Bone Fractures In Adults Research Articles

Management of Acute Nasal Bone Fractures in Adults: Systematic Review and Meta-Analysis

Management of Acute Nasal Bone Fractures in Adults: Systematic Review and Meta-Analysis

Management of Acute Nasal Bone Fractures in adults: Systematic Review and Meta-Analysis

Management of Acute Nasal Bone Fractures in adults: Systematic Review and Meta-Analysis

EPH72 Prevalence of Fractures in People over 50 Years of Age with Osteoporosis in Colombia

To describe the frequency of bone fractures in adults 50 years of age or older with osteoporosis in Colombia, based on data from the official Ministry of Health national registry (SISPRO).

Comparative Study of Interlocking Nailing versus Dynamic Compression Plating in Fractures of Tibia in a Secondary Level Hospital in Bangladesh

Introduction: Tibial diaphyseal fractures are the commonest long bone fractures in adults, most commonly managed by intramedullary interlocking nailing. However, several metaanalysis show that locking plate osteosynthesis is equally effective in managing tibial diaphyseal fractures and are associated with less number of complications. Aim: To compare the results of fixation of tibial fractures following plating and nailing in terms of union, patient satisfaction and complications. Materials and Methods: A hospital based non randomized clinical trial was performed from January 2018 to December 2019 where closed or open diaphyseal or metaphyseo-diaphyseal fractures of the tibia (closed or open Gustilo Anderson type 1 through 3B) were included. Simple sequential allocation was used for allotting the patients to two groups, one for interlocking nailing and other for plating. The patients were followed up for clinical, radiographic and functional results. Results: Thirty patients with 30 involved limbs completed follow up for one year. The duration of surgery and average blood loss during surgery was 75.45±3.03 minutes and 165.00±5.31 ml respectively in case of nailing and 85.05±2.54 minutes and184.29±5.33 ml respectively in case of plating and their difference was statistically significant. In our study union was achieved in less than 20 weeks in 21 (70%) of the patients and 25-30 weeks in nine (30%) cases. The average time of union in our study was 19.55±0.69 weeks in case of interlocking nailing and 20.38±1.39 weeks in case of plating and there was no statistically significant difference between the two. However, there is statistically significant difference in the functional score in between the two groups in terms of Lower Extremity Functional Score (LEFS). Delayed union in one case of nailing and two cases of plating, valgus malunion in one case of nailing and joint stiffness in two cases each of nailing and plating were the major complications observed. Conclusion: There was no difference between the two modalities in terms of fracture union. Complications were lesser but more serious in case of plating. Patient satisfaction was more with plating. J Shaheed Suhrawardy Med Coll 2021; 13(2): 100-104

Correlation of Temporal Bone Fracture on Computed Tomography Scan with Hearing Loss in Posttraumatic Patients

Introduction: Temporal bone fractures in adults are invariably due to motor vehicle accidents or road traffic accidents. Hearing loss is a common complaint following temporal bone fractures, but attention to it is frequently overlooked as there may be other life-threatening complications associated with it that may require immediate attention of the caregiver. Immediate detection of temporal bone fracture and its complications helps in providing early and effective treatment. Aim: The main objective of our study is to observe various types of fractures on multidetector computed tomography (CT), difference between various types, and classification of fractures of temporal bone with correlation between types of fracture and clinical hearing loss. Methods: Two-year (2019–2021) prospective study of head injured patients with temporal bone fracture presented to the Department of Radio-diagnosis (AVBRH, DMIMS, Wardha) with complaints of hearing loss was subjected for study. Temporal bone fracture patients satisfying inclusion and exclusion criteria having hearing loss were evaluated audiologically after a gap of 3 months following the initial injury once the patient was stable. Age and gender distribution, cause of injury, radiological findings, and clinical presentations were analyzed. Data were entered into Microsoft Excel data sheet and were analyzed using SPSS 22 version software. Results: Out of 173 patients having hearing loss with temporal bone fracture, majority of the patients were male (84.97%) and were between 20 and 39 years (46.24%) with a mean age of 41 years. The major cause of injury was motor vehicle accidents (84.39%). The right side was involved (49.1%) more than the left side (46.0%). Longitudinal type fracture was most frequent (64.74%). Otic capsule involvement was present in 9.25%. Conductive hearing loss was more common in otic capsule sparing and sensorineural hearing loss was more common in otic capsule-involved fractures. Otic capsule sparing was more common in (95.54%) longitudinal type of fracture. Otic capsule violation was more common in (26.09%) transverse type of fracture. Conclusion: This study suggests that image analysis of high-resolution CT can be used in fracture of temporal bone either to detect the hearing loss or to know the type and classify the fracture or to find the correlation between the types of fracture and clinical hearing loss.

Clinical characteristics of adolescent nasal bone fractures.

BackgroundThere have been many reports of nasal bone fractures in adults, but there are few clinical reports of them in adolescents, although adolescence is the main growth period of the nasal bone. In addition, previous studies have tended to classify and describe child and adolescent nasal fractures in the same category. The aim of this study was to identify the clinical aspects of nasal fractures in adolescents, and to evaluate the characteristics of nasal fractures in the growth period.MethodsOur institution’s database was reviewed to extract data on adolescent patients between the age of 13 to 18 who had isolated nasal bone fractures from March 2012 to February 2020. The study excluded patients with other facial fractures, previous facial fractures, or congenital deformities.ResultsThis study included 243 boys and 26 girls. Interpersonal violence and sports-related accidents accounted for 85 and 79 cases, respectively. There were 128 frontal impact injuries and 132 lateral impact injuries, and 97 patients had accompanying septal fractures. An accompanying septal fracture was present in 36.06% of all patients, but in 51.20% of those who underwent surgery.ConclusionThe prevalence of adolescent nasal fractures was significantly higher in boys, to a greater extent than observed for pediatric or adult fractures. The main causes of fractures were interpersonal violence and sports-related accidents. An explanation for these results is that adolescent boys are more prone to have violent accidents or companionship with active sports than other age or sex groups, leading to substantially more fractures.

The problem of dating fractures: A retrospective observational study of radiologic features of fracture healing in adults

Accurate dating of bone fractures can be crucial in the context of forensic trauma analysis since it may provide essential information for the corroboration or contradiction of statements by victims or suspects in cases of domestic abuse or torture. The different stages of bone healing have been well described in the existing literature, and some previous studies attempted to define related timelines particularly in the paediatric population. However, the bone healing process can be very variable and despite the importance of the topic in the forensic field, so far little is known about the radiological appearance of bone fractures at different healing stages, and how this correlates with time, especially in an adult population.The aim of this retrospective observational study was to describe the temporal aspect of pre-defined healing stages as they appear on radiographs of tubular bone fractures in adults, and explore the effect of potential cofounding variables. A dynamic nomogram was developed as a user-friendly tool to be eventually applied in clinical or medico-legal settings. This study showed that the posttraumatic time interval (PTTI) increased progressively with the pre-defined healing stages. However, confounding factors, such as patients’ age, sex, and location of the fracture need to be accounted for in the final estimation model.Further studies are needed to explore more potentially confounding variables to refine the presented outcomes. Better knowledge of the effect of different confounding variables in the dating of fracture healing will contribute to greater accuracy of PTTI estimation of bone fractures in adults.

Natural and Synthetic Antioxidants Prevent the Degradation of Vitamin D3 Fortification in Canola Oil during Baking and In Vitro Digestion

Vitamin D insufficiency is widespread in the northern and partly equatorial hemisphere countries. Fortification of vitamin D in commonly consumed vegetable oils can prevent rickets in children, osteoporosis and bone fractures in adults. Avoiding the loss of vitamin D3 fortification in oils during cooking is beneficial for consumer’s health. The aim of this work was to investigate the stability of cholecalciferol (vitamin D3) fortification in canola oil during baking at 80 to 230°C for 10 to 40 min. The natural antioxidants (β-carotene and α-tocopherol) and the synthetic ones (butylated hydroxytoluene (BHT) and tert-butylhydroquinone (TBHQ)) were used to prevent the degradation of vitamin D3. The kinetic degradation of vitamin D3, oxidative status of canola oil and the bioaccessibility in in vitro digestion were assessed. Vitamin D3 was relatively stable at 80 and 130°C for 10 to 40 min. High temperatures of 180 and 230°C caused the highest loss of vitamin D3 being up to 90%. Reaction rate of vitamin D3 degradation ranged from 2.01 to 6.80 × 10–2 sec–1. BHT and TBHQ had the highest antioxidant activity (> 50 %) to decrease the degradation of vitamin D3 at 230°C. The oxidative status (peroxide value, malondialdehyde content) of canola oil was improved after incorporating antioxidant agents. The vitamin D3 bioaccessibility was increased 1.5 fold after in vitro digestion. The consumption of 5 g brownie containing vitamin D3 100 μg/L and antioxidant agents 180 mg/L in 1 mL of canola oil would cover the daily intake.

Autologous bone grafting versus bone morphogenetic protein treatment for nonunion of long bone fractures in adults：a Meta analysis

To systematically evaluate the clinical effects of autologous bone grafting versus bone morphogenetic protein treatment for nonunion of long bone fractures in adults and provide reference for this fracture. According to the methods of systematic review of Cochrane, the randomized controlled trials which compared autologous bone grafting with bone morphogenetic protein treatment for nonunion of long bone fractures in adults were searched in PuMed, Embase, Cochrane library, CNKI , Wangfang data and CBM from the databases were established to March 2019. Information was screened and extracted according to the inclusion and exclusion criteria by two researchers respectively, and the qualities of the included studies were assessed by the modified Jadad quality scale. The rate of infection, successful union, second operation, hospital stays and intraoperative blood loss were compared by RevMan 5.3 software from Cochrane Collaboration for Meta-analysis. Seven randomized controlled trials with a total of 652 patients were included, 410 in the autologous bone grafting group and 242 in the bone morphogenetic protein group. Meta analysis showed there were no statistically significant differences regarding infection［RR=1.32, 95%CI (0.90, 1.93) , P=0.16］, successful union［RR=0.95, 95%CI (0.84, 1.08) , P=0.43］, second operation［RR=1.16, 95%CI (0.43, 3.12) , P=0.76］, hospital stays［MD=0.69, 95%CI (-0.38, 1.75) , P=0.21］between the two groups. But compared with the bone morphogenetic protein treatment, autologous bone grafting significantly increased the intraoperative blood loss［MD=223.00, 95%CI (32.72, 413.28) , P=0.02］. Since bone morphogenetic proteins can attain as the same fracture healing rate as autologous bone grafting and can significantly reduce the intraoperative blood loss, bone morphogenetic proteins may be a better choice for nonunion of long bone fractures in adults.

Management of Fractures Shaft of Tibia in Adult Interlocking Nailing Versus Plating in: A Comparative Study

Background: Tibial shaft fractures are the commonest long bone fractures in adults, most commonly managed by intramedullary interlocking nailing. However, several meta-analysis show that locking plate osteosynthesis is equally effective in managing tibial diaphyseal fractures and are associated with less number of complications.
 Aim: To compare the results of fixation of tibial fractures followingplating and nailing in terms of union, patient satisfaction and complications.
 Materials and Methods: Khwaja Yunus Ali Medical College and Hospital based non randomized clinical trial was performed from September 2014 to August 2017 where closed or open diaphyseal or metaphyseo- diaphyseal fractures of the tibia (closed or open Gustilo Anderson type 1 through 3B) were included. Simple sequential allocation was used for allotting the patients to two groups, one for interlocking nailing and other for plating. The patients were followed up for clinical, radiographic and functional results.
 Results: Forty patients with 41 involved limbs completed followup for one year. in our study was 19.55±0.69 weeks in case of interlocking nailing and 20.38±1.39 weeks in case of plating and there was no statistically significant difference between the two.
 Conclusion: There was no difference between the twomodalities in terms of fracture union. Complications were lesser but more serious in case of plating. Patient satisfaction was more with plating.
 KYAMC Journal Vol. 10, No.-2, July 2019, Page 99-105

The effectiveness of ultrasound in the detection of fractures in adults with suspected upper or lower limb injury: a systematic review and subgroup meta-analysis

BackgroundThe aim of the present review is to assess the effectiveness of ultrasound (US) in the detection of upper and lower limb bone fractures in adults compared to a diagnostic gold standard available in secondary and tertiary care centres (e.g. radiography, CT scan or MRI).MethodsThe review followed PRISMA guidelines and used a database-specific search strategy with Medline, EMBASE and The Cochrane Library plus secondary sources (see supplementary material for completed PRISMA checklist). Diagnostic performance of ultrasound was assessed with a qualitative synthesis and a meta-analysis of two data subgroups.ResultsTwenty-six studies were included (n = 2360; fracture prevalence =5.3 % to 75.0%); data were organised into anatomical subgroups, two of which were subjected to meta-analysis. Sensitivity and specificity ranged from 42.11 − 100% and 65.0 − 100%, with the highest diagnostic accuracy in fractures of the foot and ankle. The pooled sensitivity and specificity of US was 0.93 and 0.92 for upper limb fractures (I2 = 54.7 % ; 66.3%), and 0.83 and 0.93 for lower limb fractures (I2 = 90.1 % ; 83.5%).ConclusionUltrasonography demonstrates good diagnostic accuracy in the detection of upper and lower limb bone fractures in adults, especially in fractures of the foot and ankle. This is supported by pooled analysis of upper and lower limb fracture subgroups. Further research in larger populations is necessary to validate and strengthen the quality of the available evidence prior to recommending US as a first-line imaging modality for prehospital use.Trial registrationThe protocol is registered with the PROSPERO International register of systematic reviews: ID = CRD42017053640.

The effect of experience of ramps at rear on the subsequent ability of layer pullets to negotiate a ramp transition

In commercial situations, laying hens must negotiate levels to reach resources such as food, water and litter. Providing ramps in aviary systems reduces collisions and resultant keel bone fractures in adults. We investigated whether providing ramps during rear improved the ability of birds to transition between levels.Chicks were reared commercially in two flocks both of which provided access to raised structures from three weeks of age. One flock had no ramps, but the other flock was provided with additional access to two types of ramp (wooden ladders, and grids formed from commercial poultry slats placed at an angle). At 8 weeks of age, 64 birds (32 from each rearing condition) were transferred to an experimental facility. At 10 weeks of age, 32 pullets from each group were trained to run to a food reward. During testing at 12–14 weeks of age the pullets accessed the food reward by moving up or down a ramp. The pullets’ behaviours and time taken to complete the task were recorded. Ramp use over three days was also observed in a room replicating a small-scale single-tier system. Four groups of 16 birds aged 12–14 weeks were housed for three days and the number of transitions between the raised tier and litter were recorded.For upward transitions, more ramp-reared birds than control birds succeeded in reaching the food reward for both ladder (52% vs 13%) and grid ramps (74% vs 42%). Birds from the ramp-reared group took significantly less time to complete an upwards transition (68.8s ± 49.3) than the control group (100s ± 37.6) (p = 0.001). In addition, the control group showed more behaviours indicative of hesitancy (moving away, head orientations, ground pecking and crouching) before transitioning, and signs of difficulty when making upward transitions (crouched walks, pauses, turning, returning and escape attempts). In the group housing observations, the ramp reared groups had almost double the number of transitions between the slats and litter on day one compared to the control group. This difference was reduced by day three.In summary, this suggests there are positive effects of providing ramp experience during rear shown by any combination of bird mobility, strength or cognitive ability leading to an increase in apparent confidence in older pullets. It is not known whether these benefits persist through to the laying period, but no detrimental effects were noted so we suggest that ramps should be included from the early rearing period onwards.

A fresh look at radial shaft fracture fixation: The lateral approach to the radius.

Open reduction and internal fixation using plates is the gold standard for the treatment of displaced forearm bone fractures in adults. The ulna being subcutaneous throughout has a constant approach. However, the radius is approached from either the dorsal or the volar side. Both the dorsal and the volar approaches to the radial shaft involve meticulous dissection and preservation of important neurovascular structures. The posterior interosseus nerve is at risk in the dorsal approach and the radial artery and its branches in the volar approach. Dissection of these structures also adds to the operative time. The possibility of a third alternate approach was perceived, which could decrease the potential risks of the conventional approaches. Sixteen patients with radial shaft fractures in the middle third were operated on using the lateral approach: 6 of them had isolated radius fracture and 10 had both-bone fractures. There were 13 males and three females with a mean age of 37.9 years. Limited contact dynamic compression plate or locking compression plate of 3.5 mm was used to fix all fractures. All patients were operated on within 36 h of injury and then followed up till union. Union was assessed using serial radiographs and functional outcome using Anderson et al.'s criteria. The final functional outcome was assessed at an average 6 months after surgery and the results compiled. The mean operative time in isolated radius fractures was 37.5 min and that for plating of both bones was 80.7 min. Primary bone grafting of the radius was done in one case and secondary bone grafting in another patient with delayed union of the radius. Union was achieved in all cases at a mean time of 17.25 weeks. The functional outcome was excellent in 10 patients, satisfactory in 5 patients, and unsatisfactory in 1 patient. The lateral approach is a simple approach with low operative complexity and complications. We found this approach to provide a reliably good exposure of the middle third of the radius, enabling lateral plating without complications.

Functional and radiological outcome in management of compound tibia diaphyseal fracture with AO monolateral fixator versus Limb reconstruction system

IntroductionTibia being the most common fractured long bone represents 36.7% of all long bone fractures in adults with open fracture comprises 23.5% of all tibial shaft fracture. The lack of the muscular covering over anteromedial aspect of the tibia and poor blood supply predispose open tibial fractures to a 10–20 fold increased risk of developing infection than open fracture in any other anatomical areas and a nonunion rate as high as 28% has been reported in the literature. MethodsWe did a prospective study at our institute from 2014–2016 comprising 40 patients with compound tibia diaphyseal fracture managed with AO monolateral external fixator (Group 1) (n = 20) and Limb reconstruction system (Group 2) (n = 20) as primary and definitive tool. Final assessment for bone results and functional results were done using ASAMI (Association of the study and application of the method of Ilizarov) score. ResultsIn our study bony outcome by ASAMI score shows 6 (30%) patients had Excellent, 5 (25%) patients had Good and 9 (45%) had Poor bony outcome from Group I. In group II, 12 (60%) patients had Excellent, 4 (20%) patients had Good, 2 (10%) patients had Fair, and 2 (10%) had Poor bony outcome. The functional outcome by ASAMI score shows 3 (15%) patients had Excellent, 8 (40%) patients had Good, 5 (25%) patients had Fair, 3 (15%) had Poor bony outcome from Group I. In group II, 9 (45%) patients had Excellent, 7 (35%) patients had Good, 2 (10%) patients had Fair, and 2 (10%) had Poor functional outcome. ConclusionLimb reconstruction system (LRS) offers several advantage over AO monolateral external fixator such as ease of application, versatility, stronger fixation, less fixator related complications, early weight bearing and early bony union for management of compound tibia diaphyseal fracture as primary and definitive tool.

A randomized controlled study of dynamic compression plate (DCP) versus limited contact dynamic compression plate (LC-DCP) in treatment of forearm bone fractures in adults (age 18-60 years)

Background and objectives: Fracture of forearm bone are one of the most common injuries seen in day to day practice. The forearm, in combination with the proximal and distal radioulnar joints, allows pronation and supination movements that are important to all of us in the usual activities of daily living. The forearm serves an important role in upper extremity function, facilitating positioning the hand in space, thus helping to provide the upper extremity with its unique mobility. Exacting and decisive management is required after fractures of the shafts of the radius and ulna if function is to be restored. Methods: A prospective randomized controlled study comprising of 50 cases of Fracture of forearm bone with equal distribution of cases (using randomization list) i.e. 25 cases with Dynamic Compression Plating (DCP) (Group A) and 25 cases with Limited contact dynamic compression plating (LC-DCP) (Group B) was done with patients admitted to Sri Siddhartha Medical College, Hospital & Research Centre, Tumkur from April 2015 and April 2017. Results: The Limited contact dynamic compression plating of diaphyseal bones produced excellent Results, the advantages being early mobilization, rigid fixation and hence prevention of fracture disease. The only disadvantage is that it is more expensive than the DCP. Conclusions: The conclusion of our study was that Limited contact dynamic compression plate (LC-DCP) has a definite advantage over Dynamic compression plate (DCP) with respect to time to union and screw placement in comminuted fractures and in case of osteoporotic bone, but the complications, duration of surgery and surgical technique virtually remains unchanged.

Interlocking Nailing Versus Plating in Tibial Shaft Fractures in Adults: A Comparative Study.

Tibial diaphyseal fractures are the commonest long bone fractures in adults, most commonly managed by intramedullary interlocking nailing. However, several meta-analysis show that locking plate osteosynthesis is equally effective in managing tibial diaphyseal fractures and are associated with less number of complications. To compare the results of fixation of tibial fractures following plating and nailing in terms of union, patient satisfaction and complications. A hospital based non randomized clinical trial was performed from September 2013 to August 2016 where closed or open diaphyseal or metaphyseo- diaphyseal fractures of the tibia (closed or open Gustilo Anderson type 1 through 3B) were included. Simple sequential allocation was used for allotting the patients to two groups, one for interlocking nailing and other for plating. The patients were followed up for clinical, radiographic and functional results. Forty patients with 41 involved limbs completed follow up for one year. The duration of surgery and average blood loss during surgery was 75.45±3.03 minutes and 165.00±5.31 ml respectively in case of nailing and 85.05±2.54 minutes and184.29±5.33 ml respectively in case of plating and their difference was statistically significant. In our study union was achieved in less than 20 weeks in 29 (70.8%) of the patients and 25-30 weeks in nine (22%) cases. The average time of union in our study was 19.55±0.69 weeks in case of interlocking nailing and 20.38±1.39 weeks in case of plating and there was no statistically significant difference between the two. However, there is statistically significant difference in the functional score in between the two groups in terms of Lower Extremity Functional Score (LEFS). Delayed union in one case of nailing and two cases of plating, valgus malunion in one case of nailing and joint stiffness in two cases each of nailing and plating were the major complications observed. There was no difference between the two modalities in terms of fracture union. Complications were lesser but more serious in case of plating. Patient satisfaction was more with plating.

Musculoskeletal injuries in a resource-constrained environment: comparing diagnostic accuracy of on-the-spot ultrasonography and conventional radiography for bone fracture screening during the Paris-Dakar rally raid.

BackgroundUltrasound (US) is a good first-line alternative for the diagnosis of bone fractures in adults as well as children. Our study shows that, compared to X-ray, in a resource-constrained environment, on-site US has a high sensitivity (98%) and specificity (96%) in the diagnosis of bone fractures.PurposeTo compare the accuracy of on-the-spot US with conventional radiography in the screening for bone fractures during the Paris–Dakar rally raid.Material and MethodsEighty-three patients (81 men, 2 women) with clinically suspected bone fractures were included in 2013 and 2014. They underwent X-ray and US on the spot, blindly interpreted by two musculoskeletal radiologists. Using X-ray as gold standard, we calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for US, for each anatomic location. The accuracy of US and radiography were also assessed, as were the number of fragments and their degree of displacement (Student’s t-test).ResultsCompared with X-ray, sensitivity, specificity, PPV, and NPV of on-site US were, respectively, for the presence (or absence) of fractures: 98%, 98%, 100%, and 95%. The accuracy of US was 99%. Only one radial styloid process fracture was misdiagnosed with US. There was no significant difference between US and X-ray (P > 0.93) concerning the number of fragments and their degree of displacement.ConclusionBedside musculoskeletal ultrasound performed by trained musculoskeletal radiologists is a useful method in determining and assessing bone fractures in a resource constrained environment.

A distinct regulatory region of the Bmp5 locus activates gene expression following adult bone fracture or soft tissue injury

Bone morphogenetic proteins (BMPs) are key signaling molecules required for normal development of bones and other tissues. Previous studies have shown that null mutations in the mouse Bmp5 gene alter the size, shape and number of multiple bone and cartilage structures during development. Bmp5 mutations also delay healing of rib fractures in adult mutants, suggesting that the same signals used to pattern embryonic bone and cartilage are also reused during skeletal regeneration and repair. Despite intense interest in BMPs as agents for stimulating bone formation in clinical applications, little is known about the regulatory elements that control developmental or injury-induced BMP expression. To compare the DNA sequences that activate gene expression during embryonic bone formation and following acute injuries in adult animals, we assayed regions surrounding the Bmp5 gene for their ability to stimulate lacZ reporter gene expression in transgenic mice. Multiple genomic fragments, distributed across the Bmp5 locus, collectively coordinate expression in discrete anatomic domains during normal development, including in embryonic ribs. In contrast, a distinct regulatory region activated expression following rib fracture in adult animals. The same injury control region triggered gene expression in mesenchymal cells following tibia fracture, in migrating keratinocytes following dorsal skin wounding, and in regenerating epithelial cells following lung injury. The Bmp5 gene thus contains an “injury response” control region that is distinct from embryonic enhancers, and that is activated by multiple types of injury in adult animals.

Comparison of Ultrasonography and Conventional Radiography in the Diagnosis of New Nasal Bone Fractures in Adults

Comparison of Ultrasonography and Conventional Radiography in the Diagnosis of New Nasal Bone Fractures in Adults

The First Comprehensive AO Classification System for Fractures of the Craniomaxillofacial Skeleton.

The First Comprehensive AO Classification System for Fractures of the Craniomaxillofacial Skeleton.