Common Fracture Site Research Articles

A retrospective epidemiological analysis of maxillofacial fractures at a tertiary referral hospital in istanbul: a seven-year study of 1,757 patients.

The aim of the study was to evaluate the etiology, incidence, demographics, and characteristics of maxillofacial fractures treated at a university hospital over a seven-year period. We performed a retrospective analysis of 1,757 patients with maxillofacial fractures who were referred to our department between May 2012 and March 2019. The patients' demographic and clinical characteristics were noted, as well as the fracture type, location, and etiology. The treatment modalities were also analyzed. A total of 2,173 maxillofacial fractures were seen in 1,757 patients. The male to female ratio was 3.9:1, and the mean patient age was 31.89 ± 17.70years (range: 0-95years). Maxillofacial injuries were most prevalent in the 19-28years age group (23.9% of cases), with a general increase in injuries observed between 2013 and 2018 across all age groups. The most common etiological factor was assault (29.1%), followed by falls (26%). In male patients, assault was reported as the main cause, while in female patients, falls were identified as the main cause. The nasal bone was the most common site of fracture, followed by the maxilla. The average time from admission to surgery was 2.8days, with local anesthesia being the most frequent surgical intervention. The average time from admission to surgery was 2.8 ± 2.5days (range: 0-20days), with surgeries performed under local anesthesia being more frequent than those carried out under general anesthesia. Among the surgical interventions, the most common general anesthesia technique for fracture reduction was open reduction and internal fixation with plates and screws. Plate exposure, wound-site infection, and temporomandibular joint ankylosis were the major complications encountered in the study population. The study reveals significant variability in maxillofacial fractures based on gender, age, and etiology. Assault emerged as the leading cause of these fractures, followed by falls and road traffic accidents. Men were affected by maxillofacial trauma four times more often than women, with the highest incidence occurring in the 19-28years age group. Nasal fractures were the most frequently observed (78.7%), while condylar-subcondylar process fractures were the most common type of mandibular fracture. Given these findings, a targeted, lifelong prevention strategy focused on high-risk groups could significantly reduce the burden of maxillofacial trauma.

Head, face and neck injury patterns for electric scooter accidents identified on computed tomography scanning: Does legislative change enforcing safer riding practices have an impact on morbidity for significant head, face and neck trauma?

The purpose of this study is to review whether legislative change enforcing safer riding conditions for Electric Scooters (E-Scooter), regardless of other factors, had an impact on reducing significant head, facial and neck trauma. Additionally, to identify the radiological injury patterns for head, face and neck injuries identified on CT imaging for a patient's initial presentation to the emergency department (ED) resulting from an E-Scooter accident. A retrospective single-centre observational study at a metropolitan tertiary ED of patients presenting after an E-Scooter accident comparing 6 months before and after legislative change. Four hundred and forty-three patients presented following an E-Scooter accident: 191 patients 6 months before and 252 patients 6 months after legislative change. One hundred and sixty-two patients pre- and 217 patients post-legislative change had negative CT studies. Twenty-nine patients pre- and 35 patients post-legislative change had CT studies demonstrating significant head, face or neck trauma. The most common type of intracranial bleeding was subarachnoid haemorrhage followed by subdural haemorrhage with a significant proportion (41%) presenting with multi-factorial intracranial bleeding. There was no specific injury pattern involving the cranial vault or cervical spine. Of the patients presenting with a significant injury, facial bones were the most common injury site (84% (n = 54)). The most common site of facial fractures was the nasal bones followed by dental trauma and maxillary fractures. This single-centre, retrospective observational study has shown no reduction in serious head, neck and facial injuries. Large-scale, multicentre studies will need to be undertaken to understand the true impact of legislative change.

Pattern And Occurrence of Orbital Fractures Associated with Midface Trauma – A Hospital Based Observational Study

Aims & Objectives: To study the pattern and occurrence of orbital fractures associated with midface trauma and to assess the association of fracture pattern with etiology of orbital fracture. Methodology: All midface trauma patients treated at the Oral and Maxillofacial Surgery Department of Govt Dental College Calicut between June 2019 and June 2020 were included. Plain radiographs and available CT scans were assessed by a senior maxillofacial surgeon to diagnose and evaluate orbital fractures. The etiology of fractures was recorded, and its correlation with orbital fracture patterns was analyzed. Clinical evaluation included assessing eye movements, enophthalmos, hypoglobus, palpebral fissure length, and alignment, as well as the presence of telecanthus. Results: Out of 238 midface trauma cases, 147 had orbital fractures, comprising 139 males (58.40% of total, 94.56% of total orbit) and 8 females (3.36% of total, 5.44% of total orbit). Road traffic accidents were the primary cause (91 cases, 38.24%, 61.90%), followed by falls (35 cases, 14.71%, 23.81%). The most common fracture site was the lateral wall (105 patients, 71.43%), followed by the floor (55 patients, 37.42%). Conclusion: The lateral orbital wall was the most frequently fractured site, likely due to its prominent position and susceptibility to direct impact. Conservative management was predominantly utilized. No statistically significant association was found between the etiology of trauma and fracture patterns

A Comparative Analysis of International Classification Systems to Predict the Risk of Collapse in Single-Level Osteoporotic Vertebral Fractures.

Various classifications for osteoporotic vertebral fractures (OVFs) have been introduced to enhance patient care and facilitate clinical communication. However, there is limited evidence of their effectiveness in predicting vertebral collapse, and very few studies have compared this association across different classification systems. This study aims to investigate the association between OVF categories, according to the most widely used classification systems, and vertebral collapse. A retrospective single-center study was conducted involving patients diagnosed with acute OVFs at the emergency department of a tertiary-level academic hospital with a minimum follow-up of 6 months. Vertebral fractures were independently classified by two radiologists according to several classification systems, including those proposed by Genant, Sugita, the German Society for Orthopedics and Trauma (DGOU), and the AO Spine. Associations between vertebral collapse and OVF classification systems were analyzed using bivariate and logistic regression analyses. This study included 208 patients (82.7% females; mean age of 72.6 ± 9.2 years). The median follow-up time was 15 months, with L1 being the most common fracture site (47.6%). The most frequent OVF types observed, according to Genant's morphological, Genant's quantitative, Sugita 's, DGOU's, and AO Spine's classifications, were biconcave (50%), grade 0.5 (47.6%), bow-shaped (61.5%), OF2 (74%), and A1 (61.5%), respectively. All classifications, except for Genant's quantitative system, were significantly associated with vertebral collapse in bivariate analyses. Logistic regression analyses showed a significant association (p = 0.002) between the AO Spine classification and vertebral collapse, with 85.7% of A4 fractures developing collapse on follow-up. The AO Spine classification showed the highest predictive capacity for vertebral collapse. Specifically, A4 fracture types showed a very high risk of vertebral collapse, confirming the need for non-conservative management of these fractures. Further multicentric and prospective studies are warranted to confirm these findings.

Epidemiological Characteristics of Fracture Among Children Aged 6-17 Years - China, 2019-2021.

Fractures are a common and serious injury among children. While many studies have utilized clinical data, there is a lack of large-scale community-based research in China. This cross-sectional study provides national and regionally representative data on the prevalence of fractures among Chinese children aged 6-17 years (6.93%), with higher rates observed in males than in females (8.13% vs. 5.71%) and in rural areas compared to urban areas (7.22% vs. 6.62%). The most common site of fracture was the upper limbs (4.24%, accounting for 63.0% of fractures). The need to enhance awareness of fracture prevention is critical, particularly for children in rural areas and males in middle childhood. We recommend that local authorities increase investments in educational programs and child safety oversight. Additionally, promoting balanced diets for children, training in proper exercise techniques, and reinforcing participation in outdoor sports are essential.

Fatigue fracture of the second rib in a professional athlete

A fatigue fracture, also known as stress fracture or overuse fracture, is caused by the summation of micro-injuries resulting from a chronic state of bone overload. It affects 1.4 %- 4.4 % of professional athletes. The most common site of fatigue fractures are the lower limbs. This is related to the heavy load caused by body weight and performing dynamic activities like jumping, running. Typical fractures are fractures of the fifth metatarsal bone, fibula and tibia, and less common fractures of the femur. Fractures involving the bones of the upper limbs and thorax are less commonly reported in the literature. It affect athletes in strength sports and athletes who perform dynamic and repetitive movements with their upper limbs, most often boxers, weightlifters, wrestlers, judokas, swimmers, golfers, rowers. Fractures in the thorax most often involve the first rib. Fractures of ribs II through XII are extremely rarely described. We present an unusual case of a second rib fracture in a professional athlete. A 26-year-old athlete training in racewalking reported increasing pain in the left scapula area 7 days before competing in the European Championships. Immediately after the competition, the pain changed location to the anterior thorax area, making movement of the upper limb and breathing much more difficult. A chest tomography was performed and it revealed a fatigue fracture of the second rib on the left side. The case report presents an atypical fracture in a female racewalking athlete and presents the uncharacteristic symptoms accompanying this fracture. Incorrect initial diagnosis and application of physiotherapy procedures without performing basic diagnostic tests, delay the diagnosis and initiation of proper treatment, and thus the athlete's recovery.

Skiing Injuries in the US Pediatric Population: An Analysis of National Injury Trends and Mechanisms Between 2012 and 2022.

While prevention protocols have been implemented, skiing-related musculoskeletal injuries and concussions continue to present to emergency departments in the United States. Previous literature has suggested the pediatric population may constitute up to 40% of skiing-related injuries. To assess injury trends and the underlying mechanisms of skiing injuries in pediatric patients seen at emergency departments in the United States. Descriptive epidemiology study. The National Electronic Injury Surveillance System (NEISS) was queried for pediatric (age ≤18 years) skiing injuries between January 1, 2012, and December 31, 2022. Injury mechanism, location, disposition, and diagnosis were recorded, and the statistical sample weight assigned by NEISS by hospital was used to calculate national estimates (NEs). Injury trends were evaluated with linear regression analysis. Overall, 2951 pediatric skiing injuries were included (NE = 123,386). The mean age of the patients was 12.4 ± 3.5 years, with 61.3% of the injuries occurring in male patients. Impact with the ground was the most common injury mechanism (NE = 87,407; 70.8%). Fractures were the most common diagnosis (NE = 38,527, 31.2%), followed by strains/sprains (NE = 22,562, 18.3%), contusions/abrasions (NE = 16,257, 13.2%), and concussions (NE = 12,449, 10.1%). The lower leg was the most common fracture site (NE = 9509, 24.7%), followed by the shoulder (NE = 7131, 18.5%) and lower arm (NE = 5876, 15.3%). Analysis of annual injuries revealed no significant trend between 2012 and 2022 (P = .17), with fluctuations apparent throughout the study period. Significant decreases were seen in strains/sprains (P < .01) and contusions/abrasions (P < .01), but not in concussions (P = .57) or fractures (P = .70). Impacts with the snow/ground made up 70.8% of all injuries. Fractures were the most common injury diagnosis, followed by strains/sprains, with the lower leg being most frequently fractured. While strains/sprains and contusions/abrasions showed a significant decline, there were no significant trends in fractures and concussions between 2012 and 2022.

A New Approach in Management of Orbital Adherence Syndrome.

Orbital walls are one of the most common sites of midface fractures and account for ~40% of traumatic injuries in this region. These fractures are often associated with changes in the anatomy of the orbital cavity and frequently affect the orbital inferior wall, infraorbital groove and canal, and medial orbital wall, which leads to changes in its pattern and volume as well. Generally, the forces required for brake superior and lateral walls are greater than those required for thin medial and inferior walls. Disruption of any of these structures leads to the expansion of orbital volume that brings to the appearance of enophthalmos, diplopia, and impaired ocular mobility. The gold standard in the treatment of orbital wall fractures is surgical reconstruction, that includes fracture site exposure, freeing tissue prolapsed into the fracture site, and re-approximating the orbital wall support, usually with an orbital implant. It usually could be achieved by the usage of such as transconjunctival, subciliary, and coronal approaches and implementation of graft and reconstructive materials, including bones, cartilage, titanium, and resorbable mesh. Today, the gold standard in orbital floor reconstruction is the application of titanium mesh orbital plates. However, their implementation could be associated with a number of postoperative complications, such as mispositioning and orbital adherence syndrome. Orbital adherence syndrome is a poorly described and understood phenomenon and appears to occur after the use of large-pored titanium mesh for orbital reconstruction. It usually appears as limited eye movement that appears 1 to 2 weeks after reconstructive procedure. Prevention is possible through careful patient selection and the placement of a smooth interface medium in the initial surgery. The aim of the current study is to present the outcomes of orbital reconstruction done by both orbital mesh and customized ​​smooth-surfaced titanium orbital implants.

A Scoping Review of the Epidemiology, Management, and Outcomes of Golf-Related Fractures.

Golf is a popular sport; however, there is a paucity of data in relation to golf-associated fractures, and the rate and timing of returning to golf. The aim of this review is to describe golf-associated fractures, including epidemiology, management, and timing of returning to golf following treatment. A literature search was performed using MEDLINE/PubMed, Embase, and Web of Science. Data were extracted and summarized in a narrative synthesis. A total of 436 articles were identified with an initial search of which 58 met the inclusion criteria. Twelve anatomical sites of golf swing-related fractures were identified, of which 10 sites were specific for stress fractures. The most common sites of golf swing-related stress fractures were the ribs followed by the hook of hamate. There was a common theme of delay to diagnosis, being initially assigned to a soft tissue injury. Most golfers with swing-related stress fractures were able to return to golf with the exception of osteoporotic associated vertebral stress fractures. Timing of returning to golf was between 4 and 12 months for most of the golfers with stress fractures following conservative management. Operative intervention was an option of hook of hamate nonunion, following a stress fracture, and tibial shaft stress fractures. Golf equipment-related fractures were not rare and were associated with major trauma and in some cases associated with significant persistent morbidity. Golf-related stress fractures commonly involve the ribs and hook of hamate; knowledge of this may aid in early diagnosis and appropriate treatment when symptomatic golfers are encountered. Although golf is a noncontact sport, fractures associated with golf equipment can be life changing, and safety training guidelines should be established.

Subchondral bone fatigue injury in the parasagittal condylar grooves of the third metacarpal bone in thoroughbred racehorses elevates site-specific strain concentration

Condylar stress fracture of the distal end of the third metacarpal/metatarsal (MC3/MT3) bones is a major cause of Thoroughbred racehorse injury and euthanasia worldwide. Functional adaptation to exercise and fatigue damage lead to structural changes in the subchondral bone that include increased modeling (resulting in sclerotic bone tissue) and targeted remodeling repair (resulting in focal resorption spaces in the parasagittal groove). Whether these focal structural changes, as detectable by standing computed tomography (sCT), lead to elevated strain at the common site of condylar stress fracture has not been demonstrated. Therefore, the goal of the present study was to compare full-field three-dimensional (3D) strain on the distopalmar aspect of MC3 bone specimens with and without focal subchondral bone injury (SBI). Thirteen forelimb specimens were collected from racing Thoroughbreds for mechanical testing ex vivo and underwent sCT. Subsequently, full-field displacement and strain at the joint surface were determined using stereo digital image correlation. Strain concentration was observed in the parasagittal groove (PSG) of the loaded condyles, and those with SBI in the PSG showed higher strain rates in this region than control bones. PSG strain rate in condyles with PSG SBI was more sensitive to CT density distribution in comparison with condyles with no sCT-detectable injury. Findings from this study help to interpret structural changes in the subchondral bone due to fatigue damage and to assess risk of incipient stress fracture in a patient-specific manner.

Clinical analysis of 1301 children with hand and foot fractures and growth plate injuries.

Fractures of hands and feet are common in children, but relevant epidemiological studies are currently lacking. We aim to study the epidemiological characteristics of hand and foot fractures and growth plate injuries in children and provide a theoretical basis for their prevention, diagnosis, and treatment. We retrospectively analyzed the data of children with hand and foot fractures who were hospitalized at Shenzhen Children's Hospital between July 2015 and December 2020. Data on demographic characteristics, fracture site, treatment method, etiology of injury, and accompanying injuries were collected. The children were divided into four age groups: infants, preschool children, school children, and adolescents. The fracture sites were classified as first-level (the first-fifth finger/toe, metacarpal, metatarsal, carpal, and tarsal) and second-level (the first-fifth: proximal phalanx, middle phalanx, distal phalanx, metacarpal, and metatarsal) sites. The changing trends in fracture locations and injury causes among children in each age group were analyzed. Overall, 1301 children (1561 fractures; 835 boys and 466 girls) were included. The largest number of fractures occurred in preschool children (n = 549, 42.20%), with the distal phalanx of the third finger being the most common site (n = 73, 15.57%). The number of fractures in adolescents was the lowest (n = 158, 12.14%), and the most common fracture site was the proximal phalanx of the fifth finger (n = 45, 29.61%). Of the 1561 fractures, 1143 occurred in the hands and 418 in the feet. The most and least common first-level fracture sites among hand fractures were the fifth (n = 300, 26.25%) and first (n = 138, 12.07%) fingers, respectively. The most and least common first-level foot fracture locations were the first (n = 83, 19.86%) and fourth (n = 26, 6.22%) toes, respectively. The most common first-level and second level etiologies were life related injuries (n = 1128, 86.70%) and clipping injuries (n = 428, 32.90%), respectively. The incidence of sports injuries gradually increased with age, accounting for the highest proportion in adolescents (26.58%). Hand and foot fractures had many accompanying injuries, with the top three being nail bed injuries (570 cases, 36.52%), growth plate injuries (296 cases, 18.96%), and distal severed fracture (167 cases, 10.70%). Among the 296 growth plate injuries, 246 occurred on the hands and 50 on the feet. In contrast to previous epidemiological studies on pediatric hand and foot fractures, we mapped the locations of these fractures, including proximal, shaft, distal, and epiphyseal plate injuries. We analyzed the changing trends in fracture sites and injury etiologies with age. Hand and foot fractures have many accompanying injuries that require attention during diagnosis and treatment. Doctors should formulate accident protection measures for children of different ages, strengthen safety education, and reduce the occurrence of accidental injuries.

Prevalence and Characteristics of Pathological Fractures in Patients Referred to Specialist Palliative Care: A Retrospective Study From India.

Background: Prevalence of pathological fractures in palliative care is less studied. This study aimed to determine the annual prevalence of pathological fractures and describe the characteristics and treatments in patients with pathological fractures referred to a specialist palliative care clinic in a tertiary care cancer center in India. Methods: Data of adult cancer patients newly referred to the specialist palliative care clinic over 1year with a clinico-radiological diagnosis of pathological fracture was included. Key outcomes of interest were annual prevalence, clinical characteristics, symptoms and treatments offered. Results: 75 out of 5800 (1.29%) patients newly referred to the clinic over 1year had pathological fractures. Lung cancer was the most common primary diagnosis (n = 23).Dorsal spine (n = 25) was the most common site of fracture. Pain was the predominant symptom. Mean pain score was 7.04(SD = 1.75) and 42 patients (56%) required strong opioids for analgesia. Only 11 (16%) patients underwent surgical fixation. Median duration from diagnosis of cancer to occurrence of fracture was found to be 329days. Treatment goals changed to best supportive care in 33 patients (44%) post fracture. Patients with bone and soft tissue neoplasms and those who received only chemotherapy previously had a higher risk of occurrence of fractures. Conclusion: Annual prevalence of pathological fractures in patients referred to the specialist palliative care clinic was 1.29%. It was associated with significant symptom burden and affected oncological treatments. Close monitoring of patients with bone metastases is crucial and proactive implementation of prophylactic measures to prevent such skeletal related events is warranted.

Epidemiology and Incidence of Upper Limb Fractures: A UK Level 1 Trauma Center Perspective.

Introduction Understanding the incidence and epidemiology can inform clinicians and policymakers about the population's needs. Our study reports on upper limb fractures treated at a major trauma center over 7.5 years. Methods We collected data on fracture locations, age, gender, Charlson Comorbidity index (CCI), and treatment options of all upper limb fractures treated at a Level I Trauma Centre fromJanuary 1, 2015 to June 30, 2022. Humerus, radius, and ulna fractures were each classified as proximal, diaphyseal, and distal. Results About 9,915 patients sustained 12,790 fractures, given an overall incidence of 303.2 fractures per 100,000 patients per year. The most common fracture site was the distal radius (60.1 fractures per 100,000 patients per year, whereas carpal and metacarpal bones had the lowest incidence. The mean age and CCI were 46.4 years and 1.54, respectively. 58.1% of patients were male. All bone fractures distal to the elbow were associated with an age younger than the mean (all p<0.001), with humerus fracture patients having the oldest mean age (54.6 years). Compared to the mean gender ratio, except for ulna (no association), humerus (55% female), and radius (51% female), all other locations showed significantly higher incidences of males (all p<0.001). When plotting the incidence based on the age of injury, the entire cohort, along with radius and ulna fracture subgroups, demonstrated a bi-peak distribution. This pattern revealed that younger males and older postmenopausal females had the highest incidence rates. Conclusion To our knowledge, this represents the first study of this type in the UK since 2006. We sought to elucidate relative incidence and demographic associations with fractures to highlight changing population needs and allow policymakers and services at a regional and national level to operate with up-to-date information.

Epidemiology and Sex-Specific Analysis of Basketball-Related Lower Extremity Fractures: A 10-Year Analysis of National Injury Data.

Basketball-related fractures involving the lower extremities frequently present to emergency departments (ED) in the United States (US). This study aimed to identify the primary mechanisms, distribution, and trends of these injuries. We hypothesize that (1) lower extremity fracture frequency will decrease from 2013 to 2022, (2) the ankle will be the most common fracture site, and (3) noncontact twisting will be the most common injury mechanism. Descriptive epidemiological. Level 3. The National Electronic Injury Surveillance System (NEISS) was queried for lower extremity fractures from basketball presenting to US EDs from January 1, 2013 to December 31, 2022. Patient demographics, injury location, and disposition were recorded. The injury mechanism was characterized using the provided narrative. National estimates (NEs) were calculated using the NEISS statistical sample weight. Injury trends were evaluated by linear regression. There were 6259 cases (NE: 185,836) of basketball-related lower extremity fractures. Linear regression analysis of annual trends demonstrated a significant decrease in lower extremity fractures over the study period (2013-2022: P = 0.01; R2 = 0.64). The most common injury mechanism was a noncontact twisting motion (NE: 49,897, 26.9%) followed by jumping (NE: 39,613, 21.3%). The ankle was the most common fracture site (NE: 69,936, 37.6%) followed by the foot (NE: 49,229, 26.49%). While ankle and foot fractures decreased significantly (P < 0.05), fractures of the lower leg, knee, toe, and upper leg showed no significant trends (P = 0.09, 0.75, 0.07, and 0.85, respectively). Basketball-related lower extremity fractures decreased from 2013 to 2022, with the ankle being the most common fracture site and most fractures arising from a noncontact twist. Increasing utilization of outpatient clinics may have contributed to the decline, particularly for ankle and foot fractures. The prevalence of ankle fractures and twisting-related injuries reinforces the importance of protective footwear and targeted strengthening protocols.

Comparison of Neurosensory Recovery of the Inferior Alveolar Nerve After Open and Closed Reduction for Mandibular Fractures: A Prospective Study.

Traumatic mandibular fractures are the most common fractures of the facial region and are associated with loss of neurosensation in the inferior alveolar nerve (IAN). The present study aimed to compare IAN recovery after traumatic mandibular fractures between the open and closed reduction methods. The study included 90 patients with traumatic mandibular fractures of the body, angle, and symphysis, divided into two groups of 45 patients: group 1 was treated with closed reduction and fixation with rich arch-bar fixation under local anesthesia, and group 2 was treated with open reductionand rigid internal fixation with 2-mm titanium mini plates and monocortical screws (6 mm), and the plate was fixed to the fractured bony fragments. All patients underwent neurosensory testing using the Zuniga and Essick algorithm at baseline (preoperative), one week after surgery (postoperative), at three months, and at six months of follow-up. No statistically significant differences were observed in IAN recovery between the groups. The most common site of fracture was the body (44% in group 1 and 56% in group 2). The maximum recovery was observed in the younger age group (25-30 years). At baseline, functional nerve recovery was observed in 40 cases (88%) in group 1 and 38 cases (84%) in group 2, and the difference was not statistically significant. Levels A and B tests were affected by surgical management and improved after three months.The total recovery in group 1 ranged from 60% to 80%, and that in group 2 ranged from 56% to 72%. Based on the findings of the current study, both methods are recommended for surgical management of traumatic mandibular fractures with IAN recovery in 60-80% of cases six months postoperatively.

Influence of COVID-19 pandemic on mandible fractures – Multicentric study

ObjectiveIt is expected that the number of patients with mandible fractures will be affected by the global spread of COVID-19 because of a decline in physical activities. The purpose of this study was to investigate characteristics of mandible fractures before and during the COVID-19 pandemic. MethodsPatients with mandible fracture who visited our department or a nearby associated medical institution were surveyed, with 242 enrolled. The time period was divided into 2017–2019, before the COVID-19 pandemic, and 2020–2022, during the pandemic. ResultsThere were 138 cases before and 104 during the pandemic. The majority of patients before the pandemic were teenagers, while the majority during the pandemic were in their 20 s. Before the pandemic, May had the greatest number of patients and the greatest number during the pandemic was in December. A fall was the most common cause of injury during both time periods. Both before and during the pandemic, the most common period of time to visit a doctor following an incident was less than one day. During both time periods, the condyle was the most common fracture site, with surgical therapy the most common treatment strategy used throughout the term of the study. ConclusionsThe number of patients with mandible fractures decreased after the beginning of the pandemic, which is considered to be due to a decrease in social activities associated with refraining from going out due to the declaration of state of emergency. These findings suggest a relationship between social activities and risk of mandible fracture.

Magnitude of dural tear and its associated factors among patients with depressed skull fracture.

Trauma is a huge problem seen in developed countries as well as developing countries. Head injury is a major factor responsible for mortality in young populations. Up to 6% of all head injuries and 11% of severe head traumas might result in a depressed skull fracture (DSF), a catastrophic injury. The aim of this study was to determine the prevalence of dural tear and to identify its predictors. A retrospective review of medical records of all patients operated on for DSFs at the University Comprehensive Specialized Hospital from 1 January 2021 to 1 January 2023 G.C. (Gregorian calendar) was conducted. A total of 163 patients were included in the study. A total of 163 patients [136 men (83.4%) and 27 women (16.6%)] had a mean age of 23.9 with a standard deviation of 14.8 (range from 3 to 65). Patients with penetrating injuries (missiles, axes) were excluded. The majority, 153 (93.9%) of the patients, were younger than 50 years of age. Physical assault accounted for 102 (62.5%) of the cases. Of the assaulted cases, 62 (38%) were assaulted by stone, 32 (19.6%) by stick, and 8 (5%) by other objects (beer bottle and shovel). Bleeding from the trauma site in 124 (76.1%), headache in 76 (46.6%), loss of consciousness in 75 (46%), and vomiting in 72 (44.2%) were the most common presentations. Based on the Glasgow Coma Scale (GCS), 123 (75%) patients had mild head injuries. Based on the site of fracture, frontal depressions are the most common (61, 37.4%), followed by parietal depressions (53, 32.5%). With regard to the associated injuries, brain contusion was seen in 52 (32%), epidural hematoma (EDH) in 26 (16%), subdural hematoma in 3 (1.8%), and intraventricular hemorrhage/subarachnoid hemorrhage (IVH/SAH) in 3 (1.8%). The median duration of presentation was 15h, with an interquartile range (IQR) of 8-24 (1-96h). From the multivariable logistic regression, brain contusion and EDH were significantly associated with dural tear. The rules of our culture are reflected in the higher incidence of accidents and fractures among men. Physical assault, particularly with stones, was the most common cause of DSFs. Frontal depressions were the most common site of fracture, followed by parietal fractures. Brain contusion and EDH were significantly associated with dural tears. School-aged children are more vulnerable to injuries from horse or donkey kicks and falls.

The Relationship Between Fracture and Mortality in a Chinese Maintenance Hemodialysis Patients Cohort.

Patients on maintenance hemodialysis have an increased risk of fracture. However, the relationship between fracture and poor prognosis is not clear. A total of 182 maintenance hemodialysis patients were enrolled in the study. The relationship between fracture and poor prognosis (cardiovascular events, stroke, malignancy and 5-year all-cause mortality) were analyzed. 21 of 182 patients had a history of fracture at the time of enrollment. 26 patients had a new fracture after enrollment. A total of 57 fractures occurred in 47 patients, the most common fracture site was the rib. Patients with fracture group had a higher proportion of elderly and female, higher serum phosphorus and B-type natriuretic peptide and lower hemoglobin, albumin, and potassium compared with those without fracture. Age (OR=3.809, 95% CI: 1.064-8.966, p=0.038), hemoglobin (OR=0.961, 95% CI: 0.925-0.997, p=0.035), and serum phosphorus (OR=3.325, 95% CI:1.104-10.019, p=0.033) were the independent risk factors of new fractures in MHD patients. The incidence of malignancy and 5-year all-cause mortality in patients with fracture was higher than those without fracture (p<0.05). But there was no significant difference in the incidence of acute myocardial infarction or stroke. 25.8% of maintenance hemodialysis patients had at least one fracture, with rib fractures accounting for the highest proportion. Age, hemoglobin and serum phosphorus were the independent risk factors of new fractures. The incidence of malignancy and 5-year all-cause mortality in patients with fracture was higher than those without fracture, but there was no significant difference in the incidence of acute myocardial infarction and stroke.

Is Nothing Sacrum? Identification and Treatment of Sacral Insufficiency Fractures

Sacral insufficiency fractures are an overlooked etiology of back pain that can also be difficult to diagnose radiographically. Advanced imaging, including MR and scintigraphy, are useful modalities for diagnosis, as these fractures are frequently missed on plain films. Management is often conservative to avoid surgical fixation, a rarely performed surgery due to its high morbidity. Radiologists are also able to provide symptomatic relief via sacroplasty, a minimally invasive, percutaneous, image-guided procedure first described in 2002. The most common sites of pelvic insufficiency fractures include the sacral ala and parasymphyseal region of the os pubis. The butterfly or “H-shaped” pattern is a classic sign of this fracture on scintigraphy, best appreciated posteriorly. MR is considered the gold standard in diagnosing insufficiency fractures and is characterized by low T1 band-like signal intensity with corresponding high T2/T2 short-tau inversion recovery (STIR) signal intensity. Such fractures can be treated via sacroplasty by carefully injecting polymethylmethacrylate bone cement via one or more trocar needles. Knowledge of sacral anatomy is critical during the procedure to not violate specific sacral zones or traverse any of the neural foramina.

Analysis of fracture-related infections from Swedish insurance claims between 2011 and 2021

Fracture-related infections (FRI) pose a serious complication with an incidence of 1–2%. This study aimed to analyze compensation claims submitted to The Swedish National Patient Insurance Company (LÖF) because of FRI after closed/open reduction and internal fixation (C/ORIF) in the four most common fracture sites (proximal humerus, distal radius, hip, ankle). Patients registered in the LÖF database with a suspected FRI between 2011 and 2021 were identified by matching International Classification of Diseases and procedural codes indicative of a combination of fractures to the proximal humerus, distal radius, hip and ankle, C/ORIF and infection. Medical records were reviewed for fracture sites, pathogens and complications. Data from the Swedish Fracture Register (SFR) were extracted to estimate the proportion of reported claims to the presumed number of FRI. Of 122 FRI identified in the LÖF database, 34 were after C/ORIF in the proximal humerus, 12 in the distal radius, 28 in the hip and 48 in the ankle. LÖF compensated 111 patients (91%). Median time from C/ORIF to an FRI was 3 weeks (interquartile range 2–6), and 95% of all FRI occurred within 1 year after C/ORIF. Staphylococcus aureus was the most common pathogen in patients with a distal radius, hip and ankle FRI. In contrast, Cutibacterium spp. were the most common aetiology in FRI of the proximal humerus. The total number of fractures treated with C/ORIF in the four fracture sites registered in the SFR during 2021 was 18,711. Most of the FRI patients were diagnosed within the first year after C/ORIF, and 91% of the patients received compensation. Given an expected FRI incidence of 1–2%, our estimates with extrapolated data from the SFR indicate that < 10% of affected patients applied for compensation.