Etiology Of Fractures Research Articles

Mid-Term results in adult humeral fractures with titanium elastic nail fixation versus plate and screw fixation and locking intramedullary nailing

Aims: To compare plate-screw fixation, intramedullary nailing (IMN), and titanium elastic nailing (TEN) as a new fixation method with respect to nonunion, complication rates, and functional outcomes in the repair of adult humeral shaft fractures. Methods: A total of 38 adult patients who were treated due to humeral shaft fracture at our clinic and were followed for minimum six months between January 2012 and January 2015 were retrospectively analyzed. Age, sex, fracture etiology an length of hospitalization were recorded. Fractures were classified according to the Association for Osteosynthesis(AO) classification. Nonunion rates as assessed by X-ray during visits, angulation, shoulder, elbow and hand disability scores were evaluated using the DASH, Mayo Elbow and UCLA Shoulder scoring, and Stewart Hundley criteria. Results: There was no significant epidemiological difference between the groups. The length of hospitalization was lower in the TEN group. There was no significant difference in nonunion rates and functional scores according to the type of treatment. Angulation rate was slightly higher in the TEN group. The effect of angulation on functional score showed no influence on the functional status. The three treatment types mostly achieved excellent and good outcomes. Conclusion: Our study results suggest that TEN seems to be a good alternative treatment in eligible patients with humeral shaft fractures considering complications of other treatments. However, we believe that further, large-scale, randomized-controlled, prospective studies with longer follow-up duration are required to confirm these findings and to establish a definite conclusion. Level of Evidence: Therapeutic Level III.

The Prevalence of maxillary fractures in trauma patients referred to Shahid Rajaei Hospital in Shiraz from 2011 to 2021

Introduction: Maxillofacial fractures are one of the most common fractures in the body due to trauma. Maxillary fractures, especially Lefort fractures, are common fractures. The aim of this study is to evaluate the prevalence and etiology of Lefort fractures in patients referred to Shahid Rajaei Hospital during 2011 to 2021.
 Materials and Method: In this cross-sectional study, 2700 patients who referred to the maxillofacial surgery department of Shahid Rajaei Hospital in Shiraz between 2011 to 2021 due to trauma and fractures of the jaw and face were examined. 903 cases were related to patients with upper jaw fracture and were included in the study. The demographic information of the patients, including age, sex, cause of trauma, and also the type of fracture, were extracted from their records. The etiology of maxilla fracture was divided into three groups: vehicle accidents, violence and interpersonal conflict, and accidents during work and sports. Finally, in order to analyze the data, it was done through statistical tests.
 Results: 65% of patients were male and 35% were female. The average age of people was 38.5 years. Lefort I fracture was reported in 25% of patients, Lefort II fracture in 31% and Lefort III fracture in 11% of patients. 46% of patients had fractured maxilla due to vehicle accidents, 26% of patients due to interpersonal violence, and 27% of patients due to accidents during work and sports.
 Conclusion: The prevalence of Lefort fracture in men is significantly higher than in women. In our society, injuries caused by road accidents, especially car accidents, are the most common causes of Lefort fractures. The most common type of Lefort fracture is Lefort II fracture. Of course, the cause of injury has an important effect on the pattern of injury.

Patterns of Midface and Mandible Fractures in a Government Hospital.

Study Design: Cross-sectional study. Objective: The prevalence and etiology of facial fractures differ in each country. The aim of this study was to determine the patterns, trauma mechanism, and treatment of midface and mandible fractures in a government hospital in Mexico City. Methods: A three-year cross-sectional study was done at Balbuena General Hospital in Mexico City. The variables of interest were age, gender, place of origin, fracture site, trauma mechanism, and treatment. Between 2016 and 2019, physical and electronic data records of patients that exhibited facial fractures were included. Statistical analyses performed included descriptive analysis and a chi-square test. Results: A total of 490 cases of fractures in the maxillofacial region were reviewed, of which 237 (47%) cases presented fractures in the midface. A higher male ratio (M: F 12:1) was observed. The age range varied between 18 and 80 years, with a mean of 35.58 ± 14 years. The most frequent diagnosis was a zygomatic complex fracture, 37.97%. (n = 90). The most frequent trauma mechanism was interpersonal violence at 55.93% (n = 132) in both places of origin (P = .06). Conservative treatment was more frequent at 71.67% in intrapersonal violence (P = .019). Interpersonal violence was more frequent in males at 61.64%, and motor vehicle accident was more frequent in female at 61.11% (P = .028). Conclusions: The analysis provides information that can help to focus preventive measures regarding facial fractures, especially on efforts to reduce interpersonal violence.

Early Bony Fixation and Soft Tissue Coverage in Type IIIB Open Proximal Tibia Fractures: A Cross-sectional Study

Introduction: The tibia, the second largest bone in the human body, is largely enveloped by subcutaneous fat and skin, rendering it vulnerable to fractures and soft tissue injuries. This unique anatomical configuration contributes to a heightened susceptibility to open fractures. Notably, an aggressive treatment protocol involving radical debridement, internal fixation, and immediate or early soft tissue coverage with muscle flaps has demonstrated improved rates of bony union and reduced incidences of infection. Aim: To assess the clinical outcomes of early bony fixation and soft tissue coverage in Type IIIB open proximal tibia fractures. Materials and Methods: This cross-sectional observational study was conducted at the Department of Orthopaedics, BRD Medical College, in Gorakhpur, Uttar Pradesh, India. Total of 30 cases were enrolled between August 2021 and November 2022. The parameters assessed in the study encompassed patient demographics, including age and gender distribution, the aetiology of fractures, soft tissue coverage outcomes, time to bone union, knee joint movement postsurgery, and the incidence of complications such as superficial infections and chronic osteomyelitis. The analysis was conducted using Statistical Package for Social Sciences (SPSS) version 26.0, primarily employing descriptive statistics to present the results, with percentages and frequencies serving as the primary modes of representation. Results: All cases of Gustilo-Anderson Type IIIB high-grade open tibial fractures were included in this study, with the majority of patients being males 26 (87%) aged between 20 to 40 years. Road traffic accidents accounted for 25 (83.3%), while falls from height were responsible in 5 (16.7%) cases. Assessment of soft tissue coverage revealed 73.33% with good healing, 20% with fair healing, and 6.67% with poor healing. The time to bone union varied, with 10% of cases showing non union. Postsurgery, most cases demonstrated knee joint movement of over 120° (86.67%) and a few cases with movement ranging between 90-120° (13.33%). The incidence of complications was relatively low, with 3 (10%) cases presenting superficial infections and 2 (6.7%) suffering from chronic osteomyelitis. Conclusion: Early bony fixation and soft tissue coverage utilising the medial gastrocnemius flap, along with Split-Thickness Skin Grafting (STSG), demonstrate efficacy in treating high-grade open proximal tibia fractures (Gustilo-Anderson Type IIIB). This approach facilitates expedited bony union and contributes to a reduction in postoperative complications.

The pattern of orbital walls fractures in north of Jordan.

The aim of this study was to examine the incidence and demographic characteristics of patients with orbital walls fractures who were treated in the department of oral and maxillofacial surgery of a tertiary hospital in Jordan. A retrospective cohort study of patients with a diagnosis of with selected orbital walls fracture was designed and implemented, during a two-year period between January 2020 and December 2021. Information on patients treated for orbital walls fractures were retrieved and analyzed regarding age, sex, etiology, anatomical site, and treatment modality. Descriptive data presented as simple frequencies and percentages. A total of 76 patients with 100 orbital wall fractures, age range was 4-68 years old with a mean age 28 (SD±12), of whom were 53 (69.7%) were male and 23(30.3%) were female, with male:female ratio was 2:1. The most common etiology of all orbital walls fractures was RTA in 47 patients (61.8%; P ≤0.021), followed by violence in male patients. The most prevalent age-group was 21-30 years old with 16 patients (21.05%; P ≤0.235), and single orbital wall fractures 56 (56%) were more common than combined orbital wall fractures. In conclusion, this study will contribute to identifying the best clinical therapy and protective techniques for individuals with orbital fractures. Key words:Orbital fracture, Etiology, Orbital trauma, Road traffic accidents, Trauma.

Pattern and management of maxillofacial fractures in Jordanian children and adolescents.

The aim of this study was to analyze the characteristics, etiology and treatment of maxillofacial fractures among children and adolescents in northern part of Jordan. A retrospective cohort study which included 91 children and adolescents patients who were treated for maxillofacial fractures during a period of three years between January 2019 and December 2021 at a tertiary hospital in Jordan. Over a period of three years, a total of 91 children between the age of 0 and 19 years were treated with 156 total maxillofacial fractures. Of these, 68 (74.73%) were males and 23 (25.27%) were females. One tenth of patients (10 (10.99%) were children of the preschool group and 55 patients (60.44%) were adolescents. Road traffic accident (RTA) was the most common cause of maxillofacial fractures, accounting for 57 (62.64%) of cases. Mandibular fractures were the most common and accounted for 82 (90.2%) of all fractures, followed by the zygomatic bone fractures 40 (44%). The most common treatment was intermaxillary fixation (IMF) with 53 (33.97%) fractures. Maxillofacial fractures are predominant among adolescents in comparison to children. RTA was the most common cause of maxillofacial fractures, mandibular fractures were the most common fractures, and intermaxillary fixation (IMF) was the most common treatment modality.

The Pattern of Midface Fractures in Jordan: A Retrospective Review of Medical Records.

Midface fracture incidence and trauma patterns vary across countries, due to socioeconomic, environmental, and cultural factors. The aim of this retrospective study was to assess the etiology, pattern, and treatment of midface fractures in North of Jordan during 2018-2021. This single-center retrospective study was based on the review of the medical records of patients who had suffered midface fractures and were treated at the Department of Oral and Maxillofacial Surgery at the King Abdullah University Hospital. The dataset for this investigation spanned the 4-year period from January 2018 to December 2021. During the 4-year period, 267 patients presented with 376 different maxillofacial fractures. Of those, 140 patients had 250 midface fractures, with a mean of 1.79 per patient. Their age ranged from 2 to 68 years (mean [standard deviation] = 25.8 [12.0] years). The most frequent injury cause was road traffic accidents (RTA) (n = 72, 51.3%), followed by falls (n = 27, 19.3%). Among midface fractures, the most frequent were orbit fractures (42.4%), followed by zygomatic fractures (31.6%) and maxillary fractures (26%). The majority of fractures (77.9%) were treated through open reduction and internal fixation (ORIF), while the remaining (15.7%) required closed reduction and conservative treatment was sufficient in 6.43% of fractures. Midface fractures were more common among males, and primarily occurred in the orbital floor due to the high incidence of RTAs. Maxillary fractures were mostly of the LeFort I Type and ORIF was the most common treatment modality.

Razvoj maksilofacijalne traumatologije sa osvrtom na epidemiologiju i kvalitet života kod bolesnika sa prelomom kostiju lica

Introduction: The treatment of facial bone fractures dates back to ancient civilizations, with various methods of prosthetic immobilization developed and in the second half of the 19th and the beginning of the 20th century. In our literature, there are almost no studies that examined the quality of life of patients with facial bone fractures, although worldwide this is an extremely current topic indicating the importance of this problem. Methods: This paper will present results from professional/scientific relevant data sources on the historical development of maxillofacial surgery with reference to etiology, epidemiology and instruments for assessing the quality of life of patients with jaw bone fractures. Topic: Medical treatment of these surgical injuries involves a highly specialized team led by a maxillofacial surgeon. This paper deals with the etiology, epidemiology and quality of life of patients with facial bone fractures. Conclusion: Surgical interventions for fractures of the facial bones are becoming more and more demanding, resulting in development of maxillofacial surgery as an independent branch. In the etiology of facial bone fractures, traffic accidents are mentioned more and more often as the main way of injury. The incidence of facial bone fractures in human pathology is about 30 per 100,000 hospitalized patients. Research has shown that the quality of life in operated patients with fractures of the facial bones is significantly lower than those operated on some other region.

Comparison of Functional Outcome and Union of Proximal Humerus Fractures Fixed with Philos Plate Versus T Plate

Aim: The purpose of this study was to evaluate the differences between PHILOS and T plates in terms of functional recovery and fracture union after proximal humerus fractures. Study Design: Prospective study Place and Duration: Bahawal Victoria Hospital, Bawalpur/Nishtar Hospital, Nishtar Medical University, Multan. Jun 2020-January 2022 Methods: There were a total of 48 patients, both sexes, ranging in age from 20 to 75. All the included patients had humerus fractures and admitted to hospital for operation. Age, sex, BMI, fracture aetiology, and fracture side were recorded together with other pertinent demographic information after obtaining written consent from the patients. Patients were equally divided in two groups. Group I received Proximal Humerus Internal Locking System (PHILOS) in 24 cases and group II 24 cases received T platting. Patients were followed for 12-months. Post-operative functional and union outcomes among both groups were assessed. We used SPSS 26.0 to analyze all data. Results: There were 36 (75%) male patients and 12 (25%) females among all cases. In group I mean age was 47.9±8.42 years with mean BMI 23.6±4.23 kg/m2 while in group II mean age was 50.3±7.29 years and had mean BMI 24.5±3.42 kg/m2.RTA was the most common etiology found in group I 13 cases and 12 cases in group II. Right was the most common affected side among all cases 15 in group I and 14 in group II. Mean operative time of T plates 131.3±12.16 minutes were higher as compared to PHILOS 121.2±17.40 minutes. Blood loss was also higher in T plates as compared to PHILOS with p value <0.003. As per functional results, group I showed higher frequency of excellent and good results (16.7%, 54.2%) as compared to group II (8.3%, 41.7%). Mean union time was lower in group I 11.6±5.33 weeks as compared to group II 15.8±2.52 weeks. Post-operative complications by using T plates were found higher 6 (25%) as compared to group PHILOS group 3 (12.5%). Conclusion: We concluded in this study that PHILOS platting for the fixation of proximal humerus fractures were effective and useful in terms of less blood loss, less operative time, less union time and higher number of excellent and good results as compared to T platting. Except this complications were also found lower in PHILOS platting group. Keywords: Proximal Humerus Fracture, PHILOS Plate, T Plate, Complications, Functional outcomes

Epidemiological study of Mandibular Fractures Aetiology and Site Using computed tomography in AL Kut city

The mandible is the largest and only moveable facial bone. It begins as 2 separatebones and unites anteriorly when a child approaches 1 year of age. Being a prominent bone of the facial skeleton, it is fractured most commonly among maxillofacial injuries.This epidemiological study was conducted to evaluate the etiology of mandibular fractures and anatomical site of the fracture in 115 patients treated in the Department of Oral and Maxillofacial department ALZhraa hospital in ALKut city from 2012 to 2014. These patients were examined both clinically and radio-graphically for mandibular fractures. Records related to age, sex, and etiologies of fracture and sites of fracture were evaluated and reviewed. The most common age group affected was 21-30 years (26,08% ). Only 17.39% of patients were less than 10 years of age, and 1.7% was more than 60 years of age. Male to female ratio was 4:1. The most common cause of mandibular fractures was road traffic accidents (52.1%) followed by accidental fall (26.08%), while the least involved group was industrial accidents (1.7%), A total of 146 fractures were sustained by 115 patients at different sites there were multipl fractures in the same person .The most common site of mandibular fracture was parasymphysis (30.43%). All over the world, mandibular fractures have continued to generate discussion among researcher due to their important fuction .The male to female ratio shows 4:1 this is also in agreement with most of the studies due to their freqent participation in high risk activity such as driving vehicles sport that involve physical and active social life .

Urethral rupture concomitant with penile fracture does not adversely affect functional outcomes.

The aim of this study was to identify possible risk factors for urethral rupture and to evaluate the effect of urethral rupture repair on long-term functional outcomes and complications. The medical records of consecutive penile fracture patients were retrospectively reviewed. Penile fracture patients with and without urethral rupture were compared according to demographics, clinical and intraoperative findings. Comparisons of postoperative functional results of the groups were performed using the 5-item version of the International Index of Erectile Function (IIEF-5) and the International Prostate Symptom Score (IPSS). Finally, among them, long-term penile complications including penile curvature, painful erection, palpable nodule, and paresthesia were assessed. Fifty-three patients participated. Patients with urethral rupture (n = 8) were older (44.50 ± 10.69, 36.58 ± 10.33 years, p = 0.052). There was no significant difference in fracture etiology (p = 0.64). Urethral bleeding was present only in patients with urethral rupture (p < 0.001). Although no bilateral corpus cavernosum rupture was encountered in penile fracture patients without urethral rupture, this rate was significantly higher in those with urethral rupture at a rate of 62.5% (p < 0.001). The time from surgical repair to sexual activity was similar in both groups (p = 0.66). There was no significant difference in IPSS and IIEF-5 scores, the presence of erectile dysfunction and complication rates (p > 0.05). Older age is a possible risk factor for a concomitant urethral rupture with penile fracture and it seems to be associated with urethral bleeding and bilateral corpus cavernosum involvement. Additionally, urethral rupture repair neither adversely affected functional outcomes nor increased penile complication rates.

Skeletal muscle tissue composition ratio in patients with hip fracture: Comparison of fractured side and non-fractured side.

The extent of asymmetry in the muscle tissue composition ratios with hip fractures has not been clarified. To determine whether there is a difference in the muscle tissue composition ratios between the fractured and non-fractured sides of the trunk and thighs immediate measurement. Forty-four patients (84.6 ± 7.0 years) were included. Computed tomography images were used for measurements. The muscle tissue composition ratio was measured using muscle cross-sectional area (CSA) and attenuation coefficient (Hounsfield units; HU). Defined each HU attenuation range as follows: low-density muscle (LDM), low-quality muscle tissue with fat infiltration, normal-density muscle (NDM), muscle contractor tissue, and intramuscular adipose tissue (IMAT), fat infiltration tissue. The CSA of each muscle tissue was expressed as a percentage: %LDM, %NDM, and %IMAT. A paired t-test was performed for comparison. The %LDM on the fractured side was higher in the thigh and erector spinae. The %NDM on the fractured side was lower in the thigh. There was no significant difference in the %IMAT for all muscles. The thigh on the fractured side showed asymmetry with low %NDM and high %LDM. This characteristic captures a characteristic of muscle tissue that may have importance in hip fracture etiology.

Pediatric versus adult maxillofacial fractures

ObjectiveTo study, compare, and analyze the differences and the detailed features of the maxillofacial fractures in adults versus children.Patients and methodsThis prospective comparative study was conducted on patients who had traumatic maxillofacial fractures. Patients were categorized into 2 groups: the pediatric group and the adult group. History taking including the type of trauma, examination, computed tomography (CT) maxillofacial, fracture management, and outcome evaluation was done for all patients.ResultsWithin included 82 patients (42 adults, 40 children), males were the most affected in adult and pediatric groups and the most affected age was between 19 and 27 years (29.2%). Motor vehicle accident (MVA) was the most common cause in both the adult group (66.66%) and the pediatric group (60%). But fall represents a significant cause in children (17.5%) with a significant difference between the two groups (p = 0.038). The mandibular fracture was the most common fracture in pediatric (65%) and adult (38.1%) groups with a significant difference between both groups regarding different sites of trauma (p = 0.017). Surgical intervention was performed in 80% of pediatric patients and 92.23% with a significant difference (p = 0.035).ConclusionMVA is the main etiology of maxillofacial fractures in children and adults, but fall is an important cause of pediatric trauma. Pediatric maxillofacial fractures below school age are a rare event with increasing incidence with age. Mandibular fractures are the most common site in the adult and pediatric populations. Most cases of maxillofacial fractures are surgically treated with OR/IF with good results but conservative management is used more in pediatric than adult fractures.

Frequency and Etiology of Zygomatic Complex Fractures in Oral and Maxillofacial Trauma Patients in Tertiary Care Hospital Karachi

Aim: To determine the frequency and etiology of zygomatic complex fractures in oral and maxillofacial trauma patients. Methods: This cross sectional study was conducted at Oral and Maxillofacial department on 116 patients presenting with oral and maxillofacial trauma. Frequency and etiology of zygomatic complex fractures in these patients were determined. Frequencies and percentages were used for categorical data while mean and SD was calculated for numerical data. Chi Square test for applied for association between categorical data. Results: Mean age of the patients was 31.52±8.19. The frequency of zygomaticomaxillary complex fractures in our study was 64 (29.3%). Most common etiology was traffic accident 16 (47.1%) followed by fall from height 11 (32.4%). Conclusion: Traffic accident was the leading etiological factor of zygomaticomaxillary complex fractures. Age groups of 20 to 30 years is the most vulnerable age group for zygomaticomaxillary complex fractures. Keywords: Etiology, Zygomaticomaxillary Complex Fractures, Oral and Maxillofacial trauma

Trends of maxillofacial and mandibular fractures in level I and II trauma patients in a tertiary hospital in Saudi Arabia

BackgroundMaxillofacial injury is a major health concern worldwide. Incidence of maxillofacial fractures is influenced by socio-demographic, economic, and cultural factor of the population investigated. Identifying the patterns of these fractures is crucial to establish effective treatments and prevention measures. The aim of the study was to to analyze the incidence, etiology, and types of maxillofacial fractures in a tertiary trauma center. MethodsA retrospective analysis was conducted for all patients who were admitted with maxillofacial fractures at King Abdulaziz Medical City, Riyadh, Saudi Arabia. A total of of 422 patients with 978 maxillofacial fractures were enrolled over a 4-year period. ResultsAmong the 422 patients, 387 (91.8%) were males, and 35 (8.2%) were females. The mean age of our population was 31.1 years old. Our study has shown that motor vehicle accidents are the leading cause of maxillofacial fractures, followed by pedestrian trauma. The most common maxillofacial fractures were orbital fractures, followed by maxillary fractures. The mandibular body was most fractured among mandibular fractures. Our data has shown that males have higher incidence of maxillofacial fractures than females. ConclusionOur study further validated that road traffic accidents are the most common cause of maxillofacial fractures in our region. These findings emphasized the importance of improving road safety protocols and enforcing traffic laws.

Treatment options, complications and long-term outcomes for limb fractures in pet rabbits.

Limb fractures represent the most common orthopaedic disease in pet rabbits. However, only a few studies have evaluated therapeutic details of limb fractures. There are no data available for long-term outcomes of limb fracture treatment. The medical records of six institutions were reviewed retrospectively to identify cases of traumatic limb bone fractures in pet rabbits between 1999 and 2020. The medical records (n = 387) were analysed for details of fracture prevalence, aetiology, therapy protocols, treatment complications, outcome and long-term effects. In addition to the retrospective data evaluation, 13 rabbits were re-evaluated in person in recent clinical analyses, including orthopaedic examination, radiography and computed-tomographic imaging. Details of long-term effects of fracture treatment were requested over the telephone for a further 232 animals using a standardised questionnaire. Long bone fractures accounted for the majority of all fractures (296/387; 76.5%). Hindlimb fractures (301/387; 77.7%) were more common than forelimb fractures (86/387; 22.2%), and tibial fractures and combined fractures of the tibia and fibula (119/387; 30.8%) were observed most frequently. Most fracture treatments were based on osteosynthesis procedures (243/328; 74.1%). Treatment complications occurred in 130 out of 328 (39.6%) cases. A high bodyweight (p = 0.047) and an older age (p = 0.01) were found to be significant risk factors for the emergence of therapy complications. Overall, 75.4% of animals (175/232) had a satisfactory long-term outcome. Limb posture anomalies were evaluated in 61 cases (26.3%). The multi-centre approach led to the inclusion of various institutions, veterinarians, treatment protocols and rabbit populations that might have influenced the results. The medical records were reviewed retrospectively, so there were some data that were lacking or could not be collected in a standardised manner. Furthermore, rabbit owners' evaluation of long-term outcomes might be prone to error, despite the use of a standardised interview questionnaire. Limb fractures are a common orthopaedic issue in pet rabbits. The patient's bodyweight and age are significant risk factors for the emergence of complications during the fracture treatment process. Long-term orthopaedic effects, such as abnormal limb posture and permanent lameness of the affected limb, were observed regularly.

Zygomatic complex fractures in a Nigerian tertiary hospital: An update on the pattern of presentation and care

Aim: The Zygomatic complex [ZMC], being one of the most commonly fractured bones in the facial skeleton, is largely underreported in the literature. This study was designed to evaluate the pattern of fractures, symptomatology, and treatment modalities at our institution. Materials and methods: Information on patients’ sociodemographics, the pattern of fractures, symptomatology, radiologic diagnosis, and treatment modalities were accessed from patients’ records on our trauma register. Data collected was analyzed with SPSS 20 and the level of significance was set at p &lt; 0.05. Results: A total of 105 patients aged 19-66 years had ZMC fractures during the study period. A male preponderance was observed [M: F = 3.8:1] and road traffic crashes [RTC] accounted for the majority of fractures [79.0%]. There was a statistically significant relationship between RTC and fractures among the age groups [X2 = 33.61, df = 5, p = 0.001]. Fractures at the zygomatico-frontal [ZF] and in combination with zygomaticomaxillary [ZM] sutures were the commonest finding on imaging [39.1% % 28.6% respectively]. Subconjunctival and circumorbital ecchymosis [92.4% and 91.4% respectively] were the commonest symptomatology. Eighty four patients (80 %) were managed via surgical intervention and the most commonly employed surgical modality was mini plates [1.0mm] fixation across either ZF [n = 33, 39.3%] or ZM [n = 21, 25.0%] suture lines. Conclusion: This study revealed that RTC remains a major aetiology of ZMC fractures and mini plate ostheosynthesis was the mainstay of surgical management. Enforcement of road safety regulations on speed and the use of protective measures by road users is imperative.

The Characteristics of Mandibular Fracture In Rsup Dr. Hasan Sadikin General Hospital Bandung, Indonesia

Introduction Mandibular fracture poses a fatal complication because the mandible plays an essential role in occlusion and aesthetics. The mandible is one of the bones most affected by facial fractures commonly resulting from trauma to the face and may be associated with severe morbidity and serious consequences Methods The records of 282 patients referred to RSUP Dr. Hasan Sadikin General Hospital Bandung, Indonesia between January 2017 and January 2021 were analysed retrospectively. Data including age, sex, etiology of mandibular fracture, type of mandibular fracture, and treatment. Incompleted data from the medical record were excluded. Results Men aged 17-30 years were the most common victims of mandibular fracture. Road traffic accidents (RTAs) were responsible in 84% of cases. The most common anatomic site for mandibular fracture was parasymphysis region 28.7 with simple fractures 79%, and 82% of the total fractures were treated with open reduction Conclusion The characteristics of mandibular fracture patients describe trauma patterns in the community. This finding is similar with some readily available literature with RTAs was the most common etiology and parasymphysis was the most common fracture site. Reasons for this high frequency may include the large number of poorly maintained, overloaded vehicles on unsuitable roads, violation of traffic regulations particularly by inexperienced young drivers. Keywords: Fractures, Mandibular, Parasymphisis, Reduction

Evaluation and Prediction of Healing Morphology After Closed Reduction for Unilateral Mandibular Condyle Fractures.

Although closed reduction is common for condylar fractures, bone fragments may heal improperly. This study aimed to investigate the healing morphology of unilateral condylar fractures. We retrospectively investigated 70 patients with unilateral condylar fractures. Clinico-statistical analyses were performed on the whole-condylar fracture, closed reduction, and observation/functional therapy groups. Among these patients, 52 patients aged older than 16 years underwent closed reduction. The extent of maximum mouth opening, the incidence of malocclusion, and the relationship between healing morphology and Arbeitsgemeinschaft für Osteosynthesefragen classification or trismus were analyzed in the closed reduction group. There were significant differences in age ( P= 0.008) and sex ( P =0.025) between the closed reduction and observation/functional therapy groups. However, there were no significant differences in trauma etiologies and concomitant fractures between the 2 groups. The average maximum mouth opening extent for unilateral fractures after closed reduction was 42.6±6.1mm. Only 1 case (2.1%) of post-treatment malocclusion was observed. In all the MacLennan classification of deviation or more, regardless of the classification, upper fractures (head and upper neck) tended to heal through a spherical ( P <0.001) morphology, whereas lower fractures (lower neck and subcondylar) tended to heal through an L-shaped and lateral fusion ( P <0.001). There was no significant difference in the incidence of trismus between the healing morphology of unchanged type and others ( P =0.690). Our results elucidated the etiology, dysfunction, and healing morphology classification of unilateral mandibular condyle fractures treated with closed reduction.

The probability of whole-bone fatigue fracture can be accurately predicted using specimen-specific finite element analysis incorporating a stochastic failure model

A better understanding of the mechanisms of mechanical fatigue in bone could help improve understanding of the etiology of stress fractures. Investigations of small material samples of bone have identified a nonlinear relationship between strain magnitude, strained volume, and fatigue life, but it is non-trivial to extend these principles to predict the fatigue-life of whole bones which experience complex loading and non-uniform strain distribution. The purpose of this investigation was to experimentally validate a specimen-specific finite element (FE) model that predicts whole-bone fatigue failure using a stochastic model based on strain magnitude and volume. Thirty-four rabbit tibiae were previously tested to failure under cyclic compression, torsion, or both. Strain distribution during the test was estimated from computed-tomography based specimen-specific FE models, and a stochastic failure model based on strain magnitude and volume was used to predict the probability of failure as a function of loading cycles. Model predicted fracture risk matched experimental observations. Respectively, for the 25%, 50%, 75%, and 95% probabilistic predictions, we observed experimental failure ≤ model predicted values in 41%, 53%, 76%, and 80% of the tested specimens. A Brier scoring rule further demonstrated that this model, using strain magnitude and volume, more accurately predicted failure probability compared to two reference models that considered strain magnitude only. In conclusion, the stochastic model may be a powerful tool in future studies to assess mechanical factors that influence stress fracture risk.