Acute Traumatic Fractures Research Articles

A prospective multicenter randomized study comparing the SpineJack system and nonsurgical management with a brace in acute traumatic vertebral fractures: the SPICO study.

The objective of this study was to evaluate the efffectiveness of a titanium vertebral augmentation device (SpineJack system) in terms of back pain, radiological outcomes, and economic burden compared with nonsurgical management (NSM) (bracing) for the treatment of vertebral compression fractures. Complications were also evaluated for both treatment methods. A prospective multicenter randomized study was performed at 9 French sites. Patients (n = 100) with acute traumatic Magerl type A1 and A3.1 vertebral fractures were enrolled and randomized to treatment with the SpineJack system or NSM consisting of bracing and administration of pain medication. Participants were monitored at admission, during the procedure, and at 1, 12, and 24 months after treatment initiation. Primary outcomes included visual analog scale back pain score, and secondary outcomes included disability (Oswestry Disability Index [ODI] score), health-related quality of life (EQ-5D score), radiological measures (vertebral kyphosis angle [VKA] and regional traumatic angulation [RTA]), and economic outcomes (costs, procedures, hours of help, and time to return to work). Ninety-five patients were included in the analysis, with 48 in the SpineJack group and 47 in the NSM group. Back pain improved significantly for all participants with no significant differences between groups. ODI and EQ-5D scores improved significantly between baseline and follow-up (1, 12, and 24 months) for all participants, with the SpineJack group showing a larger improvement than the NSM group between baseline and 1 month. VKA was significantly lower (p < 0.001) (i.e., better) in the SpineJack group than in the NSM group at 1, 12, and 24 months of follow-up. There was no significant change over time in RTA for the SpineJack group, but the NSM group showed a significant worsening in RTA over time. SpineJack treatment was associated with higher costs than NSM but involved a shorter hospital stay, fewer medical visits, and fewer hours of nursing care. Time to return to work was significantly shorter for the SpineJack group than for the NSM group. There were no significant differences in complications between the two treatments. Overall, there was no statistical difference in the primary outcomes between the SpineJack treatment group and the NSM group. In terms of secondary outcomes, SpineJack treatment was associated with better radiological outcomes, shorter hospital stays, faster return to work, and fewer hours of nursing care.

Utilization of a two-material decomposition from a single-source, dual-energy CT in acute traumatic vertebral fractures.

The purpose of this study is to utilize a two-material decomposition to quantify bone marrow edema on a dual-energy computed tomography (DECT) scanner at the cervical, thoracic, and lumbar spine acute fractures in correlation with short tau inversion recovery (STIR) hyperintensity on magnetic resonance imaging (MRI) in comparison with the normal bone marrow. This retrospective institutional review board-approved study gathered patients over 18 years old who had acute cervical, thoracic, or lumbar spinal fractures scanned on a DECT scanner. Those who had a spinal MRI done with bone marrow STIR hyperintensity within 3 weeks of the DECT were included. The water (calcium) and fat (calcium) density (mg/cm3) measurements of the region of interest of the bone marrow were obtained at a normal anatomic equivalent site and at the fracture site where STIR hyperintensity was noted on MRI. A statistical analysis was performed using the paired t-test and Wilcoxon signed rank test (p > 0.05). A total of 20 patients met the inclusion criteria (males n = 17 males, females n = 3). A total of 32 fractures were analyzed: 19 cervical and 13 thoracolumbar. There were statistically significant differences in the water (43 ± 24 mg/cm3) and fat (36 ± 31 mg/cm3) density (mg/cm3) at the acute thoracic and lumbar spine fractures in correlation with edema on STIR images (both paired t-test <0.001, both Wilcoxon signed ranked test p < 0.01). There were no significant differences in the water (-10 ± 46 mg/cm3) or fat (+7 ± 50 mg/cm3) density (mg/cm3) at the cervical spine fractures. The DECT two-material decomposition using water (calcium) and fat (calcium) analyses has the ability to quantify a bone marrow edema at the acute fracture site in the thoracic and lumbar spine.

Effectiveness of unilateral percutaneous vertebroplasty for acute traumatic non-osteoporotic compression vertebral fractures.

Although vertebroplasty is a well-known treatment for osteoporotic and neoplastic compression fractures, there is limited evidence to support its use in traumatic compression fractures without osteoporotic degeneration. The purpose of this study was to evaluate the correlation of kyphosis and wedge angles with pain relief and functional outcome after percutaneous vertebroplasty. 38 patients who harbored acute traumatic non-osteoporotic compression vertebral fractures without neurological complications refractory to at least 5 days of conservative treatment were included in this study. Follow-up evaluations included pain (assessed with the visual analog scale) and medication use. Functional outcome was measured using Oswestry low back pain disability questionnaire. Cobb angles, Gardner angles and kyphotic angles were measured on the full-spine radiographs preoperatively and postoperatively. The axial pain visual analog scale score (8.05 ± 1.23 pre-op vs 1.18 ± 1.09 post-op, P < .05) and The Oswestry low back pain disability questionnaire score (33.45 ± 6.97 pre-op vs 4.47 ± 2.41 post-op, P < .05). The Cobb's angle (19.66° ± 8.68° pre-op vs 15.08° ± 7.51° post-op, P < .05), the Gardner's angle (17.72° ± 6.52° pre-op vs 14.13° ± 7.13° post-op, P < .05) and the kyphotic angle (17.51° ± 5.8° pre-op vs 8.81° ± 4.14°post-op, P < .05) were significantly reduced postoperatively therefore, local kyphosis was markedly restored after vertebroplasty. Our findings show that vertebroplasty for patients with traumatic spinal compression fractures reduces pain, improves mobility, reduces the need for painkillers, and significantly affects kyphotic angles.

Long-term outcomes of the nano-hydroxyapatite/polyamide-66 cage versus the titanium mesh cage for anterior reconstruction of thoracic and lumbar corpectomy: a retrospective study with at least 7 years of follow-up

BackgroundThe nano-hydroxyapatite/polyamide-66 (n-HA/PA66) cage is a biomimetic cage with a lower elastic modulus than the titanium mesh cage (TMC). This study aimed to compare the long-term outcomes of the n-HA/PA66 cage and TMC in the anterior reconstruction of thoracic and lumbar fractures.MethodsWe retrospectively studied 113 patients with acute traumatic thoracic or lumbar burst fractures, comprising 60 patients treated with the TMC and 53 treated with the n-HA/PA66 cage for anterior reconstruction following single-level corpectomy. The radiographic data (cage subsidence, fusion status, segmental sagittal alignment) and clinical data (visual analogue scale (VAS) for pain and Oswestry Disability Index (ODI) for function) were evaluated preoperatively, postoperatively, and at final follow-up after a minimum 7-year period.ResultsThe n-HA/PA66 and TMC groups had similar final fusion rates (96.2% vs. 95.0%). The cage subsidence at final follow-up was 2.3 ± 1.6 mm with subsidence of more than 3 mm occurring in 24.5% in the n-HA/PA66 group, which was significantly lower than the respective values of 3.9 ± 2.5 mm and 58.3% in the TMC group. The n-HA/PA66 group also had better correction of the bisegmental kyphotic angle than the TMC group (7.1° ± 7.5° vs 1.9° ± 8.6°, p < 0.01), with lower loss of correction (2.9° ± 2.5° vs 5.2° ± 4.1°, p < 0.01). The mean ODI steadily decreased after surgery in both groups. At final follow-up, the ODI and VAS were similar in the TMC and n-HA/PA66 groups.ConclusionsThe n-HA/PA66 cage is associated with excellent radiographic fusion, better maintenance of the height of the fused segment, and better correction of kyphosis than the TMC during 7 years of follow-up after one-level anterior corpectomy. With the added benefit of radiolucency, the n-HA/PA66 cage may be superior to the TMC in anterior reconstruction of thoracic or lumbar fractures.

Sacral H-shaped fractures between traumatic, insufficiency and fatigue fractures : Similarities, differences and controversies

In the basic entirety of stress fractures, insufficiency fractures are defined as fractures caused by prolonged normal or physiological loading of abone with insufficient elastic resistance. This clearly distinguishes it from fatigue fractures, in which excessive loads are continuously applied to abone with normal elastic resistance. According to Pentecost (1964) both entities of stress fracture result from "the inherent inability of the bone to withstand stress applied without violence in a rhythmical, repeated, subthreshold manner". This distinguishes them from acute traumatic fractures. In the clinical routine these differences are not always so clearly presented. The example of the H‑shaped sacral fracture is used to illustrate the relevance of aclear terminology. In this context, current controversies in the treatment of sacral insufficiency fractures are discussed.

A Retrospective Analysis of 5-Year Data of Training-Related Injuries in an Institutional Setting

Introduction:Musculoskeletal injuries sustained during training are not only the major cause of loss of training hours but also lead to attrition of precious workforce. Detailed knowledge of the pattern, type, mechanism of musculoskeletal injury, etc., helps in designing prevention strategies. Hence, the study was conducted to study the epidemiology of injuries sustained by trainees while undergoing training at an institutional training.Materials and Methods:The study is a record-based observational study. The data relating to training-related injuries sustained over 5 years (April 2014 to March 2019) were obtained from the record maintained in the medical facility of the training institute in India. The data were extracted using a case record form. The injury data (date of injury, unique identification number, trainee name, diagnosis, and type of treatment taken) were obtained from the medical record register maintained in the medical facility of the training institute. Anthropometric data (height and weight) were obtained from the record of initial medical screening done routinely on the day of joining the training institute. The descriptive analysis of the collected data was done.Results:A total of (n= 2946) trainees comprising 2584 male trainees and 362 female trainees underwent training during the period of the study. The total number of visits to the medical facility related to injury during the 5-year study period was 13,579. Most of the injuries are occurring in the 5th–20thweek in the first half of training period and 29–44 week in the second half of training period. Among male trainees, the lower limb injuries alone accounted for 72.8% of total injuries, followed by trunk and back injuries (11.97%) and upper limb injuries (11.95%). Among female trainees although lower limb injuries still account for the majority (79.66%) of injuries, among them, hip and groin injuries accounted for the highest percentage of injuries as compared to leg and knee injuries in male trainees. The twisting injuries of the knee, stress fractures, and acute traumatic fractures accounted for the majority (78.34%) of the injuries leading to repetition of the training by 24 weeks. The twisting injuries of the knee, acute traumatic fractures, traumatic shoulder instability, and head injuries accounted for the majority (83.2%) of the injuries leading to dropout from training institution (withdrawal).Conclusion:The analysis related to the injuries sustained by trainees during the 5 years found out the timings, severity, and location of injuries. The findings may be important for the formulation of preventive program in an institutional training institute.

Percutaneous vertebral augmentation for acute traumatic vertebral Fractures: A TQIP database study

Patients with vertebral fractures may be treated with percutaneous vertebroplasty (VP) and kyphoplasty (KP) for pain relief. Few studies examine the use of VP and KP in the setting of an acute trauma. In this study, we describe the current use of VP/KP in patients with acute traumatic vertebral fractures. All patients in the ACS Trauma Quality Improvement Program (TQIP) 2016 National Trauma Databank with severe spine injury (spine AIS ≥ 3) met inclusion criteria, including patients who underwent PVA. Logistic regression was used to assess patient and hospital factors associated with PVA; odds ratios and 95 % confidence intervals are reported. 20,769 patients met inclusion criteria and 406 patients received PVA. Patients aged 50 or older were up to 6.73 (2.45 – 27.88) times more likely to receive PVA compared to younger age groups and women compared to men (1.55 [1.23–1.95]). Hospitals with a Level II trauma center and with 401–600 beds were more likely to perform PVA (2.07 [1.51–2.83]) and (1.82 [1.04–3.34]) respectively. African American patients (0.41 [0.19–0.77]), isolated trauma (0.64 [0.42–0.96]), neurosurgeon group size > 6 (0.47 [0.30–0.74]), orthopedic group size > 10, and hospitals in the Northeastern and Western regions of the U.S. (0.33 [0.21–0.51] and 0.46 [0.32–0.64]) were less likely to be associated with PVA. Vertebroplasty and kyphoplasty use for acute traumatic vertebral fractures significantly varied across major trauma centers in the United States by multiple patient, hospital, and surgeon demographics. Regional and institutional practice patterns play an important role in the use of these procedures.

Imaging of traumatic mandibular fractures in young adults using CT-like MRI: a feasibility study

ObjectivesTo assess and compare the diagnostic performance of CT-like images based on a three- dimensional (3D) T1-weighted spoiled gradient-echo sequence (3D T1 GRE) with CT in patients with acute traumatic fractures of the mandible.Materials and methodsSubjects with acute mandibular fractures diagnosed on conventional CT were prospectively recruited and received an additional 3 T MRI with a CT-like 3D T1 GRE sequence. The images were assessed by two radiologists with regard to fracture localization, degree of dislocation, and number of fragments. Bone to soft tissue contrast, diagnostic confidence, artifacts, and overall image quality were rated using a five-point Likert-scale. Agreement of measurements was assessed using an independent t-test.ResultsFourteen subjects and 22 fracture sites were included (26 ± 3.9 years; 4 females, 10 males). All traumatic fractures were accurately detected on CT-like MRI (n = 22, κ 1.00 (95% CI 1.00–1.00)). There was no statistically significant difference in the assessment of the fracture dislocation (axial mean difference (MD) 0.06 mm, p = 0.93, coronal MD, 0.08 mm, p = 0.89 and sagittal MD, 0.04 mm, p = 0.96). The agreement for the fracture classification as well as the inter- and intra-rater agreement was excellent (range κ 0.92–0.98 (95% CI 0.96–0.99)).ConclusionAssessment of mandibular fractures was feasible and accurate using CT-like MRI based on a 3D T1 GRE sequence and is comparable to conventional CT.Clinical relevanceFor the assessment of acute mandibular fractures, CT-like MRI might become a useful alternative to CT in order to reduce radiation exposure particularly in young patients.

Nonoperative and Operative Soft-Tissue and Cartilage Regeneration and Orthopaedic Biologics of the Foot and Ankle: An Orthoregeneration Network Foundation Review

Orthoregeneration is defined as a solution for orthopaedic conditions that harnesses the benefits of biology to improve healing, reduce pain, improve function, and optimally, provide an environment for tissue regeneration. Options include drugs, surgical intervention, scaffolds, biologics as a product of cells, and physical and electromagnetic stimuli. The goal of regenerative medicine is to enhance the healing of tissue after musculoskeletal injuries as both isolated treatment and adjunct to surgical management, using novel therapies to improve recovery and outcomes. Various orthopaedic biologics (orthobiologics) have been investigated for the treatment of pathology involving the foot and ankle (including acute traumatic injuries and fractures, tumor, infection, osteochondral lesions, arthritis, and tendinopathy) and procedures, including osteotomy or fusion. Promising and established treatment modalities include 1) bone-based therapies (such as cancellous or cortical autograft from the iliac crest, proximal tibia, and/or calcaneus, fresh-frozen or freeze-dried cortical or cancellous allograft, including demineralized bone matrix putty or powder combined with growth factors, and synthetic bone graft substitutes, such as calcium sulfate, calcium phosphate, tricalcium phosphate, bioactive glasses (often in combination with bone marrow aspirate), and polymers; proteins such as bone morphogenic proteins; and platelet-derived growth factors; 2) cartilage-based therapies such as debridement, bone marrow stimulation (such as microfracture or drilling), scaffold-based techniques (such as autologous chondrocyte implantation [ACI] and matrix-induced ACI, autologous matrix-induced chondrogenesis, matrix-associated stem cell transplantation, particulated juvenile cartilage allograft transplantation, and minced local cartilage cells mixed with fibrin and platelet rich plasma [PRP]); and 3) blood, cell-based, and injectable therapies such as PRP, platelet-poor plasma biomatrix loaded with mesenchymal stromal cells, concentrated bone marrow aspirate, hyaluronic acid, and stem or stromal cell therapy, including mesenchymal stem cell allografts, and adipose tissue-derived stem cells, and micronized adipose tissue injections. Level of EvidenceLevel V, expert opinion.

Doctor, I fractured my ankle. When can I return to play? An updated systematic review.

IntroductionAnkle fractures in sport are common. Their optimal management is unclear, as is when patients can return to their sports activities. This systematic review provides a contemporary assessment of the literature on return to sports following acute traumatic ankle fractures managed both operatively and non-operatively.Sources of dataWe systematically searched Pubmed, Google Scholar, the Cochrane Library, EMBASE and CINAHL using the terms ‘ankle fractures’, ‘ankle injuries’, ‘athletes’, ‘sports’, ‘return to sport’, ‘return to activity’, ‘operative management’, ‘non-operative management’.Areas of agreementThirteen retrospective studies fulfilled the inclusion criteria. The methodological quality of the studies was generally poor. The proportion of patients returning to sporting activity was high. In some studies, a quicker return to sporting activity was demonstrated in patients managed non-operatively.Areas of controversyThe time to return to sporting activity and level of performance post-treatment are not universally recorded, and the optimal time to return to sport remains to be confirmed.Growing pointsConservative management for stable or undisplaced fracture may result in a higher proportion of patients returning to sport more quickly.Areas timely for developing researchRandomized controlled trials should compare conservative to surgical treatment for appropriately chosen fracture patterns. Future studies should routinely report the timing of return to sport, the level of performance reached, and the time to achieve this.

Elbow Injuries in Children

Elbow Injuries in Children

Application of a Knowledge, Attitude, Belief, and Practice Model in Pain Management of Patients with Acute Traumatic Fractures and Alcohol Dependence.

Objective To evaluate the outcome of a knowledge, attitude, belief, and practice mode (KABP) in the pain management in patients with acute traumatic fractures complicated with alcohol dependence. Methods Twenty-nine alcohol-dependent male patients with acute traumatic fractures and who received surgical treatment between January 2019 and December 2020 were included in this retrospective case-control study. The age range was 30–65 years (average 50.03 ± 7.94). Fracture Type. Six cases of spinal burst fractures and 23 cases of limb trauma fractures. Ten patients were treated with routine nursing (control group), and 19 patients were treated with pain management in KABP mode (experimental group). The control group received traditional pain care, including the conventional numerical rating scale (NRS) pain score system, with focus on symptomatic treatment. On this basis, the experimental group managed pain using KABP, including cognitive behavioral intervention, optimization programs, modification of personal beliefs, and behavior patterns. NRS, self-rated anxiety/depression scale (SAS), and quality of life (SF-36) scale were applied at admission, 1 day before surgery, and 3 months after surgery. Results The perioperative NRS score of the KABP group was lower than that of the control group, and the postoperative anxiety levels improved. Discharge satisfaction was significantly higher than that in the control group (p < 0.05). There were behaviors promoting health in the experimental group, and five patients expressed abstinence behavior after discharge (p < 0.05). Conclusion Patients with alcohol dependence represents a unique set of cases for perioperative pain management. To ensure patient safety, individualized pain management through the application of KABP can significantly reduce postoperative pain and promote the generation of healthy behaviors in patients.

Accuracy of MRI (TLICS vs AOSIS) in assessment of thoracolumbar spine injuries for guiding treatment

BackgroundThe thoracic segment represents the most common area fractured in the whole spine. Complete neurological deficits are commonly associated with thoracic injuries possibly due to a relatively small canal diameter as compared to the cervical or lumbar spine. Magnetic resonance is the gold standard of imaging, especially in patients suffering from neurological deficits as well as in soft tissue assessment mainly the disc, ligaments, and neural elements. The thoracolumbar injury classification and severity score system (TLICS) and the thoracolumbar AO Spine injury score (TLAOSIS), are two scoring systems designed to help surgeons in management plans of thoraco-lumbar injuries. The aim of our study is to compare these two main thoracolumbar injury classification systems in deciding the management strategies in thoraco-lumbar injuries. This study is a retrospective study that included 70 patients (42 males and 28 females) who suffered acute traumatic vertebral fractures. All patients underwent MRI including T1WI, T2W and STIR sequences. The MRI was viewed by two independent radiologists of 5- and 10-years’ experience and compared to surgical decisions.ResultsOut of 70 patients included in our study, the TL AOSIS matched treatment recommendation in 62 patients (88.6%), and the TLICS matched in 60 patients (85.7%). The TL AOSIS achieved sensitivity 95%, specificity 80%, while the TLICS achieved sensitivity 72.2%, specificity 100%.ConclusionBoth TL AOSIS and TLICS have very close results in their reliability for guiding treatment strategy, yet TL AOSIS matched treatment recommendation more than TLICS, with sensitivity more than TLICS, while TLICS had more specificity.

Therapeutic Potential of Platelet-Rich Plasma in Canine Medicine.

Platelets are the reservoir of growth factors and play a major role in several physiological processes, such as coagulation, angiogenesis, immune response, and tissue repair. Platelet concentrates are broadly classified into two groups depending on their fibrin content, namely platelet-rich plasma (PRP) and platelet-rich fibrin (PRF). They are further divided based on their leucocyte contents. The PRP is plasma containing supra-physiological concentrations of the platelets. The growth factors present in the PRP play a crucial role in the promotion of local angiogenesis, regulation of cellular activity, stem cell homing, proliferation and differentiation of different stem cells, and deposition of matrix proteins contributing to tissue regeneration. This review aimed to establish the therapeutic potential of PRP in canine medicine with a particular focus on the applications in ophthalmology, dermatology, and musculoskeletal disorders. A systematic literature review was performed to identify the literature published during the past 20 years (2001-2021) using authentic academic databases, such as PubMed, Science Direct, Google Scholar, and Scopus. In the initial search, 556 articles were identified and based on the specific inclusion and exclusion criteria, 59 articles were selected for further analysis. The clinical efficacy of PRP depends on the number of platelets and the growth factor concentration. The PRP-based biological therapy has broad clinical applications in musculoskeletal pathologies. It is a simple, safe, and cost-effective method that can be used to treat various diseases and disorders in canine practice. For example, PRP is used for managing corneal ulcers, corneal erosion, alkali burn, keratoconjunctivitis sicca, burn wounds, chronic wounds, cutaneous ulcers, acute traumatic bone fractures, tendinopathies, cartilage pathologies, osteoarthritis, and abdominal wall defects either as monotherapy or as an adjunctive therapeutic agent. In addition, PRP is widely used as a carrier of mesenchymal stem cells for transplanting into bone defects. Therefore, allogeneic PRP therapy can be considered a simple, safe, and cost-effective method for the treatment of various diseases and disorders in canine practice. The therapeutic application of PRP in canine medicine is limited in the present study due to the lack of consensus for collection, characterization, and clinical use. Hence, further studies are required to establish the actual worth of PRP-based regenerative strategies in canine medicine.

Rates of early complications and mortality in patients older than 80 years of age after surgical treatment of acute traumatic spinal fractures: ankylosing spondylitis versus osteoporosis.

The purpose of this retrospective cohort study was to analyze the early complications and mortality associated with multilevel spine surgery for unstable fractures in patients older than 80 years of age with ankylosing spondylitis and to compare the results with an age- and sex-matched cohort of patients with unstable osteoporotic fractures. A retrospective review of the electronic medical records at a single institution was conducted between January 2014 and December 2019. Patient demographics, surgical characteristics, complications, hospital course, and 90-day mortality were collected. Comorbidities were stratified using the age-adjusted Charlson Comorbidity Index (CCI). Among 11,361 surgically treated patients, 22 patients with ankylosing spondylitis (AS group) and 24 patients with osteoporosis (OS group) were identified. The mean ages were 83.1 ± 3.1 years and 83.2 ± 2.6 years, respectively. A significant difference in the mean CCI score was found (7.6 vs 5.6; p < 0.001). Multilevel posterior fusion procedures were conducted in all patients, with 6.7 ± 1.4 fused levels in the AS group and 7.1 ± 1.1 levels fused in the OS group (p > 0.05). Major complications developed in 10 patients (45%) in the AS group compared with 4 patients (17%) in the OS group (p < 0.05). The 90-day mortality was 36% in the AS group compared with 0% in the OS group (p < 0.001). Patients older than 80 years of age with AS bear a high risk of adverse events after multilevel spinal fusion procedures. The high morbidity and 90-day mortality should be clearly discussed and carefully weighed against surgical treatment.

Treatment of Thoracolumbar Type A3 Fractures Using a Percutaneous Intravertebral Expandable Titanium Implant: Long-term Follow-up Results of a Pilot Single Center Study

There are controversies about the optimal management of AO subtype A3 burst fractures. The most common surgical treatment consists of posterior fixation with pedicle screw and rod augmentation. Nevertheless, a loss of correction in height restoration and kyphotic reduction has been observed. The aim of this study was to assess long-term outcomes of a minimally invasive technique using a percutaneous intravertebral expandable titanium implant (PIETI). This prospective, single center, pilot study was carried out on a consecutive case series of 44 patients with acute (< 2 weeks) traumatic thoracolumbar fractures AO type A3. The average follow-up was 5.6 years. A single center in Castilla y Leon, SpainMETHODS: Clinical outcomes (pain intensity on visual analog scale [VAS], Oswestry Disability Index [ODI], analgesic consumption) and radiographic outcomes (anterior/mid/posterior vertebral body height, vertebral area, local kyphosis angle, traumatic regional angulation) were analyzed before surgery, at one month after surgery, and at the end of the follow-up period. At one-month postsurgery, significant improvements in VAS score and ODI score were observed. PIETI achieved significant vertebral body height restoration with median height increases of 2.9 mm/4.3 mm/2.3 mm for anterior/middle/posterior parts, respectively. Significant correction of the local kyphotic angle and improvement of the traumatic regional angulation were accomplished. All these improvements were maintained throughout the follow-up period. The only complication reported was a case of cement leakage. In our opinion, the main limitation of the study is the small number of patients. However, the sample is superior to that shown in other papers. This study showed that using a PIETI in the treatment of fractures type A3 is a safe and effective method that allows marked clinical improvement, as well as anatomical vertebral body restoration. Unlike with other treatments, results were maintained over time, allowing a better long-term clinical and functional improvement. The rate of cement leakage was lower than other reports.

Evaluation of Antibiotic Prophylaxis for Acute Nonoperative Orbital Fractures.

The use of antibiotic prophylaxis for the prevention of infection in nonoperative orbital fractures is controversial, with limited high-quality evidence and inconsistent recommendations in the current scientific literature. Our primary study objective was to identify the prophylactic antibiotic prescribing pattern at our institution for nonoperative orbital fractures and to determine the effect of antibiotic prophylaxis. We retrospectively reviewed 16 years of data from a single institution on patients with acute traumatic fractures of the orbital floor or medial orbital wall. Prophylactic administration of antibiotics and complication rates were evaluated, and complication rates and patient characteristics analyzed. Of 154 patients with nonoperative orbital fractures, 17 patients (group 1) received IV or oral antibiotics and 137 patients (group 2) did not. No patient in either group had documented infectious orbital complications following their orbital injury. Patients receiving antibiotics were more likely to have a concurrent periorbital laceration (58.8% ± 11.9% vs. 28.5% ± 3.9%; P = 0.01). We present the largest cohort yet reported of patients managed without antibiotic prophylaxis for nonoperative orbital fractures, with no infectious complications identified. Currently there is no evidence of utility to prophylactic antibiotics in the setting of nonoperative traumatic orbital fractures. Rather than prescribing antibiotics, we recommend clinicians educate patients on return precautions and offer close follow up for the rare, but potentially severe infectious complications of orbital trauma.

Capital femoral physeal dysplasia in cats submited to ostectomy of the femoral head and neck

ABSTRACT: This report described pathological fracture of the femoral head (physeal dysplasia) in four male cats (three mixed breed and one Bengal), with an average age of 16 months, treated by an ostectomy of the femoral head and neck. Three cats were neutered and one entire. All presented with mild intermittent lameness in the pelvic limbs. Displacement of the femoral epiphysis and resorption of the femoral neck were present and excision of the femoral head and remaining neck was performed in all cases. Hstological examination showed mild foci of compaction and trabecular fibrosis with deposition of fibrous connective tissue, permeated by granulation tissues, consistent with the original diagosis. Limb function improved in all patients from 2 to 4 weeks postoperatively. Diagnosis of physeal dysplasia is challenging and treatment is different from acute traumatic fractures. Femoral head and neck excision was considered a good alternative in these patients.

The role of chemical shift magnetic resonance imaging in differentiating osteoporotic benign and malignant vertebral marrow lesions.

PurposeTo evaluate the usefulness of chemical shift imaging (CSI) in differentiating benign osteoporotic and malignant vertebral marrow lesions.Material and methodsPatients undergoing spinal magnetic resonance imaging (MRI) for back pain, which showed altered marrow signal intensity on conventional MRI sequences, were included in the study. Patients with acute traumatic vertebral fractures, infective spondylodiscitis, paravertebral collections, etc. were excluded. The patients underwent CSI. In-phase and opposed-phase images were taken to calculate the signal intensity ratio (SIR) of the abnormal vertebra. The SIR of the mean signal intensity measured on opposed-phase to mean signal intensity measured on in-phase images was measured and recorded.ResultsThe studied population included 30 patients, in whom 58 vertebrae were accessed, which included 38 dorsal, 18 lumbar, 1 sacral, and 1 cervical. Out of 58 vertebrae, 46 (79%) were malignant and 12 (20%) were benign. The mean CSI/SIR of malignant lesions was 0.96 and the mean SIR of benign lesions was 0.76.ConclusionsConventional MRI sequences cannot always differentiate between benign and malignant lesions. So newer sequences like CSI have been developed. CSI SIR can be used as a new tool in differentiating benign osteoporotic and malignant vertebral marrow lesions.

Orthosis in Thoracolumbar Fractures: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Systematic review and meta-analysis of randomized controlled trial (RCT). The aim of this study was to evaluate radiological and clinical outcomes of acute traumatic thoracolumbar fractures in skeletally mature patients treated with orthosis, versus no immobilization. Orthosis is traditionally used in conservative treatment of thoracolumbar fractures. However, recent studies suggest no benefit, and a possible negative impact in recovery. Databases were searched from inception to June 2019. Studies were selected in two phases by two blinded reviewers; disagreements were solved by consensus. Inclusion criteria were: RCT; only patients with acute traumatic thoracolumbar fractures; primary conservative treatment; comparison between orthosis and no orthosis. Exclusion criteria were inclusion of nonacute fractures, patients with other significant known diseases and comparison of groups different than use of an orthosis. Two independent reviewers performed data extraction and quality assessment. Fixed-effects models were used upon no heterogeneity, and random-effects model in the remaining cases. A previous plan for extraction of radiological (kyphosis progression; loss of anterior height) and clinical (pain; disability; length of stay) outcomes was applied. PRISMA guidelines were followed. Eight articles/five studies were included (267 participants). None reported significant differences in pain, kyphosis progression, and loss of anterior height. One reported a better ODI with orthosis at 12 but not at 24 weeks. No other study reported differences in disability. All authors concluded an equivalence between treatments.Meta-analysis showed a significant increase of 3.47days (95% confidence interval 1.35-5.60) in mean admission time in orthosis group. No differences were found in kyphosis at 6 and 12 months; kyphosis progression between 0 to 6 and 0 to 12 months; loss of anterior height 0 to 6 months; VAS for pain at 6 months; VAS change 0 to 6 months. Orthosis seems to add no benefit in conservative treatment of acute thoracolumbar fractures. This should be considered in guidelines and reviews of health care policies. 3.