Common Fracture Type Research Articles

Gambaran Karekteristik Fraktur Radius Dital di RSUD Abdul Wahab Sjahranie Samarinda Tahun 2017-2019

Distal Radius Fractures are the most common fractures in the world. 17.5% of fractures are categorized as distal radius fractures. Distal radius fractures can occur in both young age and old age. Distal radius fractures mostly occur in young adult age group due to high-energy trauma, and in senior age group due to low-energy trauma and osteoporosis. This research aims to capture the overview of distal radius fracture characteristics at RSUD (Rumah Sakit Umum Daerah – Regional Public Hospital) Abdul Wahab Sjahranie Samarinda. The data in this research are secondary data, gathered from medical records of patients. This research was performed in February 2021. This research is a Descriptive Retrospective study. 146 patients diagnosed with distal radius fractures from January 2017 – December 2019 were selected as samples, using Total Sampling method. The result showed that most cases of distal radius fractures occurred in 10-19 years age group (29 patients, 19.9%), male (87 patients, 59.6%), students (47 patients, 34.2%). Furthermore, the most common type of fractures found was closed fracture type (137 patients, 93.8%), the most common clinical fracture found was unidentified fracture (65 patients, 44.5%), and the most common cause of fractures was from trauma (90 patients, 61.6%).

The clinician’s guide to prevention and treatment of osteoporosis

Osteoporosis is the most common metabolic bone disease in the USA and the world. It is a subclinical condition until complicated by fracture(s). These fractures place an enormous medical and personal burden on individuals who suffer from them and take a significant economic toll. Any new fracture in an adult aged 50 years or older signifies imminent elevated risk for subsequent fractures, particularly in the year following the initial fracture. What a patient perceives as an unfortunate accident may be seen as a sentinel event indicative of bone fragility and increased future fracture risk even when the result of considerable trauma. Clinical or subclinical vertebral fractures, the most common type of osteoporotic fractures, are associated with a 5-fold increased risk for additional vertebral fractures and a 2- to 3-fold increased risk for fractures at other sites. Untreated osteoporosis can lead to a vicious cycle of recurrent fracture(s), often resulting in disability and premature death. In appropriate patients, treatment with effective antifracture medication prevents fractures and improves outcomes. Primary care providers and medical specialists are critical gatekeepers who can identify fractures and initiate proven osteoporosis interventions. Osteoporosis detection, diagnosis, and treatment should be routine practice in all adult healthcare settings. The Bone Health and Osteoporosis Foundation (BHOF) – formerly the National Osteoporosis Foundation – first published the Clinician’s Guide in 1999 to provide accurate information on osteoporosis prevention and treatment. Since that time, significant improvements have been made in diagnostic technologies and treatments for osteoporosis. Despite these advances, a disturbing gap persists in patient care. At-risk patients are often not screened to establish fracture probability and not educated about fracture prevention. Most concerning, the majority of highest risk women and men who have a fracture(s) are not diagnosed and do not receive effective, FDA-approved therapies. Even those prescribed appropriate therapy are unlikely to take the medication as prescribed. The Clinician’s Guide offers concise recommendations regarding prevention, risk assessment, diagnosis, and treatment of osteoporosis in postmenopausal women and men aged 50 years and older. It includes indications for bone densitometry as well as fracture risk thresholds for pharmacologic intervention. Current medications build bone and/or decrease bone breakdown and dramatically reduce incident fractures. All antifracture therapeutics treat but do not cure the disease. Skeletal deterioration resumes sooner or later when a medication is discontinued—sooner for nonbisphosphonates and later for bisphosphonates. Even if normal BMD is achieved, osteoporosis and elevated risk for fracture are still present. The diagnosis of osteoporosis persists even if subsequent DXA T-scores are above − 2.5. Ongoing monitoring and strategic interventions will be necessary if fractures are to be avoided. In addition to pharmacotherapy, adequate intake of calcium and vitamin D, avoidance of smoking and excessive alcohol intake, weight-bearing and resistance-training exercise, and fall prevention are included in the fracture prevention armamentarium. Where possible, recommendations in this guide are based on evidence from RCTs; however, relevant published data and guidance from expert clinical experience provides the basis for recommendations in those areas where RCT evidence is currently deficient or not applicable to the many osteoporosis patients not considered for RCT participation due to age and morbidity.

One-Year Clinical Outcomes of Minimal-Invasive Dorsal Percutaneous Fixation of Thoracolumbar Spine Fractures.

Introduction: Minimal-invasive instrumentation techniques have become a workhorse in spine surgery and require constant clinical evaluations. We sought to analyze patient-reported outcome measures (PROMs) and clinicopathological characteristics of thoracolumbar fracture stabilizations utilizing a minimal-invasive percutaneous dorsal screw-rod system. Methods: We included all patients with thoracolumbar spine fractures who underwent minimal-invasive percutaneous spine stabilization in our clinics since inception and who have at least 1 year of follow-up data. Clinical characteristics (length of hospital stay (LOS), operation time (OT), and complications), PROMs (preoperative (pre-op), 3-weeks postoperative (post-op), 1-year postoperative: eq5D, COMI, ODI, NRS back pain), and laboratory markers (leucocytes, c-reactive protein (CRP)) were analyzed, finding significant associations between these study variables and PROMs. Results: A total of 68 patients (m: 45.6%; f: 54.4%; mean age: 76.9 ± 13.9) were included. The most common fracture types according to the AO classification were A3 (40.3%) and A4 (40.3%), followed by B2 (7.46%) and B1 (5.97%). The Median American Society of Anesthesiologists (ASA) score was 3 (range: 1–4). Stabilized levels ranged from TH4 to L5 (mean number of targeted levels: 4.25 ± 1.4), with TH10-L2 (12/68) and TH11-L3 (11/68) being the most frequent site of surgery. Mean OT and LOS were 92.2 ± 28.2 min and 14.3 ± 6.9 days, respectively. We observed 9/68 complications (13.2%), mostly involving screw misalignments and loosening. CRP increased from 24.9 ± 33.3 pre-op to 34.8 ± 29.9 post-op (p < 0.001), whereas leucocyte counts remained stable. All PROMs showed a marked significant improvement for both 3-week and 1-year evaluations compared to the preoperative situation. Interestingly, we did not find an impact of OT, LOS, lab markers, complications, and other clinical characteristics on PROMs. Notably, a higher number of stabilized levels did not affect PROMs. Conclusions: Minimal-invasive stabilization of thoracolumbar fractures utilizing a dorsal percutaneous approach resulted in significant PROM outcome improvements, although we observed a complication rate of 13.2% for up to 1 year of follow-up. PROMs were not significantly associated with clinicopathological characteristics, technique-related variables, or the number of targeted levels.

Role of Pronator Quadratus Repair in Volar Locking Plate Treatment of Distal Radius Fractures.

Distal radius fractures are the most common type of upper extremity fractures, and their incidence is increasing. There has been a rise in the surgical treatment of distal radius fractures, primarily with volar locking plate fixation. Although this procedure is commonly done among orthopaedic surgeons, the role of pronator quadratus repair after fixation remains controversial. The pronator quadratus serves as a secondary forearm pronator and a dynamic stabilizer of the distal radioulnar joint. Aside from a functional role, repair of the pronator quadratus has been proposed to serve as a biologic barrier between the volar locking plate and the flexor tendons to minimize tendon irritation. In this narrative review, we discuss the current treatment trends, the surgical approach for volar locking plate treatment of distal radius fractures, and the anatomy and function of the pronator quadratus. We discuss the case for and against the repair of the pronator quadratus, both for function and prevention of flexor tendon irritation and rupture. The preponderance of high-level evidence demonstrates no benefit to pronator quadratus repair for pain relief or function. The current evidence does not conclusively support or refute pronator quadratus repair as a biologic barrier from the flexor tendons.

Treatment of two or more metatarsal fractures

IntroductionMetatarsal fractures are the most common type of foot fracture. When surgical treatment is needed, pinning is typically used, either percutaneous or open. However, this fixation method has been criticized by some authors who lament residual malunion and prefer to use plate and/or screws. The primary objective of our study was to compare the outcomes of K-wire versus plate and/or screw fixation for the surgical treatment of two or more metatarsal fractures. The secondary objective was to evaluate the factors that contribute to poor outcomes and complications. We hypothesized that plate and/or screw fixation will produce better functional outcomes than K-wire fixation. Materials and methodsThis was a prospective and retrospective multicenter study carried out between 1 January 2010 and 1 June 2018 with a minimum follow-up of 12 months. Three functional scores were determined (AOFAS, FAAM and SF12 physical and mental) preoperatively, postoperatively and at the final assessment. We evaluated the outcomes in the entire study population and in four injury type subgroups, including one with isolated metatarsal fractures to control analysis bias. ResultsOur analysis compiled data from 165 patients (123 men, 42 women) who had a mean age of 38 years (16–82). The mean follow-up time was 27.9months (10–120). There were no complications in 130 patients (79%). Skin necrosis occurred in 25 patients (15%). The FAAM score was significantly higher in the plate and/or screw group 70.2 (17-84) versus 60.3 (31-84) in the K-wire group (P=0.033). The 78 (19–100) AOFAS was higher, but not significantly, in the plate and/or screw group versus 70 (12–100) in the K-wire group (P=0.144). ConclusionTrauma to the foot that causes a fracture in two or more metatarsals often occurs due to a crush injury (39%). The frequency of associated bone lesions means that a preoperative CT scan should be done routinely to analyze the injury pattern and determine the best treatment. The fixation method should be adapted to the local conditions; when possible, it is preferable to use rigid fixation with plates and/or screws as it yields better functional outcomes. Level of evidenceIV; study with retrospective component.

The Incidence and Risk Factors of Medial and Inferior Orbital Wall Fractures in Korea: A Nationwide Cohort Study.

Purpose: We aimed to investigate orbital wall fracture incidence and risk factors in the general Korean population. Method: The Korea National Health Insurance Service–National Sample Cohort dataset was analyzed to find subjects with an orbital wall fracture between 2011 and 2015 (based on the diagnosis code) and to identify incident cases involving a preceding disease-free period of 8 years. The incidence of orbital wall fracture in the general population was estimated, and the type of orbital wall fracture was categorized. Sociodemographic risk factors were also examined using Cox regression analysis. Results: Among 1,080,309 cohort subjects, 2415 individuals with newly diagnosed orbital wall fractures were identified. The overall incidence of orbital wall fractures was estimated as 46.19 (95% CI: 44.37–48.06) per 100,000 person-years. The incidence was high at 10–29 and 80+ years old and showed a male predominance with an average male-to-female ratio of 3.33. The most common type was isolated inferior orbital wall fracture (59.4%), followed by isolated medial orbital wall fracture (23.7%), combination fracture (15.0%), and naso-orbito-ethmoid fracture (1.5%). Of the fracture patients, 648 subjects (26.8%) underwent orbital wall fracture repair surgeries. Male sex, rural residence, and low income were associated with an increased risk of orbital wall fractures. Conclusions: The incidence of orbital wall fractures in Korea varied according to age groups and was positively associated with male sex, rural residency, and low economic income. The most common fracture type was an isolated inferior orbital wall fracture.

Nonaccidental Trauma in Pediatric Elbow Fractures: When You Should Be Worried.

Nonaccidental trauma (NAT) is a rising source of morbidity and mortality in the pediatric population. Fractures are often the first cause for presentation to health care providers in the case of NAT but can be misidentified as accidental. Given that elbow fractures are the most common accidental injuries among pediatric patients, they are not traditionally associated with NAT. This study aims to determine the prevalence of NAT among elbow fractures and identify common features in nonaccidental elbow fractures. Current Procedural Terminology (CPT) codes were used to retrospectively identify all pediatric (0 to 17) elbow fractures at a single, tertiary children's hospital between 2007 and 2017. Among these, all fractures for which an institutional child abuse evaluation team was consulted were identified. The medical record was then used to determine which of these fractures were due to NAT. Standard injury radiographs of all victims of NAT as well as all patients under 1 year of age were blinded and radiographically evaluated for fracture type by a pediatric orthopaedic surgeon. The prevalence of nonaccidental elbow fractures across the 10-year study period was 0.4% (N=18). However, the prevalence of nonaccidental elbow fractures in those patients below 1 year of age was markedly higher at 30.3% (10/33). Among all elbow fractures in patients below 1 year of age, supracondylar humerus fractures were the most common fracture type (19/33, 57.6%), yet transphyseal fractures (6/33, 18.1%) were most commonly the result of NAT (5/6, 83.3%). In children over 1 year of age, fracture type was not an indicator of NAT. The vast majority of pediatric elbow fractures (99.6%) are accidental. However, certain factors, namely age below 1 year and transphyseal fractures increase the likelihood that these fractures may be a result of NAT. Level IV: retrospective case series.

Comparative evaluation of ultrasonography and lateral radiography in nasal fractures diagnosis

BackgroundNasal fractures are the most common type of trauma fracture. Conventional radiography is the primary method of choice. Ultrasonography is used as a new and non-invasive method for this purpose. The aim of this study is to compare the diagnostic values of ultrasonography with nasal X-ray. MethodsThis was a prospective study which was conducted during 2018–2019 at Bouali hospital, Sari, northern Iran. 130 patients who met our criteria enrolled our study. All patients underwent nasal X-ray and ultrasonography on a day of trauma. The physical examination during the reduction in operation room considered as gold standard for nasal bone fracture. The sensitivity, specificity, precision, positive predictive values, and negative predictive values, along with 95% confidence intervals, were determined by SPSS. ResultsThe sensitivity, specificity, positive predictive values, negative predictive values, and precision of nasal X-ray were all reported to be 100% when compared to physical examination (the gold standard). Ultrasonography had a sensitivity of 78.13%, a specificity of 100%, a PPV of 100%, an NPV of 61.82%, and a precision of 83.85% in comparison to physical examination (the gold standard). ConclusionThe findings of this study suggest that ultrasonography can be utilized as a main diagnostic tool in the identification of nasal bone fractures in the vast majority of cases, avoiding the unwanted dangers and problems of X-rays. This is especially critical for expecting mothers and children.

TO EVALUATE RADIOLOGICAL AND FUNCTIONAL OUTCOMES OF INTRAMEDULLARY OSTEOSYNTHESIS OF SUBTROCHANTERIC FEMUR FRACTURES IN ADULTS WITH LONG PROXIMAL FEMORAL NAIL

Background: The subtrochanteric fractures accounts for 10-34% of hip fractures. Operative treatment is gold standard in adults in view of anatomical location, deforming forces &amp; vascularity issues. Intramedullary device are less invasive, more biological &amp; mechanically stable whereras extramedullary methods achieves better anatomical reduction but at the expense of vascularity. However, there is still no consensus over the methodology for being the best for these fractures. Objective: To evaluate clinical, functional and radiological outcomes of intramedullary osteosynthesis of subtrochanteric femur fractures in adults with long PFN. Methods: A prospective randomized control study was conducted on total 30 patients of subtrochanteric fractures and treated with long proximal femoral nail (PFN). All the patients were followed up for a maximum of 24 weeks. Outcomes were observed &amp; analysed such as tip apex distance, duration of surgery, complications, functional and radiological outcomes. Results: The average age of patients was 43.6 years ±13.26. Left sided fracture were more than right sided fracture. The most common type of fracture as per AO-ASIF classication was 32-C3 (53.33%). In 21 patients compression screw used was 95mm or above. Derotation screw of size 85mm or above were inserted in 19 patients. Mean TAD of compression screw and derotation screw was 11.59 and 13.81 respectively. Closed reductions was achieved in 27 patients. Mean surgical time was 157 minutes. Mean radiological union time of fracture was 14.16 weeks. Mean Harris hip score at 24 weeks was 84.56. Conclusions: It is concluded that intramedullary xation by long PFN is a sound and effective modality for the subtrochanteric fractures. Subchondral xation of both proximal screws probably has led to better stable xation with hundred percent union rates and no implant failure.

SURGICAL MANAGEMENT OF EXTRA-ARTICULAR PROXIMAL TIBIA FRACTURE USING MINIMALLY INVASIVE TECHNIQUE WITH LOCKING COMPRESSION PLATE: AN OBSERVATIONAL STUDY

Methods: This study evaluated the outcome of 23 patients with total 24 proximal tibia fractures, treated with Minimally Invasive Plate Osteosynthesis using LCP from 13 March 2020 – 30 September 2021 at MMIMSR, Mullana. Results: There were 17 males and 6 females, with mean age of 51 years. RTA was the most common cause of trauma (65%). Most common fracture type as per AO classication was 41-A3.1 (41.7%). The average injury to surgery interval was 2.1 ± 1.4 days. The mean duration of surgery was 98.91 ± 16.5 minutes. Average follow-up period was 20.5 weeks. Union was seen in duration of 12 ± 3.9 weeks. Full weight bearing was achieved by 12.9 ± 4.5weeks. American Knee Society Score is subdivided into knee score and function score. At 6 months follow-up, the mean Knee Score was 86.7 ± 11.5 and the mean Functional Score was 88.1 ± 13.2. The mean range of motion at 108.5° ± 16.8° at 6 months. There was 1 instance of supercial infection, 3 instances of knee stiffness and 1 instance of non-union. Conclusion: MIPPO technique for management of extraarticular proximal tibia fractures using LCP leads to excellent clinical and functional outcome.

Elbow Injuries in Children

Elbow Injuries in Children

Effectiveness and cost-effectiveness of surgery versus casting for elderly patients with Displaced intra-Articular type C distal Radius fractures: protocol of a randomised controlled Trial with economic evaluation (the DART study)

IntroductionCurrent literature is inconclusive about the optimal treatment of elderly patients with displaced intra-articular distal radius fractures. Cast treatment is less invasive and less expensive than surgical treatment. Nevertheless, surgery...

Functional Outcome and Quality of Life After Surgical Fixation of Tibial Plateau Fracture in a Tertiary Care Center of Nepal

IntroductionFunctional outcome and quality of life (QoL) of patients will change following tibial plateau fracture fixation. There are limited studies evaluating functional and radiological outcomes following tibial plateau fixation in Nepal, and none has evaluated QoL. We aim to evaluate functional outcome and QoL in patients with tibial plateau fracture with a follow up period of more than two years. MethodsThis was a cross sectional, observational study done at Dhulikhel Hospital, from August 2021 to January 2022. Western Ontario and McMaster Universities Arthritis Index (WOMAC) functional outcome and World Health Organization QoL-8 (WHOQoL-8) questionnaire were filled by patients operated for tibial plateau fracture from 2011 to 2019. Compound fractures, untraceable patients, and those managed with casts were excluded from the study. ResultsThere were 121 patients (male: female = 2.3:1) with a mean age of 37.1 years. Road traffic accidents (44.6%) were the most common mode of injury, and Schatzker type IV (30.6%) was the most common type of fracture. The average WOMAC score was 13.05±12.1 and the average WHOQoL-8 score was 30.24±4.1. The average WOMAC score in high-energy and low energy trauma patients were 17.07±12.29 and 8.21±10 respectively. The average WHOQoL-8 in high energy and low energytrauma patients were 29.28±3.59 and 31.38±4.38 respectively. ConclusionsSurgical reduction and stable internal fixation of tibial plateau fractures with long term follow up has a good functional outcome and quality of life. High energy trauma is associated with poor functional outcome and quality of life.

Distribution of Fracture Sites in Postmenopausal Overweight and Obese Women: The FRISBEE Study.

The association between obesity and fracture sites in postmenopausal women has been little studied. We examined the most common types of fractures in obese and overweight postmenopausal women compared to subjects with a normal BMI in the FRISBEE study, a cohort of postmenopausal women followed since 9.1 (7.2-10.6) years. Chi-squared tests and logistic regressions were used to compare the percentages of fracture sites in overweight/obese subjects to subjects with a normal BMI. Their mean (± SD) age was 76.7 ± 6.9years and their mean BMI was 26.4 ± 4.4. Seven hundred seventy-seven subjects suffered at least one validated fragility fracture with a total of 964 fractures in the whole cohort. Subjects with a BMI higher than 25 had significantly more ankle fractures and less pelvic fractures than subjects with a normal BMI (OR 1.63, 95% CI 1.02-2.56, P = 0.04 and OR 0.55, 95% CI 0.34-0.89, P = 0.01, respectively). There were no significant differences between overweight and obese subjects. Among those older than 75, there were significantly fewer pelvic fractures in overweight/obese subjects (OR 0.49, 95% CI 0.27-0.87, P = 0.01), but before 75, ankle fractures were significantly more frequent in overweight/obese subjects than in subjects with a normal BMI (OR 1.89, 95% CI 1.01-3.57, P = 0.04). In conclusion, the proportion of ankle and pelvic fractures in obese and overweight subjects differs from that in subjects with a normal BMI, but these differences are age dependent. Fracture prevention strategies should take into account the differential effects of excess weight according to age and the site of fracture.

Radiological comparison of the biomechanical characteristics of short segment posterior instrumentation (Moss- Miami system), with and without transverse connector, in unstable thoraco-lumbar fracture

Introduction: Wedge compression fracture was most common type of fracture (66.6 %) and first Lumbar vertebra (L1) was the most common fracture site (38 %). The choice of surgical approach and instrumentation depends on fracture type, injury level and degree of neural injury. This paper evaluated efficacy of transpedicular screw fixation by Moss Miami instrumentation with transverse connector for surgical treatment in traumatic unstable thoraco-lumbar fractures.&#x0D; Materials and Method: Fifty-five cases were prospectively studied over three years. Comparison was done between two groups- Group 1 without transverse connector and Group 2 with transverse connector. Radiologically evaluation was done in both groups pre-operatively, tenth day, six weeks and six months interval. All X-rays were assessed by lateral and dynamic antero- posterior views for measuring kyphotic (cobb’s) angle and inter-rod angle.&#x0D; Results: In both groups post-operative Mean Cobb’s angle level were increased and remained same until 6months. Variation in Group 2 with transverse connector was slightly higher in initial period (i.e.) after 10 days and then it remains minimal from 6 weeks to 6 months. But in Group 1 without transverse connector the change in angle variation was minimal which worsen over 6 weeks and it continues to remain worse at 6 months, suggestive of parallelogram effect.&#x0D; Conclusion: Transverse connector does play role in preventing parallelogram effect of implants and provides additional stability to the construct. This is first study done in vivo which is done to study the role of transverse connector and evaluate any parallelogram effect in spinal instrumentation.&#x0D; Key words&#x0D; Transverse connector, Thoraco-lumbar fracture, parallelogram effect

The grade of instability in fragility fractures of the pelvis correlates with impaired early mobilization

PurposeThis study aimed to investigate whether gait patterns of patients with fragility fractures of the pelvis (FFP) comply with the grade of fracture instability, defined by radiological patterns.Patients and methodsThis prospective, single-center, observational study included 39 patients with an FFP. Gait analysis was performed with a wearable insole force sensor (Loadsol® by Novel, Munich, Germany) 4–7 days after admission. Patients were divided in two groups: Group A included FFP type 1 fractures, which affect the anterior pelvic ring only, Group B contained FFP type 2–4 fractures with an involvement of the posterior pelvic ring. Primary outcome parameter was the FTI ratio (force–time integral (N*s)).ResultsThe mean age was 85.08 years (SD ± 6.45), 94.9% (37/39) of the patients were female. The most common fracture type was an FFP 2b (64.1%, 25/39). Group A showed a significantly higher FTI ratio (45.12%, SD ± 4.19%) than Group B (38.45%, SD ± 5.97%, p = 0.002). Further, a significant correlation of the FTI ratio and the average (r = 0.570, p < 0.001) and maximum (r = 0.394, p = 0.013) peak force was observed.ConclusionThe gait pattern of patients with an FFP type 2–4 was more imbalanced than of patients with an FFP type 1 fracture. These findings match with the radiological classification of FFP, which indicates higher instability, when the posterior pelvis is affected. Gait analysis might offer earlier functional diagnostics and may accelerate the treatment decision with shorter periods of immobility in future. Especially in cross-border cases, early gait analysis could be beneficial to clarify the indication for or against surgery.

Factors Contributing to Residual Low Back Pain after Osteoporotic Vertebral Fractures.

Although osteoporotic vertebral fractures (OVFs) are the most common type of osteoporotic fracture, few reports have investigated the factors contributing to residual low back pain in the chronic phase after OVFs by using radiographic evaluation. We examined the contribution of nonunion, vertebral deformity, and thoracolumbar alignment to the severity of residual low back pain post-OVF. This post hoc analysis of a prospective randomized study included 195 patients with a 48-week follow-up period. We investigated the associations between radiographic variables with the visual analog scale (VAS) scores for low back pain at 48 weeks post-OVF using a multiple linear regression model. Univariate analysis revealed that analgesic use, the local angle on magnetic resonance imaging, anterior vertebral body compression percentage on X-ray, and nonunion showed a significant association with VAS scores for low back pain. Multiple regression analysis produced the following equation: VAS for low back pain at 48 weeks = 15.49 + 0.29 × VAS for low back pain at 0 weeks + (with analgesics: +8.84, without analgesics: −8.84) + (union: −5.72, nonunion: −5.72). Among local alignment, thoracolumbar alignment, and nonunion, nonunion independently contributed to residual low back pain at 48 weeks post-OVF. A treatment strategy that reduces the occurrence of nonunion is desirable.

Characteristics and Patterns of Facial Fractures in the Elderly Population in the United States Based on Trauma Quality Improvement Project Data.

With the increase in the elderly population in the United States, the number of people seeking care for trauma injuries is expected to increase. However, nationwide studies on epidemiological profile of elderly facial fractures remain sparse. The authors present the epidemiological measures of elderly facial fractures on national scale. Characteristics of facial fractures among younger adults (18-64 years old) and the elderly population (65-74 years old, 75-84 years old and 85 years and above) have been examined using the 2016 American College of Surgeons-Trauma Quality Improvement Program databank. Variables studied included facial fracture patterns, mechanisms of injury, treatment variables, and demographic descriptive data. Of 104,183 elderly trauma patients, 3415 presented with facial fractures, making up 3.3% (versus 6.5% in younger adults). Majority of facial fractures in 85 and over group (60.7%) were experienced by females, compared to only 19.5% in the younger adult group. Most common mechanism of injury in the elderly was falls, versus motor vehicle trauma in younger adults. The most common type of facial fractures among both groups were nasal fractures. Elderly patients presented with fewer zygoma, mandibular and nasal fractures when compared to younger adults, whereas showing more maxillary/malar and orbital bone fractures. Elderly patients experienced less operative management (4.3%-8.2%) compared to younger adults (15.6%). Concurrently, mortality rates were higher in the elderly patients (9.9%-11.8%) when compared to the younger adults (8.0%). Elderly patients presented with different causes of injury, distribution of fractures, and rates of operative management compared to younger adults.

The Impact of Covid-19 Pandemic on the Epidemiological Pattern of Fracture Clinic Attendances

Purpose: The Covid 19 pandemic has had enormous impacts on healthcare and orthopaedic services globally. The aim of our study was to assess the impact that the covid 19 pandemic has had on the epidemiological pattern of outpatient fractures clinic attendances. Methods: An observational retrospective study was performed looking at epidemiology of fractures seen at our fracture clinics during a three-month period of level 5 restrictions of the covid 19 pandemic and the equivalent period pre pandemic. Data pertaining to demographics, aetiology and fracture types are presented. Results: Patient attendances decreased from 117 in the ‘non-covid era’ to 77 in the ‘covid era’ with a total of 109 and 77 fractures identified respectively. Patients were mostly female with a median age of 55. National lockdown measures impacted the mechanism of injury with expected decreases in sporting injuries. The most common fracture types involved the carpus and hand, foot and ankle and malleoli with the proportion of distal forearm fractures increasing in the covid era. Conclusion: Fracture clinic presentations decreased during the covid era with a higher proportion of fragility fractures. This data may raise awareness regarding the effect of lockdown on an orthopaedic outpatient service for resource allocation for potential future waves.

Classification and Treatment for Cervical Spine Fracture with Ankylosing Spondylitis: A Clinical Nomogram Prediction Study.

Objective Through the follow-up analysis of cervical spine fracture cases with ankylosing spondylitis (AS), a treatment-oriented fracture classification method is introduced to evaluate the clinical efficacy guided by this classification method. Method A retrospective analysis was performed on 128 AS patients who underwent comprehensive treatment in the Spine Surgery Department of Qingdao University Hospital from January 2009 to May 2018. Statistics of patient demographic data, distribution of different fractures corresponding to surgical methods, 3-year follow-up outcomes, and summary of objective fracture classification methods were analyzed. A prospective 5-year follow-up study of 90 patients with AS cervical spine fractures from June 2015 to August 2020 was also included. Statistical differences on the distribution of factors such as case information, cervical spine sagittal sequence parameters, and fracture classification were assessed. Correlations between surgical information, American Spinal Injuries Association grade (ASIA), modified Japanese Orthopaedic Association scores (mJOA), and other factors were analyzed to establish a nomogram predictive model for curative effect outcomes. Overall, three major types and the four subtypes of AS cervical spine fractures were evaluated based on the clinical efficacy of the classification and the selection of surgical treatment methods. Result The most common type of fracture was type II (30 cases, 33.33%), most of the subtypes were A (37 cases), followed by B (36 cases) and C (17 cases). Twenty-four of 28 patients with type I underwent anterior surgery, and 47 of 62 patients with type II and III underwent posterior surgery. The average follow-up time was 25.76 ± 11.80 months. The results of predicting clinical variables are different but include factors such as fracture type and subtype, type of operation, and age. The predictor variables include the above-mentioned similar variables, but survival is more affected by the fracture type of the patient. Conclusion This predictive model based on follow-up information delineation points out the impact of ankylosing spondylitis cervical spine fracture classification on surgical selection and clinical efficacy.