Journal articles on the topic 'Fractures Surgery'
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1
STANTON, J. S., J. J. DIAS, and F. D. BURKE. "Fractures of the Tubular Bones of the Hand." Journal of Hand Surgery (European Volume) 32, no. 6 (December 2007): 626–36. http://dx.doi.org/10.1016/j.jhse.2007.06.017.
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Age related differences in demographics, morphology, treatment and outcome were investigated in 701 fractures of the metacarpals or phalanges, including fracture-dislocations, in 655 patients. Fractures mainly due to sport occurred in 184 children, usually after 10 years of age. The base of the proximal phalanx was especially vulnerable. Thirty-seven percent of 256 young adults fractured their fifth metacarpal. The thumb was rarely involved. Half of these two groups fractured the fifth ray. Older adults had more fractures of the distal phalanx and displaced extraarticular fractures requiring stabilisation. Women predominated in the patients over 65. Forty percent of this group sustained their fracture on the road and more fractures involved the thumb, were oblique, intraarticular or multiple than in other groups. Detailed analysis of 423 X-rays demonstrated that only 10% of 70 intraarticular fractures and 19% of 363 extraarticular fractures were completely undisplaced. Patient response to postal questionnaire based outcome assessment using SF-12, MHQ was very poor.
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Kelishadi, Shahrooz S., Matthew R. Zeiderman, Karan Chopra, Joseph A. Kelamis, Gerhard S. Mundinger, and Eduardo D. Rodriguez. "Facial Fracture Patterns Associated with Traumatic Optic Neuropathy." Craniomaxillofacial Trauma & Reconstruction 12, no. 1 (March 2019): 39–44. http://dx.doi.org/10.1055/s-0038-1641172.
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Traumatic optic neuropathy (TON) is rare. The heterogeneity of injury patterns and patient condition on presentation makes diagnosis difficult. Fracture patterns associated with TON have never been evaluated. Retrospective review of 42 patients diagnosed with TON at the R. Adams Cowley Shock Trauma Center from May 1998 to August 2010 was performed. Thirty-three patients met criteria for study inclusion of fracture patterns. Additional variables measured included patient demographics and mechanism. Cluster analysis was used to form homogenous groups of patients based on different fracture patterns. Fracture frequency was analyzed by group and study population. Visual depiction of fracture patterns was created for each group. Cluster analysis of fracture patterns yielded five common “groups” or fracture patterns among the study population. Group 1 ( n = 3, 9%) revealed contralateral lateral orbital wall (100%), zygoma (67%), and nasal bone (67%) fractures. Group 2 ( n = 7, 21%) demonstrated fractures of the frontal bone (86%), nasal bones (71%), and ipsilateral orbital roof (57%). Group 3 ( n = 14, 43%) involved fractures of the ipsilateral zygoma (100%), lateral orbital wall (29%), as well as frontal and nasal bones (21% each). Group 4 ( n = 5, 15%) consisted of mid- and upper-face fractures; 100% fractured the ipsilateral orbital floor, medial and lateral walls, maxilla, and zygoma; 80% fractured the orbital roof and bilateral zygoma. Group 5 ( n = 4, 12%) was characterized by fractures of the ipsilateral orbital floor, medial and lateral orbital walls (75% each), and orbital roof (50%). A notably high 15 of 33 patients (45%) sustained penetrating trauma. Our study demonstrates five fracture pattern groups associated with TON. Zygomatic, frontal, nasal, and orbital fractures were the most common. Fractures with a combination of frontal, nasal, and orbital fractures are particularly concerning and warrant close attention to the eye.
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Özkan, Sezai, Stefan Fischerauer, Thomas Kootstra, Femke Claessen, and David Ring. "Ulnar Neck Fractures Associated with Distal Radius Fractures." Journal of Wrist Surgery 07, no. 01 (August 8, 2017): 071–76. http://dx.doi.org/10.1055/s-0037-1605382.
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Background There is little published data to guide management of ulnar neck fractures associated with fractures of the distal radius. Purpose As unplanned surgery usually reflects adverse events and this injury combination is relatively uncommon, we used a large database to study the incidence of unplanned surgeries after surgical and nonsurgical treatment of distal metaphyseal ulna fractures associated with a distal radius fracture and identify factors associated with these unplanned surgeries. Patients and Methods We identified 277 patients with an ulnar neck fracture associated with a distal radius fracture. Fifty-six (20%) ulnar neck fractures were initially treated operatively and six of them (11%) had a second, unplanned surgery. Of the 221 initially nonoperatively treated fractures, only one (0.45%) had a subsequent unplanned surgery that seemed unrelated to the fracture (ulnar nerve neurolysis). Results Bivariate analysis showed that younger age, open fracture, multifragmentary fractures, and initial operative treatment of the ulnar neck fracture were significantly associated with unplanned surgery. A multivariable analysis was not feasible due to the small number of unplanned surgeries. Conclusion Eighty percent of ulnar neck fractures associated with a fracture of the distal radius was treated nonoperatively in our region, and subsequent surgery for problems was very uncommon. Operative treatment and fracture complexity were associated with unplanned surgery, which reflected some measure of injury severity, technical inadequacy, and inherent problems associated with surgery. Level of Evidence Level II, prognostic study.
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Hadley, Mark N., Curtis A. Dickman, Carol M. Browner, and Volker K. H. Sonntag. "Acute Traumatic Atlas Fractures: Management and Long Term Outcome." Neurosurgery 23, no. 1 (June 1, 1988): 31–35. http://dx.doi.org/10.1227/00006123-198807000-00007.
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ABSTRACT Fractures of the 1st cervical vertebra (C1) represent 7% of all acute cervical spine fractures. Isolated atlas fractures are most commonly bilateral or multiple fractures through the ring of C1. Frequently (44% of cases), the atlas will be fractured in combination with the axis. Treatment of isolated C1 fractures should be governed by the rules of Spence. The treatment of combination C1-C2 fractures is dictated by the type and severity of the C2 fracture. Experience with 57 cases of acute atlas fractures is reviewed. Nonoperative external immobilization was used in 53 patients (with 1 failure), and early surgical wiring and fusion were performed in 4 patients. The long term outcome from an atlas fracture is good (median follow-up, 40 months).
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Rahim, Ashfaq ur, Sadiq Ali, Muhammad Nauman, Tannaza Qayyum, Abdullah Khan, Mohammad Abdullah Khan, and Zahid Iqbal. "Comparison of Preauricular Approach Versus Retromandibular Approach in Management of Condylar Fractures." Pakistan Journal of Medical and Health Sciences 15, no. 8 (August 26, 2021): 2137–40. http://dx.doi.org/10.53350/pjmhs211582137.
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Objectives: Surgical treatment of patients with multiple mandibular fractures involving condylar segments may be a difficult proposition for a maxillofacial surgeon. These fractures can be double or triple fractures of the lower mandible and can also be associated with other fractures of the face. While many authors have suggested that the conventional approach to reducing and stabilizing a mandibular symphysis / para-symphysis fracture is appropriate before addressing a fractured condyle, there is another school of thought that suggests that the condylar segment should be reduced and repaired first. This article aims to review the results of operations where the reduction and fixation of a fractured condyle is performed prior to other associated mandible fractures, and to explore the effectiveness of various surgical methods including preauricular and retromandibular proposed in this case. Place and Duration: In the Oral and Maxillofacial surgery department of Faryal Dental College, Lahore for two-years duration from Jan 2018 to Jan 2020. Material and methods: The study included 60 surgically treated patients with multiple mandible fractures (double / triple), including the condyle component. For treatment of the fractured condylar segments, the preauricular and retromandibular (anterior parotid-transmasseteric) approach was used. Results: Condyle fracture was the first segment to be managed during sequencing of surgical treatment, regardless of the method used. First, good reduction and stabilization have been achieved with limited complications in treating a condyle fracture. Conclusion: While it is the surgeon's prerogative to sort multiple mandible fractures, addressing the condylar segment first provides the operator with a viable alternative to the conventional technique. Key words: condylar fractures, multiple mandibular fractures, preauricular approach, retromandibular approach
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Lee, Seung, Jae Sim, Do Han, and Min Kim. "A Transpatellar Approach to Treat Distal Femoral Type C3 Fractures Combined with Patellar Fractures." Journal of Knee Surgery 31, no. 09 (February 6, 2018): 905–12. http://dx.doi.org/10.1055/s-0038-1626734.
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AbstractWe report our surgical method used to treat type C distal femur fractures accompanied by patella fractures whereby we approach the articular surface of the femur through the already-fractured patella. We treated 10 patients with type C3 distal femur and patella fractures between May 2013 and April 2015. Because the patella was fractured in all cases, we could approach the articular surface of the distal femur through the transverse gap between the retracted patellar fracture fragments, “transpatellar approach.” Any surgical complications were recorded. Knee function was evaluated using the Böstman system. The average age of the 10 patients (8 males) was 42.9 years (range, 22.0–58.0 years). All distal femur fractures were type C3, combined with patella fractures. Bony union of the distal femur and patella was achieved in all but one patient, who required an additional bone graft (without any change in the implant). Overall, three patients (30%) reported excellent results and seven (70%) reported good results, based on the Böstman system. A midline anterior approach through a patella fracture adequately exposes the entire joint surface of the distal femur, except the posterior surface. This approach is useful when treating a type C distal femur fracture accompanied by a patella fracture. The level of evidence is IV.
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Noor, Marjan, Raheel Hassan, Abid Hussain Bukhari, and Rashida Hilal. "Frequency of Parasymphysis Fracture in Mandibular Fractures Due to Road Traffic Accidents." Pakistan Journal of Medical and Health Sciences 16, no. 9 (September 30, 2022): 333–34. http://dx.doi.org/10.53350/pjmhs22169333.
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Objective: To determine the frequency of parasymphysis fracture in mandibular fractures due to road traffic accidents. Study Type: Cross-sectional study Duration and Place of Study: Department of OMF Surgery Ayub Teaching Hospital, Abbottabad from 1st December 2019 to 30thMay 2020 Methodology: One hundred and forty eight patients were shifted to the Radiology Department for X-rays of mandible . Fractures of mandible especially fracture of parasymphysis were seen. Results: The mean age was 47.46±21.25 years. Fractured parasymphysis was found in 75 (82%) male patients and female patients were 14% (8/57). Conclusions: The gender was found to be significantly associated with the outcome i.e. parasymphysis fracture in mandibular fractures due to road traffic accidents. The age, number of fractures and type of fractures were not found to be significantly associated with the outcome i.e. parasymphysis fracture in mandibular fractures due to road traffic accidents. Keywords: Parasymphysis fracture, Mandibular fractures, Facial injury
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Nickerson, Duncan, and Donald Mcphalen. "Teeth in the Line of Mandibular Fractures." Canadian Journal of Plastic Surgery 2, no. 3 (September 1994): 113–16. http://dx.doi.org/10.1177/229255039400200308.
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D Nickerson, D McPhalen. Teeth in the line of mandibular fractures. Can J Plast Surg 1994;2(3):113-116. This study considers 710 mandibular fractures occurring in 546 patients over a five-year period and notes the fate of 114 teeth involved in the line of 104 of these fractures. Analysis of retention versus removal of teeth in the fracture line and any associated infection was undertaken. Overall, 15.5% of cases that involved retained teeth became infected, as compared with 7.1% of cases in which a tooth was extracted from the fracture site. for third molars, the teeth most commonly involved in mandibular fractures, infection was associated with 20.5% of retained teeth and 10% of cases where teeth were extracted from the fracture site. These data support careful consideration of a tooth's disposition before a decision regarding retention or extraction is made. Furthermore, they suggest that even in the absence of a grossly evident risk factor for infection, such as a fractured tooth, the tooth itself may inherently predispose to infection if retained. Infection rates were higher for retained teeth regardless of whether open reduction with rigid internal fixation or closed reduction with maxillomandibular fixation was used.
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FINSEN, V., and P. BENUM. "Regional Bone Mineral Density Changes after Colles’ and Forehand Fractures." Journal of Hand Surgery 11, no. 3 (June 1986): 357–59. http://dx.doi.org/10.1016/0266-7681_86_90157-9.
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Patients who sustain a second Colles’ fracture only in one of five instances refracture the previously injured wrist. In those who have sustained fractures of the metacarpals or phalanges of the hand (forehand) subsequent fractures of the forehand are twice as likely to be ipsilateral. We investigated whether persisting regional bone mineral changes could be the mechanism underlying these observations. Bilateral bone mineral density measurements were performed on twenty patients who had sustained a Colles’ fracture and twenty-nine who had sustained forehand fractures more than one year previously. Among Colles’ fracture patients there was an increase in bone mineral density in the distal radius of the fractured side when compared to the uninjured side of thirty-nine percent. The protection of these patients from subsequent ipsilateral Colles’ fracture seems to be due to increased bone strength induced by the healing process. Among patients with forehand fractures no significant bone mineral changes could be demonstrated.
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Kobayashi, Yoshikazu, Koji Satoh, and Hideki Mizutani. "Osteogenesis Imperfecta Diagnosed from Mandibular and Lower Limb Fractures: A Case Report." Craniomaxillofacial Trauma & Reconstruction 9, no. 2 (June 2016): 141–44. http://dx.doi.org/10.1055/s-0035-1550063.
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Osteogenesis imperfecta (OI) is a congenital disease characterized by bone fragility and low bone mass. Despite the variety of its manifestation and severity, facial fractures occur very infrequently. Here, we report a case of an infant diagnosed with OI after mandibular and lower limb fractures. A boy aged 1 year and 3 months was brought to his neighboring hospital with a complaint of facial injury. He was transferred to our hospital to undergo operation 3 days later. Computed tomography images revealed multiple mandibular fractures including complete fracture in the symphysis and dislocated condylar fracture on the right side. Open reduction and internal fixation with absorbable implants was performed 7 days after injury. He fractured his right lower limb 2 months later. He was diagnosed with OI type IA by an orthopedist. He will be administered bone-modifying agents if he suffers from frequent fractures.
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Amin, Dina, Kareem Al-Mulki, Oswaldo A. Henriquez, Angela Cheng, Steven Roser, and Shelly Abramowicz. "Review of Orbital Fractures in an Urban Level I Trauma Center." Craniomaxillofacial Trauma & Reconstruction 13, no. 3 (May 8, 2020): 174–79. http://dx.doi.org/10.1177/1943387520924515.
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Objective: To perform a comprehensive review and analysis of surgically treated orbital fractures. Study Design: Retrospective cohort chart review study for surgically treated orbital fractures during 5 years. Results: A total of 173 patients (average age 41.6 years) were diagnosed with orbital fractures. Most were male with a ratio of 3.3:1. Most fractures were caused by assault (39.3%); 22.5% of the cases were bilateral. The left orbit (40.5%) was fractured more than the right. The orbital floor (97.1%) was the most common anatomic location and the maxilla (65.3%) was the most commonly involved bone. The average time from trauma to surgical intervention was 8.7 ± 14.6 days and the average time from surgical intervention to discharge was 5.1 ± 9.0 days. The transconjunctival incision (63%) was the most commonly used incision, and nonresorbable implant (92.7%) was the most commonly used implant. Finally, the length of stay for the repair of a simple orbital fracture was less than for complex orbital fracture (1.5 days and 5.9 days, respectively). Conclusion: Understanding the patterns and mechanisms of injury associated with orbital fractures can assist in developing standardized treatment protocols across all surgical specialties. This would ultimately allow for a uniform high quality of surgical care for patients with maxillofacial fractures.
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Ryant Ganda Santoso, Endang Sjamsudin, and Seto Adiantoro. "The The Incidence of Mandibular Angle Fractures Accompanied by Impacted Third Molar at Oral Surgery Clinic of Hasan Sadikin Hospital, Bandung - West Java." Dentika: Dental Journal 25, no. 1 (July 28, 2022): 42–46. http://dx.doi.org/10.32734/dentika.v25i1.6247.
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Mandibular fracture is a discontinuity of mandible bone that usually leads to trauma. The fractured area is mostly the mandibular angle located in the third molar area. Therefore, this study aims to examine the incidence of mandibular angle fractures accompanied by impacted teeth in the oral surgery clinic of Hasan Sadikin Hospital. This is a retrospective observational study and the data used were collected from the medical records of patients with mandibular angle fractures accompanied by impacted third molars at the Oral Surgery Clinic of Dr. Hasan Sadikin Bandung from January 2017 to December 2019. Panoramic radiographs were obtained for confirmation and the data collected were age, gender, fracture aetiology and location, impacted tooth type and classification, as well as treatment. The number of mandibular angle fractures with impacted third molars in male patients (92.8%) was more than in females (7.2%). Fractures caused by traffic accidents and fights were 85.8% and 14.2%, respectively, while all patients were treated with ORIF. The percentage of cases according to the classification of third molars in angle fractures are classes IA (20%), IB (6.7%), IIA (20%), IIB (20%), IIC (13.3%), IIIC (6.7%), and unerupted tooth seeds (13.3%).The incidence of mandibular angle fracture with impacted third molars at the Oral Surgery Clinic, Dr. Hasan Sadikin over the last three years has increased. This case is more common in males due to traffic accidents and is treated with surgery (ORIF).
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Lespessailles, Eric, Julien Paccou, Rose-Marie Javier, Thierry Thomas, and Bernard Cortet. "Obesity, Bariatric Surgery, and Fractures." Journal of Clinical Endocrinology & Metabolism 104, no. 10 (March 22, 2019): 4756–68. http://dx.doi.org/10.1210/jc.2018-02084.
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Abstract Context Obesity and its associated comorbidities are a recognized and growing public health problem. For a long time, obesity-associated effects on bone were considered to strengthen the bone, mainly because of the known relationship between body weight and bone mass and the long-term weight-bearing load effect on bone. However, recent epidemiologic studies have shown that obesity may not have a fully protective effect on the occurrence of fragility fractures. The goal of this article is to review updated information on the link between obesity, bariatric surgery, and fractures. Methods The primary source literature for this review was acquired by searching a published database for reviews and articles up to January 2018. Additional references were selected through the in-depth analysis of the relevant studies. Results We present data showing that overweight and obesity are often encountered in fracture cases. We also analyzed possible reasons and risk factors for fractures associated with overweight and patients with obesity. In addition, this review focuses on the complex effects of dramatic changes in body composition when interpreting dual-energy X-ray absorptiometry readings and findings. Finally, we review the data on the effects and consequences of bariatric surgery on bone metabolism and the risk of fractures in patients undergoing these procedures. Conclusion Because of various adiposity-induced effects, patients with obesity are at risk for fracture in certain sites. Bariatric surgery increases the risk of fractures in patients undergoing malabsorptive procedures.
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Anghel, S., and D. Márton. "The Loss of Correction in Thoracolumbar Burst Fracture Treated by Surgery. Can We Predict It?" Acta Medica Marisiensis 60, no. 3 (June 1, 2014): 99–101. http://dx.doi.org/10.2478/amma-2014-0020.
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Abstract Objective: This paper aims to differentially depict potential patterns of the loss of correction in surgically treated thoraco-lumbar burst fractures. These may eventually serve to foreseeing and even forestalling loss of correction. Methods: The study focused on 253 patients with surgically treated thoraco-lumbar fractures. This cohort of patients was clustered in four subgroups according to the fracture spine segment (T11-L1 or L1-L2) and surgery type (short segment fi xation or anterior approach). Relevant recorded and processed data were the fracture level, post-operative (Kpo) and last follow-up (Kf) kyphosis angle values. Correlation, regression and determination testing were performed for the last follow-up kyphosis angle and post-operative kyphosis angle, and regression equations were determined for each subgroup of patients. Results: The patterns of loss of correction were described through the following equations: Kf = 0.95*Kpo + 3.2° for the T11-L1 level fractured vertebrae treated by posterior short segment fixation; Kf = 0.98*Kpo + 3.4° for the L1-L2 level fractured vertebrae treated by posterior short segment fixation; Kf = 1.1*Kpo + 1.6° for the T11-L1 level fractured vertebrae treated by anterior approach; and Kf = 0.7*Kpo + 2.8° for the L1-L2 level fracture vertebrae treated by anterior approach. Conclusions: The loss of correction may be predicted, to a certain extent, for thoraco-lumbar fractured vertebrae treated surgically. The bestfit equations depicted for both type of surgery (short segment fixation and anterior approach) and both spinal segments (T11-L1 and L2-L3) are significantly different than the equations delineated for the collapse of non-surgically treated fractures.
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KOPYLOV, P., O. JOHNELL, I. REDLUND-JOHNELL, and U. BENGNER. "Fractures of the Distal End of the Radius in Young Adults: A 30-Year Follow-Up." Journal of Hand Surgery 18, no. 1 (February 1993): 45–49. http://dx.doi.org/10.1016/0266-7681(93)90195-l.
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76 patients were examined clinically and radiologically 27 to 36 years after a fracture of the distal radius. The average age was 31 years at the time of injury and 63 years at follow-up. In 81% of the patients there was no difference between the fractured and the non-fractured side. No patient had to change his or her occupation or leisure activities because of the fracture. There were more degenerative changes in the fractured wrist than in the non-injured side. A statistically significant correlation was found between axial compression and the presence of degenerative changes in the radio-carpal and distal radio-ulnar joints. Treatment of the fracture of the distal end of the radius in the young adult should aim to conserve the length of the radius. However, after 30 years, complaints are few and correlate with degenerative changes in the radio-carpal joint only. 47 patients with articular fractures of the distal end of the radius were examined in the same way. The average age at the time of injury was 32 years and 58% of the patients were men. In 87% of the patients there was no difference between the fractured and the non-fractured side. However 37% had minor complaints. A higher proportion of patients with articular fractures developed degenerative changes than those with non-articular fractures. The existence of radiographic signs of osteoarthritis is directly related to axial compression and the persistant incongruity, after reposition, in either the radio-carpal or the distal radio-ulnar joints.
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Sharma, Ashish, Sanjay Rastogi, Manish Shukla, Rupshikha Choudhury, Siddhi Tripathi, and Jawed Iqbal. "Use of Transgingival Lag Screw Osteosynthesis in the Management of Alveolar Process Fracture." Craniomaxillofacial Trauma & Reconstruction 12, no. 1 (March 2019): 27–33. http://dx.doi.org/10.1055/s-0038-1629906.
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The purpose of this study is to check the efficacy of transgingival lag screw osteosynthesis in alveolar process fractures of maxilla and mandible. A single-arm nonrandomized observational study was performed for the treatment of alveolar process fractures of maxilla and mandible. In this study, 20 mixed age group patients with alveolar process fracture were included. All the patients were treated by a 2.0-mm transgingival screw fixation under local or general anesthesia. All the patients were evaluated for fracture stability, anatomical reduction, bone loss and bone resorption of alveolar process, tooth loss, and wound infection at 3 months of follow-up. A simple descriptive statistical analysis was done to evaluate the parameters and it was shown that the treatment of alveolar process fracture with two or three lag screws provides adequate fracture stability and anatomical reduction with no signs of bone loss and tooth loss, and wound infections were noted post lag screw fixation. The study concludes that transgingival lag screw fixation is a suitable alternative for alveolar process fractures in all the age groups and two to three lag screws are generally sufficient to fix fractured alveolar process either under local anesthesia or general anesthesia.
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Arai, Daishi, Akihiro Yasue, Shinya Horiuchi, and Eiji Tanaka. "A Multidisciplinary Approach to Malocclusion Caused by Facial Multiple Fracture." Case Reports in Dentistry 2022 (March 3, 2022): 1–8. http://dx.doi.org/10.1155/2022/5209667.
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In the case of multiple facial fractures, a simple open reduction occasionally causes various disorders during healing process after the surgery. Moreover, esthetic disturbance of a facial deformity might be induced. Therefore, the acquisition of facial symmetry and the recovery of occlusal and masticatory functions become increasingly important. This case report presents a successful treatment of facial multiple fracture induced by a car accident. A 20-year-old male was diagnosed with suffered multiple midface and mandibular fractures induced by a car accident. Midface fractures included the LeFort I and II type fractures, as well as sagittal fracture at midline and fractures from right maxillary sinus anterior wall to orbital wall. In the mandible, midline and left body fractures were detected. The patient underwent open reduction and rigid fixation of the fractured left zygoma, comminuted LeFort I and II fractures, and midline and left body of the mandible with intermaxillary fixation by multibracket appliance; maxillary osteotomy with iliac bone grafting; orthognathic two-jaw surgery with coronoid process grafts onto the depressed zygoma; and onlay graft of hydroxyapatite block on mandible. As the result, the multidisciplinary treatments successfully recover functions and esthetics to the satisfactory level of the patient with multiple facial fractures. As treatments for multiple facial fractures are required complexity due to the extent of trauma, multidisciplinary approach under the close cooperation between hospital departments is thought to be important.
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Hartley, R., A. Baykan, P. Ronksley, A. Harrop, and F. Fraulin. "P087: A comparison of how emergency physicians and plastic surgeons evaluate and triage pediatric hand fractures: a prospective trial of the Calgary Kids’ Hand Rule." CJEM 22, S1 (May 2020): S95—S96. http://dx.doi.org/10.1017/cem.2020.293.
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Introduction: Hand fractures in children are common and most are adequately managed with immobilization alone. There is a subset of fractures that require surgery as well as a fear of growth plate disturbance. For these reasons, triaging the so-called “complex” fractures that require specialized care by a hand surgeon is critical. In an effort to improve triaging for pediatric hand fractures, we previously derived and internally validated a prediction model for pediatric hand fracture triage using multivariable logistic regression with bootstrapping. The primary outcome was “complex fracture”, a definition we assigned to any fractures that required surgery, closed reduction or more than four appointments with a plastic surgeon. The model identified six significant predictors of complex fractures: angulation, condylar involvement, dislocation or subluxation, displacement, open fracture, and malrotation with strong performance (C-statistic 0.88) and was named the Calgary Kids’ Hand Rule (CKHR). Methods: A prospective cohort study was conducted at the Alberta Children's Hospital from April 1 until December 31, 2019. Eligible patients included children 17 years and younger with a radiographically confirmed hand fracture. Both emergency physicians and plastic surgeons completed independent CKHR forms for each new hand fracture. The fracture was predicted as “complex” if any one of the six predictors were present on the form. If none of the six predictors were present, the predicted outcome was “simple”. The observed outcome was “complex” if the fracture required surgery, closed reduction, or four or more appointments with a plastic surgeon at three months follow-up. All other fractures were observed outcome “simple”. The classification performance of the CKHR was assessed via sensitivity, specificity, and C-statistic. The kappa coefficient for inter-rater reliability between emergency physicians and plastic surgeons was calculated for each predictor. Results: To date, 102 pediatric hand fractures have been included in this prospective cohort study. Of the 74 observed simple fractures, 49 were predicted as “simple” and 25 were predicted as “complex”. Of the 28 observed “complex” fractures, 25 were predicted as “complex” and 3 were predicted as “simple”. These findings correspond to a sensitivity of 89%, specificity of 66%, and a C-statistic of 0.78. Of the 3 observed “complex” fractures that were predicted as “simple”, i.e. the 3 false negatives, one was a Seymour fracture of the fourth distal phalanx for which the emergency physician did not tick any boxes on the form. Upon further investigation, we learned that the physician had commented that the fracture was open, thus alluding to their acknowledgement of the predictor “open fracture” as being present). This fracture went on to require surgery. The second false-negative fracture was a non-displaced, intra-articular fracture of the fourth metacarpal head that required multiple appointments with the plastic surgeon. The third false-negative fracture was a non-displaced Salter-Harris II fracture of the thumb proximal phalanx without malrotation that received a closed reduction by the emergency physician. The kappa coefficient for inter-rater reliability between emergency physician and plastic surgeon evaluation of predictors varied by predictor from fair to almost perfect agreement. Condylar involvement had the highest kappa coefficient (kappa = 0.85) followed by malrotation (kappa = 0.65) and dislocation (kappa = 0.64). The predictors with the lowest kappa coefficients were displacement (kappa = 0.42), open fractures (kappa = 0.50), and angulation (kappa = 0.53). Conclusion: The Calgary Kids’ Hand Rule had a sensitivity of 89% in a prospective cohort of pediatric hand fractures referred to the Alberta Children's Hospital. The sensitivity could likely be improved with knowledge translation and specific education regarding use of the prediction tool. Emergency physicians and plastic surgeons displayed the lowest inter-rater reliability when assessing displacement, open fractures, and angulation. These predictors may represent areas of future research and physician education to delineate and decrease the discordance between emergency physicians and plastic surgeons.
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Pryputniewicz, David M., and Mark N. Hadley. "Axis Fractures." Neurosurgery 66, suppl_3 (March 1, 2010): A68—A82. http://dx.doi.org/10.1227/01.neu.0000366118.21964.a8.
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Abstract BACKGROUND Traumatic fractures of the second cervical vertebra are common, representing nearly 20% of all acute cervical spinal fracture-dislocation injuries. They are divided into 3 distinct injury patterns: odontoid fractures, hangman's fracture injuries, and fractures of the axis body, involving all other fracture injuries to the C2 vertebra. OBJECTIVE An evidence-based overview of the medical and surgical treatment strategies for each axis fracture injury sub-type. RESULTS Current medical and surgical management of traumatic fractures of the axis.
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Woodbridge, Nicolas, and Martin Owen. "Feline Mandibular Fractures." Journal of Feline Medicine and Surgery 15, no. 3 (February 19, 2013): 211–18. http://dx.doi.org/10.1177/1098612x13477541.
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Practical relevance: Mandibular fractures occur commonly in cats and appropriate treatment is vital to ensure restoration of dental occlusion and masticatory function. Clinical challenges: Historically, a relatively high complication rate has been reported in association with mandibular fracture repair, and these complications can represent a significant challenge for the veterinary surgeon. Audience: General practitioners as well as specialists in small animal surgery are presented with fractures of the mandible on a regular basis. Patient group: Cats of all ages can suffer mandibular fracture; however, young cats (mean age 30 months) are over-represented. No sex predilection is reported. Equipment: The nature of the equipment required for mandibular fracture repair varies greatly, depending on the fracture type and location. An uncomplicated mandibular symphyseal fracture requires only basic orthopaedic equipment whereas the surgeon must ensure they have access to a wide range of orthopaedic equipment prior to undertaking repair of a complex mandibular fracture. Evidence base: Management of mandibular fractures is a complex subject. Over the past three decades many fixation techniques have been described in the veterinary literature, with authors analysing and discussing the surgical management of these potentially challenging injuries.
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Yang, J., T. Wang, N. F. Tian, X. Bin Yu, H. Chen, Y. S. Wu, and L. J. Sun. "Supracondylar humeral fractures in children: American Academy of Orthopaedic Surgeons appropriate use criteria versus actual management in a teaching hospital." Journal of Children's Orthopaedics 13, no. 4 (August 2019): 404–8. http://dx.doi.org/10.1302/1863-2548.13.190081.
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Purpose The objective of this study was to explore whether there were any differences between the theoretical recommendations for children’s supracondylar humeral fractures (CSHF) according to the American Academy of Orthopaedic Surgeons (AAOS) guidelines and the treatments they actually received in our institution. Methods We retrospectively reviewed the medical charts and radiographs of all CSHFs at our hospital between January 2015 and December 2018. In all, 301 children meeting our inclusion criteria were identified and evaluated using the AAOS-Appropriate Use Criteria (AUC) application for supracondylar humerus fractures. Actual treatment was then compared with the treatment recommended by the AUC. Results Actual operative management was undertaken in 0/58 (0%) Gartland type I fractures, 61/108 (56.5%) type II fractures and 98/135 (72.6%) type III fractures. Actual nonoperative management was undertaken in 58/58 (100%) Gartland type I fractures, 47/108 (43.5%) type II fractures and 37/135 (27.4%) type III fractures. Surgeon decisions for nonoperative treatment were in agreement with the AUC recommendations 100% of the time, whereas surgeon decisions for surgery matched the AUC recommendations 65.4% of the time. Predictors of actual operative management were age (p =0.003), fracture classification (p =0.000), associated orthopaedic injury requiring surgery (p =0.025) and anterior humeral line (AHL) not intersecting the capitellum (p =0.008). Conclusion We found low agreement between actual treatments and the AUC-recommended ‘appropriate’ treatments. The AUC favoured operative intervention more frequently largely on the basis of fracture classification while we emphasized age, fracture classification, associated orthopaedic injury requiring surgery and alignment of the AHL with the capitellum in our operative decision-making process. Level of evidence: Therapeutic Level II
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Aires, Carolina Chaves Gama, Lucas Viana Silva Ramos, Eugênia Leal De Figueiredo, Manoela Moura De Bortoli, and Ricardo José De Holanda Vasconcellos. "Airway Obstruction After Bilateral Mandibular Parasymphyseal Fracture: A Case Report." Craniomaxillofacial Trauma & Reconstruction Open 5 (January 1, 2020): 247275122090570. http://dx.doi.org/10.1177/2472751220905700.
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Bilateral mandibular parasymphyseal fractures may compromise airway maintenance. The aim of the present study is to report the case of a patient with bilateral parasymphyseal fracture who developed some degree of airway obstruction and required urgent surgical treatment. A 19-year-old female motorcycle accident victim presenting bilateral mandibular parasymphyseal fractures evolved with difficulty breathing, 5 hours after trauma. To improve the patient’s clinical condition, urgent surgical treatment 12 hours after the trauma was opted. The fractures were fixed with two 2.0-mm plate and screw systems at each fractured site. After surgery, the patient evolved with good oxygen saturation and no difficulty in breathing. Occlusion obtained during surgery remained satisfactory and stable over the 2-year postoperative follow-up. Emergency surgical treatment of the bilateral mandibular parasymphyseal fracture was imperative in the present case since the patient developed respiratory distress after the trauma.
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Aruse, Ophir, Igor Immerman, Omar Badir, Madi El Haj, Ido Volk, and Shai Luria. "Scaphoid fracture displacement is not correlated with the fracture angle." Journal of Hand Surgery (European Volume) 46, no. 6 (April 1, 2021): 607–15. http://dx.doi.org/10.1177/17531934211004434.
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Classifications of scaphoid fractures associate the angle of the fracture with its stability. To examine this assumption, we measured acute scaphoid fracture angles and inclinations in relation to different scaphoid axes, using fracture displacement as an indicator of instability. We examined the effect of using different axes on the measurements of angles. CT scans of 133 scaphoid fractures were classified according to the location of the fractures. Using a three-dimensional computer model, we computed four scaphoid axes. For each fracture, we then measured the fracture angle and the direction of the fracture inclination in relation to each one of the axes. We found a correlation between displacement and the angles of proximal fractures using one of these axes (the surface principal component analysis axis). No such correlations were found for waist fractures, which were the majority of fractures. There were significant differences between the measurements made with different axes. The findings indicate that the angle of the fracture and the direction of the fracture inclination are minor factors in the displacement of most scaphoid fractures. Level of evidence: III
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HUBNER, ANDRÉ RAFAEL, MATEUS MEIRA GARCIA, RODRIGO ALVES VIEIRA MAIA, DANIEL GASPARIN, CHARLES LEONARDO ISRAEL, and LEANDRO DE FREITAS SPINELLI. "MECHANICAL BEHAVIOR OF THORACOLUMBAR CORONAL SPLIT FRACTURES: FINITE ELEMENT ANALYSIS." Coluna/Columna 19, no. 3 (July 2020): 205–8. http://dx.doi.org/10.1590/s1808-185120201903223027.
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ABSTRACT Objective To analyze the behavior of thoracolumbar fractures of the coronal split type using the finite element method. Methods Two comparative studies were conducted through simulation of coronal split fractures in a finite model in which the first lumbar vertebra (L1) was considered to be fractured. In the first case, the fracture line was considered to have occurred in the middle of the vertebral body (50%), while in the second model, the fracture line occurred in the anterior quarter of the vertebral body (25%). The maximum von Mises stress values were compared, as well as the axial displacement between fragments of the fractured vertebra. Results The stress levels found for the fracture located at half of the vertebral body were 43% higher (264.88 MPa x 151.16 MPa) than those for the fracture located at the anterior 25% of the vertebra, and the axial displacement of the 50% fractured body was also greater (1.19 mm x 1.10 mm). Conclusions Coronal split fractures located in the anterior quarter of the vertebral body incurred less stress and displacements and are more amenable to conservative treatment than 50% fractures occurring in the middle of the vertebral body. Level of Evidence III; Experimental study.
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Lee, Seungjin, Daehun Shin, and Yoonsuk Hyun. "Unrecognized bony Bankart lesion accompanying a dislocated four-part proximal humerus fracture before surgery: a case report." Clinics in Shoulder and Elbow 25, no. 1 (March 1, 2022): 68–72. http://dx.doi.org/10.5397/cise.2021.00605.
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Proximal humerus fractures are the third most common fractures, totaling 4% to 5% of all fractures. Here, we present the case of a 39-year-old man with a dislocated four-part fracture of the proximal humerus with a huge bony Bankart lesion. Preoperatively, the bony Bankart lesion of the glenoid was not visualized on computed tomography scans or magnetic resonance imaging because the fracture of the proximal humerus was comminuted, displaced, and complex. It was planned for only the humerus fracture to be treated by open reduction and internal fixation using a locking plate. However, a fractured fragment remained under the scapula after reduction of the dislocated humeral head. This was mistaken for a dislocated bone fragment of the greater tuberosity and repositioning was attempted. After failure, visual confirmation showed that the bone fragment was a piece of the glenoid. After reduction and fixation of this glenoid part with suture anchors, we acquired a well-reduced fluoroscopic image. Given this case of complex proximal humerus fracture, a glenoid fracture such as a bony Bankart lesion should be considered preoperatively and intraoperatively in such cases.
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Pau, Candace Y., Jose E. Barrera, Jaehwan Kwon, and Sam P. Most. "Three-Dimensional Analysis of Zygomatic-Maxillary Complex Fracture Patterns." Craniomaxillofacial Trauma & Reconstruction 3, no. 3 (September 2010): 167–76. http://dx.doi.org/10.1055/s-0030-1263082.
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Zygomatic-maxillary (ZMC) complex fractures are a common consequence of facial trauma. In this retrospective study, we present a novel method of ZMC fracture pattern analysis, utilizing three-dimensional visualization of computed tomography (CT) images to record displacement of the malar eminence in a three-dimensional coordinate plane. The pattern of fracture was then correlated with treatment outcome. Facial CT scans were obtained from 29 patients with unilateral ZMC fractures and 30 subjects without fractures and analyzed. Briefly, displacement of the malar eminence (ME) on the fractured side was measured in medial-lateral (x), superior-inferior (y), and anterior-posterior (z) dimensions, as well as Euclidean distance, by comparison to ME location on the unfractured side. Baseline natural variance in asymmetry was accounted for by comparing ME location on the left and right sides in subjects without fractures. Patients who required open reduction and internal fixation (ORIF) to repair the ZMC fracture alone had significantly greater cumulative ME displacements than patients who did not require ORIF ( p = 0.02). Additionally, patients with a high fracture score of 3, 4, or 5 (assigned based on severity displacement in each dimension) had significantly higher rates of ORIF than patients with a low fracture score of 0, 1, or 2 ( p = 0.05). Severe displacement in one or more dimensions was associated with higher rates of ORIF than seen in patients with only neutral or mild displacements in all dimensions ( p = 0.05). Severe x displacement was most strongly correlated with surgical intervention ( p = 0.02). Overall, orbital floor repair was less strongly associated with most displacement measures than ZMC repair alone; however, patients requiring orbital floor repair had greater Euclidean ME displacements than patients who did not require orbital floor repair ( p = 0.02). Fracture severity, as determined by multiple parameters in this novel evaluation system, is associated with higher rates of ORIF in patients with unilateral ZMC fractures. Determination of ZMC fracture pattern may thus be informative when considering treatment options.
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Zhou, Peiran, and Christopher B. Chambers. "Orbital Fractures." Seminars in Plastic Surgery 35, no. 04 (November 2021): 269–73. http://dx.doi.org/10.1055/s-0041-1735815.
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AbstractOrbital fractures are common in facial trauma and can be a challenge to treat. Understanding anatomy of the orbit, the clinical evaluation, indications for surgery, surgical approaches, complications, and postoperative are essential in providing appropriate treatment for patients who have sustained orbital fractures. In this article, the authors review the diagnostic evaluation, acute management, treatment options, and common complications of orbital fractures, as well as recent advancements in orbital fracture repairs.
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Sumarwoto, Tito, Seti Aji Hadinoto, Herlambang Pranandaru, Hanif Andhika, Сholahuddin Рhatomy, and Pamudji Utomo. "Short-term Follow-up of Early Reconstructive Surgery Management in Neglected Supracondylar Humeral Fractures." Open Access Macedonian Journal of Medical Sciences 9, B (January 5, 2021): 24–28. http://dx.doi.org/10.3889/oamjms.2021.5577.
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BACKGROUND: The supracondylar humeral fracture is a fracture located in the proximal position of the trochlea and humeral capitulum. This fracture is the most common elbow fracture in children. Epidemiological research states that these fractures constitute 58% of all elbow fractures in children. It is also mentioned that 10–20% patients undergo belated admission to get therapy. Based on the literature, the fracture is categorized as neglected if the fracture treatment is 14 days post-trauma. Unfortunately, few reports can provide management guidelines. Some experts mention the “wait and see” attitude toward this fracture until a perfect remodeling happens to correct the deformity; however, a number of studies have shown good results after early reconstruction.
AIM: We aimed to evaluate the short-term follow-up of supracondylar humeral fractures that came after 14 days of injury and then open reduction reconstructions were done, followed by the installation of K-wire and screws with the figure of eight patterns based on the quick disabilities of the arm, shoulder, and hand (Q-DASH) 9-score, Flynn’s Criteria, and Mayo Elbow Performance Score (MEPS).
METHODS: The samples were five patients who underwent corrective open reduction and injury fixed with Kirschner (K)-wire and screws with the figure of eight patterns using the posterior approach at the Orthopedic Hospital from December 2019 to February 2020. Results were assessed with the quick disabilities of the arm, shoulder, and hand-9 score (Q-DASH-9 score), Flynn’s Criteria, and Mayo Elbow Performance Score (MEPS).
RESULTS: All patients after reconstruction correction showed an increase in range of motion in the fractured elbow. No complications were found from the surgical treatment.
CONCLUSIONS: Early reconstruction correction of patients with supracondylar humeral fractures gave satisfactory results based on the Q-DASH-9 Score, Flynn’s Criteria, and MEPS.
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Atul, Parashar, K. Sharma Ramesh, and Makkar Surinder. "Rigid internal fi xation of zygoma fractures: A comparison of two-point and three-point fi xation." Indian Journal of Plastic Surgery 40, no. 01 (January 2007): 18–24. http://dx.doi.org/10.1055/s-0039-1699174.
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ABSTRACT Background:Displaced fractures of the zygomatic bone can result in significant functional and aesthetic sequelae. Therefore the treatment must achieve adequate and stable reduction at fracture sites so as to restore the complex multidimensional relationship of the zygoma to the surrounding craniofacial skeleton. Many experimental biophysical studies have compared stability of zygoma after one, two and three-point fixation with mini plates. We conducted a prospective clinical study comparing functional and aesthetic results of two-point and three-point fixation with mini plates in patients with fractures of zygoma.Materials and Methods:Twenty-two patients with isolated zygomatic fractures over a period of one year were randomly assigned into two-point and three-point fixation groups. Results of fixation were analyzed after completion of three months. This included clinical, radiological and photographic evaluation.Results:The three-point fixation group maintained better stability at fracture sites resulting in decreased incidence of dystopia and enophthalmos. This group also had better malar projection and malar height as measured radiologically, when compared with the two-point fixation group.Conclusion:We recommend three-point rigid fixation of fractured zygoma after accurate reduction so as to maintain adequate stabilization against masticatory forces during fracture healing phase.
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Konarski, Wojciech, Tomasz Poboży, Andrzej Kotela, Andrzej Śliwczyński, Ireneusz Kotela, Martyna Hordowicz, and Jan Krakowiak. "The Risk of Avascular Necrosis Following the Stabilization of Femoral Neck Fractures: A Systematic Review and Meta-Analysis." International Journal of Environmental Research and Public Health 19, no. 16 (August 15, 2022): 10050. http://dx.doi.org/10.3390/ijerph191610050.
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Background: Avascular necrosis (AVN) of the femoral head often requires surgical treatment and is often associated with femoral neck fractures. We conducted a systematic review and meta-analysis of recent research on the risk of AVN following the stabilization of fractured femoral neck with implants in PubMed. We assessed the effect of age on AVN incidence among patients aged > 50 and younger, depending on fracture type, Garden stage, Pouwels degree, Delbet stage, and age category. We followed PRISMA guidelines. Relevant studies were defined as research articles describing real-world studies reporting on the risk of AVN following primary surgical fracture stabilization with implants, published between 1 January 2011 and 22 April 2021. Fifty-two papers met the inclusion criteria, with a total of N = 5930 with surgically managed fractures. The pooled mean AVN incidence was significantly higher among patients with displaced fractures (20.7%; 95% CI: 12.8–28.5%) vs. those with undisplaced fractures (4.7%; 95% CI: 3.4–6.0%). No significant correlation was observed between AVN incidence weighted by sample size and time interval from injury to surgery (p = 0.843, R2 = 0.01). In conclusion, the risk of AVN following femoral neck fractures was generally high, especially in patients with displaced fractures. The time from injury to surgery did not correlate with AVN incidence.
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Lazarides, Alexander, Tyler Vovos, James DeOrio, Mark Easley, James Nunley, and Samuel Adams. "Periprosthetic Ankle Fractures." Foot & Ankle Orthopaedics 3, no. 3 (July 1, 2018): 2473011418S0007. http://dx.doi.org/10.1177/2473011418s00073.
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Category: Ankle Introduction/Purpose: Total ankle replacements (TAR) are an increasingly popular option for the management of tibiotalar arthritis. Periprosthetic fracture is an uncommon but challenging complication of patients undergoing arthroplasty. Evidence on the management of and outcomes from periprosthetic fractures about a TAR are limited. The purpose of this study was to evaluate patients with postoperative periprosthetic fractures about a TAR and determine clinical outcomes of these patients following operative fixation. Additionally, we propose an algorithm for the management of these patients. Methods: We retrospectively analyzed 400 patients who underwent TAR from 2007 through 2017. Charts were reviewed and patients with postoperative fractures were selected for inclusion. Patients with a fracture >4 weeks from index surgery were considered candidates for inclusion. Patients with intraoperative fractures were excluded. Univariate analyses were used to identify differences in outcomes. Results: 32 patients were identified with a postoperative periprosthetic fracture about a TAR. Average age was 65.3 years. Average time to fracture was 39.5 months while average follow up from fracture was 26 months. Fractures were primarily located about the medial malleolus (60.6%). 76.8% of fractures were deemed to be stable (Table 1); 75% of these fractures were managed with ORIF or IMN, while 21% of these fractures were treated with immobilization. 80% of patients with stable fractures treated with immobilization ultimately required surgical intervention. 24.2% of fractures were deemed to be unstable. Fractures about the talus were always unstable and always required revision TAR surgery (100%, p= 0.0002). Conclusion: This retrospective review demonstrates that the majority of periprosthetic fractures about a TAR involve the medial malleolus. Additionally, the majority of stable fractures about a TAR required operative fixation. Despite attempts at nonoperative management, management with immobilization is fraught with a high rate of subsequent surgical intervention. Fractures about the talus should be treated with revision TAR surgery or arthrodesis. Based on these findings, we propose an algorithm for the management of patients with a periprosthetic fracture about a TAR.
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Mendonca, Derick, and Deepika Kenkere. "Avoiding occlusal derangement in facial fractures: An evidence based approach." Indian Journal of Plastic Surgery 46, no. 02 (May 2013): 215–20. http://dx.doi.org/10.4103/0970-0358.118596.
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ABSTRACTFacial fractures with occlusal derangement describe any fracture which directly or indirectly affects the occlusal relationship. Such fractures include dento-alveolar fractures in the maxilla and mandible, midface fractures - Le fort I, II, III and mandible fractures of the symphysis, parasymphysis, body, angle, and condyle. In some of these fractures, the fracture line runs through the dento-alveolar component whereas in others the fracture line is remote from the occlusal plane nevertheless altering the occlusion. The complications that could ensue from the management of maxillofacial fractures are predominantly iatrogenic, and therefore can be avoided if adequate care is exercised by the operating surgeon. This paper does not emphasize on complications arising from any particular technique in the management of maxillofacial fractures but rather discusses complications in general, irrespective of the technique used.
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Rani, Potharaju Swetha, and M. Zeeshan Vasif. "Study of surgical outcome of mid third clavicle fractures surgically managed by locking compression plate." International Journal of Research in Orthopaedics 8, no. 1 (December 24, 2021): 72. http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20214965.
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<p class="abstract">Clavicle is one of the most frequently fractured bones in young and active individuals. They account for 2.6-12% of all fractures and for 44-66% of fractures around the shoulder. Majority of clavicle fractures are mid shaft (80-85%). Functional outcome of midshaft fracture not only depends on the union but also on its length which has to be maintained. Thus a displaced or comminuted fracture carries a risk of symptomatic malunion, non-union or poor functional outcome with cosmetic deformity. The recent trend is shifting to internal fixation of these displaced mid shaft clavicle fracture. This was a prospective study of 20 cases of fresh mid third clavicle fracture admitted to MNR medical college and hospital from August 2020 to September 2021. Cases were taken according to inclusion and exclusion criteria. Medically unsuitable and patients not willing for surgery were excluded from the study. There were 17 male patients and 3 female patients with mid 1/3 closed clavicle fracture. 12 patients had right sided clavicle fracture and 8 patients had fracture of the left clavicle. All 20 fractures were closed fractures. Majority of the patients sustained fracture due to road traffic accident (high energy trauma) in 16 cases, fall from height in 3 cases and assault in one case. The mean duration to surgery from the day of presentation and injury was 2.1 days for middle third clavicle fractures. Functional outcome as assessed by constant and Murley scoring was favourable with excellent to good result in 97% cases and fair in 3% cases. The average constant score was 93.35 in one year follow up in middle third group. This study has some limitations. The conclusions drawn from this analysis cannot be generalized because of the small number of cases. In conclusion, for middle third clavicle fractures bony union could be achieved with locking compression plates and the clinical outcomes were satisfactory. All the fractures united and there were no cases of nonunion.</p>
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Tey, Inn Kuang, Arjandas Mahadev, Kevin Boon Leong Lim, Eng Hin Lee, and Saminathan Suresh Nathan. "Active Unicameral Bone Cysts in the Upper Limb are at Greater Risk of Fracture." Journal of Orthopaedic Surgery 17, no. 2 (August 2009): 157–60. http://dx.doi.org/10.1177/230949900901700206.
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Purpose. To elucidate the natural history of unicameral bone cyst (UBC) and risk factors for pathological fracture. Methods. 14 males and 8 females (mean age, 9 years) diagnosed with UBC were reviewed. Cyst location, symptoms, and whether there was any fracture or surgery were recorded. Cyst parameters were measured on radiographs, and included (1) the cyst index, (2) the ratio of the widest cyst diameter to the growth plate diameter, and (3) the adjusted distance of the cyst border from the growth plate. Results. There were 11 upper- and 11 lower-limb cysts. 13 patients had pathological fractures and 9 did not. 20 patients were treated conservatively with limb immobilisation; 2 underwent curettage and bone grafting (one resolved and one did not). Seven cysts resolved (5 had fractures and 2 did not). The risk of fracture was higher in the upper than lower limbs (100% vs 18%, p<0.001). Fractured cysts were larger than unfractured cysts (mean cyst index, 4.5 vs. 2.2, p=0.07). Active cysts were more likely to fracture. Conclusion. Conservative management had a 30% resolution rate. Surgery should be considered for large active cysts in the upper limbs in order to minimise the fracture risk.
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Richards, Robert S., and James H. Roth. "Scaphoid fractures." Canadian Journal of Plastic Surgery 4, no. 3 (September 1996): 1–13. http://dx.doi.org/10.1177/229255039600400306.
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Scaphoid fractures are the most common carpal bone fractures and present physicians with many problems. The majority of such fractures (90%) will unite if properly treated; however a scaphoid fracture that goes on to nonunion affects a patient's working capacity for a long period of time. This paper reviews the pathophysiology of the injury and outlines the diagnostic and treatment options available.
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Deirmengian, Gregory K., and Pedro K. Beredjiklian. "Scaphoid fractures and fracture nonunion." Current Opinion in Orthopaedics 18, no. 4 (July 2007): 315–21. http://dx.doi.org/10.1097/bco.0b013e3281f76343.
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Cairns, Mark A., Eddie K. Hasty, Mackenzie M. Herzog, Robert F. Ostrum, and Zachary Y. Kerr. "Incidence, Severity, and Time Loss Associated With Collegiate Football Fractures, 2004-2005 to 2013-2014." American Journal of Sports Medicine 46, no. 4 (January 29, 2018): 987–94. http://dx.doi.org/10.1177/0363546517749914.
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Background: The inherent risk of any time loss from physical injury in football has been extensively discussed, with many such injuries having a profound effect on the lives of National Collegiate Athletic Association (NCAA) football players. However, the incidence of fractures in collegiate football has not been well established. Purpose: To examine the epidemiology of fractures in NCAA football. Study Design: Descriptive epidemiology study. Methods: Fracture data reported in college football during the 2004-2005 to 2013-2014 academic years were analyzed from the NCAA Injury Surveillance Program (NCAA-ISP). Fracture rates per 1000 athlete-exposures, surgery and time loss distributions, injury rate ratios, injury proportion ratios (IPRs), and 95% CIs were reported. Results: Overall, 986 fractures were reported. The rate of competition fractures was larger than the rate of practice fractures (1.80 vs 0.17 per 1000 athlete-exposures; injury rate ratio = 10.56; 95% CI, 9.32-11.96). Fractures of the hand/fingers represented 34.6% of all injuries, while fibula fractures (17.2%) were also common. A majority (62.5%) of all fractures resulted in time loss >21 days. Altogether, 34.4% of all fractures required surgery, and 6.3% were recurrent. The proportion of fractures resulting in time loss >21 days was higher for fractures requiring surgery than fractures not requiring surgery (85.0% vs 50.7%; IPR = 1.68; 95% CI, 1.53-1.83). The proportion of recurrent and nonrecurrent fractures requiring surgery did not differ (35.5% vs 34.3%; IPR = 1.03; 95% CI, 0.73-1.46); however, recurrent fractures were more likely to require surgery than nonrecurrent fractures when restricted to the hand/fingers (66.7% vs 27.2%; IPR = 2.45; 95% CI, 1.36-4.44). Conclusion: Fractures in collegiate football were sustained at a higher rate in competition than practice and frequently required extended time lost from participation, particularly among those requiring surgery. Prevention strategies are warranted to reduce incidence and severity of fractures.
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N., Priscilla Valentine, Agus Santoso Budi, and Lobredia Zarasade. "Palate Fracture Profile in Plastic Reconstructive and Aesthetic Surgery of Soetomo Hospital : January 2012 – December 2017." Jurnal Rekonstruksi dan Estetik 4, no. 1 (January 8, 2021): 27. http://dx.doi.org/10.20473/jre.v4i1.29216.
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Background: Palatal fractures are often associated with maxillofacial fractures and Le Fort fractures. The diagnosis and management of palatal fractures in the midface area is a challenge for a plastic surgeon in restoring function and aesthetics. With the results of this study, it is expected to be a database of maxillofacial fractures treated at SMF Reconstructive Plastic Surgery and Aesthetic Dr. Soetomo, Surabaya and gave the ability to make a fast and precise diagnosis for time and technical maxillofacial fractures.Methods : This study uses medical record data for all patients diagnosed with palatal fractures in Dr. Soetomo General Hospital, Surabaya during January 2012 to December 2017. The variables studied were demographic data including sex, age, mechanism of occurrence of accidents, types of fractures, management, complications that occur and length of treatment.Results : There were 82 patients with palatal fractures, with traffic accidents being the most common cause of palate fracture (n = 61) followed by workplace accidents and households in second place (12 and 9%). Most sufferers were men (68%), women (14%) with the highest age range of men aged 19-30 years who were followed by ages 31-45. The most were parasagittal fractures (56%), then Sagittal (15%), paraalveolar (9%), alveolar (1%), comminutive (1%). no fractures with anterior and posterolateral alveolar types, posterolateral type or transverse type fractures. Hospitalization period with plating (12 days), transmolar wiring (10.6 days), conservative (13.8 days).Conclusions: In this study assessed the experience in the reconstruction and aesthetic plastic surgery department of Dr. Soetomo General Hospital regarding palatal fractures and accompanying demographic data. The type of fracture that occurs is also related to the management performed. Incomplete medical records caused problems in this study.
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Choi, Jun Young, Dong Joo Lee, Reuben Ngissah, Bum Joon Nam, and Jin Soo Suh. "Categorization of single cuneiform fractures and investigation of related injuries: A 10-year retrospective study." Journal of Orthopaedic Surgery 27, no. 3 (August 18, 2019): 230949901986639. http://dx.doi.org/10.1177/2309499019866394.
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Purpose: The purpose of this study was to define the fracture type and investigate the injuries related to single medial, intermediate, or lateral cuneiform fracture. Methods: From January 2008 to December 2018, 30 consecutive patients (30 cases) who were treated in the single institution for the single cuneiform fractures were reviewed retrospectively. Each fracture was categorized by location and type (intra- or extra-articular avulsion, axial compression, and direct blow). We also investigated the related foot bone fractures or dislocations on the affected side. Results: Twenty-one, one, and eight cases with single medial, intermediate, and lateral cuneiform bone fractures, respectively, were identified. More than two-thirds of the single cuneiform fractures were observed in the medial cuneiform bone. The single medial cuneiform fracture was associated with various types of foot injuries including Lisfranc injury, naviculo-cuneiform joint dislocation, or calcaneo-cuboidal dislocation. Single lateral cuneiform fractures were more frequently observed than single intermediate cuneiform fractures. Conclusion: More than two-thirds of the single cuneiform fractures were observed in the medial cuneiform bone. Most intra-articular avulsion fractures were associated with high-energy trauma. Level of Evidence: 4
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Jing, Xi Lin, and Edward Luce. "Frontal Sinus Fractures: Management and Complications." Craniomaxillofacial Trauma & Reconstruction 12, no. 3 (September 2019): 241–47. http://dx.doi.org/10.1055/s-0038-1675560.
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Frontal sinus fractures are relatively rare maxillofacial injuries (only 5–15% of all facial fractures). The appropriate management of frontal sinus fracture and associated pathology is controversial. Diagnosis and treatment of frontal sinus fractures has improved with the advances of high-resolution computed tomography technology. Treatment of frontal sinus fractures depends on several factors, including contour deformity of anterior table; the presence of CSF leak or air–fluid level in the sinus, likelihood of nasofrontal duct obstruction, and degree of displacement of posterior table. Nasofrontal duct patency should be checked if fracture pattern is highly suspicious of ductal injury. Cranialization is performed in cases of severely comminuted posterior wall fracture. Long-term complication of frontal sinus fracture can occur up to 10 years after initial injury or intervention; so, judicious long-term follow-up is warranted. This article presents the management and complications of frontal sinus fractures.
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HOVE, L. M. "Simultaneous Scaphoid and Distal Radial Fractures." Journal of Hand Surgery 19, no. 3 (June 1994): 384–88. http://dx.doi.org/10.1016/0266-7681(94)90095-7.
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Simultaneous fractures of the distal radius and scaphoid are uncommon. In a prospective 3-year study we registered 2,330 distal radial fractures and 390 scaphoid fractures, and 12 were combined. Ten of these had high energy trauma; six were styloid fractures, four Colles’ fractures, one was a greenstick fracture and one Salter–Harris Type 2 epiphyseal fracture. All but one of the 12 scaphoid fractures were stable and healed without problems, and one was a trans-scaphoid, trans-styloid peri-lunate fracture-dislocation. The study supports the opinion that the distal radial fracture constitutes the principal injury that determines the outcome and hence the treatment. If the scaphoid fracture is unstable or dislocated, we recommend internal fixation of the scaphoid. Only a small proportion of these injuries represent a more serious disruption with carpal instability.
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Borg, T., T. Melander, and S. Larsson. "Poor Retention after Closed Reduction and Cast Immobilization of Low-Energy Tibial Shaft Spiral Fractures." Scandinavian Journal of Surgery 91, no. 2 (June 2002): 191–94. http://dx.doi.org/10.1177/145749690209100211.
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Background and Aims: The aim of this retrospective study was to analyze retention in cast after closed reduction of low-energy two-fragment tibial shaft fractures. Material and Methods: The material consisted of 72 closed tibial shaft fractures AO/ASIF type A treated with closed reduction and plaster cast. Fractures were subgrouped according to the AO/ASIF classification and the initial fracture displacement was measured. Final alignment and the frequency of operative intervention due to early loss of reduction were analyzed. Results: 40 % of all fractures lost reduction and were operated on. The largest subgroup was A1.2 fractures, a spiral tibial shaft fracture with a fibular fracture at another level. Out of the 28 fractures in this group 61 % were converted from cast to early operative intervention. Conclusion: Closed reduction and cast treatment of spiral tibial shaft fractures AO/ASIF type A1.2 had a high failure rate.
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BEERES, F. J. P., M. HOGERVORST, P. DEN HOLLANDER, and S. J. RHEMREV. "Diagnostic Strategy for Suspected Scaphoid Fractures in the Presence of Other Fractures in the Carpal Region." Journal of Hand Surgery 31, no. 4 (August 2006): 416–18. http://dx.doi.org/10.1016/j.jhsb.2006.04.007.
Full textAbstract:
Bone scintigraphy will identify up to 25% of occult scaphoid bone fractures after negative scaphoid X-rays. Consequently, it deserves a place in the diagnostic process of suspected scaphoid fractures. However, the role of bone scintigraphy is less clear if scaphoid X-rays show other fractures in the carpal region. We analysed 111 consecutive patients with a suspected scaphoid fracture on physical examination. Scaphoid X-rays revealed 61 fractures. Fifty-five patients had scaphoid fractures only and six patients had other fractures in the carpal region but no scaphoid fracture. In 50 cases, no bone injury was seen on these X-rays. In three out of the six patients with other fractures in the carpal region, bone scintigraphy revealed four occult concomitant fractures: one scaphoid, one scaphoid and trapezial and one capitate fracture. In conclusion, bone scintigraphy is required when scaphoid X-rays do not confirm a suspected scaphoid fracture, even in the presence of other fractures in the carpal region.
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Nagi, Ahmed, Islam Mubark, Islam Sarhan, and Abdelaleem Ragab. "Management of Unstable Phalangeal Shaft Fractures Using External Minifixator." Ortopedia Traumatologia Rehabilitacja 21, no. 3 (June 30, 2019): 177–86. http://dx.doi.org/10.5604/01.3001.0013.2922.
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Background. Fractures of the hand are the most common fractures in the skeletal system and phalangeal fractures constitute about 46% of all hand fractures. Operative treatment of unstable phalangeal fractures should aim at anatomic fracture reduction and stable fixation that allows early mobilization of the affected finger’s joints . This study evaluates the results of fixation of unstable shaft fractures of finger proximal or middle phalanges using a non-spanning external minifixator. Material and methods. 32 men and 8 women aged 17 to 60 (median, 31.25) years suffering from fractures of 44 phalanges in 40 hands were included in the study. Four of the fractured phalanges were middle phalanges and 40 were proximal phalanges .All fractures were fixed using a mini external fixator. All procedures were done under regional anaesthetic block. The fixator was applied after closed reduction of fractures. Additional procedures included wound debridement in open fractures, and tendon repair was needed in 4 cases. We excluded fractures where intraarticular fracture extension mandates open reduction and internal fixation. Results. At the end of the follow-up period (mean follow-up 11.5 months), patients were assessed clinically and radiologically. 26 fingers (59.1 %) had “excellent” results , 14 fingers (31.8 %) had “good” results and 4 fingers (9.1%) had “poor” results as their P.I.P. flexion ranges were < 80˚. Conclusion. External fixation of displaced phalangeal shaft fractures is an effective method of treatment in terms of a minimally invasive technique with rigid fracture fixation allowing early mobilization after surgery.
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Subbiah, Venkatesh Babu. "Safe Clavicle Fracture Surgery." Journal of Orthopedics and Joint Surgery 2, no. 2 (2020): 62–65. http://dx.doi.org/10.5005/jp-journals-10079-1026.
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ABSTRACT The surgical treatment is being advocated for all types of displaced clavicle fractures currently. At the same time, the neurovascular and other serious operative complications are in rise. This article updates the applied anatomical knowledge and operative skills required for the orthopedic surgeon who intends to surgically fix the clavicle fracture safely. How to cite this article: Babu SV. Safe Clavicle Fracture Surgery. J Orth Joint Surg 2020;2(2):62–65.
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Young, K., A. Greenwood, A. MacQuillan, S. Lee, and S. Wilson. "Paediatric hand fractures." Journal of Hand Surgery (European Volume) 38, no. 8 (January 22, 2013): 898–902. http://dx.doi.org/10.1177/1753193412475045.
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This retrospective study reviews the demographics, morphology and management of paediatric hand fractures. Notes of all children with hand injuries attending a plastic surgery paediatric trauma clinic over a one-year period were reviewed. Non-bony injuries were excluded. A total of 303 fractures in 283 patients were included. Fracture incidence rose after the age of seven, peaking at 14 years of age; 76% of fractures occurred in males. Sporting injuries accounted for 47% of fractures. Physeal fractures were present in 39% of cases. Open fractures accounted for only 4% of all fractures. Management was primarily conservative. Only 5% of cases required surgical fixation; 6% of patients experienced complications.
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Shunmugam, Meenalochani, Joideep Phadnis, Amy Watts, and Gregory I. Bain. "Lunate fractures and associated radiocarpal and midcarpal instabilities: a systematic review." Journal of Hand Surgery (European Volume) 43, no. 1 (November 13, 2017): 84–92. http://dx.doi.org/10.1177/1753193417740850.
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The aim of this study was to analyse lunate fractures and any associated osseo-ligamentous injuries. A systematic review identified 34 cases. We identified carpal instabilities at the radiocarpal and midcarpal joints in volar and dorsal directions. Radiocarpal instabilities (10/34) were usually dorsoradial (8/10), with a transverse lunate fracture, best seen on a coronal image. Midcarpal instabilities (24/34) were usually volar (14/18), with a volar lunate shear fracture, best seen on a sagittal image. Instabilities were sub-classified into non-displaced, subluxated and dislocated. Associated fractures of the scaphoid and the radial and ulnar styloid processes were common. Lunate fractures without subluxation or dislocation had good outcomes with cast immobilization or fixation of associated fractures. Lunate fracture-subluxations are unstable injuries that are best managed with fixation of the carpal fractures. Lunate fracture-dislocations are complex injuries, requiring stabilization of the lunate, associated fractures and ligament injuries; complications are common and acute or delayed salvage procedures may be required.
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Ang, ChuanHan, JinRong Low, JiaYi Shen, Elijah Zheng Yang Cai, Eileen Chor Hoong Hing, YiongHuak Chan, Gangadhara Sundar, and ThiamChye Lim. "A Protocol to Reduce Interobserver Variability in the Computed Tomography Measurement of Orbital Floor Fractures." Craniomaxillofacial Trauma & Reconstruction 8, no. 4 (December 2015): 289–98. http://dx.doi.org/10.1055/s-0034-1399800.
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Orbital fracture detection and size determination from computed tomography (CT) scans affect the decision to operate, the type of surgical implant used, and postoperative outcomes. However, the lack of standardization of radiological signs often leads to the false-positive detection of orbital fractures, while nonstandardized landmarks lead to inaccurate defect measurements. We aim to design a novel protocol for CT measurement of orbital floor fractures and evaluate the interobserver variability on CT scan images. Qualitative aspects of this protocol include identifying direct and indirect signs of orbital fractures on CT scan images. Quantitative aspects of this protocol include measuring the surface area of pure orbital floor fractures using computer software. In this study, 15 independent observers without clinical experience in orbital fracture detection and measurement measured the orbital floor fractures of three randomly selected patients following the protocol. The time required for each measurement was recorded. The intraclass correlation coefficient of the surface area measurements is 0.999 (0.997–1.000) with p-value < 0.001. This suggests that any observer measuring the surface area will obtain a similar estimation of the fractured surface area. The maximum error limit was 0.901 cm2 which is less than the margin of error of 1 cm2 in mesh trimming for orbital reconstruction. The average duration required for each measurement was 3 minutes 19 seconds (ranging from 1 minute 35 seconds to 5 minutes). Measurements performed with our novel protocol resulted in minimal interobserver variability. This protocol is effective and generated reproducible results, is easy to teach and utilize, and its findings can be interpreted easily.
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Halsey, Jordan N., Ian C. Hoppe, Mark S. Granick, and Edward S. Lee. "A Single-Center Review of Radiologically Diagnosed Maxillofacial Fractures: Etiology and Distribution." Craniomaxillofacial Trauma & Reconstruction 10, no. 1 (February 2017): 44–47. http://dx.doi.org/10.1055/s-0036-1597582.
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The etiology of fractures of the maxillofacial skeleton varies among studies, with motor vehicle accidents and assaults oftentimes the most common. The number of males outnumbers females throughout most studies. Fractures of the zygoma, orbit, and mandible are usually cited as most common fracture types. This study examines a single center's experience with regards to etiology and distribution of fractures. A retrospective review of all radiologically confirmed facial fractures in a level 1 trauma center in an urban environment was performed for the years 2000 to 2012. Patient demographics, etiology of injury, and location of fractures were collected. During this time period, 2,998 patients were identified as having sustained a fracture of the facial skeleton. The average age was 36.9 years, with a strong male predominance (81.5%). The most common etiologies of injury were assault (44.9%) and motor vehicle accidents (14.9%). Throughout the study period, the number of fractures as a result of assault remained relatively constant, whereas the number as a result of motor vehicle accidents decreased slightly. The most common fracture observed was of the orbit, followed by mandible, nasal bones, zygoma, and frontal sinus. Patients sustaining a fracture as a result of assault were more likely to have a mandible fracture. Patients in motor vehicle accidents were more likely to suffer fractures of the maxilla, orbit, and frontal sinus. Mandible fractures are more common in cases of assault. Motor vehicle accidents convey a large force, which, when directed at the craniofacial skeleton, can cause a variety of fracture patterns. The decreasing number of fractures as a result of motor vehicle accidents may represent improved safety devices such as airbags.
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Rahpeyma, Amin, Saeedeh Khajehahmadi, and Somayeh Abdollahpour. "Mandibular Symphyseal/Parasymphyseal Fracture with Incisor Tooth Loss: Preventing Lower Arch Constriction." Craniomaxillofacial Trauma & Reconstruction 9, no. 1 (March 2016): 015–19. http://dx.doi.org/10.1055/s-0035-1551542.
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Mandibular fractures are the second most common fractures of the face after the nasal bone. Mandibular symphyseal/parasymphyseal fracture comprises 15.6 to 29.3% of mandibular fractures. Tooth loss in the fracture line is a known phenomenon, but space loss has not been evaluated comprehensively in the literature. In a retrospective study, patients with mandibular symphyseal/parasymphyseal fractures, who had been treated from 2012 to 2013 in Mashhad University, Iran, Emdadi Hospital, were recalled. Patients with mandibular incisor tooth/teeth loss were included in the study. Space loss, the technique used to replace the lost tooth/teeth, upper and lower dental midline relationship, combination fracture or fractures in other facial skeleton, and type of treatment were evaluated. Of 98 patients with mandibular symphyseal/parasymphyseal fractures, 22.5% had incisor tooth/teeth loss. In this group, 73% had space loss. Only four patients had replaced the lost tooth/teeth. Dental midlines did not match each other in patients whose feature was evaluated. Open reduction and internal fixation with miniplates were used in symphyseal/parasymphyseal fractures except one. Space loss after mandibular symphyseal/parasymphyseal fracture with incisor tooth loss is a common error. The most important factor to prevent complications related to space loss following mandibular symphyseal/parasymphyseal fracture accompanying incisor tooth loss is space preservation.