Common Cause Of Fracture Research Articles

Clinical analysis of internal orbital fractures in children.

In order to describe the demographics, etiologic and clinical factors, and outcomes of orbital fractures in children, we have reviewed a case series of 17 patients under 18 years of age with internal orbital fractures (i.e., without involvement of the orbital rim) presenting to the Ghil hospital between March 2000 and June 2001. For 15 of the patients, we performed orbital wall reconstruction with Medpor barrier sheet implantation (thickness 1mm) through transconjunctival approach under endoscopic guidance, while maintaining mere observation on the other 2 patients. There were 14 male and 3 female patients. The most common cause of fractures was accident (7 cases). Inferior wall involvement was most commonly seen, and the trapdoor type fracture was the most common. Thirteen patients had extraocular muscle restriction, 9 had nausea/vomiting and 5 had bradycardia. Diplopia of 9 patients disappeared after 43 +/- 23 days. Nausea/vomiting and bradycardia disappeared rapidly after surgical intervention in all cases. These results suggest that trapdoor fractures with soft tissue entrapment are the most common in pediatric orbital wall fractures, and that most of them are associated with nausea/vomiting. We suggest that early diagnosis, and prompt surgical intervention are required for those patients with oculocardiac reflex.

Fracturas mandibulares: Experiencia en un hospital de trauma

Facial trauma has reached a peak in the last decades in the world; however, scanty epidemiological information is available in Chile. To report the experience in the treatment of mandibular fractures in the maxillofacial unit at Hospital del Trabajador, Santiago. A retrospective study of patients with mandibular fractures treated in a seven years period (1990-1996). Demographic and clinical aspects of the patients are analyzed, with emphasis in causes of trauma, anatomic distribution of the fractures, treatment and complications. One hundred and sixty patients (aged 14 to 65 years old) sustained 245 mandibular fractures. Road traffic accidents were the most common cause of fractures (46%). The most common mandibular fracture was subcondylar. Thirty eight patients (24%) presented with associated facial fractures, while 34 (21%) had also other non-facial fractures. Open reduction and internal fixation was performed in 88 subjects. Complications occurred in 60 patients (38%). Road traffic accidents are the main cause of mandibular fractures in this series of patients. The most common mandibular fracture is subcondylar, which can be linked to the high rate of occlusal complications observed.

Pediatric temporal bone fractures.

To examine the etiology, presentation, and management of temporal bone fractures in children. Case control. Retrospective review of a level I pediatric trauma center from July 1, 1990 to November 1, 1996 identified 680 patients. Inclusion criteria of age less than 14 years and only blunt temporal bone trauma identified 122 patients, with 97 charts available for review. The criteria for temporal bone fracture consisted of both clinical and radiologic information. Only patients with temporal bone fractures confirmed by computed tomography, a complete otolaryngology examination, and audiometric evaluations were included in the study. The data were analyzed with the Kruskal-Wallis analysis of variance (ANOVA) for examining the three separate age groups of fractures. Chi-squared analysis was used to compare these data with previously published adult and pediatric temporal bone fracture series and to examine the three separate age groups of fractures. The review identified 72 children with 79 temporal bone fractures: 47 boys and 25 girls. The patients ranged from 6 months to 14 years of age, with a bimodal distribution of patients with peaks at 3 years and 12 years of age. The most common causes of fractures were motor vehicle accidents (47%), falls (40%), biking accidents (8%), and blows to the head (7%). Common presenting signs and symptoms included hearing loss (82%), hemotympanum (81%), loss of consciousness (63%), intracranial injuries (58%), bloody otorrhea (58%), extremity fractures (8%), and facial nerve weakness (3%). The most common causes of temporal bone fractures were falls and motor vehicle accidents. Forty-two patients were noted to have bloody otorrhea and possible cerebrospinal fluid leak. Twenty-four received intravenous antibiotics. No patient developed prolonged otorrhea or meningitis during hospitalization and the follow-up period. The classification of fracture patterns was longitudinal, 54%; transverse, 6%; oblique, 10%; squamous, 27%; and other, 3%. Hearing loss was found in 59 patients, with conductive hearing loss being the most common finding in 56% of the patients, followed by sensorineural hearing loss in 17% and mixed hearing loss in 10%. Pediatric temporal bone fractures are associated with falls and motor vehicle accidents. There is a high incidence of associated intracranial injuries and hearing loss, but facial nerve injuries are uncommon. Timely management minimizes complications.

Craniomaxillofacial trauma in the elderly

Purpose : Limited data are currently available regarding the nature of craniomaxillofacial fractures in the geriatric population. This retrospective study reviews 109 hospital records dating from 1981 to mid-1993. The goal of this study was to provide details relevant to these types of injuries. Results : Most patients were injured in motor vehicle accidents (MVA) or fall-related episodes. Females sustained 43.9% of the fractures while males sustained 56.1%. In females, falls were the most common cause of fractures, while in males MVAs caused the majority of fractures ( P < .01). Most fractures were found in the upper midface region (60.3%) and the mandible (27.5%). MVAs and falls were responsible for 82.7% of all mandibular fractures. The majority of fractures were treated nonsurgically (49.5%); however, 37.6% were treated with open reduction and internal fixation. The in-hospital mortality rate was 11.1%, and there were three postoperative complications. Conclusion : The geriatric Craniomaxillofacial trauma patient is readily treatable with both aggressive surgical measures and more conservative approaches. Elderly patients often have an underlying medical condition that may subsequently alter the patient's treatment. The findings of this study also suggest that more preventive measures and methods of minimizing mortality and morbidity need to be implemented.

Fractures in the under-3-year-old age cohort.

One hundred twenty-four urban children under 3 years of age admitted for fractures were retrospectively reviewed to determine the frequency of accidental and nonaccidental causes in this population. The fractures were categorized according to their mechanisms: motor-vehicle passenger or pedestrian accident, other accidents, or child abuse. There were no differences in the frequency of fractures by race, date of birth, or season in which the injury occurred. Skull fractures were most frequent (62%), followed by femur fractures (11%). There was a 26% increase in fractures between 1987 and 1989, especially in the non-motor vehicle cohort. Caretaker ignorance and/or carelessness was a common cause of fractures in the infant and toddler age group. Injuries were still occurring in spite of infant care seat use. The American public must be educated in preventive medicine and safety to decrease the senseless morbidity of our greatest resource.

Dynamic resistance of teeth: technical considerations and applications of an experimental device

Tooth fracture by impact is the most common cause of fracture in human incisors. We have designed an experimental system to measure the dynamic fracture force of teeth in vitro, and initial results obtained from a sample of healthy, recently removed human incisors are reported. The method was reproducible and reliable, and the results provide a baseline for studies evaluating the effect of endodontic procedures on the dynamic fracture force of teeth.

Fracture patterns in Nottingham children.

The incidence and pattern of fractures in children less than or equal to 12 years of age living in Nottingham, England, have been reviewed. The annual incidence rate is 16/1,000 children. Fractures are rare in those less than 18 months of age, and incidence increases with age. The most common cause of fracture was a fall in or around the home; the incidence rate of fractures after road traffic accidents was similar in all age groups. Fractures of the distal radius and ulna accounted for 35.8% of all fractures seen, with hand fractures the second largest group (14.7%). The most common fracture type was a green-stick fracture (51.6%), and 18.5% of fractures were epiphyseal injuries. Epiphyseal injuries in children less than 5 years of age, were uncommon whereas spiral/oblique fractures were more common. Rotational trauma is more likely to cause a spiral or oblique shaft fracture in a younger child and an epiphyseal fracture in an older child.

Fracture of the femur in the Duchenne muscular dystrophy patient.

This report summarizes the management of 20 femur fractures seen in 16 Duchenne muscular dystrophy patients. The most common cause of fracture was falling. In the ambulatory patient, reduction of the fracture was followed by casting so that ambulation could be maintained. This was the preferred treatment and was carried out in six of seven patients. Nine nonambulatory patients presented with 11 femoral fractures. Gross displacement was seldom seen. Short-term immobilization generally gave satisfactory pain relief. Prevention of further function loss during fracture treatment present a challenge to the physician caring for this group of severely disabled children.

Fractures of the Mandible in Motor Vehicle Accidents

Motor vehicle accidents are a common cause of fractures of the mandible and are the most common cause of serious and multiple fractures. The usual mechanism of injury is outlined. The common fractures that occur are through the anterior alveolar process, condylar necks, or edentulous areas of the body and symphysis. There is high incidence of other injuries associated with jaw fractures in these patients. Treatment of the mandibular fracture must wait until the patient's general condition is stabilized. Obstruction of the airway demands emergency treatment by keeping the tongue forward and repeated suction of blood and mucus from the mouth and nasopharynx. Emergency tracheostomy is rarely necessary because of mandibular fractures. The methods for immobilizing a fractured jaw are outlined. The majority of accident victims are young and therefore have teeth. When there are teeth that occlude immobilization of the mandible must include intermaxillary fixation by wiring the teeth into occlusion. Interosseus wiring is used to support unstable fragments. Intramedullary Kirschner wires are a simple and effective method for immobilizing fractures through the body and symphysis of edentulous patients.

FRACTURES IN THE AGED.

The most common cause of fractures in the elderly is falling.Urinalysis, hemoglobin determination and a thoracic roentgenogram always should be obtained for the elderly patient with a major fracture. Determination of the sedimentation rate of erythrocytes aids in assessment of the patient for treatment.Treatment should be selected on an individual basis. Good nursing care is most important, and the patient should be provided with a familiar environment or familiar articles to decrease disorientation and delirium. If surgical intervention is indicated, it should be accomplished with dispatch in accord with good surgical principles.The physician's obligation to the patient continues after the fracture has healed until the patient is returned to the best possible condition according to the injury sustained.

FRACTURES OF THE TRANSVERSE PROCESSES OF THE LUMBAR VERTEBRÆ

There is apparentIy considerabIe difference of opinion in regard to the frequency, importance and treatment of fractures of the transverse processes of the Iumbar vertebrae. From the scarcity of references to this injury one wouId think the Iesion either rare or of IittIe moment. Some even suggest that it is non-existent, the roentgen-ray appearance being due to bony abnormality. A knowIedge of the amount of disabiIity caused is important, for one thing, in estimating insurance Ioss, as many of these are compensation cases. Some state that proIonged immobiIization or more radica1 procedure is necessary, apparentIy feeIing that they are deaIing with an injury foIIowed by considerabIe disability. This paper reviews the Iiterature and our experience in IO cases at the SurgicaI CIinic of the Beekman Street HospitaI. Among injuries to the back, fractures of the transverse processes of the Iumbar vertebrae are not rare, aIthough it is to be emphasized that bony anomaIies in this region are frequent and may tend to confuse the diagnosis. The most common cause of fracture of the transverse processes is direct vioIence. The symptoms and physica signs are those of a severe sprain or contusion of the back. Sudh fractures are usuaIIy muItipIe. When uncompIicated by body fracture, a11 the fractures are usuaIIy on the same side. The disabiIity caused by the injury is due soIeIy to the associated contusion or sprain of the back, and the presence of the fracture is negIigibIe as far as proIongation of disability is concerned. Owing to the frequency of traumatic neurosis, it is preferabIe that knowIedge of an existing fracture be kept from the patient. Bony union of the fractured transverse processes is definite in some of these cases. More carefu1 examination of backs shouId be made before empIoying men over forty at hard Iabor. The treatment required is rest in bed, heat and massage. ProIonged immobiIization is no more necessary than in any contusion or sprain of the back. In this series patients were abIe to waIk after an average period of sixteen days. DisabiIity over six months is out of the ordinary. The majority of patients shouId be at work within two months with practicaIIy no compIaints referabIe to the injury.