Common Fracture Location Research Articles

Predictors of enophthalmos among adult patients with pure orbital blowout fractures.

The aim of this study was to determine the predictors of post-traumatic enophthalmos (PE) in relation to the internal orbital changes following pure orbital blowout fractures. The design was a 10-year retrospective cross-sectional study analysing 629 medical records and computed tomography (CT) data of patients with orbital fractures from January 2008 to January 2017. Demographic, etiology, co-morbidity and clinical characteristics were obtained from the medical records. Assessment of the PE, fracture site and size, intraorbital structures and muscle change were performed using the Digital Imaging and Communications in Medicine (DICOM) viewer software, OsiriX v5.8.2. Of the 629 patients with orbital fractures, 87 were pure orbital blowout fractures. Demographic pattern showed that males outnumbered females in the series, with male: female ratio of 5.7:1. The mean age was 37.2 ± 14.7 and the main etiology was motor vehicle accident. Orbital floor fracture was the most common fracture location (67.8%). The involvement of the posterior ledge and inferior orbital fissure showed statistical significant difference with PE (Fisher’s exact test, p = 0.03). Binary logistic regression showed that after controlling for age, patients with fracture size of more than 150 mm2 had three times the odds of sustaining a PE, (adjusted odds ratio (AOR) = 3.01 (95% CI 1.17–7.92).Fracture size larger than 150 mm2 was a radiological predictor of PE. Additional research investigating further on the role of concurrent fracture of the posterior ledge and inferior orbital fissure is advocated.

Understanding humerus fractures in young children: Abuse or not abuse?

Fractures are the second most common abusive injury occurring in young children, particularly those under 2 years of age. The humerus is often affected. To better identify factors discriminating between abusive and non-abusive humerus fractures, this retrospective study examined the characteristics and mechanisms of injuries causing humerus fractures in children less than 18 months of age. Electronic medical records were reviewed for eligible patients evaluated between September 1, 2007 and January 1, 2012 at two children’s hospitals in Chicago, IL. The main outcome measures were the type of fracture and the etiology of the fracture (abuse vs not abuse). The 97 eligible patients had 100 humerus fractures. The most common fracture location was the distal humerus (65%) and the most common fracture type was supracondylar (48%). Child Protection Teams evaluated 44 patients (45%) and determined that 24 of those had 25 fractures caused by abuse (25% of the total study population).Among children with fractures determined to have been caused by abuse, the most common location was the distal humerus (50%) and the most common types were transverse and oblique (25% each); however, transverse and oblique fractures were also seen in patients whose injuries were determined to have been non-abusive. A younger age, non-ambulatory developmental stage, and the presence of additional injuries were significantly associated with abusive fractures. Caregivers did not provide a mechanism of injury for half of children with abusive fractures, whereas caregivers provided some explanation for all children with non-abusive fractures.

The circumstances, orientations, and impact locations of falls in community-dwelling older women

ObjectiveWe sought to characterize the circumstances, orientations, and impact locations of falls in community-dwelling, ambulatory, older women. MethodsFor this longitudinal, observational study, 125 community-dwelling women age≥65years were recruited. Over 12-months of follow-up, fall details were recorded using twice-monthly questionnaires. ResultsMore than half (59%) of participants fell, with 30% of participants falling more than once (fall rate=1.3 falls per person-year). Slips (22%) and trips (33%) accounted for the majority of falls. Approximately 44% of falls were forward in direction, while backward falls accounted for 41% of falls. About a third of all falls were reported to have lateral (sideways) motion. Subjects reported taking a protective step in response to 82% of forward falls and 37% of backward falls. Of falls reporting lateral motion, a protective step was attempted in 70% of accounts. Common impact locations included the hip/pelvis (47% of falls) and the hand/wrist (27%). Backwards falls were most commonly reported with slips and when changing direction, and increased the risk of hip/pelvis impact (OR=12.6; 95% CI: 4.7–33.8). Forward falls were most commonly reported with trips and while hurrying, and increased the risk of impact to the hand/wrist (OR=2.6; 95% CI: 1.2–5.9). ConclusionFalls in older ambulatory women occur more frequently than previously reported, with the fall circumstance and direction dictating impact to common fracture locations. Stepping was a common protective recovery strategy and that may serve as an appropriate focus of interventions to reduce falls in this high risk population.

Thoroughbred fatality and associated jockey falls and injuries in races in New South Wales and the Australian Capital Territory, Australia: 2009–2014

Monitoring racehorse fatality and associated jockey falls provides benchmarks for intervention strategies. The aims of this study were to describe the incidence of and reasons for fatalities in Thoroughbred horses during flat races in the Australian Capital Territory and New South Wales (NSW), Australia, and to describe reported jockey falls and injuries associated with racehorse fatalities. A cohort study identified all racehorse fatalities reported through Racing NSW for the 2009–2010 to 2013–2014 racing seasons. Risks of racehorse fatality, fatal musculoskeletal injury, spontaneous death (as distinct from euthanasia) and racehorse fatality associated jockey falls and injuries were calculated using Poisson regression. A total of 167 horse fatalities were reported, with an overall incidence of 0.59 deaths/1000 starts. Forty-nine reasons for horse fatality were reported, although post-mortem examinations were conducted on only 52/165 (31.5%) horses. Musculoskeletal injury accounted for 144/167 (86.2%) fatalities, with an incidence of 0.52/1000 starts. Fractures comprised 96/167 (57.5%) fatalities, with the fetlock or proximal sesamoid bones being the most common fracture location, comprising 36/96 (37.5%) fractures. Only 22/166 (13.3%) racehorse fatalities were due to spontaneous death, representing an incidence of 0.08/1000 starts. A total of 50 racehorse fatality associated jockey falls were reported (incidence of 0.18/1000 starts), with 32 reported jockey injuries (incidence of 0.12/1000 starts). Most racehorse fatality associated jockey injuries occurred to the limbs (17/32, 53.1%), particularly the upper limb. The estimates for both horse fatality and associated jockey injury were comparable with previous estimates from other jurisdictions internationally.

The Impact of Hospital Teaching Status on Timing of Intervention, Inpatient Morbidity, and Mortality After Surgery for Vertebral Column Fractures with Spinal Cord Injury.

To investigate the impact of hospital teaching status on the timing of intervention and inpatient morbidity and mortality after surgery for acute spinal cord injury (SCI). Data from the Nationwide Inpatient Sample (2002-2011) were reviewed. Patients were included if they had a diagnosis of closed vertebral column fracture with SCI, underwent spine surgery, and were admitted urgently or emergently. Early intervention (the day of or the day after admission), inpatient morbidity and mortality rates were compared between patients admitted to teaching versus nonteaching hospitals. Multivariable regression analyses were performed. A total of 9236 patients were identified (mean age 43 years, 82.6% male gender), with 78.7% admitted to a teaching hospital (n= 7,272) and 21.3% to a nonteaching hospital (n= 1,964). The most common mechanism of injury was a motor vehicle collision (43.9%), while the most common fracture location was between C5 and C7 (35.3%), and 22% of cases were complete SCIs. Following multivariable analysis, teaching hospital status was significantly associated with early intervention (odds ratio[OR], 1.12; 95% confidence interval [CI], 1.01-1.25), butnotwith complication development (OR, 1.09; 95% CI, 0.98-1.23) or mortality (OR, 1.19; 95% CI, 0.91-1.56). In this nationwide study, patients with vertebral column fractures with SCI who were admitted to teaching hospitals were more likely to receive early intervention compared to patients admitted to nonteaching hospitals. Future studies into the long-term implications of admission to teaching hospitals versus nonteaching hospitals for patients with SCI are encouraged.

The Role of a Conservative Minimal Interventional Management Protocol in the Fractures of the Dentate Portion of the Adult Mandible

Mandibular fractures are commonly encountered by the maxillofacial surgeon. Maxillomandibular fixation (MMF) and open reduction and internal fixation (ORIF), or a combination of both, are the accepted standard treatments. This study aims to assess the role of a conservative minimal intervention protocol in the management of undisplaced/minimally displaced fractures of the dentate portion of the adult mandible and the complications associated with such minimalistic intervention. Thirty-four patients with undisplaced/minimally displaced fractures of the dentate portion of the adult mandible were advised to restrict mouth opening and limit themselves to a soft diet for a minimum of 4 weeks. All patients were advised follow-up at regular intervals for at least 3 months. Five patients were lost to follow-up. Symphysis and parasymphysis fractures were the most common fracture locations. Fourteen patients needed tension band stabilization with a mandibular arch bar/bridle wiring and three patients required extraction of luxated teeth. All patients showed satisfactory healing except three in whom additional intervention (ORIF) was performed. The improvement in mouth opening was statistically significant. Complications were seen more frequently among smokers and alcoholics. For patients with minimally displaced mandibular fractures, it is necessary to consider if the perceived benefits of intervention justify the associated added costs and possible complications. Patients have to be fully informed about the possible complications while using this minimal intervention protocol. This study concludes that a conservative minimal intervention management protocol for such fractures of the dentate portion of the mandible can produce satisfactory results.

Analysis of Pediatric Maxillofacial Fractures Requiring Operative Treatment: Characteristics, Management, and Outcomes.

Maxillofacial fractures in pediatric trauma patients require significant force and frequently are associated with concomitant injuries. The anatomic and developmental differences between the adult and child that impact patterns of injury also affect management and outcomes. The aim of this study was to analyze fracture location, mechanism, concomitant injuries as well as methods of surgical treatment and outcomes, to improve management of this patient population. A retrospective review was conducted of pediatric patients with maxillofacial fractures presenting to a level-1 trauma center during an 8-year span. Only patients requiring surgical intervention, 204, were included in this study. Data pertaining to the location of injury, mechanism, associated injuries, surgical treatment, outcomes, and complications were analyzed. The most common fracture location was the mandible (36.3%), then the nasal bone (35.3%), followed by the tripod fracture (10.8%). A total of 30.7% of patients were involved in motor vehicle accidents, with the next most common mechanisms being sports (24.4%), and assault (13.7%). A total of 46% of the patients sustained concomitant injuries, with the majority involving cerebral trauma (14.7%) or the extremities (9.3%). Total 75.4% of all fractures, excluding the nose, were treated with open reduction and internal fixation (ORIF). Our complication rate was 11.2%. Pediatric craniofacial trauma remains a frequent presentation to the emergency department of trauma centers. Facial fracture patterns and mechanism of trauma observed in the pediatric population presenting to this facility are consistent with incidences reported in the literature. Knowledge of treatment options and potential complications is an important tool in the management of the pediatric trauma patient.

Pediatric orthopaedic lower extremity trauma and venous thromboembolism.

PurposeResearch on venous thromboembolism events (VTE), such as deep venous thrombosis (DVT) and pulmonary embolism (PE), in pediatric orthopaedic trauma patients is sparse. We describe the incidence in the USA of VTE associated with pediatric lower extremity orthopaedic trauma, and characterize injury patterns and VTE treatment methods.MethodsThe Pediatric Health Information System (PHIS) was queried from 2004 to 2013 using ICD-9 codes for lower extremity fractures (pelvis, femur, tibia, ankle, foot) and dislocations (hip, knee, ankle, subtalar) and VTE. Records were queried for age, diagnoses, and VTE treatment.ResultsDuring the study period 285,611 clinical encounters reported lower extremity trauma. Of those, 167 patients were simultaneously coded with VTE (99 DVT, 50 PE, 18 combined DVT/PE), to give an incidence of VTE associated with pediatric lower extremity trauma of 0.058 %. Patients were from 39 centers, with an average age of 12.9 years (range 0–19). There were 249 fractures and 21 dislocations, with 25 (15 %) patients sustaining more than one lower extremity injury. The most common fracture locations were the femur/femoral neck (95), tibia/ankle (92), and pelvis (44). 72 % (121/167) of patients were treated with anticoagulation medication, of which the most common was low-molecular-weight heparin (111/167, 66 %).ConclusionsThe incidence of VTE events associated with lower extremity orthopaedic trauma is 0.058 %. Adolescents and polytrauma patients with injuries of the femur/femoral neck, tibia/ankle, and pelvis are more commonly affected. Low-molecular-weight heparin is commonly used to treat VTE in pediatric and adolescent patients.

Crown Preservation of the Mandibular First Molar Tooth Impacts the Strength and Stiffness of Three Non-Invasive Jaw Fracture Repair Constructs in Dogs.

Repairing mandibular body fractures presents unique challenges not encountered when repairing long bones. Large tooth roots and the presence of the inferior alveolar neurovascular bundle limit safe placement for many types of orthopedic implants. Use of non-invasive fracture repair methods have increasingly become popular and have proven safe and effective at achieving bone healing. Non-invasive fixation constructs have not been tested in dogs using cantilevered bending. Furthermore, non-invasive fracture repair constructs have not been tested at the location of a common fracture location – the mandibular first molar tooth (M1). The objectives of this study were to test the strength and stiffness of three non-invasive mandibular fracture repair constructs and to characterize the impact that tooth crown preservation has on fixation strength for fractures occurring at the M1 location. Specimens were assigned to three treatment groups: (1) composite only, (2) interdental wiring and composite (IWC), and (3) transmucosal fixation screw and composite. For each pair of mandibles, one mandible received crown amputation at the alveolar margin to simulate the effect of crown loss on fixation strength and stiffness. Regardless of the status of crown presence, IWC demonstrated the greatest bending stiffness and load to failure. With the crown removed, IWC was significantly stronger compared to other treatments. All fixation constructs were stiffer when the tooth crown was preserved. In fractures at this location, retaining the tooth crown of M1 significantly increases stiffness of interdental wiring with composite and transmucosal screw with composite constructs. If the crown of M1 was removed, IWC was significantly stronger than the other two forms of fixation.

The effects of bazedoxifene on bone structural strength evaluated by hip structure analysis

Bazedoxifene (BZA) is a selective estrogen receptor modulator that has been shown to prevent and treat postmenopausal osteoporosis. Hip structure analysis (HSA) can be used to extract bone structural properties related to strength from hip bone mineral density (BMD) scans. This exploratory analysis used HSA to evaluate changes in hip structural geometry in postmenopausal women enrolled in a phase 3 osteoporosis treatment study who were treated with BZA 20mg or placebo for 2years. This analysis cohort included women at increased fracture risk based on known skeletal risk factors (n=521); 1 or more moderate or severe fractures or 2 or more mild vertebral fractures and/or femoral neck BMD T-score≤−3.0 at baseline combined with additional women from the overall study population (n=475); a subgroup analysis included just those women at increased fracture risk. HSA was applied to duplicate hip dual-energy X-ray absorptiometry (DXA) scans acquired at screening and 24months. Percent change from baseline was evaluated using an analysis of covariance for BMD and geometric parameters including section modulus (SM), cross-sectional area (CSA), outer diameter (OD), and buckling ratio (BR). In all regions, BZA was associated with increased BMD and improvements in hip structural geometry. In the narrow neck, BZA 20mg significantly increased SM, CSA, OD, and BMD compared with placebo (P <0.05 for all). In the intertrochanter region, BZA 20mg significantly increased CSA and BMD and decreased BR compared with placebo (P <0.05 for all). Other than BMD (P <0.05), effects of BZA 20mg at the shaft did not reach statistical significance. Similar trends toward improvement in structural geometry with BZA 20mg were observed in all three regions of the hip for the subgroup of women at increased fracture risk. Overall, BZA was associated with geometry-related improvements in bone strength with regard to resistance to bending and compressive forces and to local buckling. These improvements were evident at common fracture locations such as the femoral neck and intertrochanter regions, and are consistent with the significant treatment effect reported for BZA on nonvertebral fractures in higher-risk postmenopausal women with osteoporosis.

Pediatric distal humeral fractures and complications of treatment in Finland: a review of compensation claims from 1990 through 2010.

The distal part of the humerus is the second most common fracture location in children. Complications are more common than with other pediatric fractures and are mostly related to inappropriate diagnosis and treatment. On the basis of data from 1990 through 2010 in the national registry of inpatient care treatment in Finland, we calculated the number of children less than seventeen years of age who were treated under anesthesia for a distal humeral fracture (reduction with or without internal fixation) and the number of treatment institutions. We analyzed compensation claims concerning the treatment of these fractures that were received by the Patient Insurance Centre. The risk of a complication of treatment and the number of avoidable complications of treatment were assessed. A total of 7909 children underwent a procedure under anesthesia to treat a distal humeral fracture. Claims were filed for 117 patients (118 fractures, including seventy-four supracondylar, nineteen epicondylar, nineteen condylar, and six T-type), and compensation was granted for eighty-three (71%) of the patients. Deformity (forty-nine), delayed treatment (twenty), nerve injury (seventeen), and infection (seven) were the most common reasons for compensation. On reevaluation of the claims, ninety patients were assessed as having had complications of treatment. In our opinion, complications could have been avoided for eighty-six (96%) of these patients. We believe that improving the quality of primary assessment and operative technique would decrease the number of complications in the treatment of pediatric distal humeral fractures. Centralizing operative treatment to tertiary hospitals should be considered.

Anterograde Percutaneous Treatment for Lesser Metatarsal Fractures

Metatarsal (MTT) fractures are common injuries in the outpatient orthopedic setting. Lesser MTT fractures, although often technically simple, can lead to an inordinate number of unsatisfied patients. The objective of our study was to evaluate the results obtained using an anterograde percutaneous technique for lesser MTT fractures. To our knowledge, there are no previous publications about this technique. We performed a prospective study with 14 patients from 2003 to 2008, in which we evaluated the fracture location, mechanism of trauma, associated comorbidities, and American Orthopaedic Foot and Ankle Society’s functional score for postoperative clinical assessments. The most common fracture location was the MTT neck (79%). Involvement of multiple MTTs (53%) was more common than isolated fractures (47%), and low-energy trauma (79%) was more frequent than highenergy trauma (21%). Female patients with diabetes had the worst functional postoperative results. There were no postoperative complications related to our chosen technique. The surgical technique proposed was effective for treating lesser MTT fractures and had lower complication rates compared with other established techniques.

MDCT findings after elbow dislocation: a retrospective study of 140 patients

To assess the number and anatomical location of fractures associated with elbow dislocation, to study the correlation between the direction of dislocation and the trauma energy, and to assess radiographs' diagnostic performance characteristics for fractures using MDCT as a reference standard. A retrospective study was performed at a level 1 trauma center, finding a total of 140 patients who had sustained an elbow dislocation and who had undergone a subsequent MDCT examination. The CT and radiographs of the patient were reviewed by two musculoskeletal radiologists. CT images were analyzed for the site and size of the fracture fragments. In addition, the primary direction of the dislocation, patients' age, and gender were recorded. Trauma energy was also assessed. One hundred and thirty-four out of 140 patients (96%) had a fracture that was seen on the correlative CT examination. The most common anatomical fracture locations were the coronoid process of the ulna 84 out of 140 (60%), the radial head 75 out of 140 (54%), and the humeral capitellum 57 out of 140 (41%). Multiple fractures were seen in 71 out of 134 (53%) patients with fractures. The left elbow was more commonly dislocated than the right one. The overall sensitivity of the radiographs was 62% and the specificity 96%. Small fractures and impaction fractures are almost invariably present in elbow dislocations, and half of the patients have more than one fracture. Radiographs have a sensitivity of only 62%. MDCT is an invaluable method for determining the extent of bony injury and revealing occult fractures.

Use of emergency department services for hand, wrist, and forearm fractures in the United States in 2008.

The objective of this study was to determine demographic characteristics and epidemiology of hand, wrist, and forearm fracture patients treated in the emergency departments (EDs) to identify the at-risk populations. The Nationwide Emergency Department Sample database collected by the Agency for Healthcare Research and Quality was used to estimate ED visits for hand, wrist, and forearm fractures during 2008. The overall rate of ED visits for these injuries was 54 per 10,000 population. Children aged 6 to 15 had the highest rate of ED visits at 124 per 10,000. A secondary increase in ED visits occurred at age 50 and rose with age. Metacarpals were the most common fracture location in adults aged 16 to 25, while radius and ulna were the most common fracture location in all other age groups. Demographic analysis identified children, adult males aged 16 to 25, and the elderly as target populations for preventive interventions.

A six-year retrospective study of maxillofacial fractures from radiographic findings in Brazil

Objective: this study aimed to present the causes and prevalence of maxillofacial fractures that occurred in the region of Araraquara-SP – Brazil, during a 6-year period. Methods: information regarding age, gender, etiology, and maxillofacial fracture site, as well as type of radiographic examination were evaluated. Data were gathered from the radiographic examination and radiographic report of the Division of Dentomaxillofacial Radiology, and from charts of the Division of Oral and Maxillofacial Surgery of patients attending for maxillofacial fractures from 2004 to 2009. A descriptive statistical analysis was developed using Epi-Info 3.5.1. Results: from a total of 11,728 patients assisted, 407 patients presented maxillofacial fractures. The prevalent age ranged from 21 to 30 years old. From the total patients, 322 were men and 85 were women (ratio of men to women was 3.8:1). Panoramic radiography (n = 306) was most frequently used to observe maxillofacial fractures. Mandibular fractures were frequent in the body of the mandible (n = 127), followed by symphysis (n = 102), and the prevalent cause was traffic accidents (n = 161). Conclusion: more than half of affected individuals were younger than 40 years of age. The body of the mandible was the most common fracture location vi sualized by panoramic radiography for traffic accidents and fights.

Update on Talar Fracture Patterns: A Large Level I Trauma Center Study

Prior studies of talar fracture patterns are dated and based on radiography only. The purpose of our study was to describe talar fracture patterns and associated injuries in a modern large level 1 trauma center setting using both radiography and CT. The radiolog and clinical data of patients with acute talar fractures diagnosed over an 18-month period were retrospectively reviewed. Data analysis included descriptive statistics for injury mechanisms and associated injuries. Over the study period, a total of 132 talar fractures were detected in 122 patients. The most common talar fracture location was the body (61%). The most common body fractures were dome compression (26%), lateral process (24%), and posterior tubercle (21%). Of the 132 fractures, 62% were comminuted and 21 (16%) were vertical neck fractures compatible with the Hawkins-Canale classification. Both radiography and CT were used in 91% of cases, with CT providing additional information in 112 (93%) cases. By use of CT as the reference standard, the sensitivity of radiography for detecting talar fractures was 74%. The most common fracture missed by radiography was talar dome compression (31% not seen on radiography) Talar fractures were associated with adjacent joint subluxation or dislocation in more than 66% of the cases and adjacent fracture in more than 72% of the cases. In our study, the most common site of talar fracture was the body. Current classification systems do not apply to most talar fractures. Talar fracture patterns cannot be characterized with radiography alone. CT is a critical tool for the detection and characterization of talar fractures. There is a high incidence of adjacent fracture and dislocation with acute traumatic talar fractures.

Pediatric hand injuries: essentials you need to know

The hand is a common site of injury in children and adolescents. The most common mechanism of injury in younger children is crush injury resulting from the hand caught in a closing door while most fractures in teenagers result from recreational sports. Accurate diagnosis of hand fractures is a requisite for timely management of these injuries in order to restore normal function and achieve a satisfactory outcome since poorly treated injuries can have significant functional consequences. Metacarpal and phalangeal fractures can be difficult to diagnose at radiography due to their relatively small size leading to potential delays in treatment. Recognition of common fracture locations and patterns is essential in ensuring prompt and appropriate treatment.

Stress fractures in elderly patients

The purpose of this study was to investigate specific risk factors, common fracture locations and possible sex-specific differences in elderly patients with stress fractures. This analysis enrolled 105 patients (83 women, 22 men) with stress fractures. For the analysis of possible risk factors related to increasing age, data from 82 patients (67 women, 15 men) aged 40years and older (mean age of 57.4 ± 11.0years) were compared with that from a younger control group [23 patients (16 women, seven men), mean age 28.4 ± 6.7years]. Bone mineral density (BMD) was determined using dual-energy X-ray absorptiometry bone densitometry (DXA) and blood samples were taken. A total of 211 stress fractures were found. Of these, 177 were found in the study group, of which 90.4% were located in the lower limb. Lumbar and femoral BMD was significantly lower in elderly patients; however, the BMD of most patients was within the osteopenic or normal range. Within the study group, a total of 83.8% had a vitamin D insufficiency (<30μg/l); 75.5% were not engaged in regular physical activity more than once a week. Overweight patients within the study group had significantly more stress fractures compared to normal weight patients (2.6 ± 1.7 vs. 1.9 ± 1.1, p<0.05). A similar contribution of risk factors has been found for stress fractures in elderly patients and younger controls of the general population. Stress fracture incidence seems to be rather multifactorial and not based on osteoporotic changes alone. A balanced calcium and vitamin D metabolism seems to be of paramount importance for stress fracture prevention in elderly patients.

Growing Rod Fractures

Review of a prospectively collected growing rod database. To define risk factors for and characterize the nature of growing rod fractures. Rod fracture is a common complication of growing rod treatment. The project sought to analyze risk factors for rod breakage and develop preventive strategies. Records of 327 patients in a prospectively collected growing rod database were studied. Risk factors studied were studied as patient-related and rod-related. Multivariate analysis was performed. Eighty-six rod fractures occurred in 49 patients (49 of 327, 15%). Sixteen patients had repeat fractures with eight patients having more than two fractures (maximum six). The most common fracture locations were above or below the tandem connectors (34 of 86) and near the thoracolumbar junction (35 of 86). Other locations were adjacent to anchors (12 of 86) and cross-links (2 of 86). Syndromic diagnoses had the highest rate of fracture; significantly greater than neuromuscular diagnoses (14% vs. 2%, P = 0.01). Patients who were ambulatory had a higher fracture rate (21% vs. 8.7%, P = 0.01). Single rods had a higher fracture rate than dual rods (36% vs. 11%, P < 0.001). Repeat fracture was also more common in patients with single rods (13% vs. 2%, P = 0.0002). In dual-rod constructs, the incidence of both rods breaking at the same time was 26% (7 of 27). Stainless steel rods had a higher fracture rate than titanium rods (29% vs. 18%, P = 0.02). The nonfracture group had larger diameter rods than the fracture group (P = 0.01). The fracture group had shorter tandem connectors than the nonfracture group (P < 0.001). Neither the size of preoperative scoliosis (P = 0.2) nor kyphosis (P = 0.4) was a risk factor for fracture. Length of instrumentation (P = 0.9), anchor type (P = 0.6), and pelvic fixation (P = 0.38) had no significant effect on fracture rates. Eight wound complications were reported, including three cases of skin breakdown at the rod fracture site. Risk factors for rod fractures include prior fracture, single rods, stainless steel rods, small diameter rods, proximity to tandem connectors, short tandem connectors, and preoperative ambulation. Repeat fractures are common, especially with single rods. Rod replacement, with larger diameter rods if appropriate, may be a preferred strategy over connecting the broken rods as fractures signal fatigue of the rod.

Surgical fixation of a symphyseal fracture of the mandible in a cow using cerclage wire

FRACTURES of the mandible are the most common fractures of the cranium in cattle (Elma 1988). The interdental space (diastema), the molar region and the symphysis represent the most common...