weeks, and six months postoperatively. Outcomes included Disabilities of the Arm, Shoulder and Hand (DASH) scores (primary outcome) and measurements of wrist flexion/extension, supination, pronation, grip strength, and palmar pinch. The patients in the accelerated group had better mobility, strength, and DASH scores at the early postoperative time points (zero to eight weeks postoperatively) compared with the patients in the standard rehabilitation group. The difference between the groups was both clinically relevant and statistically significant. Patients who follow an accelerated rehabilitation

  5. Comparative evaluation of the vertical fracture resistance of endodontically treated roots filled with Gutta-percha and Resilon: a meta-analysis of in vitro studies.

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    Tan, Minmin; Chai, Zhaowu; Sun, Chengjun; Hu, Bo; Gao, Xiang; Chen, Yunjia; Song, Jinlin

    2018-06-13

    Teeth treated endodontically are more susceptible to vertical root fracture (VRF). Some studies have suggested that obturating the root canals with Gutta-percha or Resilon can reinforce endodontically treated teeth, but a few others have presented conflicting results. These inconsistent results cannot guide clinicians in determining clinical approaches. The objective of this meta-analysis is to evaluate and compare the vertical fracture resistance of endodontically treated root canals obturated with Gutta-percha/AH plus and the Resilon system. Comprehensive literature searches were performed in the PubMed, Cochrane Library, ScienceDirect, Web of Science and Embase databases. The titles and abstracts of all of the retrieved articles were independently assessed by two authors according to predefined selection criteria. Data in the included articles were independently extracted. Statistical analyses were conducted using Review Manager 5.3 and Stata 12.0 software. The pooled standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated for the outcome indicators. The level of statistical significance was set at p < 0.05. The Cochran Q test (I 2 test) was used to test for heterogeneity among studies. Fourteen randomized controlled in vitro trials were included in the meta-analysis. The results demonstrated that the vertical root fracture resistance of unprepared and unfilled roots was significantly higher than that of roots obturated with Gutta-percha/AH plus (SMD = - 0.69, 95% CI = - 1.34 to - 0.04, p = 0.04) or the Resilon system (SMD = - 0.54, 95% CI = - 1.07 to - 0.00, p = 0.05). The differences in fracture resistance between the roots filled with Gutta-percha/AH plus and the prepared unfilled root canals was not significant (SMD = 0.59, 95% CI = - 0.02 to 1.21, p = 0.06). Roots obturated with Resilon had higher fracture resistance than instrumented unfilled roots (SMD = 0.83, 95

  6. Risk Factors for the Failure of Spinal Burst Fractures Treated Conservatively According to the Thoracolumbar Injury Classification and Severity Score (TLICS: A Retrospective Cohort Trial.

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    Jieliang Shen

    Full Text Available The management of thoracolumbar (TL burst fractures is still controversial. The thoracolumbar injury classification and severity score (TLICS algorithm is now widely used to guide clinical decision making, however, in clinical practice, we come to realize that TLICS also has its limitations for treating patients with total scores less than 4, for which conservative treatment may not be optimal in all cases.The aim of this study is to identify several risk factors for the failure of conservative treatment of TL burst fractures according to TLICS algorithm.From June 2008 to December 2013, a cohort of 129 patients with T10-l2 TL burst fractures with a TLISC score ≤3 treated non-operatively were identified and included into this retrospective study. Age, sex, pain intensity, interpedicular distance (IPD, canal compromise, loss of vertebral body height and kyphotic angle (KA were selected as potential risk factors and compared between the non-operative success group and the non-operative failure group.One hundred and four patients successfully completed non-operative treatment, the other 25 patients were converted to surgical treatment because of persistent local back pain or progressive neurological deficits during follow-up. Our results showed that age, visual analogue scale (VAS score and IPD, KA were significantly different between the two groups. Furthermore, regression analysis indicated that VAS score and IPD could be considered as significant predictors for the failure of conservative treatment.The recommendation of non-operative treatment for TLICS score ≤3 has limitations in some patients, and VAS score and IPD could be considered as risk factors for the failure of conservative treatment. Thus, conservative treatment should be decided with caution in patients with greater VAS scores or IPD. If non-operative management is decided, a close follow-up is necessary.

  7. Survival rates against fracture of endodontically treated posterior teeth restored with full-coverage crowns or resin composite restorations: a systematic review

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    Warattama Suksaphar

    2017-07-01

    Full Text Available This systematic review aims to summarize the current clinical studies that investigated survival rates against fracture of endodontically treated posterior teeth restored with crowns or resin composite restorations. Literature search were performed using keywords. Publications from 1980 to 2016 were searched in PubMed, ScienceDirect, Web of Science, MEDLINE, and SCOPUS. Included studies were selected based on inclusion and exclusion criteria. Three clinical studies were included: 1 randomized controlled trial and 1 prospective and 1 retrospective cohort studies. Pooled survival rates ranged from 94%–100% and 91.9%–100% for crowns and resin composite, respectively. The majority of teeth had no more than 3 surface loss of tooth structure. The studies included were heterogeneous, and were not appropriate for further meta-analysis. Current evidence suggested that the survival rates against the fracture of endodontically treated posterior teeth restored with crowns or resin composites were not significantly different in the teeth with minimum to moderate loss of tooth structure.

  8. Incidence and clinical relevance of tibiofibular synostosis in fractures of the ankle which have been treated surgically.

    Science.gov (United States)

    Droog, R; Verhage, S M; Hoogendoorn, J M

    2015-07-01

    In this retrospective cohort study, we analysed the incidence and functional outcome of a distal tibiofibular synostosis. Patients with an isolated AO type 44-B or C fracture of the ankle who underwent surgical treatment between 1995 and 2007 were invited for clinical and radiological review. The American Orthopaedic Foot and Ankle Society score, the American Academy of Orthopaedic Surgeons score and a visual analogue score for pain were used to assess outcome. A total of 274 patients were available; the mean follow-up was 9.7 years (8 to 18). The extent of any calcification or synostosis at the level of the distal interosseous membrane or syndesmosis on the contemporary radiographs was defined as: no or minor calcifications (group 1), severe calcification (group 2), or complete synostosis (group 3). A total of 222 (81%) patients were in group 1, 37 (14%) in group 2 and 15 (5%) in group 3. There was no significant difference in incidence between AO type 44-B and type 44-C fractures (p = 0.89). Severe calcification or synostosis occurred in 21 patients (19%) in whom a syndesmotic screw was used and in 31 (19%) in whom a syndesmotic screw was not used.(p = 0.70). No significant differences were found between the groups except for a greater reduction in mean dorsiflexion in group 2 (p = 0.004). This is the largest study on distal tibiofibular synostosis, and we found that a synostosis is a frequent complication of surgery for a fracture of the ankle. Although it theoretically impairs the range of movement of the ankle, it did not affect the outcome. Our findings suggest that synostosis of the distal tibiofibular syndesmosis in general does not warrant treatment. ©2015 The British Editorial Society of Bone & Joint Surgery.

  9. [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

  10. Balance in single-limb stance after surgically treated ankle fractures: a 14-month follow-up

    Directory of Open Access Journals (Sweden)

    Ageberg Eva

    2006-04-01

    Full Text Available Abstract Background The maintenance of postural control is fundamental for different types of physical activity. This can be measured by having subjects stand on one leg on a force plate. Many studies assessing standing balance have previously been carried out in patients with ankle ligament injuries but not in patients with ankle fractures. The aim of this study was to evaluate whether patients operated on because of an ankle fracture had impaired postural control compared to an uninjured age- and gender-matched control group. Methods Fifty-four individuals (patients operated on because of an ankle fracture were examined 14 months postoperatively. Muscle strength, ankle mobility, and single-limb stance on a force-platform were measured. Average speed of centre of pressure movements and number of movements exceeding 10 mm from the mean value of centre of pressure were registered in the frontal and sagittal planes on a force-platform. Fifty-four age- and gender-matched uninjured individuals (controls were examined in the single-limb stance test only. The paired Student t-test was used for comparisons between patients' injured and uninjured legs and between side-matched legs within the controls. The independent Student t-test was used for comparisons between patients and controls. The Chi-square test, and when applicable, Fisher's exact test were used for comparisons between groups. Multiple logistic regression was performed to identify factors associated with belonging to the group unable to complete the single-limb stance test on the force-platform. Results Fourteen of the 54 patients (26% did not manage to complete the single-limb stance test on the force-platform, whereas all controls managed this (p Conclusion One in four patients operated on because of an ankle fracture had impaired postural control compared to an age- and gender-matched control group. Age over 45 years and decreased strength in the ankle plantar flexors and dorsiflexors

  11. Who are we missing? Too few skeletal surveys for children with humeral and femoral fractures

    International Nuclear Information System (INIS)

    Shelmerdine, S.C.; Das, R.; Ingram, M.D.; Negus, S.

    2014-01-01

    Aim: To determine the potential shortfall in skeletal survey referral for children presenting with an acute non-supracondylar humeral or femoral fracture. Materials and methods: Plain radiograph reports were reviewed retrospectively using the radiology information system database over a 5 year study period (May 2008–2013) in children under 18 months of age who presented with an acute fracture. Subsequent skeletal survey referral was used as a surrogate marker for further investigation of child abuse. Application of robust meta-analysis derived probability data regarding likelihood of child abuse as a cause of non-supracondylar humeral or femoral fracture was applied. An estimation of the expected number of cases of abuse, with shortfall in skeletal survey referrals, was then calculated. Results: There were 288 fractures in 281 children. Three children presented with multiple fractures and were considered separately in the present data. The mean patient age was 10.5 months. Nine (3%) non-supracondylar humeral fractures were identified of which four cases may have been due to non-accidental injury (NAI). One (11%) of these patients was referred for a skeletal survey indicating a potential shortfall of three referrals. Twenty-five (9%) femoral fractures were identified of which 13 cases may have been due to NAI, with six (24%) referrals for skeletal surveys generated. This indicates a potential shortfall of seven referrals. Conclusion: The present study serves as a current analysis of practice within a tertiary paediatric referral centre. There appeared to be local under-investigation of NAI. Improved child protection education and awareness programmes have now been introduced. - Highlights: • Long bone fractures in non-ambulatory children carry high probability for child abuse. • Suspicion for child abuse should trigger a referral for a skeletal survey. • We examine the potential shortfall in skeletal survey referrals in such patients. • Only 11% and 24% of

  12. The computed tomographic evaluation of patellofemoral joint in patellar fractures treated with open reduction and internal fixation

    International Nuclear Information System (INIS)

    Benli, I.T.; Akalin, S.; Mumcu, E.F.; Citak, M.; Kilic, M.; Pasaoglu, E.

    1992-01-01

    In this study, we examined 97 patella fractures in which open reduction and internal fixation had been performed at the 1st Orthopaedics and Trauma Clinic of Social Security Ankara Hospital between January 1983 and December 1988. After 24 to 96 months, on an average of 48.4 months follow-up period, the cases were evaluated clinically for knee function complaints and by CT and roentgenography for patellofemoral articulation. In 11 of the patients (11.5%) there was patellar displacement, 2 of the patients had patellar tilt (2.1%) and in 14 patients (14.5%) there was malalignment in which 1 patient (1.1%) had both patellar tilt and displacement. This data was obtained by measuring femoral trochlear angle (FTA) and patellar tilt angle (PTA) by CT at various degrees of knee flexion. Thirty three patients (34%) had slight and 19 patients (19.6%) had severe degenerative changes in the patellofemoral articulation. It is found that there is close relation between the variability of the pain complaints of the patients and the type of the fracture and the time of management and the postoperative rehabilitation. (author)

  13. The computed tomographic evaluation of patellofemoral joint in patellar fractures treated with open reduction and internal fixation

    Energy Technology Data Exchange (ETDEWEB)

    Benli, I.T.; Akalin, S.; Mumcu, E.F.; Citak, M.; Kilic, M.; Pasaoglu, E. (Ankara Social Security Hospital (Turkey))

    1992-08-01

    In this study, we examined 97 patella fractures in which open reduction and internal fixation had been performed at the 1st Orthopaedics and Trauma Clinic of Social Security Ankara Hospital between January 1983 and December 1988. After 24 to 96 months, on an average of 48.4 months follow-up period, the cases were evaluated clinically for knee function complaints and by CT and roentgenography for patellofemoral articulation. In 11 of the patients (11.5%) there was patellar displacement, 2 of the patients had patellar tilt (2.1%) and in 14 patients (14.5%) there was malalignment in which 1 patient (1.1%) had both patellar tilt and displacement. This data was obtained by measuring femoral trochlear angle (FTA) and patellar tilt angle (PTA) by CT at various degrees of knee flexion. Thirty three patients (34%) had slight and 19 patients (19.6%) had severe degenerative changes in the patellofemoral articulation. It is found that there is close relation between the variability of the pain complaints of the patients and the type of the fracture and the time of management and the postoperative rehabilitation. (author).

  14. Bone grafting via reamer-irrigator-aspirator for nonunion of open Gustilo-Anderson type III tibial fractures treated with multiplanar external fixator

    Directory of Open Access Journals (Sweden)

    Kusnezov Nicholas

    2017-01-01

    Full Text Available Introduction: The purpose of this investigation was to evaluate the outcomes following reamer-irrigator-aspirator (RIA autogenous bone grafting (ABG of high-grade open tibia fracture nonunions stabilized via multiplanar external fixation. Methods: We retrospectively reviewed all patients with Gustilo-Anderson type III open tibia fractures treated with multiplanar external fixation and who underwent RIA ABG for nonunion at our institutional Level 1 Trauma Center between 2008 and 2015. All patients between 15 and 65 years of age with a minimum of six-month follow-up were included. The primary outcomes of interest were achievement of union, time to union, and incidence of revision surgery. Complications and all-cause reoperation were recorded as secondary endpoints. Results: Fifteen patients met the inclusion criteria with a mean age of 41.1 ± 14.0 years. RIA ABG was harvested from the femur in all cases, with a mean volume of 34 ± 15 mL. At an average follow-up of 13.3 ± 6.8 months, all patients achieved union, including two who required repeat RIA ABG. One patient experienced a femoral shaft fracture four months following RIA that required intramedullary fixation. The average time to union was 6.0 ± 6.3 months. Twelve patients (80% went on to union within six months and 13 (86.7% within one year. Five patients experienced a total of six post-operative complications including three deep infections, one refracture through the nonunion site, and one gradual varus deformity. Two patients in this series required a subsequent RIA autografting procedure secondary to persistent nonunion despite initial RIA. Conclusion: We found that RIA ABG offered a reliable solution to nonunion of Gustilo-Anderson type III open tibial fractures treated with multiplanar external fixation, circumventing the need to change the method of fixation.

  15. Elbow Fractures

    Science.gov (United States)

    ... is also an important factor when treating elbow fractures. Casts are used more frequently in children, as their risk of developing elbow stiffness is small; however, in an adult, elbow stiffness is much more likely. Rehabilitation directed by your doctor is often used to ...

  16. Fracture Mechanics

    International Nuclear Information System (INIS)

    Jang, Dong Il; Jeong, Gyeong Seop; Han, Min Gu

    1992-08-01

    This book introduces basic theory and analytical solution of fracture mechanics, linear fracture mechanics, non-linear fracture mechanics, dynamic fracture mechanics, environmental fracture and fatigue fracture, application on design fracture mechanics, application on analysis of structural safety, engineering approach method on fracture mechanics, stochastic fracture mechanics, numerical analysis code and fracture toughness test and fracture toughness data. It gives descriptions of fracture mechanics to theory and analysis from application of engineering.

  17. Isolated olecranon fractures in children affected by osteogenesis imperfecta type I treated with single screw or tension band wiring system: Outcomes and pitfalls in relation to bone mineral density.

    Science.gov (United States)

    Persiani, Pietro; Ranaldi, Filippo M; Graci, Jole; De Cristo, Claudia; Zambrano, Anna; D'Eufemia, Patrizia; Martini, Lorena; Villani, Ciro

    2017-05-01

    The purpose of this study is to compare the results of 2 techniques, tension band wiring (TBW) and fixation with screws, in olecranon fractures in children affected with osteogenesis imperfecta (OI) type I. Between 2010 and 2014, 21 olecranon fractures in 18 children with OI (average age: 12 years old) were treated surgically. Ten patients were treated with the screw fixation and 11 with TBW. A total of 65% of olecranon fractures occurred as a result of a spontaneous avulsion of the olecranon during the contraction of the triceps muscle. The average follow-up was 36 months. Among the children treated with 1 screw, 5 patients needed a surgical revision with TBW due to a mobilization of the screw. In this group, the satisfactory results were 50%. In patients treated with TBW, the satisfactory results were 100% of the cases. The average Z-score, the last one recorded in the patients before the trauma, was -2.53 in patients treated with screw fixation and -2.04 in those treated with TBW. TBW represents the safest surgical treatment for patients suffering from OI type I, as it helps to prevent the rigidity of the elbow through an earlier recovery of the range of motion, and there was no loosening of the implant. In analyzing the average Z-score before any fracture, the fixation with screws has an increased risk of failure in combination with low bone mineral density.

  18. THE FUNCTIONAL OUTCOME OF MANAGEMENT OF SCHATZKER TYPE II AND III TIBIAL PLATEAU FRACTURES TREATED WITH INDIRECT ELEVATION, PERCUTANEOUS FIXATION AND BONE GRAFTING

    Directory of Open Access Journals (Sweden)

    Sheshagiri

    2016-02-01

    . There was no complication like infection or loss of reduction in the follow-up. CONCLUSION This minimally invasive approach is technically easy, offers good results in Schatzker II & III fractures, but since the inside of the joint is not visualized, meniscal and cruciate injuries can be missed, which can be treated later.

  19. 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.)

  20. Micromechanics-based modeling of stress–strain and fracture behavior of heat-treated boron steels for hot stamping process

    Energy Technology Data Exchange (ETDEWEB)

    Srithananan, P.; Kaewtatip, P.; Uthaisangsuk, V., E-mail: vitoon.uth@kmutt.ac.th

    2016-06-14

    In the automotive industry, hot stamped parts with tailored properties have shown advantageous safety performance. Such components are produced by applying different heat treatment conditions after forming for different zones in order to obtain various combinations of hard and soft microstructures. In this work, pure martensitic, pure bainitic, and three martensitic/bainitic phase microstructures were initially generated from the boron steel grade 22MnB5 by a two-step quenching procedure in which different holding times in the bainitic temperature range were varied. Increased phase fraction of bainite due to longer holding time led to decreased yield and tensile strength; however, elongation and resulting energy absorbability became significantly higher. To describe mechanical properties and failure behavior of hot stamped parts containing multiphase microstructures, influences of microstructure characteristics should be considered on the micro-scale. Using modeling, 2-D representative volume elements (RVE) were generated from observed real microstructures and flow curves of the individual single phases were defined, taking into account a dislocation theory based model and local chemical compositions. Then, effective stress–strain curves of the heat-treated boron steels were calculated by using the isostrain and non-isostrain methods and compared with tensile test results. Regarding fracture behavior, damage curves of fully martensitic and bainitic structures were determined by means of tensile tests of different notched samples and a hybrid digital image correlation (DIC)–finite element (FE) approach. 2-D RVE simulations of a martensite/bainite mixture were carried out under various states of stress, in which the obtained damage curves were individually applied for each phase. The predicted damage curve from RVE simulations for two-phase boron steel fairly agreed with experimental fracture strains. Moreover, correspondingly normalized Lode angle could be

  1. Computed tomograms of blowout fracture

    International Nuclear Information System (INIS)

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

    1985-01-01

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

  2. Computed tomograms of blowout fracture

    Energy Technology Data Exchange (ETDEWEB)

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

    1985-02-01

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

  3. Outcome in hip fracture patients related to anemia at admission and allogeneic blood transfusion: An analysis of 1262 surgically treated patients

    NARCIS (Netherlands)

    A.J.H. Vochteloo (Anne); B.L. Borger van der Burg (Boudewijn); B. Mertens (Bart); A.H.P. Niggebrugge (Arthur); M.R. de Vries (Mark); W.E. Tuinebreijer (Wim); R.M. Bloem (Rolf); R.G.H.H. Nelissen (Rob); P. Pilot (Peter)

    2011-01-01

    textabstractBackground: Anemia is more often seen in older patients. As the mean age of hip fracture patients is rising, anemia is common in this population. Allogeneic blood transfusion (ABT) and anemia have been pointed out as possible risk factors for poorer outcome in hip fracture patients.

  4. Bone mineral density at diagnosis determines fracture rate in children with acute lymphoblastic leukemia treated according to the DCOG-ALL9 protocol

    NARCIS (Netherlands)

    te Winkel, Mariel L.; Pieters, Rob; Hop, Wim C. J.; Roos, Jan C.; Bokkerink, Jos P. M.; Leeuw, Jan A.; Bruin, Marrie C. A.; Kollen, Wouter J. W.; Veerman, Anjo J. P.; de Groot-Kruseman, Hester A.; van der Sluis, Inge M.; van den Heuvel-Eibrink, Marry M.

    Purpose: To elucidate incidence and risk factors of bone mineral density and fracture risk in children with Acute Lymphoblastic Leukemia (ALL). Methods: Prospectively, cumulative fracture incidence, calculated from diagnosis until one year after cessation of treatment, was assessed in 672 patients.

  5. Fracture characteristics in Japanese rock

    International Nuclear Information System (INIS)

    Ijiri, Yuji; Sawada, Atsushi; Akahori, Kuniaki

    1999-11-01

    It is crucial for the performance assessment of geosphere to evaluate the characteristics of fractures that can be dominant radionuclide migration pathways from a repository to biosphere. This report summarizes the characteristics of fractures obtained from broad literature surveys and the fields surveys at the Kamaishi mine in northern Japan and at outcrops and galleries throughout the country. The characteristics of fractures described in this report are fracture orientation, fracture shape, fracture frequency, fracture distribution in space, transmissivity of fracture, fracture aperture, fracture fillings, alteration halo along fracture, flow-wetted surface area in fracture, and the correlation among these characteristics. Since granitic rock is considered the archetype fractured media, a large amount of fracture data is available in literature. In addition, granitic rock has been treated as a potential host rock in many overseas programs, and has JNC performed a number of field observations and experiments in granodiorite at the Kamaishi mine. Therefore, the characteristics of fractures in granitic rock are qualitatively and quantitatively clarified to some extent in this report, while the characteristics of fractures in another rock types are not clarified. (author)

  6. Transstyloid, transscaphoid, transcapitate fracture: a variant of scaphocapitate fractures.

    LENUS (Irish Health Repository)

    Burke, Neil G

    2014-01-01

    Transstyloid, transscaphoid, transcapitate fractures are uncommon. We report the case of a 28-year-old man who sustained this fracture following direct trauma. The patient was successfully treated by open reduction internal fixation of the scaphoid and proximal capitate fragment, with a good clinical outcome at 1-year follow-up. This pattern is a new variant of scaphocapitate fracture as involves a fracture of the radial styloid as well.

  7. Pathological fractures in children

    Science.gov (United States)

    De Mattos, C. B. R.; Binitie, O.; Dormans, J. P.

    2012-01-01

    Pathological fractures in children can occur as a result of a variety of conditions, ranging from metabolic diseases and infection to tumours. Fractures through benign and malignant bone tumours should be recognised and managed appropriately by the treating orthopaedic surgeon. The most common benign bone tumours that cause pathological fractures in children are unicameral bone cysts, aneurysmal bone cysts, non-ossifying fibromas and fibrous dysplasia. Although pathological fractures through a primary bone malignancy are rare, these should be recognised quickly in order to achieve better outcomes. A thorough history, physical examination and review of plain radiographs are crucial to determine the cause and guide treatment. In most benign cases the fracture will heal and the lesion can be addressed at the time of the fracture, or after the fracture is healed. A step-wise and multidisciplinary approach is necessary in caring for paediatric patients with malignancies. Pathological fractures do not have to be treated by amputation; these fractures can heal and limb salvage can be performed when indicated. PMID:23610658

  8. Neglected simultaneous bilateral femoral neck fractures secondary to narcotic drug abuse treated by bilateral one-staged hemiarthroplasty: a case report

    Directory of Open Access Journals (Sweden)

    Vahedi Ehsan

    2010-06-01

    Full Text Available Abstract Simultaneous bilateral femoral neck fractures are extremely rare and associated with various conditions. Up to now Most cases had correlations with major trauma, repetitive minor trauma, seizure, parathyroid or renal dysfunction, anti-epileptic medications, seizure, etc. A 28-year-old addict man referred to us with a 10-year history of narcotic drug abuse and history of 8 months bilateral groin pain. He admitted with displaced bilateral femoral neck fracture. Because of long duration of this condition and osteonecrosis revealed on bone scan, one-staged bilateral hip hemiarthroplasty was done. A good function was noted after surgery to 4-month follow up. Up to now, have not be founded in the literature that a case of bilateral femoral neck fracture associated with narcotic drug abuse. Because of negative effects of opium or smoking on bone tissues, a simple bone pain should aware us about the risk of stress or fatigue fracture.

  9. Tibial Plateau Fractures

    DEFF Research Database (Denmark)

    Elsøe, Rasmus

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

  10. Effect of the As-Forged and Heat-Treated Microstructure on the Room Temperature Anisotropic Ductile Fracture of Inconel 718

    Science.gov (United States)

    Teimouri, Javad; Hosseini, Seyed Rahman; Farmanesh, Khosro

    2018-05-01

    The purpose of the present work was to investigate the effect of primary carbides and the δ-phase on the anisotropic ductile fracture of Inconel 718 in the forging process. Inconel 718 alloys were prepared by VIM + VAR processes with various carbon contents (0.009 and 0.027 wt.%). Then, the alloys were forged and annealed at temperatures of 980 and 1030 °C. The room temperature mechanical anisotropy of the alloys was evaluated at the longitudinal direction (LD) and transverse direction (TD). Tensile and impact tests were used to characterize the mechanical properties of the specimens. The microstructural characterization and the fractography of the alloys were carried out by FE-SEM. The obtained results showed that the fracture strain and the impact energy in the TD were 30-50% lower than the LD. The fracture was accelerated by the δ-phase, leading to the reduction of impact energy in the longitudinal and the lateral directions up to 50%. The low-carbon alloy indicated similar characteristics in both the LD and the TD. Aligned carbides changed the fracture path from a zigzag path in the LD to a fibrous path in the TD, while the δ-phase created a flat fracture path. The shear lip area ratio in the tensile fracture cross section was decreased by reducing ductility.

  11. Role of preoperative 3-dimensional computed tomography reconstruction in depressed skull fractures treated with craniectomy: a case report of forensic interest.

    Science.gov (United States)

    Viel, Guido; Cecchetto, Giovanni; Manara, Renzo; Cecchetto, Attilio; Montisci, Massimo

    2011-06-01

    Patients affected by cranial trauma with depressed skull fractures and increased intracranial pressure generally undergo neurosurgical intervention. Because craniotomy and craniectomy remove skull fragments and generate new fracture lines, they complicate forensic examination and sometimes prevent a clear identification of skull fracture etiology. A 3-dimensional reconstruction based on preoperative computed tomography (CT) scans, giving a picture of the injuries before surgical intervention, can help the forensic examiner in identifying skull fracture origin and the means of production.We report the case of a 41-year-old-man presenting at the emergency department with a depressed skull fracture at the vertex and bilateral subdural hemorrhage. The patient underwent 2 neurosurgical interventions (craniotomy and craniectomy) but died after 40 days of hospitalization in an intensive care unit. At autopsy, the absence of various bone fragments did not allow us to establish if the skull had been stricken by a blunt object or had hit the ground with high kinetic energy. To analyze bone injuries before craniectomy, a 3-dimensional CT reconstruction based on preoperative scans was performed. A comparative analysis between autoptic and radiological data allowed us to differentiate surgical from traumatic injuries. Moreover, based on the shape and size of the depressed skull fracture (measured from the CT reformations), we inferred that the man had been stricken by a cylindric blunt object with a diameter of about 3 cm.

  12. Complications in ankle fracture surgery

    OpenAIRE

    Ovaska, Mikko

    2015-01-01

    Mikko Ovaska. Complications in Ankle Fracture Surgery. Helsinki Bone and Joint Research Group, Department of Orthopaedic Surgery and Traumatology, Faculty of Medicine, University of Helsinki, Finland. Helsinki 2014. Ankle fractures are among the most frequently encountered surgically treated fractures. The operative treatment of this fracture may be associated with several complications. The most frequently encountered complications are related wound healing, and deep infection may have d...

  13. Outcome in hip fracture patients related to anemia at admission and allogeneic blood transfusion: an analysis of 1262 surgically treated patients

    Directory of Open Access Journals (Sweden)

    Vochteloo Anne JH

    2011-11-01

    Full Text Available Abstract Background Anemia is more often seen in older patients. As the mean age of hip fracture patients is rising, anemia is common in this population. Allogeneic blood transfusion (ABT and anemia have been pointed out as possible risk factors for poorer outcome in hip fracture patients. Methods In the timeframe 2005-2010, 1262 admissions for surgical treatment of a hip fracture in patients aged 65 years and older were recorded. Registration was prospective from 2008 on. Anemic and non-anemic patients (based on hemoglobin level at admission were compared regarding clinical characteristics, mortality, delirium incidence, LOS, discharge to a nursing home and the 90-day readmission rate. Receiving an ABT, age, gender, ASA classification, type of fracture and anesthesia were used as possible confounders in multivariable regression analysis. Results The prevalence of anemia and the rate of ABT both were 42.5%. Anemic patients were more likely to be older and men and had more often a trochanteric fracture, a higher ASA score and received more often an ABT. In univariate analysis, the 3- and 12-month mortality rate, delirium incidence and discharge to a nursing home rate were significantly worse in preoperatively anemic patients. In multivariable regression analysis, anemia at admission was a significant risk factor for discharge to a nursing home and readmission Conclusions This study has demonstrated that anemia at admission and postoperative anemia needing an ABT (PANT were independent risk factors for worse outcome in hip fracture patients. In multivariable regression analysis, anemia as such had no effect on mortality, due to a rescue effect of PANT. In-hospital, 3- and 12-month mortality was negatively affected by PANT, with the main effect in the first 3 months postoperatively.

  14. Dynamic intramedullary crosspinning technique for repair of distal femoral fractures in dogs and cats: 71 cases (1981-1985)

    International Nuclear Information System (INIS)

    Whitney, W.O.; Schrader, S.C.

    1987-01-01

    Dynamic intramedullary crosspinning was used in the surgical treatment of supracondylar and distal physeal fractures of the femur in 129 dogs and cats over a 5-year period; the records of the 44 dogs and 27 cats with follow-up information up to time of bony union were evaluated. The results were good or excellent in 66 of 71 animals (93%). The mean follow-up period was 22 months. Distal pin migration was the major complication (10 animals; 14%). The pin migrated before bony union in 2 animals because of instability and collapse at the fracture site. The pin migrated in 8 animals after bony union and was associated with intermittent lameness. In 5 of these, pin removal was performed and the lameness resolved

  15. Scaphoid fractures in children

    Directory of Open Access Journals (Sweden)

    Gajdobranski Đorđe

    2014-01-01

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

  16. [Kirschner wire osteosynthesis for fractures in childhood: bury wires or not? : Results of a survey on care reality in Germany].

    Science.gov (United States)

    Schneidmueller, D; Kertai, M; Bühren, V; von Rüden, C

    2018-02-20

    Kirschner wire osteosynthesis is considered to be the standard technique for surgical fixation of displaced supracondylar humeral and distal radial fractures in children. The Kirschner wires can be left exposed or buried under the skin. Advantages of the epicutaneous technique are, e. g. the efficiency (cost, effort) and the possibility for wire removal without the necessity of a second anesthesia. On the other hand, there is a concern about higher infection rates as well as traumatization of the children due to externally visible wires. A web-based survey of members of the DGU, DGOU, DGOOC, and the pediatric traumatology section of the DGU (SKT) was performed to evaluate current treatment concepts in Germany. The pros and cons for each technique were recorded and the need for a clinical study was examined. In addition, a cost analysis was performed for both methods. The results from the literature are summarized and discussed. A total of 710 questionnaires were evaluated. The majority of the respondents were trauma surgeons working in a hospital (80%). The buried technique was superior in both fracture groups (supracondylar humeral fractures 73% and distal radius fractures 69%), whereas a relevant difference could be found depending on the profession. The main reason for the subcutaneous technique was anxiety or observed higher infections using the epicutaneous technique. In Germany, the majority of wires are buried under the skin due to a fear of higher infection rates. In addition, other influencing factors such as pain and traditional approaches play a significant role. With respect to the results in the literature as well as a possible improvement of efficiency and avoidance of a second anesthesia, a multicentric clinical study seems necessary in the future to compare both techniques.

  17. Posttraumatic ankle osteoarthritis: How initial cartilage lesions, the deltoid ligament and hindfoot alignment affect the outcome of operatively treated ankle fractures

    NARCIS (Netherlands)

    Stufkens, S.A.S.

    2014-01-01

    The vast majority (70-78%) of ankle osteoarthritis is of posttraumatic origin. The quality of the reduction of intra-articular fractures is of paramount importance for a satisfactory outcome in all joints. Accordingly, the most important aspect of conservative or surgical treatment of ankle

  18. Oblique Axis Body Fracture

    DEFF Research Database (Denmark)

    Takai, Hirokazu; Konstantinidis, Lukas; Schmal, Hagen

    2016-01-01

    type" fracture pattern. The first patient was treated conservatively with cervical spine immobilization in a semirigid collar. However, gross displacement was noted at the 6-week follow-up visit. The second patient was therefore treated operatively by C1-C3/4 posterior fusion and the course...... for this injury and suggest early operative stabilization....

  19. A comparative evaluation of fracture resistance of endodontically treated teeth, with variable marginal ridge thicknesses, restored with composite resin and composite resin reinforced with Ribbond: An in vitro study

    Directory of Open Access Journals (Sweden)

    Vaishali Kalburge

    2013-01-01

    Full Text Available Background: The anatomic shape of maxillary premolars show a tendency towards separation of their cusps during mastication after endodontic treatment. Preservation of the marginal ridge of endodontically treated and restored premolars can act as a strengthening factor and improve the fracture resistance. Objectives: To evaluate the effect of varying thickness of marginal ridge on the fracture resistance of endodontically treated maxillary premolars restored with composite and Ribbond reinforced composites. Materials and Methods: One hundred and twenty, freshly extracted, non carious human mature maxillary premolars were selected for this experimental in vitro study. The teeth were randomly assigned in to twelve groups ( n = 10. Group 1 received no preparation. All the premolars in other groups were root canal treated. In subgroups of 3 and 4, DO cavities were prepared while MOD cavities were prepared for all subgroups of group 2, the dimensions of the proximal boxes were kept uniform. In group 3 and 4 the dimensions of the mesial marginal ridge were measured using a digital Vernier caliper as 2 mm, 1.5 mm, 1 mm and 0.5 mm in the respective subgroups. All samples in groups 2.2 and all the subgroups of 3 were restored with a dentin bonding agent and resin composite. The teeth in group 2.3 and all subgroups of 4 were restored with composite reinforced with Ribbond fibers. The premolars were submitted to axial compression up to failure at 45 degree angle to a palatal cusp in universal testing machine. The mean load necessary to fracture was recorded in Newtons and the data was analysed. Results: There was a highly significant difference between mean values of force required to fracture teeth in group 1 and all subgroups of group 2, 3 and 4 (i.e., P < 0.01 Conclusion: On the basis of static loading, preserving the mesial marginal ridge with thicknesses of mm, 1.5 mm, 1 mm and 0.5 mm, composite restored and Ribbond reinforced composite restored

  20. Treatment of midfacial fractures

    International Nuclear Information System (INIS)

    Schubert, J.

    2007-01-01

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

  1. Hip Fracture

    Science.gov (United States)

    ... hip fractures in people of all ages. In older adults, a hip fracture is most often a result of a fall from a standing height. In people with very weak bones, a hip fracture can occur simply by standing on the leg and twisting. Risk factors The rate of hip fractures increases substantially with ...

  2. [Trochanteric femoral fractures].

    Science.gov (United States)

    Douša, P; Čech, O; Weissinger, M; Džupa, V

    2013-01-01

    At the present time proximal femoral fractures account for 30% of all fractures referred to hospitals for treatment. Our population is ageing, the proportion of patients with post-menopausal or senile osteoporosis is increasing and therefore the number of proximal femoral fractures requiring urgent treatment is growing too. In the age category of 50 years and older, the incidence of these fractures has increased exponentially. Our department serves as a trauma centre for half of Prague and part of the Central Bohemia Region with a population of 1 150 000. Prague in particular has a high number of elderly citizens. Our experience is based on extensive clinical data obtained from the Register of Proximal Femoral Fractures established in 1997. During 14 years, 4280 patients, 3112 women and 1168 men, were admitted to our department for treatment of proximal femoral fractures. All patients were followed up until healing or development of complications. In the group under study, 82% were patients older than 70 years; 72% of those requiring surgery were in their seventies and eighties. Men were significantly younger than women (pfractures were 2.3-times more frequent in women than in men. In the category under 60 years, men significantly outnumbered women (pfractures were, on the average, eight years older than the patients with intertrochanteric fractures, which is a significant difference (pTrochanteric fractures accounted for 54.7% and femoral neck fractures for 45.3% of all fractures. The inter-annual increase was 5.9%, with more trochanteric than femoral neck fractures. There was a non-significant decrease in intertrochanteric (AO 31-A3) fractures. On the other hand, the number of pertrochanteric (AO 31-A1+2) fractures increased significantly (pfractures were treated with a proximal femoral nail; a short nail was used in 1260 and a long nail in 134 of them. A dynamic hip screw (DHS) was employed to treat 947 fractures. Distinguishing between pertrochanteric (21-A1

  3. Assessment of bone healing on tibial fractures treated with wire osteosynthesis associated or not with infrared laser light and biphasic ceramic bone graft (HATCP) and guided bone regeneration (GBR): Raman spectroscopy study

    Science.gov (United States)

    Bastos de Carvalho, Fabíola; Aciole, Gilberth Tadeu S.; Aciole, Jouber Mateus S.; Silveira, Landulfo, Jr.; Nunes dos Santos, Jean; Pinheiro, Antônio L. B.

    2011-03-01

    The aim of this study was to evaluate, through Raman spectroscopy, the repair of complete tibial fracture in rabbits fixed with wire osteosynthesis - WO, treated or not with infrared laser light (λ 780nm, 50mW, CW) associated or not to the use of HATCP and GBR. Surgical fractures were created under general anesthesia (Ketamine 0.4ml/Kg IP and Xilazine 0.2ml/Kg IP), on the tibia of 15 rabbits that were divided into 5 groups and maintained on individual cages, at day/night cycle, fed with solid laboratory pelted diet and had water ad libidum. On groups II, III, IV and V the fracture was fixed with WO. Animals of groups III and V were grafted with hydroxyapatite + GBR technique. Animals of groups IV and V were irradiated at every other day during two weeks (16J/cm2, 4 x 4J/cm2). Observation time was that of 30 days. After animal death the specimens were kept in liquid nitrogen for further analysis by Raman spectroscopy. Raman spectroscopy showed significant differences between groups (phydroxyapatite.

  4. The efficacy of the use of IR laser phototherapy associated to biphasic ceramic graft and guided bone regeneration on surgical fractures treated with miniplates: a Raman spectral study on rabbits.

    Science.gov (United States)

    Pinheiro, Antonio L B; Santos, Nicole Ribeiro Silva; Oliveira, Priscila Chagas; Aciole, Gilberth Tadeu Santos; Ramos, Thais Andrade; Gonzalez, Tayná Assunção; da Silva, Laís Nogueira; Barbosa, Artur Felipe Santos; Silveira, Landulfo

    2013-02-01

    The aim of the present study was to assess, by Raman spectroscopy, the repair of surgical fractures fixed with internal rigid fixation (IRF) treated or not with IR laser (λ780 nm, 50 mW, 4 × 4 J/cm(2) = 16 J/cm(2), ϕ = 0.5 cm(2), CW) associated or not to the use of hydroxyapatite and guided bone regeneration (GBR). Surgical tibial fractures were created under general anesthesia on 15 rabbits that were divided into five groups, maintained on individual cages, at day/night cycle, fed with solid laboratory pelted diet and had water ad libitum. The fractures in groups II, III, IV and V were fixed with miniplates. Animals in groups III and V were grafted with hydroxyapatite and GBR technique used. Animals in groups IV and V were irradiated at every other day during 2 weeks (4 × 4 J/cm(2), 16 J/cm(2) = 112 J/cm(2)). Observation time was that of 30 days. After animal death, specimens were taken and kept in liquid nitrogen and used for Raman spectroscopy. Raman spectroscopy showed significant differences between groups (p < 0.001). Basal readings showed mean value of 1,234 ± 220.1. Group internal rigid fixation + biomaterial + laser showed higher readings (3,521 ± 2,670) and group internal rigid fixation + biomaterial the lowest (212.2 ± 119.8). In conclusion, the results of the present investigation are important clinically as spectral analysis of bone component evidenced increased levels of CHA on fractured sites by using the association of laser light to a ceramic graft.

  5. Spectacular improvement in vitamin D status in elderly osteoporotic women: 8-year analysis of an osteoporotic population treated in a dedicated fracture liaison service.

    Science.gov (United States)

    Amouzougan, A; Deygat, A; Trombert, B; Constant, E; Denarié, D; Marotte, H; Thomas, T

    2015-12-01

    In a population of postmenopausal women with a fragility fracture, we found a drastic reduction in the proportion of women with severe (D, especially from 2009 onwards. These results show that supplementation has been very widely integrated into current practice. Vitamin D (25(OH)D) is essential for bone health. In institutionalised osteoporotic women, it reduces the risk of fragility fractures. Numerous articles suggesting the possibility of extraosseous effects have generated a growing number of publications and recommendations on more widespread administration, to limit the risks of moderate or severe hypovitaminosis D. We assessed the impact on clinical practice of these recommendations concerning 25(OH)D supplementation in elderly at-risk populations. A total of 1486 postmenopausal osteoporotic women were seen in the context of a fracture liaison service (i.e. a rheumatology consultation following a peripheral fragility fracture), between May 2005 and December 2012. Of these, 1107 had a 25(OH)D assay (femur, n = 520; humerus, n = 207; wrist, n = 380). The average age of the total population was 76.7 ± 9.9 years, while for women with an available 25(OH)D assay, the average age was 75.1 ± 11.8 years. The average 25(OH)D (nmol/L) level was similar for the three fracture sites: femur, 30 ± 36.2; humerus, 27.5 ± 24; and wrist, 31 ± 26. A drastic reduction in the proportion of women with severe (D was observed, especially from 2009 onwards, with a mean prevalence of 69 and 30 % respectively before that year and 35 and 52 % thereafter. Conversely, the proportion of women with 25(OH)D at the threshold value of 75 nmol/L increased from 1.2 to 24 %. Overall, mean serum 25(OH)D levels were significantly higher when comparing the two periods 2005-2008 and 2009-1012 (17.6 ± 14.6 and 48.4 ± 39.2 nmol/L, respectively; p elderly.

  6. Pediatric fractures – an educational needs assessment of Canadian pediatric emergency medicine residents

    Directory of Open Access Journals (Sweden)

    Dixon AC

    2015-06-01

    Full Text Available Andrew C Dixon Department of Pediatrics, University of Alberta, Edmonton, AB, Canada Objectives: To determine the gaps in knowledge of Canadian pediatric emergency medicine residents with regards to acute fracture identification and management. Due to their predominantly medical prior training, fractures may be an area of weakness requiring a specific curriculum to meet their needs. Methods: A questionnaire was developed examining comfort level and performance on knowledge based questions of trainees in the following areas: interpreting musculoskeletal X-rays; independently managing pediatric fractures, physical examination techniques, applied knowledge of fracture management, and normal development of the bony anatomy. Using modified Dillman technique the instrument was distributed to pediatric emergency medicine residents at seven Canadian sites. Results: Out of 43 potential respondents, 22 (51% responded. Of respondents, mean comfort with X-ray interpretation was 69 (62–76 95% confidence interval [CI] while mean comfort with fracture management was only 53 (45–63 95% CI; mean comfort with physical exam of shoulder 60 (53–68 95% CI and knee 69 (62–76 95% CI was low. Less than half of respondents (47%; 95% CI 26%–69% could accurately identify normal wrist development, correctly manage a supracondylar fracture (39%; 95% CI 20%–61%, or identify a medial epicondyle fracture (44%; 95% CI 24%–66%. Comfort with neurovascular status of the upper (mean 82; 95% CI 75–89 and lower limb (mean 81; 95% CI 74–87 was high. Interpretation: There are significant gaps in knowledge of physical exam techniques, fracture identification and management among pediatric emergency medicine trainees. A change in our current teaching methods is required to meet this need. Keywords: pediatric, fractures, education, radiologic interpretation

  7. Predisposing Effect of Elbow Alignment on the Elbow Fracture Type in Children.

    Science.gov (United States)

    Kang, Seungcheol; Park, Soo-Sung

    2015-08-01

    Under the hypothesis that the elbow alignment, namely the carrying angle, could predispose individuals to a specific type of pediatric elbow fracture after a fall onto an outstretched arm, we investigated the relationship between radiographic carrying angle and elbow fracture type in children. Retrospective case-control study. Level I pediatric trauma center. We reviewed 374 children who were diagnosed with supracondylar fracture (SCF, n = 208), lateral condylar fracture (LCF, n = 132), and radial neck fracture (RNF, n = 34). The association between the radiographic carrying angle and the fracture type was investigated. To adjust for bias, 2 statistical methods were used: multivariate analysis using a baseline-category logistic model and a case-matching method using propensity score analysis. In the multivariate analysis, with SCF patients set as the baseline category, a more valgus-deviated elbow (increased carrying angle, P = 0.011) predisposed individuals to RNF, whereas a more varus-deviated elbow (decreased carrying angle, P predisposed them to LCF. In the case-matched analysis, there were also significant differences in carrying angles between RNF and case-matched SCF patients (14.3 vs. 11.4 degrees, P = 0.013) and between LCF and case-matched SCF patients (7.7 vs. 11.7 degrees, P fall onto an outstretched elbow, could be a predisposing factor for specific types of pediatric elbow fracture. The results provide the additional information about the injury mechanisms of pediatric elbow fracture and may deepen our understanding of the fractures. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

  8. Fraturas em duas e três partes do úmero proximal tratadas com sutura não absorvível Two- and three-part fractures of the proximal humerus treated with non-absorbable suture

    Directory of Open Access Journals (Sweden)

    Marco Antônio de Castro Veado

    2007-10-01

    150° (106°-210° nas fraturas em três partes, sendo verificada consolidação em valgo em nove pacientes (59% e, em varo, em dois pacientes. De acordo com o escore da UCLA, verificaram-se 88,8% de bons e excelentes resultados e 11,2% de maus resultados, para ambos os tipos de fratura. Os últimos, representados por um caso de pseudartrose e outro, por uma capsulite adesiva no pós-operatório. CONCLUSÃO: As fraturas em duas e três partes do úmero proximal podem ser satisfatoriamente tratadas com sutura não absorvível com incorporação do manguito rotador, particularmente nos idosos. Complicações relacionadas aos metais estão afastadas. Pacientes com fraturas do tubérculo maior tratados com suturas podem ter resultados similares aos daqueles com fraturas do colo cirúrgico. Embora o objetivo da cirurgia seja a reconstrução anatômica, alguma deformidade residual não impede resultado satisfatório. O método é pouco invasivo, permite estabilidade razoável dos fragmentos, com altos índices de consolidação óssea e satisfação do paciente. A cooperação do paciente é crucial para o sucesso terapêutico.OBJECTIVE: To evaluate the clinical and radiographic results of patients with two- and three-part fractures of the proximal end of the humerus treated with non-absorbable sutures and with incorporation of the rotator cuff, which allows for increased stability of the fixation, mainly in patients with low bone quality. METHODS: 19 patients were operated on, fifteen female and four male, with a mean age of 57.4 years (23-79 years and a mean follow-up of 53.4 months (seven to 144 months. Based on Neer classification, the authors found ten three-part fractures (surgical neck and larger tuberosity, and nine two-part fractures (two of the larger tuberosity and seven of the surgical neck. All of them were operated in the beach chair position with endotracheal anesthesia and brachial plexus blockade. Deltopectoral approach was used for two-part fractures of

  9. Rib Fractures

    Science.gov (United States)

    ... Video) Achilles Tendon Tear Additional Content Medical News Rib Fractures By Thomas G. Weiser, MD, MPH, Associate Professor, ... Tamponade Hemothorax Injury to the Aorta Pulmonary Contusion Rib Fractures Tension Pneumothorax Traumatic Pneumothorax (See also Introduction to ...

  10. Root fractures

    DEFF Research Database (Denmark)

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

    2012-01-01

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

  11. Spontaneous rib fractures.

    Science.gov (United States)

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

    2015-07-01

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

  12. Stress Fractures

    Science.gov (United States)

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

  13. Long-Term Follow-up of Modular Metallic Radial Head Replacement: Commentary on an article by Jonathan P. Marsh, MD, FRCSC, et al.: "Radial Head Fractures Treated with Modular Metallic Radial Head Replacement: Outcomes at a Mean Follow-up of Eight Years".

    OpenAIRE

    Mansat, Pierre

    2016-01-01

    Radial head arthroplasty is used to stabilize the joint after a complex acute radial head fracture that is not amenable for fixation or to treat sequelae of radial head fractures. Most of the currently used radial head prostheses are metallic monoblock implants that are not consistently adaptable and raise technical challenges since their implantation requires lateral elbow subluxation. Metallic modular radial head arthroplasty implants available in various head and stem sizes have been devel...

  14. New C2 synchondrosal fracture classification system

    Energy Technology Data Exchange (ETDEWEB)

    Rusin, Jerome A.; Ruess, Lynne [Department of Radiology, Nationwide Children' s Hospital, Columbus, OH (United States); The Ohio State University College of Medicine and Public Health, Columbus, OH (United States); Daulton, Robert S. [Department of Radiology, Nationwide Children' s Hospital, Columbus, OH (United States)

    2015-06-15

    Excessive cervical flexion-extension accompanying mild to severe impact injuries can lead to C2 synchondrosal fractures in young children. To characterize and classify C2 synchondrosal fracture patterns. We retrospectively reviewed imaging and medical records of children who were treated for cervical spine fractures at our institution between 1995 and 2014. We reviewed all fractures involving the five central C2 synchondroses with regard to patient demographics, mechanism of injury, fracture pattern, associated fractures and other injuries, treatment plans and outcome. Fourteen children had fractures involving the central C2 synchondroses. There were nine boys and five girls, all younger than 6 years. We found four distinct fracture patterns. Eleven complete fractures were further divided into four subtypes (a, b, c and d) based on degree of anterior displacement of the odontoid segment and presence of distraction. Nine of these 11 children had fractures through both odontoneural synchondroses and the odontocentral synchondrosis; one had fractures involving both neurocentral synchondroses and the odontoneural synchondrosis; one had fractures through bilateral odontoneural and bilateral neurocentral synchondroses. Three children had incomplete fractures, defined as a fracture through a single odontoneural synchondrosis with or without partial extension into either the odontocentral or the adjacent neurocentral synchondroses. All complete fractures were displaced or angulated. Four had associated spinal cord injury, including two contusions (subtype c fractures) and two fatal transections (subtype d fractures). Most children were treated with primary halo stabilization. Subtype c fractures required surgical fixation. We describe four patterns of central C2 synchondrosal fractures, including two unique patterns that have not been reported. We propose a classification system to distinguish these fractures and aid in treatment planning. (orig.)

  15. Percutaneous cannulated screw fixation of sacral fractures and sacroiliac joint disruptions with CT-controlled guidewires performed by interventionalists: single center experience in treating posterior pelvic instability.

    Science.gov (United States)

    Fischer, Sebastian; Vogl, Thomas J; Marzi, Ingo; Zangos, Stephan; Wichmann, Julian L; Scholtz, Jan-Erik; Mack, Martin G; Schmidt, Sven; Eichler, Katrin

    2015-02-01

    The purpose of our study was to evaluate minimally invasive sacroiliac screw fixation for treatment of posterior pelvic instability with the help of CT controlled guidewires, assess its accuracy, safety and effectiveness, and discuss potential pitfalls. 100 guidewires and hollow titan screws were inserted in 38 patients (49.6±19.5 years) suffering from 35 sacral fractures and/or 16 sacroiliac joint disruptions due to 33 (poly-)traumatic, 2 osteoporotic and 1 post-infectious conditions. The guidewire and screw positions were analyzed in multiplanar reconstructions. The mean minimal distance between guidewire and adjacent neural foramina was 4.5±2.01mm, with a distinctly higher precision in S1 than S2. Eight guidewires showed cortical contacts, resulting in a total of 2% mismatched screws with subsequent wall violation. The fracture gaps were reduced from 3.6±0.53mm to 1.2±0.54mm. During follow-up 3 cases of minor iatrogenic sacral impaction (<5mm) due to the bolting and 2 cases of screw loosening were observed. Interventional time was 84.0min with a mean of 2.63 screws per patient whilst acquiring a mean of 93.7 interventional CT-images (DLP 336.7mGycm). The treatment of posterior pelvic instability with a guidewire-based screw insertion technique under CT-imaging results in a very high accuracy and efficacy with a low complication rate. Careful attention should be drawn to radiation levels. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  16. Percutaneous cannulated screw fixation of sacral fractures and sacroiliac joint disruptions with CT-controlled guidewires performed by interventionalists: Single center experience in treating posterior pelvic instability

    International Nuclear Information System (INIS)

    Fischer, Sebastian; Vogl, Thomas J.; Marzi, Ingo; Zangos, Stephan; Wichmann, Julian L.; Scholtz, Jan-Erik; Mack, Martin G.; Schmidt, Sven; Eichler, Katrin

    2015-01-01

    Highlights: • Minimally invasive sacroiliac screw fixation can be performed under CT-imaging. • Guidewires help in precise placement of cannulated sacroiliac screw. • Only a diminishing rate of misplacements can be seen. • The method appears to be a safe and very accurate procedure. - Abstract: Objective: The purpose of our study was to evaluate minimally invasive sacroiliac screw fixation for treatment of posterior pelvic instability with the help of CT controlled guidewires, assess its accuracy, safety and effectiveness, and discuss potential pitfalls. Methods: 100 guidewires and hollow titan screws were inserted in 38 patients (49.6 ± 19.5 years) suffering from 35 sacral fractures and/or 16 sacroiliac joint disruptions due to 33 (poly-)traumatic, 2 osteoporotic and 1 post-infectious conditions. The guidewire and screw positions were analyzed in multiplanar reconstructions. Results: The mean minimal distance between guidewire and adjacent neural foramina was 4.5 ± 2.01 mm, with a distinctly higher precision in S1 than S2. Eight guidewires showed cortical contacts, resulting in a total of 2% mismatched screws with subsequent wall violation. The fracture gaps were reduced from 3.6 ± 0.53 mm to 1.2 ± 0.54 mm. During follow-up 3 cases of minor iatrogenic sacral impaction (<5 mm) due to the bolting and 2 cases of screw loosening were observed. Interventional time was 84.0 min with a mean of 2.63 screws per patient whilst acquiring a mean of 93.7 interventional CT-images (DLP 336.7 mGy cm). Conclusions: The treatment of posterior pelvic instability with a guidewire-based screw insertion technique under CT-imaging results in a very high accuracy and efficacy with a low complication rate. Careful attention should be drawn to radiation levels

  17. Percutaneous cannulated screw fixation of sacral fractures and sacroiliac joint disruptions with CT-controlled guidewires performed by interventionalists: Single center experience in treating posterior pelvic instability

    Energy Technology Data Exchange (ETDEWEB)

    Fischer, Sebastian, E-mail: sebastian.fischer@kgu.de [Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt (Germany); Vogl, Thomas J. [Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt (Germany); Marzi, Ingo [Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt (Germany); Zangos, Stephan; Wichmann, Julian L.; Scholtz, Jan-Erik; Mack, Martin G. [Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt (Germany); Schmidt, Sven [Orthopaedic University Hospital Friedrichsheim, Marienburgstraße, 260528 Frankfurt (Germany); Eichler, Katrin [Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt (Germany)

    2015-02-15

    Highlights: • Minimally invasive sacroiliac screw fixation can be performed under CT-imaging. • Guidewires help in precise placement of cannulated sacroiliac screw. • Only a diminishing rate of misplacements can be seen. • The method appears to be a safe and very accurate procedure. - Abstract: Objective: The purpose of our study was to evaluate minimally invasive sacroiliac screw fixation for treatment of posterior pelvic instability with the help of CT controlled guidewires, assess its accuracy, safety and effectiveness, and discuss potential pitfalls. Methods: 100 guidewires and hollow titan screws were inserted in 38 patients (49.6 ± 19.5 years) suffering from 35 sacral fractures and/or 16 sacroiliac joint disruptions due to 33 (poly-)traumatic, 2 osteoporotic and 1 post-infectious conditions. The guidewire and screw positions were analyzed in multiplanar reconstructions. Results: The mean minimal distance between guidewire and adjacent neural foramina was 4.5 ± 2.01 mm, with a distinctly higher precision in S1 than S2. Eight guidewires showed cortical contacts, resulting in a total of 2% mismatched screws with subsequent wall violation. The fracture gaps were reduced from 3.6 ± 0.53 mm to 1.2 ± 0.54 mm. During follow-up 3 cases of minor iatrogenic sacral impaction (<5 mm) due to the bolting and 2 cases of screw loosening were observed. Interventional time was 84.0 min with a mean of 2.63 screws per patient whilst acquiring a mean of 93.7 interventional CT-images (DLP 336.7 mGy cm). Conclusions: The treatment of posterior pelvic instability with a guidewire-based screw insertion technique under CT-imaging results in a very high accuracy and efficacy with a low complication rate. Careful attention should be drawn to radiation levels.

  18. Demographics and outcome of metatarsal fractures

    NARCIS (Netherlands)

    Cakir, H.; van Vliet-Koppert, S. T.; van Lieshout, E. M. M.; de Vries, M. R.; van der Elst, M.; Schepers, T.

    2011-01-01

    Although metatarsal fractures are amongst the most common injuries of the foot, this is the first study on outcome after metatarsal fractures. All consecutive patients with metatarsal fractures treated between January 2006 and September 2008 were re-evaluated. Patients aged 16 to 75 were sent a

  19. Clavicular fractures: Classification, diagnosis, therapy

    International Nuclear Information System (INIS)

    Schunk, K.; Strunk, H.; Schild, H.; Lohr, S.

    1988-01-01

    Clavicular fracture is one of the most frequent skeletal lesions. In most cases the median third of the clavicula is affected (this is due to the peculiar biomechanical structure). Accompanying lesions and complications of clavicular fractures are rare. A total of 13 X-ray diagnostic techniques are described of clavicular fractures. X-ray film should, as a matter of principle, always be taken in two planes. Definitely the major part of clavicular fractures are treated conservatively (rucsac dressing), whereas surgery is reserved for few and strictly defined indications. (orig.) [de

  20. [Intramedullary stabilisation of clavicula fractures].

    Science.gov (United States)

    Prokop, A; Schiffer, G; Jubel, A; Chmielnicki, M

    2013-10-01

    With an incidence of 64/100,000, clavicular shaft fractures are one of the most common fractures. Intramedullary fixation with Prevot nails was initially reported in the late 1990s. This procedure offers minimally invasive stabilization of the fracture, thus enabling immediate mobilization and rapid loading capacity. Using a case study, the positioning and procedure are demonstrated on video. The intramedullary implant accommodates the varying tension loading of the clavicle. This treatment is ideal for clavicular fractures with 2-3 fragments. Compared to patients treated conservatively, operated patients achieve more rapid and improved mobility. Employment disability is shorter, and malunion occurs less frequently. Georg Thieme Verlag KG Stuttgart · New York.

  1. Clavicular fractures: Classification, diagnosis, therapy

    Energy Technology Data Exchange (ETDEWEB)

    Schunk, K.; Strunk, H.; Schild, H.; Lohr, S.

    1988-09-01

    Clavicular fracture is one of the most frequent skeletal lesions. In most cases the median third of the clavicula is affected (this is due to the peculiar biomechanical structure). Accompanying lesions and complications of clavicular fractures are rare. A total of 13 X-ray diagnostic techniques are described of clavicular fractures. X-ray film should, as a matter of principle, always be taken in two planes. Definitely the major part of clavicular fractures are treated conservatively (rucsac dressing), whereas surgery is reserved for few and strictly defined indications.

  2. Acetabular Fracture

    Directory of Open Access Journals (Sweden)

    Chad Correa

    2017-09-01

    Full Text Available History of present illness: A 77-year-old female presented to her primary care physician (PCP with right hip pain after a mechanical fall. She did not lose consciousness or have any other traumatic injuries. She was unable to ambulate post-fall, so X-rays were ordered by her PCP. Her X-rays were concerning for a right acetabular fracture (see purple arrows, so the patient was referred to the emergency department where a computed tomography (CT scan was ordered. Significant findings: The non-contrast CT images show a minimally displaced comminuted fracture of the right acetabulum involving the acetabular roof, medial and anterior walls (red arrows, with associated obturator muscle hematoma (blue oval. Discussion: Acetabular fractures are quite rare. There are 37 pelvic fractures per 100,000 people in the United States annually, and only 10% of these involve the acetabulum. They occur more frequently in the elderly totaling an estimated 4,000 per year. High-energy trauma is the primary cause of acetabular fractures in younger individuals and these fractures are commonly associated with other fractures and pelvic ring disruptions. Fractures secondary to moderate or minimal trauma are increasingly of concern in patients of advanced age.1 Classification of acetabular fractures can be challenging. However, the approach can be simplified by remembering the three basic types of acetabular fractures (column, transverse, and wall and their corresponding radiologic views. First, column fractures should be evaluated with coronally oriented CT images. This type of fracture demonstrates a coronal fracture line running caudad to craniad, essentially breaking the acetabulum into two halves: a front half and a back half. Secondly, transverse fractures should be evaluated by sagittally oriented CT images. By definition, a transverse fracture separates the acetabulum into superior and inferior halves with the fracture line extending from anterior to posterior

  3. External fixation of tibial pilon fractures and fracture healing.

    Science.gov (United States)

    Ristiniemi, Jukka

    2007-06-01

    Distal tibial fractures are rare and difficult to treat because the bones are subcutaneous. External fixation is commonly used, but the method often results in delayed union. The aim of the present study was to find out the factors that affect fracture union in tibial pilon fractures. For this purpose, prospective data collection of tibial pilon fractures was carried out in 1998-2004, resulting in 159 fractures, of which 83 were treated with external fixation. Additionally, 23 open tibial fractures with significant > 3 cm bone defect that were treated with a staged method in 2000-2004 were retrospectively evaluated. The specific questions to be answered were: What are the risk factors for delayed union associated with two-ring hybrid external fixation? Does human recombinant BMP-7 accelerate healing? What is the role of temporary ankle-spanning external fixation? What is the healing potential of distal tibial bone loss treated with a staged method using antibiotic beads and subsequent autogenous cancellous grafting compared to other locations of the tibia? The following risk factors for delayed healing after external fixation were identified: post-reduction fracture gap of >3 mm and fixation of the associated fibula fracture. Fracture displacement could be better controlled with initial temporary external fixation than with early definitive fixation, but it had no significant effect on healing time, functional outcome or complication rate. Osteoinduction with rhBMP-7 was found to accelerate fracture healing and to shorten the sick leave. A staged method using antibiotic beads and subsequent autogenous cancellous grafting proved to be effective in the treatment of tibial bone loss. Healing potential of the bone loss in distal tibia was at least equally good as in other locations of the tibia.

  4. The efficacy of the use of IR laser phototherapy associated to biphasic ceramic graft and guided bone regeneration on surgical fractures treated with wire osteosynthesis: a comparative laser fluorescence and Raman spectral study on rabbits.

    Science.gov (United States)

    Pinheiro, Antônio Luiz Barbosa; Santos, Nicole Ribeiro Silva; Oliveira, Priscila Chagas; Aciole, Gilberth Tadeu Santos; Ramos, Thais Andrade; Gonzalez, Tayná Assunção; da Silva, Laís Nogueira; Barbosa, Artur Felipe Santos; Silveira, Landulfo

    2013-05-01

    The aim of the present study was to assess, by Raman spectroscopy and laser fluorescence, the repair of surgical fractures fixed with wire osteosynthesis treated or not with infrared laser (λ780 nm, 50 mW, 4 × 4 J/cm(2) =16 J/cm(2), ϕ=0.5 cm(2), CW) associated or not to the use of hydroxyapatite and guided bone regeneration. Surgical tibial fractures were created under general anesthesia on 15 rabbits that were divided into five groups, maintained on individual cages, at day/night cycle, fed with solid laboratory pelted diet, and had water ad libitum. The fractures in groups II, III, IV, and V were fixed with wires. Animals in groups III and V were grafted with hydroxyapatite (HA) and guided bone regeneration (GBR) technique used. Animals in groups IV and V were irradiated at every other day during 2 weeks (4 × 4 J/cm(2), 16 J/cm(2) =112 J/cm(2)). Observation time was that of 30 days. After animal death, specimens were taken and kept in liquid nitrogen and used for Raman spectroscopy. The Raman results showed basal readings of 1,234.38 ± 220. Groups WO+B+L showed higher readings (1,680.22 ± 822) and group WO+B the lowest (501.425 ± 328). Fluorescence data showed basal readings of 5.83333 ± 0.7. Groups WO showed higher readings (6.91667 ± 0.9) and group WO+B+L the lowest (1.66667 ± 0.5). There were significant differences between groups on both cases (pRaman peaks of calcium hydroxyapatite (CHA) are increased, the level of fluorescence is reduced. It is concluded that the use of near-infrared lasertherapy associated to HA graft and GBR was effective in improving bone healing on fractured bones as a result of the increasing deposition of CHA measured by Raman spectroscopy and decrease of the organic components as shown by the fluorescence readings.

  5. Occupational therapy and Colles' fractures.

    Science.gov (United States)

    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.

  6. Management of penile fractures

    International Nuclear Information System (INIS)

    Ghilan, Abdulelah M. M.; Al-Asbahi, Waleed A.; Alwan, Mohammed A.; Al-Khanbashi, Omar M.; Ghafour, Mohammed A.

    2008-01-01

    Objective was to present our experience with surgical and conservative management of penile fracture. This prospective study was carried out in the Urology and Nephrology Center, at Al-Thawra General and Teaching Hospital, Sana'a, Yemen from June 2003 to September 2007 and included 30 patients presenting with penile fracture. Diagnosis was made clinically in all our patients. Six patients with simple fracture were treated conservatively while 24 patients with more severe injuries were operated upon. Patient's age ranged from 24-52 years (mean 31.3 years) 46.7% of patients were under the age of 30 years and 56.7% were unmarried. Hard manipulation of the erect penis for example during masturbation was the most frequent mechanism of fracture in 53.3% of patients. Solitary tear was found in 22 patients and bilateral corporal tears associated with urethral injury were found in 2 patients. Corporal tears were saturated with synthetic absorbable sutures and urethral injury was repaired primarily. All operated patients described full erection with straight penis except 3 of the 8 patients who were managed by direct longitudinal incision, in whom mild curvature during erection was observed. The conservatively treated patients described satisfactory penile straightness and erection. The optimal functional and cosmetic results are achieved following immediate surgical repair of penis fracture. Good results can also be obtained in some selected patients with conservative management. (author)

  7. Mandible Fractures.

    Science.gov (United States)

    Pickrell, Brent B; Serebrakian, Arman T; Maricevich, Renata S

    2017-05-01

    Mandible fractures account for a significant portion of maxillofacial injuries and the evaluation, diagnosis, and management of these fractures remain challenging despite improved imaging technology and fixation techniques. Understanding appropriate surgical management can prevent complications such as malocclusion, pain, and revision procedures. Depending on the type and location of the fractures, various open and closed surgical reduction techniques can be utilized. In this article, the authors review the diagnostic evaluation, treatment options, and common complications of mandible fractures. Special considerations are described for pediatric and atrophic mandibles.

  8. Facial Fractures.

    Science.gov (United States)

    Ghosh, Rajarshi; Gopalkrishnan, Kulandaswamy

    2018-06-01

    The aim of this study is to retrospectively analyze the incidence of facial fractures along with age, gender predilection, etiology, commonest site, associated dental injuries, and any complications of patients operated in Craniofacial Unit of SDM College of Dental Sciences and Hospital. This retrospective study was conducted at the Department of OMFS, SDM College of Dental Sciences, Dharwad from January 2003 to December 2013. Data were recorded for the cause of injury, age and gender distribution, frequency and type of injury, localization and frequency of soft tissue injuries, dentoalveolar trauma, facial bone fractures, complications, concomitant injuries, and different treatment protocols.All the data were analyzed using statistical analysis that is chi-squared test. A total of 1146 patients reported at our unit with facial fractures during these 10 years. Males accounted for a higher frequency of facial fractures (88.8%). Mandible was the commonest bone to be fractured among all the facial bones (71.2%). Maxillary central incisors were the most common teeth to be injured (33.8%) and avulsion was the most common type of injury (44.6%). Commonest postoperative complication was plate infection (11%) leading to plate removal. Other injuries associated with facial fractures were rib fractures, head injuries, upper and lower limb fractures, etc., among these rib fractures were seen most frequently (21.6%). This study was performed to compare the different etiologic factors leading to diverse facial fracture patterns. By statistical analysis of this record the authors come to know about the relationship of facial fractures with gender, age, associated comorbidities, etc.

  9. Laser-treated stainless steel mini-screw implants: 3D surface roughness, bone-implant contact, and fracture resistance analysis.

    Science.gov (United States)

    Kang, He-Kyong; Chu, Tien-Min; Dechow, Paul; Stewart, Kelton; Kyung, Hee-Moon; Liu, Sean Shih-Yao

    2016-04-01

    This study investigated the biomechanical properties and bone-implant intersurface response of machined and laser surface-treated stainless steel (SS) mini-screw implants (MSIs). Forty-eight 1.3mm in diameter and 6mm long SS MSIs were divided into two groups. The control (machined surface) group received no surface treatment; the laser-treated group received Nd-YAG laser surface treatment. Half in each group was used for examining surface roughness (Sa and Sq), surface texture, and facture resistance. The remaining MSIs were placed in the maxilla of six skeletally mature male beagle dogs in a randomized split-mouth design. A pair with the same surface treatment was placed on the same side and immediately loaded with 200 g nickel-titanium coil springs for 8 weeks. After killing, the bone-implant contact (BIC) for each MSI was calculated using micro computed tomography. Analysis of variance model and two-sample t test were used for statistical analysis with a significance level of P titanium alloy MSIs. © The Author 2015. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  10. Fracture sacrum.

    Directory of Open Access Journals (Sweden)

    Dogra A

    1995-04-01

    Full Text Available An extremely rare case of combined transverse and vertical fracture of sacrum with neurological deficit is reported here with a six month follow-up. The patient also had an L1 compression fracture. The patient has recovered significantly with conservative management.

  11. Fracture Mechanics

    CERN Document Server

    Zehnder, Alan T

    2012-01-01

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

  12. Percutaneous Vertebroplasty for Osteoporotic Compression Fracture: Multivariate Study of Predictors of New Vertebral Body Fracture

    International Nuclear Information System (INIS)

    Komemushi, Atsushi; Tanigawa, Noboru; Kariya, Shuji; Kojima, Hiroyuki; Shomura, Yuzo; Komemushi, Sadao; Sawada, Satoshi

    2006-01-01

    Purpose. To investigate the risk factors and relative risk of new compression fractures following vertebroplasty. Methods. Initially, we enrolled 104 consecutive patients with vertebral compression fractures caused by osteoporosis. A total of 83 of the 104 patients visited our hospital for follow-up examinations for more than 4 weeks after vertebroplasty. Logistic regression analysis of the data obtained from these 83 patients was used to determine relative risks of recurrent compression fractures, using 13 different factors. Results. We identified 59 new fractures in 30 of the 83 patients: 41 new fractures in vertebrae adjacent to treated vertebrae; and 18 new fractures in vertebrae not adjacent to treated vertebrae. New fractures occurred in vertebrae adjacent to treated vertebrae significantly more frequently than in vertebrae not adjacent to treated vertebrae. Only cement leakage into the disk was a significant predictor of new vertebral body fracture after vertebroplasty (odds ratio = 4.633). None of the following covariates were associated with increased risk of new fracture: age, gender, bone mineral density, the number of vertebroplasty procedures, the number of vertebrae treated per procedure, the cumulative number of vertebrae treated, the presence of a single untreated vertebra between treated vertebrae, the presence of multiple untreated vertebrae between treated vertebrae, the amount of bone cement injected per procedure, the cumulative amount of bone cement injected, cement leakage into the soft tissue around the vertebra, and cement leakage into the vein

  13. Recurrent Hip Fracture Prevention With Osteoporosis Management

    Directory of Open Access Journals (Sweden)

    A. Shahla

    2007-02-01

    Full Text Available Background:Osteoporosis is a major public health threat,and hip fracture is a serious consequence of osteoporosis.Apatient with an osteoporosis-related hip fracture has an increased risk for a second hip fracture.The effect of osteoporosis management on the risk of recurrent hip fracture was evaluated in this study.Methods:58 hip fracture patients older than 50yr and BMD < 2.5 were discharged from hospital with Ca-Vitamin D- Alendronate prescriptions, and followed up for 4 years to determine the rate of recurrent hip fractures. Rate of second hip fractures was compared with 58 hip fractures in the control group (without osteoporosis treatment which were also followed for 4 years. Results:72% of patients continued treatment for 2 years. There were no second hip fractures in the critical first 12 months in the treated group.Overall second hip fractures in osteoporosis treated and control groups were 3.4% and 8.6%(p<0.03, respectively.Conclusion:Management of hip fractures in the elderly should include bone mineral density determination and osteoporosis treatment to prevent further fractures.

  14. Evaluation results of using sole Ilizarov fixator in Pilon fractures

    Directory of Open Access Journals (Sweden)

    Ahmad Reza Mirbolook

    2014-02-01

    Conclusion: According to the results obtained and comparing them with the results of other treatments ,one can claim that this treating approach is better than the others for pilon fractures,particularly for type 3c pilon fractures.

  15. Fracture mechanics

    CERN Document Server

    Perez, Nestor

    2017-01-01

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

  16. Fracture analysis

    International Nuclear Information System (INIS)

    Ueng, Tzoushin; Towse, D.

    1991-01-01

    Fractures are not only the weak planes of a rock mass, but also the easy passages for the fluid flow. Their spacing, orientation, and aperture will affect the deformability, strength, heat transmittal, and fluid transporting properties of the rock mass. To understand the thermomechanical and hydrological behaviors of the rock surrounding the heater emplacement borehole, the location, orientation, and aperture of the fractures of the rock mass should be known. Borehole television and borescope surveys were performed to map the location, orientation, and aperture of the fractures intersecting the boreholes drilled in the Prototype Engineered Barrier System Field Tests (PEBSFT) at G-Tunnel. Core logging was also performed during drilling. However, because the core was not oriented and the depth of the fracture cannot be accurately determined, the results of the core logging were only used as reference and will not be discussed here

  17. Facial Fractures.

    Science.gov (United States)

    Ricketts, Sophie; Gill, Hameet S; Fialkov, Jeffery A; Matic, Damir B; Antonyshyn, Oleh M

    2016-02-01

    After reading this article, the participant should be able to: 1. Demonstrate an understanding of some of the changes in aspects of facial fracture management. 2. Assess a patient presenting with facial fractures. 3. Understand indications and timing of surgery. 4. Recognize exposures of the craniomaxillofacial skeleton. 5. Identify methods for repair of typical facial fracture patterns. 6. Discuss the common complications seen with facial fractures. Restoration of the facial skeleton and associated soft tissues after trauma involves accurate clinical and radiologic assessment to effectively plan a management approach for these injuries. When surgical intervention is necessary, timing, exposure, sequencing, and execution of repair are all integral to achieving the best long-term outcomes for these patients.

  18. OUTCOME OF LOCKING PLATES IN DISTAL TIBIA FRACTURES TREATMENT

    OpenAIRE

    Lokesh; Dayanand; Deepak; Hemanth

    2016-01-01

    INTRODUCTION Most of these fractures except intra-articular fractures are treated with interlocking nail. 1,2 These nails are a boon for these fractures. But as the fracture nears to the joint stability the fracture fixation will be compromised due to malreduction and alignment, it leads to increased chances of delayed and nonunion. 3 Locking anatomical plates are evaluated for anatomical and relative stability fixation. Since then most intra and near intra-articul...

  19. Tooth fractures in canine clinical practice

    International Nuclear Information System (INIS)

    Capik, I.; Ledecky, V.; Sevcik, A.

    2001-01-01

    Tooth fractures constitute a considerable fraction of all tooth diseases. Out of the 5,370 dogs treated during four years, 492 were presented with dental problems and 28.3 % of the latter were treated for tooth fractures. Canines were the most frequently affected teeth (38.8 %), followed by premolars (33.1 %), incisors (25.9 %), and molars (2.2 %), 55.4 % of the patients with canine and incisor fractures being large breed dogs. Fractures of premolars (mostly of 108, 208) were divided evenly irrespective of breed or body size. Nonsurgical endodontic treatment yielded good therapeutic results in most cases, but repeated treatment was necessary in some patients

  20. 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 ...

  1. Pisiform fractures

    International Nuclear Information System (INIS)

    Fleege, M.A.; Jebson, P.J.; Renfrew, D.L.; El-Khoury, G.Y.; Steyers, C.M. Jr.

    1991-01-01

    Fractures of the pisiform are often missed due to improper radiographic evaluation and a tendency to focus on other, more obvious injuries. Delayed diagnosis may result in disabling sequelae. A high index of clinical suspicion and appropriate radiographic examination will establish the correct diagnosis. Ten patients with pisiform fracture are presented. The anatomy, mechanism of injury, clinical presentation, radiographic features, and evaluation of this injury are discussed. (orig.)

  2. Stress fractures

    International Nuclear Information System (INIS)

    Berquist, T.H.; Cooper, K.L.; Pritchard, D.J.

    1985-01-01

    The diagnosis of a stress fracture should be considered in patients presented with pain after a change in activity, especially if the activity is strenuous and the pain is in the lower extremities. Since evidence of the stress fracture may not be apparent for weeks on routine radiographs, proper use of other imaging techniques will allow an earlier diagnosis. Prompt diagnosis is especially important in the femur, where displacement may occur

  3. Stress Fractures of the Foot.

    Science.gov (United States)

    Hossain, Munier; Clutton, Juliet; Ridgewell, Mark; Lyons, Kathleen; Perera, Anthony

    2015-10-01

    Stress fractures of the foot and ankle may be more common among athletes than previously reported. A low threshold for investigation is warranted and further imaging may be appropriate if initial radiographs remain inconclusive. Most of these fractures can be treated conservatively with a period of non-weight-bearing mobilization followed by gradual return to activity. Early surgery augmented by bone graft may allow athletes to return to sports earlier. Risk of delayed union, nonunion, and recurrent fracture is high. Many of the patients may also have risk factors for injury that should be modified for a successful outcome. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. Outcome of limb fracture repair in rabbits: 139 cases (2007-2015).

    Science.gov (United States)

    Sasai, Hiroshi; Fujita, Daisuke; Seto, Eiko; Denda, Yuki; Imai, Yutaro; Okamoto, Kanako; Okamura, Kensaku; Furuya, Masaru; Tani, Hiroyuki; Sasai, Kazumi

    2018-02-15

    OBJECTIVE To evaluate outcome of limb fracture repair in rabbits. DESIGN Retrospective case series. ANIMALS 139 client-owned rabbits with limb fractures treated between 2007 and 2015. PROCEDURES Medical records were reviewed for information on fracture location, fracture treatment, and time to fracture healing. RESULTS 25 rabbits had fractures involving the distal aspects of the limbs (ie, metacarpal or metatarsal bones, phalanges, and calcaneus or talus). Fractures were treated in 23 of these 25 rabbits (external coaptation, n = 17; external skeletal fixation, 4; and intramedullary pinning, 2) and healed in all 23, with a median healing time of 28 days (range, 20 to 45 days). One hundred ten rabbits had long bone fractures, and fractures were treated in 100 of the 110 (external skeletal fixation, n = 89; bone plating, 1; intramedullary pinning, 3; and external coaptation, 7). The percentage of fractures that healed was significantly lower for open (14/18) than for closed (26/26) tibial fractures and was significantly lower for femoral (19/26) and treated humeral (4/6) fractures than for radial (23/24) or closed tibial (26/26) fractures. Micro-CT was used to assess fracture realignment during external skeletal fixator application and to evaluate fracture healing. CONCLUSIONS AND CLINICAL RELEVANCE The prognosis for rabbits with limb fractures was good, with fractures healing in most rabbits following fracture repair (109/123). Micro-CT was useful in assessing fracture realignment and evaluating fracture healing.

  5. Mandibular ramus fractures: a rarity.

    Science.gov (United States)

    Kale, Tejraj Pundalik; Kotrashetti, S M; Louis, Archana; Lingaraj, J B; Sarvesh, B U

    2013-01-01

    To determine the incidence of mandibular ramus fractures in KLE's PK Hospital and to analyze the outcome of open reduction and internal fixation of these fractures. Using a retrospective study design, records of all trauma patients who reported to the Department of Oral and Maxillofacial Surgery, KLE's PK Hospital Belgaum, between the years January 2006 to October 2011 was obtained from the medical records office. The data variables that were analyzed were the name, age, sex, cause of injury, pretreatment occlusion, treatment given, period of MMF and post-treatment occlusion. Total number of mandibular fracture cases was 298. Ramus fractures were 10 in number which accounted for 3.3% of fractures. The age range of these 10 patients was seen to be between 20 to 80 years with the average age being 35.6 years. Of these 10 patients, 9 were male and 1 was female and 7 patients were treated by open reduction and internal fixation and the remaining 3 by closed reduction. The average period of MMF was 3 days for the patients who underwent open reduction and internal fixation. There was improvement in occlusion in all 10 patients post-treatment and there was no complication reported in any of the cases. Ramus fractures accounted for 3.3% of all mandibular fractures. Open reduction and internal fixation of ramus fractures ensures adequate functional and anatomic reduction. This study makes an attempt to throw a light on the increasing incidence of ramus fractures and a successful management of these fractures by open reduction and internal fixation. How to cite this article: Kale TP, Kotrashetti SM, Louis A, Lingaraj JB, Sarvesh BU. Mandibular Ramus Fractures: A Rarity. J Contemp Dent Pract 2013;14(1):39-42. Source of support: Nil Conflict of interest: None declared.

  6. Fraturas odontomaxilares e mandibulares em eqüídeos tratados por diferentes técnicas de osteossíntese Odontomaxillares and mandibularies fractures in equides treated with different osteosynthesis techniques

    Directory of Open Access Journals (Sweden)

    G.E.S. Alves

    2008-12-01

    Full Text Available Oito eqüinos e um muar com fraturas odontomaxilares e mandibulares foram tratados com diferentes técnicas de osteossíntese modificadas, consistindo de cerclagens associadas ou não a bandas de tensão, placa de neutralização e pino intraosseo, sendo este aplicado com metodologia não encontrada na literatura consultada. Os procedimentos cirúrgicos nos eqüideos foram realizados com os animais em estação mediante contenção física, em brete, e química, com sedação ou neuroleptoanalgesia associada a bloqueios anestésicos regionais. Os animais apresentaram capacidade de mastigação e ingestão voluntária no pós-operatório imediato e recuperação óssea adequada.Eight equines and one mule with odontomaxillaries and mandibularies fractures were treated with different osteosynthesis modified techniques, consisting of cerclages with or without tension bands, neutralization plates, and intraosseous pin applied by a methodology which was not found in the literature. The surgery procedures in equides were performed with the animals in stand position under physical contention, sedation, or neuroleptoanalgesy and regional nerve block. All animals were able to eat voluntarily in the immediate post-operatory time and had good bone recuperation.

  7. Fracture behaviour of zirconia FPDs substructures.

    Science.gov (United States)

    Kou, W; Sjögren, G

    2010-04-01

    The purpose of this study was to evaluate the occurrence of superficial flaws after machining and to identify fracture initiation and propagation in three-unit heat-treated machined fixed partial dentures (FPDs) substructures made of hot isostatic pressed (HIPed) yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) after loaded to fracture. Four three-unit HIPed Y-TZP-based FPDs substructures were examined. To evaluate the occurrence of superficial flaws after machining, the surfaces were studied utilizing a fluorescent penetrant method. After static loading to fracture, characteristic fracture features on both mating halves of the fractured specimens were studied using a stereomicroscope and a scanning electron microscope. Grinding grooves were clearly visible on the surfaces of the machined FPDs substructures, but no other flaws could be seen with the fluorescent penetrant method. After loading to fracture, the characteristic fracture features of arrest lines, compression curl, fracture mirror, fracture origin, hackle and twist hackle were detected. These findings indicated that the decisive fracture was initiated at the gingival embrasure of the pontic in association with a grinding groove. Thus, in three-unit heat-treated machined HIPed Y-TZP FPDs substructures, with the shape studied in this study, the gingival embrasure of the pontic seems to be a weak area providing a location for tensile stresses when they are occlusally loaded. In this area, fracture initiation may be located to a grinding groove.

  8. Scaphoid Fracture

    Directory of Open Access Journals (Sweden)

    Esther Kim, BS

    2018-04-01

    Full Text Available History of present illness: A 25-year-old, right-handed male presented to the emergency department with left wrist pain after falling from a skateboard onto an outstretched hand two-weeks prior. He otherwise had no additional concerns, including no complaints of weakness or loss of sensation. On physical exam, there was tenderness to palpation within the anatomical snuff box. The neurovascular exam was intact. Plain films of the left wrist and hand were obtained. Significant findings: The anteroposterior (AP plain film of this patient demonstrates a full thickness fracture through the middle third of the scaphoid (red arrow, with some apparent displacement (yellow lines and subtle angulation of the fracture fragments (blue line. Discussion: The scaphoid bone is the most commonly fractured carpal bone accounting for 70%-80% of carpal fractures.1 Classically, it is sustained following a fall onto an outstretched hand (FOOSH. Patients should be evaluated for tenderness with palpation over the anatomical snuffbox, which has a sensitivity of 100% and specificity of 40%.2 Plain films are the initial diagnostic modality of choice and have a sensitivity of 70%, but are commonly falsely negative in the first two to six weeks of injury (false negative of 20%.3 The Mayo classification organizes scaphoid fractures as involving the proximal, mid, and distal portions of the scaphoid bone with mid-fractures being the most common.3 The proximal scaphoid is highly susceptible to vascular compromise because it depends on retrograde blood flow from the radial artery. Therefore, disruption can lead to serious sequelae including osteonecrosis, arthrosis, and functional impairment. Thus, a low threshold should be maintained for neurovascular evaluation and surgical referral. Patients with non-displaced scaphoid fractures should be placed in a thumb spica splint.3 Patients with even suspected scaphoid fractures should be placed in a thumb spica splint and re

  9. Diagnosis and Management of Common Foot Fractures.

    Science.gov (United States)

    Bica, David; Sprouse, Ryan A; Armen, Joseph

    2016-02-01

    Foot fractures are among the most common foot injuries evaluated by primary care physicians. They most often involve the metatarsals and toes. Patients typically present with varying signs and symptoms, the most common being pain and trouble with ambulation. Diagnosis requires radiographic evaluation, although emerging evidence demonstrates that ultrasonography may be just as accurate. Management is determined by the location of the fracture and its effect on balance and weight bearing. Metatarsal shaft fractures are initially treated with a posterior splint and avoidance of weight-bearing activities; subsequent treatment consists of a short leg walking cast or boot for four to six weeks. Proximal fifth metatarsal fractures have different treatments depending on the location of the fracture. A fifth metatarsal tuberosity avulsion fracture can be treated acutely with a compressive dressing, then the patient can be transitioned to a short leg walking boot for two weeks, with progressive mobility as tolerated after initial immobilization. A Jones fracture has a higher risk of nonunion and requires at least six to eight weeks in a short leg non-weight-bearing cast; healing time can be as long as 10 to 12 weeks. Great toe fractures are treated with a short leg walking boot or cast with toe plate for two to three weeks, then a rigid-sole shoe for an additional three to four weeks. Lesser toe fractures can be treated with buddy taping and a rigid-sole shoe for four to six weeks.

  10. ANESTESIA PARA AMPUTACIÓN SUPRACONDÍLEA EN PACIENTE CON SÍNDROME CORONARIO AGUDO / Anesthesia for supracondylar amputation in patient with acute coronary syndrome

    Directory of Open Access Journals (Sweden)

    Marilyn Ramírez Méndez

    2012-03-01

    Full Text Available Resumen La insuficiencia arterial periférica es una enfermedad que se asocia a factores de riesgo aterogénico reconocidos, y es más frecuente en personas con hiperlipidemia, diabetes mellitus y hábito de fumar. Se presenta el caso de una mujer de 67 años de edad, con antecedentes de hipertensión arterial, diabetes mellitus e infarto de miocardio antiguo, que ingresa por signos de inflamación aguda del miembro inferior derecho como consecuencia de una insuficiencia arterial periférica. A los 8 días del ingreso presentó un síndrome coronario agudo sin elevación del segmento ST, con fallo de bomba Killip II, y una vez compensada fue anunciada para amputación supracondílea de urgencia, debido a una gangrena isquémica. Se decidió utilizar anestesia espinal subaracnoidea selectiva del miembro inferior derecho, a cual se aplicó sin complicaciones y favoreció el adecuado desarrollo de la cirugía planificada. A las 72 horas la paciente fue egresada de la UCI, sin síntomas cardiovasculares y compensación metabólica. / Abstract Peripheral arterial insufficiency is a disease that is associated with known atherogenic risk factors, and is more common in people with hyperlipidemia, diabetes mellitus and smoking habit. A case of a 67-year-old woman with a history of hypertension, diabetes mellitus and old myocardial infarction is presented. She was admitted for signs of acute inflammation of the right leg due to peripheral arterial insufficiency. 8 days after admission she presented an acute coronary syndrome without ST segment elevation with pump failure (Killip class II, and once compensated she was scheduled for emergency supracondylar amputation due to ischemic gangrene. It was decided to use selective spinal subarachnoid from the right leg, which was applied without complications and favored the proper development of the planned surgery. At 72 hours, the patient was discharged from the ICU, with metabolic compensation and without

  11. Facial symmetry evaluation after experimentally displaced condylar process fracture in methotrexate treated rats Avaliação da simetria facial após fratura experimental com desvio do processo condilar em ratos tratados com metotrexato

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    Samantha Cristine Santos Xisto Braga Cavalcanti

    2012-03-01

    Full Text Available PURPOSE: To investigate the facial symmetry of high and low dose methotrexate (MTX treated rats submitted to experimentally displaced mandibular condyle fracture through the recording of cephalometric measurements. METHODS: One hundred male Wistar rats underwent surgery using an experimental model of right condylar fracture. Animals were divided into four groups: A - saline solution (1mL/week; B - dexamethasone (DEX (0,15mg/Kg; C - MTX low dose (3 mg/Kg/week; D - MTX high dose (30 mg/Kg. Animals were sacrificed at 1, 7, 15, 30 and 90 days postoperatively (n=5. Body weight was recorded. Specimens were submitted to axial radiographic incidence, and cephalometric mensurations were made using a computer system. Linear measurements of skull and mandible, as well as angular measurements of mandibular deviation were taken. Data were subjected to statistical analyses among the groups, periods of sacrifice and between the sides in each group (α=0.05. RESULTS: Animals regained body weight over time, except in group D. There was reduction in the mandibular length and also changes in the maxilla as well as progressive deviation in the mandible in relation to the skull basis in group D. CONCLUSION: Treatment with high dose methotrexate had deleterious effect on facial symmetry of rats submitted to experimentally displaced condylar process fracture.OBJETIVO: Avaliar a simetria facial de ratos tratados com metotrexato (MTX, em dose alta e baixa, submetidos à fratura experimental do processo condilar com desvio por meio de mensurações cefalométricas. MÉTODOS: Cem ratos Wistar machos foram submetidos a procedimento cirúrgico utilizando modelo experimental de fratura de côndilo do lado direito. Os animais foram distribuídos em quatro grupos: A - soro fisiológico (1mL/semana; B - dexametasona (DEX (0,15mg/Kg; C - MTX baixa dose (3mg/Kg/semana; D - MTX alta dose (30mg/Kg. Os períodos de sacrifício foram de 1, 7, 15, 30 e 90 dias de pós-operatório (n=5

  12. Trochanteric fractures

    International Nuclear Information System (INIS)

    Herrlin, K.; Stroemberg, T.; Lidgren, L.; Walloee, A.; Pettersson, H.; Lund Univ.

    1988-01-01

    Four hundred and thirty trochanteric factures operated upon with McLaughlin, Ender or Richard's osteosynthesis were divided into 6 different types based on their radiographic appearance before and immediately after reposition with special reference to the medial cortical support. A significant correlation was found between the fracture type and subsequent mechanical complications where types 1 and 2 gave less, and types 4 and 5 more complications. A comparison of the various osteosyntheses showed that Richard's had significantly fewer complications than either the Ender or McLaughlin types. For Richard's osteosynthesis alone no correlation to fracture type could be made because of the small number of complications in this group. (orig.)

  13. Fracture Blisters

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    Uebbing, Claire M

    2011-02-01

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

  14. Ipsilateral humeral neck and shaft fractures

    Directory of Open Access Journals (Sweden)

    Zhu Bin

    2017-01-01

    Full Text Available Background/Aim. Fractures of the proximal humerus or shaft are common, however, ipsilateral neck and shaft humerus fracture is a rare phenomenon. This combination injury is challenging for orthopaedic surgeons because of its complex treatment options at present. The purpose of this study was to review a series of ipsilateral humeral neck and shaft fractures to study the fracture pattern, complications and treatment outcomes of each treatment options used. Methods. A total of six patients (four female and two male with the average age of 42.8 years (range: 36–49 years was collected and reviewed retrospectively. Two of them were treated with double plates and four with antegrade intramedullary nail. According to the Neer’s classification, all proximal fractures were two-part surgical neck fractures. All humeral shaft fractures were located at the middle of one third. Five fractures were simple transverse (A3, one fragmented wedge fracture (B3. One patient had associated radial nerve palsy. Results. All surgical neck fractures except one united uneventfully in the average time span of 8.7 weeks. Four humeral shaft fractures healed in near anatomic alignment. The remaining two patients had the nonunion with no radiological signs of fracture healing. The average University of California, Los Angeles End-Results (UCLA score was 23.1. On the contrary, the average American Shoulder and Elbow Surgeon's (ASES score was 73.3. The patients treated with antegrade intramedullary nails presented 70.5 points. The ASES scores were 79 in the double plates group. Conclusions. Ipsilateral humeral shaft and neck fracture is extremely rare. Both antegrade intramedullar nailing and double plates result in healing of fractures. However the risk of complication is lower in the double plating group.

  15. Scapular fracture: lower severity and mortality

    Directory of Open Access Journals (Sweden)

    Javad Salimi

    Full Text Available CONTEXT AND OBJECTIVE: The presence of scapular fracture is believed to be associated with high rates of other injuries and accompanying morbidities. The aim was to study injury patterns and their overall outcomes in patients with scapula fractures. DESIGN AND SETTING: Cross-sectional study of trauma patients treated at six general hospitals in Tehran. METHODS: One-year trauma records were obtained from six general hospitals Among these, forty-one had sustained a scapular fracture and were included in this study. RESULTS: Scapular fracture occurred predominantly among 20 to 50-year-old patients (78%. Road traffic accidents (RTAs were the main cause of injury (73.2%; 30/41. Pedestrians accounted for 46.7% (14/30 of the injuries due to RTAs. Falls were the next most common cause, accounting for seven cases (17.1%. Body fractures were the most common type of scapular fractures (80%. Eighteen patients (43.9% had isolated scapular fractures. Limb fracture was the most common associated injury, detected in 18 cases (43.9%. Three patients (7.3% had severe injuries (injury severity score, ISS > 16 which resulted in one death (2.4%. The majority of the patients were treated conservatively (87.8%. CONCLUSIONS: Patients with scapula fractures have more severe underlying chest injuries and clavicle fractures. However, this did not correlate with higher rates of injury severity score, intensive care unit admission or mortality.

  16. Incomplete linear tibial fractures in two horses

    International Nuclear Information System (INIS)

    Johnson, P.J.; Allhands, R.V.; Baker, G.J.; Boero, M.J.; Foreman, J.H.; Hyyppa, T.; Huhn, J.C.

    1988-01-01

    Incomplete linear tibial fractures were identified in two horses with the aid of scintigraphy. Both horses were treated successfully by strict stall confinement, and both returned to normal athletic activity. Scintigraphy can be used to facilitate the generally difficult diagnosis of incomplete tibial fractures

  17. Wrist Fractures

    Science.gov (United States)

    ... All Topics A-Z Videos Infographics Symptom Picker Anatomy Bones Joints Muscles Nerves Vessels Tendons About Hand Surgery What is a Hand Surgeon? What is a Hand Therapist? Media Find a Hand Surgeon Home Anatomy Wrist Fractures Email to a friend * required fields ...

  18. Shoulder Fractures

    Science.gov (United States)

    ... All Topics A-Z Videos Infographics Symptom Picker Anatomy Bones Joints Muscles Nerves Vessels Tendons About Hand Surgery What is a Hand Surgeon? What is a Hand Therapist? Media Find a Hand Surgeon Home Anatomy Shoulder Fractures Email to a friend * required fields ...

  19. Incidence and epidemiology of tibial shaft fractures.

    Science.gov (United States)

    Larsen, Peter; Elsoe, Rasmus; Hansen, Sandra Hope; Graven-Nielsen, Thomas; Laessoe, Uffe; Rasmussen, Sten

    2015-04-01

    The literature lacks recent population-based epidemiology studies of the incidence, trauma mechanism and fracture classification of tibial shaft fractures. The purpose of this study was to provide up-to-date information on the incidence of tibial shaft fractures in a large and complete population and report the distribution of fracture classification, trauma mechanism and patient baseline demographics. Retrospective reviews of clinical and radiological records. A total of 196 patients were treated for 198 tibial shaft fractures in the years 2009 and 2010. The mean age at time of fracture was 38.5 (21.2SD) years. The incidence of tibial shaft fracture was 16.9/100,000/year. Males have the highest incidence of 21.5/100,000/year and present with the highest frequency between the age of 10 and 20, whereas women have a frequency of 12.3/100,000/year and have the highest frequency between the age of 30 and 40. AO-type 42-A1 was the most common fracture type, representing 34% of all tibial shaft fractures. The majority of tibial shaft fractures occur during walking, indoor activity and sports. The distribution among genders shows that males present a higher frequency of fractures while participating in sports activities and walking. Women present the highest frequency of fractures while walking and during indoor activities. This study shows an incidence of 16.9/100,000/year for tibial shaft fractures. AO-type 42-A1 was the most common fracture type, representing 34% of all tibial shaft fractures. Copyright © 2015 Elsevier Ltd. All rights reserved.

  20. Treatment of Pediatric Condylar Fractures: A 20-Year Experience.

    Science.gov (United States)

    Ghasemzadeh, Ali; Mundinger, Gerhard S; Swanson, Edward W; Utria, Alan F; Dorafshar, Amir H

    2015-12-01

    The purpose of this study was to define patterns of injury and treatment for condylar and subcondylar fractures and evaluate short-term outcomes in the pediatric population. A retrospective chart review was performed on pediatric patients with mandibular condylar fractures who presented between 1990 and 2010. Computed tomographic imaging was reviewed for all patients to assess fracture characteristics. Mandibular fractures were codified using the Strasbourg Osteosynthesis Research Group and Lindahl classification methods. Sixty-four patients with 92 condylar fractures were identified. Of these patients, 29 had isolated condylar fracture and 35 had a condylar fracture associated with an additional mandibular arch fracture. The most common fracture patterns were diacapitular fracture in the Strasbourg Osteosynthesis Research Group system (n = 46) and vertical condylar head fracture in the Lindahl system (n = 14). Condylar fracture with additional mandibular arch fractures were treated with maxillomandibular fixation more often than patients with condylar fracture [n = 40 (74.1 percent) versus n = 14 (25.9 percent); p = 0.004]. No condylar fracture was treated in an open fashion. Forty-three patients returned for follow-up. The median follow-up period was 81 days (interquartile range, 35 to 294 days). Ten patients had complications (23.3 percent). The most common complication was malocclusion (n = 5). Nine of 10 patients with complications had condylar fracture with an additional mandibular arch fracture. Closed treatment of condylar fractures yields satisfactory results in pediatric patients. Pediatric patients with condylar fractures combined with additional arch fractures experience a higher rate of unfavorable outcomes.

  1. Femoral fractures : indications an[d] biomechanics of external fixation

    NARCIS (Netherlands)

    A.H. Broekhuizen (Tom); B. van Linge

    1988-01-01

    textabstractInternal fixation can be carried out in various ways. For femoral shaft fractures, an (interlocking) nail is becoming increasingly popular, instead of open realignment of the fracture. External fixation, which has become a generally accepted method of treating fractures of the lower

  2. Fracture mechanics

    International Nuclear Information System (INIS)

    Miannay, D.P.

    1995-01-01

    This book entitle ''Fracture Mechanics'', the first one of the monograph ''Materiologie'' is geared to design engineers, material engineers, non destructive inspectors and safety experts. This book covers fracture mechanics in isotropic homogeneous continuum. Only the monotonic static loading is considered. This book intended to be a reference with the current state of the art gives the fundamental of the issues under concern and avoids the developments too complicated or not yet mastered for not making reading cumbersome. The subject matter is organized as going from an easy to a more complicated level and thus follows the chronological evolution in the field. Similarly the microscopic scale is considered before the macroscopic scale, the physical understanding of phenomena linked to the experimental observation of the material preceded the understanding of the macroscopic behaviour of structures. In this latter field the relatively recent contribution of finite element computations with some analogy with the experimental observation is determining. However more sensitive analysis is not skipped

  3. Functional Treatment of a Child with Extracapsular Mandibular Fracture

    Directory of Open Access Journals (Sweden)

    Diana Cassi

    2017-01-01

    Full Text Available Condylar fractures are among the most frequent fractures in the context of traumatic lesions of the face. The management of condylar fractures is still controversial, especially when fractures occur in children: if overlooked or inappropriately treated, these lesions may lead to severe sequelae, both cosmetic and functional. The therapy must be careful because severe long-term complications can occur. In this case report, the authors present a case of mandibular fracture in which the decision between surgical therapy and functional therapeutic regimen may be controversial due to the particular anatomy of the fracture line and the age of the patient.

  4. Evaluation and Management of Proximal Humerus Fractures

    Directory of Open Access Journals (Sweden)

    Ekaterina Khmelnitskaya

    2012-01-01

    Full Text Available Proximal humerus fractures are common injuries, especially among older osteoporotic women. Restoration of function requires a thorough understanding of the neurovascular, musculotendinous, and bony anatomy. This paper addresses the relevant anatomy and highlights various management options, including indication for arthroplasty. In the vast majority of cases, proximal humerus fractures may be treated nonoperatively. In the case of displaced fractures, when surgical intervention may be pursued, numerous constructs have been investigated. Of these, the proximal humerus locking plate is the most widely used. Arthroplasty is generally reserved for comminuted 4-part fractures, head-split fractures, or fractures with significant underlying arthritic changes. Reverse total shoulder arthroplasty is reserved for patients with a deficient rotator cuff, or highly comminuted tuberosities.

  5. Conservative management of displaced horizontal root fracture

    Directory of Open Access Journals (Sweden)

    Sanjeev Kunhappan

    2011-01-01

    Full Text Available Traumatic injuries of teeth are the main cause of emergency treatment in dental practice. Radicular fractures in permanent teeth are uncommon, being only 0.5-7% of the cases. Horizontal root fractures are more frequently observed in the maxillary anterior region of young male patients and vary in severity from enamel fractures to avulsions. Fracture occurs often in the middle-third of the root followed by apical and coronal third. The present case report describes a clinical case of a horizontal root fracture located at the middle third of a maxillary left-central incisor treated endodontically after approximating fracture segment with the help of orthodontic appliance. After 6 months follow-up, the tooth was asymptomatic with normal periodontal health.

  6. Anterior fracture displacement in Colles’ fractures after Kapandji wiring in women over 59 years

    Science.gov (United States)

    Verdonk, René

    2006-01-01

    The aim of this study was to assess the radiological results of Colles’ fractures treated with Kapandji wiring and to determine the frequency of postoperative anterior fracture displacement. The X-rays of 89 fractures in women over 59 years of age were evaluated. Five weeks after injury, palmar shift of the distal fracture fragments and/or palmar tilt of more than 20° were observed in 26 patients. In ten wrists dorsal tilt was not sufficiently corrected and measured more than 10°. Increase in ulnar variance was more than 2 mm in 37 wrists and more than 5 mm in six wrists; this was more pronounced when the palmar tilt was not corrected properly or when anterior fracture displacement was present. We conclude that Kapandji wiring may not be able to prevent anterior fracture displacement in almost one-third of Colles’ fractures in osteoporotic elderly patients. PMID:16865364

  7. Epidemiology of metatarsal stress fractures versus tibial and femoral stress fractures during elite training.

    Science.gov (United States)

    Finestone, Aharon; Milgrom, Charles; Wolf, Omer; Petrov, Kaloyan; Evans, Rachel; Moran, Daniel

    2011-01-01

    The training of elite infantry recruits takes a year or more. Stress fractures are known to be endemic in their basic training and the clinical presentation of tibial, femoral, and metatarsal stress fractures are different. Stress fracture incidence during the subsequent progressively more demanding training is not known. The study hypothesis was that after an adaptation period, the incidence of stress fractures during the course of 1 year of elite infantry training would fall in spite of the increasingly demanding training. Seventy-six male elite infantry recruits were followed for the development of stress fractures during a progressively more difficult training program composed of basic training (1 to 14 weeks), advanced training (14 to 26 weeks), and unit training (26 to 52 weeks). Subjects were reviewed regularly and those with clinical suspicion of stress fracture were assessed using bone scan and X-rays. The incidence of stress fractures was 20% during basic training, 14% during advanced training and 23% during unit training. There was a statistically significant difference in the incidence of tibial and femoral stress fractures versus metatarsal stress fractures before and after the completion of phase II training at week 26 (p=0.0001). Seventy-eight percent of the stress fractures during phases I and II training were either tibial or femoral, while 91% of the stress fractures in phase III training were metatarsal. Prior participation in ball sports (p=0.02) and greater tibial length (p=0.05) were protective factors for stress fracture. The study hypothesis that after a period of soldier adaptation, the incidence of stress fractures would decrease in spite of the increasingly demanding elite infantry training was found to be true for tibial and femoral fractures after 6 months of training but not for metatarsal stress fractures. Further studies are required to understand the mechanism of this difference but physicians and others treating stress fractures

  8. A PROSPECTIVE STUDY OF DISTAL TIBIAL FRACTURES BY MIPO (LCP)

    OpenAIRE

    Chandra Sekharam Naidu; Ch.Murali Krishna; Sankara Rao; Dharma Rao; Ashok Kumar

    2015-01-01

    INTRODUCTION: D istal tibial fractures represent a significant challenge to most of the surgeons even today. They constitute 1 - 10% of all lower extremity fractures . 1 The difficulty in treating the fractures of distal tibial end is exemplif ied by orthopedists, who in the first half of twentieth century, believed these injuries were so severe and fraught with so many complications, that these fractures wer...

  9. Clinical effects of internal fixation for ulnar styloid fractures associated with distal radius fractures: A matched case-control study.

    Science.gov (United States)

    Sawada, Hideyoshi; Shinohara, Takaaki; Natsume, Tadahiro; Hirata, Hitoshi

    2016-11-01

    Ulnar styloid fractures are often associated with distal radius fractures. However, controversy exists regarding whether to treat ulnar styloid fractures. This study aimed to evaluate clinical effects of internal fixation for ulnar styloid fractures after distal radius fractures were treated with the volar locking plate system. We used prospectively collected data of distal radius fractures. 111 patients were enrolled in this study. A matched case-control study design was used. We selected patients who underwent fixation for ulnar styloid fractures (case group). Three control patients for each patient of the case group were matched on the basis of age, sex, and fracture type of distal radius fractures from among patients who did not undergo fixation for ulnar styloid fractures (control group). The case group included 16 patients (7 men, 9 women; mean age: 52.6 years; classification of ulnar styloid fractures: center, 3; base, 11; and proximal, 2). The control group included 48 patients (15 men, 33 women; mean age: 61.1 years; classification of ulnar styloid fractures: center, 10; base, 31; and proximal, 7). For radiographic examination, the volar tilt angle, radial inclination angle, and ulnar variance length were measured, and the union of ulnar styloid fractures was judged. For clinical examination, the range of motions, grip strength, Hand20 score, and Numeric Rating Scale score were evaluated. There was little correction loss for each radiological parameter of fracture reduction, and these parameters were not significantly different between the groups. The bone-healing rate of ulnar styloid fractures was significantly higher in the case group than in the control group, but the clinical results were not significantly different. We revealed that there was no need to fix ulnar styloid fractures when distal radius fractures were treated via open reduction and internal fixation with a volar locking plate system. Copyright © 2016 The Japanese Orthopaedic Association

  10. Canine total knee replacement performed due to osteoarthritis subsequent to distal femur fracture osteosynthesis: two-year objective outcome.

    Science.gov (United States)

    Eskelinen, E V; Liska, W D; Hyytiäinen, H K; Hielm-Björkman, A

    2012-01-01

    A 27-kg German Shorthaired Pointer was referred for evaluation due to the complaint of left pelvic limb lameness and signs of pain in the left stifle joint. Radiographs revealed signs of a healed supracondylar femoral fracture that had been previously repaired at another hospital with an intramedullary pin and two cross pins. In addition, there were signs of severe osteoarthritis (OA). The OA had been managed medically with administration of carprofen and nutraceuticals for nine months without any improvement. Left total knee replacement (TKR) surgery was performed to alleviate signs of pain. The patient was assessed preoperatively and at six months, one year, and two years after surgery using radiology, force platform analysis of gait, thigh circumference measures, goniometry, and lameness evaluation. Following surgery, the dog resumed normal activity without any signs of pain and a good quality of life at 3.5 months. Force plate analysis found that peak vertical force on the TKR limb was 85.7% of the normal contralateral limb after two years. Total knee replacement was a successful treatment to manage knee OA associated with a healed distal femoral fracture and internal fixation in this dog.

  11. Function impairment and pain after closed treatment of fractures of the mandibular condyle

    NARCIS (Netherlands)

    Dijkstra, P.U.; Stegenga, B.; de Bont, L.G.; Bos, R.R.

    Background: To determine the prognosis of fractures of the mandibular condyle after closed treatment. Methods: Patients (n = 144) with a fracture of the mandibular condyle, all treated closed, were included in the study. Fracture types and position of the fracture parts were determined on

  12. Technical considerations for surgical intervention of Jones fractures.

    Science.gov (United States)

    Mendicino, Robert W; Hentges, Matthew J; Mendicino, Michael R; Catanzariti, Alan R

    2013-01-01

    Jones fractures are a common injury treated by foot and ankle surgeons. Surgical intervention is recommended because of the high rate of delayed union, nonunion, and repeat fracture, when treated conservatively. Percutaneous intramedullary screw fixation is commonly used in the treatment of these fractures. We present techniques that can increase the surgical efficiency and decrease the complications associated with percutaneous delivery of internal fixation. Copyright © 2013 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  13. Hip fracture - discharge

    Science.gov (United States)

    ... neck fracture repair - discharge; Trochanteric fracture repair - discharge; Hip pinning surgery - discharge ... in the hospital for surgery to repair a hip fracture, a break in the upper part of ...

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

    Science.gov (United States)

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

    2015-09-01

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

  15. Proximal femoral fractures.

    Science.gov (United States)

    Webb, Lawrence X

    2002-01-01

    Fractures of the proximal femur include fractures of the head, neck, intertrochanteric, and subtrochanteric regions. Head fractures commonly accompany dislocations. Neck fractures and intertrochanteric fractures occur with greatest frequency in elderly patients with a low bone mineral density and are produced by low-energy mechanisms. Subtrochanteric fractures occur in a predominantly strong cortical osseous region which is exposed to large compressive stresses. Implants used to address these fractures must be able to accommodate significant loads while the fractures consolidate. Complications secondary to these injuries produce significant morbidity and include infection, nonunion, malunion, decubitus ulcers, fat emboli, deep venous thrombosis, pulmonary embolus, pneumonia, myocardial infarction, stroke, and death.

  16. Discrete fracture modelling for the Stripa tracer validation experiment predictions

    International Nuclear Information System (INIS)

    Dershowitz, W.; Wallmann, P.

    1992-02-01

    Groundwater flow and transport through three-dimensional networks of discrete fractures was modeled to predict the recovery of tracer from tracer injection experiments conducted during phase 3 of the Stripa site characterization and validation protect. Predictions were made on the basis of an updated version of the site scale discrete fracture conceptual model used for flow predictions and preliminary transport modelling. In this model, individual fractures were treated as stochastic features described by probability distributions of geometric and hydrologic properties. Fractures were divided into three populations: Fractures in fracture zones near the drift, non-fracture zone fractures within 31 m of the drift, and fractures in fracture zones over 31 meters from the drift axis. Fractures outside fracture zones are not modelled beyond 31 meters from the drift axis. Transport predictions were produced using the FracMan discrete fracture modelling package for each of five tracer experiments. Output was produced in the seven formats specified by the Stripa task force on fracture flow modelling. (au)

  17. Humeral Shaft Fracture: Intramedullary Nailing.

    Science.gov (United States)

    Konda, Sanjit R; Saleh, Hesham; Fisher, Nina; Egol, Kenneth A

    2017-08-01

    This video demonstrates the technique of intramedullary nailing for a humeral shaft fracture. The patient is a 30-year-old man who sustained a gunshot wound to his right arm. The patient was indicated for humeral nailing given the comminuted nature of the diaphysis and to allow for minimal skin incisions. Other relative indications include soft-tissue compromise about the arm precluding a large surgical exposure. This video presents a case of a comminuted humeral shaft fracture treated with an intramedullary nail. Anatomic reduction and stable fixation was obtained with this technique. This case demonstrates a soft-tissue sparing technique of humeral shaft fixation using a humeral intramedullary nail. The technique is easy to perform and has significant benefits in minimizing surgical exposure, decreasing operative time, and decreasing blood loss. In the correct clinical setting, humeral nailing provides an expeditious form of fixation that restores length, alignment, and rotation of the fracture humeral diaphysis.

  18. Anchorage strategies in geriatric hip fracture management

    Directory of Open Access Journals (Sweden)

    Knobe Matthias

    2016-12-01

    Full Text Available There is an enormous humanitarian and socioeconomic need to improve the quality and effectiveness of care for patients with hip fracture. To reduce mechanical complications in the osteosynthesis of proximal femoral fractures, improved fixation techniques have been developed including blade or screw-anchor devices, locked minimally invasive or cement augmentation strategies. However, despite numerous innovations and advances regarding implant design and surgical techniques, systemic and mechanical complication rates remain high. Treatment success depends on secure implant fixation in often-osteoporotic bone as well as on patient-specific factors (fracture stability, bone quality, comorbidity, and gender and surgeon-related factors (experience, correct reduction, and optimal screw placement in the head/neck fragment. For fracture fixation, the anchorage of the lag screw within the femoral head plays a crucial role depending on the implant’s design. Meta-analyses and randomized controlled studies demonstrate that there is a strong trend towards arthroplasty treating geriatric femoral neck fractures. However, for young adults as well as older patients with less compromised bone quality, or in undisplaced fractures, head-preserving therapy is preferred as it is less invasive and associated with good functional results. This review summarizes the evidence for the internal fixation of femoral neck fractures and trochanteric femoral fractures in elderly patients. In addition, biomechanical considerations regarding implant anchorage in the femoral head including rotation, migration, and femoral neck shortening are made. Finally, cement augmentation strategies for hip fracture implants are evaluated critically.

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

    Science.gov (United States)

    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.

  20. Orbital fractures due to domestic violence: an epidemiologic study.

    Science.gov (United States)

    Goldberg, Stuart H.; McRill, Connie M.; Bruno, Christopher R.; Ten Have, Tom; Lehman, Erik

    2000-09-01

    Domestic violence is an important cause of orbital fractures in women. Physicians who treat patients with orbital fractures may not suspect this mechanism of injury. The purpose of this study was to assess the association between domestic violence and orbital fractures. A medical center-based case-control study with matching on age and site of admission was done. Medical center databases were searched using ICD-9 codes to identify all cases of orbital fractures encountered during a three-year period. Medical records of female patients age 13 and older were reviewed along with those of age, gender and site of admission matched controls. A stratified exact test was employed to test the association between domestic violence and orbital fracture. Among 41 adult female cases with orbital fractures treated at our medical center, three (7.3%) reported domestic violence compared to zero among the matched controls (p = 0.037). We believe that domestic violence may be under-reported in both orbital fracture cases and controls. This may result in an underestimate of the orbital fracture versus domestic violence association. Domestic violence is a serious women's health and societal problem. Domestic violence may have a variety of presentations, including illnesses and injuries. Orbital fracture is an identifiable manifestation of domestic violence. Domestic violence is more likely to be detected in adult female hospital patients with orbital fracture than in matched controls with any other diagnosis. Physicians who treat patients with orbital fractures should be familiar with this mechanism of injury.

  1. Peroneal tendon displacement accompanying intra-articular calcaneal fractures.

    Science.gov (United States)

    Toussaint, Rull James; Lin, Darius; Ehrlichman, Lauren K; Ellington, J Kent; Strasser, Nicholas; Kwon, John Y

    2014-02-19

    Peroneal tendon displacement (subluxation or dislocation) accompanying an intra-articular calcaneal fracture is often undetected and under-treated. The goals of this study were to determine (1) the prevalence of peroneal tendon displacement accompanying intra-articular calcaneal fractures, (2) the association of tendon displacement with fracture classifications, (3) the association of tendon displacement with heel width, and (4) the rate of missed diagnosis of the tendon displacement on radiographs and computed tomography (CT) scans and the resulting treatment rate. A retrospective radiographic review of all calcaneal fractures presenting at three institutions from June 30, 2006, to June 30, 2011, was performed. CT imaging of 421 intra-articular calcaneal fractures involving the posterior facet was available for review. The prevalence of peroneal tendon displacement was noted and its associations with fracture classification and heel width were evaluated. Peroneal tendon displacement was identified in 118 (28.0%) of the 421 calcaneal fracture cases. The presence of tendon displacement was significantly associated with joint-depression fractures compared with tongue-type fractures (p displacement had been identified in the radiology reports. Although sixty-five (55.1%) of the fractures with tendon displacement had been treated with internal fixation, the tendon displacement was treated surgically in only seven (10.8%) of these cases. Analysis of CT images showed a 28% prevalence of peroneal tendon displacement accompanying intra-articular calcaneal fractures. Surgeons and radiologists are encouraged to consider this association.

  2. Scintigraphic observation of the course of secondary fracture healing with and without ultrasonic stimulation in animal experiments

    International Nuclear Information System (INIS)

    Klug, W.; Franke, W.G.; Schulze, M.

    1986-01-01

    Secondary fracture healing was studied in the course of closed lower leg fractures in rabbit fracture models by /sup 99m/Tc scintiscanning. The ROI activity quotient increased significantly up to the maximum value, Q = 6.44 on the 14th day after fracture. 61 fractures of the lower leg were treated by ultrasonics from the 14th to the 28th day after fracture. These stimulated fractures showed a biologic healing already on the 168th day. Fractures untreated with ultrasonics could not be proved any more scintigraphically only after the 203rd day after fracture. (author)

  3. Acidization of shales with calcite cemented fractures

    Science.gov (United States)

    Kwiatkowski, Kamil; Szymczak, Piotr; Jarosiński, Marek

    2017-04-01

    Investigation of cores drilled from shale formations reveals a relatively large number of calcite-cemented fractures. Usually such fractures are reactivated during fracking and can contribute considerably to the permeability of the resulting fracture network. However, calcite coating on their surfaces effectively excludes them from production. Dissolution of the calcite cement by acidic fluids is investigated numerically with focus on the evolution of fracture morphology. Available surface area, breakthrough time, and reactant penetration length are calculated. Natural fractures in cores from Pomeranian shale formation (northern Poland) were analyzed and classified. Representative fractures are relatively thin (0.1 mm), flat and completely sealed with calcite. Next, the morphology evolution of reactivated natural fractures treated with low-pH fluids has been simulated numerically under various operating conditions. Depth-averaged equations for fracture flow and reactant transport has been solved by finite-difference method coupled with sparse-matrix solver. Transport-limited dissolution has been considered, which corresponds to the treatment with strong acids, such as HCl. Calcite coating in reactivated natural fractures dissolves in a highly non-homogeneous manner - a positive feedback between fluid transport and calcite dissolution leads to the spontaneous formation of wormhole-like patterns, in which most of the flow is focused. The wormholes carry reactive fluids deeper inside the system, which dramatically increases the range of the treatment. Non-uniformity of the dissolution patterns provides a way of retaining the fracture permeability even in the absence of the proppant, since the less dissolved regions will act as supports to keep more dissolved regions open. Evolution of fracture morphology is shown to depend strongly on the thickness of calcite layer - the thicker the coating the more pronounced wormholes are observed. However the interaction between

  4. Treatment of neglected femoral neck fracture

    Directory of Open Access Journals (Sweden)

    Anil K Jain

    2015-01-01

    Full Text Available Intra-capsular femoral neck fractures are seen commonly in elderly people following a low energy trauma. Femoral neck fracture has a devastating effect on the blood supply of the femoral head, which is directly proportional to the severity of trauma and displacement of the fracture. Various authors have described a wide array of options for treatment of neglected/nonunion (NU femoral neck fracture. There is lack of consensus in general, regarding the best option. This Instructional course article is an analysis of available treatment options used for neglected femoral neck fracture in the literature and attempt to suggest treatment guides for neglected femoral neck fracture. We conducted the "Pubmed" search with the keywords "NU femoral neck fracture and/or neglected femoral neck fracture, muscle-pedicle bone graft in femoral neck fracture, fibular graft in femoral neck fracture and valgus osteotomy in femoral neck fracture." A total of 203 print articles were obtained as the search result. Thirty three articles were included in the analysis and were categorized into four subgroups based on treatment options. (a treated by muscle-pedicle bone grafting (MPBG, (b closed/open reduction internal fixation and fibular grafting (c open reduction and internal fixation with valgus osteotomy, (d miscellaneous procedures. The data was pooled from all groups for mean neglect, the type of study (prospective or retrospective, classification used, procedure performed, mean followup available, outcome, complications, and reoperation if any. The outcome of neglected femoral neck fracture depends on the duration of neglect, as the changes occurring in the fracture area and fracture fragments decides the need and type of biological stimulus required for fracture union. In stage I and stage II (Sandhu′s staging neglected femoral neck fracture osteosynthesis with open reduction and bone grafting with MPBG or Valgus Osteotomy achieves fracture union in almost 90

  5. Conservative management of fracture scaphoid

    Directory of Open Access Journals (Sweden)

    Mittal V

    2006-01-01

    Full Text Available Background : Conservative management of fracture scaphoid with cast is still the most common modality of management, but the results following this protocol are not always satisfactory. Methods : Twenty five patients with fracture scaphoid were treated with a below elbow scaphoid cast and were followed up for minimum duration of one year. On follow up patients were examined clinicoradiologically and functional results were evaluated using the modification of the Mayo wrist scoring chart. Results : Nineteen fractures showed union, two were malunited and five went for nonunion. Two fractures developed avascular necrosis and three patients had wrist arthritis on follow up. Nineteen patients had excellent functional results, one had good results and six patients had poor results. Patients with delayed diagnosis had nonunion and poor functional results. Patients with premature removal of cast had comparatively inferior results Conclusion : For displaced unstable fracture, open reduction and internal fixation should be the preferred modality of treatment as cast treatment gives unacceptably high rate of malunion and nonunion with poor functional results.

  6. Atraumatic femoral neck fracture secondary to prolonged lactation induced osteomalacia

    Directory of Open Access Journals (Sweden)

    Dhammapal Sahebrao Bhamare

    2013-01-01

    Full Text Available Presenting a case of atraumatic fracture neck femur secondary to 2 years of prolonged lactation. A 26-year-old lactating mother presented with pain in left hip from last 12 months. She was apparently alright before and during pregnancy. Plain radiograph showed a complete undisplaced fracture of femoral neck. Osteomalacia was diagnosed by radiological and serological investigations. The fracture was fixed using AO type cannulated cancellous screws. The fracture showed good clinical and radiological union at 3 months. Literature review shows that this is a first case of atraumatic fracture of neck femur due to prolonged lactational osteomalacia. It showed that even apparently healthy Indians are susceptible to osteomalacia, more so during pregnancy and lactation and can be presented as atraumatic fracture. Although considered relatively stable, a compression type incomplete fracture neck femur may progress to a complete fracture if not treated in time.

  7. Epidemiology of rib fractures in older men: Osteoporotic Fractures in Men (MrOS) prospective cohort study.

    Science.gov (United States)

    Barrett-Connor, Elizabeth; Nielson, Carrie M; Orwoll, Eric; Bauer, Douglas C; Cauley, Jane A

    2010-03-15

    To study the causes and consequences of radiologically confirmed rib fractures (seldom considered in the context of osteoporosis) in community dwelling older men. Prospective cohort study (Osteoporotic Fractures in Men (MrOS) Study). 5995 men aged 65 or over recruited in 2000-2 from six US sites; 99% answered mailed questionnaires about falls and fractures every four months for a mean 6.2 (SD 1.3) year follow-up. New fractures validated by radiology reports; multivariate Cox proportional hazard ratios were used to evaluate factors independently associated with time to incident rib fracture; associations between baseline rib fracture and incident hip and wrist fracture were also evaluated. The incidence of rib fracture was 3.5/1000 person years, and 24% (126/522) of all incident non-spine fractures were rib fractures. Nearly half of new rib fractures (48%; n=61) followed falling from standing height or lower. Independent risk factors for an incident rib fracture were age 80 or above, low bone density, difficulty with instrumental activities of daily living, and a baseline history of rib/chest fracture. Men with a history of rib/chest fracture had at least a twofold increased risk of an incident rib fracture (adjusted hazard ratio 2.71, 95% confidence interval 1.86 to 3.95), hip fracture (2.05, 1.33 to 3.15), and wrist fracture (2.06, 1.14 to 3.70). Only 14/82 of men reported being treated with bone specific drugs after their incident rib fracture. Rib fracture, the most common incident clinical fracture in men, was associated with classic risk markers for osteoporosis, including old age, low hip bone mineral density, and history of fracture. A history of rib fracture predicted a more than twofold increased risk of future fracture of the rib, hip, or wrist, independent of bone density and other covariates. Rib fractures should be considered to be osteoporotic fractures in the evaluation of older men for treatment to prevent future fracture.

  8. Perioperative lateral trochanteric wall fractures: sliding hip screw versus percutaneous compression plate for intertrochanteric hip fractures.

    Science.gov (United States)

    Langford, Joshua; Pillai, Gita; Ugliailoro, Anthony D; Yang, Edward

    2011-04-01

    This study was performed to determine the incidence of perioperative lateral wall fractures with a standard sliding hip screw (SHS) versus a percutaneous compression plate (PCCP) using identical meticulous closed reduction techniques in both groups. Retrospective analysis of a prospective trauma registry. Urban Level I trauma center. Over a 7-year period, 337 patients with intertrochanteric hip fractures were treated with either a SHS or a PCCP at our institution. The PCCP group (Group 1) consisted of 200 patients, of which 141 (71%) had adequate images to be included in the study. The SHS group (Group 2) consisted of 137 patients, of which 100 (73%) had adequate images to be included in the study. Closed reduction and plate application with either a standard sliding hip screw or a percutaneous compression plate for an Orthopaedic Trauma Association 31A1 or 31A2 intertrochanteric hip fracture. : Radiographic evidence of lateral trochanteric wall fracture as measured by intraoperative and perioperative radiographs. There was an overall lateral wall fracture incidence of 20% in the SHS group versus 1.4% in the PCCP group (P fracture types, there was a lateral wall fracture incidence of 29.8% in the SHS group versus 1.9% in the PCCP group (P trochanteric wall fracture compared with the SHS group. This difference became greater when just unstable intertrochanteric fractures were analyzed. An anatomic reduction, combined with a device (PCCP) that uses small-diameter defects in the lateral trochanteric wall, essentially eliminates perioperative lateral trochanteric wall fractures.

  9. Hybrid external fixation in the treatment of tibial pilon fractures: A retrospective analysis of 162 fractures.

    Science.gov (United States)

    Galante, Vito N; Vicenti, Giovanni; Corina, Gianfranco; Mori, Claudio; Abate, Antonella; Picca, Girolamo; Conserva, Vito; Speciale, Domenico; Scialpi, Lorenzo; Tartaglia, Nicola; Caiaffa, Vincenzo; Moretti, Biagio

    2016-10-01

    To determine the efficacy of hybrid external fixation in the treatment of tibial pilon fractures. Retrospective, multicentre study. Adult patients with tibial pilon fractures treated with hybrid external fixation. Fracture reduction with ligamentotaxis and fixation with XCaliber hybrid external fixator. Fracture union, complications, functional outcome (Mazur Ankle Score). Union was obtained in 159 fractures at an average of 125days; there were three delayed unions and three non-unions. The most frequent complication was superficial pin-track infections (48), all of which responded to local wound care and antibiotics. There were no deep infections and no DVT. Only one fracture had loss of reduction that required frame revision. The overall functional scores were 91 (excellent) for AO/OTA type A fractures, 89 (good) for type B fractures, and 75 (satisfactory) for type C fractures. Hybrid external fixation is an effective method of stabilising tibial pilon fractures, particularly those with marked comminution. The minimally-invasive technique and stable fixation enable early mobilisation, with good functional results and minimal complications. Level IV Case series. Copyright © 2016 Elsevier Ltd. All rights reserved.

  10. Fracture of Fully-coated Femoral Stem after Primary Total Hip Arthroplasty for Nonunion of Intertrochanteric Fracture: A Case Report.

    Science.gov (United States)

    Chun, Young Soo; Juh, Hyung Suk; Cho, Yoon Je; Rhyu, Kee Hyung

    2015-09-01

    Femoral stem fracture is an uncommon reason for the failure of total hip arthroplasty, with only 16 cases of fully coated stem fractures reported to date. Here we report a case in which a fully coated primary femoral stem fracture occurred after conversion to total hip arthroplasty for the non-union of an intertrochanteric fracture of the femur. Metallurgic evaluation of the etiology and mechanism revealed that the fracture was initiated by fatigue-related failure and completed by ductile failure on the posterior side of the fracture. Considering the recent trend of treating an intertrochanteric fracture with hip arthroplasty, possible stem failure should be considered, since most patients will have at least one of the known risk factors for stem fracture.

  11. Traumatic thoracolumbar spine fractures

    NARCIS (Netherlands)

    J. Siebenga (Jan)

    2013-01-01

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

  12. Fractures in multiple sclerosis

    DEFF Research Database (Denmark)

    Stenager, E; Jensen, K

    1991-01-01

    In a cross-sectional study of 299 MS patients 22 have had fractures and of these 17 after onset of MS. The fractures most frequently involved the femoral neck and trochanter (41%). Three patients had had more than one fracture. Only 1 patient had osteoporosis. The percentage of fractures increase...

  13. Compression fractures of the vertebrae during a "bumpy" boat ride.

    LENUS (Irish Health Repository)

    Chukwunyerenwa, C K

    2012-01-31

    INTRODUCTION: Compression fracture of the vertebrae is common, often the result of falls from height and motor vehicle accidents in the younger age groups. It can occur following minor trauma in the elderly and in those with osteoporosis. MATERIALS AND METHODS: We present an interesting case of compression fracture of the vertebral bodies occurring simultaneously in a couple during a boat ride while on holiday. One individual had fracture of the T8, while the other fractured the L1 vertebrae. Both injuries were treated conservatively with Taylor braces. CONCLUSION: We highlight one of the potential hazards of this recreational activity, and the almost identical fracture pattern in this couple.

  14. Selectively placing many fractures in openhole horizontal wells improves production

    Energy Technology Data Exchange (ETDEWEB)

    Love, T. G.; McCarty, R. A. [Chevron USA Inc (United States); Suraatmadja, J. B.; Chambers, R. W.; Grundmann, S. R.

    1998-12-31

    Result of a simulation of an openhole horizontal well that was treated with hydrajet fracturing, a new fracturing process wherein fractures are placed at different locations in a horizontal well without using sectional isolation techniques, are discussed. The process uses high-pressure jetting to concentrate fracturing energy at a precise fracture location, and data is obtained by means of surface and downhole pressure recorders, flow recorders, and tracers. This technique was used in a substantially depleted horizontal well in New Mexico with good results. The new process is reported to be expensive to implement which prevents widespread application at the present time. 7 refs., 9 figs.

  15. Assessment of fracture risk

    International Nuclear Information System (INIS)

    Kanis, John A.; Johansson, Helena; Oden, Anders; McCloskey, Eugene V.

    2009-01-01

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

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

    International Nuclear Information System (INIS)

    Lentle, B.C.; Brown, J.P.; Khan, A.

    2007-01-01

    Given the increasing evidence that vertebral fractures are underdiagnosed and not acted on, Osteoporosis Canada and the Canadian Association of Radiologists initiated a project to develop and publish a set of recommendations to promote and facilitate the diagnosis and reporting of vertebral fractures. The identification of spinal fractures is not uniform. More than 65% of vertebral fractures cause no symptoms. It is also apparent that vertebral fractures are inadequately recognized when the opportunity for diagnosis arises fortuitously. It is to patients' benefit that radiologists report vertebral fractures evident on a chest or other radiograph, no matter how incidental to the immediate clinical indication for the examination. The present recommendations can help to close the gap in care in recognizing and treating vertebral fractures, to prevent future fractures and thus reduce the burden of osteoporosis-related morbidity and mortality, as well as fracture-related costs to the health care system. Several studies indicate that a gap exists in regard to the diagnosis of vertebral fractures and the clinical response following such diagnosis. All recommendations presented here are based on consensus. These recommendations were developed by a multidisciplinary working group under the auspices of the Scientific Advisory Council of Osteoporosis Canada and the Canadian Association of Radiologists. Prevalent vertebral fractures have important clinical implications in terms of future fracture risk. Recognizing and reporting fractures incidental to radiologic examinations done for other reasons has the potential to reduce health care costs by initiating further steps in osteoporosis diagnosis and appropriate therapy. Physicians should be aware of the importance of vertebral fracture diagnosis in assessing future osteoporotic fracture risk. Vertebral fractures incidental to radiologic examinations done for other reasons should be identified and reported. Vertebral fractures

  17. Use of Pulsing Electromagnetic Fields for the Treatment of Pelvic Stress Fractures Among Female Soldiers

    National Research Council Canada - National Science Library

    Jones, D

    1995-01-01

    .... Pulsing electromagnetic fields (PEMFs)have been shown to speed the healing of non-union fractures and we have used them successfully to treat stress fractures in the lower limbs. All women at Ft...

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

    DEFF Research Database (Denmark)

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

    2007-01-01

    BACKGROUND: Reoperations after intertrochanteric fractures are often necessitated by fracture displacement following mobilization of the patient. The biomechanical complexity of the fracture, the position of the implant, and the patient's characteristics are known to influence postoperative outcome...... of the lateral femoral wall are not treated adequately with a sliding compression hip-screw device, and intertrochanteric fractures should therefore be classified according to the integrity of the lateral femoral wall, especially in randomized trials comparing fracture implants....

  19. A different trauma, a different fracture

    Directory of Open Access Journals (Sweden)

    Ü. Kaldırım

    2013-12-01

    Discussion and conclusion: The epiphyses and the apophyses are the weakest part of all the skeletal system. In these regions, avulsion fractures may occur with sudden and severe spasm of the muscles. Avulsion fractures of SIAS are mostly treated conservatively unless there is more than 2 cm fragment separated and non-union case in which case surgery is recommended. This type of injuries can be easily overlooked or misdiagnosed due to history of trauma free. It may also effects

  20. Does the surgical approach for treating mandibular condylar fractures affect the rate of seventh cranial nerve injuries? A systematic review and meta-analysis based on a new classification for surgical approaches.

    Science.gov (United States)

    Al-Moraissi, Essam Ahmed; Louvrier, Aurélien; Colletti, Giacomo; Wolford, Larry M; Biglioli, Federico; Ragaey, Marwa; Meyer, Christophe; Ellis, Edward

    2018-03-01

    The purpose of this study was to determine the rate of facial nerve injury (FNI) when performing (ORIF) of mandibular condylar fractures by different surgical approaches. A systematic review and meta-analysis were performed that included several databases with specific keywords, a reference search, and a manual search for suitable articles. The inclusion criteria were all clinical trials, with the aim of assessing the rate of facial nerve injuries when (ORIF) of mandibular condylar fractures was performed using different surgical approaches. The main outcome variable was transient facial nerve injury (TFNI) and permanent facial nerve injury (PFNI) according to the fracture levels, namely: condylar head fractures (CHFs), condylar neck fractures (CNFs), and condylar base fractures (CBFs). For studies where there was no delineation between CNFs and CBFs, the fractures were defined as CNFs/CBFs. The dependent variables were the surgical approaches. A total of 3873 patients enrolled in 96 studies were included in this analysis. TFNI rates reported in the literature were as follows: A) For the transoral approach: a) for strictly intraoral 0.72% (1.3 in CNFs and 0% for CBFs); b) for the transbuccal trocar instrumentation 2.7% (4.2% in CNFs and 0% for CBFs); and c) for endoscopically assisted ORIF 4.2% (5% in CNFs, and 4% in CBFs). B) For low submandibular approach 15.3% (26.1% for CNFs, 11.8% for CBFs, and 13.7% for CNFs/CBFs). C) For the high submandibular/angular subparotid approach with masseter transection 0% in CBFs. D) For the high submandibular/angular transmassetric anteroparotid approach 0% (CNFs and CBFs). E) For the transparotid retromandibular approach a) with nerve facial preparation 14.4% (23.9% in CNFs, 11.8% in CBFs and 13.7% for CNFs/CBFs); b) without facial nerve preparation 19% (24.3% for CNFs and 10.5% for CBFs). F) For retromandibular transmassetric anteroparotid approach 3.4% in CNFs/CBFs. G) For retromandibular transmassetric anteroparotid

  1. Multilevel Contiguous Osteoporotic Lumbar Compression Fractures: The Relationship of Scoliosis to the Development of Cascading Fractures.

    Science.gov (United States)

    Sabo, Alex; Hatgis, Jesse; Granville, Michelle; Jacobson, Robert E

    2017-12-19

    Osteoporotic patients can present with either single or multiple fractures secondary to repeated falls and progressive osteoporosis. Multiple fractures often lead to additional spinal deformity and are a sign of more severe osteoporosis. In the thoracic spine, multiple fractures are associated with the development of gradual thoracic kyphosis but neurologic deficits are uncommon. In the lumbar spine, patients with multiple lumbar fractures have more constant lumbar pain, may have symptoms related to concurrent lumbar stenosis or degenerative scoliosis, and may present with radiculopathy, especially with fractures at L4 and L5. In a review of a series of patients with recurrent multiple lumbar fractures or 'cascading' fractures, it was found that all the patients were female, had severe osteoporosis, often untreated, had a previous history of multiple previous thoracic and lumbar fractures, and all had associated scoliotic spinal deformities ranging from 6 o to 50 o . It was found that if the curve progressed and the greater the degree of curvature, the more frequently subsequent multiple fractures developed, leading to recurrent acute episodes of pain. Forty percent also had additional sacral insufficiency fractures, an unusually high percentage. Biomechanically, the lumbar spine is both more mobile and supports a larger portion of the spinal load compared to the thoracic spine. The existence or worsening of a lumbar spinal deformity from degenerative lumbar scoliosis shifts the mechanical forces more to one side on already weakened osteoporotic lumbar vertebrae and sacrum, leading to an increased incidence of these fractures. Because of the chronic and uneven lower lumbar spinal load with severe vertebral osteoporosis in certain patients with repeat lumbar fractures and worsening degenerative lumbar scoliosis, there may be a rationale to add preventive vertebroplasty at adjacent vertebral endplates when treating acute recurrent lumbar fractures to decrease the

  2. Evaluation of Fibular Fracture Type vs Location of Tibial Fixation of Pilon Fractures.

    Science.gov (United States)

    Busel, Gennadiy A; Watson, J Tracy; Israel, Heidi

    2017-06-01

    Comminuted fibular fractures can occur with pilon fractures as a result of valgus stress. Transverse fibular fractures can occur with varus deformation. No definitive guide for determining the proper location of tibial fixation exists. The purpose of this study was to identify optimal plate location for fixation of pilon fractures based on the orientation of the fibular fracture. One hundred two patients with 103 pilon fractures were identified who were definitively treated at our institution from 2004 to 2013. Pilon fractures were classified using the AO/OTA classification and included 43-A through 43-C fractures. Inclusion criteria were age of at least 18 years, associated fibular fracture, and definitive tibial plating. Patients were grouped based on the fibular component fracture type (comminuted vs transverse), and the location of plate fixation (medial vs lateral) was noted. Radiographic outcomes were assessed for mechanical failures. Forty fractures were a result of varus force as evidenced by transverse fracture of the fibula and 63 were due to valgus force with a comminuted fibula. For the transverse fibula group, 14.3% mechanical complications were noted for medially placed plate vs 80% for lateral plating ( P = .006). For the comminuted fibular group, 36.4% of medially placed plates demonstrated mechanical complications vs 16.7% for laterally based plates ( P = .156). Time to weight bearing as tolerated was also noted to be significant between groups plated medially and laterally for the comminuted group ( P = .013). Correctly assessing the fibular component for pilon fractures provides valuable information regarding deforming forces. To limit mechanical complications, tibial plates should be applied in such a way as to resist the original deforming forces. Level of Evidence Level III, comparative study.

  3. Splinting of Longitudinal Fracture: An Innovative Approach

    Directory of Open Access Journals (Sweden)

    Rashmi Bansal

    2016-01-01

    Full Text Available Trauma may result in craze lines on the enamel surface, one or more fractured cusps of posterior teeth, cracked tooth syndrome, splitting of posterior teeth, and vertical fracture of root. Out of these, management of some fractures is of great challenge and such teeth are generally recommended for extraction. Literature search reveals attempts to manage such fractures by full cast crown, orthodontic wires, and so forth, in which consideration was given to extracoronal splinting only. However, due to advancement in materials and technologies, intracoronal splinting can be achieved as well. In this case report, longitudinal fractures in tooth #27, tooth #37, and tooth #46 had occurred. In #27, fracture line was running mesiodistally involving the pulpal floor resulting in a split tooth. In teeth 37 and 46, fractures of the mesiobuccal cusp and mesiolingual cusp were observed, respectively. They were restored with cast gold inlay and full cast crown, respectively. Longitudinal fracture of 27 was treated with an innovative approach using intracanal reinforced composite with Ribbond, external reinforcement with an orthodontic band, and full cast metal crown to splint the split tooth.

  4. Fractures of the proximal fifth metatarsal: percutaneous bicortical fixation.

    Science.gov (United States)

    Mahajan, Vivek; Chung, Hyun Wook; Suh, Jin Soo

    2011-06-01

    Displaced intraarticular zone I and displaced zone II fractures of the proximal fifth metatarsal bone are frequently complicated by delayed nonunion due to a vascular watershed. Many complications have been reported with the commonly used intramedullary screw fixation for these fractures. The optimal surgical procedure for these fractures has not been determined. All these observations led us to evaluate the effectiveness of percutaneous bicortical screw fixation for treating these fractures. Twenty-three fractures were operatively treated by bicortical screw fixation. All the fractures were evaluated both clinically and radiologically for the healing. All the patients were followed at 2 or 3 week intervals till fracture union. The patients were followed for an average of 22.5 months. Twenty-three fractures healed uneventfully following bicortical fixation, with a mean healing time of 6.3 weeks (range, 4 to 10 weeks). The average American Orthopaedic Foot & Ankle Society (AOFAS) score was 94 (range, 90 to 99). All the patients reported no pain at rest or during athletic activity. We removed the implant in all cases at a mean of 23.2 weeks (range, 18 to 32 weeks). There was no refracture in any of our cases. The current study shows the effectiveness of bicortical screw fixation for displaced intraarticular zone I fractures and displaced zone II fractures. We recommend it as one of the useful techniques for fixation of displaced zone I and II fractures.

  5. 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

  6. Endogenous PTH deficiency impairs fracture healing and impedes the fracture-healing efficacy of exogenous PTH(1-34.

    Directory of Open Access Journals (Sweden)

    Yongxin Ren

    Full Text Available Although the capacity of exogenous PTH1-34 to enhance the rate of bone repair is well established in animal models, our understanding of the mechanism(s whereby PTH induces an anabolic response during skeletal repair remains limited. Furthermore it is unknown whether endogenous PTH is required for fracture healing and how the absence of endogenous PTH would influence the fracture-healing capacity of exogenous PTH.Closed mid-diaphyseal femur fractures were created and stabilized with an intramedullary pin in 8-week-old wild-type and Pth null (Pth(-/- mice. Mice received daily injections of vehicle or of PTH1-34 (80 µg/kg for 1-4 weeks post-fracture, and callus tissue properties were analyzed at 1, 2 and 4 weeks post-fracture. Cartilaginous callus areas were reduced at 1 week post-fracture, but were increased at 2 weeks post-fracture in vehicle-treated and PTH-treated Pth(-/- mice compared to vehicle-treated and PTH-treated wild-type mice respectively. The mineralized callus areas, bony callus areas, osteoblast number and activity, osteoclast number and surface in callus tissues were all reduced in vehicle-treated and PTH-treated Pth(-/- mice compared to vehicle-treated and PTH-treated wild-type mice, but were increased in PTH-treated wild-type and Pth(-/- mice compared to vehicle-treated wild-type and Pth(-/- mice.Absence of endogenous PTH1-84 impedes bone fracture healing. Exogenous PTH1-34 can act in the absence of endogenous PTH but callus formation, including accelerated endochondral bone formation and callus remodeling as well as mechanical strength of the bone are greater when endogenous PTH is present. Results of this study suggest a complementary role for endogenous PTH1-84 and exogenous PTH1-34 in accelerating fracture healing.

  7. Endogenous PTH deficiency impairs fracture healing and impedes the fracture-healing efficacy of exogenous PTH(1-34).

    Science.gov (United States)

    Ren, Yongxin; Liu, Bo; Feng, Yuxu; Shu, Lei; Cao, Xiaojian; Karaplis, Andrew; Goltzman, David; Miao, Dengshun

    2011-01-01

    Although the capacity of exogenous PTH1-34 to enhance the rate of bone repair is well established in animal models, our understanding of the mechanism(s) whereby PTH induces an anabolic response during skeletal repair remains limited. Furthermore it is unknown whether endogenous PTH is required for fracture healing and how the absence of endogenous PTH would influence the fracture-healing capacity of exogenous PTH. Closed mid-diaphyseal femur fractures were created and stabilized with an intramedullary pin in 8-week-old wild-type and Pth null (Pth(-/-)) mice. Mice received daily injections of vehicle or of PTH1-34 (80 µg/kg) for 1-4 weeks post-fracture, and callus tissue properties were analyzed at 1, 2 and 4 weeks post-fracture. Cartilaginous callus areas were reduced at 1 week post-fracture, but were increased at 2 weeks post-fracture in vehicle-treated and PTH-treated Pth(-/-) mice compared to vehicle-treated and PTH-treated wild-type mice respectively. The mineralized callus areas, bony callus areas, osteoblast number and activity, osteoclast number and surface in callus tissues were all reduced in vehicle-treated and PTH-treated Pth(-/-) mice compared to vehicle-treated and PTH-treated wild-type mice, but were increased in PTH-treated wild-type and Pth(-/-) mice compared to vehicle-treated wild-type and Pth(-/-) mice. Absence of endogenous PTH1-84 impedes bone fracture healing. Exogenous PTH1-34 can act in the absence of endogenous PTH but callus formation, including accelerated endochondral bone formation and callus remodeling as well as mechanical strength of the bone are greater when endogenous PTH is present. Results of this study suggest a complementary role for endogenous PTH1-84 and exogenous PTH1-34 in accelerating fracture healing.

  8. A clinico-radiologic study of bony remodeling of the fractured condyles in children

    International Nuclear Information System (INIS)

    Cho, Jeong Shin; Park, Chang Seo

    1995-01-01

    Bony remodeling pattern of condyle fractures in children are different from in adult for growing of condyle, also might affect treatment and prognosis of the condyle fracture. Subjects of this clinical and radiologic study were 26 temporomandibular joints diagnosed as condyle fracture in 23 patients under 15 years old age, They were treated with conservative method at Dental Hospital of Yonsei University from Jan., 1986 to Oct., 1994. Bony remodeling related with fracture pattern was evaluated. The results obtained are as follows: 1. The ratio of male to female in patients with condyle fracture was 1 : 0.9 and the difference of sex ratio was not noted. Comparing with preschool-age group and school-age group, age frequency was higher in preschool-age group (83%). 2. Fallen down (54%) was the most frequent cause of condyle fractures. Traffic accident and slip down were followed. 3. The most common clinical sign of condyle fractures was tenderness to palpation (19 cases). Mouth opening limitation (17 cases), swelling (7 cases), malocclusion (3 cases) were next in order. 4. According to sites of condyle fractures, unilateral fractures were in 20 patients and bilateral fractures in 3 patients, therefore total 23 patients-26 cases of condyle fracture were observed. According to fracture distribution, condyle fractures were in 10 patients (44%). Condyle fractures with symphysis fracture (9 patients, 39%), condyle fractures with ascending ramus fracture (2 patients, 9%), condyle fracture with mandibular body fracture (1 patient, 4%), and condyle fractures with mandibular angle fracture (1 patient, 4%) were followed. 5. In displacement pattern of fractured fragment of mandibular condyle, displacement (17 cases, 66%) was most common. Dislocation (5 cases, 19%) and deviation (4 cases, 15%) were next in order. 6. During the observation period of fractured condyles, remodeling patterns of fracture sites related with articular fossa were observed with usual congealer shape in 23

  9. A clinico-radiologic study of bony remodeling of the fractured condyles in children

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Jeong Shin; Park, Chang Seo [Department of Dentistry, The Graduate School, Yonsei University, Seoul (Korea, Republic of)

    1995-08-15

    Bony remodeling pattern of condyle fractures in children are different from in adult for growing of condyle, also might affect treatment and prognosis of the condyle fracture. Subjects of this clinical and radiologic study were 26 temporomandibular joints diagnosed as condyle fracture in 23 patients under 15 years old age, They were treated with conservative method at Dental Hospital of Yonsei University from Jan., 1986 to Oct., 1994. Bony remodeling related with fracture pattern was evaluated. The results obtained are as follows: 1. The ratio of male to female in patients with condyle fracture was 1 : 0.9 and the difference of sex ratio was not noted. Comparing with preschool-age group and school-age group, age frequency was higher in preschool-age group (83%). 2. Fallen down (54%) was the most frequent cause of condyle fractures. Traffic accident and slip down were followed. 3. The most common clinical sign of condyle fractures was tenderness to palpation (19 cases). Mouth opening limitation (17 cases), swelling (7 cases), malocclusion (3 cases) were next in order. 4. According to sites of condyle fractures, unilateral fractures were in 20 patients and bilateral fractures in 3 patients, therefore total 23 patients-26 cases of condyle fracture were observed. According to fracture distribution, condyle fractures were in 10 patients (44%). Condyle fractures with symphysis fracture (9 patients, 39%), condyle fractures with ascending ramus fracture (2 patients, 9%), condyle fracture with mandibular body fracture (1 patient, 4%), and condyle fractures with mandibular angle fracture (1 patient, 4%) were followed. 5. In displacement pattern of fractured fragment of mandibular condyle, displacement (17 cases, 66%) was most common. Dislocation (5 cases, 19%) and deviation (4 cases, 15%) were next in order. 6. During the observation period of fractured condyles, remodeling patterns of fracture sites related with articular fossa were observed with usual congealer shape in 23

  10. 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

  11. Fracture Union in Closed Interlocking Nail in Femoral Fracture

    Directory of Open Access Journals (Sweden)

    R L Sahu

    2010-09-01

    Full Text Available INTRODUCTION: Fractures shaft femur is a major cause of morbidity and mortality in patients with lower extremity injuries. The objective of this study was to find out the outcome of Interlocking nail in fracture femur. METHODS: This study was conducted in the Department of Orthopaedic surgery in M. M. Medical College from July 2006 to November 2008. Seventy eight patients were recruited from Emergency and out patient department having closed fracture of femoral shaft. All patients were operated under general or spinal anesthesia. All patients were followed for nine months. RESULTS: Out of seventy eight patients, sixty nine patients underwent union in 90 to 150 days with a mean of 110.68 days. Touch down weight bearing was started on 2nd post-operative day. Complications found in four patients who had non-union, and five patients had delayed union which was treated with dynamization and bone graft. The results were excellent in 88.46% and good in 6.41% patients. CONCLUSIONS: We concluded that this technique is advantageous because of early mobilization (early weight bearing, less complication with good results and is economical. Keywords: close reamed interlocking nail, dynamization, femoral shaft fractures, union

  12. Compartment syndrome of the thigh complicating surgical treatment of ipsilateral femur and ankle fractures

    Science.gov (United States)

    Moore, M. R.; Garfin, S. R.; Hargens, A. R.

    1987-01-01

    A 26-year-old man presented with ipsilateral femur and ankle fractures. The patient was treated with interlocking nail of his femur fracture, followed by open reduction and internal fixation of his ankle fracture under tourniquet control. Postoperatively, the patient developed compartment syndrome of his thigh with elevated pressures, requiring decompressive fasciotomies. This case illustrates the possible complication of treating a femur fracture with intramedullary nailing and then immediately applying a tourniquet to treat an ipsilateral extremity fracture. Because of the complication with this patient, we feel the procedure should be staged, or a tourniquet should be avoided if possible.

  13. Fracture mechanical materials characterisation

    International Nuclear Information System (INIS)

    Wallin, K.; Planman, T.; Nevalainen, M.

    1998-01-01

    The experimental fracture mechanics development has been focused on the determination of reliable lower-bound fracture toughness estimates from small and miniature specimens, in particular considering the statistical aspects and loading rate effects of fracture mechanical material properties. Additionally, materials aspects in fracture assessment of surface cracks, with emphasis on the transferability of fracture toughness data to structures with surface flaws have been investigated. Further a modified crack-arrest fracture toughness test method, to increase the effectiveness of testing, has been developed. (orig.)

  14. Simultaneous bilateral Mason type IIb radial head fractures in a young female: Was an increased carrying angle the cause?

    LENUS (Irish Health Repository)

    2015-01-01

    Radial head fracture is the most common type of elbow fracture in adults. It results from a fall on an outstretched hand. However, simultaneous bilateral radial head fractures are extremely rare. We report a case of simultaneous bilateral mason type IIb radial head fractures in a young female, which was treated nonoperatively with excellent results

  15. Current management of posterior wall fractures of the acetabulum.

    Science.gov (United States)

    Moed, Berton R; Kregor, Philip J; Reilly, Mark C; Stover, Michael D; Vrahas, Mark S

    2015-01-01

    The general goals for treating an acetabular fracture are to restore congruity and stability of the hip joint. These goals are no different from those for the subset of fractures of the posterior wall. Nevertheless, posterior wall fractures present unique problems compared with other types of acetabular fractures. Successful treatment of these fractures depends on a multitude of factors. The physician must understand their distinctive radiologic features, in conjunction with patient factors, to determine the appropriate treatment. By knowing the important points of posterior surgical approaches to the hip, particularly the posterior wall, specific techniques can be used for fracture reduction and fixation in these often challenging fractures. In addition, it is important to develop a complete grasp of potential complications and their treatment. The evaluation and treatment protocols initially developed by Letournel and Judet continue to be important; however, the surgeon also should be aware of new information published and presented in the past decade.

  16. Second hip fractures at Chiang Mai University Hospital.

    Science.gov (United States)

    Wongtriratanachai, Prasit; Chiewchantanakit, Siripong; Vaseenon, Tanawat; Rojanasthien, Sattaya; Leerapun, Taninnit

    2015-02-01

    Hip fractures are a major public health problem. Patients who have suffered a hip fracture have an increased risk of a subsequent hip fracture. This study examines the incidence ofsecondhip fractures and attempts to identify underlying risk factors. To examine the incidence ofsecond hip fractures in osteoporotic patients at Chiang Mai University Hospital and to identify risk factors related to second hip fractures. A retrospective review was conducted of all low-energy mechanism hip fracture patients admitted during 2008 and 2009. Analysis of second hip fractures was conducted using survival analysis and logistic regression analysis. A total of 191 patients were observed for 391.68 person-years (mean 2.05 person-years per patient). Among that group, nine second hip fractures were identified, an overall incidence rate of 0.023 second fractures per person-year. Second hip fractures tended to occur within the first year following an initial hip fracture. There were no significant differences related to either gender or comorbid medical conditions. Logistic regression analysis revealed that increased risk of a second hip fracture was associated with age (highest between 80 to 89 years) and patients who were not treated for osteoporosis following their initial fracture. The incidence of second hip fractures at Chiang Mai University Hospital was 0.023 per person-year Careful follow-up of older patients, especially those over 80, and treatment ofosteoporosis with bisphosphonate plus vitamin D and calcium supplements was correlated with a reduction in the incidence of second hip fractures.

  17. Stress fractures in military training

    International Nuclear Information System (INIS)

    Jofre, M.J.; Sierralta, M.P.

    2002-01-01

    During military training, the incidence of overuse injuries like stress fractures increase. The aim of the study was to investigate the utility of bone scan in a military population with clinical suspected stress fractures or periostitis. Material and methods: A three-year retrospective analysis was made on patients who were clinically diagnosed with stress fractures at the Military Hospital Nuclear Medicine Department. Thirty-seven patients were studied (mean age 23. +/- 8 y.o; 31 males), 28 cases of which (76%) had tibial stress syndrome. Other localizations were lumbar spine, femoral, fibular, tarsal or metatarsal. Bone scintigraphy was performed injecting 1036 MBq of Tc99m-MDP i.v. Whole body images and lateral projections of lower extremities were done. Results: Bone scan in tibial syndrome was positive for 23 cases (82%), 65% of them were bilateral and 13% also had femoral injuries. X-rays were done in 10 cases and were all negative. In other localizations, the bone scans were negative, but demonstrated other degenerative lesions. All stress fractures were conservatively treated with non-steroidal anti-inflammatories and suspension of physical activity. Conclusions: Bone scan is a reliable confirmatory tool for tibial stress syndrome diagnosis. In addition, it helps to determine both the severity and extension of the injury as well as support the indication of rest in the military population

  18. Stress fractures in military training

    Energy Technology Data Exchange (ETDEWEB)

    Jofre, M J; Sierralta, M P [Military Hospital Nuclear Medicine Department, Santiago (Chile)

    2002-09-01

    During military training, the incidence of overuse injuries like stress fractures increase. The aim of the study was to investigate the utility of bone scan in a military population with clinical suspected stress fractures or periostitis. Material and methods: A three-year retrospective analysis was made on patients who were clinically diagnosed with stress fractures at the Military Hospital Nuclear Medicine Department. Thirty-seven patients were studied (mean age 23. +/- 8 y.o; 31 males), 28 cases of which (76%) had tibial stress syndrome. Other localizations were lumbar spine, femoral, fibular, tarsal or metatarsal. Bone scintigraphy was performed injecting 1036 MBq of Tc99m-MDP i.v. Whole body images and lateral projections of lower extremities were done. Results: Bone scan in tibial syndrome was positive for 23 cases (82%), 65% of them were bilateral and 13% also had femoral injuries. X-rays were done in 10 cases and were all negative. In other localizations, the bone scans were negative, but demonstrated other degenerative lesions. All stress fractures were conservatively treated with non-steroidal anti-inflammatories and suspension of physical activity. Conclusions: Bone scan is a reliable confirmatory tool for tibial stress syndrome diagnosis. In addition, it helps to determine both the severity and extension of the injury as well as support the indication of rest in the military population.

  19. Treatment of root fracture with accompanying resorption using cermet cement.

    Science.gov (United States)

    Lui, J L

    1992-02-01

    A method of treating an apical root fracture with accompanying resorption at the junction of the fracture fragments using glass-cermet cement is described. Endodontically, the material had previously been used for repair of lateral resorptive root defects and retrograde root fillings. Complete bone regeneration was observed three years post-operatively following treatment of the root fracture in the conventional manner. The various advantages of glass-cermet cement as a root filling material used in the technique described are discussed.

  20. Fracture Penis: An Analysis of 26 Cases

    Directory of Open Access Journals (Sweden)

    G.V.Soundra Pandyan

    2006-01-01

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

  1. Fractures (Broken Bones): First Aid

    Science.gov (United States)

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

  2. Fracture toughness correlations

    International Nuclear Information System (INIS)

    Wallin, Kim

    1986-09-01

    In this study existing fracture parameter correlations are reviewed. Their applicability and reliability are discussed in detail. A new K IC -CVN-correlation, based on a theoretical brittle fracture model, is presented

  3. Rib fracture - aftercare

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000539.htm Rib fracture - aftercare To use the sharing features on this page, please enable JavaScript. A rib fracture is a crack or break in one or ...

  4. Sprains, Strains and Fractures

    Science.gov (United States)

    ... fractures. Many fractures and sprains occur during sports. Football players are particularly vulnerable to foot and ankle ... feet and ankles and take a complete medical history. He or she will also order tests, including ...

  5. Infant skull fracture (image)

    Science.gov (United States)

    Skull fractures may occur with head injuries. Although the skull is both tough and resilient and provides excellent ... or blow can result in fracture of the skull and may be accompanied by injury to the ...

  6. Ankle fracture - aftercare

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000548.htm Ankle fracture - aftercare To use the sharing features on this page, please enable JavaScript. An ankle fracture is a break in 1 or more ankle ...

  7. Atraumatic First Rib Fracture

    OpenAIRE

    Koray Aydogdu

    2014-01-01

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

  8. Stress fractures in the lower extremity

    International Nuclear Information System (INIS)

    Berger, Ferco H.; Jonge, Milko C. de; Maas, Mario

    2007-01-01

    Stress fractures are fatigue injuries of bone usually caused by changes in training regimen in the population of military recruits and both professional and recreational athletes. Raised levels of sporting activity in today's population and refined imaging technologies have caused a rise in reported incidence of stress fractures in the past decades, now making up more than 10% of cases in a typical sports medicine practice. Background information (including etiology, epidemiology, clinical presentation and treatment and prevention) as well as state of the art imaging of stress fractures will be discussed to increase awareness amongst radiologists, providing the tools to play an important role in diagnosis and prognosis of stress fractures. Specific fracture sites in the lower extremity will be addressed, covering the far majority of stress fracture incidence. Proper communication between treating physician, physical therapist and radiologist is needed to obtain a high index of suspicion for this easily overlooked entity. Radiographs are not reliable for detection of stress fractures and radiologist should not falsely be comforted by them, which could result in delayed diagnosis and possibly permanent consequences for the patient. Although radiographs are mandatory to rule out differentials, they should be followed through when negative, preferably by magnetic resonance imaging (MRI), as this technique has proven to be superior to bone scintigraphy. CT can be beneficial in a limited number of patients, but should not be used routinely

  9. Fracture heuristics: surgical decision for approaches to distal radius fractures. A surgeon's perspective.

    Science.gov (United States)

    Wichlas, Florian; Tsitsilonis, Serafim; Kopf, Sebastian; Krapohl, Björn Dirk; Manegold, Sebastian

    2017-01-01

    Introduction: The aim of the present study is to develop a heuristic that could replace the surgeon's analysis for the decision on the operative approach of distal radius fractures based on simple fracture characteristics. Patients and methods: Five hundred distal radius fractures operated between 2011 and 2014 were analyzed for the surgeon's decision on the approach used. The 500 distal radius fractures were treated with open reduction and internal fixation through palmar, dorsal, and dorsopalmar approaches with 2.4 mm locking plates or underwent percutaneous fixation. The parameters that should replace the surgeon's analysis were the fractured palmar cortex, and the frontal and the sagittal split of the articular surface of the distal radius. Results: The palmar approach was used for 422 (84.4%) fractures, the dorsal approach for 39 (7.8%), and the combined dorsopalmar approach for 30 (6.0%). Nine (1.8%) fractures were treated percutaneously. The correlation between the fractured palmar cortex and the used palmar approach was moderate (r=0.464; p<0.0001). The correlation between the frontal split and the dorsal approach, including the dorsopalmar approach, was strong (r=0.715; p<0.0001). The sagittal split had only a weak correlation for the dorsal and dorsopalmar approach (r=0.300; p<0.0001). Discussion: The study shows that the surgical decision on the preferred approach is dictated through two simple factors, even in the case of complex fractures. Conclusion: When the palmar cortex is displaced in distal radius fractures, a palmar approach should be used. When there is a displaced frontal split of the articular surface, a dorsal approach should be used. When both are present, a dorsopalmar approach should be used. These two simple parameters could replace the surgeon's analysis for the surgical approach.

  10. Functional outcome of intra-articular tibial plateau fractures: the impact of posterior column fractures.

    Science.gov (United States)

    van den Berg, Juriaan; Reul, Maike; Nunes Cardozo, Menno; Starovoyt, Anastasiya; Geusens, Eric; Nijs, Stefaan; Hoekstra, Harm

    2017-09-01

    INTRODUCTION: Although regularly ignored, there is growing evidence that posterior tibial plateau fractures affect the functional outcome. The goal of this study was to assess the incidence of posterior column fractures and its impact on functional outcome and general health status. We aimed to identify all clinical variables that influence the outcome and improve insights in the treatment strategies. A retrospective cohort study including 218 intra-articular tibial plateau fractures was conducted. All fractures were reclassified and applied treatment was assessed according to the updated three-column concept. Relevant demographic and clinical variables were studied. The patient reported outcome was assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS). Median follow-up was 45.5 (IQR 24.9-66.2) months. Significant outcome differences between operatively and non-operatively treated patients were found for all KOOS subscales. The incidence of posterior column fractures was 61.9%. Posterior column fractures, sagittal malalignment and an increased complication rate were associated with poor outcome. Patients treated according to the updated three-column concept, showed significantly better outcome scores than those patients who were not. We could not demonstrate the advantage of posterior column fracture fixation, due to a limited patient size. Our data indicates that implementation of the updated three-column classification concept may improve the surgical outcome of tibial plateau fractures. Failure to recognize posterior column fractures may lead to inappropriate utilization of treatment techniques. The current concept allows us to further substantiate the importance of reduction and fixation of posterior column fractures with restoration of the sagittal alignment. 3.

  11. Comparison of surgical techniques of 111 medial malleolar fractures classified by fracture geometry.

    Science.gov (United States)

    Ebraheim, Nabil A; Ludwig, Todd; Weston, John T; Carroll, Trevor; Liu, Jiayong

    2014-05-01

    Evaluation of operative techniques used for medial malleolar fractures by classifying fracture geometry has not been well documented. One hundred eleven patients with medial malleolar fractures (transverse n = 63, oblique n = 29, vertical n = 7, comminuted n = 12) were included in this study. Seventy-two patients had complicating comorbidities. All patients were treated with buttress plate, lag screw, tension band, or K-wire fixation. Treatment outcomes were evaluated on the basis of radiological outcome (union, malunion, delayed union, or nonunion), need for operative revision, presence of postoperative complications, and AOFAS Ankle-Hindfoot score. For transverse fractures, tension band fixation showed the highest rate of union (79%), highest average AOFAS score (86), lowest revision rate (5%), and lowest complication rate (16%). For oblique fractures, lag screws showed the highest rate of union (71%), highest average AOFAS score (80), lowest revision rate (19%), and lowest complication rate (33%) of the commonly used fixation techniques. For vertical fractures, buttress plating was used in every case but 1, achieving union (whether normal or delayed) in all cases with an average AOFAS score of 84, no revisions, and a 17% complication rate. Comminuted fractures had relatively poor outcomes regardless of fixation method. The results of this study suggest that both tension bands and lag screws result in similar rates of union for transverse fractures of the medial malleolus, but that tension band constructs are associated with less need for revision surgery and fewer complications. In addition, our data demonstrate that oblique fractures were most effectively treated with lag screws and that vertical fractures attained superior outcomes with buttress plating. Level III, retrospective comparative series.

  12. Metatarsal stress fractures - aftercare

    Science.gov (United States)

    ... Metatarsal stress fracture. In: Safran MR, Zachazewski J, Stone DA, eds. Instructions for Sports Medicine Patients . 2nd ed. Elsevier Saunders; 2012:648-652. Smith MS. Metatarsal fractures. In: Eiff PM, Hatch R, eds. Fracture Management for Primary Care . 3rd ed. ...

  13. Relationships between fractures

    Science.gov (United States)

    Peacock, D. C. P.; Sanderson, D. J.; Rotevatn, A.

    2018-01-01

    Fracture systems comprise many fractures that may be grouped into sets based on their orientation, type and relative age. The fractures are often arranged in a network that involves fracture branches that interact with one another. Interacting fractures are termed geometrically coupled when they share an intersection line and/or kinematically coupled when the displacements, stresses and strains of one fracture influences those of the other. Fracture interactions are characterised in terms of the following. 1) Fracture type: for example, whether they have opening (e.g., joints, veins, dykes), closing (stylolites, compaction bands), shearing (e.g., faults, deformation bands) or mixed-mode displacements. 2) Geometry (e.g., relative orientations) and topology (the arrangement of the fractures, including their connectivity). 3) Chronology: the relative ages of the fractures. 4) Kinematics: the displacement distributions of the interacting fractures. It is also suggested that interaction can be characterised in terms of mechanics, e.g., the effects of the interaction on the stress field. It is insufficient to describe only the components of a fracture network, with fuller understanding coming from determining the interactions between the different components of the network.

  14. Obesity and fracture risk

    OpenAIRE

    Gonnelli, Stefano; Caffarelli, Carla; Nuti, Ranuccio

    2014-01-01

    Obesity and osteoporosis are two common diseases with an increasing prevalence and a high impact on morbidity and mortality. Obese women have always been considered protected against osteoporosis and osteoporotic fractures. However, several recent studies have challenged the widespread belief that obesity is protective against fracture and have suggested that obesity is a risk factor for certain fractures.

  15. Imaging of insufficiency fractures

    Energy Technology Data Exchange (ETDEWEB)

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

    2009-09-15

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

  16. Reconstruction of Acute Traumatic Tibial Fractures with the Ilizarov ...

    African Journals Online (AJOL)

    The average time for application of the apparatus to fracture healing was 4.3 months. One fracture required autogenous bone graft for union. One patient is undergoing callus transportation for bone replacement. The most common complication was pin tract infection seen in nine (25.7%) patients. Conclusion: We treated 35 ...

  17. Femoral neck fractures: A prospective assessment of the pattern ...