Common Fracture Type Research Articles

Effect of additional free sustentaculum tali screw fixation through modified sinus tarsi approach on intra-articular calcaneal fractures

BackgroundCalcaneal fractures are the most common type of tarsal fractures. The sustentaculum tali (ST) offers anatomical stability in calcaneal fractures, and recently, ST screws have been widely used in their treatment. This study aimed to investigate the clinical efficacy and value of ST screw fixation via a modified sinus tarsi approach (MSTA) for treating displaced intraarticular calcaneal fractures (DIACFs).MethodsThis study enrolled 64 patients (64 feet): 32 patients in the calcaneal locking plate combined with the ST screw group (CLP-STS Group) and 32 patients in the simple calcaneal locking plate internal fixation group (CLP Group). The minimum follow-up duration was 18 months. Ankle function was evaluated using VAS, AOFAS, and Short Form-36 scores. Imaging evaluation included the Böhler angle, Gissane angle, length, height, and width of the calcaneus, and the Böhler angle in both groups 1 year after surgery.ResultsFunctional evaluation revealed that postoperative AOFAS and VAS scores in the CLP-STS Group were significantly better than those in the CLP Group. After surgery, the Böhler angle, Gissane angle, and length, height, and width of the calcaneus were significantly corrected compared to the preoperative values; however, the difference in these indicators between the two groups was not significant. Nevertheless, at the 1-year postoperative follow-up, the calcaneal Böhler angle loss in the CLP-STS Group was significantly better than that in the CLP Group.ConclusionCompared to simple calcaneal locking plate internal fixation, combining the plate with the additionally free ST screw can resolve the limited intraoperative exposure of MSTA, reduce postoperative foot pain in patients, and improve clinical efficacy.

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

BackgroundThe 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.MethodsWe 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.ResultsA 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 ± 17.70 years (range: 0–95 years). Maxillofacial injuries were most prevalent in the 19–28 years 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 2.8 days, with local anesthesia being the most frequent surgical intervention. The average time from admission to surgery was 2.8 ± 2.5 days (range: 0–20 days), 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.ConclusionThe 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 19–28 years 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.

Calcaneus Fractures, Epidemiology and Treatment– data on 3 949 fractures from the Swedish Fracture Register

BackgroundDue to changing population demographics and evolving treatment strategies updated epidemiological data are needed. This study aims to provide nationwide epidemiology data regarding calcaneus fractures of all types and treatment. MethodsThe study is based on data from the Swedish Fracture Register and include patients ≥18 with a calcaneus fracture sustained between April 2012 and June 2022. Patient characteristics, injury mechanism, fracture classification and primary treatment were analysed. With access to data on each separate fracture, all bilateral fractures, n=320, could be identified and were studied in a separate analysis. ResultsThe study included 3629 unilateral calcaneus fractures in 3618 patients. The mean age was 48 years (SD ± 18) and 2178 (60%) were men. Fall from height was the most common mechanism of injury (n=1683; 46%) and high-energy trauma was documented in 887(28%) patients. Overall, AO/OTA type A fractures (avulsion), and type C fractures (intra-articular) was equally common, but the type C fracture was the most common fracture type in men. The vast majority of type A (n=1105; 89%) and B (n=717; 93%) fractures were treated non-surgically, while surgical treatment was more common in type C (n=499; 43%) fractures. Fracture fixation with plate and screws was the most common surgical method. Arthrodesis as a primary treatment was rarely used.Of the patients with bilateral fractures 80% were male, (n=128). They were generally younger (mean age of 38 years (SD±14.5, p<0,001) and had a larger proportion of high-energy traumas, n=107 (67%) compared with patients with unilateral fractures. ConclusionCalcaneus fractures occur most frequently in the middle-aged population, and the majority of patients are male. The difference in prevalence between men and women is less pronounced than previous studies have shown. In male patients the fractures were more severe, more often caused by high-energy trauma, and more frequently treated surgically. Level of evidenceIV, retrospective observational cohort study

Automatic AI tool for opportunistic screening of vertebral compression fractures on chest frontal radiographs: A multicenter study.

Vertebral compression fractures (VCFs) are the most common type of osteoporotic fractures, yet they are often clinically silent and undiagnosed. Chest frontal radiographs (CFRs) are frequently used in clinical practice and a portion of VCFs can be detected through this technology. This study aimed to develop an automatic artificial intelligence (AI) tool using deep learning (DL) model for the opportunistic screening of VCFs from CFRs. The datasets were collected from four medical centers, comprising 19,145 vertebrae (T6-T12) from 2735 patients. Patients from Center 1, 2 and 3 were divided into the training and internal testing datasets in an 8:2 ratio (n = 2361, with 16,527 vertebrae). Patients from Center 4 were used as the external test dataset (n = 374, with 2618 vertebrae). Model performance was assessed using sensitivity, specificity, accuracy and the area under the curve (AUC). A reader study with five clinicians of different experience levels was conducted with and without AI assistance. In the internal testing dataset, the model achieved a sensitivity of 83.0 % and an AUC of 0.930 at the fracture level. In the external testing dataset, the model demonstrated a sensitivity of 78.4 % and an AUC of 0.942 at the fracture level. The model's sensitivity outperformed that of five clinicians with different levels of experience. Notably, AI assistance significantly improved sensitivity at the patient level for both junior clinicians (from 56.1 % without AI to 81.6 % with AI) and senior clinicians (from 65.0 % to 85.6 %). In conclusion, the automatic AI tool significantly increases clinicians' sensitivity in diagnosing fractures on CFRs, showing great potential for the opportunistic screening of VCFs.

Characteristics and Management of Neck and Trochanteric Femur Fractures at a Tertiary Hospital in Indonesia: A Retrospective, Single-Center Study

Background: Although hip fractures are common among the elderly population, there are still limited studies on neck-trochanteric fractures, one of the less common types of hip fractures. This study aims to describe the characteristics of patients and their management in patients with neck trochanteric fractures. Methods: This retrospective cross-sectional study analyzed medical records of patients aged &gt;18 years with trochanteric fractures from a tertiary hospital in Central Java, Indonesia, between January and December 2021. Fracture types were identified and classified using the Garden, Pauwels, and AO/OTA classifications. Demographic data, risk factors, fracture locations, and treatment types were also collected. Statistical analysis was performed using SPSS 21.0 to describe patient characteristics. Results: The total sample was 77 patients, most were female (n = 55 (71.4%)) and aged &gt; 60 years. More than a third of diagnosed fractures were neck of the femur fractures in 33 patients (42.9%). Among the most common classification types of fractures were Garden Type 3, Pauwels Type 3, and AO/OTA type A1.1. A total of 33 patients (42.9%) underwent open reduction of the fracture with internal fixation. Conclusions: Our findings show that the prevalence of neck-trochanteric fractures mostly occurs in patients &gt; 60 years of age and in females. Although open reduction with internal fixation is generally performed, there are several cases of fractures that are not classifiable due to limited imaging examinations. Further research on a wider population is needed to confirm the findings of this study.

Effect of Rotational Speed on Microstructure and Properties of Al‐Based Composite Reinforced with High‐Entropy‐Alloy Particles Fabricated by Friction Stir Processing

In the present investigation, the production of composites based on 7075Al is involved, reinforced with particles of high‐entropy alloy (AlCoCrFeNi), using the friction stir processing (FSP) technique. The primary objective is to examine how varying the rotational speed during processing affects the uniformity of the composite microstructure, the strength of the bonding between different materials, and the mechanical properties of the composite. In these findings, it is indicated that higher processing rotational speeds lead to enhanced homogeneity of the composite material and promote strong bonding with the matrix. The Al13Co4 phase is generated at the interface before the formation of the Al5Co2 phase. The microhardness of the composites exhibits an increase in hardness of 78%, 84%, 86%, and 83% compared to the hardness of the 7075Al. Similarly, the tensile strength is enhanced by 26%, 36.7%, 49%, and 40%, respectively. The broken surface shows an even spread of particles with many small depressions, which is a clear sign of a common type of fracture that can stretch without breaking. The primary processes that enhance the strength of the FeCoNiCrAl/7075Al composite manufactured by FSP include the load‐transfer effect, dispersion strengthening, grain refinement strengthening, and thermal mismatch strengthening.

Common elbow injuries in children

Elbow injuries are one of the commonest paediatric musculoskeletal injuries. Their spectrum varies from pulled elbow to elbow dislocation. Supracondylar fractures are the most common type of paediatric elbow fractures accounting for 65–75 % of all paediatric elbow injuries. Other common paediatric elbow injuries include Lateral condyle fractures, Medial epicondyle fractures, Radial neck fractures, olecranon fractures, TRASH injuries and Elbow dislocations. Osteochondral fractures in kids can be missed due to their benign appearance or invisibility on x rays. TRASH stands for “The Radiological Appearance Seems Harmless”. In contrast to the full form, the abbreviation TRASH tells the harmful consequences of missing these injuries. This article will discuss the salient points regarding common elbow injuries, their diagnosis and best treatment practices. It will help the caregivers to be more prepared to deal with these situations and thus avoiding complications and getting better outcomes.

Distal radius fractures and distal ulna fractures among adults in a southern China county during the 11-year-period 2010 to 2020.

Most distal radius fractures are associated with distal ulnar fractures. However, there is still a lack of consensus on the incidence of different types of distal ulnar fractures among adults in China. Therefore, we analyzed the incidence of distal radial fractures with and without associated distal ulnar fractures among adults in a southern China county from 2010 to 2020. Registry data of 2333 patients (2351 sides) with a distal radius fracture from 2010 to 2020 underwent evaluation, encompassing parameters such as age, sex, distal radius fracture classification, fracture side, and distal ulnar fracture classification. Distal radial fractures were classified according to the AO/OTA classification. Distal ulnar fractures were examined using the Q-modifier classification. 1719 females (73.68%) and 614 males (26.32%) were included in the study. Compared to men, the incidence of distal radial fractures accompanying distal ulnar fractures in women was approximately 2.8 times higher. Additionally, 49.81% of distal radius fractures were associated with fractures of the distal ulna, while 46.44% were associated with fractures of the ulnar styloid. The most common fracture type was that of the ulnar styloid Q1 (93.73%). The mean age of female patients was 61.71 ± 12.13, while male patients had an average age of 50.63 ± 14.86. The Q1 type was the most common type of distal ulnar fracture. We also found that more females (age range: 50 years or older) had type C distal radius fractures compared to males. However, type B fractures were observed more frequently in males than in females (range: 18-49 years). Osteoporosis was believed to be the main cause of fractures in women aged >50 years old. Moreover, the peak incidence of radius fractures in males was lower than in females in different age groups.

Lateral Compression Fragility Fractures of the Pelvis: Diagnosis, Classifications, and Modern Management.

To describe the diagnosis, classification, and modern management of lateral compression fragility fractures of the pelvis. Practice patterns are shifting toward early operative treatment of fragility fractures of the pelvis among patients who are unable to mobilize or whose injuries demonstrate occult instability on stress imaging. Early internal fixation appears to decrease pain, facilitate mobilization, accelerate hospital discharge, and minimize morbidity in this population. Lateral compression pelvic ring injuries are the most common type of fragility fracture of the pelvis. Similar to fragility fractures of the hip, lateral compression fragility fractures of the pelvis are typically sustained in a ground level fall. These injuries are associated with long acute hospital and post-acute facility admissions, loss of physical function, loss of independence, mortality, anxiety, sleep disturbance, and caregiver burnout. Unlike hip fractures, for which urgent operative treatment and early mobilization reduce mortality, lateral compression fragility fractures of the pelvis are commonly treated without surgery. Recommendations for nonoperative management of these injuries in older adults may be inappropriately generalized from studies of younger patient populations with high-energy mechanisms of pelvis fracture. However, strong evidence to support early internal fixation of these injuries practice is lacking. High quality investigations of early surgical intervention for lateral compression fragility fractures of the pelvis are needed to guide care for these patients.

Multi-objective constraints for path planning in screw fixation of scaphoid fractures

PurposeScaphoid fractures, a common type of clinical fracture, often require screw placement surgery to achieve optimal therapeutic outcomes. Path planning algorithms can avoid more risks and have vital potential for developing precise and automatic surgeries. Despite the success of surgical path planning algorithms, automatic path planning for scaphoid fractures remains challenging owing to the complex bone structure and individual variations. MethodsThus, we propose a Multi-objective constrained Path planning Algorithm (MPA) for fracture screw placement, which includes the identification of the center of the fracture surface. Further, three constraint conditions were introduced to eliminate infeasible paths, followed by adding three objectives to the remaining paths for more accurate planning. Finally, the Nondominated Sorting Genetic Algorithms (NSGA)-II algorithm was used to optimize the surgical paths. ResultsWe defined the vertical compression distance (VCD), a common observation index in clinics. The experiments show that the average VCD of the MPA paths is measured at 23.88 mm, outperforming the clinical planning paths by 21.71 mm. Ablation experiments demonstrated that all three objectives (distance, length, and angle) effectively optimized the path planning. Additionally, we also used finite element analysis to compare and analyze the MPA path and clinical path. The experimental results showed that the MPA path always outperformed the clinical path in terms of scaphoid strain and screw stress. ConclusionThis study presents a solution for the path planning of scaphoid fractures. Our future research will attempt to enhance the model's performance and extend its application to a broader range of fracture types.

Determination of distal fibula fracture for prediction of ankle injuries

Objective This study quantified the local fracture tolerance of the distal fibula. The purpose of this data is to refine the understanding of ankle fracture tolerance in the population and enhance injury prediction by computational tools. Methods Fracture patterns of the fibula were obtained from the US National Highway Traffic Safety Administration (NHTSA) Crash Injury Research Engineering Network (CIREN). Of 143 cases of ankle injury, 120 included fibula fracture, many of which accompanied by radiology images. The most common fibula fracture type was a Weber C fracture, which was then used as the testing target to replicate with postmortem human surrogates. Isolated distal fibulae (male and female, across a wide anthropometric range) were subjected to quasi-static lateral-medial four-point bending superimposed on axial precompression. Results Of the 20 specimens tested, 17 fractured in compression and bending, two fractured in compression, bending, and shear, and one did not fracture upon the imposed displacement. Fractures occurring outside of the target testing span were treated as right-censored data points. Fracture patterns varied among specimens, with oblique fractures being most common, followed by segmental fractures. At failure, compressive force ranged from 77 N to 370 N and bending moment from 17 Nm to 47 Nm. Conclusions From the 19 fractured specimens, the variety of fracture patterns observed were generally consistent with the range of fibula fracture types and locations commonly observed in the field. While comparative studies with fibula specimens are largely absent from literature, comparison of this study to other long bones (radius and ulna) show that bending moment at fracture is similar. To the author’s knowledge, this is the first study to quantify the fracture tolerance of isolated distal fibulae under loading conditions representative of ankle injury mechanisms in motor vehicle collisions. By combining the results of this study with complementary results from parallel tibia-focused experiments (currently in-press), these results will aid development of tissue-level lower leg fracture prediction of human body models, thus enhancing prediction of ankle injury during safety assessment simulations. Specifically, the fracture tolerance information might generate an injury risk function to guide tissue-level injury prediction with human body models.

Clinical and Surgical Results of Treatment Modalities in Orbital Roof Fractures: Single-Center Experience.

Orbital roof fractures are uncommon craniofacial fractures. Due to the location of the fracture and the mechanism of trauma, it is often associated with neuroophthalmological injuries. The authors aimed to evaluate the results of conservative and surgical treatments of patients with orbital roof fractures and present our clinical experiences regarding optimal treatment planning, especially in cases of moderate or severe head trauma. The authors retrospectively identified 145 patients who were treated for orbital roof fractures. Three colored silicone-injected cadaver samples and a dry skull were used to show the panoramic view of the anatomy of the orbital region. In this study, orbital roof fractures were classified under 4 types. The most common fracture type was type 1 (42%). Intracranial hemorrhage was observed in 60% of all cases and was most common in type 3 fractures (68%). Neuro-ophthalmological deficits were detected in 16% of all patients and were most common in Type 4 fractures (47%). Third cranial nerve deficit was the most common deficit (39%). Neuroophthalmological deficits were detected in 9.5 % of patients with mild head trauma and 32.5% in patients with moderate or severe head trauma. Moderate or severe head trauma was detected in 28% of the cases. Moderate or severe head trauma makes it difficult to detect neuro-ophthalmological complications, which are critical in determining the need for acute surgery. In patients with moderate or severe brain injury, treatment should be individualized according to the nature of the displacement and the relationship between concomitant fractures and intracranial hemorrhage.

Rotationally stable screw anchor (RoSA) vs. Gamma3 Nail (G3N) in pertrochanteric femoral fractures : Afunctional outcome analysis

The pertrochanteric femoral fracture (PFF) represents one of the most common fracture types throughout Germany. To enable early mobilization of patients, the primary surgical goal is load-stable osteosynthesis. Implant failure still represents the largest group of implant-related complications (>80%). The aim of the study was to document and analyze the influence of the implant on the functional outcome and an evaluation of the rotationally stable screw anchor (RoSA) vs. Gamma3 nail. In aretrospective study 43patients with PFF (AO 31A1-A3) were included in the study. The influence of the implant on the functional outcome was assessed by 2standardized questionnaires (SF-36, NMS (New Mobility Score)) and analyzed in aretrospective evaluation. In the study no significant differences in functional outcome scores ≥ 1year after osteosynthesis of the PFF could be shown depending on the implant used. There is an overall tendency for abetter outcome in the G3N group. In the literature the superiority of intramedullary nailing over extramedullary implants is continually discussed. Implant failure is still the most frequent complication. In intramedullary implants, such as the G3N, the primary cause is failure of the head-neck component. For conventional extramedullary implants the biomechanical properties on the femoral shaft also pose a challenge in the case of unstable PFF. The further development of the RoSA to an intramedullary implant could combine the advantages of intramedullary load carriers with the advantages of the blade-screw combination in the head-neck fragment and lead to a reduction in implant-associated complications.

Characteristics and effectiveness of deep and ultradeep tight sandstone fractures: Insights from geologic and geophysical data analysis

Effective natural fractures are those that contribute to reservoir storage and conductivity. In this study, the effectiveness of fractures in deep and ultradeep reservoirs (depths &gt; 6 km) is evaluated by using geophysical image logs, cores, microstructures, mechanical tests, and geologic evidence of the tectonic context (including current in situ stress) and sedimentary faces and diagenesis. Intraformational open-mode fractures are the most common fracture type in this tectonically active region, and their effectiveness is affected by the coupling between past tectonic activity, in situ stress, and chemical reactions such as mineral precipitation or dissolution (diagenesis). Our results show that the effectiveness of fractures is mainly related to the aperture and filling, and fractures formed by early tectonic movement are more likely to be filled by minerals, reducing their effectiveness. Strata near orogenic belts in strongly cemented, tight diagenetic facies exhibit a greater abundance of mineral-filled fractures, whereas dissolution increases the fracture apertures, produces secondary pores in host rocks, and roughens the fracture walls. The effective normal stress acting on the fracture surface decreases when the fracture is parallel to the maximum horizontal stress component, so the fracture has a large aperture and, therefore, is more effective. The results of our laboratory measurements reveal that the contribution of fractures to the reservoir space is limited, and the reservoir space provided by fractures accounts for only 13% of all types of reservoir space, whereas the presence of fractures increases reservoir permeability by 1–2 orders of magnitude. Fractures improve the effectiveness of the reservoir by connecting the dispersed pores in the reservoir matrix. Fractures with a low angle to the maximum horizontal stress component have greater apertures and permeabilities and are the main channels for fluid flow.

Research progress of pelvic acetabular fractures combined venous thromboembolic disease

Pelvic acetabular fractures(PAFs) are one of the most common types of pelvic fractures, mostly high-energy injuries, with complex pelvic acetabular structure and limited surgical methods. The trauma of the acetabular fracture itself and the need for long-term bed rest after surgery cause particularly complicated clinical complications. Venous thromboembolism (VTE) is one of its high incidence and serious complications. This review mainly focuses on VTE after PAFs, and describes the epidemiology, risk factors and prevention measures of VTE, aiming to help improve the prognosis and avoid the occurrence of serious complications.

Comparative Evaluation of Two Different Preparation Designs and Materials on the Fracture Resistance of Laminate Veneers: An In Vitro Study.

Introduction Laminate veneers are thin porcelain or composite resin shells bonded to the front of teeth for cosmetic enhancement. The design of the tooth preparation is crucial; it involves minimal enamel removal to ensure a proper fit and strong bond. This careful preparation increases the veneers' fracture resistance by preserving tooth structure and evenly distributing stress, ensuring durability and natural appearance. Aim Our aim was to determine the fracture resistance of two preparation designs with two different materials for the fabrication of laminate veneers. Materials and methods An in vitro study was conducted on 40 laminate veneers divided into two groups based on the material used: Group 1 (Cerec Tessera (Dentsply Sirona, Charlotte, NC, USA)) and Group 2 (Upcera, Shenzhen, China). Each group was further divided into two sub-groups based on tooth preparation designs: butt joint and feather edge. The fracture resistance of these veneers following thermocycling was determined, and the mode of fracture was evaluated using a stereomicroscope. Results Feather edge preparation with Cerec Tessera laminate veneer restoration demonstrated the highest fracture resistance at 111.5 N, followed by butt joint preparation with Cerec Tessera laminate veneer restoration, which showed a fracture resistance of 90.8 N. The study identified laminate fractures as the most common type of fracture observed in the veneer restorations, followed by cement interface fractures. Conclusion The study suggests that the feather edge preparation design contributed to higher fracture resistance compared to the butt joint design. This finding aligns with the idea that modifying the preparation design can have a significant impact on the overall strength and durability of veneer restorations. The use of Cerec Tessera, especially in combination with the feather edge design, yielded the maximum fracture resistance.

COMPARISON OF VERTEBRAL AND INTERVERTEBRAL DISC STRAINS IN AXIAL COMPRESSION AND FLEXION, AND THE EFFECT OF DISC DEGENERATION

IntroductionVertebral compression fractures are the most common type of osteoporotic fracture. Though 89% of clinical fractures occur anteriorly, it is challenging to replicate these ex vivo with the underlying intervertebral discs (IVDs) present. Furthermore, the role of disc degeneration in this mechanism is poorly understood. Understanding how disc morphology alters vertebral strain distributions may lead to the utilisation of IVD metrics in fracture prediction, or inform surgical decision-making regarding instrumentation type and placement.AimTo determine the effect of disc degeneration on the vertebral trabecular bone strain distributions in axial compression and flexion loading.MethodsEight cadaveric thoracolumbar segments (T11-L3) were prepared (N=4 axial compression, N=4 flexion). µCT-based digital volume correlation was used to quantify trabecular strains. A bespoke loading device fixed specimens at the resultant displacement when loaded to 50N and 800N. Flexion was achieved by adding 6° wedges. Disc degeneration was quantified with Pfirrmann grading and T2 relaxation times.ResultsAnterior axial strains were 80.9±39% higher than the posterior region in flexion (p&lt;0.01), the ratio of which was correlated with T2 relaxation time (R2=0.80, p&lt;0.05). In flexion, the central-to-peripheral axial strain ratio in the endplate region was significantly higher when the underlying IVDs were non-degenerated relative to degenerated (+38.1±12%, p&lt;0.05). No significant differences were observed in axial compression.ConclusionDisc degeneration is a stronger determinant of the trabecular strain distribution when flexion is applied. Load transfer through non-degenerate IVDs under flexion appears to be more centralised, suggesting that disc degeneration predisposes flexion-type compression fractures by shifting high strains anteriorly.Conflicts of interestThe authors declare none.Sources of fundingThis work was funded by the Engineering &amp; Physical Sciences Research Council (EP/V029452/1), and Back-to-Back.

Classification and Treatment Strategies of Tibial Tubercle Fractures in Adults.

Tibial tubercle is a crucial player in maintaining the structural integrity and functional stability of the knee joint. Currently, there is no standardized protocol for the classification and treatment of tibial tubercle fractures in adults. This study analyzed the incidence and treatment strategies of tibial tubercle fractures in adults according to the four-column and nine-segment classification system. Data of patients with proximal tibial fractures involving tibial tubercle fractures who were treated at our hospital from August 2007 to March 2023 were retrospectively reviewed. The fractures were classified using the AO/OTA classification and four-column and nine-segment classification systems, and the treatment protocol (surgically treated or conservatively treated) was recorded. The number and distribution proportion of patients were counted. A two-sided t-test was conducted to determine the significance of differences between the gender and sides. In total, 169 tibial tubercle fractures were found in 1484 proximal tibial fractures. According to the AO/OTA classification, seven of the 169 patients, (4.1%) were type A, 36 patients (21.3%) were type B, and 126 patients (74.6%) were type C. According to the four-column and nine-segment classification, type 1 cleavage without free fragments was the most common type of fracture (93/169, 55.0%), followed by type 2 dissociative segmental fragments (48/169, 28.4%) and type 3 comminuted fractures (28/169, 16.6%). Overall, 139 of the 169 proximal tibial fractures with tuberosity involvement were treated surgically. Among them, additional fixation of the tubercle fragment was performed in 52 fractures. The incidence of tibial tubercle fractures involved in proximal tibial fractures was approximately 11.4% (169/1484) in adults, and approximately one-third of the tubercle bone fragment required additional fixation (30.8%, 52/169). The injury types in the four-column and nine-segment classifications are helpful for accurately judging and making treatment-related decisions for tibial tubercle fractures.

Pediatric Wrist.

Pediatric wrist injuries pose unique diagnostic challenges due to distinct bone characteristics in children and their diverse injury patterns. The dynamic development of the wrist, marked by changes in bone age and emerging ossification centers, is crucial to evaluate growth and identify potential pathologies. The skeletal composition, rich in cartilage, renders bones relatively weaker yet more elastic, impacting their susceptibility to fracture. Forearm fractures display diverse patterns influenced by torsional forces. Scaphoid fractures, less common in children, differ from those in adults. Conditions like Madelung's deformity and ulnar variance are more common wrist disorders in the pediatric population. In addition, the scarcity and nonspecificity of symptoms in those with tendon injuries and triangular fibrocartilage complex lesions can be diagnostically challenging. This article reviews pediatric wrist injuries, emphasizing ossification patterns, common fracture types, and developmental variants. Grasping these complexities in pediatric wrist development and associated pathologies is essential for precise diagnosis and treatment.

Epidemiological and etiological factors of various fractures and its pharamacological treatment options in a tertiary care teaching hospital - a prospective cohort study

A fracture is a broken bone that can range from a thin crack to a complete break bone. A fracture can occur crosswise, length wise in several parts and in too many pieces. Causes of fracture include physical trauma, accidental fall, sports injuries, stress, and osteoporosis. Fractures can be treated with Medications and lifestyle changes. The objective of the study was to identify common types of fractures mostly affected by people, reduce the incidence rate of fractures and to provide patient counseling regarding precautionary measures to avoid accidents and assaults. In the study period, 120 fracture cases were collected, of this 64 (53.33%) are males and 56 (46.66%) are females. Higher incidence of fractures 27 (22.5%) occurred in 50-60 years of age group. Major fractures 48 (47.5%) were occurred due to trauma. 21 (17.5%) were diagnosed by X-rays, 15 (14.5%) patients are diagnosed by CT scan. 22 (18.33%) patients are categorized under femur bone fractures. 52(43.3%) patients were treated with NSAIDS, 33 (27.5%) patients were treated with antibiotics. 29.33% were treated with vitamins and mineral supplements. The study concludes that out of 120 study subjects, major fractures were occurred due to trauma. Clinical pharmacists and other health care professionals intervention to create awareness regarding fractures, medications, lifestyle modifications and other safety measures helps them to recover faster from fractures.