Fractures In Young Patients Research Articles

Interfragmentary motion assessment for three different fixation techniques of femoral neckfractures in young adults.

Vertical femoral neck fractures in the youth could be happened in high-energy accidents, and because of dominant shearing forces, this fracture is considered as a troublesome injury with a controversy regarding selection of the best fixation method. The long term goal of this quasi-experimental study was to find the more stable fixation method among cannulated screws (CSs), proximal femoral locking plate (PFLP), and dynamic hip screw with derotational screw (DHS+DS) for this kind of fracture. Twelve fresh-frozen cadaveric femurs were assigned to three groups that were matched for mean bone mineral density and stiffness of intact bone. Vertical fractures were artificially mimicked in the specimens and fixed using three different implants, i.e. CSs, PFLP, and DHS+DS. Then, the samples were tested under incremental, cyclic, and failure loading phases. The differences in all biomechanical parameters were statistically significant among tested groups (p<0.05). All biomechanical parameters for the DHS+DS method of fixation are significantly different from those corresponding to CSs (p<0.05). There were no significant differences in failure load and failure energy between the PFLP and CSs techniques (p>0.05). Also, there were no significant differences in relative stiffness and femoral head displacement between the PFLP and DHS+DS groups (p>0.05). Based on the clinical assumption that restricted weight-bearing regimen is recommended in the postoperative rehabilitation protocol, the results of this study suggest that the priority order of selection for the stable fixation implant of vertical femoral neck fracture in young patients is DHS+DS, then PFLP, and finally CSs.

Clinical epidemiology features of the acetabular fracture in patients with different ages

Objective To analyze the epidemiology, mechanisms of injury, type of fracture, clinical and radiological feature of acetabular fractures in patients aged 60 years and older. Methods Retrospectively analyzed the clinical data of patients with acetabular fractures between Janurary 1990 and December 2013 in Orthopaedic Department of the First Affiliated Hospital of Soochow University. According to certain inclusion and exclusion criteria, a total of 637 patients (637 hips) with acetabular fractures were included in the study. The patients were divided into 2 group acetabular fractures in elderly (≥60 years) and acetabular fractures in younger patients (<60 years). Analysis of mechanism of injury, fracture pattern, the annual incidence of fracture, radiological features, associated injuries. Results 133 patients were ≥60 years and the remaining 504 were <60 years. We identified a significant increase in the incidence of elderly with acetabular fractures between 1990 and 2013 (6.7% in 1990 vs. 40.0% in 2013). The incidence of associated injuries were significant lower in the elderly than younger (27.1% vs. 48.8%). The most common mechanism of injury in the elderly was a fall (36.1%), but this accounted for only 0.2% of the younger with fractures. The incidence of anterior wall, anterior column, anterior and posterior hemitransverse were significant higher in the elderly than younger. The incidence of radiological features were significant higher in the elderly than younger, including quadrilateral plate fracture, Gull sign, anterior dislocation of hip, femoral head injury, comminuted posterior wall fracture and posterior wall marginal impaction, except posterior dislocation of hip which was significant lower in the elderly than younger. Conclusion There was an increasing trend of the proportion of elderly in acetabular fractures and the mean age of patients with fractures during the period of study. The older had a different incidence of associated injuries, mechanism of injury, fracture pattern, and radiological features compared with the younger. Key words: Acetabular; Aged; Epidemiologic studies

KAPANDJI TECHNIQUE AS AMINIMALLY INVASIVE PROCEDURE FOR SELECTED PATIENTS WITH TWO- AND THREE-PART FRACTURES OF THE PROXIMAL HUMERUS.

Current algorithms for decision making in proximal humerus fractures consider the fracture pattern along with the patient characteristics and surgeon’s experience. Minimally invasive techniques for reduction and internal fixation of many types of these fractures have recently been widely promoted, especially with the use of the newly developed locking plate systems. Intramedullary flexible nailing is one of the oldest techniques using minimally invasive reduction and fixation of proximal humerus fractures. Kapandji technique uses the “Deltoid V” landmark as entry point for intramedullary insertion of the flexible nails into the humeral head. The authors report their experience with this procedure in twenty-six, relatively young patients with good bone quality, presenting with displaced 2- or 3-part extra-articular fracture of the proximal humerus, treated with percutaneous reduction and intramedullary flexible nailing as described by Kapandji. Nineteen medical records were available for this retrospective review, with 9 to 12 months follow-up. There were 15 excellent and 1 good results when patients were assessed for pain, function and range of motion of the shoulder. The authors submit that Kapandji technique is a valuable procedure for management of extra-articular displaced 2- and 3- part proximal humerus fractures in young patients with good bone quality.

Lateral compression type B 2-1 pelvic ring fractures in young patients do not require surgery.

According to Young and Burgess, type B 2-1 pelvic fractures are a type of lateral compression fracture (LC-1) and are the most common pelvic injury at all ages. Although they are considered unstable in rotation and despite biomechanical recommendations for anterior stabilization, most authors recommend non-operative treatment. However, studies comparing outcomes and complications regarding operative versus non-operative treatment are still scarce. Seventy-one patients aged under 65years with a type B 2-1 pelvic fracture were treated between 2006 and 2011. Patients in Group I (n=35) were treated non-operatively and patients in Group II (n=36) were treated operatively. Postoperative complications, clinical course, and follow-up (VAS for Pain, SF 36, EQ-5D) of at least 1year postoperatively were evaluated. Our data show that operatively treated patients had a significantly higher complication rate. Preoperatively, the only significant difference between the non-operative and operative groups was the amount of anterior fracture dislocation and the presence of an isolated pelvic ring fracture. In the postoperative follow-up, no significant differences were found regarding pain or quality of life. Type B 2-1 pelvic ring fractures in young patients should be treated non-operatively.

Incidence and Demographics of Cervical Spine Fractures over a 10 Year Period at a Level I Trauma Center

ABSTRACT Background In an effort to capture all cervical fractures in the trauma setting, many institutions have implemented protocols for urgent cervical computed tomographic (CT) imaging for any patient with traumatic neck pain. This has led to a high frequency of negative imaging studies. Objectives The objective is to characterize a consecutive series of cervical spine fractures diagnosed at a single Level I trauma center over a 10-year period. It is expected that a greater awareness of the associations between age, injury mechanism, and fracture type may facilitate the diagnosis and management of patients with cervical spine trauma. Methods In this study, every cervical CT scan ordered in the Emergency Department (ED) at our institution was reviewed and evaluated for fractures. The relevant demographic data and mechanism of injury for patients with fractures were recorded. Results Of 763,099 ED visits, 13,896 cervical CT scans were ordered (1.8% of visits) and 492 scans (3.5% of scans, 0.06% of visits) were found to have cervical fractures resulting from blunt trauma. There was a bimodal distribution of fractures with respect to age, with peaks at 20 to 24 and &gt;85 years of age. These age ranges were also found to have higher incidence of fracture than would be predicted by population alone. Fractures in younger patients resulted from high-energy trauma and fractures in older patients resulted primarily from falls. Conclusion This elucidation of epidemiology and mechanism of cervical fractures can be used to improve the rapidity of diagnosis and management of these potentially devastating injuries. Blizzard DJ, Miller CP, Blizzard ST, Grauer JN. Incidence and Demographics of Cervical Spine Fractures over a 10 Year Period at a Level I Trauma Center. The Duke Orthop J 2016;6(1):21-25.

Manejo de las fracturas traumáticas toracolumbares. Serie de casos

BackgroundThe thoracolumbar spine fractures are among the most severe injuries of the human skeleton, especially in younger patients, where they are often related to high energy trauma such as traffic accidents or falls from a great height. The objective of the study is to review our management of traumatic thoracolumbar fractures in young patients. Materials and methodsA cases series study was performed, including review of medical records of 28 patients treated from 2008 to 2013, ranked by Magerl-AO, Load-Sharing, TLICS, conservative and surgical treatment, monitoring and radiological functional according to the scale of the SF-36. Results12 men, 16 women, median follow-up of 3.1 years, mean age of 36.8 years. According Magerl-AO: A1 6 types, 12 types A3, 2 types A4, 4 types 4 types B2 and C2. According Load-Sharing: 9 score greater than 6. According TLICS: 6 with less than 4 rating and 10 with the highest score to 5. Radiographically: preoperative kyphosis of 12.3° and 16.7° and the last control 9.7 and 5° for conservative and surgical respectively. The average preoperative wedging was 30.9%, the ultimate control of 6.6 and 6% respectively conservative and surgical. Conservative treatment in 6 patients and surgical in 22 patients, five short fixation without fusion and 17 long fixation with fusion. According to the SF-36, the average was 73 points for conservative management and surgical treatment 60.1. DiscussionAccording Load-Sharing Burst fractures, surgical treatment with short instrumentation without fusion is an effective method to achieve the desired sagittal alignment stability and preserving the function of the segments. In unstable fractures while the long posterior instrumentation provides good results sacrifice function of adjacent segments that could be preserved with combined anterior and posterior instrumentation. Evidence levelIV.

Comparison of Three Fixation Methods for Femoral Neck Fracture in Young Adults: Experimental and Numerical Investigations.

Femoral neck fractures in young patients are usually caused by a high-energy trauma, which results in a perpendicular fracture. Although efforts are focused on preserving the femoral head in young patients, vertical femoral neck fracture is a problematic orthopedic injury due to the domination of shear forces. Due to controversy regarding which fixation method is the best choice, the purpose of this study was to find the most stable fixation method for this kind of fracture. This study includes experimental testing on cadaveric bone samples and finite element analysis (FEA) for three fracture fixation techniques, namely cannulated screws (CSs), dynamic hip screw with derotational screw (DHS + DS), and proximal femoral locking plate (PFLP). Experimental results of bone-implant stiffness, average femoral head displacement, failure load, failure energy, and relative position of the fractured fragments indicate that DHS + DS offers the strongest structure for stabilizing a vertical femoral neck fracture. Experimental data and FEA results both indicate that under static loading, the DHS + DS method of fixation produces the lowest femoral head displacement and interfragmentary movement, followed by PFLP and then CSs. The results of this research suggest that, based on the clinical assumption that a restricted weight-bearing regimen is recommended in the postoperative rehabilitation protocol, the DHS + DS method of fixation is a better choice compared to CSs and PFLP for a vertical femoral neck fracture fixation in young adults.

Fragility fractures of the pelvis: treatment and preliminary results.

With increasing life expectancy, fragility fractures of the pelvic ring (FFP) are becoming frequent. In elderly, osteoporosis leads to a decrease of bone strength and resistance to the ligament's traction; this represents the most important difference between FFP and fractures in young patients. Usually, these fractures are underestimated and treatment is often conservative. To evaluate clinical and surgical outcomes of surgically treated patients with FFP. We retrospectively enrolled 14 patients, in our Trauma Center, underwent surgery procedures for FFP between 2012 and 2014. All patients attended clinical and radiological investigation at 1, 3, and 6 months postoperatively and every year after surgery with a mean follow-up of 22 months. At 6-month follow-up, 11 patients resulted asymptomatic: able to maintain standing position and walk without crunches. Two patients were able to walk with one crunch. The patient with history of previous acetabular fracture walks with two crunches and is still waiting for total hip arthroplasty. The compromised health status and the diminished bone-healing capacity, in elderly, decrease chances for a good clinical outcome. In literature, many authors suggest that mortality rate in patients with FFP is similar to those with hip fracture. Diagnosis of FFP is very important: these fractures are highly disabling in elderly and can lead to displacement and instability. For these reasons, correct diagnosis and well-conduct preoperative plan are necessary to improve stability of fractures and support bone healing. After diagnosis, an anti-osteoporotic treatment is indicated to improve bone quality and bone healing. Our study shows encouraging results and demonstrates that minimally or less invasive osteosynthesis technique could lead to good outcome in these patients.

English

BACKGROUND: Supracondylar fractures are one of the commonest fractures encountered in high velocity trauma which are associated with high morbidity and mortality.1 Isolated fracture can itself lead to complications such as ARDS and pulmonary embolism1. This necessitates early stabilization of fractures. Internal fixation is the choice of treatment in supracondylar fractures (AO type–A).2 Retrograde supracondylar nail has shown to give one of the best results in terms of recovery, fracture union, return to work and the functional outcome. METHODS: 20 patients with supracondylar fracture femur were studied (AO type-A). Supracondylar fractures femur were treated by closed or open reduction and internal fixation by Retrograde supracondylar nail inserted through inter-condylar notch between July 2012 to September 2014 at our institution. The patients were evaluated clinically and radiologically for outcomes. All patients were followed up for an average of 12 months. Outcome was assessed using NEER’S SCORE.3 RESULTS: Supracondylar femoral extra-articular fractures in 20 patients were treated in this study with retrograde intramedullary supracondylar nail after closed or open reduction. The AO-ASIF fracture classification was used. All extra-articular fractures were selected for study. Six were compound fractures according to the Gustilo-Anderson classification,4 the fracture was stabilized with the chosen system at an average of 6.9 days post-trauma, with an average operative time of 65. 9 minutes. In 15 cases closed reduction was possible while 5 required open reduction. Post-operatively all patients were shifted to continuous passive mobilization with early toe touch walking and gradually progressive weight bearing with appearance of clinical and radiological signs of union. Evaluation was done according to Neer’s rating system.3 65% excellent results were found. In the present study, road traffic accidents were observed to be the predominant cause of distal third femoral fractures in young patients. All fractures had a sound clinical and radiological union with an average radiological union time of 16.2 weeks and average full weight bearing time was 13.4 weeks. Average knee flexion was 108 degrees with an extensor lag of 4.15 degrees.

Association of Bisphosphonate Use and Risk of Revision After THA: Outcomes From a US Total Joint Replacement Registry.

Total hip arthroplasty (THA) is often performed in patients who are older and may take bisphosphonates to treat a variety of conditions, most commonly osteoporosis. However, the clinical effects of bisphosphonate use on patients who have undergone THA are not well described. (1) Is bisphosphonate use in patients with osteoarthritis undergoing primary THA associated with a change in the risk of all-cause revision, aseptic revision, or periprosthetic fracture compared with patients not treated with bisphosphonates? (2) Does the risk of bisphosphonate use and revision and periprosthetic fracture vary by patient bone mineral density and age? A retrospective cohort study of 12,878 THA recipients for the diagnosis of osteoarthritis was conducted; 17.8% of patients were bisphosphonate users. Data sources for this study included a joint replacement registry (93% voluntary participation) and electronic health records and an osteoporosis screening database with complete capture of cases as part of the Kaiser Permanente integrated healthcare system. The endpoints for this study were revision surgery for any cause, aseptic revision, and periprosthetic fracture. The exposure of interest was bisphosphonate use; patients were considered users if prescriptions were continuously refilled for a period equal to or longer than 6 months. Bone quality (based on dual-energy x-ray absorptiometery ordered based on the National Osteoporosis Foundation's clinical guidelines taken within 5 years of the THA) and patient age (< 65 versus ≥ 65 years) were evaluated as effect modifiers. Patient, surgeon, and hospital factors were evaluated as confounders. Cox proportional hazards models were used. Hazard ratios (HRs) and 95% confidence intervals (CIs) were determined. Age- and sex-adjusted risks of all-cause (HR, 0.50; 95% CI, 0.33-0.74; p < 0.001) and aseptic revision (HR, 0.53; 95% CI, 0.34-0.81; p = 0.004) was lower in bisphosphonate users than in nonusers. The adjusted risk of periprosthetic fractures in patients on bisphosphonates was higher than in patients not on bisphosphonates (HR, 1.92; 95% CI, 1.13-3.27; p = 0.016). Lower risks of all-cause revision and aseptic revision were observed in patients with osteopenia (HR, 0.49; 95% CI, 0.29-0.84; and HR, 0.53; 95% CI, 0.29-0.99, respectively) and osteoporosis (HR, 0.22; 95% CI, 0.08-0.62; and HR, 0.33; 95% CI, 0.11-0.99, respectively). Patients considered bisphosphonate users who underwent THA had a lower risk for revision surgery. Bisphosphonate use was associated with a higher risk of periprosthetic fractures in younger patients with normal bone quantity. Evaluation of bone quality and bisphosphonate use for the diagnosis of osteoporosis is encouraged in patients with osteoarthritis who are candidates for primary THA. Further research is required to determine the optimal duration of therapy because long-term bisphosphonate use has been associated with atypical femur fractures. Level III, therapeutic study.

Femoral neck fracture

The incidence of femoral neck fractures increases exponentially with rising age. Young patients are rarely affected but when they are it is mostly due to high energy accidents, whereas older patients suffer from femoral neck fractures by low energy trauma due to osteoporotic changes of the bone mineral density. Treatment options have not essentially changed over the last few years. Non-operative treatment may be a choice in non-dislocated and impacted fractures. Due to the high risk of secondary fracture displacement prophylactic screw osteosynthesis is recommended even in Garden type I fractures. Osteosynthetic fracture stabilization with cannulated screws or angle stable sliding screws, is usually applied in non-displaced fractures and fractures in younger patients. Older patients need rapid mobilization after surgery; therefore, total hip arthroplasty and hemiarthroplasty are commonly used with a low incidence of secondary complications. In addition to sufficient operative treatment a guideline conform osteoprosis therapy should be initiated for the prophylaxis of further fractures and patients should undertake a suitable rehabilitation.

Biological restoration: A solution for restoring teeth with coronal fractures in young patients

The “biological restoration” is an excellent technique for reconstruction in young traumatized teeth, which is used as intra-root reinforcement an extracted natural tooth. This article reports a case where an 11-year-old patient had his upper incisors affected by fractures from trauma. Due to the young age of the patient, the absence of the natural tooth fragment, the major structural loss and its high degree of anxiety, it was chosen to perform the treatment by this restorative technique that uses the “biological restoration” in addition to intra-root pins in an adjacent central incisor.

Femoral Neck fracture in young patients, managed by osteosynthesis using Primary double angle barrel plate combined with valgus inter trochanteric osteotomy-Long term result

Introduction: Femoral neck fracture at any age always shows relatively higher rate of complications like non union, avascular Necrosis of femoral head, loss of fixation, screw cut-out and delayed secondary osteoarthritis. These fractures in physiologically old age are managed by replacement of femoral head. In Femoral neck fractures in young adult the main aim is to preserve the natural head and these cases are managed by Multiple cancellous screw, CanulatedCancellous Screw(CCS) with fibular graft either free fibular or vascularised fibular graft. Replacement surgeries in these cases are a difficult choice as young age and also high cost of implants. Also in these patients it is difficult to restrict squatting for lifelong due to social culture and lack of toilets. Now days also preferences are given to head sparing surgeries and osteosynthesis. We use primary double angle barrel plate with intertrochanteric valgus osteotomy for the management of femoral neck fracture in young adults. Material and method: Cases were selected from the patients attending in Orthopaedics OPD and emergency trauma centre of UPRIMS & R, Saifai, Etawah from May 2006 to August 2013. During this period total 44 cases of fracture neck femur were selected for primary fixation with dauble Angle Barrel Plate (DABP). Out of 44 cases 30 were female and 14 were male with age range from 18 yrs to 48 yrs and average age of 42 yrs. Average duration from injury to operative procedure was 1.3 weeks (10 Days) and range from 2 days to 15 weeks. These cases were operated by Double angle barrel plate with intertrochanteric valgus osteotomy and long term result evaluated using Modified Askin and Bryan criteria. Result: Out of 44 cases operated 42 cases followed up to the average duration of 48 months and all these 42 cases show good(18) to Excellent(20) results after 4 yrs according to Harris hip score. 4 cases shows fair result and other secondary procedure were required in these cases. Complication seen

A prosthodontist can play a vital role in management team of maxillofacial fractures in young patient: A clinical report

The aim of this case report is to present the treatment method used for a 6-year-old boy patient with a history of mandibular fracture due to fall from rooftop 2 days back. Treatment principles of this patient differ from that of an adult due to concerns regarding mandibular growth processes and dentition development. The goal of this fracture treatment is to restore the underlying bony architecture to its preinjury position in a stable fashion as noninvasively as possible and with minimal residual esthetic and functional impairment.

Multiple repetitive fragility fractures in young patients- differentiation between osteogenesis imperfecta, osteomalacia (secondary to vitamin D deficiency) and domestic abuse

Fragility fractures (i.e. fractures occuring in abnormal bones, caused by minimal or no trauma) during childhood are infrequent and secondary to rare metabolic or bone diseases. The presence of multiple fractures should also raise the suspicion of inflicted injury (abuse), which is much more frequent, thus it is extremely important to distinguish between genuine fragility fractures and traumatic fractures.<br/> We report the case of a 20 years old male with a history of multiple unexplained fractures of the long bones during the entire childhood and adolescence. In this patient a diagnosis of both osteogenesis imperfecta and severe vitamin D deficiency was made on the basis of the clinical picture, biological data and radiographic findings. We provide a brief overview of the most important elements to be sought for in the differential diagnosis between fractures caused by induced trauma and fragility fractures secondary to either osteogenesis imperfecta or defective bone mineralisation due to vitamin D deficiency.

Evidence based update: Open versus closed reduction

Outcomes after operative treatment of displaced femoral neck fractures in young adults are fraught with high complications rates including non-union and avascular necrosis. Among the therapeutic controversies that persist is the role of open reduction, which would allow surgeons a direct means to improve the quality of reduction, a predictor of successful treatment. We performed a systematic review of the literature to compare the outcomes (nonunion, avascular necrosis, and deep infection) after open reduction with internal fixation (ORIF) to closed reduction with internal fixation (CRIF) of acute (surgery performed less than 6 weeks from injury) femoral neck fractures in young adults (average age of 50 or younger) followed for at least one year. Despite the large literature investigating outcomes after operative treatment of femoral neck fracture, relatively few studies aimed to determine the relative risk of complications associated with method of reduction. Therefore, both observational and randomised studies as well as case series with clear descriptions of surgical approach and outcomes were included. We identified 21 studies that matched our inclusion criteria. The incidence of nonunion was 11.6% in closed reduction and 14.9% in the open reduction group (P=0.25). The incidence of avascular necrosis for CRIF and ORIF were 17.2% and 17.7% respectively (P=0.91). The incidence of deep wound infection was 0.49% in the closed reduction group and 3.9% in the open reduction group (P=0.0019). Meta-analysis of risk ratios estimated from six of the studies with comparative data revealed no significant difference in the incidence of nonunion, avascular necrosis or total complications between the two reduction techniques. In summary, systematic review of the literature reveals a lack of evidence in support of ORIF versus CRIF as a means of treating displaced femoral neck fractures in young patients with respect to union and avascular necrosis; however, the incidence of surgical site infections may be lower with CRIF. Firm conclusions cannot be drawn given the lack of high quality prospective studies and patient reported outcomes. In the future, randomised controlled trials will be required to test the effect of reduction method.

A multidisciplinary direct restorative approach for recovering crown-root fractures in young patients: a case report

O objetivo deste artigo e descrever passo a passo, um protocolo para tratamento de emergencia de pacientes jovens, com abordagem multidisciplinar e restauracao direta em resina composta para a reabilitacao de fraturas corono-radiculares. Fraturas de incisivos superiores sao uma consequencia frequente de traumas em criancas e adolescentes. Pino de fibra de vidro associados a restauracoes em resina composta representam abordagem conservadora para este tipo de situacao. Este artigo apresenta caso clinico de um paciente do sexo masculino de 14 anos de idade, com fratura corono-radicular em incisivo lateral superior esquerdo. Inicialmente, o paciente foi submetido a cirurgia periodontal para aumento de coroa clinica. Depois, foi realizada cimentacao do pino de fibra de vidro, seguido de restauracao direta em resina composta. Por fim, um protetor bucal foi confeccionado para prevenir novo trauma. O tratamento multidisciplinar descrito para reabilitacao de fraturas corono-radiculares e simples, proporcionando estetica e funcao com uma abordagem conservadora em pacientes jovens.

Aneurysmal Bone Cyst Presenting as a Pathologic Fracture in a 12-Year-Old Football Player

ObjectiveThe purpose of this report is to describe a case of an aneurysmal bone cyst presenting as a pathologic fracture in a young athlete. Case reportA 12-year-old patient presented to a chiropractic teaching clinic with a 1-week history of posterior neck pain and stiffness following a helmet-to-helmet collision in football practice. Cervical spine radiographs were taken. Lateral view radiograph demonstrated a pathologic fracture through a lytic, expansive lesion in the posterior arch of C7 with mild subluxation of the C7/T1 apophyseal joints and angulation of the C7/T1 disk space. Based upon these findings, additional diagnostic imaging was ordered. Findings on advanced imaging studies included the following: On computed tomography, the C7 lesion showed medullary destruction, cortical thinning and expansion, and a horizontally oriented fracture through the spinous and lamina. Magnetic resonance imaging studies for sagittal T2 and contrast-enhanced T1-weighted magnetic resonance images revealed fluid/fluid levels in the C7 spinous and peripheral enhancement with contrast. OutcomeThe patient was referred to a local hospital for treatment. The lesion was treated with resection of the posterior arch, and an aneurysmal bone cyst was confirmed histologically. The patient developed a kyphotic deformity at the site of resection and cervical instability. A subsequent fusion was performed. ConclusionAneurysmal bone cysts are rare lesions. In this case, the initial traumatic history masked the underlying pathology. Although rare, pathologic fracture should be considered in cases of vertebral fracture in young patients.

Die Schenkelhalsfraktur bei jüngeren Patienten (15–50 Jahre). Klinisch-radiografisches Outcome 4 Jahre nach operativer Therapie

Traumatic fractures of the neck of the femur are rare injuries in younger patients between 15 and 50 years old. The short-term and long-term complications may cause substantial problems, in particular non-union and avascular necrosis (AVN) of the head of the femur. In the literature (and from some experts) the impression is occasionally given that there might be "proven" successful therapeutic procedures. For this purpose we retrospectively analysed follow-up-data from our own patients in the years 2003-2007 and compared them with the literature. We identified 23 of a total of 376 patients with a femoral neck fracture as a cohort being younger than 50 years. 17 of those 23 patients were treated with an internal fixation. We were able to collect and analyse complete clinical and radiological data of 11 of these 17 patients 4.2 years after surgery. The mean interval between accident and surgery was 22 hours. Only one of the patients developed an AVN after internal fixation of the fracture and was implanted a total hip replacement 18 months postoperatively. There was no non-union of the femoral neck The clinical outcome after 4.2 years was very good. The mean Harris Hip Score was 95 points (of a max. of 100 pts.). The osteosynthesis of femoral neck fractures in younger patients showed good results and a low risk of AVN and non-union. Therefore the internal fixation of the femoral neck fracture should be preferred for the younger patients instead of a primary total hip replacement.

Acetabular fractures in patients aged &gt; 55 years

The increasing prevalence of osteoporosis in an ageing population has contributed to older patients becoming the fastest-growing group presenting with acetabular fractures. We performed a systematic review of the literature involving a number of databases to identify studies that included the treatment outcome of acetabular fractures in patients aged > 55 years. An initial search identified 61 studies; after exclusion by two independent reviewers, 15 studies were considered to meet the inclusion criteria. All were case series. The mean Coleman score for methodological quality assessment was 37 (25 to 49). There were 415 fractures in 414 patients. Pooled analysis revealed a mean age of 71.8 years (55 to 96) and a mean follow-up of 47.3 months (1 to 210). In seven studies the results of open reduction and internal fixation (ORIF) were presented: this was combined with simultaneous hip replacement (THR) in four, and one study had a mixture of these strategies. The results of percutaneous fixation were presented in two studies, and a single study revealed the results of non-operative treatment. With fixation of the fracture, the overall mean rate of conversion to THR was 23.1% (0% to 45.5%). The mean rate of non-fatal complications was 39.8% (0% to 64%), and the mean mortality rate was 19.1% (5% to 50%) at a mean of 64 months (95% confidence interval 59.4 to 68.6; range 12 to 143). Further data dealing with the classification of the fracture, the surgical approach used, operative time, blood loss, functional and radiological outcomes were also analysed. This study highlights that, of the many forms of treatment available for this group of patients, there is a trend to higher complication rates and the need for further surgery compared with the results of the treatment of acetabular fractures in younger patients.